celebrates Labor Day by exploiting the tragedies of women of color


I get it.

The folks at, primarily doulas, believe that the best way to promote themselves and expand their employment opportunities is to criticize modern obstetrics. As far as I’m concerned, there’s plenty to criticize. But they go a step too far when they attempt to promote doulas, natural childbirth and homebirth by exploiting the tragedies of women of color.

I found this example particularly repulsive.

ImprovingBirth gowns

Twelve hundred gowns, for the 1200 mothers who lost their lives giving birth in the U.S. in 2013. It’s a very sobering sight, thinking about what each one of the gowns stands for.

Big thanks to the people who have donated their time sewing the gowns to help honor these mothers- and to hopefully reduce the number of women dying in the future.

The implication is that these 1200 women (there is some dispute about the actual number) died because of high tech obstetrics and therefore, their deaths are an excellent marketing tool in promoting doulas, natural childbirth and homebirth.

Nothing could be further from the truth.

Here was my response:

Improvingbirth 9-6-15

[pullquote align=”right” color=””]The real tragedies? Women whose lives and babies could be saved if we had more high tech interventions.[/pullquote]

If you really cared about maternal deaths, you would do something about it besides exploit them to publicize your own organization.

There is some dispute about the actual number of mothers who died, but there’s little dispute about why they died. From the report that cited the number 1200:

“Hospitals across the USA lack a standard approach to managing obstetric emergencies and the complications of pregnancy and childbirth are often identified too late. Nationally endorsed plans to manage obstetric emergencies and updated training and guidance on implementing these plans is a serious and ongoing need.

A second factor is the increasing number of women who present at antenatal clinics with chronic conditions, such as hypertension, diabetes and obesity, which contribute to pregnancy-related complications. Many of these women could benefit from the closer coordination of antenatal and primary care – including case management and other community-based services that help them access care and overcome cost and other obstacles. In the USA, women who lack health insurance are three to four times more likely to die of pregnancy-related complications than their insured counterparts.

So these women, disproportionately women of color, die because they need HIGH TECH care. What is doing to obtain high tech care for these women?

Absolutely nothing, right? Oh, wait, that’s not true. You’re exploiting their deaths to promote an agenda that has nothing to do with them.

Apparently the folks at ImprovingBirth. org were stung … so they removed my comment. That indicates to me that they understand that they are exploiting the tragedies of women of color, want to continue exploiting those tragedies, but don’t want anyone to KNOW that’s what they are doing.

Apparently Dawn Thompson has been particularly stung by the criticism. She made this video last night:

Dawn Thompson video

Her primary claim is that modern obstetrics is rotten because, as a doula, she’s seen it with her own eyes.

But Dawn, who is so very impressed by what she has seen, can’t fathom that others, including obstetricians such as myself, have seen everything she’s seen AND a lot more.

Dawn is a privileged white woman who attends privileged white women who are creating a “birth experience.” There’s nothing wrong with that but it’s a tiny fraction of maternity care. Lots of women, particularly women who aren’t privileged, are more concerned with the literal survival of their babies and their own survival. They have serious pre-existing medical conditions; they’ve had difficulty accessing well woman care prior to pregnancy and these medical conditions have often progressed to further impair their health; they suffer from serious complications of pregnancy like pre-eclampsia and postpartum cardiomyopathy; they lack access to the most high tech care generally found only in regional medical centers … and as a result, they die and their babies die.

These are the real tragedies of modern obstetrics: women whose lives and babies could be saved if we had more perinatologists, more perinatal ICUs, more high tech interventions. Their lives CANNOT be saved by doulas; their lives CANNOT be saved by natural childbirth; their lives CANNOT be saved by homebirth. So why are their deaths being touted with stupid publicity stunts such as sewing pastel colored hospital gowns? Because the women of don’t care about deaths women of color; they care about THEMSELVES and their employment opportunities.

They are entitled to care only about themselves and other privileged white women who want to create a specific “birth experience.” But they aren’t entitled to exploit women who die in childbirth, disproportionately poor women and women of color, in order to do it.

They should be ashamed of themselves. Indeed, they ARE ashamed or they wouldn’t have deleted my comment.

Here’s how they can assuage that shame:

Stop the stupid publicity stunts like sewing pastel colored hospital gowns! Devote that effort to demanding greater access to high tech obstetric care for the women who die for lack of it!

That’s why they would do if they really wanted to improve birth, not merely improve their own employment prospects.

102 Responses to “ celebrates Labor Day by exploiting the tragedies of women of color”

  1. HL
    October 2, 2015 at 1:13 am #

    I signed up to go to one of these in my city in the southeast because I do believe that our hospitals and services need improvement-& I truly do think that csections are often performed unnecessarily. However, as the date approached, it seemed that more and more of the comments (& those participating) had a home/natural birth/bash doctors agenda. So, I just couldn’t bring myself to participate.

  2. attitude devant
    September 9, 2015 at 4:13 pm #

    Dawn Thompson is a joke. She knows nothing about anything but believes fervently that maternal death is caused by the horrors of modern medicine. She should be so lucky as to never learn first-hand how wrong she is.

    • yugaya
      September 9, 2015 at 4:31 pm #

      Since her only proof needed is what she sees with her own eyes (insert eyeroll), she also uses same level of evidence for proving that HBA3C is not a particularly lethal idea because both she and her baby survived it.

      • araikwao
        September 9, 2015 at 5:30 pm #

        *jaw dropping*

        • yugaya
          September 9, 2015 at 5:41 pm #

          With a CPM no less. She calls that “making an educated decision”.

  3. Ash
    September 8, 2015 at 7:45 pm #

    Improving Birth chicago FB page–demonstration of the # of women in the USA who died in childbirth, and another photo on their profile of “pregnancy is not a disease” OK then.

    • Guest
      September 8, 2015 at 9:45 pm #

      Look closely at the photos of the rally. Their agenda looks much more akin to a movement towards legalization of CPMs, distinction of doulas and the homebirth movement than any actual concern over the issues that impacted the lives of any of the women each gown represents. The significance of the hospital gowns are just the NCB and homebirth movement pawns. The deaths of these 1200 women are exploited through the purposes of their agenda without evidence that the Rally did anything other than allow the memory of these mothers to be buried twice.

      • yugaya
        September 9, 2015 at 4:02 pm #

        “Their agenda looks much more akin to a movement towards legalization of CPMs, distinction of doulas and the homebirth movement than any actual concern over the issues that impacted the lives of any of the women each
        gown represents.”

        Totally. I like how the Brits have special national watchdog that looks into each and every case of maternal death (CDC does the same with its special pregnancy related maternal death program but they don’t publish as much online). Just reading through the last report gives insights into both how seriously all cases are investigated and how carefully everyone involved in care of pregnant women on the medical side is making sure that all avoidable deaths in the future are prevented.

        The irony is that Improving Birth, by pulling cheap publicity stunts like this one with 1200 gowns supposedly showing how little medical system cares about maternal deaths, is only showing that they are the ones who do not really care about those dead women at all beyond scoring themselves some TV time and Dawn Thompson getting accolades for this idiotic video from her followers.

    • Daleth
      September 9, 2015 at 2:56 pm #

      That is actually hilarious (I mean the contradiction you’ve pointed out, not the facts, obviously).

  4. Anonymous
    September 8, 2015 at 1:07 pm #

    The gown thing is a joke. Are they trying to assert that these were women who died in a hospital setting that they could have saved had they employed a midwife or doula? SMH.

  5. Rae Rae Martinez
    September 8, 2015 at 11:01 am #

    Can someone explain the gown stuff? What does sewing a bunch of gowns have to do with anything? How does that help anyone? Do they donate these? Even if they did donate these, is that something that a lot of people are in desperate need for? Certainly no one needs a hand sewn gown, right? Certainly someone could go to work, make some money, and donate money to be used to purchase these gowns wholesale or something, right?

    • Michele
      September 8, 2015 at 12:37 pm #

      Or sell these gowns to raise money for programs that would help women with pre-natal care.

  6. Adelaide
    September 7, 2015 at 10:16 pm #

    If you want to improve outcomes for women and babies of color support the medical professionals of color. There is a cultural gap that we so often don’t see because we speak the language of power and privilege.

    • demodocus
      September 8, 2015 at 10:06 am #

      Both my obs and my pcp are people of color. Latino, Nigerian, and Indian. ‘Though I expect the latter two would have some of the same cultural translation issues as my Yankee self.

    • demodocus
      September 8, 2015 at 10:07 am #

      Both my obs and my pcp are people of color. Latino, Nigerian, and Indian. ‘Though I expect the latter two would have some of the same cultural translation issues as my Yankee self. They’re clearly 1st generation Americans.

  7. yugaya
    September 7, 2015 at 7:02 pm #

    Dawn removed all comments highlighting her privileged agenda opportunism and on top of it posted a series of classic bigot defense status updates along the lines of “I’m not racist, I have friends who are …” that were further laced with selling her faulty POW and highlighting her racial hypocrisy when it comes to maternal mortality in USA. Check out what she lists as her and Improving Birth’s accomplishments when it comes to racial disparity of maternal deaths she is exploiting:

    ” One of the coordinators of Improving Birth in Chicago has spent years
    working (some paid work, some volunteer work) with multiple non-profit
    organizations in the area to help improve outcomes and conditions.” Translation: someone was working as a doula or a homebirth midwife and making a profit.

    “This work has included teaching expectant parents about pregnancy and childbirth on a sliding scale, providing labor support (which had been proven to improve outcomes) on a free or low-cost basis for families without the financial means to have such professional support, assisting care providers with prenatal education, connecting families in need with additional resources, fundraising for efforts to help families in need (both in the United States and internationally) and more.”
    Translation: someone was charging for childbirth classes and promoting Improving Birth.

    ” A large number of families who participate in one of these programs are people of color, and concerted efforts are made to be conscious of racial disparities and in some cases, cultural differences. We do need to be mindful that different people have different roles and boundaries, and it would be inappropriate for individuals to ignore their appropriate scope of
    practice to deal with some of these specific issues, but our community
    is working hard at a variety of levels to make huge improvements to our
    maternity health care system, especially for the most vulnerable
    populations. ”
    Translation: Improving Birth is working so hard on making HUGE IMPROVEMENTS in maternity health care, ESPECIALLY for the most vulnerable populations, that by the way she is describing the magnitude of their impact she’s invented with her own hands a 100% effective way to diagnose and treat AFE at least.

  8. mabelcruet
    September 7, 2015 at 5:10 pm #

    Off topic maybe, but I am very angry at the moment. I did an autopsy on a newborn baby who died following a stay in neonatal ICU. Mum had decided against all antenatal investigations, she was an older mum, delivered in a stand alone unit. Baby came out flat, very sick, urgent transfer, ccoagulopathy, bleeding from every orifice, massive brain haemorrhage, respiratory problems, lines in every vessel available. Poor wee mite had a couple of days fitting and bleeding, being poked and ventilated before he died. Turns out she had complex congenital heart disease. If an ultrasound had been done during the pregnancy, this would have been known about and she could have delivered somewhere appropriate with paediatric cardiology ready and waiting, and she might have had a chance. Instead she got a brief miserable existance because mum didn’t want to medicalise her pregnancy and have a scan. I know it’s maternal choice and all that, but it seems so selfish to me.

    • Who?
      September 7, 2015 at 6:09 pm #

      The ripples from a tragedy extend a very long way.

      When we know more, we can do better. Who knows what decision this family might have made, armed with all the facts? Surely the baby’s life, however long, could have been less traumatic for her and those around her, if her condition had been recognised.

      • The Computer Ate My Nym
        September 8, 2015 at 4:29 am #

        If nothing else, if the condition had been known about ahead of time the baby could have been put on hospice and not been subjected to all those (futile) interventions.

        • Who?
          September 8, 2015 at 4:58 am #

          That was my thought too-if they decided to go to term, it may have been kinder for everyone to do just that. So glad I’ve escaped such terrible decisions so far. It’s a fierce introduction to parenthood, that’s for sure.

          • mabelcruet
            September 10, 2015 at 2:59 pm #

            Where I am, we frequently get babies going to term who have lethal abnormalities (babies with renal agenesis and lethal skeletal dysplasia are not uncommon)-its not something that I think I could go through personally knowing that the baby I was carrying would inevitably die within hours or minutes, but some families decide to do this and that this their absolute right. But its a choice that suits them and it’s made on the available evidence, and the babies end up spending their short lives in their parents arms, not being ravaged by lines and wires and painful interventions. I genuinely don’t see why having a scan can be seen as medicalising the pregnancy-its basically a picture. They can choose to take action on the findings or not, but surely for the sake of their baby its better to be prepared? I really don’t understand the motivation of women who purposefully put their babies into harm’s way-its like shoving a toddler into the middle of the road and only the ‘worthy’ will get across without being splattered.

      • mabelcruet
        September 8, 2015 at 4:30 pm #

        I generally don’t get told that much of the back story-this seems to have been a couple who live in quite a rural area and they would have had to travel a fair distance to the main feto-maternal medicine unit. She was >35 and had two previous early first trimester losses-I’ve no idea how she was considered low risk enough to deliver in a stand alone unit. Maybe the outcome would have been bad even if she delivered in the high risk unit, but at least there would have been a plan of action in place and not a mad panic to get the baby into a transport incubator whilst he was arresting.

    • yugaya
      September 7, 2015 at 6:34 pm #

      So, so cruel.

    • Cobalt
      September 7, 2015 at 9:19 pm #

      What a heartwrenching job to have to do. That poor baby. I’m so sorry.

    • KeeperOfTheBooks
      September 7, 2015 at 10:33 pm #

      I am so very sorry for you and for this baby. How miserable for all involved; I’m glad that baby is at least at peace now.
      If I knew you in real life, I’d buy you a stiff drink.

  9. araikwao
    September 7, 2015 at 4:53 pm #

    Here’s something I witnessed last week during a day on birth suite, in my extremely privileged position as a medical student at a leading tertiary hospital – not one, but two women who were, I estimate, at most 30 minutes from death in the absence of adequate help and resources: one from a large PPH, the other didn’t have a clear cause at the time. Both women needed a big team of people and a heap of resuscitation, but they made it.
    A doula couldn’t have prevented that. Not having an epidural would have just made the whole process more traumatic (hand in uterus, anyone? Hmm. I thought not), not having IV access would have made the situation even more dangerous, and one little IM shot of Synt/Pit wouldn’t have touched the sides. These women survived because of emergency protocols, medicine, technology and sufficient trained staff – I.e. because they were in a hospital. That improved their birth.

    • moto_librarian
      September 7, 2015 at 5:04 pm #

      I can attest to how fucking awful a manual exam of the uterus is without pain medication. I also realize that I am incredibly lucky that they were able to run an I.V. in the absence of a hep lock given that I am a hard stick due to small veins. At least whatever they gave me once they were able to run the I.V. knocked me out. I remember watching the lights on the ceiling as they wheeled me back to the O.R., but not another thing until 4 or 5 hours after I was out of surgery.

      I will always be grateful to modern medicine and the team that made sure that I survived the birth of my eldest child. These sanctimonious twits need to get some perspective.

      • Monkey Professor for a Head
        September 7, 2015 at 10:26 pm #

        I was so grateful for the epidural when I had my PPH. I don’t think they did the whole “hand in the uterus” thing, but they definitely did a cervical exam and I didn’t feel a thing. In fact the epidural let me ignore everything going on from the waist down and focus on my son. I think the whole experience would have been much scarier and traumatic without it.

        I’m also very glad that I had an IV already in place because of the epidural. Even with immediate intervention I dropped my Hb from 144 to 80 and ended up with a blood transfusion. Seeing as it took multiple attempts to get that IV in, things could have been much worse.

      • Cobalt
        September 8, 2015 at 6:51 am #

        Ah, the old hand-on-the-wrong-side-of-the-cervix trick. Great for removing any physical obstacles to uterine clamping. Feels a bit like giving birth backwards, only faster and with more repetitions. Hurts like having an arm in your abdominal cavity. Not my favorite part of my birth experience, but it worked and I walked out of the hospital 36 hours later instead of the tragic alternative.

        • moto_librarian
          September 8, 2015 at 9:43 am #

          Exactly. I could very easily turn this into a narrative of how I was “birth raped” since they didn’t ask if they could do these things. My midwife told me what she was doing as she did it. There wasn’t time for informed consent (in fact, my husband had to consent to surgery, including the possibility of a hysterectomy, because I was in and out of consciousness).

          • Cobalt
            September 8, 2015 at 4:23 pm #

            My OB looked at me and said she could do it RIGHT NOW, without pain relief because I was without an epidural, or knock me out for surgery. I went for the immediate action. It hurt severely, but I’m glad she did it. The chunks she pulled out were…enlightening.

      • araikwao
        September 9, 2015 at 5:42 pm #

        I did think of you as I was commenting, and am also sorry for the awful things you’ve been through. I wonder how it is that some would use that kind of experience to justify eschewing most/all medical care next time, and yet you can rationalise it as a necessary, albeit horrible step towards a good end result.

        • moto_librarian
          September 10, 2015 at 10:08 am #

          I think that it helps to talk through these types of things with a therapist or healthcare provider. Since I am a lifelong depressive, I scheduled an appointment with my psychiatric NP within a couple of months of giving birth. Since I receive all of my care through the same healthcare system, she had already accessed my record to see how my birth had gone. Her first words, “My goodness, you had a really tough time of it, didn’t you?” We talked a bit about what had happened, and that was immensely helpful.

          I also think that we have to stop worshiping at the altar of “natural” birth. We are setting ourselves up for failure with unrealistic expectations. Every time that I hear a woman state that she feels like she failed because she had an epidural, or feels that she has to justify her c-section, I want to tear my hair out! This is ridiculous, and it needs to stop. Now.

    • Chelsie S
      September 8, 2015 at 2:44 pm #

      from a reformed natural birther: I had a massive pph, the midwofe couldn’t do squat- and I had hands rummaging around my uterus four times at the hospital, NO pain meds. I have never thought I was so close to death- and I have never imagined greater pain. My body was in shock. This is what led me to the SOB, those midwives and doulas promoting their beliefs- who misled and manipulated me and so many others- shame on all of them. They couldn’t have cared less about me after I left the ER… They just wanted me see me try to breastfeed after 48 hours fighting for my life. Sick, sick people. Thanks for sharing this story- they cannot prevent or treat life threatening emergencies and are quick to try to hide that fact.

      • moto_librarian
        September 8, 2015 at 3:14 pm #

        I am so sorry that this happened to you! I had a really hard time getting past my first birth, and I never doubted the compassion of my care providers. Our oldest son just turned six last week, and he was asking us about his birth. I only share basic things with him, but my husband suddenly got very serious and said that it was a tough day for our son and for mommy, and that he was very scared for awhile. We took pains to point out that both of us were being cared for, but it’s still a bit sobering to think about even six years later.

        • Chelsie S
          September 8, 2015 at 6:47 pm #

          It’s just so sobering thinking that what should be the happiest day of your life- also brings so many traumatic, painful memories of how close you were to not making it… I totally feel you on that. I still don’t know how I will one day explain it to her because i want her to know how very happy we were to be blessed with our beautiful healthy baby, but I can’t help but think that minutes or hours more without professionals helping me could have meant death for me and being motherless for her, I want to shout it to all the natural birthers that IT ISNT WORTH it… I was at a freestanding birth center across the street from a hospital and it STILL took the midwife about 50 minutes to realize how bad it was and for the fire truck to take me to ER. It was walking distance. Lesson learned, I hope our stories can help others. I am so sorry to hear that you had such a scary experience as well.

          • Who?
            September 8, 2015 at 8:23 pm #

            It’s frustrating to hear people say they want a natural birth ‘at any cost’. The cost can be extraordinary. When someone who has no children says that, I can kind of understand it, because they perhaps don’t yet have the visceral knowledge of being a parent-love, responsibilty and all that goes with it. It really isn’t just all teddies and cute baby clothes.

            Thanks for sharing what you’ve learnt. I hope you don’t get too much pushback from anyone: NCB followers can be quite aggressive when challenged.

          • Daleth
            September 9, 2015 at 2:58 pm #

            People actually say that?!? People are nuts.

    • Daleth
      September 8, 2015 at 3:49 pm #

      Keep up the good work, Araikwao. I went into hypovolemic shock in recovery after my c-section and am alive and well only because I was in a hospital with a heplock and post-delivery monitoring (so they saw my BP plummet or whatever it was that told them I was in trouble, and a squad came rushing in immediately).

  10. TsuDhoNimh
    September 7, 2015 at 4:08 pm #

    Lots of women, particularly women who aren’t privileged, are more
    concerned with the literal survival of their babies and their own
    survival. They have serious pre-existing medical conditions; they’ve had
    difficulty accessing well woman care prior to pregnancy and these
    medical conditions have often progressed to further impair their health;
    they suffer from serious complications of pregnancy like pre-eclampsia
    and postpartum cardiomyopathy; they lack access to the most high tech
    care generally found only in regional medical centers … and as a result,
    they die and their babies die.

    I worked at a large county hospital … the number of untreated gestational diabetes and pre-eclampsia cases I saw that could have been prevented was depressing.

    The patient that I remember as the example of this is the woman who was not poor enough to get free care, not making enough money to afford private care, and had no health insurance from her spouse’s job. The working poor.

    She came in in full labor with zero prenatal care, went into eclampsia and DIC and then various organ failures, and it took several months and over a QUARTER OF A MILLION DOLLARS to save her life.

    That would have provided basic prenatal care to over 1,000 women at the clinic.

  11. TsuDhoNimh
    September 7, 2015 at 4:01 pm #

    What are they doing to get better access to pre-natal care for these woman?


    • yugaya
      September 7, 2015 at 7:12 pm #

      According to the photos from their Chicago rally, a bunch of middle class white women parading their vagendas around is how they are working to improve outcomes for women of color.

  12. Karen in SC
    September 7, 2015 at 3:27 pm #

    I posted this yesterday as comment and didn’t add anything:
    In the United States –Of the 1,751 deaths within a year
    of pregnancy termination that occurred in 2011 and were reported to CDC, 702 were found to be pregnancy-related. The pregnancy-related mortality ratio was 17.8 deaths per 100,000 live births in 2011.
    Considerable racial disparities in pregnancy-related mortality exist. In 2011, the pregnancy-related mortality ratios were

    12.5 deaths per 100,000 live births for white women.

    42.8 deaths per 100,000 live births for black women.

    17.3 deaths per 100,000 live births for women of other races.

    The graph below shows percentages of pregnancy-related deaths in the United States in 2011 caused by

    Cardiovascular diseases,15.1%.

    Non-cardiovascular diseases,14.1%.

    Infection or sepsis, 14.0%.

    Hemorrhage, 11.3%.

    Cardiomyopathy, 10.1%.

    Thrombotic pulmonary embolism, 9.8%.

    Hypertensive disorders ofpregnancy, 8.4%.

    Amniotic fluid embolism,5.6%.

    Cerebrovascular accidents,5.4%.

    Anesthesia complications,0.3%.
    The cause of death is unknown for 5.9% of all 2011 pregnancy-related deaths.

    Now, today, they are all about helping black mothers. Detoured quickly, though Dr. Amy has always talked about this disparity over and over. So it’s not really a news flash.

    • yugaya
      September 7, 2015 at 7:15 pm #

      At least she learned something from you because she ripped you off and posted the same link later as a recommended source of more information on the role that race plays in maternal mortality in USA.

    • The Computer Ate My Nym
      September 8, 2015 at 4:09 am #

      Note that none of the conditions that are common causes of maternal mortality would be in any way helped by a home birth. I suppose BB would argue that infection is less likely to occur in the home, but is it, really? Most infections are from the mother’s endogenous bacteria, not hospital acquired organisms and being in the hospital would improve the chances of effective early intervention.

      Are there any numbers on maternal mortality in home births? I know that some have occurred since Dr. Tuteur has reported on them, but I don’t know whether the rate is higher or lower than for hospital.

      • Cobalt
        September 8, 2015 at 6:53 am #

        Theres not enough home births with stats tracked to tell. Logic says it will be higher in comparable risk groups, but thankfully it’s too rare a choice to prove.

        • The Computer Ate My Nym
          September 8, 2015 at 7:28 am #

          Yeah, when you’re looking for an event that occurs in X per 100,000 it’s hard to find a signal. Especially in the setting where it’s so hard to get the denominator right: In an emergency, the midwife can transfer and lie about it being a planned home birth (or just disappear and tell her client to deny that she was there). Or just bury the bodies. Given some of the stuff that has come out about The Farm I wouldn’t be surprised to learn that there were bodies buried there after a birth went wrong.

          • Amy M
            September 8, 2015 at 12:15 pm #

            Also, we know that statistically, the homebirth crowd is healthier. One, because most of them are middle-upper class white, and two because most women who know they have some sort of complication won’t choose homebirth.

          • The Computer Ate My Nym
            September 9, 2015 at 5:05 am #

            There are on the order of maybe 30-50,000 home births per year? Is that right? If so and if we assume that the maternal death rate is about that of average risk white women (though it’s presumably a little lower given the risk population), you’d expect maybe 3-5 deaths at home birth per year. Unfortunately, I don’t know what the real number is, so can’t calculate a risk ratio. But that does suggest that there “should” be a couple of cases per year so the knowledge that they anecdotally do occur is not evidence that home birth is more dangerous. OTOH, the fact that deaths that would not have occurred in a hospital that was working even reasonably well (i.e. Carol Lovett’s) is evidence that home birth is dangerous.

      • Young CC Prof
        September 8, 2015 at 8:14 am #

        Neonatal deaths from infection are actually more common at home birth, because, as you said, the organisms most likely to do harm are the ones the mother walks in with. (Yes, there are people in the hospital with dangerous infections, but the maternity ward is separated from them in many ways.)

        There’s not enough data on the maternal deaths, but we do have anecdotal accounts of women dying at home birth who probably could have been saved with some pretty simple treatments if they’d already been in the hospital, such as Caroline Lovell.

  13. Bombshellrisa
    September 7, 2015 at 3:07 pm #

    Just had the thought that if they want to Improve hospital birth, they could sew these gowns and donate them to hospitals for one time use for the women who use the excuse “I don’t want to wear a gown someone might have died in yesterday/I want to wear my own clothes/I feel like a prisoner being forced to wear what everyone else is wearing” as an excuse to birth at home.

  14. Anna
    September 7, 2015 at 2:59 pm #

    “Lots of women, particularly women who aren’t privileged, are more concerned with the literal survival of their babies and their own survival”. You just couldn’t be more right. Unprivileged women know nothing about unneeded interventions, unnecessereans, evil epidurals, etc. They just want their babies to live! I read about a poor Mexican/Native American woman who cut her belly herself (!!!) so that her baby boy could live! Now that is a Mother. And all these snobs bragging about “birth experience” are just a bunch of high-schoolers, who want to impress their peers. If they don’t show off as birth goddesses their friends will think they are somehow uncool… Grow up, that’s what they must do until it is too late. Grow up and realize that giving birth is one of the most dangerous events in one’s life, be it at home or in hospital, only in hospital they will take care of the comlications and at home they will not!

    • Kelly
      September 7, 2015 at 8:51 pm #

      They will never be able to top the lady who gave herself her own c-section and lived.

  15. Bombshellrisa
    September 7, 2015 at 2:30 pm #

    These are probably the same people who are part of the “give cloth diapers, give hope” campaign, which is exactly what it sounds like. Apparently there is an out of touch group of overprivileged women who believe that contributing to a fund to donate cloth diapers to mothers in impoverished countries “gives hope”. My question is this: what do you think they are using as diapers? Maybe not cloth diapers as we know them, but most likely cloth diapers fashioned from textiles they already had.
    Hate to break it to Improving Birth, but their idea isn’t original. Ina May Gaskin’s quilt is older and insinuates the same thing.

    • Cobalt
      September 7, 2015 at 2:51 pm #

      There are people who would benefit from cheap cloth diapers, but they’re not people who are already using cloth diapers by necessity. Making cloth an OPTION available to the needy in the US would help those families that are reusing disposables AND have the laundry resources to make cloth viable.

      • Bombshellrisa
        September 7, 2015 at 2:55 pm #

        Exactly. And the donations aren’t even for US women. Not sure how to reconcile how “green” they feel cloth diapers are if these women are having to wash the diapers in a stream, lake or river. They must think everyone has access to a washing machine and dryer.

        • Bugsy
          September 7, 2015 at 8:51 pm #

          Yes – and the time to wash/dry/prepare the diapers as well. Not insignificant.

          • KeeperOfTheBooks
            September 7, 2015 at 10:37 pm #

            And if you’re using a laundromat or apartment complex laundry area, don’t forget dealing with older kids during that. Just hauling 3-4 kids with you every time you have to walk across the (potentially unsafe) complex to flip the laundry over, or bringing them to the laundromat for hours might be pretty freaking intimidating.

          • Cobalt
            September 8, 2015 at 6:57 am #

            And if cloth diapers can be sold on craigslist for profit (and they can), they will get stolen from that complex laundry facility if left unguarded.

          • KeeperOfTheBooks
            September 8, 2015 at 8:43 am #


        • Cobalt
          September 7, 2015 at 9:24 pm #

          Not just access- affordable access. If you’re paying $6 a load (just to wash- forget the dryer) at the laundromat plus transportation, and needing to wash diapers three times a week, disposables look cheaper all the time.

          • The Computer Ate My Nym
            September 8, 2015 at 4:33 am #

            Not to mention that in an area where water is in short supply, disposables may actually be better for the environment by the time you factor in the water and energy used to wash the cloth diapers.

          • Roadstergal
            September 8, 2015 at 12:22 pm #


          • The Computer Ate My Nym
            September 9, 2015 at 5:10 am #

            Yep. Plus energy. My critter was born the year of the great northeastern blackout. If we’d been using cloth diapers we couldn’t have laundered them (no electricity so at best cold water and we were extremely lucky to be in a building just low enough for the water to flow without pumping so we could easily have been without water too–a lot of people were). In short the saying about creeks and paddles would have been extremely relevant. Modern disposables are smaller than the “classic” version and made to degrade in landfills. I’m sure they’re not wonderful for the environment, but using them isn’t like using an SUV or flying everywhere.

    • Ash
      September 7, 2015 at 8:24 pm #

      I went to the “give cloth diapers, give hope”website. it is a USA only program.

      • Bombshellrisa
        September 7, 2015 at 9:18 pm #

        Ok, the one I am thinking of is different then, the diapers go to other countries.

  16. Mel
    September 7, 2015 at 2:24 pm #

    The folks at Improving Birth would worry me more if they had their shit together.

    I went to their emergency help page for use in upcoming appointments OR if your rights are being violated labor. You need internet access + your name, email, phone number, age, EDD, city, state, PCP’s name and address (but they won’t contact them) and all the details of the incident. You also have radial button choices for pregnancy complications (Y/N), VBAC (Y/N) and planned birth location (hospital, birth center, home).

    All of the listed categories are required.

    My take-away is that IB is more into collecting unverifiable horror stories than actually helping women in real time. Otherwise, they’d have a 24/7 staffed emergency line like suicide help lines, the domestic abuse hotline and poison control

    • TsuDhoNimh
      September 7, 2015 at 4:11 pm #

      The temptation to flood their database with fictional horror stories is growing.

      • Bombshellrisa
        September 7, 2015 at 4:25 pm #

        Just make sure they are all home birth stories, but then again there are too many true stories that you would have to post quite a bit before you were able to get to the fictional ones.

      • Who?
        September 7, 2015 at 6:14 pm #

        You could do one with the dolphins going horribly wrong-morphing into killer whales maybe?

  17. JellyCat
    September 7, 2015 at 1:55 pm #

    They also push their agenda in Canada. It is very disturbing.

    • Angharad
      September 7, 2015 at 3:37 pm #

      This is very OT but I just realized that your username looks familiar to me because my daughter’s favorite toy is Jellycat brand. Is there a story behind your name?

  18. Young CC Prof
    September 7, 2015 at 1:27 pm #

    How to help reduce maternal and newborn mortality and serious morbidity (without having any medical skills):

    1) Help low-income pregnant women with the paperwork aspects of care, from applying for Medicaid to finding a doctor who will take it to making appointments.

    2) Help arrange transportation and childcare so that they can get to appointments.

    3) Advocate for better legal protections for pregnant women and new parents, from work limitations to time off for medical appointments to paid leave after birth.

    4) Raise awareness about serious complications of pregnancy, whether preeclampsia, heart disease, preterm labor or severe flu.

    5) For patients with limited English or limited social capital, help them to communicate with healthcare providers and self-advocate.

    Any more ideas?

    • Bombshellrisa
      September 7, 2015 at 2:24 pm #

      Going along with the Medicaid part-help them with their children or other responsibilities while they wait for endless hours on hold trying to get the application kinks worked out. Help them locate what documents are needed to verify employment and income. Attend their first doctors appointment with them and make sure that the care provider explains things to them in a way that they understand and if they feel talked down to, help them communicate that.

      • Cobalt
        September 7, 2015 at 2:47 pm #

        The application hoops to get help are incredibly discouraging and limiting, some of which I think is a deliberate effort to save money by reducing approved applicants while still getting to claim that people are being helped.

        I don’t know how many times I’ve heard “Why don’t they just get Medicaid? It’s free and it covers everything. (Stupid poor people!)”. If it were that easy, they would’ve done it already!

        • Angharad
          September 7, 2015 at 3:40 pm #

          I’ve heard a theory that they deliberately make applications for student financial aid more difficult for the same reason. The more hoops to jump through, the less they need to pay out in the end.
          On the other hand, it may just be plain old-fashioned bureaucracy and reluctance to ever get rid of any paperwork.

          • Who?
            September 7, 2015 at 6:19 pm #

            I tend to favour cock-up as an explanation over conspiracy. People love to create a form, collect every bit of information they ever might want or need, including for the crackpot survey du jour then store it all in 10 different places and no one ever looks at it again.

          • Young CC Prof
            September 7, 2015 at 6:43 pm #

            Actually, there’s a lot of reasons why schools have so much paperwork, and one is regulatory compliance. Every time the feds pass a regulation on colleges, every college needs to hire another full-time staffer just to stay in compliance. And of course, decisions about forms and documents are made by dean-level people, folks whose number-one problem is accreditation and federal and state regulations. It’s not that they don’t care about the effect on students, it’s just they have other issues to consider, like staying in business.

          • Who?
            September 7, 2015 at 7:05 pm #

            The compliance industry is a bit mad, no question. Combine it with a for-profit organisation selling what used to be a service (at least around here, don’t know about the US) and is now a commodity, and nothing good for the end-user (including the poor soul who has to help someone work through it) will happen.

            My bigger issue is that as regs change, not much is ever dropped off forms-it’s always adding. I do some work in that space, and it’s really instructive to look at version 10 of a form created (say) 10 years ago, and see what needs to be there: there’s often stuff to take off. It’s hard to get around to that though in the scramble to just keep up. Recording and keeping more-despite the storage and privacy issues that generates-is considered the most risk averse result.

    • Mel
      September 7, 2015 at 2:28 pm #

      Building off YCCP and Bomb, centralize all gov’t welfare and health services and create one application form with all needed documentation spelled out.

      It will save parents time and money as well as decrease government paperwork.

      • FrequentFlyer
        September 7, 2015 at 4:11 pm #

        Good idea, but my experience as a government employee tells me that nothing that simple and logical will ever happen.

        • Mel
          September 7, 2015 at 7:00 pm #

          Oh, I know. Trying to deal with transfer students from in-state was crazy-out of state was a draconian nightmare.

      • TsuDhoNimh
        September 7, 2015 at 4:13 pm #

        We can’t do that!

        That’s what CUBA does, and they are Communist.

    • Bombshellrisa
      September 7, 2015 at 2:50 pm #

      Help the women find out what programs they are eligible for like food stamps, assistance to pay for utilities, ect and help them apply. There are programs in my state that help pay for land lines and provide transportation to and from doctors appointments and very few people on Medicaid know about it.
      I was thinking too that helping locate pharmacies that take Medicaid and being willing to help in whatever way the woman needs (transportation, child care) to get those prescriptions would help enormously. The ridiculousness I had to put up with to get my glucose test strips at a pharmacy three minutes away at most with my private and very good insurance was beyond frustrating. I can only imagine what it would be like having to take three buses and hauling my other children and have to go back and then have to make three phone calls to get a refill.
      Help the women with getting to their postpartum appointments and help them write down a list of questions to ask the doctor about.

      • Young CC Prof
        September 7, 2015 at 3:02 pm #

        My CC has a “single-stop” benefits center where there are people to help folks do all of that. Haven’t personally observed how well it works, but I’ve referred students there.

        • Bombshellrisa
          September 7, 2015 at 3:09 pm #

          That is awesome! More places need to follow that, it would help so much. I know that in my state, when you finally find out you qualify for Medicaid, if you are eligible for other programs that you get mailed some pamphlets. You have to call and apply or go online with Internet Explorer (the website doesn’t work with any other browser).

      • Dr Kitty
        September 7, 2015 at 3:30 pm #

        At least in the UK your Midwives and Health Visitor come to YOU post partum, as often as needed, for as long as needed, and most of the pharmacies will deliver to your home free of charge.

        Not only does that mean that there is no logistical barrier to making appointments, but the MW and HV get a good idea of the home (is it clean? Warm? Is there food in cupboards? Are the older kids ok?).

        My HV called today, and I got leaflets for local Buggy Fit, baby yoga and La Leche League meetings, but if she had been on the other side of town she’d have given out info on Surestart, child benefit and tax credits, food banks, charities offering baby clothes and equipment, stop smoking info, and support groups for single parents.

        There are places with good systems in place. The UK system isn’t perfect but it’s not bad.

        • Bombshellrisa
          September 7, 2015 at 3:34 pm #

          We HVs here, it can also help with PPD and getting help for that.

        • Who?
          September 7, 2015 at 6:59 pm #

          We had our first child in the depths of a UK winter, with family across the world and our only friends in town also with new babies.

          The midwives and health visitors were an absolute lifeline. We had no idea how to equip a pram for a new baby, let alone in the freezing weather, and they were great with all that practical stuff, even if they did make me turn down the central heating thermostat on the basis that babies and parents are not hothouse flowers. I thought 22c was quite reasonable-almost tshirt warm!

          They would always make the time for a cup of tea and a chat, which I really appreciated as the days were long and could be very lonely.

      • Amy M
        September 8, 2015 at 12:28 pm #

        I was high-risk for pre-term labor, and was assigned to a nurse, (via my insurance), who would call me every so often. She explained the signs of PTL, and would check in. I guess, over the phone, there wasn’t much she could do, and I ended up with PTL anyway, but thanks to her, recognized a problem when it started. I believe women in some of the underprivileged groups are at greater risk for PTL (among other things), so a caseworker who could identify the risks to them, explain the symptoms, and be a liaison with a doctor perhaps might be helpful.

    • demodocus
      September 7, 2015 at 5:46 pm #

      Have odd-hours appointment slots.

    • Gatita
      September 7, 2015 at 8:26 pm #

      This reminds me of promotoras, who are community-based lay people trained to give out health information: A similar model exists in India and has been very successful.

  19. Cobalt
    September 7, 2015 at 1:24 pm #

    This is like trying to solve people dying of starvation and malnutrition by promoting guides for berry picking nature walks instead of using science to effectively maximize agriculture or better human rights actions to increase access to food markets.

    How many mother’s lives does waterbirth, HBAC, or refusing prenatal testing save? Zero.

  20. Dr Kitty
    September 7, 2015 at 1:05 pm #

    They just don’t get it.

    They need to look at causes of maternal deaths.

    How would Doulas/CPMs identify and manage peripartum cardiomyopathy?
    Or eclampsia/HELLP?
    Or stroke secondary to uncontrolled hypertension?
    Or DVT/PE?
    Or APH/PPH?
    Or sepsis from RPOC or untreated UTI?
    Or AFE?

    Those are the things killing women. We’ve all seen posts from NCB proponents who have issues with urine dipsticks and BP measurements, because they “medicalise” or “pathologise” pregnancy. They are part of the problem, not part of the solution.

    OT: my little guy is now 9oz above his birthweight at 13days old, following his centile perfectly, and feeding voraciously. Very different to his sleepy, jaundiced older sister, who took a bit longer to get a hang of the whole BF thing. He’s got very big feet and his head circumference is a good 2 centimes above his weight, so I figure he has a bit of catching up to do. a

    • Bombshellrisa
      September 7, 2015 at 2:53 pm #

      Dr kitty I didn’t get to congratulate you yet, so happy belated birth–day to the little guy and so glad everything is coming along so well.

      • Dr Kitty
        September 7, 2015 at 3:38 pm #

        He’s great and kiddo#1 is the best big sister.

        • Amazed
          September 7, 2015 at 4:40 pm #

          Hey! Just today the Intruder said *I* was the best big sister. I can teach your girl some tricks.

          Happy your litter is fine!

  21. Tiffany Aching
    September 7, 2015 at 1:03 pm #

    Want better maternal and perinatal mortality outcomes ? Petition for universal health care. Want happy breastfeeding mothers ? Demand a longer paid maternity leave, and free local maternal counseling facilities. One of the thing that irks me the most about NCBers is that they think baby care is the sole mothers’s responsability, and that it is an individual problem. They depoliticize the issue.

  22. demodocus
    September 7, 2015 at 12:22 pm #

    It is a terrible thing that any mothers die in childbirth, and it’s no bad thing for the doulas to acknowledge it and try to raise awareness of it.
    BUT, I agree that much more needs to be done, and that is NOT more doulas and more pain-filled labors. Plainly, poor women have a tougher time getting access to doctors. My obese and “elderly” self was asked to see the ob a dozen times and I was able to because of our insurance. I *know* I’m lucky. Do the women of Improvingbirth know they are lucky too?

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