A “medwife” reflects on 3rd world birth and American homebirth

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A new guest post from the “Medwife“:

I’m a Medwife and I take call, about 72-96 hours a week to be exact. My phone rings at all hours of the day and through the night. The inevitable page comes through at family reunions and playoff games. Everything from the usual Friday afternoon 30 minutes after office closes “I think I have a UTI” to the Saturday morning 5:00am “I think I have a yeast infection”, spaced between “My pessary fell out” or “I can’t find my IUD strings” and the “Can I take Robitussin while breastfeeding” or “I think my water broke”. Top it off with a few late night calls from the ED and few more from Labor & Delivery and it’s a full time effort to be sure. Add in a few less common favorites “my nipple ring got stuck in the shower curtain” and you just never know what concern is waiting at the other end of the receiver.

But there’s that one call that makes time stop, a stomach churn and the thud of one’s own pulse resonate as whooshing sound through a medwife’s ears: “The baby’s not moving.” Silence. Now I’m not a fan of discussing Monistat-7 at 5:00am on Saturday morning, but “the baby’s not moving” is why it’s impossible to become complacent in the usual barrage of ringing during call hours. It’s the call that makes you hold your breath, the call that makes you wish warp-speed time travel existed and the call you never dismiss. When you’ve done this long enough, you know the last words you always hear before you diagnose a stillbirth are: “The baby’s not moving”. The dreaded call came in last night, despite 8 weeks of discussions on kick counts and a full 24 hours after the last perceived movement. In anticipation of her arrival to Labor and Delivery, commence the breath holding, conduct a review and mental checklist of risk factors (Primigravida, IVF and Gestational Diabetes) and recall last evaluation in office (48 hours ago, Glucose well controlled, Reactive NST, BPP 8/8, AFI 14).

Upon arrival to L&D, the mother was placed on the fetal monitor and a reactive NST was obtained. (Exhale). An ultrasound was ordered and returned a BPP 6/8 with AFI 10. It took a long discussion to convince her it was in her baby’s best interest for continuous monitoring over night with a repeat BPP in the morning. In the morning, the BPP had decreased to 2/8 and new onset of oligohydramios with an AFI of 4, which prompted the move towards a 36 week induction. Her labor progressed with an epidural in place and she proceeded to spontaneously deliver a growth restricted infant. The baby was handed to the Neonatologist for evaluation with Apgars 9-9. A placenta with a velamentous insertion and a hypocoiled cord was delivered. Mom and baby remained stable postpartum and Hepatitis B vaccine was given.

The decision-making was quite straight forward and outcome excellent, not something case studies are made of. However, sitting with this well-educated recently emigrated family awaiting their baby’s safe arrival was a good reminder of how fortunate we are to have the model of care we do in the US:

Health Care Providers: Although providers are available in her country, many women seek care with traditional healers and the extent of physician care is often limited to emergencies. The mother received care in an office and hospital setting with a CNM, Obstetrician, Perinatologist and Endocrinologist according to established standards of care. An Anesthesiologist placed an epidural and a Neonatologist was present to provide resuscitation care at birth.

Gestational Diabetes: When we discussed Gestational Diabetes, the father informed me it is rare for such a diagnosis in his country and that Diabetes is usually only diagnosed in older adults. When I asked him how many women in his family may have been screened in his country, he replied that they simply don’t test for it. No test, no diagnosis. He seemed a bit taken aback when I further discussed the actual rate of in his country is in fact 11 times as prevalent as US Caucasian rates.

Ultrasounds: The father commented on the number of ultrasounds performed during the course of pregnancy. In his country, it was rare to have even one. He questioned the utility or overuse of imaging. She had multiple early IVF ultrasounds for location, number and viability, as well as a third trimester growth ultrasound with weekly BPP/AFI after 34 weeks. Final ultrasound identified a baby with a significant perinatal morbidity risk.

Epidurals: The mother was unable to explain the concept of epidural pain management to her family in her country of origin. They couldn’t understand the concept of controlling pain in labor or the safety of doing so. She eventually gave up. Although she had planned epidural placement from the onset of pregnancy, yet was still quite delighted in how it removed an element of fear of the process of labor.

Hepatitis B Vaccine: The parents consented to Hepatitis B vaccine administration to the baby at birth. In fact, the father had a smile when we asked “You can do that right here? He can get vaccinated?” His response perplexed me until I realized the magnitude of Hepatitis B infection in his country and the relatively new program of pediatric immunization schedules with a history for very low compliance.

As I head home at the end of the day, I am reminded of how grateful I am to be a part of the US healthcare system, its technology and the safety it provides. How differently that phone call could have turned out if the system wasn’t there? How different it would have been if this family was in their country of origin with a perinatal mortality rate 8x’s higher than the US? How different this outcome could have been?

But then again, if we replace the country of origin with US Homebirth… would it really have been any different at all?

248 Responses to “A “medwife” reflects on 3rd world birth and American homebirth”

  1. saramaimon
    May 8, 2014 at 4:11 pm #

    saying that a BPP was 6, doesn’t say what was so concerning. i suppose no movements were seen by the ultrasound. but thats odd if the NST was reactive. strange. if it was the absence of breathing movement, i’m unaware of any clinical guidelines that suggest that continuous monitoring is indicated. in any case, the author should actually provide the details instead of initials and numbers that she thinks make her look good in front of a lay audience. this has nothing to do with homebirth either, by the way, since the woman wasn’t laboring at home either, she wasn’t in labor at all. she came in to have a problem checked. She could have been a homebirth client too and done the same thing.

    • Poogles
      May 8, 2014 at 4:28 pm #

      “in any case, the author should actually provide the details instead of initials and numbers that she thinks make her look good in front of a lay audience. ”

      I’m guessing she doesn’t want to reveal too many potentially patient-identifying details, especially since this appears to have been very recently.

      Besides, what would those extra details have added to this post? This particular family’s story was used only as a frame for the real point of the post – the differences in maternity care between countries like the US and “3rd world” countries, with a small point at the end that US homebirth has much more in common with the maternity care in 3rd world countries than the maternity care recieved in US hospitals by actual health professionals.

      • Young CC Prof
        May 8, 2014 at 4:31 pm #

        OK, this saramaimon is not only a troll but an off-topic troll. Don’t stress about hir.

      • saramaimon
        May 8, 2014 at 5:19 pm #

        not the patient identifying details good lord- the clinical details. some of us want to actually see if the clinical picture makes sense.

        • UsernameError
          May 9, 2014 at 3:57 pm #

          “In the morning, the BPP had decreased to 2/8 and new onset of
          oligohydramios with an AFI of 4, which prompted the move towards a 36
          week induction.”

          What other clinical details do you want? A BPP of a 2 and AFI of 4 = induction. Or at least it should…

          • saramaimon
            May 9, 2014 at 4:01 pm #

            no, before that. i’m a bit confused about what what the specific indication to keep her overnight.

          • CrownedMedwife
            May 9, 2014 at 5:50 pm #

            Again, you are missing the point. It is not about the management of care in this case. It IS about the fact HB midwives do not have the expertise or background to provide care to a level any better than a country with a perinatal mortality 8x’s greater than the current US perinatal mortality rate. The point is these mothers put there faith and trust in CPMs who tout their expertise in ‘normal’ birth. Their ‘expertise’ is lethal. THAT is the point.

            For instance, if we don’t test (or inadequately test via opt out or perform ‘testing’ not in accordance with guidelines), the CPM would have failed to diagnose GDM and the inherent risks of failing to manage it.

            Decreased FM, variation or normal or perform couchside doppler NST (inadequate evaluation) and false reassurance, CPM would have failed to verify presence of absence of fetal well being.

            IVF pregnancy and decreased fetal movement in setting of GDM, failure to recognize importance of ultrasound with all of the aforementioned contributing to increased perinatal risk.

            That is the point. The point is CPM’s are luring women into trusting their expertise and women are being led down a path that everything will turn out just fine if they ‘trust birth’ enough. Unfortunately, MANA’s own data shows that ‘trust’ leads to atrocious outcomes and is no better than a ‘third world country’.

          • saramaimon
            May 9, 2014 at 6:08 pm #

            there are homebirth or birth center midwives who have exactly the same training as you and who practice in hospitals alongside their homebirth practices. admittedly this may change with the cdc data study.

          • saramaimon
            May 9, 2014 at 6:10 pm #

            anyway would it be so hard to answer the question? i’ve looked some of the things up and i think i got it already but still

          • CrownedMedwife
            May 9, 2014 at 6:16 pm #

            Please specify as to type of midwives, CNM or CPM, to maintain clarity when posting. Thank you for making the point that some midwives DO practice in HB or Birth Centers. Yes, that is true. The problem is the failure to recognize risk status. This patient should never been a candidate for HB or BC management though, agreed?

          • saramaimon
            May 9, 2014 at 6:36 pm #

            agreed on that. however please note that you had just written “homebirth midwives” without specifying, which is why I didn’t either.

          • CrownedMedwife
            May 9, 2014 at 6:43 pm #

            Fair enough, however, it should be assumed as ‘CPM’ was specified THREE times further in the post. If you are unfamiliar with difference between CNM and CPM, do refer to previous posts and atrocious outcomes to familiarize yourself as THAT is where the issue of this entire post lies. Now your question please? I have catching up to do on two excellent posts Dr. Amy has provided over the last two days and my time and patience are dwindling.

          • CrownedMedwife
            May 9, 2014 at 6:16 pm #

            ….and what IS your question?

          • CrownedMedwife
            May 9, 2014 at 6:05 pm #

            Let’s look at what has been presented:
            A primigravida with IVF pregnancy complicated by GDM with new onset of decreased FM and a BPP 6/8. Would you have advocated for sending home a patient with multiple risk factors for adverse outcomes and repeating testing in 24-48 hours instead of observation overnoc and repeat testing in 12 hours?

            I suppose in the absence of risk factors, that could have been a viable option. However, because those risk factors were present and not just a variation of normal, there was every reason for overnoc observation.

            I hope this helps you get past the patient’s management and move on to the real issue of the parallels to CPMs and third world care.

        • Poogles
          May 9, 2014 at 4:25 pm #

          “some of us want to actually see if the clinical picture makes sense.”

          Why? The only rationale I can come up with is because you want to deem this as “bad” care, possibly even to try and condemn hospital birth in general. What other reason is there for wanting to know more details than what was provided in an article that was not primarily about the clinical picture of this particular patient?

          • saramaimon
            May 9, 2014 at 4:39 pm #

            why would i want to condemn hospital birth in general? i had one myself. pitocin and epidural too. would probably make the same decision again if the circumcstances were to repeat themselves. this is what i mean by extreme. everyone is shoved into two polarized categories around here. just because i dont agree with everything everyone says does that mean i’m out to get yall? now to the question itself, i apologize for my antagonistic tone. i am interested in comparing this with the guidelines i have have been given in my own practicing settings. as a nurse i do not set the guidelines, i just practice by them, and if they differ, i can not say who is right or wrong, or if i am merely misunderstanding, but in any case i should know, shouldnt i?

          • Poogles
            May 9, 2014 at 4:46 pm #

            “i am interested in comparing this with the guidelines i have have been given in my own practicing settings. as a nurse i do not set the guidelines, i just practice by them, and if they differ, i can not say who is right or wrong, or if i am merely misunderstanding, but in any case i should know, shouldnt i?”

            Fair enough. You absolutely should know what guidelines you should be following and it’s not bad to know if guidelines differ in other settings and why that may be.

            However, I’m not sure what sort of medical professional goes to a random blog post for the answer to those questions. Between that and the admittedly antagonistic tone (which you have since apologized for), you’ll have to forgive that I felt you were likely another NCB advocate trying to come here and tell all the medical professionals here that they are just doing it wrong (we get them pretty frequently).

          • saramaimon
            May 9, 2014 at 4:52 pm #

            that wasn’t why i came here… the topic just came up at me. i stop by because amy often reports on new and important studies that i’d like to be aware of, and the discussions can be very hopping and just draw one in. im skeptical too, but skeptical of everyone, on either side. it puts me in an antagonistic mood because of what i see as prejudice and hyperbole. anyway what i would do is asked what its based on and look up over there, not just rely on the bloggers say so. just as a starting point, get it?

          • Poogles
            May 9, 2014 at 5:09 pm #

            “im skeptical too, but skeptical of everyone, on either side. ”

            Rather than being skeptical of people or “sides”, shouldn’t you be focusing your skeptism on the science and evidence regarding these topics? As a nurse you should be decently qualified to analyze it yourself, yes?

            “it puts me in an antagonistic mood because of what i see as prejudice and hyperbole. ”

            I can understand, I have also gotten into those moods due to something Dr. Amy has said. It doesn’t change the dismal facts about homebirth in the US, though.

          • saramaimon
            May 9, 2014 at 5:27 pm #

            While i believe i can see the difference between a serious study and buffoonery, i am not qualified to engage in an actual critique of this study or another. I have to rely on guidelines of expert bodies. (not individuals- i mean for example like ACOG or CDC and so forth). when there are conflicting approaches, i personally do not have the capability to make a determination between the two, but i do think its the patients right to know about the existence of both. (if the want to that is- some would rather just do what the dr says and be done with it)

          • May 9, 2014 at 5:23 pm #

            Makes sense. Dr. Amy is really good about linking to the journals and articles she’s using for her data, so it’s definitely a good way to keep up with the studies.

          • Amy Tuteur, MD
            May 9, 2014 at 5:27 pm #

            You are not a skeptic. You seem to be confused about the colloquial meaning of skepticism (expressing doubt) with the meaning of scientific skepticism (requiring scientific proof before accepting a claim).

            You aren’t a skeptic in either sense since you apparently believe a lot of stuff made up by other natural childbirth advocates who have no idea what they are talking about.

          • saramaimon
            May 9, 2014 at 5:29 pm #

            here you go again amy. painting the whole world with your black and white colors.

          • Amy Tuteur, MD
            May 9, 2014 at 5:35 pm #

            No, NOT the whole world, YOU. YOU grossly overestimate your own knowledge and experience. YOU grossly underestimate the knowledge and experience of other commentors. YOU are surprisingly gullible when it comes to natural childbirth tropes. YOU have chosen to believe in things for which there is no scientific evidence. YOU are not a skeptic. Not the whole world, YOU!

          • saramaimon
            May 9, 2014 at 5:38 pm #

            some of your criticisms of me are on target. while we are at it is there any way to delete some of my comments? specifically referring to my personal experiences being that i used my real name without expecting people to actually look me up and press me for details?

    • Young CC Prof
      May 8, 2014 at 4:30 pm #

      This story isn’t about home birth except indirectly. There was an indication that something MIGHT be wrong in a high-risk pregnancy near term, it was followed up on, problem was confirmed, induction, healthy baby.

      The point is that a homebirth midwife would probably have ignored the early signs of a problem and would not have had the equipment to do an NST or BPP.

      • saramaimon
        May 8, 2014 at 5:18 pm #

        sorry but thats bullshit. i worked in a perinatal center and we commonly had patients referred to us by homebirth midwives. you’ve probably been reading amy’s blog too long with her massive generalizations. Amy takes the extreme and classifies it as mainstream.

        • yugaya
          May 8, 2014 at 6:50 pm #

          “takes the extreme and classifies it as mainstream”

          Isn’t Midwifery Today mainstream homebirth organisation? How about MANA?

          A lay CPM midwife ( educated by MANA standards and according to them allowed to practice as one) crowdsourced ideas on Midwifery Today fb page in order to more convincingly persuade a mother to ignore multiple tests showing her post dates baby was in dire distress, and the baby died as a direct consequence of that. The worst thing about this whole lay-midwife-birth-junkie extremist shopping around on social networks in a real life emergency situation for ideas and wondering “how risky can it be, really” was that there were unison replies from heaps of other lay midwives to that post saying she should just ignore all the test results because “babies are not library books” and shit like that. “Try stevia” after second BPP showed the same zero amount of amniotic fluid.

          That was mainstream, Midwifery Today, openly endorsing baby killing extremism of completely incompetent lay midwifery and acting as an enabler in manslaughter through negligence.

          And no, this fiasco never resulted in industry mainstream organisations like MANA or Midwifery Today making a public statement, or God forbid something that we demand from any other such organisation – that they take upon themselves the ethical and professional responsibility of establishing mechanisms that will prevent any possibility of that ever happening again.

          Now THAT is what I call bullshit.

        • OBPI Mama
          May 8, 2014 at 7:04 pm #

          In what state? Midwives don’t refer women here until they are close to death or their baby is… then it’s a race to the hospital… sometimes.

          • saramaimon
            May 8, 2014 at 7:17 pm #

            new york

        • Sue
          May 8, 2014 at 10:08 pm #

          “we commonly had patients referred to us by homebirth midwives. ”

          So what percentage of HBMWs referred, and what percentage didn’t? Are there even any data kept? Does the group who refer make up for the ones who don’t?

        • Poogles
          May 9, 2014 at 4:38 pm #

          “i worked in a perinatal center and we commonly had patients referred to us by homebirth midwives. ”

          You say “referred” – does this mean for complications tested for and identified before labor started, or transfers during labor? If before labor started, for what complications?

          If they were transfers during labor, how many were timely transfers with good outcomes and how many resulted in damage (or death) from the delay of a transfer?

          Without this sort of information, your assertion that you commonly had patients referred by HB midwives doesn’t mean much of anything.

          “you’ve probably been reading amy’s blog too long with her massive generalizations. Amy takes the extreme and classifies it as mainstream.”

          Well, many of the readers here, myself included, used to be homebirth advocates and/or had homebirths. There’s even some mothers here who lost their precious babies because their midwives ignored signs of complications until it was too late.

          Plus, many of the readers here read homebirth stories quite frequently and we see the same situations over and over again – and these aren’t stories written by anti-homebirth people, they are the birth stories written by the mothers who are frequently happy with the sub-standard care they received, clueless as to how lucky they were.

          • saramaimon
            May 9, 2014 at 4:47 pm #

            i would love to answer the question but i don’t want to give any further information about myself and my employment history. i did not expect that i would be the subject of huge speculation and investigation via google merely for participating in a discussion with a somewhat different point of view than the rest of the club. next time ill know better and will use a fake handle.

          • Poogles
            May 9, 2014 at 5:02 pm #

            “i did not expect that i would be the subject of huge speculation and investigation via google”

            Eh, don’t flatter yourself. You yourself said we could easily google your name, letting us know that your handle was your real name. There was no “huge”
            speculation/investigation, it was more of a sidenote or distraction to the rest of the comments.

    • CrownedMedwife
      May 8, 2014 at 9:35 pm #

      After reading through your comments, I am not sure you understand the purpose of this post although I am glad you have stumbled on and participated in the comments. With limited time this evening, I will briefly respond to the confusion you have expressed at the original post.

      This post and site have nothing to do with using ‘initials’ or ‘numbers’ or ‘looking good’ in front of a ‘lay audience’, nor does it have anything to do with what management of antenatal testing may or may not have been indicated. I believe the breadth of knowledge, experience and backgrounds of frequent commenters is something you are completely unaware of and such pettiness or attempts to appear impressive reflects a level of unawareness on your behalf. (Your thoughts on management of abnormal BPP in the setting of decreased FM in a high risk pregnancy are an entirely different subject.) No, she wasn’t laboring at home. The purpose of the vignette has obviously been lost on you. Perhaps if you care to reread the factors contributing to the difference in hospital care with qualified providers versus homebirth care or care in a country with a dismal mortality rate, you will be able to see the parallels. If not, stick around because I believe you may learn a thing or two.

  2. attitude devant
    May 8, 2014 at 2:36 pm #

    Medwife, I want to compliment you on the very thoughtful and appropriate care you gave this family!

    • saramaimon
      May 8, 2014 at 4:18 pm #

      how do you know? did you understand the details of what she wrote? or do you accept it on faith?

      • Poogles
        May 8, 2014 at 4:21 pm #

        “how do you know? did you understand the details of what she wrote? or do you accept it on faith?”

        What reason do we have to believe that it wasn’t? Did you get a different impression from what was written?

        • saramaimon
          May 8, 2014 at 5:22 pm #

          as i wrote above , there are some details missing from the clinical data. which does not mean her care was bad, it just means hey, can you please share a bit more, i am just responding to your knee jerk congratulations. this is supposed to be a skeptical website after all, not a cheerleading squad for any and all medical interventions, is it not?

          • Sue
            May 8, 2014 at 10:24 pm #

            Sara Maimon – Are you asking that as a ”Health, Wellness and Fitness Professional”?

            Isn’t that ALL about cheerleading?

          • Certified Hamster Midwife
            May 8, 2014 at 10:59 pm #

            There is a Sara Maimon who is a currently licensed RN in New York State. Whether she has experience working with babies isn’t clear, but she does live in a part of the state with a high birth rate.


          • attitude devant
            May 8, 2014 at 11:47 pm #

            Woah, Sara Maimon, you do Google well! One of the things I’ve learned by being on this blog is that when people give their first and last names they are HOPING, HOPING, HOPING that we will look them up. What’s up? Are all the frum blogs not accepting your comments anymore?

          • saramaimon
            May 9, 2014 at 3:13 pm #

            no i wasn’t expecting it actually. i dont google foks who comments on online forums. why should i? its what they say thats important, not who they are.

          • saramaimon
            May 9, 2014 at 3:13 pm #

            btw do you know me? if so send me a private message.

          • saramaimon
            May 9, 2014 at 3:09 pm #

            yes, thats me.

          • Poogles
            May 9, 2014 at 4:20 pm #

            “Whether she has experience working with babies isn’t clear.”

            If I had to guess based on just her comments, I would guess no, she doesn’t have medical experience with L&D. Usually when someone uses the “I’m a nurse, so I know what I’m talking about!” here they make sure to mention it is in L&D if that is the case.

          • Amazed
            May 9, 2014 at 4:21 pm #

            She mentioned that she’s a doula. As we know, some of them fancy themselves obstetricians’ superiors.

          • Bombshellrisa
            May 9, 2014 at 4:23 pm #

            With the RN she could also be a monitrice (a doula who does things like cervical exams). There was someone here who “worked in the medical field” and was a doula and mentioned being a monitrice.

          • saramaimon
            May 9, 2014 at 3:10 pm #

            dont know, i didn’t mke the category up, some search engine did it

          • Amazed
            May 9, 2014 at 3:05 pm #

            What the hell do you know about clinical data, DOULA? Has it ever occurred to you that the obstetricians around here might have some knowledge that enables them to understand without being spoonfed like, say, a DOULA?

            And that isn’t an offense against doulas. We have a beloved commenter here, Doula Dani. She’s remarkable because she feels comfortable within her doula parameters without trying to promote herself as being more educated than doulas are.

            I must admit, it was pretty amusing to watch a doula acting all condescending towards an obstetrician just because she is uneducated enough not to understand what the OB understood straight away.

          • saramaimon
            May 9, 2014 at 3:18 pm #

            who are you addressing, me? that is an appeal to authority, and does not qualify as an argument of logic or fact. show me where i err and ill admit my mistake, or at the very least, give your comment a thumbs up.
            doula dani- i just visited your blog yesterday and i really liked it. very factual, without all the extremism and hyperbole of this blog.

          • Amazed
            May 9, 2014 at 3:21 pm #

            You err in trying to paint yourself as more qualified and evidence-based than most of the commenters here without realizing that some of their experience trumps your ow trump card “I work in a perinatal centre” by far.

            If you’re so much against arguments of authority, why do you try to look like an authority with your whole “I am a nurse and a doula” speech?

          • saramaimon
            May 9, 2014 at 3:23 pm #

            sorry about that, what i mean is that my experience differs from their massive stereotyping. it was not intended as an appeal to authority.

          • Amazed
            May 9, 2014 at 3:30 pm #

            I’ll quote a part of my edited post: Why do you say, “Trust me because I work in a perinatal centre and don’t trust your eyes that showed you how a bunch of mainstream midwives headed by someone in a very high position in what passes for mainstream among my circles killed a baby in real time on Facebook.”

            I wonder… You praise homebirth midwives because you’ve seen transfers. Do you know how many of them don’t transfer? Of course you don’t!

            If transfer was mainstream, we wouldn’t be seeing low-risk babies dying in planned homebirths in a 4 time higher rate than they do in hospitals.

            How can you say Dr Amy is doing a “massive stereotyping” when we saw what a mass of midwives – some of them teaching student midwives in midwifery schools – did, namely killed a baby real in time in Facebook and deleted almost all comments (ironically, almost all of them written by lay people) who advised the midwife to take the mother to the hospital where her baby’s life could have been safe?

            What greater proof do you want than this? It isn’t massive stereotyping, it’s massive screwups on midwives’ part!

          • yugaya
            May 9, 2014 at 8:19 pm #

            “I work in a perinatal centre” says doula and assumes the credibility of an actual formally trained, licensed and regulated health care professional.

            “I attend births” says birth photographer and assumes the credibility of actual formally trained, licensed and regulated health care professionals.

            “I am a CPM midwife and that is the same as CNM midwives who work in hospitals” says Christy M. Collins to parents of Gavin Michael and assumes the credibility of an actual formally trained, licensed and regulated health care professional.


          • CrownedMedwife
            May 9, 2014 at 9:17 pm #


          • Amazed
            May 9, 2014 at 10:37 pm #


      • Durango
        May 8, 2014 at 10:27 pm #

        Since AD is an obstetrician, I’m sure she understood the post.

      • MLE
        May 8, 2014 at 11:32 pm #

        Obviously you haven’t read “12 things not to say to Dr. Amy…” because you’re appearing very foolish.

      • attitude devant
        May 8, 2014 at 11:42 pm #

        And your problem is? No faith involved: I’m an obstetrician, as noted below, and her care and her rationale for it was very nuanced. She should be congratulated.

        Not sure what your angle is, but you’re only making yourself look bad, so have at it.

  3. The Bofa on the Sofa
    May 8, 2014 at 11:17 am #

    OT: I was just reading about Bill Nye’s appearance with some CNN host talking about climate change. Bill Nye is dropping facts. The host is complaining about “scare tactics” and “bullying.”

    Yep, same attacks that get laid on folks like Dr Amy. Similarity between climate change deniers and homebirthers.

    • The Bofa on the Sofa
      May 8, 2014 at 11:23 am #

      Just found this Bill Nye quote:

      Everyone you will ever meet knows something you don’t.-Bill Nye

      That is just beautiful.

    • saramaimon
      May 8, 2014 at 4:20 pm #

      do you also believe that all blacks or chinese look the same? what a sweeping prejudiced statement. then again, thats this whole blog in a nutshell.

      • Poogles
        May 8, 2014 at 4:31 pm #

        “do you also believe that all blacks or chinese look the same?”


        How do you go from someone comparing the similarities between 2 groups of people whose beliefs are usually based on faulty (or non-existent) evidence, to accusing that person of racism?

        • The Bofa on the Sofa
          May 8, 2014 at 4:36 pm #

          2 groups of people whose beliefs are usually based on faulty (or non-existent) evidence

          and the similarity of their response to being called out on that…

    • Young CC Prof
      May 8, 2014 at 4:25 pm #

      Scientific disagreement is not an act of explicit or implicit violence. People who don’t get that don’t get science.

      • The Bofa on the Sofa
        May 8, 2014 at 4:26 pm #

        I think you are being generous in calling it “scientific disagreement.”

  4. RN who has seen too much
    May 8, 2014 at 12:36 am #

    Great post!! We had a father the other night who was being a huge jerk because their birth plan didn’t go as they wanted. I was pissed, we saved his baby’s life and he’s mad because the baby didn’t get enough skin to skin time?? People are so ignorant.

    • Danielle
      May 8, 2014 at 11:05 am #

      When I was pregnant and reading for the first time about childbirth, this effect was one of the main things that bugged me about the natural childbirth literature. The idea of skin on skin time, or feeling in touch with your “laboring body,” and so on is all very nice, and worthwhile insofar as its possible. Who doesn’t want baby cuddle time? Why wouldn’t I want this honored in the post-birth routine, provided all is going well?

      But the literature made it sound like these things were so important and necessary. And not just this, someone would be trying to snatch it away! And if I didn’t get that time, something would be irreparably lost! So much anxiety, and so much fixation on a minor point. In a word: too much pressure. It annoys me that people are all set up to feel they’ve succeeded or failed based on whether the right checkboxes have marks in them. The script is damaging: It is possible to feel empowered by the hospital experience. The doctors saved my baby! And a short time later I got to hold him, and it was wonderful! But nope, the script required the parents to feel violated, and the doctors to be oppressors.

      As it turns out, my baby required intervention too, so I only got to hold him very briefly before I had to give him back so that he coild go to the NICU. The last thing I needed was some little voice in my head going, “Think of what you just lost!” Screw that. I had my baby and we bonded just fine. Thank you very much for your concern, childbirth gurus.

      • Mac Sherbert
        May 8, 2014 at 2:25 pm #

        So True, but hospitals aren’t always perfect. When my son was born my LD nurse said they would bring him to me as soon as I got to my room. I requested my baby and never got baby…no explanation, no nothing. I freaked out thinking he wasn’t ok. Thankfully, my mother went and threw fit and they finally brought him to me and there was nothing wrong. The nurses seem unconcerned I hadn’t got hold him since he had been born hours before. Things like that need to be fixed. If something is wrong, fine…but even if that had been the case I deserved an explanation.

        It didn’t upset me to the point of homebirth, but when I went for my next birth I made it clear I wasn’t happy about what happened the first time. My nurse the 2nd time around told me if they didn’t bring my baby to me in X amount time to throw a royal fit. Thankfully, I didn’t have to do that.

        • attitude devant
          May 8, 2014 at 2:45 pm #

          I’m with you! NOT OK!

        • Young CC Prof
          May 8, 2014 at 4:32 pm #

          Yeah, that is NOT acceptable. Just not bringing the baby for hours because you, like, forgot? Not cool.

        • Medwife
          May 8, 2014 at 5:21 pm #

          There are hospitals with the routine of taking newborns into the “well baby nursery” for assessment including temp monitoring, bathing them (guaranteed to drop their temp), giving them their shots. It’s done kind of assembly line style, and they can get stuck in said assembly line for WAY longer than expected. They don’t go back to their families until their temps are back up from the baths, so that’s another way they get delayed. I did some of my training in a hospital where this was the routine, and it was kind of painful to see the babies going through their “quiet alert”, rooting period stuck in the nursery for no good reason.

          The hospital where I work now is much smaller, has no well baby nursery, and the assessments and everything are done at the bedside. If baby has dropped his temp after a bath, we get them skin-to-skin with their moms rather than use the warmer (this is of course with no sign if respiratory distress or other reason to think sepsis).

          • saramaimon
            May 8, 2014 at 5:48 pm #

            well i wish i was in your hospital. my baby had a bit of trouble breathing when he was born although his five minute apgar was good, they told me they needed to take him for special observation so i agreed. i insisted that his father accompany him which they fought about but then grudgingly allowed. his father later told me that he wasn’t under special observation, just in the regular nursery with all the other babies. the only special observation he got was from daddy…. luckily they honored our request to delay his first bath til next shift, so he didn’t have to stay there for hours and hours….

          • OBPI Mama
            May 8, 2014 at 7:09 pm #

            The one thing nice about hospitals is that there are many of them… not happy with your care? file a complaint and then switch hospitals. A hospital near my sister-in-law had a protocol she wasn’t happy with and so for her next baby she switched to a different hospital. I drive over an hour away to have my babies at a hospital I like over the one closest to me. Sometimes a pain, but totally worth it during post-partum!

          • Young CC Prof
            May 8, 2014 at 7:28 pm #

            That, and they HAVE complaint procedures. You can file a complaint, and it goes in a file. Not a circular file. Might not change anything, but it does get recorded.

          • OBPI Mama
            May 8, 2014 at 8:10 pm #

            I sent an email to one of the children’s hospitals after one of my son’s surgeries there. It wasn’t a formal complaint, but just a “head’s up” as there were some things I thought were off. They took the email beyond seriously. First they called me and talked with me and with my permission they circulated the email with my thoughts (written nicely and politely yet firm in my thoughts and experience) to some different departments for discussion. They had a special nurses meeting for the nurses on the floor where my son was post-op (all the brachial plexus surgeries go to that floor) then they had a meeting with residents to discuss the protocols for surgery post-ops. And they made one other change. I was blown away by their response from one email. Just showed me the passion they have for families and children and the drive hospitals have to be #1 in so many areas. I speak with many families that use them and have not heard any of the issues we had since.

          • Bombshellrisa
            May 8, 2014 at 8:38 pm #

            I had a close friend do this while interviewing CNMs. She dumped her midwife due to the policies of the hospital the midwife had privileges at. She was perfectly happy driving farther out and she and her baby were still in excellent hands when it came time to deliver. (I should add her CNM did homebirths but she didn’t want a home birth, despite the fact she would have been a good candidate)

          • Mac Sherbert
            May 8, 2014 at 11:22 pm #

            True, but it really isn’t always that easy. The hospital where I had my first baby was already an hour away. For my second baby I considered a VBAC only because I wanted to keep the baby with me. I interviewed doctors at different hospitals about not just VBAC, but their hospitals policy about keeping the baby in recovery, if I had a c-section. One hospital was closer say 30 mins without NICU and one was an hour and a half…I couldn’t find a hospital that would let me keep my baby with me in recovery, so I just went back to the first hospital (which also offered VBAC).

          • OBPI Mama
            May 9, 2014 at 6:35 am #

            My hospital is an hour and a half too… pain in the butt for prenatal appts. or when I had to drive there when I got an umbilical hernia during my last pregnancy (“ow, ow, kids behave in the back seat! ow, ow” haha). I don’t know of any hospitals here who let babies go to recovery either. My doctor did say he was working on trying to persuade whoever makes up protocol to change that, but it didn’t happen by my 4th. They washed the babies up for me though (I like a clean newborn, but I know everyone is different) and did all their vitals and info while I was in recovery though so it worked out. Fortunately, the nurses were really good about bringing the baby to me as soon as I got moved to my room. I am so sorry yours was not! That is awful!

          • Medwife
            May 8, 2014 at 8:04 pm #

            What was his one minute apgar? How much resuscitation did he need?

          • saramaimon
            May 8, 2014 at 8:18 pm #

            its strange because his medical record is very different than one i remember. the record states apgars of 6 and 9, but to me it seemed like a lot longer to get himi breathing. the record only states “neonatal oxygen administration” but i remember them using an ambu in the corner of the room. so you will have to excuse me that i am a bit fuzzy on this. i did hold him briefly and i did note some nasal flaring. but he didn’t get any special observation.

          • saramaimon
            May 8, 2014 at 8:20 pm #

            oh yeah i was gbs positive and had labor augmented due to mild fetal tachycardia. so maybe thats why they took him. but, he didn’t get special observation.

          • Medwife
            May 8, 2014 at 10:22 pm #

            So he needed resuscitation and there was concern for sepsis, maybe? Did your husband see if maybe there was a pulse ox sensor on him while he was in the nursery? Does he have a clinical background?

            It kills me when people leave the low risk category and are then pissed off because we stop treating them like low risk patients. All was not normal so it was not safe for baby to be left alone with its parents. They care! They want your baby to be healthy! Why are they the bad guys?

          • saramaimon
            May 9, 2014 at 3:27 pm #

            at the time i was ok with it, it was only after when i found out that there was no special observation. i was told that in that hospital initial separation is done routinely for all babies.

          • Sue
            May 8, 2014 at 10:14 pm #

            One of the great things about the ”well baby nursery” process is that the baby’s Dad often gets to go with them and be present at the first weighing and checking, and snuggling time (while the mother is recovered, stitched, whatever). I’ve seen fathers still tear up with the emotion of this special time, years later.

            Breast-feeding mothers will have an abundance of skin-to-skin in succeeding months. It’s great that fathers can have this special bonding time with a brand new baby.

          • Mac Sherbert
            May 8, 2014 at 10:27 pm #

            My husband did get to do all that…then he was sent to recovery with me…I was in recovery for a long time! When I finally got to my room where I had been promised and reassured I would get my healthy baby…NO BABY!

            And while it is special for my husband…I’ve been fascinated by newborns my whole life and I really do wish it had worked out so I could have experienced an alert fresh out of the womb baby.

            However, I would never be willing to put that experience over a lifetime with a healthy child. Priorities.

          • Mac Sherbert
            May 8, 2014 at 10:22 pm #

            Thank you for understanding. I do not regret my c-sections and I know I received good care. However, I do wish I could have had my babies with me during their “alert” times. Especially, my second baby that was later to sleepy to latch on for days.

          • Medwife
            May 8, 2014 at 11:09 pm #

            Oh yeah, it can be REALLY hard to get a baby interested in latching if you miss the window of the first hour.

            It’s ok to not like some aspect of your experience. I am happy I work in a place where the staff keep the baby and mom together whenever reasonable. It’s not like you’re saying, “I didn’t get to hold my baby after he was born, therefore I wish I’d had him in my bedroom away from all you baby-haters”.

    • saramaimon
      May 8, 2014 at 5:43 pm #

      why weren’t you able to leave the baby with them longer?

      • Young CC Prof
        May 8, 2014 at 5:46 pm #

        Presumably because the baby needed medical attention!

        • saramaimon
          May 8, 2014 at 6:20 pm #

          why presume without asking? isn’t this supposed to be a skeptical website

          • yugaya
            May 8, 2014 at 7:40 pm #

            Yes, and on a skeptical website you will find out that believing based on anecdotes and individual perception how medical professionals are a bunch of ‘uneducated’ clowns who do things just to ruin perfect bonding experiences is an assumption that is good for laughs only.

          • saramaimon
            May 9, 2014 at 3:21 pm #

            No, often it is done for efficiency. anyway there was nothing to believe, because the poster didn’t say anything. this is one prejudiced extreme blog.

          • MLE
            May 9, 2014 at 3:32 pm #

            She doesn’t owe you any explanation, and what she said was perfectly adequate. You asking for more information doesn’t strike me as curious, it strikes me as second guessing, which is disrespectful.

          • saramaimon
            May 9, 2014 at 3:41 pm #

            good lord second guessing is disrespectful? skeptical blog??? sure it could definitely be that my knowledge is lacking, as it is in many areas, but in that case why not just answer the question, or show me where my assumptions are in error?

          • AgentOrange5
            May 11, 2014 at 2:28 pm #

            @saramaimon…..What is there to 2nd guess when mom & baby both ended up alive & well? OBVIOUSLY the right choice was made, because of the positive outcome. 2nd guessing is what is done when either mom or baby doesn’t end up well, in order to ascertain if something could have been done different to affect a more positive outcome. This is almost always the case with negative homebirth outcomes, almost always a more positive outcome would have happened had the mother been in a hospital where she could have gotten prompt, medical care.

          • saramaimon
            May 11, 2014 at 2:49 pm #

            by that logic, there is nothing to second guess when a homebirth mom and baby end up doing well either.

          • AgentOrange5
            May 11, 2014 at 2:54 pm #

            Who here is doing that? I don’t see anyone 2nd guessing, although I have seen some women who had successful home births who now realize how lucky they are that things didn’t go wrong, who are saying they would not take that risk again. That’s not 2nd guessing, that is just no having a truer picture of the risk/benefit of homebirths and deciding that in no way is the benefit worth the risk.

          • Amazed
            May 9, 2014 at 3:36 pm #

            Sara, I can’t wait to see you at Midwifery Today’s Facebook page! If you’re so offended by what you perceived as a “prejudiced extreme blog”, you must be frothing at the mouth at a prejudiced extreme blog that certainly killed AT LEAST one baby.

            At least we didn’t group-killed anyone.

            Don’t forget to drop a note here when you call THEM out. I’d like to see your post before they delete it.

          • saramaimon
            May 9, 2014 at 3:38 pm #

            never heard of that page before reading about that incident right here today. i do admit that was enlightening to me in a bad way of course, as i personally never encountered something so low.

          • Amazed
            May 9, 2014 at 3:44 pm #

            You can read something about it here in the mother’s own words. Go to February posts here, and you’ll find a screenshot of the page Midwifery Today promptly deleted.

            I strongly advise that you read it before making ANY more comments about massive stereotyping.


          • saramaimon
            May 9, 2014 at 3:56 pm #

            i don’t doubt you, and in fact i did read them today. still, why does that being true mean that everyone else is the same?

          • The Bofa on the Sofa
            May 9, 2014 at 4:00 pm #

            Nice strawman.

          • Amazed
            May 9, 2014 at 4:04 pm #

            Nice moving of the goalposts. Congratulations!

            If you’re totally OK with the highly respected editor of Midwifery Today being an illiterate loon, virtually every midwife who commented showing an appalling lack of knowledge, midwifery lecturers and childbirth educators dispersing equally deadly advice, a baby dying as a part of the 4 times higher homebirth mortality – and your take of it is that WE are massively stereotyping – well, you’re beyond help. It looks like you’re beyond moral, as well, but as we know, moral doesn’t mean much to those you’re defending.

            By their company shall you know them…

          • Durango
            May 9, 2014 at 3:52 pm #

            When you read what midwives themselves write, you realize that Amy is very often spot on with her characterizations. We commenters here still refer to the time when a midwife recommended sucking on a cinnamon candy and blowing that air in the face of a hemmorhaging mother to stop the bleed. That is what passes for knowledge among homebirth midwives. Sure, they don’t all believe that, but no one lifts a finger to stop these extremely uneducated birth junkies. And then babies get hurt, again and again.

          • Bombshellrisa
            May 9, 2014 at 4:18 pm #

            The cinnamon thing illustrates woo contradicting itself: in studying the woo, I was taught cinnamon is a blood thinner and contraindicated for PPH. I was taught to use Rescue Remedy to prevent shock and stabilize bleeding

          • The Bofa on the Sofa
            May 9, 2014 at 4:05 pm #

            never heard of that page before reading about that incident right here today.

            Another victim of Pablo’s First Law of Internet Discussion: regardless of the topic, assume someone knows more about it than you do.

            You came in here thinking you knew a lot about midwives based on your experience. Now, you have discovered, there is a lot about midwives you don’t actually know, and people here DO know it.

            And as has been noted, we are NOT talking the fringe or extreme here. It’s hard to claim that Midwifery Today is not mainstream.

            Stick around. I’m sure there are things you know that could help us learn, too. However, you never know what those things are a priori.

          • Poogles
            May 9, 2014 at 4:14 pm #

            “why presume without asking? isn’t this supposed to be a skeptical website”

            Well…she did say “we saved his baby’s life”, so it seems to be a pretty safe assumption that medical care was needed in this case.

      • RN who has seen too much
        May 9, 2014 at 1:29 pm #

        Was “we saved his baby’s life” not clear enough for you? Obviously we can’t save a baby’s life while it is ON the mom. When babies need help, then need to be on a flat surface so we can do CPR, so we can inject epinephrine, so we can intubate. Healthy happy babies get to go to mom, because that’s the best thing for them. We are not about what the mom wants, we are about what is BEST for mom and baby, presumably that means both of them are living when they leave my care.

        • fiftyfifty1
          May 9, 2014 at 8:19 pm #

          Are you sure all that baby life saving you did wasn’t just “done for efficiency” as saramaimon suggested?

          (isn’t a blessing that someone as wise as saramaimon can use the tool of “skepticism” to help you rethink all your unexamined assumptions? Before you had her to help, you just went about your job as a mindless zombie, harming multiple families in the process with your life-saving “protocols”)

  5. Beth S
    May 7, 2014 at 11:15 pm #

    It’s weird to see how much has changed in six years even, when I was in the hospital tonight for abdominal pains I thought might be labor the nurse looked at the ultrasound and apologized because since the baby was footling breech I was going to have to have surgery. DH laughed and asked her if she’d read the chart because if she had she see I was scheduled for the section anyway so she didn’t have to apologize. Turned out it wasn’t labor just a UTI and the docs sent me home and told me to come back in a week and a half for my delivery.
    I’d never seen a nurse apologize for a C-section before, it blew my mind, because it was not just a variation of normal. With that said I wonder if possibly she’s used to patients like the Medwife had who don’t really know what’s going on or unlike these patients have bought into the NCB lore that makes birth seem like it’s all about Mommy and nothing to do with baby at all.
    PS: I forgot to ask, can I take cough syrup while pregnant?

    • Mer
      May 8, 2014 at 2:15 am #

      Dextromethorphan is in most cough syrup and that’s the one you need to avoid. It’s the cough suppressant, and kind of pointless to take any without it. I can’t remember why it’s contraindicated though, just that it was. Oh and fun fact, you can’t use it if you’re on Zoloft/sertraline either! Has a nasty interaction which I didn’t know about until a pharmacist told me about it.

      • attitude devant
        May 8, 2014 at 12:12 pm #

        Ummmm. No. Dextromethorphan is labelled Class C for pregnancy use only because there have been anomalies noted in chick embryos if the hens were fed it. Beth S is due any day and her baby’s organs are all formed. She’s fine to take it. Also Beth S if that’s not enough for your cough you can take a codiene cough syrup…you’ll need a prescription.

        • Mer
          May 8, 2014 at 2:11 pm #

          Ok, like I said I had no idea why it was contraindicated. Good to know!

    • Sue
      May 8, 2014 at 10:17 pm #

      Cough syrup doesn’t really work anyway. Best thing is symptomatic stuff to break up mucus like inhaling steam or drinking hot tea or soup. Pregnant women have very mucousy air passages due to relative swelling of the mucous membranes from additional blood flow. (OBs pls correct me if I have the pathophysiology wrong).

      • Mishimoo
        May 9, 2014 at 2:49 am #

        That’s why I prefer ones that contain Bromhexine hydrochloride – it thins out the phlegm which helps your body expel it more efficiently. It’s only used in pregnancy over here after the 1st trimester and under doctor’s advice/supervision, but it’s not classed as breastfeeding safe.

        I’m also glad that there is a cough syrup that works for me, is easily available, and doesn’t contain opiates. Yay, allergies! (Of the “Crap, I can’t really breathe and I’m very itchy!” kind)

  6. ducky
    May 7, 2014 at 9:16 pm #

    Which country is medwife referring to?

    Great post. Our birth system’s not perfect but it does a lot for people.

    • Trixie
      May 7, 2014 at 9:21 pm #

      I suspect she doesn’t want to give too much info about her patient.

    • Luba Petrusha
      May 8, 2014 at 10:58 am #

      It could be many “third world” nations although, having worked in India, it sounds a lot like India to me.

      • attitude devant
        May 8, 2014 at 12:13 pm #

        I thought Latin America with the diabetes rates.

        • AmyP
          May 8, 2014 at 1:43 pm #

          Indians are also very susceptible to diabetes.

  7. Who?
    May 7, 2014 at 6:50 pm #

    Thanks for this post. Yesterday I watched an address by an obstetrician who works in PNG. Heavily pregnant women walk for hours to come to the clinic because they knew that they and their babies are safer there than birthing in their villages. The medical staff travel by boat between islands providing care.

    He speaks so passionately about their work, and the critical importance of respecting local culture and customs while introducing interventions that improve outcomes-even those as simple as gloves and gowns.


    • Ob in OZ
      May 7, 2014 at 8:29 pm #

      heard a bit while in my car. Wish I could have stayed for all of it. Will be making a donation in honor of my wife on mother’s day.

      • AmyP
        May 7, 2014 at 11:06 pm #

        Awwww, that’s a really good idea.

      • Sue
        May 7, 2014 at 11:17 pm #

        You can listen again at the website – go to abc, then Life Matters, then click on story – there is audio and transcript.

      • prolifefeminist
        May 8, 2014 at 12:36 am #

        Lovely idea – I’m going to copy you and do that in honor of my mom.

    • Sue
      May 7, 2014 at 11:15 pm #

      I heard that too! SOB-commenting must correlate with Radio National listening.

      That man was originally a carpenter and project manager in a remote area of PNG, saw how poor the access to maternity care was, and got himself re-educated – first in medicine, then diploma of O&G. Now he’s back there delivering the service – in his late 50’s.. Wow!

      Contrast that with the CPMs who either couldn’t be bothered or are not capable of being trained in a health care profession, but relying on the medical/hospital system to pick up the pieces when they mess up. Ugh.

      • prolifefeminist
        May 8, 2014 at 12:37 am #

        Now THAT is dedication (the carpenter turned OBGYN, not the birth junkies turned CPMs). Amazing.

      • Siri
        May 8, 2014 at 2:10 am #

        Was it Harrison Ford?

    • guest
      May 8, 2014 at 9:14 am #

      With more and more woman deciding to use cnm’s, it would be a good idea to have hospitalist on standby. If over half of the hospitals do not have obstetricians on site, what happens in an emergency? A nurse would call a doctor in advance, a cnm would allow a laboring mom to go further. I believe these hospitals need to have an on site ob when they allow cnm’s to deliver.

      • guest
        May 8, 2014 at 9:18 am #

        Oops sorry. Picked wrong post. Meant to be down in NY times.

  8. May 7, 2014 at 5:24 pm #

    Kind of off topic, but this article just went up on the New York Times op-ed page. It’s about the eeeevil C-sections and OBs who do them for convenience and how our C-section rate is too high, with obligatory mention of the cascade of interventions.

    Have fun, ladies and gents.

    • Young CC Prof
      May 7, 2014 at 5:33 pm #

      They compare the c-section rate of a hospital in San Francisco with a beautiful birthing center in it to one in East LA. Oh, joy.

      • Ash
        May 7, 2014 at 5:42 pm #

        I noticed that too. SFGH appears to have a Level III NICU and many other resources. Los Angeles Community Hospital doesn’t even have its own website.

        • Squillo
          May 7, 2014 at 7:56 pm #

          SFGH is a fabulous public hospital in many respects. It does have a level III NICU. And 24-hour obstetrical anesthesia. And, as Rosenberg points out, salaried physicians (and CNMs) who work shifts, which not only means the docs have no financial incentives to do “more,” it also means all those resources are available 24/7, so yeah, they can do VBACs pretty safely. Also, about 40% of births at SFGH start out managed by the midwives, which means that, despite the diverse patient population (SFGH serves primarily the city’s un- and underinsured population), 40% start off in the low-risk category (although I believe midwives there can co-manage obese and diabetic women with OBs.) If a woman’s preganancy becomes seriously complex, chances are she’s going to end up at the sister hospital, UCSF.

          If the majority of community hospitals had the resources of SFGH–plus a patient population content to take whoever is on call to attend their labor–there would be a lot more VBACs.

          • Jenny_from_da_Bloc
            May 7, 2014 at 8:53 pm #

            Most OBs are paid a global maternity fee, which clearly informs the patient that the doctor gets paid the same for vaginal and c-section deliveries. It’s a set fee no matter which way things go, meaning there is no financial incentive. The money argument is invalid in most cases. The fee for service argument is just something lay-midwives and homebirth bloggers/advocates use to manipulate pregnant women into believing OBs and hospitals are evil capitalist ready to cut them at any minute.

          • Mac Sherbert
            May 8, 2014 at 2:35 pm #

            Yep. Same fee and in the case of C-sections and extra follow -up visit is included. (If I remember correctly.)

        • Young CC Prof
          May 7, 2014 at 8:50 pm #

          Hmm. My comments on that post disagreeing with other commenters all went through almost immediately. My comment disagreeing with the author are still in moderation hours later. Actually, I don’t see any new comments posted there at all.

    • Ash
      May 7, 2014 at 5:51 pm #

      I’m always amused by the whine of “OBGYNs are only good at surgery! They do too many interventions! Too many C-sections! They do inductions so that women have epidurals and then have C-sections!”

      I kindly invite all these folks to attend medical school and complete an OBGYN residency, and become the Magical OBGYN who has all patients who have 100% vaginal deliveries with zero medications and zero adverse events for mom or baby. I triple dog dare them!

    • Amy Tuteur, MD
      May 7, 2014 at 6:16 pm #

      Am I missing something, or did Rosenberg just write an entire piece about hospital safety without mentioning mortality rates.

      • Young CC Prof
        May 7, 2014 at 6:17 pm #

        Correct. And apparently without talking to any obstetricians.

        • Squillo
          May 7, 2014 at 8:21 pm #

          She talked to the chief of OB at SFGH.

      • May 7, 2014 at 6:23 pm #

        Nope, she did in fact not mention mortality or morbidity rates.

        I’m M from Dallas over on the NYT boards- it’ll be a bit before my comments post, probably, but I tried.

      • Lena
        May 7, 2014 at 7:59 pm #

        Nope. I read the whole thing and saw not a single mention of morbidity or mortality. I did a search to be extra sure.

        I want to say it’s unbelievable, but I’ve been reading this blog for too long.

    • Young CC Prof
      May 7, 2014 at 6:25 pm #

      Oh, look, 2 months ago she wrote an article about the horrors of early elective deliveries and how they used to happen ALL THE TIME!!! but now obstetricians are not so stupid and they’re finally beginning to listen to reason and not inducing unsuspecting pregnant women just because they want to go on vacation and inflicting lifelong damage on the poor 38-week preemies.

      By the way, how much difference did the 39-week rule really make? Not much. In 2003, 30.9% of term births (37+) were at 37 or 38 weeks. In 2006, the rate peaked at 33.1%, then the 39-week rule began to be promulgated and in 2010 it was down to 30.5%. So, early elective induction accounted for at most 2% of births at its maximum popularity.

    • MLE
      May 7, 2014 at 8:23 pm #

      UGH, in NBC parlance, it’s vee-back, not vee-bee-ay-see! Riddled with errors.

      • MLE
        May 7, 2014 at 8:24 pm #

        UGH it’s NCB in NCB parlance, not NBC!

    • Lena
      May 7, 2014 at 8:37 pm #

      I find her using a hospital “for the poor” as this great example of obstetrics care extremely problematic in all sorts of ways. Because the low c-section rate there is directly due to the lack of value given to the health of poor people, and that means that they’re saving money in other ways that have a higher likelihood of negative outcomes. That she doesn’t even mention mortality rates says it all.

      • Young CC Prof
        May 7, 2014 at 9:16 pm #

        Except it isn’t really a hospital for the poor, certainly not compared to the other hospital under discussion! In San Francisco, only 16% of residents live in poverty, and only 12% of children, while in Los Angeles, 26% of residents and 28% of children live in poverty. The LA hospital is a neighborhood clinic in a poor area, the SF hospital is comprehensive with the services to attract low-risk wealthy women.

        • Squillo
          May 8, 2014 at 10:38 am #

          Except they don’t attract wealthy women for prenatal services. The low-risk wealthy women go to CPMC (which has all the luxury services you could want) or Kaiser. Overall, the majority of SFGH’s patient population is MediCal/Medicare and uninsured (80%, according to the foundation’s website.) They provide the vast majority of maternity care for the city’s homeless and undocumented workers. The well-insured don’t choose SFGH for routine or maternity care. Their well-insured population comes from trauma, as SFGH is the only level I trauma center in the area.

          So while it may not be directly comparable to LACH in terms of number of poor served, it’s certainly accurate to say SFGH is a hospital for the poor when it comes to maternity services.

          • Young CC Prof
            May 8, 2014 at 7:31 pm #

            OK, good to know. Haven’t been there myself.

      • fiftyfifty1
        May 7, 2014 at 9:24 pm #

        I trained at a hospital that served mainly the poor. It was easy having a low c-section rate there. Almost no advanced maternal age. Almost no assisted reproduction so fewer twins and no triplets. Most women were multips and the nullips were women in their late teens or early twenties. And most of all: no level 3 NICU.

        • saramaimon
          May 8, 2014 at 3:58 pm #

          what a disgusting use of stereotypes against the poor. you should be ashamed of yourself. i have worked with poor mothers my whole life and they come in all ages- but with more medical complications. they are MORE likely to need c/sections, not less. shame on you.

          • nohika
            May 8, 2014 at 7:10 pm #

            Different poor populations in different places have different needs. Don’t be so quick to judge just because the poor population in your area is demographically different with different medical needs.

          • Medwife
            May 8, 2014 at 8:09 pm #

            Uh. I’m sorry, is it false that low socioeconomic status is linked with lower age of first birth and higher parity?

            What kind of work do you do? Are you, say, a doula? That’s my bet. Prove me wrong?

          • saramaimon
            May 8, 2014 at 8:26 pm #

            well i don’t have to answer personal questions but since you can google me, i might as well answer. i am a nurse, and i have practiced in the past as a doula as well.

            now first things first- saying that there is a linkage is very different that the nullips were all in their teens and early 20s. and what about diabetes and obesity and other medical complications?

            its the breeder stereotype that got me

          • PrimaryCareDoc
            May 8, 2014 at 8:44 pm #

            Wow. Boy, did you read something into her comment that wasn’t there.

          • fiftyfifty1
            May 8, 2014 at 9:53 pm #

            How have I used these stereotypes against the poor? And please let me know exactly which of my assertions you think is false.

            -fact: If you are uninsured or underinsured you won’t have access to assisted reproduction which is a big problem for poor women because their rates of infertility are often higher than those of rich women…but this sad inequality does lead to fewer multiples.

            -fact: Women who give birth for the first time in their teens or 20s are far less likely to need a c-section than women giving birth for the first time in their 30s or 40s. Poor women are more likely to give birth for the first time at an earlier age and far less likely to give birth for the first time at advanced maternal age.

            -fact: some cultures prize large families. If your hospital is located in a neighborhood with many immigrants from these cultures, the average family size will be larger than the American average as a whole. First births are generally more difficult than subsequent births and result in a higher primary c-section rate. Conversely a population enriched in multips will lead to a lower rate.

            -fact: access to effective birth control is non-existent in many refugee camps. Therefore most females of reproductive age who arrive from these camps will no longer be nullips and will already have a “proven pelvis”. Their first babies may have died in the process, but they almost certainly will not have received a c-section. Women who have already had a vaginal birth and have never had a c-section have a very low c-section rate (~5% or less) in the future.

            -fact: if your hospital does not offer a level 3 NICU, you will be sending all your sickest patients elsewhere. This will lower your c-section rate.

    • Jenny_from_da_Bloc
      May 7, 2014 at 8:44 pm #

      That article made me gag and so did the comments! “Because SFG is a teaching hospital they have a better focus on evidence based care.”
      What if the evidence suggests a c-section is necessary? And no formula? I thought I was reading about one of the maternity wards in my native Ukraine and trust me I would crawl to Germany before I gave birth there.

    • Anj Fabian
      May 7, 2014 at 8:48 pm #

      Reading the comments…
      I’m close to bingo.

      • Anj Fabian
        May 7, 2014 at 8:52 pm #

        One commenter
        “The NIH conference findings, which have been published in peer-reviewed
        journals, confirm that vaginal birth for the vast majority of births is
        as safe as c-section for the baby,”

        Anyone have an idea what she is referring to?

        • Young CC Prof
          May 7, 2014 at 9:08 pm #

          It sounds like a vacuously true statement in that if all women with an indication for c-section get one, then neonatal outcomes of vaginal birth will be excellent.

          I have no idea what the specific paper is.

        • CanDoc
          May 7, 2014 at 11:24 pm #

          Absolutely. Vaginal birth IS just as safe as c-section for the “vast majority” of births. It’s just that it’s catastrophically unsafe for the rest of them.

    • CanDoc
      May 7, 2014 at 11:38 pm #

      Boo. I commented hours ago and must have been “censored out.” Was it the scientific citations? The proper use of punctuation?

      • Young CC Prof
        May 7, 2014 at 11:54 pm #

        Look again, a bunch of “controversial” comments (probably ours) just went through the filter.

    • guest
      May 8, 2014 at 9:20 am #

      With more and more woman deciding to use cnm’s, it would be a good idea to have hospitalist on standby. If over half of the hospitals do not have obstetricians on site, what happens in an emergency? A nurse would call a doctor in advance, a cnm would allow a laboring mom to go further. I believe these hospitals need to have an on site ob when they allow cnm’s to deliver.

    • Lombardi
      May 8, 2014 at 10:42 am #

      How likely are poor mothers to be young? It seems to me that alone could contribute to lower c sections rates.
      OT: I do agree that switching to salary from fee based pay is a good idea. Fee based pay provides strong incentive for more procedures and more patents . Especially in light of things like this: http://thehill.com/policy/healthcare/203127-medicare-cash-flowed-to-doctors-charged-with-fraud

      • May 8, 2014 at 1:34 pm #

        Oh yeah, that is a good idea. But most OBs are already paid for the whole childbirth thing as one fee- it would be better if they were salaried, but they really aren’t earning any extra money for doing a C-section either.

    • MLE
      May 8, 2014 at 11:18 am #

      Oh goodness. Is this comment a joke? It sounds like it was taken directly from some NCB propaganda flier:

      Mindy Portland, Or 2 hours ago
      My daughter opted for a home birth with a midwife. I was not sure this was a good idea, but after research on the internet learned that it was. For healthy mothers with uneventful pregnancies, home birth has better maternal and infant outcomes.

      The baby was two weeks late, but the midwife said it was best to wait. Sure enough, my granddaughter arrived on her own schedule healthy and robust. As the midwife said, some women are “long gestators.” All too often we try to push everyone into the same mold, rather than recognize that there is wide range of normal.

      • May 8, 2014 at 1:35 pm #

        Probably not a joke, no. After all, getting lucky means it’ll work out for every woman every time, right? Right!?

        • saramaimon
          May 8, 2014 at 6:23 pm #

          almost every time. the still birth rate does rise post date, but it’s still less than 1/2000. people should learn the odds and make informed decision.

          • Young CC Prof
            May 8, 2014 at 7:31 pm #

            A bit higher than that. This says 1 per 1,000 at 42 weeks http://www.ncbi.nlm.nih.gov/pubmed/22914394, I’ve also heard 1 in 650.

            For women with risk factors, like advanced maternal age, GD, low fluid, or other issues, it’s MUCH higher.

          • Becky05
            May 9, 2014 at 2:45 pm #

            AND with increasing gestational age neonatal mortality, neonatal morbidity and postneonatal mortality are also rising. It takes about 375-400 routine inductions at 41 weeks to prevent one perinatal death.

          • saramaimon
            May 9, 2014 at 3:52 pm #

            thanks. i stand corrected.

          • The Bofa on the Sofa
            May 8, 2014 at 7:51 pm #

            Learn the odds? Or have someone lie about them?

            Like you have done.

          • May 9, 2014 at 12:30 am #

            That doesn’t count as almost every time. That’s an awfully high risk of death for something so inane as giving birth at home … the odds are not in your favor if you have a 0.05% chance of killing your baby just from the postdates alone. Add in all the other complicating factors of homebirth, and it’s actually a much higher risk than that.

          • saramaimon
            May 9, 2014 at 3:51 pm #

            for myself i agree, which is why i didn’t choose a homebirth for myself. but for people who arent used to looking at things on an epedemiological level, .o5 seems like pretty good odds.

          • May 9, 2014 at 4:52 pm #

            Sure. But they’re wrong. And they must be pointed out as wrong.

            Part of making an informed decision isn’t just being given the numbers, but understanding what they mean.

          • saramaimon
            May 9, 2014 at 5:00 pm #

            different people have different risk levels they are comfortable with. i’m ok with it if someone says, hey i’m aware of the risk and im comfortable with it. but you are correct that many people are in denial of risk altogether.

          • May 9, 2014 at 5:18 pm #

            I’m okay with that too. I think homebirth is an incredibly stupid choice, but it is one people have the right to make.

            However, I’m not okay with (many, the vast majority, but not all) homebirth midwives lying to their patients and telling them homebirth is as safe as hospital birth. It’s not. I’m not okay with homebirth midwives having zero real medical training. I’m not okay with them blocking transfers the mothers request. There is a whole lot that is very wrong with homebirth, especially in the US, and that’s why this blog exists. To teach people, to point them at the data and the resources to learn the truth. If someone is truly aware of the risks, then yeah, informed consent. But most people really, truly are not aware, and if they’d known, they never would have done it.

          • fiftyfifty1
            May 9, 2014 at 7:30 pm #

            “people should learn the odds and make informed decision.”

            Absolutely. Women should learn that going past 41 weeks both increases their risk of stillbirth AND increases their risk of C-section. The sensible informed decision is to induce!

        • MLE
          May 9, 2014 at 12:48 am #

          Right. Turns out after some innernet research, everything will be A OK. Well that’s a relief!

  9. anh
    May 7, 2014 at 2:59 pm #

    I’ve talked about this before…but this just reminds me so much of an experience I had living in the Persian Gulf area. One of my best best best friends was from Chad but had grown up in another Gulf country, had two babies, and then moved to the country where we both lived. Both of us spoke Arabic as a second language and fortunately I could keep up with her linguistically…mostly.
    She talked about how in the first country she’d given birth in she wasn’t allowed to have anyone with her. She was so excited that in this new country she could have her sister with her. Because the ob had to be a woman, and she couldn’t risk losing her veil while delivering the baby in front of her husband (ps, her husband was awesomely bonded to his kids despite missing the birth)
    When she was around 7 months the doctor told her she could have an epidural if she wanted. After the check up she asked me what the hell she was talking about. I did my ABSOLUTE best to explain to her what an epidural was and she responded by laughing uproariously and kind of chuffing me for being so silly. She was like “you haven’t had a baby honey, there is NO WAY you can do it without horrible pain”.
    she wasn’t scared of the pain, just kind of resolved that that was how things went, nbd. I kind of wish her OB, who spoke better Arabic than me, would have explained it better to her.

    • CrownedMedwife
      May 7, 2014 at 4:40 pm #

      I really appreciated this family sharing their thoughts during labor. Our society spends so much time vilifying effective intrapartum pain management that we really can forget there are places in the world who cannot even fathom what we are so fortunate to have.

  10. theadequatemother
    May 7, 2014 at 2:51 pm #

    I’ve been rolling this excellent post around my brain for the last few hours and one of the reasons it has stuck with me is its an excellent example of a health professional working with a family, appreciating their background, context and culture and using that understanding to help provide appropriate clinical care.

    Whereas it seems to me that lay midwives and CPMs try to indoctrinate their clients into North American Natural Childbirth/ Homebirth culture. Dr Amy has written before about how CPMs and lay midwives offer one-size-fits-all care and this post is another example of how real medical professionals tailor care to inviduals.

    • saramaimon
      May 8, 2014 at 6:31 pm #

      amy’s one size fits all portrayal is a total caricature, the fact that some natural advocates portray all obs as one size fits all, is no excuse to do the same stereotyping in the other direction. note how illogical your comment was- because this midwife gives professional, individualized care, that means others don’t? what is your point, to promote good care, or simply to badmouth?

      • theadequatemother
        May 8, 2014 at 7:15 pm #

        Oh the indoctrination into NCB and homebirth culture by lay midwives in the US is a very real phenomenon. Certainly, like all things in life (other than taxes and death) not 100%, but widespread enough to warrant some attention.

      • Poogles
        May 9, 2014 at 3:07 pm #

        “the fact that some natural advocates portray all obs as one size fits all”

        It’s actually a pretty main tenet of NCB, and especially homebirth advocacy, that hospitals are “factories” and like “assembly lines” or “revolving doors” where the doctors simply want to get you in, go down a mental checklist of interventions, section you and get you out to free up the bed for the next woman.

        “note how illogical your comment was- because this midwife gives professional, individualized care, that means others don’t?”

        I think you’re confused. The author of this post (the medwife) is a CNM (or equivalent), NOT one of the CPMs/DEMs/ lay midwives that theadequatemother was referring to in her comment. CNM’s are “real medical professionals [who] tailor care to inviduals” unlike the lay midwives who “offer one-size-fits-all care”.

        By the way, the accusation of lay midwives offering one-size-fits-all care isn’t something we threw out there because NCB says it about hospitals/OBs – it’s the logical conclusion after having encountered stories of the same care (or lack thereof) provided by these midwives over and over and over again.

  11. May 7, 2014 at 2:28 pm #

    In health policy there’s a lot of talk of “over-utilization” and “inappropriate use” – but this seems to illustrate why “under-utilization” should be an equivalent concern.

    • MLE
      May 7, 2014 at 2:30 pm #

      If anything, I would say it’s of greater concern. Unless your concern is saving money by allowing people to die early deaths.

      • The Computer Ate My Nym
        May 7, 2014 at 3:16 pm #

        Yep. The concern about “over-utilization” is about the insurance companies saving money and nothing but.

        • Young CC Prof
          May 7, 2014 at 5:15 pm #

          As long as we are honest about it, there’s nothing inherently wrong with bean-counting. The fact is, resources are not infinite, and we want to make sure that we are spending them in ways that provide the greatest return in life and health.

          Of course, I happen to believe that maternity care is right up there with nutrition and infectious disease control on the list of really important health care needs at the national level. For any nation.

          • The Computer Ate My Nym
            May 8, 2014 at 10:00 am #

            Resources are not infinite, but we’re spending way too little on medicine and public health. We’re probably also spending it in the wrong ways and I have no objection to considering the relative benefit versus costs of various interventions, but it shouldn’t be THE thing that people worry about while we still have people dying unnecessarily because they didn’t get care.

          • Young CC Prof
            May 8, 2014 at 10:02 am #

            Honestly, in a wealthy nation, I don’t see what’s wrong with spending, say, a third of GDP on health care. Beats spending it on toys.

    • Sue
      May 7, 2014 at 11:20 pm #

      Australia is going through a discussion of alleged over-use of general practice services. But who is to say, in advance, which visits were ”necessary”? Just like cesarean delivery – retrospectocope is not available, and crises avoided are not measured.

      • Young CC Prof
        May 7, 2014 at 11:37 pm #

        Um, how can there be such a thing as overuse of the GP? The GP decides what people need and what they don’t. Overuse of certain diagnostic tests, maybe, especially in cases where the test is very unlikely to affect treatment or outcome. But overuse of “going to the doctor to check it out?” That’s kind of a weird concept to me.

        • Mishimoo
          May 8, 2014 at 3:12 am #

          Part of the problem is that a medical certificate is required by most workplaces for taking a single day off from work, which is clogging up waiting rooms. There’s also a problem with people going to the ER instead of their GP, because the hospital is free and not all GPs choose to bulkbill. For example: My husband’s grandma goes to a non-bulkbilling GP, which costs her $120 per short visit, ~80 of which is able to be claimed back from Medicare.

          My personal concern is with the new contracts that my state government wants doctors in the public health system to sign. I worry that someone will come along and try implement a caeserean quota as a cost-cutting measure.

          • Karen in SC
            May 8, 2014 at 8:37 am #

            Our schools require a medical note, too. But I figured out right away that since 10 unexcused absences are allowed per term, I didn’t need to get one when the kids just stayed home for a cold or stomach bug. I did however, go to the doctor when my youngest had H1N1 and got a note to cover the entire week.

          • Young CC Prof
            May 8, 2014 at 9:59 am #

            OK, yeah, excuse notes for minor illnesses are in fact GP overuse, or at least stupid use. And yes, people going to the ER for something that they know isn’t an emergency is also a problem.

          • Sue
            May 8, 2014 at 10:29 pm #

            Notes for minor illness are indeed a poor use of resources, but this is a tiny element of GP work that takes almost no time or resources.

            Similarly, the few less complex cases in ED consume very little – it’s the complex elderly who take time and resources. They are the people in our society who get sick. What are we to do other than see and treat them?

          • Who?
            May 8, 2014 at 8:47 pm #

            Hi fello banana bender, yes I think you’re right about the contracts: they are likely the softening up before the actual cutbacks come into force. My question is how will the state government tie it all in a nice bow before the election in March, when on current numbers they will get a caning?

            And yes YCCP, it is weird that a trip to a gp to check out a potential issue, and nip it in the bud, could be considered ‘excessive’. Some ‘think-tank’ (ahem) came up with the stat that Australians go to the gp eleven times a year. Too often! they cried. Turned out the actual figure is about half that, but hey, why let the facts get in the way of an ideological rampage?

          • Mishimoo
            May 9, 2014 at 1:42 am #

            I wonder if it’s the same thinktank that is always contracted to provide the estimated profits for all of the new toll roads/bridges…

            That’s my favourite conspiracy theory, which is based in part on what allegedly happened to one of the superclinics as well as how the companies building/running the toll roads/bridges seem to go bankrupt fairly soon after the infrastructure is completed.

      • araikwao
        May 8, 2014 at 7:09 am #

        What the?? I haven’t heard about that, more about the proposed $15 co-pay for GP visits and the ED co-pay. How do you overuse a GP anyway? Should I let my febrile, lethargic toddler with acute otitis media progress to mastoiditis rather than risk an unnecessary GP visit?

        • Christina Maxwell
          May 10, 2014 at 2:32 pm #

          I don’t think anybody would consider that unnecessary. In the UK we seem to have a threefold problem; 1) people going to the GP when they really don’t need to, a visit to the pharmacist would be more productive (I had an aunt who went to the GP at least once a week, every week and she wasn’t unusual). 2) People visiting the ER because they can’t get a GP appointment for a fortnight (Plus drunks. Lots and lots of drunks) and 3) People demanding an ambulance for ridiculous reasons, quite often delaying help for actual emergencies, particularly in rural areas. Of course there is no immediate cost to the patient, it’s all ‘free’, therefore no incentive to avoid these behaviours. I could go on for paragraphs about why these things happen but it would be just my opinion and would bore you all stupid.

    • PrimaryCareDoc
      May 8, 2014 at 8:03 am #

      That’s terrible. As a primary care doctor, I’d rather see 100 patients that have nothing than miss the one with a heart attack because he figured that it wasn’t important enough to be seen. I agree that there is over-use of the ER, but that’s from people not having proper primary care access or not knowing what they should be seeing their primary care doctor for. The answer is patient education and more primary care.

  12. hmm hmm
    May 7, 2014 at 2:12 pm #

    OT: Wow, check out the crap on Gloria LeMay’s Facebook page. Worthy of a post unto itself.

    • Young CC Prof
      May 7, 2014 at 2:22 pm #

      Has anyone ever done a study of term stillbirth under HB midwife care? It might be tough because a lot of women are planning a home

      birth but simultaneously seeing an OB. I suspect it’s too high, but I’ve got no way to find out.

    • Young CC Prof
      May 7, 2014 at 2:30 pm #

      Oh, my, the “Day of the Midwife” post. All about how being a registered midwife is so horrible and objectionable, because you have to pay money to the society and be a “highly controlled obstetric nurse” with, like, practice guidelines and outrageous things like that.

      I’m going to pretend that’s satire.

      • Melissa
        May 8, 2014 at 12:18 am #

        And when she has to hire a lawyer, I’m sure that she wouldn’t want one who had to pay their Bar membership dues and follow the rules of ethics.

    • Squillo
      May 7, 2014 at 8:15 pm #

      Gloria Lemay is the Ken Ham of birth.

      • AgentOrange5
        May 11, 2014 at 7:34 pm #

        @Squillo….at least Ken Ham never killed anyone (from what I’m aware of.)

    • theadequatemother
      May 8, 2014 at 12:09 am #

      Can some of the lawyers help me out here…when gloria is ranting about the “day of the midwife” she is saying that she can care for pregnant women and act as a midwife legally as long as she doesn’t call herself a midwife. Is that true? Did she win an appeal or something because all I can find is that a permanent injection was brought against her so that she could not care for pregnant women or attend births in 2002 bc of the dead and damaged babies se left behind. Did she win an appeal I am not aware of? Or is she misrepresenting the truth on her FB page?

  13. prolifefeminist
    May 7, 2014 at 2:00 pm #

    Excellent post, Medwife – thank you! That last paragraph especially is very powerful.

  14. The Computer Ate My Nym
    May 7, 2014 at 12:30 pm #

    “my nipple ring got stuck in the shower curtain”

    I’m trying to work this one through. Is she calling from the shower, still attached? If not, I’m not sure what the emergency necessitating calling you is. If she is…oh, dear! It sounds uncomfortable!

    • GuestS
      May 7, 2014 at 1:09 pm #

      That does NOT bode well for breastfeeding!

    • MLE
      May 7, 2014 at 2:13 pm #

      Not necessarily still in the shower. She could take down the curtain and bring it with her to the Dr.

      • Young CC Prof
        May 7, 2014 at 2:27 pm #

        Now I have a mental image of someone cutting a piece out of the shower curtain with a switchblade and going to the clinic with it still attached under a loose shirt. Yikes!

        • MLE
          May 7, 2014 at 11:14 pm #

          I was imagining taking it off the rod/rings and wrapping it around myself like a plastic robe. Because if I had a nipple ring, this WOULD happen to me. Hence the lack of piercings.

          • Beth S
            May 7, 2014 at 11:16 pm #

            I’d do the same thing, I tend to do stupid things like trip over doors or fall up stairs, so if something hilariously bad like this were going to happen it would happen to me. And I’d use the shower curtain like a sheet unless it was see through.

        • Mishimoo
          May 8, 2014 at 3:19 am #

          That comment reminds me of the ‘Things I learn from my patients’ thread over at the Student Doctors Network. (Warning: equal parts dark humour, WTF? and sad)

          • The Bofa on the Sofa
            May 8, 2014 at 9:34 am #

            It reminds me of Jeff Foxworthy.

            “If you ever had your nipple bitten off by a beaver, you might be a redneck.”

    • CrownedMedwife
      May 7, 2014 at 4:22 pm #

      Hah, yes that one was a doozy, ripped out ring opening shower curtain. I didn’t see the humor in it when it woke me from a sound sleep. However, as posts and discussions have been so tense and frustrating since about the time of Thor, felt we all needed a bit of comic relief.

  15. PrimaryCareDoc
    May 7, 2014 at 12:24 pm #

    Thanks for such a terrific post.

  16. Mel
    May 7, 2014 at 11:25 am #

    I’ve had the pleasure of working in an area with a large immigrant community. My students who have babies get them vaccinated religiously. My students often know people who died of those ‘treatable childhood diseases’ that the anti-vaxx community ignores and minimizes.

    Amazing how quickly we forget…..

    • yugaya
      May 7, 2014 at 6:59 pm #

      I’ve had the same experience working/living in places with large ethnic Roma community (the original ‘gipsy’ lifestyle inventors). They vaccinate regularly, bring their babies for well checks, take formula on prescription when breastfeeding is not working, push babies in prams, bring their sick kids to doctors to get examined and treated…

  17. sleuther
    May 7, 2014 at 11:15 am #

    We take so much of this for granted nowadays. It’s good to be reminded.

    I had two relatively uneventful pregnancies and two c-sections and now enjoy my two beautiful children who are 7 and 9 years old. I don’t understand how a specific “birth story” can become so important to people when lives are on the line…. I just don’t.

    • mostlyclueless
      May 7, 2014 at 1:25 pm #

      I had a relatively uneventful pregnancy and c-section. My daughter and I both got through the surgery with no complications. But it still was a very difficult and painful experience for me. It’s ok for women to be upset about how their birth story transpired, even when everyone’s healthy. The fact that it didn’t trouble you doesn’t mean other women’s feelings aren’t valid. My c-section was absolutely the right call, but it was also terrifying and very sad for me.

      • Young CC Prof
        May 7, 2014 at 1:36 pm #

        And that’s OK. Birth can be physically and emotionally very hard no matter how you do it.

        The problem is when people insist on “aiming for natural birth” to the point where mother or child are endangered, or insist that if you just do it naturally you WON’T feel any trauma, fear or pain.

        • Jenny_from_da_Bloc
          May 7, 2014 at 9:01 pm #

          Great point! Nobody said you couldn’t be sad about having a c-section, but the bigger picture needs to be recognized as well. The baby is alive and healthy and so is mom. Natural birth does not equate no trauma, most of my friends who have had a natural birth traumatize me with their birth stories.

          • sleuther
            May 8, 2014 at 9:59 am #

            Seriously. My friend had a 3rd degree tear with her natural unmedicated vaginal birth. We’re close enough friends that she confided some of the details to me, and it sounded horrible. It took her much longer to heal than my c-section did.

          • saramaimon
            May 8, 2014 at 4:07 pm #

            thats true… but did you know that standard hospital practices directly contribute to 3rd degree tears? and almost no hospitals focus any effort on protecting women’s perineums? when after c/section, that is the highest worry of most women. guarantee if it was men and their privates, that would be the first statistic that hospitals would be aiming to improve….

          • Poogles
            May 8, 2014 at 4:42 pm #

            “but did you know that standard hospital practices directly contribute to 3rd degree tears?”

            Which practices? What is your source(s) for that claim? The only practice I know of that directly leads to more 3rd (and 4th) degree tears is forceps delivery, which is not a “standard” practice and has become more and more rare as CS has become safer and more easily accessible.

            “and almost no hospitals focus any effort on protecting women’s perineums? ”

            What efforts? What evidence do you have that a) the efforts you refer to actually protect women’s perineums and b) the efforts you refer to are done in very few hospitals?

          • saramaimon
            May 8, 2014 at 5:42 pm #

            one of the main culprits is the midline episiotomy. now many have shifted to the mediolateral episiotomy, so i guess its incorrect what i said about nothing at all being done. epidural anesthesia is also a contributing factor. These are studied in the literature.
            There are other suspects that have not been studied, among them the intense, coached pushing favored in hospitals, (which may also explain the epidural connection, in which the mother can not feel the natural urge to push.)
            why i say that hospitals don’t care is because they don’t collect statistics on it. at least not in new york, where i am from. if you don’t believe me, look for the statistics yourself. you won’t find them. you will find episiotomy but not tears in the statistics.
            homebirth midwives, on the other hand, often proudly trumpet their perineal results cuz taht will draw clients. of course i suppose you could say they were lying.
            water birth is one of the most effective ways of preventing tears. but thats another story.

          • Young CC Prof
            May 8, 2014 at 5:54 pm #

            Um, actually I have found statistics on tears. This group is tracking them off insurance records: https://www.hcup-us.ahrq.gov/reports/statbriefs/sb131.jsp

          • Medwife
            May 8, 2014 at 8:13 pm #

            They are tracked by my facility.

          • May 8, 2014 at 6:18 pm #

            Granted that this is only anecdata, but I’ve read of some truly horrific tears at homebirths that weren’t properly diagnosed or treated, leading women to need reparatory surgery months or years later and pretty much preventing future vaginal births.

          • saramaimon
            May 8, 2014 at 6:35 pm #

            yeah could be. i met someone with just such a story. really botched repair job. but for her next birth she insisted on having a vaginal delivery in the hospital and what do you know- no tears at all. so i could be wrong about this, or perhaps my exposure is not typical.

      • Trixie
        May 7, 2014 at 1:43 pm #

        I had a similar experience. The key is realizing you’re incredibly lucky to have had this difficult experience, because it’s way less difficult than the alternative.

        • prolifefeminist
          May 7, 2014 at 2:08 pm #

          Exactly. My first c-section was emergent/suspected abruption (post MVA), and the physical recovery was long and painful. I’d had two pretty easy vaginal births already and assumed I’d have another, so I was not mentally prepared for a c/s, especially an emergency c/s. My third c-section (failed TOLAC, but non-emergent) was so much easier to recover from physically. Mentally, I was very prepared for it so there was virtually no problem there either.

          Expectations make a great deal of difference. And, as Trixie alluded to, keeping it all in proper perspective is very important. Things change, and when the likely scenarios shift from “natural vaginal birth or c-section” to “c-section or dead/injured baby,” that’s when you can realize how incredibly lucky you are to have access to a difficult but lifesaving surgery.

          • saramaimon
            May 8, 2014 at 4:04 pm #

            expectations make a difference, but thats not all it is. i’ve been a nurse for over a decade so no one can tell me i didni’t know about childbirth. in fact i had higher expectations, because i’d seen the beautiful, empowering births, and not just the TV style screaming births that most people are exposed to. but there was something i didn’t know, a secret that i found out upon becoming a mother- Traumatic feelings following childbirth are COMMONPLACE to t he point of being almost expected. upon becoming a mother, other mothers shared such things with me that they never shared with me as a nurse. and staff members responded to my feelings as “oh of course your feeling like that, you just gave birth!” somethting has to be done.

          • Poogles
            May 8, 2014 at 4:37 pm #

            “Traumatic feelings following childbirth are COMMONPLACE to t he point of being almost expected.”

            This doesn’t surprise me at all. Even “uncomplicated” births are still a massive life-changing event, frequently involve pain and the possibility of injury and/or death is a real concern.

            “and staff members responded to my feelings as “oh of course your feeling like that, you just gave birth!” somethting has to be done.”

            What do you feel they should have done? What sort of feelings were you expressing? I agree that if you were mentioning feelings that could be symptoms of developing PPD or even PTSD, they should have referred you to a mental health professional.

          • saramaimon
            May 8, 2014 at 5:30 pm #

            “what do you think has to be done”
            great question
            in a nutshell, respect for modesty, privacy and autonomy.
            seeing as some of the main causes of trauma, (after extreme pain- managed by availability of epidural-)
            and shame and feelings of intimate violation

          • Poogles
            May 9, 2014 at 2:53 pm #

            “in a nutshell, respect for modesty, privacy and autonomy.”

            In what ways are these already not being respected by most hospitals, though?

            “seeing as some of the main causes of trauma, (after extreme pain- managed by availability of epidural-)
            and shame and feelings of intimate violation”

            I have to say I find it hard to believe many women are being shamed and intimately violated at their hospital births. Survey’s of mother’s feelings regarding their hospital birth experiences are largely positive and I don’t recall any such issues mentioned.

            Do you personally feel your modesty, privacy and autonomy were not respected? Or that you were shamed or violated? What do you think led you to feel that way?

      • moto_librarian
        May 8, 2014 at 10:14 am #

        I think that we all have some idea of what my “ideal” birth looks like. When you’re pregnant for the first time, you haven’t encountered the messy reality that often accompanies childbirth. I had a planned unmedicated delivery, and it left me feeling betrayed and angry because I felt that my childbirth educator had flat out lied about how painful it would be. I also had severe complications that led to a long recovery – a far cry from the whole “up and walking around 10 minutes after birth” stories that I had been told. It took me a really long time to process the experience because I couldn’t figure out why I hadn’t found the experience to be transcendent or empowering. Finding this blog helped a lot.

        It’s okay to be upset, sad, even confused. You recognize that a c-section was needed, and you’re not bashing doctors or other healthcare professionals for intervening. I hope that you will come to peace with it in time.

  18. Karen in SC
    May 7, 2014 at 11:12 am #

    The last paragraph – what a kicker! Excellent!!

  19. fiftyfifty1
    May 7, 2014 at 11:01 am #

    Terrific post!

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