Midwifery research: dumb and dumber


Recent midwifery research runs the gamut from horrifying to horrifyingly stupid.


Midwives’ clinical reasoning during 2nd stage labour: Report on an interpretive study by Jefford and Fahy

Clinical reasoning was once thought to be the exclusive domain of medicine – setting it apart from ‘non-scientific’ occupations like midwifery. Poor assessment, clinical reasoning and decision-making skills are well known contributors to adverse outcomes in maternity care. Midwifery decision-making models share a common deficit: they are insufficiently detailed to guide reasoning processes for midwives in practice. For these reasons we wanted to explore if midwives actively engaged in clinical reasoning processes within their clinical practice and if so to what extent’. The study was conducted using post structural, feminist methodology…


Over half of the participants demonstrated the ability to use clinical reasoning skills. Less than half of the midwives demonstrated clinical reasoning as their way of making decisions. The new model of Midwifery Clinical Reasoning includes ‘intuition’ as a valued way of knowing. Using intuition, however, should not replace clinical reasoning which promotes through decision-making can be made transparent and be consensually validated.

Factors affecting midwives׳ confidence in intrapartum care: A phenomenological study by Bedwell et al.

[M]idwives are frequently the lead providers of care for women throughout labour and birth. In order to perform their role effectively and provide women with the choices they require midwives need to be confident in their practice. This study explores factors which may affect midwives׳ confidence in their practice…


[T]he principal factor affecting workplace confidence, both positively and negatively, was the influence of colleagues. Perceived autonomy and a sense of familiarity could also enhance confidence. However, conflict in the workplace was a critical factor in reducing midwives׳ confidence. Confidence was an important, but fragile, phenomenon to midwives and they used a variety of coping strategies, emotional intelligence and presentation management to maintain it.

Conclusion and implications

[T]his is the first study to highlight both the factors influencing midwives׳ workplace confidence and the strategies midwives employed to maintain their confidence. Confidence is important in maintaining well-being and workplace culture may play a role in explaining the current low morale within the midwifery workforce. This may have implications for women׳s choices and care. Support, effective leadership and education may help midwives develop and sustain a positive sense of confidence.

Passing yarns forward: unravelling the dimensions of knitting and birth by midwife Sarah Wickham

To the best of my knowledge and that of the MIDIRS Reference Database, it was a male surgeon, Michel Odent (1996, 2004) who first made the very practical art of knitting a topic for debate within the midwifery literature. Perhaps it was such an unremarkable, everyday activity to the midwives who were doing it that it didn’t warrant special mention or consideration…

In this first article, entitled Knitting needles, cameras and electronic fetal monitors, Odent (1996) focused on Gisele’s knowledge of physiology and on the importance of privacy and darkness. In simple terms, a woman may feel less observed by a midwife whose attention appears to be focused on knitting …

Later, Odent (2004) returned to this topic in print and cited further research showing that repetitive tasks are an effective means of reducing tension. He has also proposed that, from the perspective of a birthing woman, the knowledge (which can be gained through the audible clicking of the needles, even if she doesn’t actually watch her midwife) that her midwife is knitting can be reassuring (Odent 2008, personal correspondence). If the midwife is knitting, then she or he cannot be too worried about what is happening. Knitting helps keep midwives’ adrenaline levels low, ensuring a sense of security all round.

These three papers cover disparate areas, but are united by several characteristics that are depressingly common in midwifery research. First, the focus is not on patients and not on outcomes, but on midwives themselves. Second, they are not quantitative, merely descriptive. Finally, their conclusions are alarming. Apparently, a substantial proportion of midwives don’t use, and don’t know how to use, clinical judgment, midwives’ confidence is not based on performance, but rather the opinions of colleagues, and there is no limit to the stupidity of certain practicing midwives.

If this is what passes for research among midwives, and if these are their conclusions, they shouldn’t be allowed to care for houseplants, let alone patients.

276 Responses to “Midwifery research: dumb and dumber”

  1. sdsures
    January 26, 2015 at 9:18 pm #

    I recently came across this gem at the Baby Center website. Snarking at “Hurt by Homebirth”.


    One quote:

    “Statistically, the chances of having a tragedy like that is the same for hospital and home. So that means that for every hurtbyhomebirth story there’s a hospital tragedy to even it out.”

    The hell there is!!!!

    To me, that’s as vile as snarking directly at the grieving parents and their dead kids.

    • Young CC Prof
      January 26, 2015 at 9:38 pm #

      The scariest thing is how many women read “hurt by homebirth” and think such things can’t possibly happen to them. Why not? They’re low-risk, right? And they interviewed midwives correctly.

      Home birth midwives lie about their qualifications, they lie about testing and risking out, they lie about their previous adverse outcomes, and they lie about backup.

  2. Cobalt
    January 23, 2015 at 10:42 am #

    OT: This measles business is creeping pretty close to my hometown, and I’m worried about my too-young-for-MMR 5 month old. I’m pretty sure I had at least one shot as a kid (my lazy-on-medical-care mother may have skipped the other and just signed the school form, who knows), and I know for certain the rest of my house is fully vaccinated.

    I am already signed up at the health department to get an MMR, since there’s no safety reason not to get one. What they don’t know is if the shot will create any resistance in the baby. I’m breastfeeding, and wondering if any vaccine-induced sparkles will transfer to him. The CDC just says breastfeeding is not contraindicated. LactMed says breastfeeding can enhance the response of the infant to certain vaccine antigens (but I don’t know what that really means). Are there any interpreted-for-laymen studies on this?

    • The Bofa on the Sofa
      January 23, 2015 at 10:47 am #

      I know they will do MMR shots at younger ages in high risk areas. Consult with your doctor about that possibility. You might need to wait until 6 mo, but that’s better.

      • Cobalt
        January 23, 2015 at 11:24 am #

        I’ve read the MMR doesn’t work as well before 12 months, but I’ll ask the pediatrician if it’ll help and get if I can. We go for other shots at 6 months anyway. I really don’t want my baby to get sick. These anti-vaxx idiots are keeping me up at night. Measles is just so contagious, I’m worried about taking the little guy out of the house.

        • The Bofa on the Sofa
          January 23, 2015 at 3:57 pm #

          OK, it “doesn’t work as well” but that’s still better than not getting it at all. And you can get a booster.

        • Sue
          January 23, 2015 at 5:01 pm #

          Here is a relevant study:


          It’s a balance between maternal antibodies waning and the baby/infant being able to sero-convert.

        • Happy Sheep
          January 24, 2015 at 10:02 pm #

          I got it for my 8 month old last year as a special consideration since we were traveling to an area with an outbreak and then to Disney Wolrd, which is as my Doctor put it “the happiest cesspool on earth”
          He had to get it redone at the regularly scheduled time as well, which IIRC was 15 months, and he will get it again around 4?
          He also strongly recommended that I not get pregnant before our trip since I am one of the sooper speshul people that seems not to get immunity from the MMR vaccine. I’ve had the shot 3 times as an adult and I had the measles as an infant, still no immunity

    • Montserrat Blanco
      January 23, 2015 at 3:29 pm #

      I would certainly get the shot for myself. You are probably going to produce some antibodies and transfer them through the milk to your infant and that is always a good thing as this might offer some protection to your baby agaisnt the infection, resulting on a less severe case in case the baby gets infected. According to the CDC the shot is safe during breastfeeding period.

      I would certainly talk to your pediatrician about the possibility of your baby getting the shots earlier. I am not aware if it is possible so early. If it is not it might be a good idea to not let him be in contact with unvaccinated people. I am the mother of a premature baby and we make sure that any visits are fully vaccinated, everybody washes their hands when we enter the house and we do not go to places with a lot of people on a closed space, that means a walk in the park is great, but a shop full of people is not. He does not go to childcare facilities either.

      • Cobalt
        January 23, 2015 at 4:24 pm #

        I’m definitely getting the shot, there’s not really a downside to it other than a sore arm. Totally worth it.

        I’m going to call the pediatrician before our 6 month checkup to see if they’ll consider an early MMR. I’d rather he get an extra shot than rely on the “cocooning” method. Too nerve-wracking. Stupid anti-vaxxers.

    • Box of Salt
      January 23, 2015 at 3:42 pm #

      The CDC recommends infants over 6 mos traveling abroad get the MMR: http://www.cdc.gov/vaccines/vpd-vac/measles/fs-parents.html
      See the bottom of the blue box to the right

      In this case, the measles are traveling to you. I know I saw a recommendation somewhere about getting infants immunized ahead of schedule, but since my kids have had both doses already I didn’t save the link and now googling is coming up with anti-vax sites instead (if I have time I’ll keep looking).

      Definitely discuss it with your pediatrician.

  3. A
    January 23, 2015 at 10:10 am #

    “The study was conducted using post structural, feminist methodology…” I’m not an expert, but… “Feminist methodology”?! How does one “use feminist methodology”?

    Loved the one about confidence too. Poor, poor, midwives. Their feelings are getting hurt by sane colleagues who question their risk-taking and number of dead patients, and there’s also all these nasty “regulations” they want to force on them! They’re so persecuted! BABIES AND MOTHERS DIE, OKAY?! That’s no big deal! It’s so mean that there are people trying to make midwives bad about killing people, when everyone knows they have a right to walk away after a patient’s death feeling great! It’s those awful comments that get them to lose their confidence!

    “In simple terms, a woman may feel less observed by a midwife whose attention appears to be focused on knitting …” Yeah! I don’t know about you, but I feel super-safe and awesome when a provider who is supposed to be looking after me and, you know, preventing my death just stands there doing something else entirely. All of healthcare should be like this! If I’m in terrible pain and go to see a doctor about it, I want him to be playing Candy Crush on his mobile phone instead of examining me. When I complain he’s not doing anything to help me, I want him to point out that it can’t be anything serious, because if I were in real danger, would he be playing Candy Crush? Of course not! Therefore, I’m safe as houses!

    • yugaya
      January 23, 2015 at 11:47 am #

      “In simple terms, a woman may feel less observed by a midwife whose attention appears to be focused on knitting…” translation: even if your idiot lay midwife is just sitting there knitting and doing nothing, you’re supposed to think that she is using her magical midwifery powers of adequate monitoring. In case she dozes off, know that she is not a reckless moron as it would appear to an average person, instead, she is using ancient Atlantean technique of making a diagnosis through interpretation of dreams and visions. If she snores, all is well, just trust birth and carry on empowering yourself until she wakes up and resumes with more obvious ways of doing her job.

  4. Mishimoo
    January 23, 2015 at 7:49 am #

    Mildly OT: My dear brother is visiting and brought Fireball whisky (cinnamon flavoured whisky) to share. I made an offhand comment about cinnamon breath, and later he came out with a gem about “Now I can save someone simply by exhaling at her vagina. Wait, what do you mean at her face? It wasn’t logical to begin with and now you’re telling me that I’m supposed to waft it at the opposite end to the problem. How does that even work?”

  5. Psychae
    January 22, 2015 at 9:38 pm #

    Now I understand why I get 3 am phone calls from our midwives to tell me ‘She looks fully, you’d better come in.’ Invariably they’re 5 cm and OP when actually examined. Now I get it though! Australian midwives use their intuition!

    • Margo woo zealand
      January 23, 2015 at 12:36 am #

      Margo WooZealand …question…why don’t the midwives do a vaginally exam prior to phoning you? Wouldn’t that make more sense.

      • Margo
        January 23, 2015 at 12:37 am #

        Margo WooZealand….oops fingers not working…I meant to type ve or vaginal exam.

        • birthbuddy
          January 23, 2015 at 12:53 am #

          NZ woo infested midwives believe that VE’s “cause” C- sections.
          I kid you not.

          • Margo
            January 23, 2015 at 2:55 am #

            Yep…I know…although I have worked in environments where the CS rate has been under review, for being way above “acceptable numbers” and I did work in one hospital where ve assessment rate fell because it was felt…rightly or wrongly that some CS were done perhaps more hastily than need be…ie slow dilatation so ve’s were avoided……not a very scientific approach to the perceived problem…and some practioners really do believe ve’s invasive and therefore to be avoided…i think careful use of ..ve’s when done in a timely manner are a useful tool….part of the overall picture.

          • EmbraceYourInnerCrone
            January 23, 2015 at 11:01 am #

            OK, not a health care worker (IT tech) but I must be missing something..How does one tell how far a woman is dialted without a VE? Also there is something else I am curious about, wouldn’t the mortality and morbidity numbers be what a hospital should be looking at to see if they are doing “too many” CS ? I mean if your hospital is doing a lot of births but very few CS but there are a high number of babies that die during delivery or are brain damaged (or otherwise damaged) wouldn’t that mean not enough CS’s are being done?
            Or conversely if a hospital is doing a lot of CS is it because they only have anesthesiologist coverage for OB part time and don’t want a difficult delivery to go to long and then not be able to do a CS?
            I feel like I am missing something. Sorry if this doesn’t make sense.

          • Cobalt
            January 23, 2015 at 11:12 am #

            You check dilation by measuring a magic purple line that appears on the mother’s butt.

          • EmbraceYourInnerCrone
            January 23, 2015 at 11:51 am #

            I must have been broken, I don’t think I had one of those when I was in labor….also bwahahhahahah!
            Thank you I need a chuckle.

          • MLE
            January 23, 2015 at 12:42 pm #

            Oh, it’s real. And in the interest of TMI, I was pretty sure my ass was going to split like the San Andreas fault at one point. If anyone had tried to assess dilation based on that line though, I would have knocked them off the Richter Scale.

          • Cobalt
            January 23, 2015 at 1:02 pm #

            Ha! I can see it:
            “Midwife, please check my dilation without actually assessing any of the parts directly involved”

            “Sure, just turn around so I can measure your magic purple crack line…you seem to be dilated to two hand widths, go ahead and push whenever you feel the need. Today, tomorrow, whenever.”

          • Samantha06
            January 23, 2015 at 1:21 pm #

            Midwife, giving report to Doctor at referring hospital:

            “She’s ready to push– classic purple butt crack present”

            Doctor: “Are you on crack???”

          • Cobalt
            January 23, 2015 at 2:16 pm #

            Because nothing says “other ways of knowing” better than repeated natal cleft exams.

          • Samantha06
            January 23, 2015 at 8:23 pm #

            Pretty much!

          • Samantha06
            January 23, 2015 at 1:12 pm #

            That is so hilarious!

      • Psychae
        January 23, 2015 at 1:18 am #

        It would, and most of them do, but we have a significant minority who believe that comes secondary to watching the woman and listening to whether she wants to push…never mind that many women will want to push at 5-6 cm if the baby is OP. The article is spot on with its description of ‘intuition’ or ‘feeling’ vs actual clinical assessment.

        • Margo
          January 23, 2015 at 2:39 am #

          Margo. Woo zealand….that must be challenging, to be called in when not necessary…our obs always expected a ve assessment, amongst other assessments,prior to coming in,not an unreasonable request…all about team work really….and trust between professionals…I always knew I could depend on the ob coming in if I called him/her, very reassuring for all concerned to be on “same page”.

  6. Trulyunbelievable2020
    January 22, 2015 at 6:15 pm #

    Another OT post from the BabyCenter UC forums (http://community.babycenter.com/post/a53384449/uc_and_rh-?cpg=2)

    The poor woman with the schizoaffective disorder is Rh- and is on the fence about a rhogam shot. Resident gingerbread house dweller Marlene Waechter weighs in with what is actually fairly reasonable advice: she tells her that there are serious risks and that she should consider getting the shot.

    Her conclusions are solid, but her reasoning is infuriating. Marlene only believes that this is a serious concern because she had a client who had had two previous unassisted births. The first one resulted in brain damage. The second one resulted in the death of her baby. It was only after the death that this dingbat actually decided that it might be a good idea to get blood drawn. She still decided to have another homebirth, but this time she hired Marlene, who thankfully decided to transfer the baby for a transfusion.

    So basically Marlene was not concerned about this issue until she actually met someone who had lost a baby. All of those other complications? They’re just Munchausen by proxy, of course, until Marlene actually sees them.

    This woman has done what? 500 or 600 births? It’s not surprising that she hasn’t seen every possible complication. And yet she completely ignores empirical evidence until a baby actually dies.

    Aleksandr Solzhenitsyn has a great passage in The Gulag Archipelago where he talks about how every man who was arrested, placed in solitary confinement, and ordered to sew an ID patch onto their uniform had to independently discover how to thread a needle, a skill that women had understood for thousands of years.

    This is how these maniacs want to practice medicine.

    • MLE
      January 22, 2015 at 6:25 pm #

      Marlene has a book called “The Joyful Mysteries of Childbirth.” Alternative title: “Anything I haven’t personally witnessed is inexplicable by default.”

    • Bugsy
      January 22, 2015 at 6:29 pm #

      The Baby Center forums in general scare the crap out of me; this issue is case-in-point.

      So sick of seeing moms post their all-natural badges in their signatures there. “anti-vax, intact, lactivist mom with platinum boobies!” Spend too much time on those forums, and you think that that crowd is the norm…

      • Trulyunbelievable2020
        January 22, 2015 at 6:31 pm #

        Baby Center is an oasis of sanity when compared to Mothering.com. Even the ladies in the natural and unmedicated forum told this woman that UC was a very bad idea.

        I’d like to try to start a forum on one of those sites for crack smoking mothers (“Support only!”). I wonder if they’d let that slide.

        • Bugsy
          January 22, 2015 at 6:37 pm #

          Eeeck. Glad I didn’t go there.

        • Bugsy
          January 22, 2015 at 6:40 pm #

          Just stepped over there for a visit. Oh, wow. Do these moms realize that what they post is publicly accessible? What a nutty crowd…

      • Comrade X
        January 24, 2015 at 1:09 pm #

        What the fuck are platinum boobies? Inquiring minds needs to know….

    • yugaya
      January 22, 2015 at 6:54 pm #

      “While USUALLY, the bloods don’t mix, this example proves that even with a UC homebirth, sometimes they do,”

      Because a UC homebirth USUALLY prevents what…everything???

      • Sue
        January 22, 2015 at 11:48 pm #

        UCing prevents INTERVENTION, of course!

        • yugaya
          January 23, 2015 at 3:34 am #

          And interventions cause COMPLICATIONS!

          It is such a happy place, the land of Ignorantia.

          • EmbraceYourInnerCrone
            January 23, 2015 at 10:45 am #

            Wait what? Thats like saying having the snowplows ready, causes it to snow a foot…How do people get through life thinking like this? What part of “we’re going to keep an eye on your baby’s heart beat with this machine, if your baby seems to not be recovering from the contractions we may want to think about getting them out sooner, here are your options, and this is what I recommend” is hard to understand??
            Full disclosure this is pretty much exactly what happened with my daughter’s birth: Late decels, meconium stained fluid when they ruptured my membranes. Asked me if they could do internal monitoring, that looked worrisome as well. Episiotomy and Vacuum. NICU team cleared her lungs. Fast foward a few minutes, pink, happy baby being held by her parents.

          • Young CC Prof
            January 23, 2015 at 1:24 pm #

            We try to adopt the opposite superstition: Preparation prevents bad things from happening. Like carrying an umbrella to make sure it doesn’t rain.

          • The Bofa on the Sofa
            January 23, 2015 at 2:37 pm #

            For me just going the hospital would most likely cause my labor to stall.

            You know, being able to deliberately stall labor in progress would be a good ability to have. If this were really true, why aren’t people exploiting it to our advantage?

            No more “race across town in labor” stories, just do whatever it takes to stall it.

      • Dr Kitty
        January 24, 2015 at 12:10 pm #

        It apparently prevents car accidents and falling over onto your belly, which are two common ways maternal and foetal circulations can mix during pregnancy, and have nothing to do with OBs and interventions.

    • manabanana
      January 23, 2015 at 11:42 am #

      “Resident gingerbread house dweller Marlene Waechter … ”

      OH THANK YOU for this apt description. THANK YOU THANK YOU.

      Perfecto ‘m’wah’ beautiful!

      That woman is quite prolific at dispensing truly frightening advice.

  7. Sue
    January 22, 2015 at 6:02 pm #

    Where I work, we have just successfully resuscitated a young person from cardiac arrest, using knowledge and skill, learned protocols, clinical reasoning and technology, and collaborative team-work.

    Doctors, nurses, porters, radiographers, social worker – all working together, with mutual respect. Not a trace of ideological phenomenology to be seen! Yay us!

    • Trulyunbelievable2020
      January 22, 2015 at 6:03 pm #

      Did one of you touch a brass surface that day? I’m pretty sure that explains how you managed to save this person’s life. It’s well established that brass has magical curative properties. I wouldn’t be so quick to credit so-called “knowledge,” “skill,” “protocols,” “clinical reasoning,” “technology,” or “team-work.”

      • MLE
        January 22, 2015 at 6:14 pm #

        Are you thinking of copper?

        • Trulyunbelievable2020
          January 22, 2015 at 6:16 pm #

          Copper? That’s witchcraft.

        • Bugsy
          January 22, 2015 at 6:31 pm #

          I figured it was colloidal silver. 🙂

      • sdsures
        January 23, 2015 at 2:54 pm #

        Rub some amethyst prayer beads?

    • Luba Petrusha
      January 22, 2015 at 8:48 pm #

      DId you extend the life line with a biro?

      • Sue
        January 22, 2015 at 11:50 pm #

        BIRO? No, silly! We used charcoal. It’s paleo.

  8. Trulyunbelievable2020
    January 22, 2015 at 5:28 pm #

    OT: I just posted this in response to a thread on the BabyCenter unassisted forum (http://community.babycenter.com/post/a54773305/my_biggest_uc_fear.?cpg=1#c2482574868) .

    I wonder how long it will stay there:


    1) “I understand that there’s a possibility of a complication, but isn’t there that possibility no matter where you go?”

    Yes, there are risks in each setting. That doesn’t mean that those
    risks are equal. If you go to the zoo, there is a risk that a tiger
    will escape and kill you. The risk is tiny, but it’s happened. If you
    go to the zoo and decide to jump into the tiger pit to pet them, there’s
    also a risk that you’ll be killed. The risk is, of course, far, far

    2) “From what I have seen, there’s an increased chance of a
    complication at a hospital because often it seems they make up
    complications and the interventions they do to fix them cause an actual
    complication. No thank you!”

    You’re confusing “complications” and “interventions.” If, for
    example, you go to the hospital and have continuous monitoring, they
    will pick up on signs of possible fetal distress and intervene. When
    they see disturbing patterns, they’re not “making it up.” Nor does it
    mean that they believe that your baby will definitely die if they don’t
    intervene. In fact, everyone will admit that in most situations
    everything would probably be ok without the intervention. All that it
    means is that they believe that the risk is substantial enough to
    justify the intervention. If you’re doing a UC, you’ll never know
    about the complication, so you won’t have an intervention.

    3) “Of course I know that the same complications could happen in a
    hospital, but these days people have the mindset that if it happens in
    the hospital you are resolved of all responsibity, there was nothing
    they could do, but if something happens at home it is automatically
    assumed that ‘this wouldn’t have happened if you’d been at the

    When babies die at the hospital, it’s almost always because there is a
    catastrophic complication that the staff is unable to treat or fails to
    treat effectively. That is to say that an intervention is necessary,
    but it is not provided, not provided in time, or not provided
    effectively. In these situations, the baby almost certainly would have
    died in an out of hospital setting as well. I don’t exclude the
    possibility that there have been deaths in hospital settings that
    wouldn’t have occurred had the baby been born at home, but that’s a
    tiny, tiny subset. On the other hand, homebirth deaths– and especially
    UC deaths–quite frequently occur in circumstances where the baby would
    have been absolutely fine in the hospital.

    4) “No, actually my biggest fear and the only thing that is really
    keeping me on the fence about UC is knowing that IF I did have a
    complication and something happened to the baby, everyone in the family
    would blame me and I would never live it down.”

    Your “biggest fear” isn’t that your baby might die, but that you might be blamed for it? I don’t even know what to say to that.

    5) Marlenecpm said: ” I could make a long list of Munchhaussen-by-proxy obstetrical (or iatrogenic) complications.”

    Munchausen by proxy refers to a situation where a caregiver
    intentionally makes the person under their care sick in order to get
    attention and sympathy. Are you seriously suggesting that medical staff
    actually want patients to suffer? Seriously?

    Finally, I just want to point out that the OP has mentioned several
    times that she suffers from a schizoaffective disorder and that she is
    not taking medication for it. No one has even raised an eyebrow. Do
    you ladies realize that a schizoaffective disorder is a very serious
    mental illness? The symptoms include hallucinations, paranoid delusions,
    and disorganized thought processes. Do you really think that a person
    who is prone to psychotic episodes is a good candidate for UC?

    (None of this should be taken as an argument that no one should ever
    have a UC. It’s a matter of weighing risks vs. benefits. If you’re a
    healthy person with a crippling fear of hospitals or a person whose
    religion forbids medical treatment, then it might very well make sense
    to accept what is still a relatively small degree of absolute risk.
    However, no one should base this decision on the mistaken view that UC
    is as safe or safer than a hospital birth or a birth with an
    experienced, knowledgable midwife. It isn’t.)

    • yugaya
      January 22, 2015 at 5:34 pm #

      That comment is providing a reality check so thorough that it ought to get you banned forever from that board. And cheering someone with that disorder into UC is downright evil.

    • MLE
      January 22, 2015 at 6:00 pm #

      OMG – “If you suspect people you know wont support your birth method or will blame you if a complication arose, just dont tell those people you are pregnant. do things your way, then tell them about the baby after it is born. And you dont have to tell them how or where you gave birth, so if there was a complication, they can assume it was at a hospital.”

    • Dr Kitty
      January 22, 2015 at 6:02 pm #

      This is the very definition of “child protection concerns”.
      Someone with a history of both affective and psychotic mental illness, not currently on medication or under treatment, planning to UC.

      This lady is at very, very high risk of a serious postnatal deterioration in her mental health. Presumably there is no midwife, GP, psychiatrist, mental health nurse or other professional aware of the situation or able to monitor it.

      This could end so, so badly.

      • MLE
        January 22, 2015 at 6:04 pm #

        It’s got to be a nightmare for those who care about her.

        • Dr Kitty
          January 23, 2015 at 4:42 am #

          But that’s the issue.
          As a part of her illness this lady may have persecutory or paranoid delusions and lack insight into the dangers she and her baby are risking.
          It is unreasonable to expect someone who is unwell in that way to make the best choices about their health.
          Her loved ones should be stepping up here, to ensure she receives appropriate psychiatric and prenatal care, or at the very least an assessment of her competency to make major medical decisions and a crisis managment plan in place should things go wrong…

          • MLE
            January 23, 2015 at 9:23 am #

            I agree, I’m just sympathizing with her family because I know how difficult it is to get someone to access healthcare when they are grown and you’re not their spouse. It’s a delicate balance between scaring them off and keeping the lines of communication open while helping them make the right choices. I feel the one who has the most influence and power to do something here is her husband, and it sounds like he’s going along with her plans. So that’s even harder when the closest person to her is allied with her.

          • Dr Kitty
            January 23, 2015 at 10:23 am #

            Which is a big red flag…
            Seriously, if you have the mentally well parent deferring to the mentally ill parent when it comes to parenting decisions, that is not seen as a positive thing by people concerned with safeguarding children.

            You can only hope that if it does go pear shaped, husband grows a pair and is prepared to be the bad guy in order to keep his baby safe and get his wife help.

          • MLE
            January 23, 2015 at 12:46 pm #

            Yes, it sounds like it sucks all around. She said none of her friends or family support her, although they respect that she has the right to make the choice. They are probably tearing their hair out. And the husband has agreed not to tell his family about her plans, so they will be blissfully unaware until the shit hits the fan.

          • Dr Kitty
            January 23, 2015 at 1:06 pm #

            I hope someone is able to get her to at least check in with a mental health professional at some point, and I really hope she is lucky with the birth and her mental health…

      • Trulyunbelievable2020
        January 22, 2015 at 6:04 pm #

        Wait, a minute… I was mistaken when I said that she’s not on medication. She does take Valerian and chamomile tea.

        And, no– I’m not making this up.

        • Elaine
          January 22, 2015 at 11:40 pm #

          I literally spluttered when I read this.

          I quit reading MDC a while ago (never did read Babycenter) and I so do not miss it. Some people are just craaaaaazy.

          Every once in a while I had a positive impact on someone (I still remember a thread in my due date club, someone getting wiggy about all the “additives” in the vit K shot, I explained what each one did, and her response boiled down to “Wow, I didn’t know that, I think I will get it after all”) but overall it’s not worth it.

      • Medwife
        January 23, 2015 at 5:51 am #

        She might be afraid of child protective services not letting her keep the baby. I have had women transfer in during attempted UCs who were pretty clearly motivated by that fear.

        • Dr Kitty
          January 23, 2015 at 8:11 am #

          In my experience the single best way of keeping your baby is doing exactly what social services and medical professionals advise you to do, co-operating fully with all management plans and basically doing what you are told, and involving them as early as possible if there is a potential problem.

          If you are obstructive, oppositional or difficult, people tend to think you are more of a risk to your children, and worry that you’re not taking on board the constructive ideas to reduce risks.

          • Medwife
            January 23, 2015 at 12:05 pm #

            My experience as well, although I can think of many cases where the mom retained custody after not doing any of the things listed in your first paragraph. The single best way to make sure you take your baby home is to live in a place with an overwhelmed foster care system.

          • Dr Kitty
            January 23, 2015 at 1:00 pm #

            Without saying too much in specifics…
            My experience is that people with mental illnesses and learning disability with be very actively supported by services throughout their pregnancies and their children’s early years, and that everyone really WANTS them to be able to retain custody.

            I can think of cases where, really, psychiatric services, GP, social services and OBGYN have bent over backwards to do absolutely everything possible to help people successfully parent their children.

            In particular I have one case in mind involving a previous infanticide where there was lots of support for subsequent pregnancies and everything worked out very well, with parents retaining custody and no issues at all.

            But you’re really, really stuck if someone presents as a possible risk to their child and themselves and resists all efforts either to clarify or reduce the risk.

            What could have been a few chats over a cup of tea and a written plan then suddenly become detained psychiatric admissions and emergency care orders.
            The law here is absolutely clear- the right of the child to safety trumps absolutely every other consideration.

            Thankfully, Irish families being what they are, it is common for grandparents or extended family to be able to foster, especially in short term placements.

          • Allie P
            January 24, 2015 at 5:41 pm #

            Meh. In my town, they are trying to take away a couple’s children because they walked home from the park. You hear a few stories like that and you start to get scared, especially if you really have something to worry about (like untreated mental illness).

        • fiftyfifty1
          January 23, 2015 at 8:12 am #

          Yes, worried about scrutiny. Afraid if they go for prenatal care, the doc or CNM will push a psychiatric consult that will recommend meds or order a child-protection visit. Then at the end they have had no prenatal care and they are worried how that will look if they just show up at the hospital in labor.

          When I was growing up, a close friend of my mother’s UCed her (many) births after the first 2. I think it was a combination of factors. She did have untreated mental illness with psychosis episodes. She was very religious and held some Quiverful-like ideas even though Quiverful wasn’t a movement (at least around here) yet. Her husband was abusive and alcoholic. The children were poorly looked after and “unschooled” at a time when homeschooling itself was rare. Her deliveries had always been easy.

          I’m sure the idea of going through the hassle of filling out the Medicaid application to do medical visits that scared her anyway was not appealing.

    • Trulyunbelievable2020
      January 22, 2015 at 10:41 pm #

      Well, I suppose that the “owner” of the board hasn’t logged in to delete this heresy. I did get an inevitable nonresponse, though: “WHY are you in this group?”

      To which I replied:

      “In order to have true ethical consent, that consent must be informed. I am entirely supportive of a woman’s right to choose to UC, but only if she actually understands what that means. You can’t have informed consent if you believe that resolving catastrophic complications forty minutes away from the closest hospital without a trained attendant present is merely a matter of “doing your research” and figuring out how to resolve these complications. That’s what the OP seems to believe, and everyone is encouraging her in that belief.

      You are not going to find a web site that tells you how to deal with a
      significant hemorrhage at home. You are not going to find a web site that will train you to effectively provide resuscitation for a baby that won’t start breathing even after you rub him, talk to him, or give him a few rescue breaths. These are things that doctors and trained midwives are equipped to handle. If you want to acknowledge and accept the risks of birthing without a qualified assistant, that’s fine. I support your right to do that. But don’t pretend that all risks are inherently equal. Don’t pretend that internet research is going to show you how to effectively respond to true emergencies without training, practice, and equipment. And don’t pretend that these things only happen because of medical interventions. That’s not true.

      The OP has said on several ocassions that she has been diagnosed with a schizoaffective disorder and that she is not taking medication for it, and yet not a single person has acknowledged this. You ladies are acting like she said that she has freckles or that her eyes are blue. She has a serious condition that makes her a terrible candidate for UC, especially when she’s moving to a country that has a robust midwife support system. I am under no obligation to support her decision to make an uninformed, foolish decision.”

      I then added:

      “‘A person with schizoaffective disorder has severe changes in mood and some of the psychotic symptoms of schizophrenia, such as hallucinations, delusions, and disorganized thinking. Psychotic symptoms in schizoaffective disorder occur even when mood symptoms are no longer present, and reflect the person’s inability to tell what is real from what is imagined.'”

      Seriously: what part of “inability to tell what is real from what is
      imagined” do you think goes well with ‘planning a safe delivery of a

      • Samantha06
        January 22, 2015 at 11:46 pm #

        Daaammnn…I wonder how many of them were slack-jawed after reading that? I’m so glad you wrote that.. even if it only gets through to one person, it might save a life…

        • sdsures
          January 23, 2015 at 2:56 pm #

          So many words with too many syllables. How will they cope?

      • T.
        January 23, 2015 at 3:18 am #

        Even if it will be deleted at least somebody will have read it!
        Good job!

    • Sue
      January 22, 2015 at 11:52 pm #

      Went there, found this:

      “actually my biggest fear and the only thing that is really keeping me on the fence about UC is knowing that IF I did have a complication and something happened to the baby, everyone in the family would blame me and I would never live it down.”

      Her biggest fear is not the baby dying, but being blamed for it. Ugh.

      • Young CC Prof
        January 23, 2015 at 1:38 am #

        If you believe (or have convinced yourself to pretend to believe) that complications are random things like lightning strikes that generally can’t be predicted or treated, then it makes sense. After all, the outcome will be the same in both places, right?

      • yentavegan
        January 23, 2015 at 12:58 pm #

        Can we all be in agreement…Women who desire UC’s are mentally ill and they deserve treatment and their unrealistic grasp of reality ought not be indulged.

      • PrudentPlanner
        January 26, 2015 at 3:31 pm #

        I read that as: Baby could die [and] I would be blamed.

        A similar sentiment helped push me from a home birth CNM to an OB/CNM practice at 36weeks pregnant.

        For me it was a bit more “if something terrible happened at home, could I ever forgive myself?”

  9. AdelaideGP
    January 22, 2015 at 5:01 pm #

    Well it usually takes some post graduate study to know how to design and execute/ write up valid research papers. We all know how much these “midwives” have aversions to any real education. Who on earth is publishing this “research” though?

  10. Life Tip
    January 22, 2015 at 3:51 pm #

    When I’m bleeding to death after giving birth, my number one priority is having someone present to calmly observe the situation. I’d hate for anyone to panic or express concern. God forbid the midwife feel worried! I will happily pay someone to maintain the ever important sense of security while I die a totally preventable death.


    • Amy M
      January 22, 2015 at 3:55 pm #

      Well, I had a PPH, and there was one nurse, among the small horde of people who rushed into the room to save me, who seemed to be doing nothing other than holding my hand. She happened to be a nurse I recognized and liked from my month-long hospital bedrest stint, and I remember just focusing on her face. I am ever grateful for her presence and to this day (6yrs tomorrow!) I wish I had been able to thank her directly. But of course, there were all those other people actually stopping the bleeding so I didn’t die, so it was ok for one to be the calmer. And she was trying to keep me calm/conscious, not herself.

      • Sue
        January 22, 2015 at 6:04 pm #

        That caring role is really important – I often take it on myself – but it certainly doesn’t REPLACE the competent clinical care.

        • Cobalt
          January 23, 2015 at 9:42 am #

          That’s where a good doula’s work is- being there to support the person while the medical team does the medical management. In an easy birth it might be an unnecessary function, but when bad things happen it can make a huge psychological and emotional difference to the patient to have someone there for that. The medical team needs to be unemotional and very efficient in a crisis, it improves outcomes (first priority!), but can be completely overwhelming to the patient.

          Having a good doula (even if it’s a stranger) to support moms in crisis might reduce the homebirth rate by helping reduce the perception of “hospital induced trauma”.

          • Samantha06
            January 23, 2015 at 10:30 am #

            I like working with good doulas. They are very helpful and make my job a lot easier! Even in a standard birth, they are great. In a crisis they are valuable as well. It’s the ones who work outside their scope I have major problems with. Those doulas pit patients against healthcare workers, and sometimes their attitudes mirror home birth midwives.

          • JJ
            January 23, 2015 at 11:21 am #

            I have a family member who just became a doula and thinks epidurals should be banned and formula is evil. It probably helps that she has never been in labor or tried to breastfeed.

          • Samantha06
            January 23, 2015 at 1:09 pm #

            That pisses me off to the point of wanted to scream!! It would be tempting to have a nice, subtle discussion about what is NOT in her scope (influencing her clients’ medical decisions). Maybe ask her what would happen if a patient made a bad decision because of HER influence, especially since she has NO medical education… Grrrrrr!!!!!! It will also be interesting to see what happens when SHE has a baby!

        • Amazed
          January 23, 2015 at 10:28 am #

          “While they attempted to deliver his body they got out their 1 oxygen
          mask and passed it between me and Shridam. It was done so poorly because
          there were only TWO people there, they had to try to deliver and do
          oxygen and it just WASN”T ENOUGH. One of midwifes, M, was crying and in
          near hysterics, she kept kissing me and saying they loved me, they loved
          this baby. I appreciate that she was scared for us but I feel like her
          lost cool affected her ability to do her best on the delivery.”

          That happened at Shridam’s birth. https://midwife101.wordpress.com/tag/home-birth-midwife/

          And almost made me want to vomit. I’m reminded of the Hungarian OB/homebirth midwife who, I can swear, was at one point IN BED with her labouring patient hugging her.

          Disgusting. The fact that Shridam didn’t make it makes it all even more so. Get out of my personal space, you crazy bitch. I don’t want you to love me, I want you to save my baby which was the fucking point of hiring you in the first place.

          • yugaya
            January 23, 2015 at 12:01 pm #

            Well she was nowhere intentionally when a mother bleeding almost to death with a dead baby dangling out of her was picked up by the ambulance in one of the cases she was tried for – her claim was that the birth happened in her birth center “by accident” and that she was just, you know, passing by or something.

            The sad part is that while she was a practicing OB she was according to her former colleagues one of the best in the country, and that she made very important changes for better in maternal care in Hungary. Nowadays she is merely more proof that babies die from preventable deaths during OOH birth even when the “midwife” is a fully trained and licensed OB.

    • Mel
      January 22, 2015 at 3:37 pm #

      Nope. Nope. Nope. Nope. NOPE.

      No freaking way.

      I will not lift a baby – or an organ for that matter- out of my own body. Ever.

      • Amy M
        January 22, 2015 at 3:50 pm #

        Dang, that’s sad. The article is a bit confusing too, the timeline is kind of all over the place and there seems to be information missing. I hope that if this truly was a giant hospital screw-up, that they learn from the mistake and put measures in place to ensure it isn’t repeated.

      • Ash
        January 23, 2015 at 1:30 am #

        Very sad. I hope the hospital system improves its communications and call system so this doesn’t occur again.

      • toni
        January 23, 2015 at 9:44 am #

        This happened to my friends in st albans. The midwife not showing up I mean.. their baby was fine thank God. but my friend had to deliver his own daughter! They called the hospital repeatedly to chase her up and they kept saying she was on her way…for three hours. They can laugh about it now but sheesh

    • Dr Kitty
      January 22, 2015 at 3:50 pm #

      Those are big babies!

  11. Young CC Prof
    January 22, 2015 at 1:32 pm #

    A study of confidence? Among practicing professionals, not brand-new ones?

    Speaking as a professional, you know what makes me confident? Experience, practice, and lots of double-checking. In some ways, I get more laid-back as the years go by. I know how to teach what I teach, I don’t have to psych myself up before lectures. But when it matters (like students’ final grades, or typos on departmental exams that will go out to thousands of students) I’ve gotten MORE intense rather than less.

  12. Amy Tuteur, MD
    January 22, 2015 at 1:32 pm #

    It seems to me that what these papers have in common is metaphysical solipsism, which Wikipedia describes as:

    “the philosophical idea that only one’s own mind is sure to exist. As an epistemological position, solipsism holds that knowledge of anything outside one’s own mind is unsure; the external world and other minds cannot be known and might not exist outside the mind. As a metaphysical position, solipsism goes further to the conclusion that the world and other minds do not exist.”

    The only thing that matters to these midwives is what they think and feel. They behave as if mothers and babies don’t have an independent existence. Their only purpose is as props for the midwife’s self-image. There is no objectivity, only the midwife’s subjective experience. To the extent that mothers and babies don’t follow the midwife’s plan to glorify herself or be lauded by her friends, by having a serious complication or dying, it’s always the patient’s fault or “meant to happen.” It is never the midwife’s responsibilty since her only responsibility is to feel good about herself.

    • Young CC Prof
      January 22, 2015 at 1:35 pm #

      YES. That’s the issue with these papers. Insight into a medical professional’s mind might be useful. I’ve read some very interesting papers on why medical professionals make mistakes and how they might be prevented. These studies, however aren’t trying to connect midwives’ feelings or mental processes to their performance.

      • Amy Tuteur, MD
        January 22, 2015 at 1:38 pm #

        That’s because their objective performance doesn’t matter to them. The only thing that matters is their feelings of self-worth.

      • Amy M
        January 22, 2015 at 1:39 pm #

        Sure. If they were using this kind of study to determine practices (why, that would be evidence based now, wouldn’t it?) that could be useful. A totally ridiculous example, but just to make the point: if the study showed that midwives lost confidence and were more likely to make mistakes if the patient wore red, then the midwives might provide non-red colored johnnies for the laboring women to wear, to eliminate that variable. Or even the midwives using “intuition”—all well and good as long as they follow it up with actual and appropriate medical practice.

        • Young CC Prof
          January 23, 2015 at 1:41 am #

          Even if they were just studying the effect of various conditions on the midwives, that might make sense. Healthcare workers deal with various occupational hazards, and an article about, say, mental health or burnout among midwives might be a useful thing to write. But the article didn’t even seem to be saying anything like that.

          • Amy M
            January 23, 2015 at 9:58 am #

            Oh I know, I was trying to say what you just said in the above comment. Not well, evidently. 🙂

      • attitude devant
        January 22, 2015 at 2:20 pm #

        So, by contrast, actual medical/nursing professionals are empiricists. We gather data and draw conclusions based on knowledge arrived by prior observations (our own and others). How we FEEL doesn’t enter into it.

        • yugaya
          January 22, 2015 at 3:38 pm #

          Well, I do prefer to ask doctors and other health care professionals for their medical opinions, not their inner thoughts. Not that I do not care about people’ feelings, it’s just that in that situation and with me as a patient how they FEEL is objectively completely irrelevant for the questions I am asking.

          • Amazed
            January 22, 2015 at 3:58 pm #

            That’s because you think you’re the person who matters. Poor yugaya, let go of your pride and realize that it’s all about the midwife and homebirth in general. You don’t matter nearly as much and if you happen to suffer an unfortunate birth outcome (been here long enough to know what they mean by this definition?), well, you made The Choice and should own your outcome. With time, your widower will find great comfort in that, I’m sure.

          • yugaya
            January 22, 2015 at 4:20 pm #

            What can I say, I’m spoiled rotten. It’s all about ME ME ME and MY BABY, so I’ll make my choices based on professional opinions of qualified and licensed people who are not practicing ‘alegally’ or illegally due to lack of regulation in a fringe branch of the pseudomedicinal quack industry.

    • sdsures
      January 22, 2015 at 3:26 pm #

      Interesting progression or connection! NCBers are focused (originally) on the mother’s own experience of the birthing process (result: unimportant), and now we can link that to adding the midwives’ need for having a similar “positive experience” of any given birth (again, result unimportant). They’ll be so pleased to be able to have another category in which they can one-up each other.

  13. January 22, 2015 at 1:23 pm #

    KNITTING. FOR FUCK’S SAKE. Here’s a wild and crazy idea… how about the person responsible for my life and my baby’s life do their job, even if it stresses them out, and I’ll have a family member knit quietly for ambience?

    • MLE
      January 22, 2015 at 1:55 pm #

      Looking forward to future studies on midwife background activities such as watching the game while eating chips, one-woman rounds of pickup sticks, and pencil chewing while pondering the daily jumble.

      • yugaya
        January 22, 2015 at 5:50 pm #

        “Advantages of crowdsourcing care options in real time”

        • MLE
          January 22, 2015 at 9:20 pm #

          Crowd sourcing is more of an active avoidance of responsibility vs the passivity of doing something entirely unrelated while ignoring the patient.

    • Roadstergal
      January 22, 2015 at 2:48 pm #

      My favorite part is the bit where she says that knitting reassures the woman that the midwife doesn’t see anything to be worried about.

      And by ‘favorite,’ I mean ‘you must be fucking kidding me on at least two levels.’

      • sdsures
        January 22, 2015 at 3:33 pm #

        “And by ‘favorite,’ I mean ‘you must be fucking kidding me on at least two levels.'”

        Multiplied exponentially.

    • sdsures
      January 22, 2015 at 3:30 pm #

      Ooh, maybe I should start advertising myself as a “Birth Knitter” – you know, offer to attend homebirths and knit quietly in the corner, so the midwife can focus on…ummm…lighting the incense candles. Yeah! 😉

      • Cobalt
        January 22, 2015 at 5:20 pm #

        And here I am over here working for a living.

        • Amazed
          January 22, 2015 at 5:27 pm #

          Thinking along the same lines! I suppose I could learn knitting – but if it turns out that it isn’t my cup of tea, I’ll just hold the labouring mother in the sacred space of silence.

          • KarenJJ
            January 22, 2015 at 9:30 pm #

            Would playing Plants vs Zombies work? Because I can’t knit…

          • Amazed
            January 23, 2015 at 7:26 am #

            If you include in in the client’s birth plan… Why not?

      • demodocus' spouse
        January 22, 2015 at 5:54 pm #

        Now that’s a job I’d be good at! Just watch your lace around the candles

    • yugaya
      January 22, 2015 at 5:21 pm #

      There was also like a real thesis or a paper on how midwives use poetry to show and evaluate their “other ways of knowing”. I kid you not.

    • Medwife
      January 23, 2015 at 12:19 pm #

      I’ll bet you could find the sound of knitting on a white noise app, for like $0.99.

  14. January 22, 2015 at 1:18 pm #

    I’ve wandered over here today – almost 19 years after the hospital birth of my only child.

    According to all my knitting, hippie, alterna-medicine, acupunturist, yoga-class taking, herbal tea-drinking midwife friends I failed. The only way in which my birth was natural was that I (narrowly) avoided a c-section.
    I tried meditating, avoiding all medicines, walking to induce labor, I was a healthy weight when I got pregnant, I had been vegetarian before pregnancy, I took my vitamins. But none of this prevented slowly developing pre-eclampsia and a post-term pregnancy in which labor just wouldn’t start. At nearly 42 weeks I finally had an emergency induction, with my blood pressure spiking up to 170/100 at times (it had always been low before). Fetal distress, late decels, hemorrhaging after he was born, and 3 days on mag sulfate.

    No one had any respect for me. They all thought I had done something wrong. I didn’t talk about my birth to anyone for years. I was ashamed; ashamed of failing, ashamed of my epidural, ashamed of my prolonged recovery time.

    My friends have over the years proudly posted details every time they achieve some natural homebirth “achievement” and everyone rushes to pat them on the back. This has become the litmus test for caring about yourself as a woman and being a feminist, apparently.
    I’ve come to drift away from the feminist movement in part because of this. How can I belong when I can’t do anything but grit my teeth through one more glowing description of one of my friends screaming in a bathtub while her midwife rubbed her back and hear it described as empowering? What am I going to say? “I took a nap after I got my epidural, it was awesome” and have them sneer at me?
    I’ve said it before but I’ll say it again – thank you for your website, it’s a breath of sanity in an insane world.

    • Young CC Prof
      January 22, 2015 at 1:24 pm #

      I am sorry you were shamed for using appropriate and necessary medical care! It makes me furious the way the feminist mantle has been stolen by the natural childbirth crew, who aren’t feminists at all but biological essentialists.

    • January 22, 2015 at 1:25 pm #

      You will find many women here who have been in similar shoes. Myself included. We really need t shirts or a secret handshake or something. I’m sorry you’ve had to feel the awful rejection and judgements these crunchy b*tches excel at.

    • Maria
      January 22, 2015 at 1:42 pm #

      Your method of giving birth doesn’t define whether or not you are a feminist and any “feminist” who tries to say so is full of it. I am a feminist. Have been since I knew what feminism was. I had a glorious epidural and got to nap while my body did the work of labor. It was awesome, but it was also just a few hours out of my life. How could that possibly be a defining thing? Becoming a Mom? Now that has been life changing and defining! Don’t let these women hijack something that is important to you!

    • moto_librarian
      January 22, 2015 at 1:48 pm #

      I had one of those “natural” births. And it was so fucking awful that we almost didn’t have a second child because of it. I have never felt more disempowered in my life than while writhing in pain while pushing. If I hadn’t delivered in a hospital, I would have bled to death from a cervical laceration that resulted in a pph.

      I do tell people how lovely my second birth was. An epidural so strong that I couldn’t feel my toes yet had no problem feeling the urge to push. It was wonderful. Having choices is what’s empowering.

      • Samantha06
        January 22, 2015 at 3:22 pm #

        Yes, and I feel the NCB movement has effectively obliterated choice for women with their obsession with medication-free births. There is something terribly, terribly wrong when a laboring mother is in such excruciating pain, her eyes roll back in her head and she writhes around in the bed like a trapped animal yet refuses pain relief because the NCB movement tells her she “should.”

        • nomofear
          January 22, 2015 at 5:53 pm #

          Yes, I was SO relieved to find the adequate mother’s epidural essays linked here. All the NCB stuff I’d gotten deluded by told me that epidurals hurt babies, so I suffered through my first in a freestanding birth center. And pushed for nearly three hours…I was so out of my mind from pain that I couldn’t process that if I just actually worked to push, it would all be over. I actually actively ignored contractions. When I got pregnant with my second, despite that horrible experience (and questionable all-around care), I was still in that mindset, until I found this site. I read and read and read, and read all the comments, and learned so much ACTUAL SCIENCE! I love all of you folks, and it’s not just pregnancy hormones talking. This time, I’ll gladly take every “intervention” that modern science offers. And if they so much as mention that a C-section might, possibly, be better for some reason? Sign me up! I feel so wonderful and free. What a sea change. It’s like being awoken to the real, free world, after being caught in a cult. Oh wait. It is that. 🙂

          • Samantha06
            January 22, 2015 at 7:10 pm #

            Congratulations on your impending arrival! I am so sorry you had such a bad time with your first. It’s just so unnecessary. Epidurals are so different now. They are effective, yet moms can move their legs and some can even walk to the bathroom! Although most moms feel so much relief they just take a nap until it’s time to push. So happy for you and keep us posted! 🙂

    • rational adult
      January 22, 2015 at 1:49 pm #

      I too took a restorative, feminist nap after I got my epidural. Not a dang thing wrong with that. For me it goes back to that hallowed right to choose what is right for my body. As for the other “interventions” you describe, true friends will be glad that you and your medical team did what was necessary for you and your child to enjoy these past 19 years of life together. Now that is worth celebrating!

    • just me
      January 22, 2015 at 2:48 pm #

      This is crazy. You had a healthy baby. You survived. The end. Success!!!!

    • Lauren
      January 22, 2015 at 3:32 pm #

      I’m so sad that your ‘friends’ have acted…well, crappy.
      I’ve had friends like that – and I dropped them. I talked to them openly about how their views about NCB, Kombucha, ‘organic’ and all other sorts of woo didn’t sit well with me, but that they were of course free to make those choices and live whatever way they felt was best for them – just please stop pushing it on me and criticizing every aspect of my life that didn’t fall in line with their beliefs. Some respected that, many didn’t. So I told them we couldn’t be ‘friends’ anymore.

      I really hope you find more support that you so totally deserve both from this site, and from new friends.

      • Samantha06
        January 22, 2015 at 3:50 pm #

        It’s similar to religious fanaticism when “friends” try to push their religious views and criticize someone’s choices because they differ from their own. And really, in any aspect of life. It’s just plain judgemental and who needs so-called “friends” like that? Life is too short.

        • just me
          January 22, 2015 at 4:59 pm #

          I think this is worse. These aren’t lifestyle choices, these are medical decisions made to save lives.

    • yugaya
      January 22, 2015 at 6:04 pm #

      “No one had any respect for me. They all thought I had done something
      wrong. I didn’t talk about my birth to anyone for years. I was ashamed;
      ashamed of failing, ashamed of my epidural, ashamed of my prolonged
      recovery time.”

      Thank you for being here, you and other brave women like yourself breaking out of the circle of natural childbirth shame. There is a mom out there fighting that same battle against that same silencing right now, this is her page: https://www.facebook.com/homebirthlossandtraumasupport

    • Francesca Violi
      January 23, 2015 at 9:14 am #

      I’m really sorry for your experience, but there is something I would like to say about feminism and NCB. I consider myself feminist, and it strikes me as deeply not-feminist to value a woman according to the performance of her uterus and vagina. Feminism is about freedom of choice for women, and not being nailed by just another stereotype on motherhood. This whole warrior-mother rethoric is ludicrous, really… can you imagine a website where adult males proudly, seriously celebrate their inseminator-warriors successes?

      • StThomas
        January 23, 2015 at 9:43 am #

        You don’t have to imagine it; try this “Men’s Rights” site, if you like a different flavour of ludicrous. A rich source of unintentional comedy. Trigger warning: misogyny


        • EmbraceYourInnerCrone
          January 23, 2015 at 10:34 am #

          Or if you want to get an idea of what AVFM is about and some awesome snark on them try http://wehuntedthemammoth.com (the new misogyny tracked and mocked)

        • Francesca Violi
          January 23, 2015 at 10:59 am #

          Ugh… There are more things on heaven and hearth… But these AVFM don’t focus especially on reproduction practices and performance, though, do they?

          • StThomas
            January 23, 2015 at 4:38 pm #

            No, though I think they would if they persuaded anyone to reproduce with them.

      • Allie P
        January 24, 2015 at 5:49 pm #

        I’m a feminist and I would never dream of a natural childbirth. That anti-scientific foolishness has no place among any feminist I know, so I’m not sure who you are hanging out with.

    • birthbuddy
      January 24, 2015 at 6:51 pm #

      I hope you have other real friends apart from these losers.

  15. Bugsy
    January 22, 2015 at 1:16 pm #

    “Later, Odent (2004) returned to this topic in print and cited further research showing that repetitive tasks are an effective means of reducing tension. ”

    Errm, doesn’t it depend on _what_ type of repetitive tasks? A midwife knitting during labour wouldn’t have relaxed me, but my OB & nurses repeatedly checking my son’s fetal stats and my dilation certainly did put my mind at ease.

    I’m also pretty sure that my biting my nails during work meetings didn’t reduce the tension of any of my coworkers…

    • LovleAnjel
      January 22, 2015 at 1:18 pm #

      Just because it reduces tension doesn’t mean it’s appropriate! And, only the person performing the repetitive task is helped. So the midwives are relaxing, not the parents. It’s all about the midwives’ comfort.

      • Bugsy
        January 22, 2015 at 1:21 pm #

        Well, that sounds just delightful!…maybe I should sign up to be a midwife. After all, I’m a mom who had an uncomplicated vaginal delivery. That experience alone certainly qualifies me to assist at all other births, I’m pretty sure!

      • January 23, 2015 at 1:28 am #

        Yes, if the laboring woman is the one knitting, then I’d agree that knitting might be a relaxant…

  16. GiddyUpGo123
    January 22, 2015 at 1:08 pm #

    I knit while I’m watching TV. Sometimes when I’m counting stitches or
    following a particularly complicated pattern, I have to mute the TV while I work through it. Also, I often have to rewind scenes because I was too focused on my knitting to follow what was going on.

    Maybe I’m just not a very competent knitter, but imagine if that TV was a laboring woman.

    • OBPI Mama
      January 22, 2015 at 1:39 pm #

      Same here! I tend to tune out a lot when I’m concentrated on my crochet work.

      • GiddyUpGo123
        January 22, 2015 at 1:46 pm #

        Also, if it’s Sherlock or Game of Thrones, I have to put my knitting down so I can give the show the attention it deserves.

    • Elaine
      January 22, 2015 at 11:46 pm #

      “I’m pushing!” “Ah, shoot, hang on. I’m trying to pick up stitches.”

  17. GiddyUpGo123
    January 22, 2015 at 1:03 pm #

    You know, when I am on an airplane and we hit some really crazy turbulence, I look over at the flight attendants for reassurance. Because they fly every day, and if they look worried then I think that’s a pretty good indication that something is wrong.

    If, however, the flight attendants were all knitting and I was really hoping to get a ginger ale, I think I’d be annoyed at them for not doing their jobs.

    So, knitting is evidently midwifish for “everything is fine.” Personally, I would like to have a provider who uses actual words to say, “everything is fine,” but that’s just me.

    I think being a midwife might be the only job in the world where you actually get paid to not do anything. Imagine hiring a security guard who sits in the corner and knits instead of actually checking to make sure his workplace is secure.

    No wonder so many unqualified people want to be CPMs.

    • Bugsy
      January 22, 2015 at 1:20 pm #

      …and I’d argue that in many cases, CPMs can give the superficial appearance of looking skilled without actually having any skills/education/decent training to back it up. Similar to my toxicophobe friend, who runs a constant diatribe against all evil toxins in the world without actually being educated in …well…pretty much anything.

      • yugaya
        January 22, 2015 at 6:23 pm #

        CPMs are skilled at faking skills.

      • The Bofa on the Sofa
        January 22, 2015 at 8:28 pm #

        How can you tell the difference between “confident reassurance” and “oblivious to what’s going on”?

    • JJ
      January 22, 2015 at 3:38 pm #

      CPMs should at least stop knitting to ask if I am ‘trusting birth” though. My trust needs to be monitored frequently to prevent a bad experience.

  18. moto_librarian
    January 22, 2015 at 12:44 pm #

    If you are not employing clinical assessments and are relying on intuition when treating a patient, you have no business being a healthcare provider. I am appalled by the nonchalance of these “midwives.” Intuition is NOT EVIDENCE-BASED CARE!!! This is insane.

    • attitude devant
      January 22, 2015 at 12:52 pm #

      I know, right? Sometimes I am working with a mom, and it’s so easy to get caught up in all the emotion in the room, all the expectations, and hopes. (expectations of an easy birth, hopes to avoid c/s) and I always remind myself that I am being paid for my ability to critically assess what’s happening. How’s the FHR pattern? I can see the scalp, but what station is the skull at? Is there progress? and so forth. Encouragement is all very well and good, but sometimes a dose of reality has to be injected, as in, “You’ve been pushing really hard for three hours and, although we can see the scalp, the skull is actually only at 1+ station, so this is distinctly off the curve for a normal pattern. What’s more, my assessment is that this child is about 9 lbs (although I may be wrong). Now, the heart rate pattern is reassuring, so I have no problem with your continuing to push, but I do have a concern about this prolonged second stage.”

      • Samantha06
        January 22, 2015 at 1:16 pm #

        I totally hear you. I was in this exact situation recently. The patient was actually pushing caput, and had to be sectioned.

    • January 23, 2015 at 1:30 am #

      I’m not sure they know the difference between “intuition” and “evidence-based care”.

      • moto_librarian
        January 23, 2015 at 12:51 pm #

        Regrettably, you are almost certainly correct.

  19. Anonymous
    January 22, 2015 at 12:33 pm #

    “The study was conducted using post structural, feminist methodology…”

    That line is pretty much the only one that you need to read to realize the entire study is crap.

  20. Amy M
    January 22, 2015 at 12:25 pm #

    Are the midwives in these papers CPMs? Or are they actual midwives in Europe or Canada or Australia?

    • Roadstergal
      January 22, 2015 at 2:52 pm #

      The first paper is Australia, the second is the UK.

  21. Siri
    January 22, 2015 at 12:23 pm #

    Sara Wickham was one of my lecturers during my Midwifery degree course 1997-2001; at one point, she and a colleague selected a small number of students to accompany them on a visit to Ina May on The Farm. I was not one of the Chosen. In retrospect, I can see why (!). Later, Sara was reprimanded for telling us that a post-partum haemorrhage (she used the example of finding a newly delivered woman collapsed in a bathroom) could be managed by putting the baby to the breast. I also recollect her talking about managing pre-eclampsia with roast turkey (= protein, cf Brewer). I was never one of her favoured students, and I always had a feeling that she was full of bovine excrement…I am not proud of my connection with this woman.

    • Ash
      January 22, 2015 at 12:27 pm #

      OMG. Collapsed postpartum woman=call emergency services!

      • Siri
        January 22, 2015 at 12:30 pm #

        This was a hospital scenario, so emergency help would be available straightaway. 2 wide-bore cannulas, fluids, drugs, the whole kit & caboodle.

    • Dr Kitty
      January 22, 2015 at 12:33 pm #

      Was this “putting the baby to the breast while pushing the big red panic button and waiting for the oxytocin/cytotec, IV fluids and blood products to arrive” or was this “putting the baby to the breast…job done”.
      Because I can kind of see sense in the first approach, none in the second.
      But clearly- Wickham is a woonatic.

      • Siri
        January 22, 2015 at 12:36 pm #

        It was a case of ‘natural is best’, as in let’s begin with a nice bit of breastfeeding and see how we go. She is steeped in woo; a fine example is her theory that anti-D may be best avoided if you happen to be Rh-…

        • moto_librarian
          January 22, 2015 at 12:41 pm #

          Before Christmas, a baby died whose parents were delivering at the Farm. She was transferred for failure to progress, and the baby was stillborn. I can’t get any additional details. I contacted the county newspaper and was basically told to eff off. I’ll bet that things are played quite fast and loose out there.

          • OBPI Mama
            January 22, 2015 at 1:41 pm #

            They are… and that place is very… cultish. Very. I went to a midwife’s assistant course there 10 years ago.

        • Dr Kitty
          January 22, 2015 at 3:41 pm #

          And they allow her to lecture and propound that view to students?

          Not good.
          Not good at all.

        • January 23, 2015 at 1:32 am #

          Of course anti-D can be avoided if the mother is Rh neg! Rh neg women should never become pregnant by Rh pos men, and that solves the problem “without interventions”!

      • Samantha06
        January 22, 2015 at 1:04 pm #


        I love it!!!!

    • Sarah
      January 22, 2015 at 12:54 pm #

      Of course she needed reprimanding, she never mentioned cinnamon.

  22. Amy
    January 22, 2015 at 12:16 pm #

    Knitting? Well that’s pretty horrifying. Good to know that my excellent knitting skills make me a better birth attendant than a non-knitter who’s actually been to med school. Not enough brain bleach in the world. That rivals Ina May’s inappropriately sexual comments about her patients.

    • Amy M
      January 22, 2015 at 12:20 pm #

      Well, the noise of the clicking needles was mentioned as key, so really all that needs doing is a recording of that noise, and play it on loop while a woman labors. If there’s anything to it, it should have the same effect right? (yes, I’m being facetious here) I wonder if there are other noises that are on par with that one, maybe a dog with long nails walking on a hardwood floor? Freezing rain falling on a glass window? And what if the midwife crochets? That’s a much quieter activity due to only one needle….

      • Dr Kitty
        January 22, 2015 at 12:36 pm #

        Maybe running a few ASMR Youtube videos during labour would be a good replacement for a knitting midwife-whispering, finger tapping, mouth noises etc.

      • demodocus' spouse
        January 22, 2015 at 12:44 pm #

        But I’m deaf! I can barely hear *my* needles clicking. I’m doomed!!

        • Amy M
          January 22, 2015 at 1:24 pm #

          Well maybe in your case, just turn up the bass really loud and play hip hop music? You’d be able to feel the vibrations, no? I mean, so would all your neighbors, but they would all be relaxed too!

      • Mariana Baca
        January 22, 2015 at 3:43 pm #

        Can’t they just get a metronome?

    • Samantha06
      January 22, 2015 at 12:27 pm #

      Not mention her fondling of them during labor… what a sick woman..

      • Wowed
        January 22, 2015 at 12:38 pm #

        Oh my gosh! I ha e to read about that. Send me in the direction needed to read about her practices.

        • The Bofa on the Sofa
          January 22, 2015 at 12:40 pm #

          Look in the Erotica section of the book store…
          (but seriously, it reads like low-grade erotica)

          • Samantha06
            January 22, 2015 at 12:41 pm #

            Yes, for sure!

          • attitude devant
            January 22, 2015 at 1:00 pm #

            With the explosion of free porn fanfic, low-grade seems to be the only kind around any more. (Fifty Shades, I’m looking at YOU)

          • The Bofa on the Sofa
            January 22, 2015 at 1:01 pm #

            I was thinking, “the type of stuff we used to right in junior high” but, pretty much the same idea, yeah.

          • Samantha06
            January 22, 2015 at 2:17 pm #

            I started reading that book about 2 years ago. I read about 100 pages and threw it in the trash.

          • yugaya
            January 22, 2015 at 6:29 pm #

            My soon to be ex-husband bought it when it came out in local language and suggested I read it because ” everyone is talking about it and you read books all the time anyway”.

            I should have red flagged the fact that the marriage was beyond repair right there and then. 😀

          • Samantha06
            January 22, 2015 at 8:20 pm #

            Maybe he was hinting he wanted to try some of the “antics” in that book!

          • The Bofa on the Sofa
            January 22, 2015 at 8:47 pm #

            Now I’m tempted…

          • Samantha06
            January 22, 2015 at 8:57 pm #

            The thing is, if it didn’t read like cheap, trashy porn it might be somewhat appealing.. not my thing though..

          • The Bofa on the Sofa
            January 22, 2015 at 9:31 pm #

            I, on the other hand…

            Actually, reading above that it started out as Twilight fan fic is a good sign it’s not MY thing. You are saying this stuff is poorly written, I’m like, in comparison to Twilight? Jeezus

            Admittedly, I only read the first of Twilight, but for pete’s sake, I’ve never had a book where I so rooted for the “protagonist” to get killed. I was like, come on, someone PLEASE put her out of my misery!

          • Guesteleh
            January 22, 2015 at 11:33 pm #

            I read it when it was free fanfic online and I found it entertaining.** It’s not worse than Twilight. Nothing is worse than Twilight.

            **Would I pay to read it/watch the film? No. Not even for Jaime Dornan.

          • Samantha06
            January 22, 2015 at 11:41 pm #

            What is Twilight fan fic? I must live a boring life, because I have no idea what that is! lol!

          • yugaya
            January 23, 2015 at 3:27 am #

            Yeah probably. There are far more inspirational detailed pages depicting the same subject in books written by quality authors, but since he didn’t read books he had no idea. 🙂

          • Roadstergal
            January 22, 2015 at 2:55 pm #

            I have definitely read slash fanfic that is a more enjoyable and stimulating read than 50 Shades. (Which makes sense, considering that it started life as shitty Twilight fanfic.)

          • MaineJen
            January 22, 2015 at 4:27 pm #

            I read (or…started to read) the excerpt available on the Amazon page, and had to quit before too long. ’50 Shades’ is SO poorly written, it’s difficult to discern exactly what she’s trying to say in some places. I’m floored that it got published, to be honest. I can only cringe in horror at the thought of what the movie must be like.

          • Dr Kitty
            January 22, 2015 at 5:09 pm #

            I’m sad Jamie Dornan is in that movie.
            He was a nice boy (he and my little sister knew each other in high school), and is actually a good actor (the Fall), but I don’t think this film was a good move.

          • Guesteleh
            January 22, 2015 at 11:31 pm #

            *gasp* You knew him?? I find him unspeakably hot. Nothing to do with 50 Shades. He just radiates sexy. Unf, I say. Unf.

          • Dr Kitty
            January 23, 2015 at 4:06 am #

            I knew him when he was the sweet 16/17 year old my sister dated a few times and went to parties with.
            Very polite, nicely brought up boy.

            When they ran into each other in London a few years later (when he was in a band, after CK and Keira Knightly, before the acting took off) he asked after her family and was, again, a nice person, who was thrilled to see someone from back home.

          • Dr Kitty
            January 23, 2015 at 4:44 am #

            Oh, both Jamie Dornan’s father and stepmother are OBGyns. 🙂

          • Guesteleh
            January 23, 2015 at 2:08 pm #

            Aw, that’s lovely. I saw him on Graham Norton and he seemed like a sweetie. Good to know it’s not just an act.

          • Samantha06
            January 22, 2015 at 5:11 pm #

            And it’s a series of three books, I’m sure all just as bad..

          • Anj Fabian
            January 23, 2015 at 7:47 am #

            The movie is probably better. 50 Shades is literally fan fiction.

            I disliked the True Blood series because although the writing was good, the longer story arcs were not well thought out and the whole series has serious Mary Sue issues. The television series is a huge improvement because it addressed the issues I listed.

            As written, the characters in 50 Shades are implausible, two dimensional and not very likable. At least one of those needs to go in order for the audience to spend time with them for over an hour.

          • January 22, 2015 at 8:58 pm #

            I love that you admit to reading slash fic. I used to read a ton and loved it.

        • Samantha06
          January 22, 2015 at 12:43 pm #

          Dr. Amy has quoted from her book on her post, “Ina May Gaskin leads her own Cult” from June 2013… it’s quite disturbing…

    • Medwife
      January 23, 2015 at 12:24 pm #

      I… I… I CAN’T KNIT. Do I have to give up my license? 🙁

      • January 23, 2015 at 1:02 pm #

        I’ll be happy to “mentor”, Sister. All it takes is an apprenticeship, not eddication. Bet there isn’t a single CPM who did an advanced degree in knitting, and just look how professional they are!

        • Medwife
          January 23, 2015 at 8:21 pm #

          I’ll just look it up on YouTube.

  23. Zen
    January 22, 2015 at 11:59 am #

    I wish I didn’t have to pay for the first paper. I’m quite curious as to what “feminist interpretive analysis” means in this context.

    • Ash
      January 22, 2015 at 12:00 pm #

      I will copy paste a bit

      Exemplar: Non-Analytical Decision making

      midwives used non-analytical ways of decision-making. Another narrative
      told by Maggie (above) was selected because she gave such a detailed
      example of non-analytical decision-making.

      story is from the same midwife, Maggie. In this case she was the
      primary midwife for Carla, (a multigravida) who is herself a midwife and
      Maggie’s personal friend. Alison, Carla’s support person is also a
      midwife and a friend of both Maggie and Carla. Maggie had been a
      clinical mentor to be Carla and Alison during their midwifery training.
      Maggie told me that Carla had doubted her body’s ability to give birth
      throughout first stage labour. Maggie now takes up the story…

      I just ‘knew’[intuition]
      Carla had gone through the transition stage because she’d been really
      distressed and very unsure of herself, and I could hear she was
      occasionally grunting at the height of her contractions [cue clustering]. Carla became agitated and was thinking she wasn’t in 2nd stage or ready to birth and she asked if I would [vaginally] examine her to see where she was [woman asking for evidence].

      first thought was: I normally trust a woman’s judgment and when the
      woman says to me “I’m concerned, I don’t think it’s time”, I normally
      trust them and often they are right. But in my experience, particularly
      with midwives in labour, they often second-guess themselves and often
      misread their body signs [pattern-matching; intuition]. I wasn’t looking closely at Carla so I don’t know whether there were any other physical signs of 2nd stage to be seen such as: fetal descent or perineal bulging and/or anal pouting [failure to acquire cues by assessment]. To me it was very obvious Carla was in 2nd stage [pattern matching] I expected her to birth well because she had birthed well twice before [cue clustering].

      My dilemma was: should I examine Carla to check if she was in 2nd stage or not? [evaluation of treatment options] I was aware that Carla, herself, would have performed a vaginal examination on a woman to establish 2nd
      stage. So I was questioning myself whether I needed to act, as she
      would have done. I was the senior midwife (in the room) so I felt there
      was more pressure to get it (the diagnosis) right (emphasis).
      I suppose I didn’t want to make a mistake so, I guess I was questioning
      my thinking carefully and looking at what decisions I was making (even though Maggie did not engage in systematic cue acquisition).
      I started to ask myself, is the baby in a mal-presentation? Is the
      cervix not fully dilated? Do I need to diagnose there is something
      holding the birth of the baby up? Can I wait a little while longer as
      Carla has only [potentially] been in 2nd stage 15–20 min [ruling in normal progression of 2ndstage labour]?
      I knew there was no reason to suspect these problems as I had done a
      palpation at the beginning of labour; I had seen the (emotional) signs
      of 2nd stage [failing to collect focused cues by doing another palpation and looking for external signs of descent].
      Maybe if I could get Carla to relax enough the [fetal] head would come
      down deep enough, the baby would rotate and the cervix would fully
      dilate around the head naturally and birth would happen [again
      failing to collect cues to rule out failure to progress; diagnosis
      seems to be woman’s tension is slowing labour progress]. It should be easy, especially in a woman who has had two children before. I knew I didn’t need to examine her; I felt (emphasis) [intuition] she was ready to birth [Maggie
      has not engaged in non-invasive ways of collecting assessment data
      therefore her knowing is not fully supported from clinical evidence].
      I told Carla I didn’t need to and would not examine her. As I know
      Carla very well, I just held her close to me, telling her to trust her
      body, to let go of negative thoughts, feel the baby coming down and just
      let the birth happen. Carla birthed her baby very shortly after. [This
      outcome is excellent but the process for deciding was non-analytical. A
      good clinical outcome and a good clinical decision-making process are
      not, necessarily, equivalent].”

      • Ash
        January 22, 2015 at 12:00 pm #

        Exemplar: Partial Analytical Decision Making and Failure to act

        midwives partially used clinical reasoning but gave up trying to make a
        decision and/or failed to implement their decision. Maggie’s narrative
        is the selected example.

        has been a midwife for 28 years; she told me this story as an example
        of good decision-making. She works within a group midwifery practice as
        part of a birth centre, attached to a major maternity unit. She was the
        primary midwife for an Afghani woman Raja, a primigravida. Raja and
        Mohammed, her partner, speak quite good English. Raja and Mohammed
        deferred to Zita: Raja’s, non-English speaking, Mother-in-law who
        accompanied them to the birth centre. (This is crucial to what unfolds).
        Maggie was informed early in the ante-natal period within the Afghan
        culture women believe the birthing stool is a good place to labour.
        Maggie now takes up the story…

        found the birthing stool a very comfortable position to be in and to
        cope with labour and pushing. She was pushing for quite a long time i.e.
        over four hours [cue acquisition but no clear diagnosis].
        I felt unhappy with Raja being on the birthing stool for so long
        because research has shown in 2nd stage you really shouldn’t sit on a
        birth stool for a very long time [cue interpretation] because of the risk of perineal oedema and that’s what I’ve found in practice [good knowledge base about perineal trauma]. I could see in the mirror under the birthing stool Raja’s perineum was becoming quite oedematous [focused cue acquisition]. I tried to encourage Raja to come off the birth stool and go forward and kneel [evaluation of treatment options], but she didn’t want to move [may be because the woman didn’t have enough information].
        There was much discussion between Raja, Mohammed and Zita. Mohammed
        told me his Mother said “Raja needs to stay on the birthing stool
        because the baby needs to come”. Zita was continuously touching Raja
        encouraging her to stay on the birth stool [cultural and knowledge gap between family and Maggie].

        was very difficult for me. I felt challenged and questioned in my
        practice and my knowledge and my decision-making but I didn’t want to be
        disrespectful towards Zita because the dynamics in the room were that
        Zita was very much managing the labour. [Maggie
        is focused on the interpersonal and cultural aspect of care. She has
        stopped thinking about the clinical decision; Maggie is not using either
        pattern-matching or clinical reasoning]. To me culture is
        very important, especially as Raja has only Mohammed’s family in
        Australia and Raja has to go home with that family. For me to cause Zita
        to lose face in front of her family was not something I was prepared to
        do so I left Raja on the birth stool. [Maggie
        is more concerned about Zita feeling OK than she is about the risk of
        perineal trauma due to oedema for the woman. This a failure to make and
        act on a decision]. Outcome: The baby was born on the
        birth stool and fourth degree tear had to be repaired under anesthetic
        in the operating room.”

        • Ash
          January 22, 2015 at 12:01 pm #

          Exemplar: Analytical Decision-Making Using Clinical Reasoning

          of the 20 midwives demonstrated good clinical reasoning (i.e. the
          midwife’s thinking processes largely matched the clinical reasoning
          process noted in Table 2). Nicoli’s narrative is the selected example:

          has been a midwife for 10 years. He works in a consultant-led public
          hospital in a city. On the day of this scenario, Nicoli was working with
          a senior student midwife Mandy, (an RN) Nicoli and Mandy had been
          caring for Jane (a multigravida woman) who had been labouring for about
          six hours. At the time that this scenario starts the change of shift is
          in progress. Nicoli left the student midwife and Jane in the birthing
          room to give handover. Jane was now in late 1ststage labour with a CTG attached. When, approximately 15 mins
          later, he returned to the room, Nicoli discovered the midwifery student
          had consulted a doctor because she interpreted the CTG printout to be
          showing early decelerations, which she believed suggested the baby was
          experiencing some distress. The doctor had subsequently taken a fetal
          scalp blood sample. Nicoli takes up the story….

          finished the handover and went straight back to the birthing room. The
          doctor decided he wanted to do a vacuum extraction. A second doctor came
          into the birthing room seeking clarification of what was happening. The
          second doctor was junior to the first doctor, so once the situation had
          been explained, the junior doctor deferred to the senior doctor’s
          decision. When I heard the first doctor repeat that he was going to do a
          vacuum extraction I asked him if Jane’s cervix was fully dilated [cue acquisition]. He said, “Yes.”

          Jane had only been in 2nd stage for no more than 20 min at this point [cue clustering]. I was thinking several things: the CTG I had looked at before I left the birthing room (15 min ago) wasn’t that bad [cue interpretation] there had been early decelerations from a baseline of around 140 bpm to 115 bpm lasting around 15–30 s [ruling out significant fetal distress]; the fetal blood sampling test had shown the baby was coping as the pH was within normal limits (result was 7.35) [ruling out fetal distress] the fetal head was low [cue acquisition]; Jane did not have an epidural and had birthed vaginally before [cue clustering] so I could see no reason why she could not push this baby out vaginally [evaluation of treatment options]. I made the decision Jane did not need a vacuum extraction and that she could have a vaginal birth [diagnosis].

          ] I turned to Jane and, ignoring the junior doctor, said, “We
          (emphasis) need to push this baby out now [ ]. The two doctors just
          looked at me but kept silent. I was forceful in encouraging Jane to push
          [implement treatment plan]. [ ] The two doctors stayed in Jane’s birthing room to watch. During pushing fetal decelerations persisted [focused cue acquisition], although they had changed to late decelerations [ruling in fetal distress]. The baby was born spontaneously and was fine at birth with good Apgar’s [evaluation of treatment outcomes].”

          • attitude devant
            January 22, 2015 at 12:07 pm #

            Oh Jeez. These guys are worse than polyamory folks endlessly processing every damn thing. Mind blown….

          • SarahSD
            January 22, 2015 at 12:13 pm #

            Thanks! The use of the midwives’ first-person narrative of the events as the data from which to analyze their decision making process seems to be part of the “post-structuralist feminist methodology” here. This (working from an elicited subjective account) actually seems like a reasonable thing to do when analyzing decision-making. Material records and outsider observations would not get this level of detail about the midwife’s thought process. Through this analysis the authors can show that “clinical reasoning processes” are not being employed or are not being employed in a consistent or systematic sense.

        • attitude devant
          January 22, 2015 at 12:14 pm #

          So, Maggie lets down her primary responsibility (to Raja) in order to reinforce Zita’s power over her daughter in law? Good to know! I’m sure Raja’s thrilled to know that even in Australia her personal welfare comes second.

          • Amy M
            January 22, 2015 at 12:21 pm #

            I bet even Zita would have made Raja get off the stool if she knew what was at stake. All they had to tell her was that her grandchild’s (preferably grandson I suppose) life was in danger.

          • moto_librarian
            January 22, 2015 at 12:45 pm #

            This is simply awful.

        • Dr Kitty
          January 22, 2015 at 12:47 pm #

          has been a midwife for 28 years; she told me this story as an example of good decision-making. ”

          GOOD decision making?
          No. Poor decision making which directly contributed to maternal morbidity.
          You can be respectful of cultural differences, but, at the end of the day, your patient’s wellbeing comes first.
          You can be the bad Western person that the family blames for insulting mama, and you can make it so that it is clear that it is you in control and Raja wasn’t able to obey Zita. Then you’re the bad guy, Zita’s nose is out of joint but Raja gets no blame.
          “Raja, I insist you get off that stool- you are swelling up and you risk a big tear that could damage you, or more swelling that could stop the baby coming out. I’m taking the stool out of the room now- Zita, I’m sorry, but if you try to stop me I’m afraid you’ll have to leave the room too”.

          • attitude devant
            January 22, 2015 at 12:53 pm #


        • Sarah
          January 22, 2015 at 12:58 pm #

          A 4th degree tear, ffs! Are Afghan women cursed with inadequate care in labour the world over?

        • Medwife
          January 23, 2015 at 8:23 pm #


      • attitude devant
        January 22, 2015 at 12:10 pm #

        Oh Good Night in Heaven. Just do a damn vaginal exam!

        • Ash
          January 22, 2015 at 12:19 pm #

          ” I wasn’t looking closely at Carla so I don’t know whether there were any other physical signs of 2nd stage to be seen such”

          So….uh…why would one not examine your patient, err, client more carefully? Oh, gotta knit, my bad.

          • attitude devant
            January 22, 2015 at 12:24 pm #

            Apparently, an appropriate exam to evaluate your laboring mother’s concerns is a Bad Thing.

          • Mariana Baca
            January 22, 2015 at 2:32 pm #

            This is so ridiculous. It is one thing to object to internal exams for whatever stupid reason (fear of infection, trauma), claiming there are sufficent external signs they can check. But refusing to monitor secondary signs which are not invasive in favor of “guessing” is ridiculous.

            “I started to ask myself, is the baby in a mal-presentation? Is the cervix not fully dilated? Do I need to diagnose there is something holding the birth of the baby up?”

            She is talking about “diagnosing” as if it were a decision she makes, instead of an observation that leads to a conclusion. This is just magical thinking.

      • Amy M
        January 22, 2015 at 12:32 pm #

        I can only assume names have been changed here, but how stupid are these women to publish their incompetence? Any prospective client reading these stories should wonder why the midwives spent so much time thinking about things and so little time actually doing anything. Sure, maybe everything worked out for Carla, but maybe examining her would have been a good idea. Or at least monitoring the baby occasionally. (I guess she might have, but she gives the impression that she was knitting, on the other side of the room.)

        And of course there’s Raja’s story. If they’d taken some action, Raja might be able to laugh wo/peeing herself today. A 4th degree tear THAT WAS PREVENTABLE is not a good outcome (though a healthy baby was).

      • Daleth
        January 22, 2015 at 2:03 pm #

        So… it just happened to go well, and therefore the midwife thinks her decision-making process was correct?!

      • yugaya
        January 22, 2015 at 7:05 pm #

        Excuse my language but “what the fuck did I just read” is all I can come up with in response to this.

      • Zen
        January 22, 2015 at 7:25 pm #

        So, the takeaway here is that for me to be a great midwife and ensure a good outcome, I just have to be skilled in waffling long enough when the mother thinks something is wrong. Gotcha.

        I love how even they admit that there wasn’t a good clinical decision-making process here, and this is a pro-midwife article. How confidence-inspiring!

      • January 23, 2015 at 1:36 am #

        “Non-Analytical Decision making”? What does that mean, toss a coin? Say “eeny-meeny-mynie-mo?”

    • Amy M
      January 22, 2015 at 12:17 pm #

      I’ve read what Ash c/p’d and a lot of what they seem to think is “intuition” is experience. I think this came up on a post just recently–how a midwife or OB who has seen enough births will recognize certain things and from a lay-perspective, it looks like magic.

      Regardless, I wouldn’t want any medical care from someone who didn’t confirm their suspicions with actual medical tests or expert observations.

  24. Mel
    January 22, 2015 at 11:38 am #

    I have a way to test the knitting hypothesis:
    1) Put random people in a room with no stimuli and tell them not to talk
    2) Give one ADHD person a pen that clicks when a button is pushed.
    3) Sample the cortisol levels of the random people as time progress and the clicking progresses.


    • Cobalt
      January 22, 2015 at 11:44 am #

      So I tensed up reading that. I’m also a terrible knitter. Is my birth attendant career officially over?

      • January 22, 2015 at 11:50 am #

        And now I know why I’m such a good midwife! I’m always knitting! [or crocheting]

        • Cobalt
          January 22, 2015 at 12:00 pm #

          I am a passable crocheter, by which I mean my finished projects are recognizable, and, given enough years, I can produce a really cute toddler sized scarf.

          • Amy M
            January 22, 2015 at 12:23 pm #

            I once crocheted a tiny yarmulke. My dad laughed at me.

        • Amy
          January 22, 2015 at 12:14 pm #

          But the crochet hook doesn’t click on anything. Think of all the patients you may have caused distress by crocheting instead of knitting!

      • The Bofa on the Sofa
        January 22, 2015 at 12:00 pm #

        Fortunately, the PCM credential does not requite knitting, but you do have to catch up on your 80s pop culture.

        PCM’s don’t knit. We quote lines from Family Ties.

        • attitude devant
          January 22, 2015 at 12:07 pm #

          The Millenial PCMs quote Drake and Josh.

          • The Bofa on the Sofa
            January 22, 2015 at 12:15 pm #


            True PCMs are even hesitant on the Buffy thing, but will generally accept conversation about Willow or Seth Green, but even then because they know there is a chance it will end up in a discussion about the Star Wars episodes of Family Guy.

    • no longer drinking the koolaid
      January 22, 2015 at 11:47 am #

      Personally, I prefer bamboo knitting needles. The clicking of the metal ones is like nails on a chalkboard for me.

    • namaste863
      January 22, 2015 at 12:16 pm #

      I volunteer to be the ADHD pen clicker!

    • The Bofa on the Sofa
      January 22, 2015 at 12:17 pm #

      Just have them sit in the corner texting on their phone. Wouldn’t that be pretty much the same idea?

      • Samantha06
        January 22, 2015 at 12:29 pm #

        That noise drives me insane!

  25. Roadstergal
    January 22, 2015 at 11:32 am #

    Peer pressure is a substantial motivator, confidence is fragile and must be nurtured, and even though you have the capability of thinking rationally, you’d rather not. Is this a medical profession or high school?

  26. demodocus' spouse
    January 22, 2015 at 11:00 am #

    Knitting? What on earth? Although I know a doc who knits to decompress (she used to come to our stitch and gab while in and just after med school in the area, before she got a job on the East coast) and have had conversations about it with a nurse while preparing for an ultra sound, I don’t really want my provider to be ACTUALLY knitting DURING this kind of thing. It’s unprofessional. When I substitute, I am not knitting during tests or study, I’m wandering the room to make sure everything is okay. And lives are not at stake there!

    • sdsures
      January 22, 2015 at 11:05 am #


      • demodocus' spouse
        January 22, 2015 at 12:36 pm #

        ‘Xactly. (The conversation had started in the waiting room as I packed up my sock, and was finishing up as I settled onto the table.)

        • sdsures
          January 22, 2015 at 3:21 pm #

          I’ve found knitting to be frowned upon when actually in the CT scanner, though. 😉

  27. Daleth
    January 22, 2015 at 10:36 am #

    “Confidence was an important, **but fragile,** phenomenon to midwives…”
    Hahahaha SNORT
    Wonder why it’s fragile? Could it be because they lack the skills necessary to produce real confidence?

  28. fiftyfifty1
    January 22, 2015 at 10:25 am #

    “In order to perform their role effectively and provide women with the choices they require midwives need to be confident in their practice. ”

    No, you need confidence to be a good CON MAN. But to be a good medical provider, no, you don’t need confidence. What you need is good clinical skills combined with humility. Studies of doctors show that the doctors with the best clinical diagnosis skills were also the most likely to recognize a complicated case, question their own assessments, and ask for second opinions from colleagues and specialists. It’s the flip side of Dunning Kruger.

  29. Cobalt
    January 22, 2015 at 9:59 am #

    “The study was conducted using post structural, feminist methodology…”

    What does that mean?

    • fiftyfifty1
      January 22, 2015 at 10:27 am #

      Chats over a cup of herbal tea.

      • Cobalt
        January 22, 2015 at 10:55 am #

        With women who are really disorganized.

      • lawyer jane
        January 22, 2015 at 11:10 am #

        At least this study concludes that midwives should actually use reason and not just rely on intuition! I think by “post structural, feminist methodology” they mean that they consider things like power and social context when analyzing how people perform in society. That may sound overly fuzzy, but it seems relevant to consider those elements if your question is something like “how do people make decisions.”

    • Daleth
      January 22, 2015 at 10:39 am #

      I believe the colloquial term for “post-structural methodology,” feminist or otherwise, is “bullshit.”

      But don’t take my word for it:

      Seriously though, the basic gist seems to be “nothing is real, everything is subjective, what we think is reality is really just words…” (see, e.g., http://www.strath.ac.uk/aer/materials/6furtherqualitativeresearchdesignandanalysis/unit4/feministpost-structuralistresearch/).
      Not exactly an approach I personally want from my healthcare providers!

      • Amazed
        January 22, 2015 at 10:42 am #

        So that’s why they hide dead babies away? Because they aren’t real?

        Look real enough to me to be buried twice.

      • Cobalt
        January 22, 2015 at 10:58 am #

        I was completely unable to comprehend the Wikipedia article. Those might be English words, but that ain’t English.

      • Amy M
        January 22, 2015 at 12:36 pm #

        I’d rather have a bottle in front of me than a frontal lobotomy?

      • LovleAnjel
        January 22, 2015 at 1:16 pm #

        Ideally feminist analysis takes into account historical and sociopolitical context as well as data. But I don’t see how that is an appropriate method for this study. All they want to know is how and why they differed from acceptable clinical methods.

    • January 22, 2015 at 11:51 am #

      Nothing whatever, but it just sounds so pompous.

    • Claire
      January 22, 2015 at 12:15 pm #

      blah, blah, blah Patriarchy! Blah, blah, blah penis.

      • Roadstergal
        January 22, 2015 at 3:00 pm #

        I’m all in favor of smashing the patriarchy, and it bothers the shit out of me when people use ‘feminist’ and ‘antiscientific’ as synonyms. Feminism means we have the potential to be just as good at rational thought and the scientific method as anyone, regardless of genitalia.

        • KarenJJ
          January 22, 2015 at 9:39 pm #

          Yup. It’s why I derided feminism for so long. But the conversation is getting interesting again, so I don’t find feminism discussion as embarrassing as I did 15 years ago.

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