Homebirth isn’t about women or birth; it’s about midwives


I’ve been engaged in an online discussion with other healthcare providers about the NEJM Oregon study of out of hospital birth and it has crystallized for me something I’ve suspected for a long time:

Homebirth isn’t about women, babies or birth; it’s about midwives.

[pullquote align=”right” cite=”” link=”” color=”#C61210″ class=”” size=””]Homebirth is not popular among women. Most have no interest in anything that raises the perinatal death rate.[/pullquote]

Think about it: Except in the Netherlands, homebirth is (and has been for decades) a fringe practice. Anything that engages 2% of the population or less is almost by definition a fringe practice. So why does it receive so much attention? In part it’s because of the high death rate. The people who care for women and babies have a particular revulsion for preventable infant death and anything more likely to cause it. They pay attention to it because they are trying to prevent those deaths.

But I would argue that the real reason for so much attention is that the entire project is being driven by midwives. The proportion of midwives in the US, the UK, Canada and Australia who favor homebirth exceeds the proportion of women who favor homebirth by an extraordinary margin. Midwives are infatuated with homebirth for a number of reasons:

1. It is the natural end point of their obsession with promoting what they can do and demonizing what they cannot. They’ve gone from favoring the employment of midwives in maternity units, to midwife led units and birth centers. Homebirth is the logical next step, freeing them from any scrutiny by other health professionals.

2. It reflects the intellectually and moral bankrupt philosophy that the “best” birth is NOT the safest birth, but the birth with the least interventions.

3. It ensures that women cannot get effective pain relief.

4. It is a midwife full-employment plan. In contrast to a hospital based unit where one midwife can care for multiple women at a time, homebirth (in many countries) requires two midwives to care for one woman.

The truth is that homebirth is not popular and will never be popular among pregnant women. Most women have no interest in anything that raises the risk of perinatal death. Homebirth is deeply unpopular among obstetricians; most of us abhor anything that increases the risk of perinatal death. Homebirth is anathema among neonatologists for the same reason.

The provider discussion about homebirth crystallized that point. Among the participants, there was only one obstetrician on the record as favoring homebirth (though, to my knowledge, he doesn’t provide coverage for homebirth). There is not a single neonatologist who favors homebirth. Homebirth is relentlessly promoted by the midwives in the group. Sure, they dress it up with the usual nonsense that maternity care is in crisis, that we need to look at why women choose homebirth in the first place, etc.

But maternity care is not in crisis: neonatal mortality has never been lower. Women who in the past could not get pregnant, women who did not survive their serious medical illnesses to get pregnant or did not survive pregnancy are now having healthy babies. To the extent that there is a crisis it is reflected in maternal mortality and too LITTLE technology; some women with serious medical complications don’t have easy access to the technology that could save their lives.

The cries of “crisis” come from those who think that failure to privilege unmedicated vaginal birth is the crisis.

The pressure to support homebirth is not being driven by women. It is being driven by midwives and the rest of the natural childbirth industry (doulas, childbirth educators, natural childbirth lobbying organizations).Homebirth represents 100% of the income of American homebirth midwives, and it represents professional autonomy and a lack of professional scrutiny for others. The question we ought to be asking is not why some women choose homebirth; it’s why midwives promote homebirth as safe when it manifestly increases the risk of death.

The NEJM paper indicates the risk of homebirth death is underestimated, that at least in the US (and possibly in other countries as well), homebirth leads to preventable perinatal deaths. Yes, some women will choose it anyway despite the increased risk of death, but then some women will refuse to vaccinate. We don’t spend our time trying to make refusing vaccination safe; we educate our patients on the deadly consequences of their choice; that’s what we should do here, too.

Homebirth isn’t about women or babies or birth; it’s about midwives … and women contemplating homebirth need to understand both the risks of homebirth and the self-serving motivations of those who promote it.

116 Responses to “Homebirth isn’t about women or birth; it’s about midwives”

  1. leslienuss
    January 13, 2016 at 12:25 pm #

    I agree that home birth is driven by home birth midwives and doulas, etc. The educational standards are very poor-children with special needs should NOT NOT NOT be born at home but find a home birth midwife who supports 1st trimester prenatal testing. Then, when you do have some calamity during your home birth, the midwife quickly washes her hands of it and the whole home birth community ends up blaming you, the mother.

  2. Sue
    January 12, 2016 at 12:23 am #

    Not only has neonatal mortality never been lower, but hospital choices have never been better. Low-risk women birthing in hospital can have minimal intervention, use birth balls, showers or tubs, have visitors, effective pain relief, including epidurals, labor in bed, or walk around. Hospitals keep improving both health care practice and flexibility for families needs (“baby friendly” silliness notwithstanding), while HBMWs just keep doing what they always did – ie nothing much.

  3. Dr Kitty
    January 11, 2016 at 9:06 pm #

    The Holidays and a bad cold have totally thrown off #2’s schedule. He’s trying to reverse cycle, and is sleeping 1am-6am and 8am-2pm, wide awake the rest of the time…which is why I’m awake at 2am, having just fed him.

    Anyone have any ideas?
    All I really want is for him to sleep at 11pm again.

    • crazy grad mama
      January 11, 2016 at 9:14 pm #

      Can you wake him up after a certain amount of napping during the day, so that he doesn’t sleep 8am–2pm straight? Not letting my little guy sleep too long during the day helped a lot, although it meant breaking the sacred commandment of never waking a sleeping baby.

      • Kelly
        January 11, 2016 at 9:18 pm #

        I did that too. I would wake my third up and feed her. Getting more food during the day eventually helped her sleep more at night.

    • ForeverMe
      January 11, 2016 at 9:59 pm #

      Alternatively, if he falls asleep right after feeding at 8 am, keep him up a little longer each day ( until 9 am, then 10 am, then 11 am), before letting him nap. but only let him sleep for a few hours (maybe from 9-1 one day, then 10- 2 the next, etc.) Then wake him up, and try to keep him awake progressively later each night until it’s the bedtime you want.

      (At least, that’s what I think I did.)

      I’ve heard of women who regularly wake up their babies (usually by changing the baby’s diaper) after feedings so that the baby doesn’t associate food with sleeping, making it easier to make/change the baby’s sleep schedule and / or sleep train later on. (So baby learns to go to sleep alone in the crib, after a bath or rocking, instead of while being fed.) I didn’t regularly do this, but I know it’s one strategy.

      Good luck.

    • CSN0116
      January 12, 2016 at 7:01 am #

      How old is he?

    • PrudentPlanner
      January 12, 2016 at 8:22 am #

      My son recently started trying to feed every 2 hours at night. I have started supplementing him with 2oz. before bed. It makes the difference for my kid. I give him pumped breast milk now, but it’ll be formula once my stash runs out.

  4. CSN0116
    January 11, 2016 at 8:35 pm #

    So don’t quote me but I believe the ‘thesis’ goes that a few things are needed to establish professionalism, especially as it pertains to medicine: (1) you need qualifications, the higher the better and more professional you will be seen as, (2) you need a governing body and evidence-based standards and regulations, and (3) you need autonomy, again the more you have the better. Psychiatrists and chiropractors are examples of groups who have achieved a substantial increase in professional dominance using these tactics.
    Midwives, and this will of course vary amongst CNMs and CPMs, want to exist in this OB-like world in all three of these categories but are doing nothing to address their current categorical shortcomings. The rigor of education is not going up, it’s actually going down via CPMs and doulas. The governing body and regulations are off-point and/or flat-out fabricated. And the level of autonomy can only increase when they’re outside the hospital, i.e. home.
    I therefore agree with Dr. Tuteur that this whole thing *is* undeniably about midwives. More specifically, IMO, it’s about their haphazard attempt at increasing their level of professionalism. But they’re only controlling for 1/3 of the equation here. Skipping steps 1 and 2 to get to 3 is a recipe for disaster —> neonatal mortality. Ironically though, their efforts to increase professionalism (at all costs) seems to be focused more on ego than finances. I think? Does one really stand to make that much more via hosting homebirths (not covered by insurance) versus as a staff member in a hospital or OB practice?

    • demodocus
      January 11, 2016 at 9:07 pm #

      Chiros could use some strengthening in their education.

      • CSN0116
        January 11, 2016 at 10:10 pm #


      • MaineJen
        January 12, 2016 at 9:35 am #

        Chiropractors just need to stop telling people they can help with anything but back problems. Is your back killing you? Chiropractor might help. Got an autoimmune disorder or allergies? Go to a real doctor. Don’t even get me started on “infant chiropractic.”

        • CSN0116
          January 12, 2016 at 10:06 am #

          I’ve seen a chiropractor in late pregnancy before and got some great relief from low back pain, but then he started trying to sell me on anti-vaxxing, the evils of epidurals and all pharmaceutical drugs basically, some sort of nutrition shakes, vitamin supplements, and, yes, bringing my baby back for an adjustment immediately after birth, because, “even the most normal births are traumatic to a newborn and misalign them.” Why are most of them so weird?! There is a chiropractic school at the college where I work and that whole wing is like another planet of weird…

          • Roadstergal
            January 12, 2016 at 11:06 am #

            That whole newborn chiropractic fad is fecking scary.

          • MaineJen
            January 12, 2016 at 11:12 am #

            Seriously dude? Don’t touch my baby.

        • Roadstergal
          January 12, 2016 at 11:13 am #

          I just can’t think of a reason to go to a chiropractor instead of a physical therapist for back pain, or a real doctor for anything else.

        • demodocus
          January 12, 2016 at 11:46 am #

          There’s a chiro practice on the way to my local yarn shop and they advertise their pediatric care. Um, no thanks.

        • Chant de la Mer
          January 12, 2016 at 4:12 pm #

          Really and honestly the chiropractor I see is so very helpful for my back and hip issues and has not ever tried to get me to do adjustments for anything else. She also does physical therapy and exercise education so perhaps she follows a medical based system. Either way I always recommended chiropractics based on her, but after hearing all the crazy things about so many of them, I think I just have an outlier and have stopped recommending them to anyone except locals that can see the same one.

    • Sue
      January 12, 2016 at 12:25 am #

      Generally agree, but not sure whether you meant Psychiatrists or psychologists? Psychiatry is a medical specialty, just like OB is.

      • CSN0116
        January 12, 2016 at 9:34 am #

        Ah ha. Phone chooses words for me if I don’t pay attention. Sorry about that.

    • Luba Petrusha
      January 12, 2016 at 10:43 am #

      “Does one really stand to make that much more via hosting homebirths (not covered by insurance) versus as a staff member in a hospital or OB practice?”

      Only CNMs would be hired by hospitals or OB practices, and that’s where most of them do actually work. CPMs, etc. don’t have the qualifications for such work and thus depend on home deliveries.

  5. Valerie
    January 11, 2016 at 5:01 pm #

    “Sure, they dress it up with the usual nonsense that maternity care is in crisis, that we need to look at why women choose homebirth in the first place, etc.”

    I think hospitals have listened to why some women prefer homebirth and made changes. My local hospital has an alternative birthing wing that is as home-like as they can make it (run by CNMs, birthing balls, early discharge program, etc). I would like to know what bar these homebirth advocates think hospitals must clear to be good enough. Can they picture a hospital with the right policies, bells, and whistles for women desiring low-tech births that they would endorse it over homebirth because of its added safety features?

    • Roadstergal
      January 11, 2016 at 5:03 pm #

      It’s just like asking anti-vaxxer “vaccine safety advocates” what vaccine safety would look like to them. It would be something equally fantasy-land. “All spontaneous, unmedicated vaginal births with a 0% C-section rate” or the like.

      • Valerie
        January 11, 2016 at 6:58 pm #

        Yeah, I just looked up the criticisms, and it’s kind of the same song. They have too strict risk-out criteria and the rest of the hospital has a too high CS rate, you will get the midwife who is on-duty while you are in labor (not necessarily the anti-interventionist one you bonded with during prenatal visits), etc. Maybe if they somehow, non-judgementally allowed any woman to labor and deliver there AMA? They would probably have poor outcomes, but it would be better for those women than if they had delivered at home.

    • Madtowngirl
      January 11, 2016 at 5:53 pm #

      The hospital I delivered at makes the place as home-like as possible. They’ll let you labor in a tub (but not deliver there), watch T.V., play music, use a birthing ball, get in whatever position you want (assuming no epidural), and even diffuse pseudononsense oils. You can have whoever you want in the room, too! Doulas, midwives, your entire family, whatever. It’s as home-like as you can possibly get, with the safety of trained doctors and nurses, an OR a few feet away, and the highest level NICU in the state.

      Why would any sane person choose anything else? Yet, they do!

      • SarahSD
        January 11, 2016 at 6:15 pm #

        Because obstetric medicine has made birth so safe that we have lost a shared sense of how dangerous “natural” birth really is. It’s an illusion that makes it possible to believe that the risks posed by medical interventions outweigh the risks of going without access to those same interventions. I don’t have a hard time understanding how a layperson could come to believe this – I did myself. But I don’t understand how homebirth midwives continue to believe and promote this, especially after that first close call or preventable bad outcome.

      • StephanieA
        January 12, 2016 at 1:17 am #

        Having been around the birth boards quite a bit the last two years, people have a really skewed idea of what L&D is like. They hear horror stories from friends about their inductions and sections and run with it. So many women think that delivering in a hospital means you’re strapped to the bed and pumped with meds, and that the nurses push you to get epidurals. Oh and my favorite, that a doctor would rather do a section than a vaginal birth (hahaha). Taking a tour of the unit would help, and I think there’s a lot of patient education that should be done during prenatal visits that doesn’t happen (I know doctors have very little time with patients).

        • Roadstergal
          January 12, 2016 at 11:08 am #

          I’ll keep saying it – if doulas and lay midwives really wanted to help women, they’d do L&D tours to demystify the experience and make it less scary.

    • swbarnes2
      January 11, 2016 at 6:48 pm #

      From what I’ve read here, I think a lot of these midwives really really want to catch the babies, and hospitals won’t let you be anything more than a doula without lots and lots of training.

      So the bar for many would be “they have to let untrained people like me deliver” which is never going to happen.

  6. Megan
    January 11, 2016 at 3:22 pm #

    Since this is a homebirth article, I have to post this slightly-OT-but-not link. Think of all the interventions men could avoid! After all, urologic care is in crisis and this is just the way to fix it!


    • Roadstergal
      January 11, 2016 at 3:25 pm #

      It would only be better if it had a Sawzall.

      • Megan
        January 11, 2016 at 6:23 pm #

        Yes, but the tools shown are pretty close in quality to what a home birth midwife has, no?

        • Roadstergal
          January 11, 2016 at 6:26 pm #

          Excellent point. I’m really thinking about that hideous little boast-post SkOB posted some months ago from the woman who ‘rocked’ her birth in her bathtub (small footnote that the baby had to go to the hospital) – you could perfectly re-create that as a rockin’ home vasectomy in the tub (and no babies would be harmed).

    • Gatita
      January 11, 2016 at 5:16 pm #

      GAH BLOOD BLOOD (can you tell I’m not cut out to be a clinician? pun not intended)

  7. Gatita
    January 11, 2016 at 2:02 pm #

    Fascinating article about two women who married and were pregnant at the same time: http://nymag.com/thecut/2016/01/dual-pregnancy-c-v-r.html

    I’m having a harder time breast-feeding — of course! Surprise, surprise, my boobs are duds. Eddie wasn’t getting enough milk and Reid is chubby already. The doctor and the lactation consultant told me I have to supplement Eddie with formula. That’s hard to hear when, right next to you, you see a mother feeding very easily. Emily has super-milk. No joke, she will pump and in five minutes she has filled two bottles. I pump and I get an ounce. It’s so sad. You have to have a sense of humor about it, otherwise I would be so depressed. I do think: Why is this so much harder for me? But what’s amazing is that she’s able to nurse Eddie when I can’t. For her, she’s able to bond with Eddie in a better way than I can with Reid. She has Eddie on her breast at least three or four times a day. He’s latching on to her. He knows her. For me and Reid, it’s harder. The trials and tribulations of a mother who doesn’t have milk! I have to nurse, give a supplement, and then go pump. That’s a 45-minute process every couple of hours. There’s really no break for me. But I want to be able to feed both babies and also I want to help Emily! I don’t want her to be the only one who has to nurse both babies. I think there’s guilt on both sides even though we don’t talk about it. I feel guilty that she has to take on this responsibility. I think she feels a bit guilty that she’s able to do this with such ease and finds pleasure in it. There’s a little bit of inadequacy that I feel. But again I am trying to have a sense of humor about it. I have nicknamed her “moomie.” Oh, boys, your “moomie” is here!

    • crazy grad mama
      January 11, 2016 at 2:30 pm #

      “For her, she’s able to bond with Eddie in a better way than I can with Reid.” GAH. Must we perpetuate the narrative that nursing=bonding?

      • Gatita
        January 11, 2016 at 2:43 pm #

        Can you imagine being mommy-competitive with your WIFE? It must be hell.

        • T.
          January 11, 2016 at 2:52 pm #

          I wonder how does this work, AP-wise? Are the two mothers interchangeable? (since AP basically says that “the mother must do everything always beyond -her- sanity)

          Or does only the one who has given birth to the particular baby works?

          I can see this making problems for their philosophy ;P

          • Amy M
            January 11, 2016 at 3:36 pm #

            Maybe the bio mom for Baby A, is the dad-equivalent for Baby B? Though I guess that would mean that each woman would only care for her bio son. It’s an option, but then they’ll be more like a Brady bunch type family. I said above, maybe they should view them as twins. I don’t know how AP people manage twins, but surely some do?

          • fiftyfifty1
            January 11, 2016 at 7:08 pm #

            Maybe some day we won’t have “moms” and “dads” and “dad-equivalents” etc. Instead we’ll have just parents who will be given the freedom to develop relationship with their children naturally over time, without preconceived notions of how they ought to do it based on their labels. I hope.

          • Roadstergal
            January 11, 2016 at 7:12 pm #

            This emphasis on breastfeeding as so very special and important is regressive, in that sense. Moms Stay Home And Lactate, Dads Go Work, and households without a conventional biological mom + dad are unacceptable. That really bothers me.

          • Amy M
            January 12, 2016 at 7:52 am #

            Oh that would be good, but the AP’ers seem to need the distinction at present.

      • The Bofa on the Sofa
        January 11, 2016 at 3:42 pm #

        Yeah, see my comment above. She is even measuring bonding by how much time the baby spends on the breast.

        Bonding: Dads need not apply.

        I wonder, where did she get the idea that nursing = bonding?

        • momofone
          January 11, 2016 at 4:42 pm #

          I see your point, but it seems significant that in this situation Dad isn’t an option.

          • Roadstergal
            January 11, 2016 at 4:45 pm #

            The religious overtones and basis of AP do reveal themselves. There is Mom, who stays home and nurses and bonds, and Dad, who goes out and makes money and doesn’t touch the baby and is the distant authority figure. Gay couples? Well, that just fucks up the narrative, better pick a side.

          • Dr Kitty
            January 11, 2016 at 9:50 pm #


            I was weirdly reminded of this British minor celebrity who became pregnant naturally after 3 failed rounds of IVF….a few weeks after her gestational surrogate got pregnant.

            The two babies were born within a month of each other, she celebrates their birthday on the same day and has decided not to make public which baby is which. To all intents and purposes, they are twins.

            I doubt there was much AP going on though…

          • Megan
            January 11, 2016 at 10:06 pm #

            That reminds me of my friend who tried for months to get pregnant and could t, ended up doing IVF, had one embryo transferred and also got pregnant the same cycle, resulting in fraternal twins. Wild story…

          • demodocus
            January 12, 2016 at 7:26 am #

            My best friend’s cousins are apparently a natural version of this. The ob was quite sure that J was conceived a month after his brother.

          • demodocus
            January 12, 2016 at 7:23 am #

            Oh my. That must have been a shock for her and her partner.

          • The Bofa on the Sofa
            January 11, 2016 at 5:00 pm #

            I see your point, but it seems significant that in this situation Dad isn’t an option.

            No, it doesn’t because my comment has nothing to do with there being a dad in this situation or not.

            You could just as well say “formula feeding moms”.

            The issue is that she thinks bonding means that the baby is sucking on her boob. There is so much wrong with this that it bears wondering, where in the hell she ever got that idea?

          • RMY
            January 11, 2016 at 9:33 pm #

            You could also say “non-gestational parent” it covers both dads and any mother who didn’t carry the baby.

          • The Bofa on the Sofa
            January 11, 2016 at 9:41 pm #

            But that’s still not enough. It’s anyone who doesn’t breast feed.

            Again, the idea that bonding = baby stuck on the breast is wrong on many, many levels.

          • CSN0116
            January 11, 2016 at 10:16 pm #

            I feel it’s a lot like HB or VBAC-ing – it’s all about how the *mom* feels. If *she* feels a stronger bond then it’s true for the child as well. Period.

      • RMY
        January 11, 2016 at 9:32 pm #

        I know a chick who is preparing to wean her child who actually said “How will I be his mom without our nursing relationship?” Some crunchy moms seem to see breastfeeding as mothering.

        • crazy grad mama
          January 11, 2016 at 9:56 pm #

          That’s just… I don’t even know what I would say to that. Wow.

        • CSN0116
          January 11, 2016 at 10:12 pm #

          Creepy. I’ve done a lot of reading on the bonding process of adoptive mothers and their newborns. Nursing is in no way required to establish bond. So the “bonding” is not a valid argument. Perhaps they think this is an “elite” bond of sorts? Something separate?

          • demodocus
            January 12, 2016 at 7:20 am #

            Dad bonded with his adoptive mother even though she beat the hell out of him when he was bigger and she didn’t much like babies. Fortunately, they did have Grandpa.

        • Christy
          January 12, 2016 at 1:32 pm #

          My husband I did a very brief stint as foster parents. In that time we cared for or knew kids who had been thrown down the stairs by a parent, left alone for hours at a young age, and were born addicted to hard drugs. You know what they all had in common? Even after being lovingly cared for by responsible adults, all they really wanted was their biological Mom. Bonding is so much more complicated than simply breastfeeding, skin to skin contact, babywearing or any of that. Babies want to bond and for the most part they will, given half a chance.

    • AirPlant
      January 11, 2016 at 3:12 pm #

      I don’t know, I thought it was kind of sad and kind of sweet? They are different women and they are having different experiences, but they love one another and they love their babies and their life changed and things are hard right now but they are making the best choices that they can for their family.
      It is completely normal that the mother who is having trouble nursing and had trouble getting pregnant and who had a difficult birth would feel sadness around the experience, and it is normal that she would have feelings of sadness around seeing it all come so easily to her partner, and I would even say that it is normal that this early on she would feel more bonded to the child that she carried. Time will pass and she will heal and I believe that everything will right itself and she will love both of her sons like she wants to.
      I could be missing something, but they just seem like two lovely women who love each other who got into kind of a crazy situation and are working through it.

      • Amy M
        January 11, 2016 at 3:22 pm #

        They don’t seem to be viewing it like a twins situation. I wonder if that would make a difference? Like that’s your baby, this is my baby–instead, these are our babies? Maybe because they are both moms, they can’t do that?

        • An Actual Attorney
          January 11, 2016 at 6:01 pm #

          From the viewpoint of a lesbian mom of a singleton and another on the way, this whole relationship seems, well, a touch off.

          ETA, also, the doc seems idiotic to take those chances.

          • fiftyfifty1
            January 11, 2016 at 6:58 pm #

            Yes, what was that doc thinking? Encouraging the second mom to get started before the first mom had even had a chance to see how many IVF eggs she produced! and then implanting all 3. They are lucky they only have “twins”.

          • Dr Kitty
            January 11, 2016 at 8:14 pm #

            Wouldn’t freezing for a future sibling make more sense (in a lot of ways) than simultaneous pregnancies?

            Or implanting one and saving two for subsequent tries, given this was an out of pocket IVF cycle in a 36 year old?

            Deliberately choosing the option most likely to result in a high risk multiple pregnancy, when there is already a high risk AMA pregnancy in the couple seems…odd.

            There certainly seem to be some “this is my baby, that is your baby” issues already, which might have been less of an issue with differently timed pregnancies.

          • An Actual Attorney
            January 11, 2016 at 8:50 pm #

            It seems to be against what I understand as the RE codes of ethics. I think they are voluntary. But still…

            And while annoying at the time, I’m glad our RE practice required pre procedure counseling.

          • demodocus
            January 11, 2016 at 9:17 pm #

            I think ours did too, but it’s been a while. We didn’t for the FET, just confirmation that we both still wanted to. (The bard stayed home with our toddler, who was still in a cast)
            Congrats, by the way.

          • An Actual Attorney
            January 11, 2016 at 9:22 pm #

            Maybe these folks did, maybe the article is not fair, but it still seems odd to me on several levels.

          • demodocus
            January 12, 2016 at 7:11 am #

            I hope you’re right, ’cause it seems odd to me, too.

          • Dr Kitty
            January 11, 2016 at 8:54 pm #

            Oh…I had a horrible and deeply cynical thought.

            If you had this couple as patients and you personally felt that the chances of pregnancy were slim to none, even with multiple embryo transfer, one might implant all the embryos, knowing that there is already a pregnancy and failure in this cycle might be psychologically easier to deal with if they still get a baby in nine months…

            I mean, if you are very pessimistic about the IVF cycle being successful, maybe you think putting all the eggs in one basket makes sense, rather than setting up two or three more disappointments, at times when your patients might find failure harder to deal with.

            Maybe the doctor fully expected the IVF to fail, and thought that they’d either settle for one baby, or a second baby via IUI with the mother who got pregnant more easily at some point down the line.

          • Brix
            January 16, 2016 at 11:03 am #

            I am struggling with infertility and the number of embryos implanted was totally our decision. They likely implanted all 3 because at 36, statistically, IVF is more likely to fail than to succeed.

          • demodocus
            January 16, 2016 at 11:53 am #

            Good luck! We also did ivf when i was 36; here’s hoping you’re successful, too.
            I’m guessing either your personal odds are different than mine or your clinic has different guidelines. We were strongly encouraged to try just 2 embryos at a time. My docs gave us a 50/50 for both each embryo individually and for twins, so roughly a 75% of pregnancy.

          • Brix
            January 16, 2016 at 2:21 pm #

            Congratulations so much on your success!!! People don’t realize how traumatic infertility is. You probably have some health factors that increased your odds (like high egg reserves for your age, etc.). Everything I’ve read puts the average success rate for women aged 35 – 37 @ 33 – 36%; less if there are health issues. I had one fail last year with 2 implanted embryos and I was 39 at the time, with stage 4 endometriosis. I’m hoping we’ll have more success this year.

          • demodocus
            January 16, 2016 at 7:30 pm #

            I’ve heard about endometriosis and how it sucks. Probably somewhere here, actually.
            Thank you, by the way.
            We don’t actually know if i have any fertility issues at all; my only partner has some very inconvenient scarring.

          • Brix
            January 17, 2016 at 11:07 am #

            I hope, for your sake, that you don’t. It’s awful in so many ways. Like your partner, I have scarring; mine is in my left Fallopian tube. Between that and the inflammation from the endo TTC has been heartbreaking.

          • demodocus
            January 17, 2016 at 12:43 pm #

            Oh, don’t worry about me. 2 tries and 2 pregnancies (i’m currently 18 weeks along) and I think i’m going to be done after this. I hate being pregnant.

          • Dr Kitty
            January 11, 2016 at 8:18 pm #

            Congrats on your forthcoming addition!
            What good news.

          • An Actual Attorney
            January 11, 2016 at 8:47 pm #

            Thanks, everyone! 2 months to go. CS scheduled. On my way home from what is my last work trip (ob says no more travel). So all is good.

          • Gatita
            January 11, 2016 at 8:56 pm #


          • Dr Kitty
            January 11, 2016 at 9:03 pm #

            Good stuff!
            Having a definite date makes things much easier when you have an older child to consider, and will take a little bit of stress off you and your wife. I’m sure they’re excited!

          • An Actual Attorney
            January 11, 2016 at 9:10 pm #

            I have this feeling though that we’re not going to make it till 39 weeks, but the date is helpful. Whole family is excited, but Actual Kid, who is 5, is also clearly getting a little nervous. I guess we all are.

          • Mishimoo
            January 11, 2016 at 10:26 pm #

            Congratulations! Hope everything goes smoothly.

          • Amazed
            January 11, 2016 at 8:37 pm #


          • Medwife
            January 11, 2016 at 8:39 pm #

            Aw that’s great! Congratulations!

          • PeggySue
            January 11, 2016 at 8:48 pm #

            Congratulations! As to the couple, I hope they find a way to talk about what’s going on, and, yeah, simultaneous pregnancies sounds way hard.

          • RMY
            January 11, 2016 at 9:29 pm #

            I agree. (I’m an infertile lesbian whose wife doesn’t want to carry.) I think that doctor made a very bad call. She should’ve waited to inseminate the younger woman until the older one’s IVF cycle finished.

            Also congrats on the next one on the way!

      • Roadstergal
        January 11, 2016 at 3:24 pm #

        It sounds like the writer is spending a lot of time and effort to nurse, while her partner is easily making enough for two babies?

        “The trials and tribulations of a mother who doesn’t have milk! I have to nurse, give a supplement, and then go pump. That’s a 45-minute process every couple of hours. There’s really no break for me. But I want to be able to feed both babies and also I want to help Emily! ”

        That sounds terrible. Why can’t they split duties according to what each of them has the biology and time for? It sounds like the Must Breastfeed To Bond thing has gotten to her.

        • Amy M
          January 11, 2016 at 3:31 pm #

          I agree and that’s (the must breastfeed for bonding) silly. My husband and I had two babies to care for, neither of us breastfed and we all bonded (so sick of that word) just fine. We figured out how to bottle feed both babies simultaneously and took shifts, at the beginning.

          Usually, my husband and I did the “dinner” feed together—we’d each take a baby and all sit in the living room and feed them. We didn’t assign one baby to me and one to him, we alternated so we each could have that time with both babies. I’d say it was the highlight of many days. When breastfeeding is interfering with bonding, rather than facilitating it, maybe its time to stop.

          • Kelly
            January 11, 2016 at 9:36 pm #

            We did something like that with our second. One would feed the baby and the other would sit in the room and we would talk about our day. It was quite good for our marriage.

          • CSN0116
            January 11, 2016 at 10:53 pm #

            Twins? Me too. The twins were like an assembly line. One bath, two bath. Scoop and spoon in one mouth, scoop and spoon in the other. I would prop them on Boppy pillows and hold the bottles to feed simultaneously. I didn’t get the one-on-one time to sit and stare like I did with my three singletons.
            But guess what?
            They’re all bonded the fucking same. Imagine that.

          • Amy M
            January 12, 2016 at 7:47 am #

            Exactly! Were your twins your first? If not, you were already used to dividing your attention, and if so, you don’t know any different anyway, and neither do they. I guess I can understand why people who have one baby and then get pregnant with another feel a bit guilty about taking something away from the first kid. But if the age gap is close enough, first kid won’t remember a time pre-siblings anyway.

          • CSN0116
            January 12, 2016 at 9:02 am #

            They were my firsts, so we’ve never had a non-sibling experience. We also had them before our first wedding anniversary! So our entire marriage has been babies, we know no different haha. And having them first made the singletons so easy, I was like people bitch about this lol? I never worried about going from the twins to the third, then the fourth, and then the fifth (and last!). So perhaps experiencing the twins first made me incapable of that? But it’s also my demeanor. I don’t “feels” much and overthink shit. Not into it 😛

          • Megan
            January 12, 2016 at 12:04 pm #

            I am honestly worried about how my relationship with my daughter will change when this baby is born. They’ll only be 18 months (and maybe less) apart so she won’t remember it in the long term but in my hormonal state I get to worrying how it will affect her and I worry about how much I will miss our time together. So I guess it’s about both of us.

        • AirPlant
          January 11, 2016 at 3:44 pm #

          True, but post partum is not a particularly rational place and I don’t think her sadness is coming just from the breastmilk, but from everything that has happened to them in the past year. Infertility is difficult in the best of times, but to struggle and struggle and then have pregnancy come easily to the person that you love most in the world? And then having to bite back your feelings and keep on going while one thing after another is hard for you and easy for her? It could be the little sister in me talking but that just seems rough.
          And even if it is just the milk, it is one thing for breastfeeding to not work out and therefore formula, but it is another thing entirely to have it not work and then have to pass the baby over to your wife who has enough milk for two. In a heterosexual couple the transition to formula would mean bottles all around, but in her situation she has to watch someone else easily breastfeed her child like she wanted to. Even if I do not value breastfeeding to that extent that sounds super hard, particularly in the haze of taking care of two newborns.

          • Roadstergal
            January 11, 2016 at 3:49 pm #

            “No joke, she will pump and in five minutes she has filled two bottles. ”

            It sounds like there’s bottles happening already, so why is she so stressed to make her own milk instead of using her wife’s?

            Like you say, the haze of new parenthood is hard enough, and it sounds like the pressure to breastfeed is giving her a lot of stress and sleep deprivation. “There’s really no break for me.”

            I’m not blaming her, to be clear – I think BREASTFEEDING IS ALL OF THE BONDING and all of the other lactivist crap is doing this woman exactly _zero_ favors.

          • AirPlant
            January 11, 2016 at 4:02 pm #

            You are right, the lactivist party line probably isn’t helping the situation, but I think that even without it she would still be sad. It is hard to watch your body fail you. I am an asthmatic and I get so angry that I can’t even walk to the store in cold weather without embarrassing myself. I love to run, but I can’t six months of the year because it is just so dangerous for me in winter. Sometimes I will get an attack when I am trying to make a presentation at work and I will not be able to make my point because I can’t breathe and I need to leave the room and it is frustrating and infuriating that my body can’t do what other people do every single day without even thinking.
            She is doing what needs to be done to get the baby fed, but it isn’t what she wanted, and I can understand that she would need to grieve that loss.
            I also got a completely unsubstantiated feeling from her that she was getting a bit of the PPD and that was what was causing her to feel like she wasn’t bonding enough.

          • Roadstergal
            January 11, 2016 at 4:06 pm #

            “I think that even without it she would still be sad”

            It’s legitimate for her to feel sad about her body not doing something she wanted it to; my husband is mildly asthmatic and I’ve seen the same things you describe. 🙂

            But still, if she were raised in a culture that didn’t think breastfeeding was so very massively important, and didn’t have so many messages on how that’s the only way to raise a baby, and it’s so easy if you just do the right things – would she feel the same way? Would she be spending all this time pumping and nursing? Would she just note that wow, her partner makes enough milk for both, and isn’t that fun! I mean, asthma is one thing, because breathing is something we do every day. But you don’t have to lactate to have and raise a baby (like dads and adoptive parents), so isn’t it more an issue that she has come to feel so strongly about something that isn’t that important in the big picture?

          • AirPlant
            January 11, 2016 at 4:31 pm #

            Some people are romantic about that kind of thing. My mom tells me that when she got pregnant she was absolutely in love with the idea of breastfeeding and wanted the whole earth mother gaia experience.
            I agree that we as a culture need to back off on the message that breastfeeding is the only way to love your child, but everyone is different and there is nothing wrong with wanting to breastfeed as an end in itself as long as you are not neglecting your baby to make it happen. It is completely understandable to mourn the nursing relationship that you wanted. I have absolutely no compunction to breastfeed, but I was pretty invested in the piano as a girl and it was a pretty rough transition when I realized how little talent that I actually had with the instrument. My grief wasn’t any less just because failing as a musician isn’t life threatening. What really matters I think is how you pick yourself up and make peace with your life. If this woman is still upset in five years or so then there is for sure something pathological going on, but she is still in the thick of things and I don’t see anything strange about her still being in the middle of her feelings about how things worked out.

          • RMY
            January 11, 2016 at 9:27 pm #

            “How will I be his mom without our nursing relationship?” is something someone (who wants to be a lactation consultant) wrote. Adoptive mother, foster mothers, mothers who can’t breastfeed apparently aren’t “mom” to her.

          • An Actual Attorney
            January 11, 2016 at 11:20 pm #

            That’s the weird bit, what about his other mom? What about her other son? So different compared to what all the other gay parents I know stress.

          • RMY
            January 12, 2016 at 11:03 pm #

            This is a single mother by choice. She just happens to be a lesbian too.

          • demodocus
            January 12, 2016 at 7:04 am #

            And implies that children of male gay couples are lacking *the* most important relationship, in a lactivist’s estimation

      • Gatita
        January 11, 2016 at 3:39 pm #

        I agree with everything you said but I think it must be terribly difficult to struggle so much when your life partner is sailing through it right next to you at the same time. It must feel terribly lonely. I’m sure they will work it out but I feel for her.

        • AirPlant
          January 11, 2016 at 3:47 pm #

          Oh god, my heart absolutely breaks for her. I know it will get better, but it just sounds so tough and such a hard way to be introduced to motherhood.

        • Megan
          January 11, 2016 at 3:47 pm #

          Hell, it felt lonely just watching my best friend sail through while I had struggle after struggle with pregnancy, delivery and breastfeeding. Now I don’t care nearly as much but when you’re in that postpartum haze it can feel like you’re one big failure if you allow yourself to compare.

    • The Bofa on the Sofa
      January 11, 2016 at 3:39 pm #

      she’s able to bond with Eddie in a better way than I can with Reid. She has Eddie on her breast at least three or four times a day. He’s latching on to her.

      Is she suggesting bonding is reflected in how much the baby is “on the breast”?

      (Sorry, I didn’t see the comment below; just know I agree with crazy grad mama)

      • Gatita
        January 11, 2016 at 5:19 pm #

        Struggling to nurse every two hours and feeling defeated after every feed doesn’t exactly do much to make you bond with the baby.

    • Medwife
      January 11, 2016 at 8:42 pm #

      That last bit is something my SO and I do. Around these parts they call me ‘Boobs’. No inadequacy feelings involved though.

      • crazy grad mama
        January 11, 2016 at 9:08 pm #

        Similarly, one of my son’s first words was “mama,” but he didn’t use it to refer to me, he used it to mean “food.” I thought it was hilarious.

    • RMY
      January 11, 2016 at 9:34 pm #

      As a lesbian, the general consensus I’ve heard on this subject is that concurrent pregnancies are for idiots. This article doesn’t disprove this theory at all.

    • mstudent
      January 11, 2016 at 10:40 pm #

      I have to say a lot of their wording was off-putting to me. I suppose I am pretty sensitive to the wording used about (or by some) two-mom families because I was the non-gestational mom to our twins. I just can’t imagine having “your own” baby because you carried it and accepting that “of course” you were closer to them because they are your biological offspring and you breastfeed them (which I also found a little odd… they could choose to just switch back and fourth or split it more evenly). It gets too close to biological essentialism.
      I did think at one point that being pregnant at the same time would be fun but after going through my wife’s pregnancy, I would never ever do it. However by the end they sounded okay and I hope it all evens out and works well for them.

      • mstudent
        January 11, 2016 at 10:42 pm #

        *edit: having two babies/children but one was “your own”…

      • swbarnes2
        January 12, 2016 at 3:45 pm #

        As a straight, gestating mother, it sounded odd to me too. If I were doing something like that I think I’d want both moms to breastfeed (or in this case, mom with less supply breastfeeds + supplements) both babies. I would think that the goal is for all the parents to be equally parenting all kids, gestation and breastfeeding are weird, and in the grand scheme of things, short exceptions.

    • Amazed
      January 12, 2016 at 7:04 am #

      I find it fascinating in a deeply dark way that there is already separation of the children. Like, mine and more mine. As if they come into the relationship each with her own kid.

      I wonder how I ever managed to bond with my dad. Sure, he bathed me on his own on my very first day home – and make no mistake, he had never touched a baby this young before. Sure, he rose with me each time I cried to soothe me or bring me to Mom if he didn’t succeed. Sure, he told and read me stories since before I can remember. But since he didn’t have the right equipment to feed me – and no bottletime either since Mom was clearly a milk factory – we’re so sadly and deeply unbonded.

      This kind of thinking is so insidious and freaking dangerous. It shouldn’t be prevalent, or else more women will enter motherhood with those painful notions that are bound to give them pain.

  8. namaste863
    January 11, 2016 at 1:30 pm #

    As I see it, the NCB/HB/UB movement is more of a religion than anything else, and as such, life, death, or permanent disability is viewed as being beside the point as long as the object of worship, an unmediated birth at home, is preserved. Look at their response to the death of Claire Teague a few years ago after she bled out from a retained placenta. They said “At least she had a really lovely, spontaneous birth at home.” Her death was treated by the midwives as martyrdom to their religion, and therefore really not that bad an outcome. The problem is that the cult like nature of it wil make it exceptionally difficult to combat. This is meant as no disrespect to the practice of religion, as long as nobody gets hurt. I myself adhere to a religion, though a more liberal form thereof. The problem with this particular religion is that it is enforced on those who have absolutely no say, and they often die as a result.

    • CSN0116
      January 11, 2016 at 10:26 pm #

      As a religious person, I agree. Marx didn’t call it the opium of the masses for no reason 😉 Religion will often attract those who are “lost” in other senses. During times of instability religiosity increases, people who are poor are more likely to be religious, women express higher rates of religiosity, etc.
      It gives people without a whole lot else to independently identify with, or be proud of, something to fill that void. It also works to make people feel better about themselves, often using an “us vs. them” platform. Many of these HB mothers seem to fit these characteristics.
      You might not have much else (money, education, fame, power, ability, looks, etc.) but goddamit you have a uterus and the ability to exploit it for the sake of asserting the only sense of superiority you can muster.
      And like you, my comments on religion are not meant to offend. I am aware of my affiliation as well as what it does and promotes, collective consciously-speaking.

      • SporkParade
        January 12, 2016 at 2:58 am #

        I’m religious, and I agree with you 100%. I would add that the natural childbirth movement is part of a larger trend in society to turn health into a religion, complete with reward for virtue and punishment for sin. The difference is that, in this religion, nature takes the place of gods.

  9. AirPlant
    January 11, 2016 at 12:26 pm #

    Midway down, in the sentence “women who did not survive their serious medical illnesses to get pregnant or did not survive pregnancy are now having health babies” I think you meant “healthy babies” 🙂

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