OMG! OMG! OMG! I was pressured to have a C-section just because I was a 40 year old insulin dependent diabetic with pre-eclampsia and bloody urine

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Yesterday, the Washington Post published I didn’t realize the pressure to have a C-section until I was about to deliver, excerpted from Narrative Matters section of the journal Health Affairs, Watching The Clock: A Mother’s Hope For A Natural Birth In A Cesarean Culture.

I’ll paraphrase it for you:

Look at me! Look at me! Look at me!

I embody everything that is wrong about contemporary obstetrics. Those meanie doctors were pushing me to have a C-section just because I was a 40 year old insulin dependent diabetic with pre-eclampsia, bleeding from my bladder suggesting that my blood was no longer coagulating properly, hooked up to a magnesium sulfate drip to prevent seizures and labored for several days.

I am a cautionary tale about the way that doctors push low risk women into having C-sections they don’t need.

How dare they! I’m a doctor and I know best.

That pity party is Dr. Keirns’ effort to shoehorn herself into the natural childbirth advocacy narrative of choice: I was low risk and they wanted me to have a C-section, but I showed them!

Who is Dr. Keirns? She is Assistant Professor of Preventive Medicine, Assistant Professor of Medicine and Clinical Ethicist at Stony Brook University. In other words, she should know better.

Before I get any further into lampooning Dr. Keirns’ absurd nattering, I want to make one point very clear:

Dr. Keirns is telling two stories at once. The first, which would be laughable if it weren’t a matter or life and death, is the classic natural childbirth advocate’s tale of woe. That deserves to be ripped apart. The second, simultaneous, story is one of poor bedside manner and poor preparedness for an emergency. That is a real story, too, and there is nothing that justifies that. Had Dr. Keirns chosen to wrie about her provider’s poor bedside manner and poor preparedness, she would have told a tale that is woefully familiar to anyone who has ever been hospitalized. She would have been raising an important issue that must be addressed: how to we treat patients with respect and dignity even as we struggle to save their lives? Unfortunately, that’s not the story that Dr. Keirns chose to tell.

For reasons beyond my comprehension, Dr. Keirns told a tale that was supposed to demonstrate what is wrong with contemporary obstetric practice, but, instead, demonstrates what is wrong with contemporary natural childbirth advocacy. Unintentionally, Dr. Keirns illustrates how natural childbirth advocacy privileges process over outcome, encourages women to make birth plans that are absurdly unrealistic, and considers vaginal birth both a success and a rebuke to obstetricians even if the baby is nearly dead.

Let’s start with the basics.

Perhaps somewhere there is an alternate universe where Dr. Keirns might have been considered low risk, but it isn’t this one.

Dr. Keirns and her pregnancy were extremely high risk. She was 40 years old, which put her at risk right from the get go, but in addition she had a very serious pre-existing medical condition. Although Dr. Keirns implies that her diabetes was related to pregnancy, her need for insulin in the first trimester suggests that she may have type II diabetes unrelated to pregnancy. Furthermore, although she doesn’t explain the diagnosis, the fact that she was on magnesium sulfate to prevent the seizures of pre-eclampsia, and was spontaneously bleeding from her bladder, suggests that she was developing HELLP syndrome, a particularly dangerous variant that also affects blood clotting and liver function.

In other words, Dr. Keirns is precisely the kind of woman who dies during pregnancy.

She seems to have utterly no awareness of the risk to herself (that, of course, is not part of the typical natural childbirth narrative) and instead chooses to focus on two factors that do make up the typical narrative: the health and brain function of the baby, and the “pressure” to make sure labor doesn’t go on too long.

Dr. Keirns goes off the rails immediately. She apparently started from the natural childbirth premise that birth is safe and that vaginal birth is best. But childbirth is not safe and at every point in her labor she faced a high risk of dying, and her baby faced an even higher risk of death or permanent injury. And it only go worse from there!

At nearly every point, C-section was the safest option for her and for her baby, but she wanted to try for a vaginal delivery; that was reasonable. But once her induction (presumably for diabetes and incipient pre-eclampsia) had dragged on, C-section was ever more clearly the safer option. Regardless of what natural childbirth advocates like to tell themselves, a longer labor means a greater risk of death or permanent injury of the baby.

If Dr. Keirns had agreed to a C-section at that point, she would have almost certainly had a vigorous healthy baby, and she would have been free to moan forever after about her “unnecessarean.” She would have avoided the risks of prolonged inductions, avoided the serious compromise of her baby, avoid the postpartum hemorrhage, possibly avoided the magnesium sulfate to prevent seizures, and possibly avoided the bleeding in her bladder.

Instead, she insisted on a vaginal delivery and she was “successful”:

… My son came out blue and not breathing. I listened for crying but didn’t hear any. I barely heard the doctors say it was a boy. Meanwhile, as the NICU unit was summoned to attend to my son, I began to hemorrhage …

After we were both stabilized, they handed the baby to my husband; I was too exhausted to safely hold him.

If nearly killing your baby and yourself qualifies as a “successful” vaginal delivery, I’d hate to see what failure looked like.

Dr. Keirns then regurgitates the standard misinformation offered by natural childbirth advocates. She repeats the childbirth lie that will not die, apparently unaware that in 2009 the World Health Organization withdrew its recommended C-section rate, acknowledging that there had never been any scientific evidence to support it.

Kearns claims:

As a doctor, I don’t discount any of the problems my doctors were worried about. I know that our obstetric colleagues are working in territory that is fraught with risk, uncertainty and liability.

She babbles on about failure to progress, completely discounting the problems in her doctors were worried about, and pretending the issue in her case was the slow progress of her labor, when it was really the ever growing risk from her serious chronic disease (insulin dependent diabetes) and her serious pregnancy complication (pre-eclampsia with possible HELLP syndrome).

Dr. Keirns was the obstetric patient from hell, doing everything in her power to kill her baby or herself, blissfully clueless to this very day about the dangers she aggressively ignored.

… I barely escaped a Caesarean I didn’t need. In the end, my son is healthy, I’m fine and we had the vaginal delivery that epidemiological data suggests was safest for both of us…

No, Dr. Keirns, the fact that you had a vaginal delivery of a nearly dead baby, a postpartum hemorrhage, intrapartum insulin and magnesium sulfate indicates that you DID need a C-section. Moreover, there is NO DATA that suggest that a vaginal birth was safest for YOU with diabetes, pre-eclampsia and possible HELLP syndrome, or YOUR BABY, who barely survived the labor.

In the end, Dr. Keirns’ tale is not a cautionary story about the rush to perform C-sections, but instead a cautionary story about the absolute nonsense peddled by natural childbirth advocates that threatens the lives of babies and mothers and is believed even by Dr. Keirns who should have known better.

Physician, heal thyself!

418 Responses to “OMG! OMG! OMG! I was pressured to have a C-section just because I was a 40 year old insulin dependent diabetic with pre-eclampsia and bloody urine”

  1. sara, MD
    April 7, 2016 at 1:22 pm #

    Is this a joke? I would have been begging my docs to cut me because I did not want to die, have a stroke, get DIC,. In fact, I already told my OB that I’d rather a CS than a 3 day induction on mag (or anything a bad 3rd degree or above, or a baby in the NICU or worse). And I’m a total hippie and have previously stated only half jokingly that one of my goals in life is to die with an intact peritoneal cavity.

  2. Fab6
    January 10, 2015 at 6:22 pm #

    Just reading this again. Because the original article is just so baffling to me, at first I thought it was posted on The Onion. This woman is a mental case.

  3. Amy Tuteur, MD
    January 10, 2015 at 2:00 pm #

    Oh, the irony!

    • Karen in SC
      January 10, 2015 at 2:25 pm #

      She “hearted” him but didn’t listen to him?

      • Samantha06
        January 10, 2015 at 8:19 pm #

        And publicly humiliated him… wow..

    • CrownedMedwife
      January 10, 2015 at 3:49 pm #

      Preventative Medicine. Exactly, preventative medicine to mitigate modifiable risk factors. Preconception folic acid, immunization, smoking cessation, teratogen avoidance and weight management to mitigate modifiable risk factors.

      I’ve watched with interest as the comments in response to Dr. Keirns’ narrative have discussed the multiple issues involved in her recollection of her risk factors and the management of her care. Several discussions have ensued regarding risk factors associated with obesity and morbid obesity in pregnancy, yet many discussions seem to have been tempered by a hesitation to fully address obesity as a significant risk factor for perinatal morbidity and mortality. It’s an interesting phenomena that we can discuss and conclude risks associated with postdates, oligohydramnios, TOLAC, homebirth and a myriad of other identified risk factors for increased morbidity, but have yet to fully discuss obesity risks as a single risk factor without a subtle or overt apologetic undertone. It isn’t disrespectful to discuss the implications of obesity, it’s a realistic objective for providers and patients to work together to identify and mitigate the risks of a pregnancy complicated by obesity. We should be able to do so without apologies, but with the true sincerity we address all other risk factors in pregnancy.

      As much as some women with pregnancies complicated by obesity and morbid obesity might prefer not to be labeled as high risk, there is no disputing the risks of SAB, NTD, CHD, IUGR, Macrosomia, Amniotic Fluid disturbances, Preeclampsia, GDM, IUFD, SD, Anesthetic Risks, CS rates with Postoperative complications, PPH and Thromboembolic Events. There is a level of sensitivity that needs to accompany a discussion addressing the risks with an individual patient. However, we also can’t hesitate to discuss these risks preconception as a measure of Preventative Medicine to reduce obesity rates through referrals for nutrition counseling and exercise plans or to mitigate associate risks by recommending increased Folic Acid intake and screening for preexisting HTN, DM or Thyroid disorders.

      As a provider, I strive to identify and address risk factors. When it comes to addressing obesity, I address it with the same sensitivity and thoroughness as I do all other issues that place a pregnancy at high risk. In reality, the perinatal morbidity and mortality rates of obesity in pregnancy make it high risk, just as DM, HTN, IUGR, Oligohydramnios, Postdates, etc. We shouldn’t hesitate to address it simply on the basis of it being a sensitive issue.

      • Deborah
        January 11, 2015 at 3:35 pm #

        It’s probably the pessimism about it really being a MODIFIABLE risk factor. Whether or not any durable, significant weight loss can be achieved by diet and exercise alone is quite debatable. Bariatric surgery works like a charm, but the up-front risk is significant. It’s just not realistic to say, “Lose 100# before you try to get pregnant, see you in a year or two.” And we certainly have to deal with noncompliance on all the other issues too, it’s just they are MUCH MUCH easier to manage/resolve than morbid obesity. I mean, if the only treatment for hypertension was a diet/exercise regimen that had a 5% long term success rate, or major surgery . . . well, thank goodness almost every other issue is easier to deal with.

        • CrownedMedwife
          January 11, 2015 at 4:57 pm #

          Obesity is a modifiable risk factor to the extent of diet and exercise to effect weight loss, combined with increased Folic Acid preconception and identification of underlying DM and HTN. I agree with the pessimism as whether it is a realistically modifiable risk factor regarding the degree of difficulty and magnitude of its maintenance. It can be difficult to address these issues preconception and still come across as a sensitive provider. I’ve heard woman say they are looking for a plus size sensitive provider and I’m perplexed every time I hear it. It’s a professional responsibility to identify, discuss and manage risk factors, obesity being no different. Unfortunately, addressing obesity preconception or during pregnancy can be seen as fear mongering or ‘fat-shaming’ and this makes it a very difficult high risk condition to accept.

          • Box of Salt
            January 11, 2015 at 5:09 pm #

            Deborah and CrownedMedwife, re obesity (or just being overweight) as a modifiable risk factor.

            Weigh (word play intended) against age and the risk of chromosomal abnormalities.

            I could modify one risk (my weight), but only at the expense of increasing the other.

          • CrownedMedwife
            January 11, 2015 at 6:32 pm #

            Yes, each carries it’s own set of risks. It is a balance between age related risks which continue to advance and weight related rates which tend to decrease modestly as BMI decreases. In terms of risks associated with BMI, there is a significant (not creative enough for an appropriate word play) difference in risks between a BMI>40 and BMI 30. If AMA looms in the future, any modest decrease in BMI improves outcomes along with Folic Acid and addressing any underlying health issues.

            My patient population has a tendency to reflect rates of obesity somewhat higher than the US average and it is not uncommon to have several women pregnant with BMI’s 50-60. I’ve learned working with any women with any risk factors calls for a lot of honesty and compassion, whether it is AMA, HTN, or obesity, in order to work as a team to improve outcomes and patient satisfaction with care.

          • Young CC Prof
            January 11, 2015 at 5:47 pm #

            As far as “plus sized sensitive provider,” that could mean two things, one desirable, the other undesirable.

            Some overweight people have experienced doctors who seem to want to attribute every health complaint they have to obesity, or felt that doctors were treating them rudely because of their size.

            So if plus sized sensitive means a doctor who will work with plus-sized women to have healthy pregnancies without devoting lots of appointment time to unhelpful lecturing, good. If it means a provider who will literally pretend obesity is not a risk factor for complications in pregnancy, that’s not good.

    • Young CC Prof
      January 10, 2015 at 4:07 pm #

      Smoking doesn’t inevitably lead to lung cancer. Stop the unnecessaquitting! Exercise your autonomy and keep smoking! *sarcasm*

    • January 10, 2015 at 4:59 pm #

      How is she claiming her OBs did NOT pressure her to have a cs?! Did she read her own article??

    • Guesteleh
      January 10, 2015 at 5:40 pm #

      Her. Baby. Was. Born. Not. Breathing. So her medical risk factors did lead to a complication, a pretty goddamned serious. one.

      I’m not being facetious when I say I’m starting to think she’s mentally ill.

      • fiftyfifty1
        January 10, 2015 at 6:11 pm #

        Let’s not malign people with mental illness. I have a number of terrific patients with serious persistent mental illness who are perfectly capable of listening to medical advice to keep themselves and their kids healthy. This lady’s problem is she’s a self-important jackass and rebel without a clue.

        • Guesteleh
          January 10, 2015 at 8:32 pm #

          I’m thinking Axis II, some kind of personality disorder.

        • sdsures
          January 12, 2015 at 2:14 pm #

          True. Mental illness isn’t quite the same thing as personality disorder. Mental Illness often involves the patient (or loved ones of the patient) realizing there is a problem, and deciding if they want to get help, if appropriate.

          You can’t cure or treat a personality disorder because the person who has it doesn’t think there is anything that needs to be treated. ie If you’re worried that you might have a personality disorder, good news – you don’t.

          • fiftyfifty1
            January 12, 2015 at 6:08 pm #

            Actually, it’s not uncommon to worry about having personality disorders and actually have them. I’ve had a couple of conversations in the last month with young women terrified that they might meet criteria for Borderline Personality Disorder…and sure enough they did.

          • sdsures
            January 12, 2015 at 8:52 pm #

            That they recognized that they have problems is a good sign. You know the saying: A patient has to want help in order to get better.

            I guess I’m just skeptical because I have had personal experience of a woman (online, in a forum) faking dissociative identity disorder, and it was blatantly obvious that 1) she didn’t have it, and 2) she did it to get attention.

    • fiftyfifty1
      January 10, 2015 at 6:02 pm #

      I wonder what it would take for her to call something an obstetric complication. Me, at a minimum, I am counting 3:
      1.Baby born not breathing
      3. Pre-eclampsia

      She could have done a much better job at preventing these by being willing to accept timely interventions. Think if she had accepted even just the standard advice for women over 40 and accepted an induction at 39 +0 weeks. Then she would have delivered without needing mag, her placenta would have been 1 week fresher, her baby likely smaller, her labor less protracted, less risk of PPH because no evolving blood disorder. She very likely might have avoided it all AND gotten the vag birth she so desperately wanted. Timely induction is PREVENTIVE MEDICINE.

      • Box of Salt
        January 10, 2015 at 7:02 pm #

        “I wonder what it would take for her to call something an obstetric complication.”
        It will taking getting over the cognitive dissonance and admitting that she did not in fact make decisions that were best for herself and her baby.

      • sdsures
        January 12, 2015 at 2:12 pm #

        I thought her baby was born not breathing.

    • fiftyfifty1
      January 10, 2015 at 6:08 pm #

      Heck, timely inductions are preventive medicine. Might have avoided all of this had she been willing to listen to standard recommendations for her medical risk factors and induce at 39 wks.

      • CrownedMedwife
        January 10, 2015 at 7:15 pm #

        I don’t understand what point she is trying to make in her statement, because in her case medical risk factors are EXACTLY what lead to her obstetric complications. On a side note, I would really like to know at what point her preeclampsia was initially diagnosed as her induction really may have been indicated even before 39 weeks. Not likely we’ll ever know at what point her providers did in fact recommend an induction. The entire scenario and her ability to rationalize her objections baffles me.

        • fiftyfifty1
          January 10, 2015 at 7:27 pm #

          Well we know that they recommended it at 39 wks. There is no MFM on earth who wouldn’t do that at a minimum with her risk factors.

          • CrownedMedwife
            January 10, 2015 at 7:39 pm #

            Agreed. I’m just wondering whether her BP had been elevated prior to 39 weeks and whether there had been an even earlier recommendation to induce between 37-39 weeks or had she been declining an induction. Waiting till 39.5 with all of her risk factors makes me wonder if there is more to the story she didn’t tell regarding her provider’s recommendations.

    • sdsures
      January 11, 2015 at 10:51 am #

      Right, I can totally write off my cerebral palsy and hydrocephalus as possibly leading to obstetric complications! (A friend of mine who has hydrocephalus had seizures during labour. She and her kids are doing fine now.)

      • Amazed
        January 11, 2015 at 11:11 am #

        That’s because she did not let them bully her into them nasty unneeded interventions, right? Why did you omit this part?

        • sdsures
          January 12, 2015 at 2:10 pm #


        • sdsures
          January 12, 2015 at 2:11 pm #

          I’m not exactly sure what complications CP might present re labour. CP is incredibly diverse.

  4. Salome Ellen
    January 10, 2015 at 12:16 pm #

    This has maybe been said before, but what about being “an insulin-dependent diabetic with pre-eclampsia and bloody urine” stops a woman from having the right to choose her own and her baby’s medical care?? It seems to me that no-one tried to reason with her, cite studies or statistics, or persuade her to choose the C-section. They just assumed it was what was going to happen, hence the ill-preparedness and bad bedside manner.

    Mocking her choices doesn’t mean she was unfit to make them.

    • Young CC Prof
      January 10, 2015 at 12:37 pm #

      And her rights WERE respected. No one should have forced her to have a c-section, and no one did. Maybe her providers did do a bad job of explaining why a c-section was necessary, maybe they didn’t.

      What I do disagree with is her claim that her doctors were wrong to strongly recommend a c-section.

    • fiftyfifty1
      January 10, 2015 at 12:49 pm #

      “Mocking her choices doesn’t mean she was unfit to make them.”

      Absolutely true! The right to refuse medical treatment is an incredibly important ethical right and must be respected even when a patient is making a very dangerous decision. The woman gets to make the final call. It’s her body, and until the fetus is born, the fetus is treated as her body as well.

      Doesn’t mean we have to agree with what she did. She presents her choices as laudable. I’m free to mock her choices as stupid.

    • The Bofa on the Sofa
      January 10, 2015 at 12:50 pm #

      This has maybe been said before, but what about being “an
      insulin-dependent diabetic with pre-eclampsia and bloody urine” stops a
      woman from having the right to choose her own and her baby’s medical

      Where did she not? Pay attention: she never had a c-section. Regardless of how stupid of a decision it was to take that risk, they let her do it. So take your strawman argument elsewhere.

      It seems to me that no-one tried to reason with her, cite studies or statistics, or persuade her to choose the C-section.

      What the hell are you talking about? Half of her story is whining about how she was “pressured” to have a c-section. So let’s see…they never tried to persuade her to choose the C-section, but she was pressured to have a c-section?

      Mocking her choices doesn’t mean she was unfit to make them.

      That she was “fit” to make them doesn’t make them not worth mocking, either.

      I’ll mock anyone who takes silly risks and then boasts about it afterward.

    • Amy Tuteur, MD
      January 10, 2015 at 1:37 pm #

      Your comment is interesting because I never questioned her right to choose her medical care. I questioned her fantasy that her doctors were recommending dangerous care ( for reasons beneficial only to them), while she valiantly held out for the safer option. Keirns presents her story as a cautionary tale of pressure to have a C-section and I think it is a cautionary tale about irresponsible natural childbirth advocates who believe misinformation and value process over outcome.

      Why are you trying to change the topic to “choice” when that’s not what either the original piece or my post concerns choice?

      • The Bofa on the Sofa
        January 10, 2015 at 2:01 pm #

        Why are you trying to change the topic to “choice” when that’s not what either the original piece or my post concerns choice?

        Because it’s easier to defeat a strawman than to address the topic.

    • DaisyGrrl
      January 10, 2015 at 3:59 pm #

      As Dr. Amy pointed out in her post, there were two stories being told. And yes, it appears that this woman’s doctors dropped the ball in some respects. And nobody has said she doesn’t have the right to make a stupid decision regarding her own care.

      But it’s also very clear that Dr. Keirns was *very* selective in how she presented her story. She doesn’t mention her morbid obesity. While she mentions her diabetes, she omits the pre-eclampsia (an uneducated reader will not know what the mag sulfate was for). It is quite possible that there were other risk factors she didn’t mention. So I am going to take her account of what her doctors told her with a grain of salt.

      There’s mention of an MFM telling her that her odds of a c-section are 50%. But Keirns comes across as a woman hell-bent on a vaginal birth at all costs. I imagine that her doctors used every tool at their disposal to convince her to consent to a c-section. The liability of not performing a c-section for this patient would probably have been quite high.

      The worst part about Keirns’ story is that she’s encouraging other, less educated, women to make the same decision as she did. She misrepresents statistics and the evidence to fit her narrative and in doing so further alienates women from their care providers. For a medical ethicist to do this strikes me as profoundly unethical.

      • Amy Tuteur, MD
        January 10, 2015 at 4:12 pm #

        Exactly! You summed it up so perfectly that I shared your comment with Dr. Keirns on Twitter.

    • Amazed
      January 10, 2015 at 7:06 pm #

      What about the woman’s article made you think that someone stopped her from choosing her own care and her baby’s medical care? This pre-eclamptic, insulin-dependent diabetic, peeing bloody urine, placed on mag drip, morbidly obese nutso (please don’t equate nutsos with people suffering from mental illnesses!) refused herself and her baby almost to death, the baby WAS born almost dead and then she rushed to paint herself as this sweet valiant tormented mom who was taken advantage of.

      Nutso took advantage of her helpless baby to achieve her ridiculous aim of vaginal delivery at all costs. Congrats, nutso. Congrats to you too, Salome Ellen, for making such a nice strawmen.

      • Samantha06
        January 10, 2015 at 8:20 pm #

        “Salome Ellen” is probably Keirns herself..

    • Who?
      January 10, 2015 at 11:07 pm #

      Okay, she was fit to make a choice. It was a bad choice because the baby nearly died and has who knows what as yet undiagnosed problems. A better choice would have seen a nice pink baby out the escape hatch.

      And she’s written a victim story about her experience, not the baby’s. Pass the sick bucket, seriously. A bit of mocking isn’t much to put up with in all the circumstances.

  5. Thankfulmom
    January 9, 2015 at 9:23 pm #

    Dr. A and other doctors who post here, Would you have been willing to attempt a vag. Delivery in a pt like this?

    I had my youngest in my late 40’s, with type II diabetes and chronic hypertension. I was not obese and I had a history of quick vag deliveries. Bp and blood sugar were well controlled until I started developing pre-e. I was admitted for mag and increased bp meds to bring my bp down and received two doses of steroids for my baby’s lung development. Protein level was not quite at diagnostic level for immediate delivery and my bp came down. At a subsequent admission, protein levels were high enough for official pre-e diagnosis and I was induced at 33 weeks and delivered eight hours after induction was started. If a c/s had been suggested if my labor had been prolonged or my baby showed any signs of distress I would have agreed to a c/s. Or if I had had bleeding prior to labor starting that would have scared me silly.

    I’m surprised the doctor who posted her story had the ability to even be calling others for a second opinion. The magnesium made me so tired, weak and disoriented there was no way I could have been argumentative. If refusing the mag could have been an option, I would have. I knew that was not even a negotiable point. Is magnesium given in different doses?

    • fiftyfifty1
      January 10, 2015 at 12:52 pm #

      Willing to attempt a vaginal delivery in a patient like this? They have no choice if the patient refuses a CS.

      • Thankfulmom
        January 10, 2015 at 10:52 pm #

        You would have wanted to go straight to a c/s? I’m just wondering what the tipping point was so to speak and it sounds like being over 40, diabetic, and preeclamptic was enough. Our situations had similarities, but I have a history of quick deliveries and that must have been my saving grace. I’m glad I didn’t wind up needing a c/s because my recovery was so easy. However, at the first suggestion of a c/s I would have said okay because I trusted my dr.

        I’m baffled at her lack of trust in her care provider. That the the writings of others convinced her a vaginal delivery was the goal & prize is surprising.

        • Medwife
          January 11, 2015 at 12:14 am #

          You had a history of normal vaginal births, and perhaps your cervix was favorable. A c/s at 33 weeks can lead to heavier blood loss; the lower uterine segment is not thinned out like it is closer to term. If you have a patient (like you!) who is at high risk of DIC (bad bad bleeding problem that is sometimes a consequence of heavy blood loss) due to HELLP syndrome, or could rapidly develop HELLP, it would be nice to keep that patient out of the OR. Your baby must have looked good on the monitor, too.

          Scary stuff! I’m glad you and baby came through it healthy.

          • Thankfulmom
            January 11, 2015 at 8:39 pm #

            Thank you for helping me understand the differences better. I had no idea a c/s at 33 weeks could potentially lead to increased bleeding. My baby did great during labor except for when my bp bottomed out after the epidural. The nurse went on break right after it was put in and the nurse covering for her didn’t know my bp had been running in the 180+/100 range. It dropped down to 76/56. Only other irritating thing that happened was a nurse almost giving me more than double my regular insulin dose when I was in the antepartum unit. She apparently looked at the dosage I had when I was given steroids. Thankful I questioned the dose!

        • Susan
          January 11, 2015 at 1:30 am #

          Reading this I think the important point is more that her doctors were realistic that the chances of a vaginal delivery were not so great. But, I do think that most doctors I work with would prefer a vaginal delivery with these risk factors ( preeclampsia, diabetes, morbid obesity). C/S do have risks and most of them are increased with morbid obesity. Not that I agree with her attitude… i

        • fiftyfifty1
          January 11, 2015 at 9:48 am #

          “You would have wanted to go straight to a c/s?”

          Nobody who posts here has ever said that. C/S have their risks, especially in patients with severe obesity. The point is that this option wasn’t even on the table, as it is clear that this woman was refusing c/s at every turn, even long past the point where all the specialists agreed that labor was going very poorly and a c/s was the safest choice. What I’m sure her OBs would have preferred to do was induce her back when it was indicated. This woman had multiple reasons that made an induction at 39 weeks at the LATEST be indicated.

          So basically this is the story of an extremely high risk woman (although she hides and misrepresents her risks in her essay) who refuses timely induction (although she leaves that part out in the essay), who finally accepts induction after the shit has already started hitting the fan, who refuses C/S when the shit continues to hit the fan and spray around the room, who finally delivers vaginally nearly killing her baby and herself in the process, who then writes an essay blaming her care team and urging other women to distrust their care teams. So unethical it’s hard to wrap your head around.

          • Thankfulmom
            January 11, 2015 at 8:21 pm #

            Thank you for clarifying. I wasn’t trying to put words in your mouth, just trying to figure out if being 40+, insulin dependent , and preeclamptic all point to an automatic c/s. It is good to know that those of you who responded to my question would not rule out an attempt for a vag. delivery. I’m seeing more clearly now the differences between her situation and mine.

          • yugaya
            January 12, 2015 at 3:31 am #

            Automatic? No. Amost universally medically indicated and recommended as safer? Yes.

          • yugaya
            January 12, 2015 at 3:30 am #

            Adding to that huge pile of bs the fact that she is a Clinical Ethicist, turns her birth story into probably the worst smelling pile of vaginal birth medal bs that is available on the internet.

  6. sdsures
    January 9, 2015 at 3:27 pm #

    The stupid, it burns. Oy.

  7. Fab6
    January 9, 2015 at 9:27 am #

    This woman’s story has been going around my Facebook for the last couple of days, posted by NCB friends. I have tried to find words to describe how I felt about the article, and your have put it so well. Thank you. Thank you, thank you, thank you. “Dr. Keirns told a tale that was supposed to demonstrate what is wrong with contemporary obstetric practice, but, instead, demonstrates what is wrong with contemporary natural childbirth advocacy.” YES, thank you!!!!

  8. meglo91
    January 8, 2015 at 11:23 pm #

    I was biting my nails reading this lady’s account, fearful that it would end in stillbirth, loss of uterus, or something else awful. She dodged a bullet, stupidly, and is bragging about it. Let’s count the dumb stuff here: 1) she is 40 years old; 2) she is diabetic; 3) she has super high blood pressure (I’ve been on magnesium sulfate — it is not for wimps). And then she hemorrhages and her baby is born not breathing. What a great outcome! So much better than a c-section! Near death for the win! Awesome job, lady!

    • Samantha06
      January 9, 2015 at 8:57 pm #

      I would bet that she has never been a favorite with her colleagues even before her pregnancy. I bet all of them were dreading dealing with her.. I wonder what kind of reception she will get from her colleagues when (and if) she returns to practice? I hope she likes humble pie…

  9. Amy Tuteur, MD
    January 8, 2015 at 5:07 pm #


    • Guestll
      January 8, 2015 at 5:29 pm #

      I would pay good money to hear the other side of this story.

    • Guesteleh
      January 8, 2015 at 5:42 pm #

      Okay, so they just gave her mag for shit and giggles? And yes the fetus was distressed, he was born not breathing and needed resuscitation FFS! But let’s say Amy was wrong about all that. The mother was still an insulin-dependent diabetic, over 40 and morbidly obese so yes you crazy bitch you were high risk and needed a CS. Jaysus.

      • rh1985
        January 8, 2015 at 8:00 pm #

        Yeah, why else would she be on mag? That stuff is evil. I’ve never heard of it being used for anything other than pre-e and related disorders and pretermlabor.

        • Anj Fabian
          January 9, 2015 at 8:47 am #

          Mag is nasty stuff. It messes you right up from all reports.

          If she wanted to fight interventions that would have been an ideal place to stage her first battle.

          • Cobalt
            January 9, 2015 at 9:18 am #

            I had it for 36 hours-ish for preterm labor. Made my heart real slow and painful, like I had sand in my chest. Stopped dilating though and stayed pregnant another 5 weeks, so it beat the alternative.

            I know two others that have been on it, one was for HELLP syndrome (lost both babies, almost lost mom, 26 weeks), the other was preeclampsia (term, induced, everyone went home happy).

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

            When I had a mag drip just after labor it messed me up so bad. But when I had to go back for another two weeks later, it didn’t.

    • sdsures
      January 9, 2015 at 3:29 pm #

      Has she deleted your replies yet because they’re not all gooey and supportive?

      • January 9, 2015 at 4:36 pm #

        You can’t delete other people’s replies on Twitter. You can block them so you can’t see them, or report the person to Twitter, but that’s about it.

    • yugaya
      January 12, 2015 at 3:43 am #

      Her birth story has been shared over on Improving Birth fb page:

      The comments there are too funny, ripping her account to pieces and claiming that she had no idea what c-sections were really for, and that the induction was the only cause of all of her complications.

      IOW, Dr Keirns, natural birth movement is objecting to your vaginal birth medal based on you being completely ignorant and uneducated as far as birth is concerned. :)))

  10. January 8, 2015 at 4:28 pm #

    Mildly ot but – there’s a lot of whining about America’s increased C section rate and blame handed to insurance companies or over-zealous doctors. But a bigger reason is the aging of motherhood. More women put off motherhood now until their 30s or 40s, and like it or not, that’s simply more risky for both mother and baby.
    The new American woman at age 40 may look like a 20 year old of the past, but her reproductive system doesn’t act like that of a 20 year old. Not to say women should go back to the 1950s or anything, but medical intervention is simply more likely at 40 for good reason.

    • Guestll
      January 8, 2015 at 4:31 pm #

      Another big reason is the rise in obesity. Half of pregnant American women are overweight and a third are obese.

    • OldTimeRN
      January 8, 2015 at 5:09 pm #

      Yeah, you just can’t say there are to many c/s because each case has to be judged on a case to case basis.

      Like you stated the age of the older plays a big role. So does infertility which could be grouped with the game bracket. Obesity plays a huge role. I’ve never seen so many gest diabetics then I have in the last few years which leads to bigger babies, which leads to more sections. Then there is pregnancy induced hypertension whose babies are usually smaller, but if mom’s blood pressure keeps rising or lab work shows a deteoriating mother an induction might have to aborted and a section performed right away. There are some sick pregnant woman out there.

    • Young CC Prof
      January 8, 2015 at 8:55 pm #

      A woman in her late teens, expecting her first baby, has less than 20% chance of c-section based on current US data. By age 40, that’s over a 50% chance.

      That, and the fact that c-sections have gotten safer. It’s almost unheard of for a woman in the first world to die of complications from a c-section if she wasn’t close to death beforehand.

      A few generations ago, when c-sections were still very dangerous to the mother, for example, breech babies were allowed to just… come out breech. Some of the babies died of it, but skilled doctors or midwives saved most of them. Now, if there’s even, say, a 3% chance of the baby dying, most women would gladly choose a c-section.

      • Wombat
        January 12, 2015 at 5:50 am #

        For serious. I don’t -want- a C-Section, but over a dead baby (and even if you disregard that, possibly doing it all again just to face an even more likely section due to increased age and previous delivery/stillbirth)?

        Just duh. And knowing that I’ll likely be somewhat older for my first child (almost 26 and it is way more 5 year plan than 2 year plan atm, though we are at the point in the nearly six year relationship where if it happens, it happens) it’s just… rational that it’s on the table, regardless of complications. Age and risks of ‘normal’ delivery alone.

        But rationality really is the issue here, I’m increasingly convinced.

    • Dr Jay
      January 8, 2015 at 11:22 pm #

      And given the fact that the age of first time mothers isn’t likely to rise that much further (given the natural decline in fertility after the age of 40), there’s very little reason in my opinion to get hysterical about the CS “epidemic” or the “alarming rise in CS.” It’s likely going to be a self-limiting problem.

      • Young CC Prof
        January 8, 2015 at 11:48 pm #

        The maximum age of first-time mothers has reached a cap, but births to teens and women under 25 will probably continue to decline as they have for the past couple decades.

        • Roadstergal
          January 9, 2015 at 9:50 am #

          I hope they do, as access to LARC at low or no cost increases. It’s a good thing all around, but as you imply, it will likely increase the rate of C-sections by pushing the mean/median age of delivering moms upwards. Good on you, NCB folk, decrying by implication the ability of young women to control their fertility.

          • Medwife
            January 10, 2015 at 6:55 pm #

            With all the difficulty an “elderly primip” (cringeworthy term I know) entails, I would SO rather see more of them and fewer teenagers whose babies practically get sneezed out.

    • Fab6
      January 9, 2015 at 9:35 am #

      In addition, more mothers are obese, and more are having multiple births due to increased usage of fertility drugs/procedures. All increase the “Risk” of having a c-section.

    • fiftyfifty1
      January 10, 2015 at 5:41 pm #

      “The new American woman at age 40 may look like a 20 year old of the past”

      Honey, let’s not fool ourselves….

  11. dbistola
    January 8, 2015 at 4:19 pm #

    I think Dr. Amy deserves special props for the hilarious title. I have been chuckling all day.

  12. Haelmoon
    January 8, 2015 at 2:06 pm #

    I am a high risk obstetrician. I know full well that not all pregnancies produce a healthy newborn and that all moms will not come though pregnancy without harm. However, I am concerned about the current focus on the process of having a baby instead of the outcome of a pregnancy.

    To understand where I am coming from, consider that story. This was written by a physician who lamented that she barely escaped a c-section. However, look at the outcome – a baby that needed resuscitation and a mom with a postpartum hemorrhage. Hopefully the long term outcome for both will be good, but I don’t consider either a good outcome. How did avoiding a c-section improve things for mom or baby? The simple medical answer is that it didn’t. However, there is a faction on the internet (NCB believers) who thinks that a c-section would have been a worse outcome.

    I want to be clear. A vaginal delivery is a process by which to produce (hopefully) a healthy baby. A c-section is a process by which to produce
    (hopefully) a healthy baby. Complications can occur in labour, complications can occur with a c-section. I prefer that my patients have as uncomplicated delivery as possible; a healthy baby and mother whenever possible. The actually mode of delivery is trivial compared with the outcome.

    • SporkParade
      January 9, 2015 at 4:46 am #

      As a woman at the start of her childbearing years, it is terrifying to me that this article was written by a doctor. I can shrug off Ina May and her ilk (well, except that she let her baby die), but doctors may actually influence the practice of medicine. How much woo are you seeing among medical professionals these days?

      • Haelmoon
        January 9, 2015 at 2:43 pm #

        I think it is even more terrifying that she is in preventative medicine. Why can’t see understand that the offer of a c-section was a type of preventative medicine. Her physicians were trying to prevent the very same complications that she considers successful – a baby needing resuscitation and a mom with a PPH.

        It is true that most babies needing resuscitation are fine in the long run, but some are not. Is the mother’s experience really more important than the baby’s brain? I think not. We know that women will care for their children long after the delivery experience has passed. How many mothers truly want to look after a child with delays that could have been prevented by a timely intervention. Honestly, if they were truthful, none. The experience may seem important at the time, but it is such a small part of raising your child. Preventative medicine and obstetrics are the same – we try to reduce the risk of bad things happening. Some people who under go intervention may never have developed the complication, but we can’t be sure ahead of time. Why take unnecessary risk?

        • yugaya
          January 9, 2015 at 5:21 pm #

          Because according to trust birth dogma, unless your uterus actually ruptures to pieces there was never any real risk of it rupturing, unless your baby dies after monitoring picks up distresss there was no real distress to begin with and so on and so on…

  13. Guestll
    January 8, 2015 at 1:39 pm #

    Completely OT: the click-bait above the comments, one of the pieces is, “7 Rare Dog Breeds You May Have Never Seen Before”. The dog depicted is a Newfoundland.

    My country weeps.

    Carry on.

  14. Amy Tuteur, MD
    January 8, 2015 at 1:24 pm #

    More from Dr. Keirns:

    • staceyjw
      January 8, 2015 at 1:46 pm #

      ? I don’t see anything

    • Life Tip
      January 8, 2015 at 1:57 pm #

      And yet I believe she quotes the old “WHO guidelines say only 15% c-sections!1!!” in her article.

      Old guidelines indeed. Awkward.

      • yugaya
        January 8, 2015 at 3:37 pm #

        People who quote these guidelines are probably aware of the accompanying mortality rates in majority of the countries around the world that do have c-section rates 15% or lower. With a very, very few exceptions ( only Netherlands in 2010 report and that myth has been thoroughly debunked on this blog on several occasions), these are places where there is nothing good in obstetrical care to look up to, quite the opposite – these are the countries where cultural and religious ignoring of women’s rights, corruption, poverty or the deadly combo of all of these factors results in lack of access to proper care and c section rates that only complete idiots would recommend anyone tries to replicate.

        List of countries with c-section rates lower than 15% source global WHO report from 2010:

        Syrian Arab Republic 15.0%
        Ukraine 14.2%
        Armenia 14.1%
        Netherlands 13.5%
        Honduras 13.0%
        Saudi Arabia 13.0%
        Namibia 12.7%
        Montenegro 12.0%
        Moldova 11.9%
        Guatemala 11.4%
        Kuwait 11.2%
        Kazakhstan 11.0%
        Cape Verde 10.7%
        United Arab Emirates 10.0%
        Viet Nam 9.9%
        Philippines 9.5%
        India 8.5%
        Tunisia 8.0%
        Swaziland 7.9%
        Azerbaijan 7.6%
        Bangladesh 7.5%
        Libya 7.5%
        Pakistan 7.3%
        Ghana 6.9%
        Indonesia 6.8%
        Oman 6.6%
        Cote d’ Lvoire 6.4%
        Uzbekistan 6.3%
        Algeria 6.0%
        Chad 0.4%

        So yeah, nice try. Perhaps in order to put her money where her mouth is, Dr. Keirns wishes for her next pregnancy to move to one of the representative countries with the 10-15% c-section rate she quoted as ” the goal worldwide — and not warranted by concerns for fetal or maternal health”, and let us all know how that translates into reality.

        If she survives, which, with her list of conditions, would be only in case if she had access to obstetric care that most women in these countries can only dream of.

        • moto_librarian
          January 8, 2015 at 4:54 pm #

          Oh yes, let’s all aim for the level of care available to women in the developing world.

          I think I concussed myself when I headdesked.

        • Young CC Prof
          January 8, 2015 at 9:00 pm #

          The 10-15% limit probably makes sense if you are practicing in an environment where:

          1) The hospital’s resources are limited, so the death rate and serious complication rate from c-sections will be higher.

          2) Many women do not have the resources or the freedom to limit their family size, and may not be able to get medical attention for the next pregnancy.

          Under those circumstances, doctors should do a c-section only when there really is no other choice. But ultimately the goal should be to eliminate those adverse conditions.

          • Deborah
            January 9, 2015 at 11:08 am #

            When I was in residency we delivered a set of vaginal triplets on a woman from Africa (sorry don’t remember which country!!!) and she insisted on a vaginal birth, even to the point of disability or death of one of the babies, because she was planning on returning to her home country and was TERRIFIED of VBACing (or getting a cesarean) at home. We agreed with her reasoning, risk assessment, and went with her plan — and luckily got a good outcome. But normally the risk/benefit ratio of years past or rural third world areas do NOT apply to American medical practice!!!

          • Young CC Prof
            January 9, 2015 at 2:19 pm #

            I would also be afraid of that situation.

        • KarenJJ
          January 9, 2015 at 4:55 am #

          It also doesn’t make sense to be trying to reduce the c-section rate, when a population’s risk is increasing (older fatter mothers and more people with underlying conditions getting pregnant through IVF etc).

          There would have to be a significant technological change to identify women that are safely able to try for a vaginal birth as well as a women actually choosing to try for a vaginal birth.

          In all honesty I just don’t know many women that are so keen on vaginal birth that if they are taking some sort of risk to themselves or their baby. The slightest indication and a mother that is only planning a couple of kids and has had problems falling pregnant (eg me) – well I’d have to be really really keen on a vaginal birth to attempt a VBAC and I just wasn’t.

  15. FEDUP MD
    January 8, 2015 at 1:15 pm #

    She is giving female doctors a bad name.

    I had a similar situation with failed induction for post dates, ending in urgent c section due to meconium on AROM coupled with NRFHT.

    I heard many of the same things before and during my labor that she did (although I had no risk factors other than post dates). Turned out my OBs were right when they had a feeling my placenta wasn’t doing so well. The difference is I listened to my OBs and had a discussion with them because I knew they had my and my baby’s best interests at heart. Just like I do with all my patients.


    • NoLongerCrunching
      January 8, 2015 at 2:54 pm #

      Wat. What does her femaleness have to do with the fact that she’s an idiot? Does Dr Oz give all male doctors a bad name?

      • Roadstergal
        January 8, 2015 at 3:09 pm #

      • FEDUP MD
        January 8, 2015 at 9:05 pm #

        Her femaleness has nothing to do with her being an idiot, but until a man gives birth, we’re the ones with skin in this game. And she is the one putting herself up as a the standardbearer of an educated female doctor giving birth. All of my crunchy relatives are posting it like she is our representative, like “look, this is how even female doctors feel!” Well, I don’t think she represents us at all.

      • FEDUP MD
        January 8, 2015 at 9:07 pm #

        And if Dr. Oz talked about his own health and some stupid argument he got into about taking stevia for his own testicular cancer or such, and represented it as “look at how badly men’s health is treated by the system” then yes, he would be giving male doctors a bad name.

  16. staceyjw
    January 8, 2015 at 1:03 pm #

    Sounds like she is trying to convince HERSELF that she didn’t almost DIE and kill her baby too.

    What an asshole. I cannot imagine being her docs. They would have been in deep shit had she died, but she doesn’t are one bit about them, other than to complain. I do not believe her at all when she says they weren’t respectful.

    I am sure others reading can see the clear need for a CS. But I guess a blue, not breathing baby is an OK price for a VB…

    And SHAME on the editor that decided to publish this rubbish.

    • The Bofa on the Sofa
      January 8, 2015 at 1:23 pm #

      I am sure others reading can see the clear need for a CS. But I guess a blue, not breathing baby is an OK price for a VB…

      And a PPH.

  17. stenvenywrites
    January 8, 2015 at 12:36 pm #

    Have any of these nut cases ever seen a healthy c-section patient (I mean, someone who gets a non-emergency but still necessary section, or a planned section for medical conditions)? If you base all of your opinions about c-sections on crash sections or situations when the patient is exhausted and the baby stressed from a “failed” attempt at vaginal birth, then of course you’re going to think they must be avoided if at all possible. But if you were to see a mother (like, say, me) alert and comfortably chatting in the o.r. during the procedure and well-rested, unmedicated, and very happy to be leaving the hospital with a healthy baby in her arms 48 hours later, you might think you want to check this c-section thing out. There’s a lot of confirmation bias and self-fulfilling prophecy in their approach.

    • Dr Kitty
      January 8, 2015 at 12:50 pm #

      There’s video of me, taken about 2hrs after my elective pre-labour CS.
      I’m beaming, holding my lovely baby, who was sleeping after a nice nursing session, and telling my friend “this is definitely the way to have a baby”.

      • wookie130
        January 8, 2015 at 5:23 pm #

        You’re not kidding! If we want to place any value on the process of birth and the “experience”…both of my planned c[-sections were relaxed, pleasant, calm, and overall wonderful. My hospital stays weren’t far off of spa vacations. I’d take it any day over vaginal birth, honestly.

  18. horrified
    January 8, 2015 at 12:24 pm #

    As someone in the medical profession I am ashamed to read this post and the comments. While it is certainly legitimate to discuss the details of Dr. Keirns’ assessments and conclusions, she presents her story from the perspective of a patient trying to make choices and get a sense of what is going on. Our patients deserve our respect and care in vulnerable times, even if communication is difficult, and even if priorities and understanding of the situation diverges. The tone of these comments is outrageously disrespectful and shines a horrible light on the entire practice of obstetrics. In fact these shameful, insulting, humiliation-seeking comments legitimize the fears and suspicions many women have that their obstetricians (who we would expect would be on women’s side in the endeavor to deliver a healthy baby) might in fact be laughing at them behind their backs, even as they go through one of the most vulnerable human processes of giving life.

    • Anonymous
      January 8, 2015 at 12:25 pm #

      Ok horrified, so do you disagree with Dr. Tuteur’s assessment of the situation, if so, why?

    • A
      January 8, 2015 at 12:26 pm #

      Obstetricians ARE on women’s side in the endeavor to deliver a healthy baby. Which is precisely the reason why they do not agree to having a vaginal birth at all costs, hurting a mother and her child in the process. And if they have to come across as meanies because they won’t agree to supporting the mother’s every whim even when it’s dangerous, well it’s better than being responsible for one or two deaths.

    • PrimaryCareDoc
      January 8, 2015 at 12:28 pm #

      That’s right. We’re on the baby and the mother’s side. We want a healthy baby.

      horrified- what, exactly, do you do in the “medical profession”?

    • Guestll
      January 8, 2015 at 12:31 pm #

      Keirns presents her story from the perspective of a physician who had already made up her mind on the best course of action — not “from the perspective of a patient trying to make choices and get a sense of what is going on.”

      What does it mean to be “on women’s side in the endeavor to have a healthy baby?” You know that medicine isn’t like Burger King, you can’t just have it your way. Are obstetricians supposed to agree with stupid and risky choices, for the sake of being “on women’s side”

      Your tone trolling is duly noted.

    • A
      January 8, 2015 at 12:33 pm #

      Besides, go back and read what Dr. Amy wrote:

      “The second, simultaneous, story is one of poor bedside manner and poor preparedness for an emergency. That is a real story, too, and there is nothing that justifies that. Had Dr. Keirns chosen to write about her provider’s poor bedside manner and poor preparedness, she would have told a tale that is woefully familiar to anyone who has ever been hospitalized. She would have been raising an important issue that must be addressed: how to we treat patients with respect and dignity even as we struggle to save their lives? Unfortunately, that’s not the story that Dr. Keirns chose to tell.”

      We’re not criticising THAT story. We’re not criticising her for trying to tell THAT story. But the reason she wrote her post is not to tell THAT story, either. She wrote to brag about how she got her way, risking two lives in the process. That is what we don’t agree with, and I don’t think any person with some common sense could agree with it, or argue that it doesn’t deserve to be criticised.

    • CanDoc
      January 8, 2015 at 12:39 pm #

      As an obstetrician, I have two patients – a woman, and her fetus. The woman needs to be informed at all times of the situation including if I have concerns about protracted labour, infection, and risks to the baby by which there may be a lower risk of fetal harm with a Cesarean section. It sounds as though Dr. Keirns has spurned the attempts of clinicians to discuss the situation with her and willfully disregarded legitimate worries because of her dedication to a vaginal birth. I have worked with enough hundreds of L&D nurses over the years to know that they don’t run in and a panic over a recurrently “lost baby” or tracing, they just pop in, say, oops, we aren’t tracing the baby (or “we lost the baby”, whatever), let’s fix this. If they’re that concerned they discuss an internal monitor. One gets no appreciation that she is trying to “make choices and get a sense of what is going on” – all one reads is that she has her own agenda and priorities, namely a vaginal birth, and claims that anyone who dares to question her birth plan is incompetent.
      In spite of this, my main problem with Dr. Keirns is that as a physician she is a professional and needs to remember that her words will carry great weight. And yet, she propagates scientifically unsound speculation as fact (optimal cesarean section rate, vaginal birth as “best” for all except twins and breech, and other falsehoods). Because of who she is, she will not be fact-checked or questioned.
      And yes, patients like her, who are hostile and denigrate my expertise rather than engaging in actual conversation, are my worst nightmare, because they cannot be reasoned with, even at times of grave danger to themselves and their infants. Fortunately, this particular brand of narcissism is exceedingly rare in my community – most of the NCB crowd are interested in being involved in the decisions and process around their care, not just telling me how much more they know. Since I’ve only delivered 3000 babies or so.

    • Anonymous
      January 8, 2015 at 12:39 pm #

      So what do you do in the medical profession? After reading the article I see no issue with what the OBs did. The patient is an older woman, with complications including diabetes and other serious symptoms.

    • moto_librarian
      January 8, 2015 at 12:44 pm #

      Save your pearl clutching for somewhere else. Dr. Amy made it quite clear that there were very real issues with bedside manner and preparedness, but it is disingenuous for the author of the original piece to leave out key pieces of her story. This doctor is demonizing c-sections when her delivery is Exhibit A for why they can be necessary. A 40 year old primip with preexisting diabetes (or did you miss the part where she needed insulin in her first trimester), morbid obesity (she didn’t mention that either), pre-eclampsia (why else would she be on magnesium sulfate?), and symptoms suggestive of HELLP is about as high risk as a patient comes. She got her vaginal birth, and I surely hope that her son doesn’t pay for it.

    • Life Tip
      January 8, 2015 at 12:59 pm #

      The patient received respectful care. She was rude to her healthcare providers. They continued doing their job, ultimately saving her life and the life of her baby.

      And then she went out, bragged about her unsafe choices and bitched about her providers all over the internet. And to make matters worse, she’s encouraging others to make similarly bad choices.

      Who exactly is acting shamefully here? How does this reflect badly on the entire practice of obstetrics? What about her situation makes her above reproach?

      • The Bofa on the Sofa
        January 8, 2015 at 1:21 pm #

        I will make the comparison again. Suppose it was a case of her insisting on driving drunk and all her friends trying to talk her out of it. She goes through with it, and makes it home. Oh sure, she ran over the garbage cans and her kids bike in the driveway, but the garbage cans have been replaced and her kids bike is fixed. So at this point, all is well.

        Now apply Life Tip’s comment:

        And then she went out, bragged about her unsafe choices and bitched about her providers all over the internet. And to make matters worse, she’s encouraging others to make similarly bad choices.

        Who exactly is acting shamefully here? How does this reflect badly on [her friends, who tried to convince her to not drive drunk]? What about her situation makes her above reproach?

    • staceyjw
      January 8, 2015 at 1:04 pm #

      You have a reading comprehension problem, apparently.
      I would explain why, but its really not worth it, I doubt you would bother to understand.
      I do know if this mom had managed to kill herself, her baby, or both, you would be here bemoaning how awful OBs are.

    • PrimaryCareDoc
      January 8, 2015 at 7:32 pm #

      No return parachuting. I’m kind of starting to suspect that “horrified” might be Dr. Keirns.

      • Samantha06
        January 8, 2015 at 11:45 pm #

        I was thinking the same thing…

    • Stacy48918
      January 8, 2015 at 8:08 pm #

      “on women’s side in the endeavor to deliver a healthy baby”
      Except women like Dr. Keirns who are endeavoring to deliver a baby SPECIFICALLY vaginally only. The process was Dr. Keirns’ primary goal – “escaping” a C-section.

      Doctors ARE on the side of healthy babies…but sometimes the mothers themselves aren’t. They have other priorities that lead them to take horrific risks with their baby’s life…like Dr. Keirns did.

      • Medwife
        January 8, 2015 at 8:30 pm #

        A healthy baby is their priority too. But they KNOW their babies are healthy and will continue to be healthy. The rest of us aren’t privy to that knowledge. That’s the problem. They are not statistics. They are special.

        I wish!

  19. lilin
    January 8, 2015 at 12:20 pm #

    I want to ask these people if there are any other situations in which a procedure that causes your child to turn blue and stop breathing would be considered a success.

    I’m guessing there aren’t.

    • namaste863
      January 8, 2015 at 12:28 pm #

      NASA called Apollo 13 a “Successful failure” in that the original objective of landing on the moon was aborted when disaster struck, but the crew returned to Earth safely against some pretty horrific odds. The same line of reasoning applies here, I suppose. Everyone survived this obstetrical disaster, even if it was by only the narrowest of margins.

      • Roadstergal
        January 8, 2015 at 1:49 pm #

        If the Apollo 13 crew had some evidence of the issue with the O2 stirrer/heater that had burned its fuse open and burnt off its insulation, and decided they had some moral obligation to use that tank and that detanking procedure anyway, I’d think the situation would be more comparable…

        Of course, one of the things that, to me, constitutes a ‘successful failure’ is the bit where you and everyone else learns from the mistakes. A plane crashes, and an extensive investigation starts with the aim of finding out what went wrong and preventing it in the future. Not a celebratory high-fiving that most of the passengers survived.

      • KarenJJ
        January 9, 2015 at 5:02 am #

        I like the term “successful failure”. It describes a lot of engineering.

  20. Bethany Barry
    January 8, 2015 at 12:07 pm #

    I mulled this one over overnight. I think what bothers me most is that a
    specialist in preventative medicine can fail to understand that she was not
    trading a delivery aided by medical intervention for a “natural,” intervention
    free birth. She was choosing one set of interventions over another. And what she chose was a less effective set of interventions, to no gain whatsoever. She still suffered. Her baby still suffered. Her spouse still had what was probably a pretty traumatic day. She suffered more, perhaps, than she would have had she had the dreaded c-section.

    And yes, it’s not cool to say apparently, but she did end up costing her care team a tremendous amount of time and physical and emotional stress (and her thank you is apparently a middle finger in the air). I know the patient comes first, but the NCB movement seems to have zero appreciation for the fact that you are asking a room full of human beings who have made caring for others their life’s work to watch you try your very best to passively kill or at least seriously injure yourself and possibly a helpless baby. NICU teams aren’t made of up of robots, wheeling in to clean up your mistakes.

    • Ash
      January 8, 2015 at 12:13 pm #

      So much going on in the article. I can’t even. At thirty-six weeks, the disliked MFM doc told the author about the high risk of C-sections. Author was also in a priviliged position as a physician, access to all the medical journals and expert OBGYN advice she wanted–she undoubtedly knew that a section was a real possibility.

      “If we couldn’t have an honest discussion about the physicians’ fears about my delivery,”

      She was talking to MFMs in her FIRST trimester! She was in the hospital for labor induction for TWO DAYS.

      But there wasn’t an opportunity for discussing your concerns with your care team? to put it in the language of the Internet, r u srs?

      • B. B. Walsh
        January 8, 2015 at 12:39 pm #

        PURE, IRRESPONSIBLE CONJECTURE ALERT: When I read “”If we couldn’t have anhonest discussion about the physicians’ fears about my delivery,” I hear “the physician told me something I did not want to hear, something I am afraid of, and rather than listen to my weak arguments against his expert opinion, he kept repeating the thing I didn’t want to hear.” The fear here is not with the MFM specialist, the fear is with Dr. Keirns. She feared a c-section more than she feared death (because she could surgery is a big-bad she can except as real more readily than she can accept her own mortality.

        • anonymous
          January 8, 2015 at 12:45 pm #

          There’s an unspoken rule at my hospital that women in labor are considered irrational until proven otherwise. A few years ago we had a female OB come in with almost the same set of complications and she flat out lied to us about eclampsia until she had a seizure in front of us. Afterwards her only response was a teary “I just wanted a normal birth” despite the myraid of issues she was having. She even admitted later that if it had been one of her patients she’d have done a c-section immediately.

          • B. B. Walsh
            January 8, 2015 at 5:37 pm #

            I agree, although as someone who works in another branch of medicine I’d say that “unspoken rule” extends to anyone who is frightened and/or in pain, especially if they are ashamed of being frightened and/or in pain.

          • SporkParade
            January 9, 2015 at 6:05 am #

            That’s an unfortunate rule, if only because many NCBers use it to justify denying an epidural to women who ask for it. “Oh, she’ll thank us for delaying until it was too late afterwards.” The Lamaze website even promotes doing just that.

          • Roadstergal
            January 9, 2015 at 11:11 am #

            I think it’s still valid when you combine it with the comment below. A patient in pain is less rational than a patient not in pain, therefore safely lessening that pain is practically a moral obligation.

          • Young CC Prof
            January 9, 2015 at 2:19 pm #

            I would say it makes sense to believe a woman in labor if she says things are not OK, but NOT to believe her if she says things are fine, especially not if objective evidence says otherwise.

          • Thankfulmom
            January 9, 2015 at 8:23 pm #

            How could she lie about eclampsia? Wouldn’t her bp have been sky high?

  21. Bethany Barry
    January 8, 2015 at 12:06 pm #

    How would Dr. Keirns feel if one of her patients rejected all of her expert advice, became desperately ill, and then wheeled into the office with the team of nurses and beeping machines keeping him alive in tow, only to flip her off and gloat over how he proved her wrong by still being alive?

    • attitude devant
      January 8, 2015 at 1:12 pm #

      When I was in labor with my second and my blood pressure hit 170/110, my partner said he’d need to start Mag. When I opened my mouth to say something, he said, “What would you do if you were in my shoes?” That shut me right up.

      • sdsures
        January 11, 2015 at 10:50 am #

        I’m not a medical professional, so could someone please explain to me what magnesium does in terms of pregnancy, and why it’s hard on the patient?

      • Medwife
        January 12, 2015 at 11:17 pm #

        Question- did you feel as you would have expected to feel with a bp that high? Headache, visual changes, generally “not right”?

        • attitude devant
          January 13, 2015 at 9:44 am #

          No. I was mildly puffy. That’s all. I felt fine. Instructive, isn’t it?

          • Medwife
            January 13, 2015 at 1:04 pm #

            Very. I have seen a lot of women who present with these ridiculous bps but feel fine, but if it was me I can imagine feeling a little incredulous. Symptomatic women are the lucky ones!

  22. PrimaryCareDoc
    January 8, 2015 at 12:04 pm #

    I wonder if she had to have ART to conceive. Given that the chance of a woman over 40 getting pregnant spontaneously is only about 5% per month, and a BMI over 40 (which she certainly has) decreases that tiny chance by 26-43%, my guess is that it is very unlike that she conceived naturally.

    I’m always amazed by women who are happy to accept Western medicine in all of its glory to help them conceive, but snub their nose at it when it comes time to deliver.

    • Guestll
      January 8, 2015 at 12:11 pm #

      I’m not. I was 40 and had ART to conceive my one successful pregnancy. I know a lot of women who’ve had high tech conceptions and want to feel like they’ve at least done something “natural” when it comes to birth. I was one of them.

    • Guestll
      January 8, 2015 at 12:19 pm #

      I think your characterization is unfair. I went through multiple cycles of ART, multiple losses, spent tens of thousands of dollars and over a year of feeling like a human guinea pig, and I did it because I wanted a baby, not because I was happy to accept it. There’s a shade of difference there. I wanted a sense of control over my body back, to feel like something wasn’t being DONE to me all of the time. Is it rational? No. Was it the right thing to do? No. Is it strange or unusual to feel that way? No.

      • PrimaryCareDoc
        January 8, 2015 at 12:30 pm #

        Guestll- I’m sorry if I hurt you. I certainly understand WANTING things to feel in control after such an arduous experience. What I really can’t understand, though, are women who actually go through with a risky birth plan when they’ve gone through so much to get pregnant (I’m thinking of the case at hand and also the woman who lost her baby in the planned breech homebirth at the hands of Karen Carr).

        • Guestll
          January 8, 2015 at 12:38 pm #

          I don’t see why women who’ve used ART to conceive should be held to a different standard than those who haven’t. Risky birth plans are stupid all around, risking a baby’s life (or yours) is not cool no matter how the baby got in there.

          You might not understand it, and I wouldn’t have before I went down that path, but I do now.

          Thanks for your apology.

          • stacey jw
            January 8, 2015 at 1:12 pm #

            Because ART is the height of technological baby making! It makes zero sense, to an outsider, that technology was fine to help make the baby, but it’s not wanted come delivery time. Im sure it looks different from the inside, where emotions are high, but to the observer, why is one technology considered OK, and the other reviled?
            Its not a slam against anyone, just an observation.

          • Guestll
            January 8, 2015 at 1:27 pm #

            I get that the though process doesn’t make sense. But it isn’t a rational thing.

            I will say though that part of what motivates my thinking now in hindsight is the notion that as a mother, as a pregnant woman, I am in some circles (especially infertility circles, ironically enough) held to a higher standard than women who haven’t had to pursue ART in order to become mothers. My birth choices, my parenting choices, the choices I made while pregnant, were viewed in that context, and it was not helpful. One instance: I can clearly recall a family member chastising me for having a glass of wine at Christmas when I was in my second trimester. “I just don’t get why you’d have a glass of wine, when you went through all of that.”

            Extrapolate that thinking to pretty much every choice — why CVS, when you went through all of that? Why try for a vaginal birth, why not have a section, when you went through all of that? Add to that: You’re going to be such a good Mum, you waited so long and went through all of that.

            I believe this elevated standard contributes to the fact that the rate of PND is higher for women who’ve undergone ART. Because you believe it yourself — I went through all of that — therefore I must do my best to be a better mother.

            I just don’t think women who’ve undergone ART should be held to a different standard with respect to foolish birth choices. Yes, I get why people like you and others feel the way you do. But again — stupid choices are stupid choices, no matter how the baby got there.

          • PrimaryCareDoc
            January 8, 2015 at 1:35 pm #

            Thank you for sharing your experience with us. I’m finding it really helpful and I think it will help me to be more understanding!

          • Guestll
            January 8, 2015 at 1:44 pm #

            You’re welcome.

            It was my RE who recommended midwifery care (RM, Canada). Many of her patients (she specialized in AMA women) ended up choosing midwifery over an OB. If I did it all over again, I wouldn’t make the same choices. But I understand why I did and I know why my RE (who was amazing) referred to RMs.

          • Cobalt
            January 8, 2015 at 6:24 pm #

            Thank you for sharing this experience, I hadn’t thought of it and will benefit from the perspective.

          • KarenJJ
            January 9, 2015 at 5:10 am #

            I would love to see some info on the rate of anxiety for new mums, and mums that had ART. I passed all the PND stuff happily but looking back my anxiety levels were through the roof.

          • KarenJJ
            January 9, 2015 at 5:08 am #

            I’m an insider, in that I required IVF. The one thing that does make sense to me was the idea I had that my body wasn’t doing its female duty and I saw a natural birth as a way to try and “redeem” it somehow. That failed, so I then focussed on breastfeeding, which also failed. I’m over it all now, especially considering a need a daily medication to keep healthy. Bodies are bodies and one is not more deserving than another.

          • attitude devant
            January 8, 2015 at 1:15 pm #

            We hear you. We really do. I can see some idiot like BWF, who seems to get pregnant at the drop of a hat, not thinking through her risks. But for someone whose pregnancy was established at great cost and risk to take big chances is odd to us.

          • wookie130
            January 8, 2015 at 6:10 pm #

            While I completely agree with what you’re saying as a woman of advanced maternal age who needed ART to conceive my first child, I do understand the point PrimaryCareDoc is making as well.

    • Ainsley Nicholson
      January 8, 2015 at 1:21 pm #

      I’m one of those rare women who concieved easily after age 40 (first cycle), but that didn’t make me consider my baby to be any less precious and irreplacible than one that was concieved with the help of ART. I think that a woman’s susceptibility to the NCB mythology is unrelated to their acceptance of western medicine in other aspects of their medical care. I’ve never heard of anyone refusing painkillers at the dentist because “it is better for me and my teeth” or insisting that an abcessed tooth be allowed to rot and fall out because “some teeth just aren’t meant to live”.

  23. namaste863
    January 8, 2015 at 12:01 pm #

    Denial- Not just a river in Egypt. Everyone involved dropped the ball here, from the mother, an MD with the education to goddamn well know better than to treat her multiple risk factors with such shocking nonchalance, to her caregivers, who, IMHO, should have said to her “Get your head out of your ass! This could be a riskier situation, but I don’t know how!” And of course the baby ultimately ends up paying the price for it, and is treated as nothing more than collateral damage. What a tragedy.

    • A
      January 8, 2015 at 12:13 pm #

      When told that if she weren’t a doctor she’d have been scheduled for a c-section already, her thoughts are that she’s getting preferential treatment for being a doctor and “oh these poor women who get forced c-sections because they aren’t doctors like me, this should be brought to public attention so they don’t have to get any more forced c-sections!” She’s just too clueless to realise that by trusting her better judgement, her doctors weren’t doing her any favours – she still made the wrong decision, even if it didn’t end in death.
      I don’t blame the docs as much, to be honest – there is only so much they can do, and they can’t treat a patient who refuses treatment, and she was very clear about not wanting to get a c-section without any regards to risks.
      (According to her story, though, the doctors somehow were going to force a c-section on her by any means, despite the fact that, huh, I don’t know… They actually let her give birth vaginally even when it was an awful choice for her and ended badly. But they only let her because she was a “warrior mama”, I guess?)

  24. A
    January 8, 2015 at 11:43 am #

    I have a hard time trying to picture any better candidate for a c-section. I mean, what other risk factors could she have had? Twins? Breech? What would have convinced her that a c-section was needed? Oh, wait, I know the answer to that one: nothing. Besides, it’s not like anyone died! In the NCB world, that’s a success story.

    • Ash
      January 8, 2015 at 11:46 am #

      ” If my baby had been breech or I had twins, the evidence supports
      Caesarean delivery as the safest approach. But I didn’t. I also didn’t
      have other complications that would have made C-section important for my
      safety.” –WaPo

      • PrimaryCareDoc
        January 8, 2015 at 11:48 am #

        So glad she was concerned about HER safety. Forget about the baby.

        • A
          January 8, 2015 at 11:54 am #

          Good thing she didn’t have other complications. So I guess advanced maternal age, morbid obesity, insuline-dependent diabetes, pre-eclampsia and bloody urine, ending in hemorrhage and a blue baby, are all variations of normal. Good to know. She was a perfect, low-risk candidate. Should have tried a homebirth too, or what the hell, an unassisted homebirth while she was at it! After all – what could possibly go wrong?!

          • PrimaryCareDoc
            January 8, 2015 at 11:58 am #

            She should totally go for a home birth for her next baby!!!

            Just kidding (only because an innocent baby’s life is at stake).

      • Guestll
        January 8, 2015 at 11:54 am #

        She was an elderly obese primip with diabetes, pre-e, and possible HELLP.

        I don’t even know what to say to this fuckery.

        • Ash
          January 8, 2015 at 12:02 pm #

          My opinion as a lay person–I’m somewhat surprised that the MFM practice didn’t offer a pre-labor c-section at term as an option. Maybe they did, or maybe they didn’t since it’s clear that the author values vaginal delivery.

          If I were a 40yr old insulin dependent woman (even if the other risk factors did not exist), a vaginal delivery would not be very important to me. I wouldn’t be worried about future sections, as I would be unlikely to have many more biological children.

          • Guestll
            January 8, 2015 at 12:08 pm #

            Who knows what the MFM did or didn’t offer since we’re only getting Keirns’ side of the story. I wouldn’t knock a 40 year old woman for wanting a vaginal delivery if her rationale was more children, it’s not unheard of though it’s obviously much more difficult to conceive beyond 40 and the risks climb appreciably. I don’t have a problem with wanting vaginal birth for any reason (I was 40, I wanted one, I didn’t want more kids), it’s when the desire for one trumps common sense that gets on my every last nerve.

            Dr. Keirns got hers, at all costs, and she and her son narrowly dodged a bullet meant for both of them that in nature would have hit the mark and likely killed them both. Ain’t no mag sulfate or machine that goes ping in nature.

          • Ash
            January 8, 2015 at 12:18 pm #

            This is true. The author knew the risks of continuing labor induction, the care team did their best to keep her going (induction, insulin, magnesium) and it was Dr Keirns’ decision to continue. But she can’t pretend that it is absurd that her team wanted to “talk about having a cesarean” or say that “epidemiological data suggest was safest
            for both of us and for any future siblings”

          • Roadstergal
            January 9, 2015 at 11:14 am #

            I keep falling over the idea she had that Data Suggest That Vaginal Delivery Is Safest. No, sorry. You do not get to look at population data and totally ignore very specific and relevant factors in your case. Please turn in your ‘preventive medicine’ badge, because you suck at it.

          • Young CC Prof
            January 9, 2015 at 2:18 pm #

            The population data suggest that I should be three inches shorter than I am. Is this a problem?

        • anonymous
          January 8, 2015 at 12:52 pm #

          Morbidly obese

      • Mer
        January 9, 2015 at 2:05 am #

        My first thought when I read that line was, yeah they kinda do those for the baby’s safety. My second thought was, and for mom too when she’s sick and baby needs to come for her sake, like when she has pre-e and the cure is to not be pregnant anymore. Just ignore that bruised callus on my forehead, I’ve been head-desking a little too much lately.

  25. Life Tip
    January 8, 2015 at 8:58 am #

    I wonder how her doctors are feeling right now. I know they are professionals, but they are human beings as well.

    Doctors provide excellent medical care that allow mom and baby to survive pregnancy.
    Doctors provide care during labor, tell her what she needs based on the reality of her situation and what’s best for both mom and baby.
    Patient ignores/denies their advice, calls her friends instead.
    Patient makes stupid choices, doctors continue to give her the best recommendations possible while still respecting her autonomy.
    Shit happens, exactly what doctors tried to avoid.
    Doctors save mom and baby’s life.
    Patient responds by…shitting all over her doctors/nurses on social media.

    Do doctors ever just want to stand up and scream, “I just saved your fucking life, you moronic ingrate?”

    Because I sure would.

    • Karen in SC
      January 8, 2015 at 11:37 am #

      I hope these doctors have printed out and archived this.

    • PrimaryCareDoc
      January 8, 2015 at 11:42 am #

      I wonder if she delivered at the hospital at Stoneybrook, where she works. Awkward.

  26. Amazed
    January 8, 2015 at 4:08 am #

    She’s a cautionary tale about the way some patients are in denial. I really, really hope that she won’t turn into a cautionary tale about the way some patients sue because doctors didn’t save them from their own stupidity when they refused to be saved because denial. For her baby’s sake and yes, the medical professionals who treated this insulin dependant, pre-eclamptic, 40-year old morbidly obese walking disaster, I sincerely hope so.

    • attitude devant
      January 8, 2015 at 1:27 pm #

      There was a big case in Philadelphia where a mom refused c/s, refused, c/s, refused c/s…..and then sued her doctors for failure to do a timely c/s. So it happens.

      • Amazed
        January 8, 2015 at 3:37 pm #

        Why am I not surprised? And I can bet our collective asses here (all of us, or maybe our only ass since we’re all Dr Amy in dusguise running around here) that in this case, she won’t present herself as this informed physician who made her educated choices but the poor mom failed by her providers.


      • Samantha06
        January 9, 2015 at 12:04 am #

        And she probably won too… damned if you do, damned if you don’t..

  27. Samantha06
    January 8, 2015 at 12:33 am #

    It’s bad enough reading garbage like Keirn’s article day in and day out from the NCBers, but from a doctor? How pathetic. Surely she had to have some clue how sick she was! She should have been a scheduled C/Section. I don’t know that even Aviva Romm is that stupid.. well.. maybe not the same level of stupid.. but my God, this woman is just a piece of work. I’m glad you called her out, Dr. Amy, she deserves it!

    • Guesteleh
      January 8, 2015 at 11:32 am #

      Aviva Romm isn’t stupid, just opportunistic.

      • yugaya
        January 8, 2015 at 5:36 pm #

        She threads the line of liability so well. In total support of homebirth as a medical doctor in terms of education and medical authority position, but not willing to put her medical license on the line for it.

  28. DaisyGrrl
    January 8, 2015 at 12:17 am #

    Reading her account of the birth, I am really having a hard time understanding why a c-section would have been such a bad thing. Labour for days, all kinds of drugs and monitoring, pph, blue baby??? And then she was too exhausted to hold him!

    Contrast with pre-labour c-section (or getting one at least a day earlier) where her baby would have been much better off, she probably wouldn’t have hemorrhaged, and she would have had the energy to enjoy her son’s first few hours of life.

    She’s not making a great case for vaginal birth here.

    • yugaya
      January 8, 2015 at 9:52 am #

      She is making a case for vaginal birth at any cost. Luckily, she did not end up like Maria Zain making that case at all costs by paying the price with her life.

  29. Ash
    January 7, 2015 at 11:57 pm #

    Oh, this makes me sad. From the WaPo comments, a father recounts his wife’s labor. She had started labor intending to deliver vaginally without an epidural. “Finally we went with the epidural. She said, “I’m sorry, I’m sorry honey!” I don’t know why.” It makes me sad that she apologized to someone (baby? Father?) for getting an epidural. No one should feel like that.

  30. Life Tip
    January 7, 2015 at 11:56 pm #

    It’s baffling that her entire experience points to a reality that is basically the exact opposite of the conclusion she makes. Kind of like the MANA stats clearly show the exact opposite of what MANA claims they say.

    Do they think people won’t notice or something? It’s just bewildering.

    • Ash
      January 8, 2015 at 12:03 am #

      A bunch of WaPo commenters think that induction was the mistake (despite that the author doesn’t go there ).

  31. Amy Tuteur, MD
    January 7, 2015 at 10:30 pm #

    Twitter exchange with Dr. Keirns:

    • January 7, 2015 at 11:22 pm #

      Oh, I am looking forward to more of this exchange.

    • MLE
      January 7, 2015 at 11:39 pm #

      Because life ain’t fair.

    • Guesteleh
      January 7, 2015 at 11:47 pm #

      Ugh, her response to you. So why was she on a mag drip?

      Wow @ATuteur You can diagnose HELLP syndrome without vital signs, labs, or clinical exam. Amazing.— Carla Keirns (@CarlaKeirns) January 7, 2015

      • Laura Thomas
        January 8, 2015 at 12:00 am #

        You wrote, “Possible HELLP syndrome.” And you don’t need a specific diagnosis to know that all those risk factors greatly increase her and her baby’s chances for an adverse outcome, like hemorrhaging and a blue baby. And those are the minor possibilities!

        • Deborah
          January 10, 2015 at 1:29 pm #

          Either HELLP, or the baby’s head is putting so much pressure on the bladder that it’s bleeding, which if it goes on for many hours puts her at risk of fistula. Neither choice is really awesome.

  32. Sue
    January 7, 2015 at 10:05 pm #

    OT: Australia marshalls its forces against the misinformation of anti-vax Ohio DO, Sherri Tenpenny:

    • Mishimoo
      January 7, 2015 at 10:13 pm #

      I truly hope that the rest of her tour is cancelled (as well as her visa) because I have heard that they will lie in order to book venues.

  33. OldTimeRN
    January 7, 2015 at 10:01 pm #

    This patient sounds like a nightmare. I’m sure she knew it all. She read all the books, attended all the classes and joined all the FB groups.

    I’m sure she refused pacifiers, sweet ease for painful procedures, sugar water, breast shields and baby formula. Rooming in of course! I bet baby nursed well at first but they was sleepy and wouldn’t nurse. She probably wanted to cry and was getting frustrated. By day 2 she was more then likely weepy and exhausted because her once sleepy baby realized he wanted to eat. And wanted to do so every hour. More then likely she was getting frustrated with nurses, whom she previously refused help from for not helping her enough and blaming them for her baby losing 10% of his weight and now we’ve ruined her dream of breastfeeding. It’s all their fault!

    We can see this type of mother coming from a mile away.

    • ninswhim
      January 8, 2015 at 7:14 am #

      I actually do blame the nurses a little for the opposite problem. I was a first time mom, was trying breastfeeding and they kept telling me it looked good while my baby got sleepier, yellowed, rapidly rising billirubin, had orange urine and lost more and more weight. I kept asking if I should offer a bottle and they said it wasn’t necessary because he hasn’t lost quite enough weight yet. They sent me a lactation consultant who said to nurse then pump every two hours around the clock.

      The pediatrician the day after our discharge was the one who told me what jaundice actually was, that my son had now lost 12% of his body weight and that we were almost in need of readmission! My spouse and I spent the first week of our healthy full term, uneventful delivery boys life terrified, urging him to wake long enough to eat. My milk came in eventually as it should but his latch was never great. Maybe if he hadn’t been jaundiced and exhausted in those early days we’d have done better?

      All I know is I feel misled by the hospital nurses and pediatricians about what was happening to my son and what the risks of not supplementing were. Come to find out the hospital was going for baby friendly status and getting graded on me nursing exclusively at discharge. They pushed off telling me to supplement on my son’s pediatrician and put my son at risk. Maybe not a high risk, but it should have been my call based on all the info!

      • EmbraceYourInnerCrone
        January 8, 2015 at 9:03 am #

        I honestly don’t get this…health care professionals basically endangering a baby’s health and not concerned even though the baby is obviously not getting enough to eat and the mother is exhausted but they tried to preserve the “exclusive” breastfeeding label so its all good! WTF. I am glad you and your bably are Ok, but I think Baby Friendly is very Baby UNfriendly.

      • lawyer jane
        January 8, 2015 at 12:54 pm #

        I had a similar experience. They discharged us noting elevated bilirubin and a loss of 8% bodyweight, but nothing advised except to keep on breastfeeding. The ped the next day immediately said “formula” and it was like our baby sprang to life immediately after he got those 2 oz in him, and a trip to the lab for a pretty traumatic heel stick to measure his bilirubin levels.

        I think this is related to the baby friendly hospital nonsense – they get “points” for discharging a breastfed baby, so they push it to the limit.

      • Young CC Prof
        January 8, 2015 at 2:33 pm #

        In my case, I think the nurses just dropped the ball. My son was discharged 11% below birth weight, and NO ONE TOLD ME. By the next day, he was down 14%, with jaundice right on the edge of brain damage territory. He was readmitted, and he never breastfed.

        I was willing to supplement, in fact I actually did, but I didn’t supplement enough, because no one told me how to supplement, and because I was allowed to believe that what we were doing was working when it clearly wasn’t.

      • Mer
        January 9, 2015 at 2:21 am #

        I frequently hear these horror stories about breastfeeding babies getting severe jaundice. I’ve gotta say that I think the exclusive breastfeeding regime might be doing some harm. Every single baby that has had jaundice that was cause for concern was breastfed and usually the mom was attempting to exclusively breastfeed. My own anecdotal experience was that my EBF baby developed jaundice levels that were concerning but the baby that was supplemented formula (for being a giant hungry 10 pounder with borderline low blood sugar) had zero problems with jaundice, even though he was at higher risk from a rough delivery. We actually managed to go 9 month EBF so those few oz of formula didn’t hurt that, and may have saved us from a lot of worry. I think it’s something that might need to be studied but perhaps it’s just been in my group of friends and not the general population.

  34. junebug
    January 7, 2015 at 9:54 pm #

    Unsurprisingly, the feminist breeder and friends think this is an amazing and important piece, have no idea why it’s horseshit.

    • Life Tip
      January 7, 2015 at 11:46 pm #

      Either they are delusional, stupid, or didn’t actually read the article.

      Or all of the above, I guess.

    • yugaya
      January 8, 2015 at 10:04 am #

      As long as it is natural horseshit it’s all good and useful for furthering their cause.

  35. Sue
    January 7, 2015 at 9:52 pm #

    Her story reads like a person who has had medical education, but been out of clinical practice for a long time. And lacks insight.

    The most recent deliveries she has seen were as a medical student. She is now forty – about twenty years later.

    She second-guesses her care team WHILE IN LABOR – asking for advice over the phone from friends. WOuld these friends be prepared to be held to account for the outcomes of their advice? Why wouldn’t they be encouraging her to work together with her own – extensive – care team?

    A clinician with patient-care responsibilities should understand risk-assessment and decision-making, with safety in mind. The fact that they allowed her to keep stalling, against their better judgement, shows that they DID consider her opinion. I hope she develops some insight over time.

  36. Sue
    January 7, 2015 at 9:48 pm #

    ”When I talked over what happened later with clinical colleagues, the consensus was: “If you weren’t a doctor, you would have been sectioned on Wednesday.” “”

    What an irony. If she hadn’t fought against her medical team, she and her baby could have been saved all that danger, bleeding and hypoxia.

    • Life Tip
      January 8, 2015 at 8:45 am #

      And it’s another point of her narrative that invalidates her own conclusions. She was told a c-section was the best option (excuse me, “pressured” to have a c-section) and yet was not forced to have one. Her autonomy was not violated even though she was making irrational, stupid choices.

      And the outcome (oxygen deprived baby and bleeding mother) show that her doctors were right in the first place.

      So, what’s her point exactly?

    • Kelly
      January 8, 2015 at 12:45 pm #

      Can’t believe other medical professionals were encouraging this. Sounds like that department has been infected with woo.

      • Mel
        January 8, 2015 at 9:14 pm #

        Or the author is oblivious to the looks of abject horror on the face of her terrified colleagues.

  37. CanDoc
    January 7, 2015 at 9:39 pm #

    I thought maybe you’d cherry-picked the full WP piece for good quotes, but alas, the ENTIRE PIECE is one train wreck of a quote. I should not have read the WP article. Now I can’t bleach my eyeballs, and my blood is boiling. Of all the narcissistic, selfish, unscientific bits of medical tripe, this is one of the worst because it comes from a clinician. She brushes off magnesium, IUPC, insulin, protraction disorder, as if they were scenery, not major risk factors for a DEAD BABY… then she wound up with, oh right, almost a dead baby. Or at least, a limp blue one. I wonder if she’s friends with Aviva Romm.

    • Ash
      January 7, 2015 at 9:40 pm #

      Don’t miss the fun of the full Health Affairs article as well!

      • CanDoc
        January 7, 2015 at 9:42 pm #

        NO, NO, NO! I can’t take any more!
        The stupid, it burns. I don’t feel this kind of deep, searing rage very often, but when I feel it, I can’t shake it.
        Does nobody care about fetal health anymore?

        • Ash
          January 7, 2015 at 9:49 pm #

          “Suddenly I realized I might lose any say
          in what was happening. Was I at the mercy of doctors who didn’t know me and had already made up their minds? I didn’t see a compelling medical reason for a cesarean, at least not yet. I thought, “This is what my natural childbirth friends were talking about” when they said women got rushed into surgery they often didn’t need.”

          • Elizabeth A
            January 7, 2015 at 9:51 pm #

            Saying that a pre-eclamptic woman with a term pregnancy and a non-progressing induction didn’t need a c-section stretches the definition of “need” in some rather uncomfortable ways.

            It appears we are supposed to believe that this woman is right about her care choices because nobody died. Other choices would still have been safer.

          • anotheramy
            January 7, 2015 at 9:56 pm #

            i would hate to see the situation where this lady says a c-section was needed.

          • Anj Fabian
            January 8, 2015 at 7:01 am #

            “I’m not dead yet!”

          • CanDoc
            January 8, 2015 at 12:26 pm #

            But she DIDN’T lose her say in what was happening. Just because somebody talks to her about their concerns about the baby and how this might not be moving in the desired direction doesn’t mean anyone is FORCING her to do anything.
            I once had a 45-year old patient, 1 cm dilated, not in labour, first baby, with a fetal heart that kept dropping to 50 (yes, FIFTY) for 30 seconds at a time call her biology professor friend on the other side of the country to discuss whether she really needed the cesarean section. I have greatest sympathy for this patients caregivers.

  38. Sue
    January 7, 2015 at 9:28 pm #

    It appears that her BMI might have added additional risk to this older woman with diabetes.

    It is surprising that a person with expertise in public health was unaware that Cesarean births have better outcomes for babies, or thinking that squeezing out a flat baby vaginally was somehow good for it. I guess this is evidence that ideology can trump knowledge sometimes.

    Yes, she ”narrowly escaped” a Caesarean. And, in doing so, her baby ”narrowly escaped” preventable, serious injury.

    • Amazed
      January 8, 2015 at 3:36 am #

      Do we know that the baby actually escaped preventable serious injury because the nutter just had to escape a C-section?

      She would have been laughable had the matter been not so serious. Just how many other babies does she think she’ll have from age 40 on to be screaming hysterically over a C-section?

      Fucking nutso. I predict with absolute certainty that she’ll be the next darling of the NCB industry. A doctor who decries modern obstetrics!

      • Mer
        January 9, 2015 at 2:27 am #

        Amazed is breaking out the swear words, I now feel validated over my Facebook freak out when my loony woo infested friend posted this. I was so relieved I could come over here to vent my spleen without all my home birthing nutty friends getting butthurt about it. (How DID I end up with so many nuts as friends? I have no idea but I figure it’s good for them to have me around)

  39. Becca
    January 7, 2015 at 8:48 pm #

    Standing ovation!!!!!!!!!!!! Great article.

  40. Kate
    January 7, 2015 at 7:55 pm #

    I have to say, reading this article makes me wonder why my OB went for an induction over scheduling me a c/s…

    • Medwife
      January 8, 2015 at 11:44 am #

      It can be worth a shot to see if you can induce and have a nice, fast, easy vaginal delivery. It’s best in high risk situations to be ready to “call it” immediately once it looks like it’s not going to be like that. If the induction doesn’t take, if progress stalls, if baby or mom starts looking less than perfect- whichever of those happens first- then ok, you gave it a chance, it wasn’t meant to be, let’s have a baby.

  41. drmoss
    January 7, 2015 at 7:37 pm #

    “My son came out blue and not breathing.”

    I imagine she might rethink her assessment of all is well and I did the right thing to refuse a section when she notices her son walks stiffly and isn’t doing so well at school. I would hazard a guess that she might then be telling her lawyer the doctors should have insisted on the section. I don’t like it when adults choose unsafe or higher risk courses for themselves, but I can’t understand how any responsible person, never mind a physician with an interest in preventive medicine, could choose to take risks on behalf of their infant. Not a sign of a parent to be with a proper sense of priorities!

    • Karen in SC
      January 7, 2015 at 7:46 pm #

      I hope her doctors have printed out and archived the story in preparation for that possibility. The child may also decide to sue.

    • OldTimeRN
      January 7, 2015 at 9:16 pm #

      I hope those doctors and nurses charted the exact events as they happened. I can see this case coming back to find them in a few years.

    • anotheramy
      January 7, 2015 at 10:29 pm #

      Yeah, she totally seems to gloss over that scary detail! I don’t understand how a doctor can not be alarmed by that.

    • Guesteleh
      January 7, 2015 at 10:44 pm #

      Oh that’s horrible. I hope that doesn’t happen. Poor kid shouldn’t pay the price for his mother’s stupidity.

    • SporkParade
      January 8, 2015 at 5:22 am #

      No, she’ll blame it on the fact that the doctors weren’t prepared to catch the baby when it came out probably.

  42. NatashaO
    January 7, 2015 at 7:37 pm #

    Also, I hate her characterization of nurses running in to the room in a “panic” crying ‘we’ve lost the baby’. Seriously? L&D nurses know that babies move, and moms move, and that external monitors will need to be adjusted. In a high risk pregnancy with a mom on mag and pit with an epidural and probably an insulin drip, nurses were probably very consciensious about keeping her baby on the monitor. We also know that patients with high BMIs are particularly hard to monitor, so the nurses were probably in and out of that room a lot. But seriously, does she think intermittent monitoring would have been appropriate in her case?!

    • Mishimoo
      January 7, 2015 at 7:59 pm #

      Mine always had a bit of a giggle at my cheeky bubs moving/hiding and having to find them again, but then, I wasn’t as highrisk as she was.

      • Medwife
        January 8, 2015 at 1:30 pm #

        It’s a bit amusing when you can’t get a tracing on a baby because it’s so dang active. That was mine, too. Hard to get too worried when you’re feeling your baby kick the whole time the poor nurse is chasing it with the transducer. Oh memories!

    • Amazed
      January 8, 2015 at 3:39 am #

      I love this detail! How stupid of those nurses to be “panicked” over losing a baby. A random baby from the street, judging by the narrative, not the nutso’s very own baby.

      • Nikki
        January 8, 2015 at 9:16 am #

        Yeah those stupid nurses, the baby was just fine, which is why he came out blue and not breathing. Unbelievable.

  43. NatashaO
    January 7, 2015 at 7:28 pm #

    A “natural” birth? I think she means she just wanted the baby to come out of her vagina. If it was totally left up to ‘nature’, mother nature would probably have killed them both with the diabetes, low fluid, pre-eclampsia, PPH, etc. You would think a doctor would have more insight into and gratitude towards modern obstetrical practice.

    • Gwen Bazzrea
      January 7, 2015 at 10:09 pm #

      That’s what I kept thinking…she had a VAGINAL birth- not a NATURAL birth. So why exactly are the NCB club getting excited about this article? As one of my mentors told me during my first pregnancy, “there’s no cookies after delivery for women who did it ‘right’.”

      • Rachele Willoughby
        January 8, 2015 at 2:01 am #

        Mmm… but I got a Hardee’s, Hot Ham and Cheese every time, regardless.

        • Gwen Bazzrea
          January 8, 2015 at 11:12 am #

          Okay, true- but you don’t get a cookie from “The Goddess of Perfectly Woo-filled Crunchy Orgasmic Birth.”

          My cousin brought subs for me and DH. She’s still my hero. (Pun intended)

      • Amy
        January 8, 2015 at 10:08 am #

        Maybe not, but I got a delicious roast beef sandwich, brought to me by my dad, the day after my c-section!

      • demodocus' spouse
        January 8, 2015 at 10:45 am #

        I got a cookie, even if I got it a little “wrong” My DH and my sister brought me a cookie, a chicken salad sandwich and a monster cup of hot Irish Breakfast tea! But I hadn’t eaten in 28 hours. The wee one was having his first nap.

      • Cobalt
        January 9, 2015 at 7:11 am #

        I did it ‘right’ and I didn’t get anything but a dry sandwich from the fridge. Next baby is having “deliver during normal cafeteria hours” listed in bold at the top of the birth plan.

        • Gwen Bazzrea
          January 9, 2015 at 11:00 am #

          You could also write “I want warm food ASAP after delivery ” on your inner thigh with a sharpie. ..just in case someone skips reading the birth plan. I threatened to write “this child’s name is NOT Eugene ” on my leg because my husband kept threatening to name our son after his dad!

  44. January 7, 2015 at 6:00 pm #

    This Washington Post story was posted on VBAC Facts Facebook page and Jen Kamel, yet again, went on a deleting spree…. she apparently didn’t like that people were bringing up the high risk complications?

    • Mishimoo
      January 7, 2015 at 6:02 pm #

      They’re just variations of normal.

    • PrimaryCareDoc
      January 7, 2015 at 8:02 pm #

      OMG, that Facebook page. There is someone on there who claims to be a nurse saying that Mag sulfate is contraindicated in a laboring woman. WTF??? Because it says so it the PDR, she claims.

      Ah, the PDR. Which no doctor uses for anything other than a doorstop.

      She’s also claiming that gestational diabetes does not confer an increased risk of fetal demise.

      • jenny
        January 7, 2015 at 8:38 pm #

        “And various other medical textbooks.” Holy shit, folks, it’s a *reference*, not a substitute for med school or knowing how the stuff works and when the benefits outweigh the risks. Nurse Chemtrails is special, for sure.

      • Mishimoo
        January 7, 2015 at 8:48 pm #

        *blinks* They’re holding a photo contest for the 2015 ‘Face of Accreta’

      • D/
        January 7, 2015 at 10:50 pm #

        That is an LPN/ doula/ childbirth educator/ certified lactation counselor whose services include access to an extensive lending library of books/ DVDs and “continuous … informational support during labor, birth, and the first few hours postpartum” and whose role “is to provide evidence based information to help you make informed choices … but NOT to take the place of or intrude on the role of … your chosen Primary Care Provider for your birth.”

        I’d imagine that could be a pretty tricky balance, providing continuous informational support without intruding on the role of an OB, especially for a doula who believes that “most OBs have seen very few if any NORMAL vaginal births”, who sees only normalcy in risk factor after risk factor after risk factor and who considers her understanding of the obstetric management of AMA, pre-e and diabetes superior to that of an OB.

        • PrimaryCareDoc
          January 8, 2015 at 8:11 am #

          Oh, she’s an LPN! So, basically…not much in the way of medical education.

        • Life Tip
          January 8, 2015 at 9:07 am #

          So, basically she’s convinced people to pay her to google nonsense for them while pregnant and then pass on whatever crap she pulls up.


      • Guestll
        January 8, 2015 at 11:22 am #

        Correct me if I’m wrong, but isn’t AMA an independent factor for stillbirth? Even if pre-e, GD, postdates, etc. are removed?

  45. Ellen Mary
    January 7, 2015 at 5:57 pm #

    Powerful analysis . . . There is a certain freedom in realizing you are no longer low risk . . . Even strictly from a maternal dignity POV, I will say that I would do my Cesarean over again before I would do my prolonged vaginal birth over again.

    • fiftyfifty1
      January 7, 2015 at 7:32 pm #

      “There is a certain freedom in realizing you are no longer low risk . . . Even strictly from a maternal dignity POV,”

      It’s sad that this is true, but it is. If you are part of a social circle that strongly values NCB ideals, there is a huge pressure to do birth following a very rigid script and having to adhere to that script can rob a woman of her autonomy and dignity. In these circles, paradoxically, the only way a woman may gain freedom is to be undeniably high risk. In reality being high risk limits a woman’s medical options, but if it may get her a “get out of jail free card” with her peer group and her options actually expand from what they had been!

    • Elaine
      January 7, 2015 at 9:33 pm #

      At a certain point a c/s seems like a reprieve from a long and awful birth… I will never understand these moms who gleefully post the stories of their three-day no-epidural labors. I guess if everyone gets out alive & healthy no harm done, but I don’t see what’s so great about that experience.

      • MLE
        January 7, 2015 at 9:57 pm #

        Segueing into round the clock breast feeding!

        • Anj Fabian
          January 8, 2015 at 7:04 am #

          With pictures. You can’t merely claim to BF. You have to post pictures.

          Everyone looks like a narcissist on the internet…

  46. mostlyclueless
    January 7, 2015 at 5:51 pm #

    In all seriousness though, are there any medical professionals who can respond to the Washington Post with a Letter to the Editor? This is so beneath them. Or at least I thought it was.

    • CanDoc
      January 7, 2015 at 9:40 pm #

      I’ve been writing it in my head for the last 10 minutes. But then my brain wants to explode over the myriad factual inaccuracies.

  47. mostlyclueless
    January 7, 2015 at 5:50 pm #

    If she simply hadn’t gone to the hospital, surely she could have prevented the pre-eclampsia, advanced maternal age, and diabetes, right? Isn’t that how it works? Did she not say enough affirmations or something? Maybe she should have just trusted her body.

  48. yugaya
    January 7, 2015 at 5:33 pm #

    I’m reading what she wrote and how she wrote it in detail now.

    “Admittedly, I was a more complicated case than the average. I became
    pregnant with my first child at the age of 40, an “elderly” first-time
    mother in the jargon of obstetrics, and my pregnancy was complicated by
    gestational diabetes.”


    By all means yes, if what she means to convey by wording it that way is that she was a more complicated case than an average high risk case. Otherwise she is downplaying her multiple conditions considerably to fit her argumentation into pre-prepared NCB narrative, by implying that her case was just a wee bit more complicated than “the average” pregnancy.

    “Elderly” in quotation marks and ascribing it to professional jargon rather than acknowledging it as a valid risk factor is a bonus.

    • Medwife
      January 8, 2015 at 1:26 pm #

      And as Amy pointed out, NOT gestational diabetic, because she was placed on insulin therapy in the first trimester! That makes her preexisting type 2. If she doesn’t get the difference, it’s time to head back to medical school.

      • Deborah
        January 10, 2015 at 1:37 pm #

        I bet she’s one of those fat activists who claim that obesity is not a risk factor for bad medical outcomes.

  49. GiddyUpGo123
    January 7, 2015 at 5:13 pm #

    “I barely escaped a Caesarean I didn’t need.”

    Why is a c-section something you have to “escape?” I know everyone’s experience is different but I’ve had two of each, two vaginal deliveries and two c-sections. I honestly couldn’t favor one over the other, except that it was kind of nice to have an extra couple of days in the hospital after my c-sections, before having to go home and try to meet the demands of my other children. Oh and also the c-section was a lot less painful.

    So you avoided a c-section. Big effing deal. You delivered a baby who wasn’t breathing and may have actually been close to death, but you avoided a c-section. Yay for you. You risked your life and your baby’s life to “escape” something that really probably wouldn’t have been that big a deal.

    Unless, of course, you’d been brainwashed into thinking that it was.

    • Box of Salt
      January 7, 2015 at 10:01 pm #

      “I barely escaped a Caesarean I didn’t need.”

      But did the baby need one?

  50. Dr Kitty
    January 7, 2015 at 4:37 pm #

    Call me crazy, but if I had to choose between which I would find more invasive, a CS or an induced labour with two IVs, a manometer in my uterus and a clip on my baby’s scalp, I’d take the one that didn’t involve wires in my vagina.

    OT: met with my GP today for the “I’m starting to get sick, give me cyclizine for now and expect a call for Zofran in a couple of weeks” appointment. He was very sweet, and thankfully didn’t suggest acupuncture or going without drugs.
    I’m eating while I still can, on the basis that I lost 10% of my body weight last time, 40kg is a weight I don’t want to see again, and the nausea has started earlier and shows no sign of letting up.

    • Mer
      January 7, 2015 at 4:44 pm #

      If this means you are pregnant, Congratulations!!!! Otherwise, I’m terribly sorry you are not feeling well and hope you will be able to eat.

      • Box of Salt
        January 7, 2015 at 4:47 pm #

        And the NCB folks like to spout off “pregnancy is not a disease!”

        It sure does a fair imitation of one, though.

        And if I haven’t said ao already, Dr Kitty – congratulations!

        • Mer
          January 7, 2015 at 5:01 pm #

          yeah for not being a disease, pregnancy sure does require a lot of medications sometimes. Heck even if you have a textbook pregnancy you still have to take prenatal vitamins and as I’ve been told repeatedly, they count and need to be written down as medications.

          • Dr Kitty
            January 7, 2015 at 5:14 pm #

            Yep, all being well baby number two will be making an appearance this summer.
            As I keep reminding myself, the sickness is a good sign.
            A really unpleasant good sign.

          • rational adult
            January 7, 2015 at 5:43 pm #

            Dr. Kitty, congratulations! I had HG up to the day I delivered last time and always happy to chat about treatments (Zofran, Reglan, Phenergan via suppository, tried em all) and commiserate. Anecdotally my sickness started earlier in this pregnancy but had actually abated in the second trimester and I’m back up to my pre-pregnancy weight. I’m still carrying emesis bags around just in case the “really unpleasant good sign” surges back.

          • January 7, 2015 at 6:32 pm #

            PREACH. I barfed for 8 months straight. I’m glad we weren’t planning on more, I don’t think I could do it again.

          • Mishimoo
            January 7, 2015 at 6:51 pm #

            I couldn’t do it again either, and mine wasn’t as bad as that. No morning sickness with my first two pregnancies, bad with the third (to 27 weeks) and worst with the youngest (to 30 weeks, maxolon was my most favourite thing in the entire world, and I lost 5kg in the first trimester)

          • Mer
            January 7, 2015 at 5:47 pm #

            I’m so happy for you and baby number 2 and sympathetic to the HG. I didn’t have it, but did have severe “normal” pregnancy sickness that stopped as expected at the 2nd trimester. I simply can’t imagine how awful it would be to feel like that throughout pregnancy and I hope that the zofran does miracles for you!

          • Maria
            January 7, 2015 at 5:54 pm #

            Congratulations and hopefully you will feel better in time!

          • Sue
            January 7, 2015 at 9:30 pm #

            Part of that “perfect design for birth” the NCBers keep referring to, no?

    • January 7, 2015 at 4:52 pm #

      Ugh, HG is hell. Best of luck and hoping you don’t suffer too much!

    • Mishimoo
      January 7, 2015 at 5:22 pm #

      Thinking of you and hoping that it’s easier this time around.

    • DiomedesV
      January 7, 2015 at 6:10 pm #

      Are there concerns about Zofran? I thought it was considered safe.

      • rational adult
        January 7, 2015 at 8:52 pm #

        My big concern with Zofran is that the resulting constipation can be worse than the nausea so I tend to save it for situations where it would prevent dangerous dehydration. If it weren’t for that, I’d take it more liberally.

        • Allie P
          January 8, 2015 at 8:59 am #

          Yeah, I take it with fiber gummies and a big glass of water. Thanks to the Z, I can keep those other things down.

        • S
          January 8, 2015 at 9:26 am #

          I took it with regular enemas. Ugh, pregnancy. =)

        • Mer
          January 9, 2015 at 2:39 am #

          I have to laugh because I unfortunately learned the hard way about the side effects! Some docusate and lots of water and some coffee sorted me back out, but it was an ongoing issue for sure. Still didn’t keep me from taking my magic zofran every 8 hours on the dot!

      • Dr Kitty
        January 8, 2015 at 10:05 am #

        Oh it’s safe, it’s just expensive (to the NHS, not to me personally) and causes constipation, so it is second line.

        As I’m only moderately nauseated and vomiting once or twice a day at the moment, I’m saving the Zofran for when I really need it.

        Buccal prochlorperazine, while excellent for nausea, also makes me sleep for 16hrs straight…so really only an option for weekends. this BTW, is just me, other people are fine with it.
        Metoclopramide gave me extra-pyramdial side effects as teenager when I had it after surgery, so I’m not anxious to try it again. I cope better with nausea when I’m busy, so any anti-emetic which makes me unable to work is a non starter.

    • Anj Fabian
      January 7, 2015 at 6:25 pm #

      Oh my goodness! I didn’t know!
      Congratulations and may the drugs ever work in your favor.

    • yugaya
      January 7, 2015 at 6:27 pm #

      Congrats and may the force of logic and medicine be strong with you always if you were to encounter any woovillains along the way. 🙂

    • Cobalt
      January 7, 2015 at 7:25 pm #

      I hope all goes well for you and the bean!

    • no longer drinking the koolaid
      January 7, 2015 at 7:30 pm #

      In some states HG is a qualifying condition for medical marijuana

      • Dr Kitty
        January 8, 2015 at 3:30 am #

        Not a treatment option I will be using.

    • Sarah
      January 8, 2015 at 3:12 am #

      I had a number of wires in my vagina after my vaginal birth became complex last time round. It was some of the least fun I’ve ever had. Hope the morning sickness is easier this time.

    • Allie P
      January 8, 2015 at 8:58 am #

      Zofran was the first thing I asked for at my first appt. Let’s not have the fun of HG again.

    • S
      January 8, 2015 at 9:28 am #


    • moto_librarian
      January 8, 2015 at 9:59 am #

      Congratulations, Dr. Kitty! I had unrelenting nausea throughout the fifth month, but no vomiting, with my second. I cannot imagine how awful HE must be. I hope that the meds work well, and that your pregnancy is uncomplicated.

    • Carolina
      January 8, 2015 at 12:29 pm #

      Congratulations!! Zofran is the nectar of the gods as far as I’m concerned. I liked the Diclegis I was offered this time around too – it seemed to work 80% of the time. I hope it gets easier soon and/or that you have much support to get through this.

    • araikwao
      January 9, 2015 at 11:54 pm #

      Congratulations !!! May the nausea be fleeting and manageable

  51. Mer
    January 7, 2015 at 4:17 pm #

    I am ridiculously excited to see this post today. I read this article yesterday and had pretty much all the same thought about it and desperately wanted to see what everyone here and Dr. Amy herself thought about it. I don’t have the education nor coherence of thought to do a thoughtful ripping apart of all the nonsense so yay to reading this! I was troubled by both her need to have a “natural” birth and the seeming lack of respect she received as a patient.

    Did anyone else notice the part where she said that monitoring INCREASES C-sections? Like that was the sole cause to haul a woman to an OR, that she was being monitored, and no relation to the baby possibly being in distress as the reason for the C-section. Nope it was because she was monitored not because baby was having decels.

    • Therese
      January 7, 2015 at 5:36 pm #

      She is referring to earlier studies that showed continuous fetal monitoring increased c-sections without decreasing mortality rates. So basically, a high false positive rate. What she doesn’t understand is that larger studies done on EFM does show that it saves babies’ lives. But the entire NCB world seems completely in the dark that these newer studies exist.

      • Mer
        January 7, 2015 at 5:56 pm #

        I figured that’s what she was talking about, it just astounds me that she would even mention that. I mean I was into the woo with my 2nd pregnancy and if my doctor had come in and told me that my baby wasn’t looking so good and they’d like to do a c-section to prevent problems I would have been walking myself to the OR. If someone plays the dead baby card, I’m going to listen and do what they tell me to do and bitch and moan about it AFTER everything is ok.

        • Cobalt
          January 7, 2015 at 7:23 pm #

          Better an unnecessarian than an unnessacrib.

          • anotheramy
            January 7, 2015 at 10:40 pm #


          • junebug
            January 7, 2015 at 10:53 pm #

            A crib you don’t need because your baby is dead.

          • Mer
            January 9, 2015 at 2:42 am #

            Well you know some babies just aren’t meant to live. (Extreme sarcasm alert!)

      • realitycheque
        January 7, 2015 at 7:09 pm #

        NCB advocates? Cherry-picking studies to support their existing beliefs? Never!

  52. Allie P
    January 7, 2015 at 3:33 pm #

    When you have pre-eclampsia, you have the baby. Any idiot who has watched Downton Abbey can tell you that.

    • guest
      January 7, 2015 at 9:17 pm #

      Not necessarily immediately. I was under the care of an MFM for my already high risk pregnancy (advanced maternal age + twins) and around 30 weeks I developed pre-e. After an overnight in the hospital for observation which confirmed protein in urine plus continuous high BP, was was sent home on modified bed rest with increased monitoring. Made it another 5 weeks. And pre-e doesn’t mean a c-section automatically – I did have one, but only because of fetal heart decels after about six hours of contractions. I listened to my doctors every step of the way, and spent some time on the pre-e boards. The only way to end pre-e is to have the baby, but if you’re not term and your symptoms are not too severe, you don’t have to have it immediately.

      If you are term, though, get that sucker out.

  53. Amy M
    January 7, 2015 at 3:27 pm #

    OT: some other actress touting homebirth and placentaphagy.

  54. Mel
    January 7, 2015 at 3:19 pm #

    “Research has shown that, compared with having a doctor listen to fetal heart tones with a fetascope or a hand-held ultrasound device, electronic monitoring decreased the rate of seizures in babies but did not change infant mortality or cerebral palsy rates.”

    It has greatly improved intrapartum fetal deaths, though, which is a far bigger concern.

    Also, CP rates are a bit of a red herring since many CP patients have either other complicating factors prenatally or are pre-term deliveries.

    Well, and I’m biased. I much prefer my CP life than being in a very tiny grave.

  55. baileylamb
    January 7, 2015 at 2:51 pm #

    OT and some what personal. I’m scheduled for a rcs on the 16th. Yesterday I went in for a weekly appointment, and complained about less movement. Ive lost about 1lb btw. Ob sent me to L&D for NST and ultrasound. The NST was good, but the ultrasound showed borderline low fluid. They decided to send me home, I have another appointment on Tuesday (nst included). Is that pretty standard (basically talk me out of my anxiety please).

    • moto_librarian
      January 7, 2015 at 3:32 pm #

      I am not a doctor (obviously), but a friend was monitored closely for low fluid during her second pregnancy. Like you, she was scheduled for a repeat c-section. She was put on bed rest and had regular NSTs and ultrasounds. She made it to her scheduled date, and has a healthy baby girl.

    • demodocus' spouse
      January 7, 2015 at 3:40 pm #

      If they are really worried, they’d probably have scheduled you for Friday or something. Of course, If something seems wrong, go see your doc asap. Anecdotally, I had a high bp at week 38 (foolishly cleaning too vigorously) and although the second reading several minutes later was fine, they had me come in 3 or 4 days later, to be sure.

    • Gynechiatrist
      January 7, 2015 at 6:13 pm #

      Decreased movement and borderline amniotic fluid? What exactly is the point of continuing the pregnancy? 9 extra days in utero? I’ve been doing this for 25 years and I still don’t understand how some OB/Gyns practice medicine.

      I’m guessing you are 37 weeks plus 5 days. If you were my patient you would be holding your baby tonight.

      • baileylamb
        January 7, 2015 at 8:17 pm #

        Thanks. Something to think about.

      • Cobalt
        January 8, 2015 at 9:43 am #

        The 39 week rule might be coming into play here, it might not be the doctor’s choice.

    • Medwife
      January 8, 2015 at 10:33 pm #

      In my practice we generally repeat a sono showing borderline oligo a day or 2 after the initial finding. What was your actual AFI?

  56. Felicitasz
    January 7, 2015 at 2:49 pm #

    Thank you 🙂
    I was quite disturbed yesterday reading this story from a medical doctor, thinking of all the stuff that commenters immediately started listing below the other post where I had posted the link. At the point where she writes about the not breathing baby, I waited for a turnaround, a punchline, a moral. None came. I was thinking of my own c/s with gratitude, astonished by the statement that c/s would have been unneded in the author’s case.

  57. attitude devant
    January 7, 2015 at 2:38 pm #

    “I knew vividly from my time on Philadelphia’s busiest maternity ward…” and that would be Pennsylvania Hospital (and I see she went to Penn, so that would be one of her choices for rotation) and (at least in my day) Pennsy turfed all their really high-risk cases to HUP for care, so she may never have seen a case like her own. People choose Pennsy for their rotation when they want to see a lot of low-risk births and get some catches.

  58. mostlyclueless
    January 7, 2015 at 2:26 pm #

    Nothing is more frustrating or embarrassing to me than people who are credentialed, educated, and still say jaw-droppingly ignorant things like this. This lady and Mayim Bialik deserve some kind of prize — people I would most like to strip of their degrees before the embarrass the academy any further.

    • Amy
      January 7, 2015 at 4:35 pm #

      And Christiane Northrup, Dr. Oz, Dr. Jay Gordon, Dr. Romm, and the Doctors Sears. That’s still few enough to count on your fingers, and the very same crunchies who decry doctors as morons who never learn anything at med school (as opposed to themselves, who learn so much from Google University) are very quick to point out their credentials as proof that they know what they’re talking about. Lord help us.

  59. attitude devant
    January 7, 2015 at 2:07 pm #

    Thank you, Dr. Amy! I read this in the Post and was dizzy from the eyeroll. I also saw myself in the story. I’m the physician she didn’t want. I tell every woman I meet who is pregnant over 40 that her chance of c/s is 50%. Because it is. We don’t know why it is, but it is. And I’m sorry but you should know that going in. It may not seem fair that pregnancy is harder on mom and babe after 40 but it’s not helpful to ignore the fact that it is. I’m simply amazed at this lady. This couldn’t have been a higher-risk situation. The lady is a walking obstetrical board exam. And if it had been me taking care of her with that outcome, I would feel that I had failed her by failing to prevent her newborn’s sorry condition and her post-partum hemorrhage.

    I had a ridiculously difficult and complicated second birth. Premature labor, IUGR, HELLP syndrome. Pit, Magnesium sulfate, the works. And I was so grateful to my partners who got me and my little girl through it safely. Someone needs to school that clueless doctor.

    • Therese
      January 7, 2015 at 3:48 pm #

      Just curious, is the 50% c section risk for mom over 40 just for first time moms over 40 or all of them, regardless of whether they’ve had vaginal births in the past?

      • attitude devant
        January 7, 2015 at 4:28 pm #

        It’s really weird because we see it in multiparas too. A fairly common scenario is someone who has several births in her twenties then re-partners in her forties and has a c/s. It’s probably multifactorial but at present is poorly understood.

        • Gynechiatrist
          January 7, 2015 at 6:37 pm #

          My thought has always been that the cartilaginous symphysis pubis and the sacroiliac joints that hold the pelvis together get rigid and inflexible as we age.

          The pelvis is a really dynamic structure during labor. It changes shape as the baby descends. I suspect the flexibility of these joints decreases with age.

          • attitude devant
            January 7, 2015 at 6:44 pm #

            Hmmmm. I do see the uterus just not contracting well. Poorly organized contractions, contractions that just aren’t strong or regular, even with pit. Chubbier babies. More vascular disease so the placental perfusion is poorer with poorer fetal tolerance of labor

          • fiftyfifty1
            January 7, 2015 at 8:11 pm #

            Let’s face it. People in their 40s are old. A 40 yo is half way to 80. A 45 yo half way to 90.

            Do you see arthritis on a back film of a 20yo? Almost never. Do you see arthritis on the back film of a 40yo? Almost always there is some.

            When a 25 yo has a heart attack I am always shocked. The only cases I have ever seen were cocaine-induced. People in their 40s, even non-smokers who eat right and work out, have heart attacks. Sure it’s less common than at 50 or 60, but it’s never shocking Everybody knows somebody in their 40s who dropped dead of a massive MI.

            A 25 yo with colon CA or breast CA? I’ve seen that only in the face of familial high risk genetic syndromes (BRCA, familial polyposis etc). But I see women in their 40s with colon CA and breast CA and no family risk factors at all.

            The uterus is our strongest muscle and relies on incredibly intense anaerobic bursts. There are plenty of women in their 40s who jog, but do you know any 40 yo elite 400m runners? Hell no.

            Continuing to wear a size 2 at age 40 =/= still being 20.

          • Empliau
            January 7, 2015 at 10:37 pm #

            I wanted to upvote this, but I’m 54, and I try not to do the math of what I’m halfway to … yup, I’m old. And I don’t even wear a size 2.

          • attitude devant
            January 7, 2015 at 11:45 pm #

            Neither does Dr Keirns

    • Susan
      January 7, 2015 at 8:27 pm #

      Yes. I read it yesterday too came up on Facebook and I was so disgusted. What an ungrateful piece of work.

    • Sue
      January 7, 2015 at 9:54 pm #

      ”The lady is a walking obstetrical board exam. And if it had been me taking care of her with that outcome, I would feel that I had failed her by failing to prevent her newborn’s sorry condition and her post-partum hemorrhage.”

      Exactly that, AD. Exactly that.

  60. Medwife
    January 7, 2015 at 1:53 pm #

    Oh yeah. She was real lucky to avoid that section. What, she would have lost less blood? (No.) she would have felt more exhausted? (No.) her baby would have been in worse shape? (No.)

    What an idiot.

    • Amy M
      January 7, 2015 at 2:53 pm #

      She would have gone against NATCHURRRR!!!

      • Roadstergal
        January 7, 2015 at 3:02 pm #

        Sounds like she went against Nature by being alive afterwards.

    • Melissa
      January 7, 2015 at 8:18 pm #

      And now her kid can’t kill MacBeth!

      But seriously, the only thing she gained from this was some sort of bragging right for a very limited audience of people. She gets to say that she gave birth the “natural” way and feel superior to other mommies who had a c-section (or maybe she’ll offer them some sort of pity that they weren’t able to avoid it like she did). And when she sees their children come down with a cold or an ear infection she’ll think to herself that their immune system is weak because they didn’t absorb the vaginal fluids of their mother (or some such bit of idiocy).

      But I think most people who read her story get to the blue baby and realize that she made a bad decision, even if they lived through it.

      • Roadstergal
        January 8, 2015 at 11:34 am #

        I’d upvote this just for the MacBeth reference.

  61. just me
    January 7, 2015 at 1:44 pm #

    Wtf she’s a real medical doctor? Not a naturopath or someone with a doctorate in psychology or something? If she’s that misinformed/in denial/batty what hope is there in convincing regular folks?

  62. PrimaryCareDoc
    January 7, 2015 at 1:06 pm #

    Check out Dr. Keirn’s picture.

    Now we can add morbid obesity to her list of risk factors.

    • Guesteleh
      January 7, 2015 at 1:14 pm #

      To be fair, she may have become obese after giving birth. Ask me how I know. Signed, 40-year-old primigravida who gained 50 pounds and never lost it.

    • attitude devant
      January 7, 2015 at 1:59 pm #

      OK, I’m not into fat-shaming but puhleeze! This is a professor of preventive medicine? What diseases might she prevent by taking some conventional medical advice to lose weight? Diabetes, hypertension, hypercholesterolemia to name a few. Physician, heal thyself!

      • NoLongerCrunching
        January 7, 2015 at 3:09 pm #

        I get what you’re saying but some overweight people just can’t keep their weight down no matter how much they try. They may lose and regain the same 50 lbs over and over. It increases her risk profile to be sure, but “conventional medicine ” has not yet figured out how to help people lose weight and keep it off. So I do find it fat-shaming to suggest that she just needs to follow medical advice to lose weight.

        • junebug
          January 7, 2015 at 4:15 pm #

          Is there a study out there that demonstrates when people actually stick to exercise and diet ‘prescriptions’ they mysteriously gain weight regardless of how well they follow the plan?

          I’m honestly curious.

          • NoLongerCrunching
            January 7, 2015 at 4:24 pm #

            No, they usually lose weight, but at the 1-year mark something like 98% of people are back to baseline. In my n=1 experience, when I gain weight from overeating, I can lose that and keep it off, but it requires constant vigilance. I’m about 20 lbs overweight, and the only time I was ever normal weight was when I starved myself.

        • attitude devant
          January 7, 2015 at 4:34 pm #

          Yes. I’m fairly zaftig so I get it. But here’s someone who claims to be an expert in Preventive Medicine who (since she needed insulin early in pregnancy) is a diabetic before she gets pregnant and fails to realize it even though she clearly has every risk factor. It’s like she can’t apply what she knows to herself.

          • LibrarianSarah
            January 7, 2015 at 4:56 pm #

            You know that friend that gives great advice but whose own life is in shambles because she/he can’t seem to take it? This lady is the healthcare equivalent of that friend. Except that in this case her advice sucks.

        • Sue
          January 7, 2015 at 9:36 pm #

          The point here is not to shame her for being overweight, but to call out her denial of all the risk factors in her pregnancy, of which her weight was one.

          A rational approach would be something like ”Yes, I understand that my weight is an issue. So are my diabetes and blood pressure. I can’t do anything about these right now, but I will have to accept that a complicated pregnancy will need treatment to mitigate the risks.” Or something like that.

      • DiomedesV
        January 7, 2015 at 3:58 pm #

        Losing weight and keeping it off is notoriously difficult. I don’t see why she didn’t mention the obesity as another risk factor, though.

        • PrimaryCareDoc
          January 7, 2015 at 4:03 pm #

          Well, she also didn’t see fit to mention pre-eclampsia as a risk factor!

    • shannon
      January 7, 2015 at 3:23 pm #

      I am a morbidly obese mother and the fact that she left this crucial risk factor out of story is unbelievable. She clearly weighs close to 300 lbs, if not more, and add that to the diabetes and everything else, it’s amazing she had the audacity to write this article. I’m not on board for fat-shaming, but I am on board for realism. And realistically, this is a profoundly unhealthy woman.

      • Sarah
        January 7, 2015 at 3:45 pm #

        Yes. I don’t care at all whether she weighs five stone or fifty, that’s her business and nothing to do with me. It was dishonest not to mention size as a risk factor though. For the record, I have had a BMI in the overweight (26-30) category when commencing both my pregnancies, so I’m not going to throw stones in my glass house. But when you’re outside ideal range, it does increase your risk of various problems.

    • Amy Tuteur, MD
      January 7, 2015 at 3:46 pm #

      Just one more aspect of her mind boggling denial.

    • Ash
      January 7, 2015 at 3:57 pm #

      Now I’d also like to know if Dr Keirn’s saw an anesthesiologist prior to delivery. The disliked MFM doc was surprised that the patient hadn’t been referred for an anesthesia consult. I wonder if anyone ever made the referral.

      OB anesthesia buddy who did not see her in person said, “They’re
      looking at the clock. They’re not looking at you.”

      What would someone looking at her see?

      Morbidly obese 40 yr old primip. Insulin dependent diabetes mellitus starting 1st trimester. Possible pre-e/HELLP (btw, did she allude to pre-e when she mentioned ‘swollen feet’ or just typical swelling? And you’re saying all they see is a clock when considering her risk?

      • theadequatemother
        January 7, 2015 at 4:41 pm #

        I’d see difficult epidural placement and higher risk of epidural failure. Id see a difficult bag mask ventilation and a risk of difficult intubation of about 1/50. I’d see a high risk of pph. Once the pre-e and hematuria a started id see someone that would need a high risk ga, possibly an awake intubation. I’d want an early cs to reduce risk not an emergent one where I would have to chose the mother and sacrifice the fetus because it would be unsafe to put her to sleep quickly. I’d see a high risk of renal failure, heart failure and pulmonary edema as well as emorrhagic stroke and if hellp then possibly liver rupture.

        The clock has nothing to do with it.

        • Sue
          January 7, 2015 at 9:56 pm #

          Yep – not just an obstetric nightmare – an anesthetic nightmare too.

      • fiftyfifty1
        January 7, 2015 at 8:22 pm #

        Either Dr. Keirn has the most screwed up co-dependent friends from medical school, or she is one seriously unreliable historian!

        If I had to guess, I would guess the latter. I bet she is someone who only hears what she wants to hear.

    • Erin Porter
      January 8, 2015 at 1:33 am #

      She authored an essay entitled “Dying of a Treatable Disease” in 2009. Oh the irony of almost killing yourself and/or your child by not accepting a treatment that would have been so much less likely to do that.

      She wasn’t successful; she was lucky. That’s it.

  63. Guesteleh
    January 7, 2015 at 1:00 pm #

    Holy shit, if this woman wasn’t a candidate for a CS then who is??? I would like to hear more about what you think about the poor bedside manner and lack of preparedness for emergency. That is interesting and a real problem that I’d like to know more about.

    • Ash
      January 7, 2015 at 1:01 pm #

      Yeah, this would have been a great discussion with the hospital staff…what were the circumstances that led to a provider not being present at the actual delivery? Would it have been possible to do something different so one of the OBs was present?

      • Rachele Willoughby
        January 7, 2015 at 4:05 pm #

        I told the on call ob I was feeling pushy at 9. I was delivering my fourth and she’d just come in to break my water. She said she’d be right back but must of gotten caught up with the mum next door. In any case, forget about the instrument tray my *husband* delivered our fourth baby. Either there was an emergency in the other room (the other patient delivered before me) or she didn’t read my chart (since this wasn’t the first time). She did do a great job where I really needed her though, sewing up my poor parts after such precipitous third stage. I shudder to think what it would be like down there if a midwife had told me it “wasn’t that bad.”

        The moral of the story: That’s what you get for delivering on Memorial Day weekend. 😉

        • junebug
          January 7, 2015 at 11:04 pm #

          My 3rd was delivered on father’s day (and my OB’s wife’s birthday). He was wearing a hawaiian shirt and sandles because there was no time for scrubs.

          To be fair I went from a 14 odd hour 3-7cm time frame to 7-10 before the nurse could get back to her station, so I’m impressed he made it at all, he was obviously on his way.

      • fiftyfifty1
        January 7, 2015 at 8:32 pm #

        Sounds like the room was poorly stocked. Every room should have an instrument tray ready to go + backup in case one gets dropped. This is a stocking problem and stocking is an important safety issue. The nursing manager (or whoever is in charge of assuring stocking on this ward) needs to step up to the plate.

    • Kelly
      January 7, 2015 at 1:25 pm #

      I bet she felt like that because she was resistant at all turns to a c-section.

  64. no longer drinking the koolaid
    January 7, 2015 at 12:58 pm #

    She may have done an OB rotation as part of her clerkship or medical school internship, but it doesn’t appear that much of what they tried to teach her, stuck with her. I’m just a midwife and it was easy to see all the parts she was leaving out. I’ve seen too many of these same scenarios. Yes, a vaginal birth is preferable if it is expeditious, but mom is also becoming more ill and the factors affecting baby’s ability to survive are decreasing.
    Yep, should would like to know what her VSs and LFTs looked like.

  65. Jenn C
    January 7, 2015 at 12:42 pm #

    So how do we talk about risk if this woman can pass herself off as “low” risk? Has that term lost all meaning? This woman has no idea or won’t let herself think about how lucky she and her baby are. A mag drip isn’t something that’s done for shits and giggles.

    • Ash
      January 7, 2015 at 12:44 pm #

      I don’t think the author describes herself as “low risk.”

      “Though many groups have called for more use of midwives for low-risk
      deliveries, this solution doesn’t address the growing
      number of women like me, who are considered “high
      risk” for complications and, therefore, beyond their scope of practice.”

      “As expectant mothers become older, with more preexisting medical
      guidelines need to evolve beyond those for the
      low-risk mother in her twenties, and recommendations to avoid cesareans
      evolve beyond “choose a midwife instead of an

      “In my first trimester I started taking insulin
      and made an appointment with a maternal-fetal medicine
      (MFM) specialist, someone who specializes in high-risk obstetrics.”

      • Trixie
        January 7, 2015 at 12:55 pm #

        She still seems to want the cesarean rate to remain the same as it would for low-risk women in their twenties.

        • fiftyfifty1
          January 7, 2015 at 8:39 pm #

          And a rate of 0% for herself.

      • The Bofa on the Sofa
        January 7, 2015 at 1:10 pm #

        So she acknowledges she is high-risk, but should not be treated like a high-risk patient because … she is special or something?

        I hate to keep coming back to the analogy, but this sounds to me like those guys who claim that they are better drivers when they are drunk, and all those drunk driving accidents and deaths are due to those OTHER people who can’t hold their booze.

        “You’re drunk, you should get a cab”
        “Oh I’m ok, I drive more careful when I’m tipsy”

        • Ash
          January 7, 2015 at 1:22 pm #

          Yeah, the narrative really waffles back and forth…on one hand the baby is doing beautifully per her report, on the other, but the author is not in a good situation from what we know (insulin dependent diabetes, magnesium needed , advanced maternal age). The labor progression is slow, but it’s really not too slow. Failure to progress is subjective, so it’s not necessarily appropriate to do a c-section based on that, but subjectively, she’s doing fine despite IV mag, oxytocin, insulin. There wasn’t an opportunity to discuss the author’s fears about delivery, but she discussed her delivery with a variety of people, prenatally, during labor, and physician buddies who weren’t in her care. Not enough information was shared with her but she knows exactly what was being debated during rounds.

          Not a lot of consistency here….

          • yugaya
            January 7, 2015 at 2:33 pm #

            And she is ready to push and can “feel it is time” and ends up with an hour and a half of coached pushing, plus the time needed for the nurse to fetch the OB, plus seven minutes.

            But omgodzees she could FEEL it was time.

          • Therese
            January 7, 2015 at 3:59 pm #

            That’s normal for a first time mother though. It doesn’t mean it wasn’t time to push.

        • Joy
          January 7, 2015 at 1:52 pm #

          Or, I’ve been stabbed, but I’m pretty sure it hasn’t hit anything major and I’m pretty healthy so it probably won’t get infected and a stabbing isn’t an illness. I’ll just wait and see if I am going to bleed to death.

          • The Bofa on the Sofa
            January 7, 2015 at 2:00 pm #

            Hey, I survived. See, you were worried about nothing! All this concern over being stabbed….

          • yugaya
            January 7, 2015 at 2:15 pm #

            …and playing the “stabbed to death” card.

            I think she was proving points, I think that with her birth she dodged not a bullet but an AK-47 assault, and I think that there was a MANA board of directors or something similar at stake here. She did not manage a homebirth medal, bt you know, she now has empirical knowledge of how to avoid an unnecessarian.

      • Jenn C
        January 7, 2015 at 1:22 pm #

        Yes, she does acknowledge being high risk – but it seems as if she thinks that has no meaning when it comes to the recommendation for c-section. So, I guess the question is how can we talk about risk meaningfully if this is how a high risk situation is presented? (For the record, I had HELLP syndrome and eclampsia – my son survived his c-section birth, but we were very lucky.)

        • Ash
          January 7, 2015 at 1:28 pm #

          She basically paints herself as being high-risk during the antenatal period but low-risk during the birth because there is no abnormality on the fetal monitors. That’s how I perceive it. Very inconsistent.

          • Box of Salt
            January 7, 2015 at 1:50 pm #

            I read as she’s wishing herself low-risk:
            “The guidelines for risk assessment are written for young women, therefore they do not apply to me, since I’m not a young woman.”

            Never mind that advanced age is yet another factor that increases the risks.

        • The Bofa on the Sofa
          January 7, 2015 at 1:30 pm #

          And ultimately, she DID end up in an emergency situation for both the baby (rushed to the NICU) and her (PPH, she says).

          Could it be that these are the things the doctors hoped to avoid?

      • Amy Tuteur, MD
        January 7, 2015 at 2:09 pm #

        It’s bizarre because although she acknowledges that she is high risk, she quotes the recommendations for low risk women insisting that those apply to her.

        • Ash
          January 7, 2015 at 2:14 pm #

          During the labor process, she compartmentalized what she perceived as her health vs the baby’s despite that they are linked together. Basically no amount of intervention necessary to keep her going (insulin, magnesium, oxytocin) meant that the baby’s life was at risk. The fetal heart rate was fine, she was “tolerating labor” so ”

          point to the objective data”

          To me, the objective data points to a woman who is at very high risk for adverse outcomes from a vaginal delivery!

          • Box of Salt
            January 7, 2015 at 3:04 pm #

            “The fetal heart rate was fine”
            Except for all those times the baby slipped off the monitor.

          • Susan
            January 7, 2015 at 8:51 pm #

            I have to wonder if the her BMI contributed to why there wasn’t more
            Of a push for c/s. Is it just where I am that ob’s would much prefer to see a very morbidly obese mom deliver vaginally because a c/s is
            No picnic either.

      • Dr Kitty
        January 7, 2015 at 3:22 pm #

        Notice she says “recommendations to avoid CS” NOT “recommendations to ensure a healthy baby and mum”.
        Avoiding a CS was her goal.

  66. Trixie
    January 7, 2015 at 12:34 pm #

    Thanks for writing this, Dr. Amy. It was hard for me to read this yesterday without my palm on my face the whole time. The only thing that got me through was the hope that you’d write about it in the morning. Her baby almost died! Yet she found it hysterical when they kept losing him on the monitors.

    • Amy M
      January 7, 2015 at 12:39 pm #

      Ugh seriously. They saw it as though he was misplaced, as opposed to dead. If a nurse came running into my room freaking out about losing a baby, I’d worry my baby had died!

      When I was on hospital bedrest, they did heart monitoring on the babies every day, and NSTs a few times/week. Baby A was pretty much stuck in one place, so it was easy to find his heartbeat. Baby B was always moving around so he was harder to track—the nurses called him “trouble devil” because he would move and they’d have to start the 10min count all over again. But, we knew he wasn’t dead, because we could feel him moving around, so joking was ok.

      • MLE
        January 7, 2015 at 1:44 pm #

        Yes, I was thinking how during my perfectly low-risk first child’s birth, I silently panicked every time the baby escaped from the monitor and we “lost” the heartbeat for a few seconds. It wasn’t funny, and there wouldn’t have been anyone more concerned than I was. I don’t get it.

      • Therese
        January 7, 2015 at 4:02 pm #

        I had twins too, so tons of monitoring and it was so hard to keep both babies on the monitor, but never once did a nurse act alarmed about it. So it does indicate something more serious could have been going on, if the nurses were actually freaking out.

        • The Bofa on the Sofa
          January 7, 2015 at 4:12 pm #

          How about the fact that she was a high risk pregnancy and they needed to monitor her closely, so when they lost the baby, it set off alarms?

          My wife went in at one point with some false labour, and I’m sure if the monitor fell off there they wouldn’t have panicked. Then again, she wasn’t high risk.

          • Therese
            January 7, 2015 at 5:37 pm #

            Yeah, I was high risk too, still didn’t have nurses getting alarmed when the babies fell off the monitor.

  67. Amy M
    January 7, 2015 at 12:22 pm #

    So if the baby was being monitored the whole time, yet came out in bad shape—was that not noticed? Was it just that she was so close to delivery that if they DID notice something off in the heartbeat patterns they would just encourage her to push harder and get him out asap?

    In the longer story, she said a doctor checked her at 11:30am, and said if baby wasn’t out by 2:30pm, she would be sectioned. So at 11:30, baby must have looked fine on the monitors, because the doctor was ok with waiting another 3 hours. But the mother says that the baby was born 7 minutes after that. Could she be leaving something out? Like maybe 2 minutes after the doctor assessed the situation, the monitor signaled a problem, and they said “get baby out now or else?” I could see how she wouldn’t report that, because then the Csection would have been necessary and she’s trying to paint a picture of how pointless all those Csections are.

    As it stands, it sounds like the NCB stories where the “baby was just fine until it was born dead.” In those stories however, there is inadequate monitoring. In this woman’s case, she was monitored up the wazoo (kinda literally), so if baby looked “beautiful” (her words) on the tracings in those last 7 minutes, how did he come out blue and not breathing?

    • Medwife
      January 7, 2015 at 12:30 pm #

      Like I usually say when I read these stories, I would love to read that strip and know her vitals, etc.

    • Stacy48918
      January 7, 2015 at 12:39 pm #

      Just having the heartrate, electrical pattern, recovery, etc…doesn’t say everything about the baby’s brain function, ability to breathe, etc. It’s the best monitoring we have…but not 100% predictive. All the more reason not to push off a C-section…just having a good tracing doesn’t mean baby is 100% OK. Dr. Amy wrote a post on this at some point…can’t remember the title so maybe someone else can dig it up.

      • Amy M
        January 7, 2015 at 1:45 pm #

        I see your point, and believe you are right (I am no doctor), but Dr. Amy said this in one of the links you provided:
        “…but the problem with monitoring is that it may indicate fetal
        distress when the baby is not distressed. In contrast, it is extremely
        reliable when a baby is experiencing oxygen deprivation. In other words,
        electronic fetal monitoring may lead to unnecessary C-sections, but if
        your baby is really in distress, it won’t miss it.”

        Can a baby NOT really be in distress, or in some kind of low-level distress that isn’t picked up by monitors and still come out blue and not breathing? (genuinely asking because I don’t know, not being obnoxious) Can something subtle (’cause obviously there was no cord prolapse here or something dramatic like that) happen in the last seconds of delivery that could lead that that scenario? Also, the top (last) comment in the discussion section of the HIE post was from a woman whose child suffers HIE because the hospital staff wasn’t properly trained on how to read the strips….so that’s always a possibility too. Dr. Keirns is not an OB so I doubt she could read the strips herself.

  68. PrimaryCareDoc
    January 7, 2015 at 12:09 pm #

    I hate doctors when they become patients. 🙂

    • January 7, 2015 at 2:31 pm #

      It’s not just doctors. I’m sure my being a nurse-midwife gave the folks taking care of me during my three births palpitations. I know the orthopedic staff during my hip replacement were extremely happy to see me go home

    • yugaya
      January 7, 2015 at 2:59 pm #

      I once had a class of older generation other foreign languages teachers as students at zero beginner level, their school had a lot of immigrant children and they needed to learn English to be able to communicate the basic stuff to parents. They were the worst students ever, tore me apart, kept insisting on me using the good ole’ backwards ways of teaching, complaining constantly at how little homework I was assigning and angrily asking why I could never just simply write the grammar rule of the lesson on the board at the beginning of the lesson like normal teachers do… it was a painful experience for all involved.:))) Eventually we all learned a lot, they passed their exams and the best thing was that the grumpiest student in that class came back to tell me how she was using some of my ‘new tricks’ in her own work.

      • KarenJJ
        January 9, 2015 at 6:32 am #

        At my work there is a sign above the coffee machine that says “If the machine is not working, LEAVE IT ALONE and contact reception”. I work in an office full of engineers and electricians that are used to “fixing” things.

  69. NoLongerCrunching
    January 7, 2015 at 11:56 am #

    Why do you think her doctors didn’t counsel her to get a cesarean from the getgo?

    • Amy Tuteur, MD
      January 7, 2015 at 12:02 pm #

      Maybe they did.

      I’m not sure that she is a reliable reporter since she was hell bent on jamming herself into the NCB narrative of “unnecesarean.”

      • January 7, 2015 at 2:32 pm #

        Is there any possibility she is being satirical? The story is just too outre to be believed, IMO.

      • Sue
        January 7, 2015 at 10:02 pm #

        Reading between the lines, I suspect that they spotted her for a Cesarean from the start, but they acquiesced to her wishes. How ironic that she now complains, or sees it as some sort of a victory, when the predicted complications ensued.

  70. Ash
    January 7, 2015 at 11:51 am #

    “Labor is an intricate dance of hormones, muscles, and emotions, usually triggered by the baby when he or she is ready to breathe
    outside the womb.” Now babies are the “deciders”!

    • ArmyChick
      January 7, 2015 at 12:46 pm #

      Apparently they are, especially in the eyes of the folks in the NCB community who blame the baby when he/she dies during childbirth “the baby decided not to breathe” or the “baby decided he/she didn’t want to live”.

      I have heard those “statements” so many times when reading stories of tragic homebirths that I have lost count.

      • yugaya
        January 7, 2015 at 2:23 pm #

        Yeah, not only blame it on the mother but blame it on the baby who grew too large of its own accord and against the fact that “you cannot grow a baby too big”, or a baby who forgot it should have been born sooner because “babies are not library books and they know when to be born”, or when a baby refuses to listen to its mother or idiot midwife telling it to start breathing because “babies in emergencies respond best to gentle voices” or when a baby does not tell it is in distress because “your baby will tell you if there is something wrong”…

        The long and ever growing shitlist of all the ways in which lay midwifery mindset likes to shift blame for anything and everything onto both the mothers and the babies infuriates me.

    • Medwife
      January 7, 2015 at 1:55 pm #

      Well, the fetal thyroid hormone levels seem to effect timing of labor. But most people wouldn’t say the thyroid “thinks”. Weird, weird way to put it.

  71. The Bofa on the Sofa
    January 7, 2015 at 11:41 am #

    On New Year’s Eve, there were likely MILLIONS of people who drove home safely despite being drunk.

    Just shows you all the money wasted on those free cab rides that were being provided. Oh, I’m sure their friends were pressuring them to take a cab, or otherwise not drive, but they sure showed them!

    • Roadstergal
      January 7, 2015 at 3:12 pm #

      I had an unnesscabride at 1am on NYD; after all the partying, I ended up having just two glasses of champagne and feeling great. I should have trusted my body to do what it knew how to do and drive home on my own – maybe paying someone to sit in the back seat and cheer me on with a gentle voice.

      I’m sure sitting in the back seat of a cab had consequences for my microbiome.

      • yugaya
        January 7, 2015 at 6:19 pm #

        Next time, if you still feel that the cab is the safest option for you (and we all choose what is safest for ourselves and no one should be judging other people who chose differently when it comes to drinking and driving, I’ve been having unnecessary cab rides for years when I was out drinking but I have also been educating myself and doing my own research and have had an empowering DDA40CR* just last week), you should totally INSIST that the cab driver swabs the inside of your car and puts some of its lifesaving microbiome onto his back seat.

        Also, you may wish to explore traditional, “other ways of driving while drunk” techniques taught by our ICRAN** chapter. Drunk people die in cabs too and we need to educate the public how to avoid the horrible risks associated with this often completely unnecessary driving intervention.Our bodies were designed to drive and you should trust driving, you can never drive a car too drunk anyway.

        My DDA40CR was an amazing experience, it left everyone breathless especially the EMTs who were pulling me out of the wreckage, but it was best day of my life! I succeeded at drinking and driving after years of thinking my body had failed me !!!!!!!!!!!!

        *DDA40CR = drunk driving after 40 cab rides
        **ICRAN = international cab ride awareness network.

        • yugaya
          January 7, 2015 at 6:23 pm #

          That’s the average lay person’s version, Dr. Keirns would be the equivalent of a more eloquent driving instructor boasting about similar drunk driving achievement.

        • Mer
          January 9, 2015 at 2:58 am #

          Yugaya, your story is just so inspiring! You are such a drunk driving warrior! I feel som empowered just from reading this that I almost want to drink just so I too can have my healing drunken car driving experience! Thank you for sharing! Hugs!

  72. moto_librarian
    January 7, 2015 at 11:40 am #

    Thank you for this. It was clear to me that she was withholding a great deal of information in the WaPo article. The clues were there for anyone with a knowledge of pre-e, diabetes, etc., but an astounding number of people will read her account and take it at face value. I noted that she gave no reason for her induction, but it’s clear that it was done because of diabetes and pre-e. By leaving that out, she creates a narrative in which her doctors started her out with an “unnecessary intervention.” I find it amusing that she blames pitocin and mag sulfate for her baby’s condition at birth – it just couldn’t be the two days of labor and an increasingly sick mother! She also suggests that pitocin was the cause of her pph, despite the fact that a long labor in of itself can cause uterine atony leading to hemorrhage.

    • Deerhart23
      January 7, 2015 at 1:05 pm #

      The preeclampsia can cause the PPH. In some women, the progress of the condition will eventually use up all your clotting factor as smaller clots are formed in the placenta and the rest of the body. Essentially it follows a process like DIC

      There is a reason that c-sections are very common in women with preeclampsia and those of us who delivered vaginally are actually in the minority.

      • moto_librarian
        January 7, 2015 at 2:48 pm #

        I have a friend who delivered HELP over the course of a few hours. She went from normal BP readings at her appointments to a reading so high that the nurse got a different cuff because she thought it must be broken. She was sent straight to L&D, and she sensed that people were tiptoeing around her situation because she was a CNM patient. She asked for the attending midwife and told her that she didn’t care about how she gave birth, but that the health of mom and baby were the priority. She had a c-section, and both she and baby are fine today, although it did take awhile for her BP to stabilize after delivery.

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