Of course Caroline Lovell’s homebirth death was preventable; nearly all homebirth deaths are

Cardiogram in green

Homebirth advocacy is based in large part on mistruths, half truths and sometimes outright lies. One of the bigger lies that you often hear in the wake of a homebirth death is “it would have happened in the hospital, too.”

No, it wouldn’t have for a very simple reason: when you “trust” birth, you assume that everything will be fine and therefore avoid real medical care until it is too late.

[pullquote align=”right” cite=”” link=”” color=”#004C01″ class=”” size=””]Homebirth killed Caroline Lovell.[/pullquote]

Caroline Lovell’s story was horrifying even before we knew the details. Death from a routine childbirth complication like bleeding is almost unheard of in an age of blood transfusions and surgical repair … but not in an age of homebirth.

Lovell was an Australian homebirth activist who wrote the following in response to midwifery legislation under consideration:

On a personal note, I am quite shocked and ashamed that homebirth will no longer be a woman’s free choice in low-risk pregnancies… I feel the decision to outlaw homebirth’s is contrary to women’s rights … Please find a solution for women and babies who homebirth after this date as their lives will be in threat without proper midwifery assisstance. And as a homebirthing mother I will have no choice but to have an unassisted birth at home as this is the place I want to birth my children.

Yours sincerely,
Caroline Flammea, Nick Lovell and daughter Lulu Lovell

Lovell did not act on her dare, but perhaps she would be alive if she did. Instead she hired midwife Gaye Demanuele.

The testimony at the Coroner’s inquest was chilling:

“A mother told her midwives she was dying and needed to go to hospital in the moments after she gave birth to her second daughter in her Melbourne home, the Victorian Coroners Court was told on Tuesday…

But just over an hour after the “overjoyed” couple greeted their daughter in their Watsonia home, the court heard Ms Lovell told her midwives she needed to go to hospital. Ms Lovell, 36, died later that night in the Austin Hospital.

And so Caroline Lovell bled to death … slowly, preventably … because the midwife she depended on was too ideologically brainwashed to perform even the most basic midwifery tasks. Instead, as reported by the assistant midwife Melody Bourne:

Just over an hour after Zahra was born in a birth pool, Ms Bourne said Ms Lovell was light-headed and hyperventilating, telling her midwives she was dying and needed to go to hospital.,,

“Gaye and I also made efforts to calm and reassure Caroline.”

Five minutes later, Ms Lovell became pale, cold and unresponsive and an ambulance was called. Examination by hospital clinicians revealed Ms Lovell had suffered two tears and a blood clot.

Any real healthcare provider will tell you that the most chilling words you can hear from a patient are: “I think I’m dying.” That’s because they probably are dying and it is up to you as the provider to undertake whatever examinations and tests are necessary to prove that they are not.

It would have been laughably simple for the Demanuele to have assessed Lovell BEFORE she reassured her. Her life threatening blood loss would have been easily diagnosed by taking her blood pressure or checking her pulse. Nothing sophisticated was required, merely the most basic of clinical skills.

The Coroner offered his assessment this morning:

After Ms Lovell gave birth at home in 2012, Coroner White said the baby had blood on her head – a sign that Ms Lovell may be bleeding. Despite this, Ms Demanuele allowed Ms Lovell to remain in the pool for an hour unchecked. Her baby was with her most of the time so they could bond.

Had Ms Demanuele turned on the lights, Coroner White said she may have noticed the pool had turned a reddish brown due to her blood loss. The blood loss was likely caused by injuries to her vaginal wall, perineum, and probably her uterus.

When Ms Lovell tried to get out of the pool, she fainted. After regaining consciousness, Ms Lovell said she feared she was dying and asked for an ambulance to be called. Ms Demanuele did not call an ambulance. Later, Ms Lovell collapsed again. Ms Demanuele started CPR and an ambulance was called.

Furthermore:

Coroner White said while Ms Lovell was being treated at the Austin, Ms Demanuele returned to her Watsonia home and removed the pool and its contents, “despite what I am satisfied was her comprehension of the potential relevance of this evidence to questions likely to be later asked of her”…

He said Ms Demanuele had:

failed to conduct a proper risk analysis before deciding to approve a home birth for Ms Lovell
failed to consult Ms Lovell’s GP throughout her antenatal care
failed to provide a safe environment for her to give birth, which made it difficult to observe the complications unfolding
failed to call for an ambulance when Ms Lovell needed one; and
failed to provide paramedics and Austin hospital staff with adequate information.

Despite these damning findings, I’ve already seen homebirth advocates declaring on line that it wasn’t homebirth that killed Ms. Lovell, it was Gaye Demanuele’s malpractice.

Let’s be clear:

Homebirth killed Caroline Lovell.

Yes, hemorrhagic shock was the proximate cause of her death … in the same way that hemorrhagic shock may be the proximate cause of death of a pedestrian hit by a drunk driver.

It is disingenuous to blame Demanuele’s irresponsible commitment to demedicalized childbirth for Lovell’s death. As in the case of many homebirths, she was hired precisely because she was willing to sacrifice safety on the altar of natural birth.

Homebirth is ALWAYS a gamble, or perhaps more accurately a dare. The mother gambles that she or the baby will not experience a life threatening complication at home. In the world of homebirth, greater risk factors mean a greater dare and therefore a greater “triumph” if mother and baby come through unscathed.

The dreadful irony is that had Lovell given birth unassisted, she might be alive today. When she told her husband she was dying, he may have called an ambulance to summon real medical professionals.

Instead, Ms. Lovell trusted homebirth Gaye Demanuele who was willing to defy basic safety precautions to attend her homebirth. In an effort to prevent “medicalization” Demanuele reassured Caroline Lovell she was fine even as her life ebbed away.

Ms. Lovell believed homebirth was safe and that belief killed her.

Her death, like nearly all homebirth deaths of babies or mothers, was entirely preventable.

  • Roadstergal

    O/T – looking up some references for Jeano (a waste of time, I can now see, after reading the thread) took me on a delightful skim through the UK press that make me happy I’m an ocean away from Cathy Warwick; I would not be able to resist hunting her down and punching her if I lived in the same country.

  • The Computer Ate My Nym

    Okay, so let’s assume that Dr. Tuteur is wrong and this is a case of a “bad apple” among homebirth midwives. In that case, what is the homebirth community and the homebirth midwife organization in particular doing to ensure that she does not put further patients at risk? I understand that the midwife in question resigned her license, but only after 3 deaths. It’s hard to imagine an OB continuing to practice after 3 unexpected deaths of previously healthy women and fetuses. Their malpractice alone would preclude that. Also, the midwife only returned her license “in disgust” at being investigated. She clearly did not think that losing 3 healthy patients was something that should lead to an investigation. Heck, if I lost three cancer patients unexpectedly, I’d WANT to be investigated because I’d start to wonder about myself. (Well, okay, not pancreatic, but if 3 women with limited breast cancer died while receiving adjuvant chemotherapy that I’d ordered? Fuck yeah! Investigate me!) Finally, the midwife is still attending births as a “support person”. Why is this allowed by the community? In short, even if homebirth were perfectly safe in the presence of competent attendants–which is not true, but even if–it’s unsafe because there is no mechanism or will to remove incompetent attendants.

    • Azuran

      That’s the thing. As soon as midwives will be at risk of being held accountable for their malpractice, they’ll have to take decision based on medical standards. They’ll have to risk out twins, breech,GD, VBAC, late term, older mother, anyone with pre-existing medical condition or any kind of risk. They’ll have to make sure everyone gets adequate prenatal care and monitor the baby during the birth, then they’d have to transfer at the first sign of distress on the baby.

      If that happened, they would be part of the medical establishment. They would be nothing special. The point of a home birth is basically defiance of medicine.

  • AA

    Please keep in mind that not only are these “physiological” obsessed MWs endangering their patients, but they are also the preceptors and teachers of new MWs. Other Advance Practice Providers have not fallen into this “natural” obsession. It is a disgrace to all the APPs who work hard to truly care for their patients rather than prioritizing ritual.

  • concerned midwife

    I would hope one day to see women with previous traumatic births find a midwife who says, “yes, you had a traumatic birth, but you have risk factors that mean it is unsafe to do this at home – I will come to the hospital with you”.

    Instead, we continually see midwives who take on high risk women for home birth. Swipe their Medicare card for a few months and then drop them at the hospital after a long protracted labour when they realise they are in strife. Or worse, not transfer.

    Yes, I work in a hospital. I do not benefit financially if I convince a woman that she would be safer birthing in a hospital if she has big risk factors.

    • Margo

      If I remain the woman’s midwife in a high risk hospital situation, I too get a fee.

      • Margo

        Only a mad midwife would put a fee ahead of putting a woman her baby and herself at risk by doing a Homebirth instead of going to hospital, sadly there may be a few of that ilk out there.

        • Chi

          Especially since there is a financial incentive in the form of a ‘bonus’ for providing a home birth ($451) or a birthing center birth ($256).

          Source: Action to Improve Maternity (AIM) NZ.

          http://aim.org.nz/did-you-know/

          How many midwives would not risk out because they want their bonus? We have no real way of knowing.

          • Margo

            The “bonus” covers the extra cost of maintaining and supplying equipment for a home birth and the “bonus” is there to help towards the cost of paying your second backup midwife who attends the birth as the second back up midwife, else that midwife would be attending for free so to speak, or the first midwife, without the extra funds would be paying the second midwife out of her own pocket, that’s the reason for the extra payment. Same as rural based midwives get a little extra payment in recognition of the fact that they have extra costs around travel.

          • Margo

            And we could look at this another way…how many women are encouraged to birth NOT in hospital because that saves the hospital money …just a thought. And, yes we may never know how many midwives do homebirths to catch the “bonus” fee

          • moto_librarian

            So why don’t they just pay the second midwife?

          • Roadstergal

            Seriously. You posting this comment made me read Margo’s comment, and this ‘bonus’ thing is just ridiculous. If a midwife needs supplies, get her the supplies; if she needs a second midwife, supply a second midwife. What, are they giving OBs a ‘bonus’ for doing a C/S that is meant to cover the cost of gloves and tools?

            That ‘bonus’ system sounds like a scam.

        • VikingAPRNCNP

          As an aprn I can’t imagine putting patients at risk in this manner. I’m not a certified nurse midwife but this case boggled my mind. 2 children left without a mother and a husband lost his partner

  • cookiebaker

    The midwife was horrible, but why didn’t her husband call for an ambulance? If I passed out and said I was dying, my husband would call the ambulance, police, fire department, my mother, the redneck neighbors, my best friend, the EMT who lives up the street, and whoever else that might help him. Such a sad situation.

    • Siri Dennis

      Because he trusted the midwife. Your husband would do no such thing, any more than he would call another hospital and arrange a transfer, and what you are saying smacks of victim-blaming.

      • momofone

        I can’t speak for cookiebaker, and this is not intended as victim-blaming, but I can say without a doubt that my husband absolutely would have called, midwife’s approval or not. I am curious about his reasons for not calling as she begged the midwife to do so and said she believed she was dying.

        • Siri Dennis

          I think that’s the kind of comforting thing we tell ourselves for reassurance; personally I’d have to see it to believe it.

          • momofone

            I don’t need to reassure myself in that way; I know him. I’m not sure what you need to see (my husband calling?), but he would not stand by as I died without calling for help, regardless of who disagreed.

          • Amazed

            The problem here is, did he truly believe that she was dying? To me, it looks like they both trusted the midwife.

            I am one of the hardliners here who believe that homebirth mothers shouldn’t be patted on their poor heads because they couldn’t have known. I think they’re grown-ups. But my problem here is with adult men and women letting themselves become so entangled in something that they no longer recognize red flags and that someone is dying right in front of them, not that once they realized what was going on, they didn’t take actions. In this case, I don’t think the husband knew.

            Rose Kacary comes to mind. “My husband would have called an ambulance if I told him to!” Well, Rose, you were the fucking midwife who was called to give her professional opinion. Why didn’t you tell Claire’s husband to call the EMS?

          • momofone

            I think you’re right. And my husband and I are both decidedly non-woo. He and I were just talking about this, and he sees it much like he sees some religious groups; belief precludes/overrides everything else, including thought.

          • Allie P

            My husband would NOT have called the ambulance. He’s terribly hospital and medical averse, and has all kinds of woo friends. I don’t even let him take the kids for the shots anymore because once he brought her home without all of them (“I thought she’d had enough that day and they didn’t have the nasal flu shot”) leading me to not be aware my child had not had the flu shot for MONTHS. I make the medical decisions in my house. He once ignored his appendicitis until it perforated. SMH

    • Bombshellrisa

      Not sure about the circumstances, but I know there are examples of homebirth midwives who take away people’s cell phones, shoo husbands out of the room, don’t allow family members near after the birth because “bonding”.

  • MichelleJo

    As I understand the post, it was the home birth ideology that killed the mother. And that includes giving birth at home with the attendance of someone who subscribes to that ideology. A homebirth midwife thinks it is more important to let the mother and baby bond than check the mother’s vital signs. Had that same midwife been in the hospital, it wouldn’t have come to it, because no hospital would let a women sit in a mucky pool in the dark for an hour after birth with no monitoring. And hospitals have protocols. If a woman passes out, the midwife would probably have to code the doctors. She wouldn’t have been able to act the way she did in a home birth setting. Yes, had she acted as soon as the mother asked her to, there would have been a slightly better chance of survival. If she was already at the point of collapse, I imagine that intervention would have to be far quicker than the time an ambulance could get her to the hospital. The culprit was that a women whose life was precarious, as every woman’s is in the hour after birth, felt safe as she was, and the midwife felt she was being responsible, is because the home birth movement says so.

  • MJeano

    If this woman had been in the hospital and her provider ignored her assertion that she felt she was dying, would the provider be at fault, or would hospital birth in general be at fault?

    You say her blood loss could have been easily diagnosed and prevented by “the most basic of clinical skills.” Thus can’t we assume that had the midwife assessed her properly and gotten her to the hospital sooner, her life could have been saved? In this case, it was the provider’s failure to accurately asses and treat her quickly enough, not the fact that she was at home. If the midwife had noticed the problem immediately and taken appropriate action, and she STILL had died BECAUSE of the time it took to transfer her to the hospital, then you can say it was homebirth that killed her. But in this case it sounds like it was the provider’s lack of judgment and quick action, not homebirth.

    • Dr Kitty

      Quick question.
      In a PPH you can lose more than 500mls a minute.
      If you are losing1/6th of your blood volume every minute at home, is it being at home that kills you, or a 1 minute delay in calling an ambulance?

      If your midwife’s malpractice, if it happened in a hospital, would likely have resulted in you surviving your PPH, isn’t it the location and not the attendant that killed you?

      • MJeano

        In your first example, if we’re talking a matter of minutes then yes, it is probably the setting. I think a minute delay is less likely to be attributed to malpractice. In this case it says the midwife didn’t check her for an hour.

        I’m not sure exactly what you mean by your second question. My point is even if you are in a hospital, if a midwife (or any provider) fails to check you in a reasonable amount of time and you die, would you attribute it to the provider or to hospital birth?

      • MJeano

        If this woman had been in the hospital and her provider ignored her assertion that she felt she was dying, would the provider be at fault, or would hospital birth in general be at fault?

        You say her blood loss could have been easily diagnosed and prevented by “the most basic of clinical skills.” Thus can’t we assume that had the midwife assessed her properly and gotten her to the hospital sooner, her life could have been saved? In this case, it was the provider’s failure to accurately asses and treat her quickly enough, not the fact that she was at home. If the midwife had noticed the problem immediately and taken appropriate action, and she STILL had died BECAUSE of the time it took to transfer her to the hospital, then you can say it was homebirth that killed her. But in this case it sounds like it was the provider’s lack of judgment and quick action, not homebirth.

      • MJeano

        Whoops I just typed a response and lost it. Here it is again:

        In response to your first question, if the blood loss is happening so rapidly that it is a matter of minutes, then yes it is probably the setting, not malpractice.

        I’m not sure what you’re asking in your second question. My point is that if a midwife or any provider, even in a hospital, fails to check the patient in a reasonable amount of time and she dies because of it, is it the provider or hospital birth in general that is to blame?

        • Rachele Willoughby

          If a hospital fails to have in place and enforce policies that require the most basic clinical assignments post-birth, it’s the hospital *and* the provider’s fault.

        • Sue

          That hypothetical case just could not occur. There are teams in hospital, not just an isolated provider, and post-partum women are never left to bleed in the dark in a pool of water.

          Even an incompetent person in hospital would be relatively protected by the rest of the team and hospital processes.

          • Margo

            Hmmm, not if everyone else is busy an incompetent team member could be left on their own and not follow procedure. I know of two cases where women did bleed, not in a pool, but in their bed, both nearly died, and why did this happen, well it happened because in one instance, staff shortages and a women was left in her room, on her own for nearly an hour and the other was in her room, surrounded by family and a midwife busily writing notes, not monitoring the woman, blood pooled under the bed and relative noticed and alerted the staff member, pretty much as the same time that the woman said, “I don’t feel good”….lucky for both women they were in hospital. I would be inclined not to say anything might “never” happen, because sometimes things do happen and usually the fault is lack of monitoring.

          • Margo

            And at home births generally speaking, in NZ there are two providers at birth and for some period of time after, so the expectation is the midwife is not entirely on her own.

          • MaineJen

            Yes, at this birth there was the totally inept midwife, and her completely brainwashed assistant who reassured this mother she was “fine” even as she bled out into that filthy pool. Forgive me if I’m not totally convinced.

          • Dr Kitty

            Two providers at each homebirth…a finite number of midwives…and complaints of understaffing in maternity units.

            Correct me if I’m wrong, but increasing homebirth, without increasing staffing in maternity units, makes hospital birth less safe and still doesn’t make homebirth safer than hospital.

            Simply on the grounds of justice and beneficence, encouraging homebirth within a national health service is unethical. Homebirth takes resources from high risk women and their babies and women who don’t want to homebirth, making their experiences less safe and less pleasant, just so low risk women who want to give birth at home can have a “better” (but still, less safe) experience.

          • Margo

            I agree with your point re staffing in hospital, that needs to be encouraged, absolutely. Midwives in NZ can choose to work within a hospital setting, paid by their DHB or work outside the hospital as self employed midwives who are paid via government funding. I guess the shift to being a lead maternity carer, which is what self employed midwives are called has seen midwives move out of the hospital setting into the community and thus this has led to some staff shortages of hospital midwives, and this does need to be addressed.

          • Phascogale

            There’s a reason you are supposed to be doing 15 minutely vitals in the first hour after birth including looking at loss and fundal height and tone. But your example certainly illustrates how that doesn’t happen. And unfortuately it’s more common than people like to think.

          • Margo

            Yes it is more common than people think, that’s why we should all be aware that just because we are in a hospital setting it doesn’t necessarily mean we are without risk post birth if the required assessments are not done, for whatever reason. That’s why women need to know what sort of post birth care they should expect to receive before they labour etc.

          • Sue

            Post-partum haemorrhagic death in hospital is very rare.

          • Margo

            How rare, where are the stats to back this up? Where are the stats for pph either at home or in hospital. I am not that reassured from reading that I have done that pph death is very rare.

          • Amazed

            Yeah, let’s move the goalposts! Let’s not discuss this homebirth advocate’s death! Let’s talk about making hospital birth safe by expecting that the staff will multiply when we wave our wands!

            When is Professor McGonagall making an appearance?

            Err, Caroline Lovell? Who was she?

          • Sue

            “lucky for both women they were in hospital”

            Indeed, because, no matter how busy people are, women are not left sitting in water for an hour, and, when someone calls out for help, a team is available.

          • Margo

            We will have to agree to disagree, because I have worked for over thirty years in and out of hospitals and at times a team has not been available. Women have been left unattended. Not acceptable, on any level. That’s why women should be demanding better staffing levels in hospital etc.

          • Daleth

            Absolutely, women should demand better staffing levels in hospitals, because staffing is a key resource that prevents disability and death in postpartum moms and babies. For the same reason–the need for resources that prevent disability and death–they should also be demanding to give birth in hospitals, not at home.

          • Amazed

            Ah I expected to see you here and you are. I expected to see your nice little strawman here and it is.

            Do you really compare someone who is left unattended because the team is stretched over too many women to serve them all adequately with their knowledge with someone who had not one but two supposed midwives focusing solely on her THE EXACTLY WRONG WAY with their LACK OF knowledge? The problem with Caroline Lovell wasn’t that adequate help was stretched thin, it was that inadequate help was focused so obsessively on her. But of course, that’s what you do. Compare apples and oranges. When homebirth is concerned, everything is acceptable, even comparing things that are vastly different, right?

          • Margo

            I was answering a previous post that said something along the lines that women were/ would never be left unattended in hospital. I had also previously stated that the behaviour of the midwife in the Homebirth case was wrong, what happened there is unforgivable. I have never said or subscribed to the notion that “where Homebirth is concerned, everything is acceptable”…that’s not what I was saying at all. I never suggested that in the Homebirth case that the help was stretched thin. I agree (d) that the help was inadequate, because what happened is utterly indefensible. In fact it was criminal and I do not understand how a midwife could be so entrenched in a philosophy that leads to women and babies dying.

          • Daleth

            What country did those two cases you mention happen in, Margo?

          • Deborah

            “…lucky for both women they were in hospital”
            Bingo

          • MJeano

            It sounds like you are implying that a woman wouldn’t die in the hospital because of the protocols put in place. Then why does the US rank 33 in the world for our maternal mortality rate, the highest of any developed country, even though we spend more money than any other country on maternity care? And hemorrhage is the 4th leading cause of those deaths. And please don’t say all those deaths are coming from home births, because home births are too small a percentage of the overall number of births to account for the mortality rate.

          • swbarnes2

            Because Americans count it differently than other countries. The US looks at deaths quite a ways after the birth and calls them “maternal” if the underlying conditions that cause the death were exacerbated by pregnancy. It’s NOT about more women bleeding to death in hospitals.

          • LaMont

            Also just off the top of my head, aren’t the pre-existing problems of heart disease, diabetes, aging etc., more of a concern in the US than other developed nations? Thus costing more *and* causing more maternal risk? These arguments touch my nerves as both woman and applied-math-person.

          • The Computer Ate My Nym

            Yes, the US has a high maternal mortality. There are multiple reasons for this, including relatively poor prenatal care, often due to lack of health insurance, high numbers of minority women who are at higher risk for a variety of reasons, more women who have 5+ children and the attendant risks, more pregnant women in poor health, relatively high rates of violence against pregnant women (yes, that’s a cause of maternal mortality and should be counted as such). Which of these problems would increased homebirth help with?

      • Margo

        Hmmmmm. Well yes of course rapid blood loss. But even at home, measures can be taken, as in hospital, whilst waiting for crash team (hospital) or ambo(home) to come. Measures that may stop the pph. Better still vigilant post birth monitoring wherever you are located is expected practice. This midwife was negligent if I have read the facts correctly as presented here.

        • Sue

          Margo – do you honestly think it is plausible that a post-partum woman could have been left for an hour to bleed out in a pool of water in the dark?

          It’s just not possible for this to happen in hospital. Even if only because they need the beds.

          • Margo

            I don’t think I have suggested it is plausible

          • Margo

            However, I guess it could be plausible. When systems/protocols/guidelines breakdown, when people take their eye of the ball, stuff, usually bad stuff happens, in and out of hospital.

          • Phascogale

            Theoretically this could happen at a hospital. Understaffing (it’s a chronic issue) and a busy birthsuite may mean that a recently birthed mother may be left unattended for 30 or more mins while they are dealing with a birth in another room or a resus or a difficult assessment. But that would only be at a hospital where they do waterbirths.

          • Margo

            Well yes, if we are just discussing water birth then it would have to be a waterbirth hospital but an emergency such as pph can happen anywhere and it could be that a pph could go undetected due to staff not being in the room, I know this case is about dark room and water colour not picked up on along with all the other signals….but women can bleed into a bed and loose a lot of blood and be put at serious risk before anyone notices if assessment post birth is not carried out as per protocol, so not theoretical, but fact, because these sort of things do happen whether in water at home or water in hospital or in the shower or toilet or in the bed, where ever women give birth and then are left unattended or left with someone who does not assess properly tragedy is potentially just around the corner.

          • momofone

            This reads to me as very much like “babies die in hospitals too.”

          • Tiffany Aching

            So you mean if absolutely nothing happens like it is supposed to happen in a hospital it could definitely happen ? Do I understand you properly ?

          • Daleth

            Even if she’s unattended, as long as she’s on electronic monitoring–as I was when I gave birth in the hospital–alarms will sound at the nursing station and in her room when her blood pressure plummets, which automatically happens during a hemorrhage.

            And it’s a good thing I was on electronic monitoring, since my hemorrhage was internal–there wasn’t an inordinate amount of blood outside my body, just a huge distended womb filling up with about 25% of the blood in my body.

          • momofone

            It seems this would be a good argument for having a team of people, as in what you would find in a hospital.

        • MaineJen

          Measures…like applying tinctures and cinnamon candy? Come ON.

          • Margo

            You come on! That’s A pretty insulting assumption on your part.

        • Daleth

          But even at home, measures can be taken, as in hospital, whilst waiting for crash team (hospital) or ambo(home) to come

          What “measures,” specifically, can be taken at home?

          • Margo

            Speaking as I do from NZ I first want to say that it seems different countries do different things post birth. In nz women are not routinely hooked up to monitors post birth or pre birth unless they have a risk factors, ie a CS . At a home birth a pph can be addressed by insertion of IV line, administering of medication via injection or an infusion via IV line, manual compression can be applied, O2 is on hand help is called (ambulance) medics transfer of the woman is organized. Hospital admit is organized. Pph is a fearful event and is not taken lightly, there are those midwives who might use herbal remedies, I do not subscribe to this. So, what I have stated above are the measures we take, at home,if a pph occurs.

          • Margo

            The midwife puts in the IV line, administers the medication, calls for extra backup (ambulance) consults with the ob team at the base hospital. Every year we are obliged to prove ourselves competent re management of pph, the very initial response to a pph is the same as in hospital setting. Homebirth midwives in nz carry O2, IV lines, IV fluids, medication , as we are permitted to prescribe and administer meds. Hope this answers your question re measures.

          • Charybdis

            But is a heplock established at the beginning, or do you have to wait until the hemorrhaging starts before trying to start an IV?

          • Margo

            Mostly at a home birth and IV is not in situ.

          • The Computer Ate My Nym

            But not blood. Women at a home birth aren’t typed and screened prior to the birth. They don’t have a hep lock in. If they need blood the blood is the time it takes to summon an ambulance plus the time it takes to get into it plus the travel time to the hospital plus time to assess, type and cross, get the blood from the blood bank, and give it. Not to mention how hard it is to get an IV into a person whose BP has tanked from hemorrhaging. In a hospital it only has to be picked up from the blood bank and slammed in as fast as it will go.

          • Inmara

            I suppose that in NZ and other countries where midwives are sufficiently trained and integrated with hospitals, pregnant women ARE screened for a blood type and HCPs maintain detailed medical records so transfers to hospital are much smoother than in US. In my country, every pregnant woman has “Mother’s Passport” with all relevant data about her health and pregnancy care so she can get into any public hospital at any time to give birth. Also, if a homebirth midwife calls to a hospital that there will be transfer for xyz problem, hospital staff start to arrange necessary equipment and team. Not that I would choose homebirth myself, because the risk is higher anyway, but it differs from a system with lay midwives.

          • Erin

            We have a similar system here but that still relies on a woman engaging. Most of my birth trauma group who are planning home births have refused most if not all ante natal NHS testing, including the booking appointment so they don’t have proper notes.

          • Irène Delse

            I wonder about the psychological motivation behind this avoidance of tests: do these women feel that testing and preparing for bad scenarios already invites them to happen? A superstitious mindser, to be sure, but sadly pretty frequent. “I don’t want to know about it” as if not mowing many it wouldn’t happen.

          • Daleth

            Yes, I think that’s it, in part. The superstitious part is as you say: believing that by even considering the possibility that it (GD, pre-e, etc.) might happen, you will make it more likely to happen. And the non-superstitious (but still stupid) part is the belief that by considering the possibility, you might scare yourself and make you waver in your certainty that your birth will be Natural And Perfect, thus weakening your resolve to refuse interventions.

          • Erin

            In some cases definitely. Bearing in mind they are members of a Birth Trauma group, so their first foray into childbirth ended badly in their perception for physical, mental or a mixture of reasons. I’d say I’m the only person in said group who believes that all the interventions carried out up to and including my emcs were necessary to ensure mine and my son’s survival. Everyone else has twisted what happened to them into a narrative of Doctor’s are evil, stay away otherwise you might as well just sign up for an elective section. The focus is very much on “your body works”, it’s interventions including testing which makes you doubt yourself which is the problem.

          • Irène Delse

            Depressing. Added to it all, I bet, is the belief that a Positive Attitude™ makes your body work as it’s “meant” to work, and bad outcomes are magically avoided.

            I think there’s an element of pop culture that cross in: have you noted that very often, in TV shows, movies or books, someone has an emergency delivery outside of the hospital (at home, on the road, in the wilderness…) and *everything goes well* despite lack of medical resources. Sometimes a doctor is present, but hasn’t much to do except say “Push!” and catch the baby. Sometimes it’s played for laughs, sometimes there’s tons of emotion and drama, but hey, if you believe strongly enough, all’s that ends well! No 3rd-degree tear, no life-threatening PPH, no distocya, no still birth…
            It’s a trope I wish writers would stop using!

          • KeeperOfTheBooks

            I have recently started rewatching “ER” as an adult (yeah, yeah, I know…) and in the first season, there’s an episode in which an ER doc, through no particular fault of his own, ends up with a dead mom on his hands because of systematic failures combines with Sometimes Mother Nature Is Out To Get Ya. (Think pre-eclampsia followed by full-blown eclampsia, induction for same, big baby, shoulder dystocia, placental abruption, crash C-section, etc.) It’s something that it wouldn’t hurt a lot of the general public to see again, because while yes, it’s unlikely that all those things would happen to a mom at once, several of them aren’t at all outside the realm of possibility.
            Also, one of the running themes was that while as an ER doc he had delivered a couple of hundred babies (busiest ER in Chicago) during otherwise straightforward births, he still didn’t have the experience or knowledge he needed to save mom’s life once the shit hit the fan. Something the average CPM might want to consider. (Yeah, right!)

          • Irène Delse

            Heh. Michael Crichton is said to have drawn upon his experiences as an MD in a busy hospital to write the scenario of what would become that 1st season. He must have seen a few obstetrical scares!

          • Roadstergal

            We watched The Paper the other night (yes, trawling for older movies), and I will definitely give it props for presenting an obstetric emergency as a true emergency.

          • Daleth

            Why are they allowed to do that? What I mean is, why is it not a condition of planning an NHS or private-insurance home birth that you do XYZ prenatal tests?

          • Erin

            To quote the NHS themselves:

            Under „common law‟ or „case law‟ patients have the following rights;

            The right to consent – to give or refuse consent to treatment (including life saving treatment) or examination or advice. This is still the case even if the decision is completely irrational. Nor can the decision be overridden by professionals, unless the patient is detained under the Mental Health Act 1983 (but see the section below on mental capacity). Consent is necessary before someone can take part in a clinical trial.

            ——-

            You can’t be forced into testing as a condition of treatment. They can threaten you with Social Services but they are also overstretched and not really interested in the fact that someone is potentially endangering themselves or a fetus.

            As far as I can tell, you get a letter to cover their backs saying you have refused x, y and z against medical advice but no one will force you to do anything.

          • Daleth

            Yes. Although it doesn’t always differ, as Caroline Lovell’s death shows. She might as well have been in the US with a fanatical CPM.

          • The Computer Ate My Nym

            It’s still going to take longer than if the woman were in the hospital already and all that needed to be done was have someone run (and I do mean run) to the blood bank for the proper type of blood and start infusing as fast as possible. Those minutes will rarely make a difference, but when they do, they are life or death. (Though I agree that homebirth in the setting you mentioned sounds safer than in the US where it would be completely disorganized.)

          • Daleth

            It sounds much safer than home birth in the US. Although still not as safe as birth in the hospital.

          • MJeano

            In the US I can think of one story where a mother started bleeding too much at home, and the midwife injected her with both pitocin and methergine, which together caused the uterus to contract in such a way as to stop the hemorrhage

          • Amazed

            Resorting to anecdotes once again. Sweet. And I’m supposed to take your word that this actually took place, that the haemorraging was of the same scale like the one that nearly killed my mom in just a few minutes (by the way, that was an actual case of medical malpractice and no, no one got as much as a slap on the wrist for that, as far as I know, A Communist country in a crisis right before 1989 was a place where such things were just so bizarre) and that the midwife was acting in a way that’s uniform to most homebirth midwives?

            Sorry, MJeano. No, no, and no.

          • MJeano

            No, I don’t know what scale the hemorrhage was, never said I did. I simply replied to a question about what measures can be taken at home to stop a hemorrhage. And there isn’t any way for you to know if that story is true, but if you do a search for intramuscular pitocin and methergine injections you can see for yourself.

          • demodocus

            If they regularly use intramuscular pitocin, why did I get it in the middle of my back?

          • Amazed

            The question wasn’t just about a haemorrage at home. The question was about losing 1/6 of your blood in a minute at home. You know, the type of bleeding that often requires a transfusion. The one that can kill you in under 10 minutes if a super agressive treatment isn’t applied immediately.

            Dr Kitty is a physician. She had a reason to ask this exact question. The one that you didn’t answer, in fact.

          • Irène Delse

            Or, alternately, the bleeding stopped on its own and the woman was very, very lucky. In all probability, she didn’t have a hemorrhage on the same scale as the one that killed the woman in the original article. You admitted yourself that you don’t know how bad it was, and just surmised that *any* bleeding can be stopped with just a few shots of easily available drugs.

            No. My mother had a friend who nearly died in childbirth. Luckily for he she hadn’t tried home birth! She was in a hospital, the baby has just been born, all was going well, and suddenly there was this flux of blood. The thing that most impressed her at the time, that stayed printed in her memory, was how fast and decisively the OB acted: he didn’t first try to clamp the artery but inserted an IV into the patient’s arm to start transfusing before the veins were deflated. Had she been at home, she could have been dead in minutes.

          • Daleth

            I had already been injected with pitocin when I hemorrhaged and nearly died. Despite the pitocin, and the immediate response of medical staff, I still lost about 25% of my blood.

            Sometimes pitocin doesn’t work. The same is true of the drug combo you mention above. Sometimes there is nothing you can do to prevent a hemorrhage, which is why you need to be in a hospital–because that’s the only place you can be treated and saved from a major hemorrhage.

          • Daleth

            Problem is, that doesn’t always work. I was given pitocin as a precaution–every woman who gives birth at my hospital gets it to help prevent PPH–and I still went into hypovolemic shock and lost about 25% of my blood.

            So as a home birth midwife, are you prepared for emergencies when the “measures” you know how to take aren’t enough? Precisely how are you prepared?

          • MJeano

            Well since I’m not a home birth midwife, I can’t answer personally

          • Daleth

            Use your knowledge and common sense. The answer will come to you.

          • KeeperOfTheBooks

            They generally don’t. I knew one midwife, and I suspect this was the norm in our border state, who would periodically go on road trips with another midwife to Mexico in order to buy Pitocin etc from some of the rather shadier pharmacies down there in order to maintain a supply. Of course, they were also counting on that actually being Pitocin and not, say, sterile water in the vials…

          • MaineJen

            Would a CPM have access to pitocin or methergine? Legally?

        • Charybdis

          The crash team at the hospital is usually seconds away, or at least the first responders are seconds away, if not already in the room.

          But please share. What measures can be taken at home to stem a PPH, especially if there is not a lot of blood gushing from the mother’s vaginal area?

          • Margo

            IV meds fundal pressure, vaginal packing,manual compression to start with. I don’t prescribe to notion of sniffing herbs or praying that everything will be fine…that is why we do post birth obs, a good assessment can pick up when things are going awry, we don’t need gushes of blood from the vagina to recognise a bleed may be occurring…

    • Margo

      I agree with you MJeano. Absolute lack of judgement and proper monitoring of the situation. The woman Faints twice, says she’s dying, the midwife doesn’t check the colour of the pool water or listen to signs of impending doom (I’m dying), all signals that were ignored and should not have been.

      • Daleth

        all signals that were ignored and should not have been.

        And WOULD not have been in the hospital, because the electronic monitors would have been screeching with alarms as her blood pressure plummeted, and a team–not a single isolated provider who was free to use her own personal philosophy, but a team that was required to follow hospital procedures–would have been responsible for responding.

    • Sue

      “If this woman had been in the hospital and her provider ignored her assertion that she felt she was dying, would the provider be at fault, or would hospital birth in general be at fault?”

      This could not have happened in hospital, because there is a team there – not a single isolated provider. And because a post-partum woman would not be left for an hour in a pool of water in the dark. Never.

    • Amy Tuteur, MD

      The problem is the philosophy of homebirth that killed Caroline Lovell.

      • Margo

        The problem is the philosophy of SOME Homebirth advocates put women and babies at risk, the philosophy of SOME home birth advocates and followers result in deaths….and that is totally totally unacceptable. That’s my opinion.

        • MaineJen

          “Not all homebirth midwives”

          • Sean Jungian

            Hashtag.

          • The Bofa on the Sofa

            You’re new, but MaineJen is referring to “Bofa’s Law of Professions” which says that if a common defense of a group consists of “Not all of them are bad” then that group has a serious underlying problem.

            So let’s hashtag it #BofasLaw

        • swbarnes2

          There was a poster way back in the archives who was told by her homebirthing midwife that there was no such thing as an emergency that would develop so fast that she would not get to the hospital in time to save her child. Do you agree with that statement? Because if you do not, then there is no such thing as a homebirth that doesn’t put lives at risk.

        • MaeveClifford

          But it’s not just a fringe element. It’s the bulk of homebirth advocates who side with “sisters in chains” over the patients they’ve maimed and killed. Who vilify the very medical establishment that cleans up after their messes. Who cheer on stunt birthers (freebirth? HBA3C? drowning your newborn at a waterbirth? You birth warrior, you!).

          If the leaders of the movement were serious about risking people out and creating accountability, we’d be having a different conversation.

      • MJeano

        So if a woman is given pitocin (a high-alert medication because of the risks it poses, which I’m sure you know) to augment her labor in the hospital and she has a tetanic contraction because of it that ends up killing her baby, is it the hospital philosophy (of intervention) that killed her?

        • nomofear

          Has this happened since, like, the initial uses of pitocin in labor?

          • MJeano

            Tetanic contractions? Yes, I doula I work with had it happen to her client after she was given pitocin.

          • nomofear

            No, not tetanic contractions in general – ones that kill a baby in a hospital setting. I don’t believe THAT. I could see it as being more likely to happen years ago, but not today, with titrated doses and CFM. They’d have the baby out in a crash section before you could say boo.

          • Susan

            I misread that to say “They’d have the baby out before you could say woo” LOL

          • Amazed

            You’re a homebirth midwife, aren’t you, MJeano? You’re here to fight for your income, even if it goes over the corpses of many more Caroline Lovells. That’s why you’re rushing to prove that hospitals are also this bad, using “proofs” like “a non-medical professional who’s also ideologically indoctrinated told me… Oh, no one died. Doesn’t matter! The hospitals are just as bad.”

            People like you make me sick. Can’t you find another career, preferably one that doesn’t leave people dead or damaged for life?

          • Bombshellrisa

            I think this is the same poster who is a “future nurse midwife”, who posted under the name Megan for a few days. Also wrote about how evil pitocin is. So proving that CNMs are also susceptible to the woo and worse, are spreading it.

          • Amazed

            Bofa’s Law proven again.

          • MJeano

            Wow, that’s interesting that you would make such a bold assumption about what I do. Because I mention a risk of pitocin for the sake of an argument, you automatically assume I am a home birth midwife? Wow. (I am not, for the record).

            Where did I say hospitals are bad? Can you give me a quote? The point I was making is that if there is a complication due to provider negligence, whether it is at home or in the hospital, it is the provider, not the setting that is at fault. Aren’t you the one using the “proof” of Caroline Lovell to say that ALL home birth midwives are negligent?

            And “people like me”?? How do you know who I am? Because of a few comments I posted you assume you know exactly what I do? Wow.

          • Amazed

            Because you mention a scenario that’s almost unheard of (I am saying almost because I’m sure it happened once or twice. The world is a wide place and there is incompetence everywhere. Sometimes, fatal things happen, no matter how rarely) among many other presumptions implying that hospital is just as bad, ignoring literally every study on homebirth because all of them – yes, even the MANA joke – show that homebirth is far more dangerous. Because your “arguing for the sake of argument” rests of the false assumption that this specific type of negligent care is as common and deadly in hospital births as it is in homebirths. It isn’t and all the studies prove that

            There is a complication leading to death and there is a “complication leading to death” like the one you fantasied for us so you can say “what IF that happens in hospital” and then you go out and lie that it has happened. With the tiny detail that no one died.

            I’m using the studies to make up my mind. Caroline Lovell just illustrates the validity of those studies. You have the harder task. You must sidestep around her death and the studies to maintain the lie.

            You’re here to show us how smart you are and how safe homebirth is. Caroline Lovell and all studies on homebirth are terribly inconvenient, aren’t they? Because they show what happens in real life and not hypothesis you aim to build so painstakingly. And because they all point at death. Higher than comparable risk hospital birth deaths.

          • MJeano

            “literally every study on homebirth”

            Links? Are they peer-reviewed? Did they compare planned vs. unplanned home births? I would be curious to read them for myself.

          • Amazed
          • MJeano

            Thank you. I’ll refer to the studies based the order you posted them.

            1. Interestingly, this study found that when you differentiate the type of midwife that attended the birth by nurse-midwife or “other midwife,” outcomes for “planned home births that were attended by certified nurse-midwives did not differ significantly [from hospital births], except that infants who were born in a hospital were more likely to experience NICU admissions.”

            That actually supports my original point that I first made when commenting on this article: that homebirth itself is not necessarily to blame, but that the provider can be. Furthermore, “other midwife” does not tell us anything about the midwife’s credentials. Many of them may be CPMs, but that could also include lay midwives who don’t have any formal training or licensure. When midwives have adequate training, such as CNMs, this study actually shows that there is not a significant difference in outcomes.

            This article further points out that their overall findings of more adverse outcomes in home birth is not consistent with outcomes of home birth in England. Their proposed reason for the difference in the US brings up an extremely important point:

            “The liaison between home-birth providers and in-hospital physicians may not be as well-defined in the United States. Further, women who attempt home births that require transfer of care to hospitals can be ostracized as “failed home births,” which may lead to decreased willingness to seek consultation and potentially the loss of critical time when complications arise.”

            Dr. Tuteur and many of the people commenting on here (who you have suggested are doctors) illustrate that beautifully; when in-hospital providers are so biased against home birth and the midwives who attend those births, their view may actually CONTRIBUTE TO the adverse outcomes that sometimes occur in home birth, because it makes it harder for those women to get the care they need quickly should a complication arise. Dr. Tuteur commented earlier that in Caroline Lovell’s story, it was the philosophy of home birth that killed her. But the very article you are referencing suggests that the philosophy of doctors like Amy may be what is killing some. Home birth is not going to go away, but perhaps we can make it safer by improving collaboration and transfer of care between home birth midwives and hospital providers when it is needed. But the attitudes espoused by most on this blog certainly aren’t going to make that happen.

            2. This study does not differentiate between type of midwife. Had they differentiated between CNM and “other,” perhaps the results would have been similar to those of the first study.

            3. I already commented on this study.

            4. Comparing 5-min Apgars of 0 doesn’t really tell us much. It doesn’t tell us whether or not the baby died or was able to be successfully resuscitated without permanent damage, it doesn’t tell us which babies were already dead before labor began, doesn’t tell us anything about congenital abnormalities. Only looking at Apgars of 0 doesn’t separate outcomes that can actually be related to place of birth or attendant.

            Here are a couple studies that show that outcomes between hospital and home birth do not differ significantly:

            http://www.ncbi.nlm.nih.gov/pubmed/9271961

            http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2742137/

            Interestingly, the second study found that “Compared with women who planned a midwife-attended hospital birth, those who planned a home birth were less likely to have a newborn who had birth trauma (RR 0.26, 95% CI 0.11–0.58), required resuscitation at birth (RR 0.23, 95% CI 0.14–0.37) or required oxygen therapy beyond 24 hours (RR 0.37, 95% CI 0.24–0.59)”

            So to say that “literally every study” shows home birth is far more dangerous is a bit of an exaggeration.

            But I already posted the Oregon findings that mortality rates are higher in home birth, and we could go back and forth for days scrutinizing every study. So even if SOME studies suggest they are less safe, that would still bring us back at my main point: there are certain risks inherent in any birth setting that the mother must take into account when deciding where SHE wants to give birth.

          • Susan

            ” The point I was making is that if there is a complication due to provider negligence, whether it is at home or in the hospital, it is the provider, not the setting that is at fault.”
            That would be true if patients were fully informed of the risks of homebirth, the providers all steps to make it as safe as possible including telling high risk patients no, and the providers carried malpractice insurance. In the vast majority of homebirths not one of these criteria are met. If hospitals have systems that harm patients the setting is indeed liable just as the providers are. It is very different,

          • MJeano

            “In the vast majority of home births not one of these criteria are met”

            can you please provide peer reviewed studies that show that?

          • moto_librarian

            I’m guessing that you’re an example of why my primary CNM had a such a low regard for doulas in general. When I asked her about hiring one for my first delivery, she told me that the vast majority of the doulas in our large metropolitan area had a habit of interfering and making her job more difficult. There was exactly one who she felt comfortable with.

          • DelphiniumFalcon

            This baffles me as well.

            I mean, I just finished my CNA course and I’m studying for my state exam.

            I’m now trained to assist in CPR, feeding, bathing, toileting, observing changes, assisting with ambulation, pulse obliteration blood pressures, temperatures, respiratory rates, and so on. But as soon as something like medication, a fall, observable changes from the norm are present what am I supposed to do? Get the RN PDQ

            So how is someone that isn’t required to have and probably has less training than my nine week course with thirty supervised clinical hours supposed to make calls on if a patient in labor or her baby is dying or in distress?

          • MJeano

            I happen to know a CNM in MY large metropolitan area who always recommends that her clients get doulas because she says it makes her job easier. Guess everyone’s different. And again, that’s a bold assumption to assume I am an example of her low regard for doulas.

          • moto_librarian

            Because you have spewed every NCB talking point in the book! You have minimised the perinatal mortality rate of home birth, demonized c-sections, relief on outdated and inappropriate studies to support your beliefs, made outrageous claims, and proven to be impervious to facts. I don’t believe for one second that you keep your opinions to your self. Douglas routinely practice out of scope and interfere when a doctor or midwife recommends something for the health and safety of mother and baby since it interferes with “natural” birth.

          • Susan

            The term “tetanic” is old terminology but yes, that can happen. You are monitoring and if it does happen you turn the Pitocin down or off. If that doesn’t work there are other things that can be done too. Did the staff just let the “tetanic” contractions continue unabated or did they do something?

          • MJeano

            Yeah you’re right, there are things that competent providers can and usually do do, and fortunately that was the case in the situation I mentioned. But if the provider made an error due to negligence, then the situation could have ended up much worse. Just like in the case of Caroline Lovell – there were things that a competent provider could and should have done to prevent the outcome, but she made a huge error due to negligence that cost the mom her life

          • Karen in SC

            I had NATURAL tectanic contractions, btw. I was not aware that my baby was at risk of dying from them. If so, I would have demanded an immediate c-section.

        • Charybdis

          If she “trusted birth and her body” enough, she wouldn’t have had a stalled labor that required the pitocin. /sarcasm. I bet the hospital would have a continuous fetal monitor on the mother and if a tetanic contraction pattern started, I would thing an emergency or crash CS would be in order. Can’t do that at home.

          How long has she been in labor? Membranes ruptured? How’s the baby look on the monitoring equipment (snort…like they have that at home). How long has the labor been slowed/stalled? Is the pitocin an option to kickstart labor to avoid the “awful, terrible, no-good, life ruining” c-section?

          In a hospital situation, you have to get consent before giving medications like pitocin. CPM’s have been known to surreptitiously slip a pitocin injection to the mother and not say a thing.

    • Box of Salt

      MJeano,

      what allowed Caroline Lovell to die was a lack of resources – life saving resources.

      She chose to forgo those resources, by choosing to give birth at her home, instead of a location (the hospital) where those life saving
      resources are automatically in place.

      The fact that those who were supposed to be responsible for her care did not act appropriately when the emergency occurred does not change the fact that she, Caroline, had already chosen to limit the resources available to her.

      I remain sorry for the Lovell family’s loss.

    • MaeveClifford

      Here’s the difference. In a hospital birth, the team is *supposed* to adequately monitor the mother and baby. In a homebirth, most monitoring is seen as unnecessary intervention, and counter to the natural bonding process.

      Women chose homebirth because they don’t WANT to have cervix checks, leads, wires and blood pressure cuffs “tying them down” to beds, having their vitals taken constantly. They hire the kind of midwife Demanuele is BECAUSE she is so hands-off and so reluctant to transfer.

      Negligence is a feature, not a bug, in homebirth philosophy.

      • MJeano

        I don’t know of any home birth providers (I’m a doula) who would say monitoring is an unnecessary intervention. Any reasonably competent home birth midwife I’ve ever talked to has said that regular monitoring of baby’s heart rate and mom’s vital signs is absolutely a part of home birth. Otherwise, it wouldn’t be safe. If I heard a home birth midwife say that any type of monitoring was an unnecessary intervention I would run in the other direction.

        • Charybdis

          There is monitoring and then there is monitoring. And the chance that you are picking up the mother’s heartbeat instead of the baby’s is not an unknown situation. Also, the CPM’s tend to say things like “Strong heart tones” which really doesn’t mean a damn thing. How many bpm is it beating? What’s the mother’s blood pressure? How often are these things checked? Once upon arrival, I would wager and then how often afterwards? Every 15 minutes? Hourly? After a couple of hours? How do they check the mother’s oxygen saturation? DO they even think to check that? Do they know the proper way to check blood pressure or do they just strap on an OTC wrist cuff to check? Do they monitor the mother’s temperature? What if the mother won’t allow any of the above because she “trusts her body and trusts birth” and the specific reason she wanted a home birth is to avoid all these unnecessary monitorings and interventions?

          It seems as if the CPM’s doing home birth are more than willing to let the mother run the show and dictate what can and cannot be done, even if some things must be done for safety reasons. And some CPM’s are not adverse to “interventions”; they sneak the mother a pitocin shot, use vacuum extractors, give injections of sterile water for pain (wtf is that about) and carry oxygen tanks, although it is a crap shoot if the tank actually contains any oxygen.

          Monitoring is not done just to inconvenience the mother; it is done to keep abreast of the labor, how the baby is tolerating the trial of labor, how the mother is tolerating the labor, if any fever shows up, indicating the beginning of an infection, strength of contractions, how fast labor is progressing, is mom getting enough oxygen so that the baby is getting enough oxygen, a myriad of information that is needed to keep everybody safe. Many mothers see it as “an inconvenience”, a breach of their bodily autonomy, “a threat to MY childbirth experience”, and possibly “a pain in my ass that is not to be condoned, encouraged, or performed in my presence or on/to my person.”

          • MJeano

            Based on your questions, I wonder how much you actually know about home birth and how much you’ve gotten from this site? Doppler heart monitors DO measure beats per minute. The heart rate is measured before, during and after a contraction, and the midwife is looking to see whether the heart rate lowers during a cxn and if it does, how quickly does it come back up? This happens at regular intervals in the course of an hour (of course if baby is showing signs of distress, it should be monitored more closely). How do you know that CPMs say things like “strong heart tones?” How do you know that “strong” doesn’t refer to an absence of late decels during a contraction, rather than the actual quality of the beat itself? Yes, they would check blood pressure regularly. Yes, they check her temperature. And why are you assuming they are using an OTC wrist cuff and don’t know the proper way? Why do you assume the oxygen tanks wouldn’t contain oxygen? Can you provide me with scientific studies studies that support your doubts?

            As for sterile water injections, there have been studies showing they reduce pain, and I have heard anecdotally that they are quite effective (one mom said her doctor told her about it, so it’s not just a “hippie midwife” thing). And the pitocin shot you mention – an injection of pitocin can be life-saving in the event the mother starts to hemorrhage. You want to criticize home birth midwives for being dangerous, but then criticize the fact that they HAVE life-saving measures with them in the event of an emergency?

          • swbarnes2

            Checking oxygen tanks, checking blood pressure, checking fetal heartbeat, checking temperature…that sound an awful lot like “medicalization” of a totally natural process that will go fine if you just “trust birth”. Empirically, I don’t see that midwives or their clients want their homebirth to look like that.

          • Charybdis

            Well, for one, let me say I’m in the US so home birth is not an option here with real, medically trained CNM’s (Certified Nurse Midwives who were RN’s first and then get specialized training for the CNM credential. Similar to Nurse Practitioners) and the “home birthing crowd” use CPM’s (Certified Professional Midwife, which is a made-up credential and just recently strengthened their requirements to require a High School Diploma) who have little to no actual medial training. So yes, they don’t know their asses from their elbows about how to actually assess and manage an emergent situation and they are also so entrenched in the “trust birth, vaginal birth at all cost, no medications, no pain relief in labor other than getting in the birth pool and changing position” mindset that they do a great deal of harm.

            I know enough about birth and the process, but I am not a “birth worker” or “birth enthusiast” or whatever. And the incidents I was referring to can be found on sites like Hurt by Homebirth and Banned From Birth Pages, written by the women themselves about their abysmal home birth experiences and the way they were treated by the homebirth midwives.

            I am sure that the CNM’s and the midwives of other countries (where they are RN with specialized training in birth equivalents) DO know how to start an IV, place a heplock, monitor properly, note and chart properly, administer medications, take blood pressure using a stethoscope and sphygmomanometer, use an O2 monitor, etc and do so in midwife led birth centers attached to a hospital or birth wing. And they probably have a travel kit for home births. They also *probably* risk out appropriately and refer women with certain risk factors to an OB. CPM’s counsel their clients to forego gestational diabetes testing, routine ultrasounds and claim that garlic in your vagina or douching with Hibiclens is a perfectly fine way for dealing with mother who is Strep B positive.

            This is the disconnect when speaking about home birth in the US as opposed to the rest of the world. “Midwife” here has a completely different connotation than it does elsewhere and those here that are CNM’s are more in line with what the midwives in other countries are. With one HUGE distinction: CNM’s do NOT attend home births. CPM’s do. And are woefully unprepared for the task.

            That being said, I would never opt for a home birth, even if it was an option here. Nor would I use a midwife for my pregnancy care, even if they were a CNM and required delivery in birth center or hospital. Why? Because the NCB woo is creeping into the CNM ranks and that kind of BS is not acceptable.

          • swbarnes2

            I don’t think it’s true that CNMs don’t do home births. (It’s old, but this is the first citation that popped up http://www.ncbi.nlm.nih.gov/pubmed/8568573 ) They don’t do the majority of them; CPMs do. But it is a fringe choice that only a small % of CNMs do, 95% of CNMs work in hospitals, a few more in different birth centers.

          • The Bofa on the Sofa

            There are CNMs that do home birth. However, they are also typically untrustworthy whackadoodles, and consequently are no better than cpms.

            They are ideologues, like the evil wench who killed Ms. Lovell.

          • MJeano

            All I’m going to say is, CNMs CAN and DO do home births in the US. Not sure where you got the notion they don’t but it’s not true. Yes, the majority of them work in a hospital but it’s false to say they can’t do home births.

            I don’t doubt there are incidents that you’ve read about online. But I also know there are websites out there with women traumatized from treatment at a hospital birth. I think there is room to be in the middle. It sounds like you see anyone who supports natural birth as supporting it “at all costs” and unable to see their ass from their elbows. And perhaps some people on the NCB side see all OBs as evil and any intervention as evil. Both of those views are extreme. I personally try to look at scientific evidence.

          • swbarnes2

            But how many of the traumatized women in hospitals got to go home with a live, healthy baby? Homebirth traumas usually don’t end like that. When mother or baby dies in the hospital, it’s usually despite a heroic effort on the part of a team of medical staff who just got unlucky. With homebirth, it’s usually because the midwife has no clue what was happening and thought everything was fine until oops, “well, not all babies are meant to live” and “well, she had the wonderful homebirth she wanted”.

          • Charybdis

            As do I, and home birth IS riskier than hospital birth. Vaginal vs. CS is a judgement call. They both have risks; it just depends on how you want to assign that risk. One is not better than the other, or more virtuous or more fulfilling or whatever. If a woman is informed of the risks of both types of delivery, truly informed and not mislead or outright lied to, then she can make whatever choice she wants/feels good about making.

            I don’t mind if someone wants a “natural birth”: vaginal, no medication, etc. I don’t care if they want Demerol (or whatever narcotic is used these days) until they hit 3 cm dilated and then get an epidural or if they want an epidural right off the bat. I don’t care if they want a maternal request c-section or if they want to be induced. CNM-led birthing unit/center, OB staffed hospital, or CNM home birth, whatever they wish, as long as it is informed consent. Personally, I went the scheduled CS, hospital route, but I wasn’t opposed to a hospital, epidural-ed vaginal birth. That was not to be, but I didn’t care.

            I personally think the homebirth option is barking mad and don’t understand how anyone would want/prefer one, but I don’t have to. I was not forced to have a midwife attend me for my pregnancy, nor was I forced to have a homebirth (and by forced I mean “this is the option my insurance allows, any deviation from this *delightful* option will either a) not be covered and not an option or b) be strictly out of pocket). I can dislike their choice and keep it to myself as it was not my choice to make and they did not ask for my input.

            Do I think homebirth is the best way forward for labor and delivery? No. Is it a Pyrrhic victory for the NCB group? Probably, just like the BFHI. Clean up the midwife profession in the US (CNM’s only, no CPM’s, birth junkies, or unlicensed/uncredentialed “birth attendants” and things might change overall.

            Homebirth IS more dangerous than hospital birth. And will remain so until a lot of things change,

          • It always will be more dangerous to birth outside of a hospital than in one, though the degree of danger changes if we follow your suggestions (CNMs only, strict risking-out criteria, etc). Sometimes things will just go horribly wrong, no matter how low-risk the pregnancy, and being in a hospital is just safer for those situations.

            Other than that caveat, I agree with what you’re saying. I just take issue with your final sentence, because it will always be safer to give birth in a hospital than at home. Always.

          • Charybdis

            I completely agree that the hospital is now, and will always be the safest place to give birth. I only added the “unless a lot of things change” bit because I still have a tattered shred of hope in fairness, justice and humanity and things *could*get better.

            I’m only 99.1% jaded these days.

          • Daleth

            CNMs CAN and DO do home births in the US.

            But they almost never do. And remember, Caroline Lovell’s midwife was educationally the equivalent of a US CNM. In other words credentials and education can only make a laboring mama safer if the midwife’s philosophy of birth is more on the normal/healthy end (“it can be beautiful but can also be incredibly dangerous so I have to watch out for complications, risk out high-risk patients, err on the side of caution” etc.) and not on the woo end.

          • Susan

            If you are working with someone who thinks they can “hear” a subtle late decel you are working with a fool

          • MJeano

            You’re right, they would be a fool if they said that, because a limitation of intermittent auscultation is that you can’t detect subtle late decels. Instead, the number of beats is recorded for each of 12 5-second periods during a minute following a contraction, and this can be charted to look at patterns.

            Despite this limitation, studies have shown that there is no significant difference in neonatal outcomes (with the exception of neonatal seizures, which is already a very rate outcome) between intermittent auscultation and continuous electronic monitoring; however, there is nearly double the risk of a Cesarean with continuous EFM compared to IA.

            Since no one here seems to believe a word I say, look at the information for yourself:

            https://www.rcm.org.uk/sites/default/files/Intermittent%20Auscultation%20(IA)_0.pdf

            http://evidencebasedbirth.com/evidence-based-fetal-monitoring/

            http://www.collegeofmidwives.org/collegeofmidwives.org/prac_issues01/ia99bb.htm

          • Who?

            Your choice of words is interesting-‘no significant difference’; ‘already very rare’; ‘the risk of cs’.

            What you’re advocating is accepting a very small increased risk to the baby, in return for avoiding the small risk to the mother of cs.

            Which is fine, so long as the mother understands that’s what you’re saying. As I read it, and considering your other comments, you understate the risk to the baby, and stress the risk to the mother.

            Many women would weigh those risks and choose to take the risk on themselves, particularly if they want (say) a maximum of four children.

          • MJeano

            My choice of words like “no significant difference” reflects how scientific research is conducted. If you see a difference, it could be due to random chance, so you need statistical calculations to help determine whether or not that difference is “significant,” or due to random chance.

            When we’re talking about relative risks (i.e. risk to baby vs. risk to mother), one would need to consider the absolute risks of each. Also, I am not necessarily stressing risks to the mother over the baby, because there are increased risks to the baby, too, with a CS (e.g. respiratory distress). And I totally agree that women should understand the risks and be able to make the choice for themselves. Unfortunately, while the risks of a CS are pretty much always spelled out (at least in my experiences), I haven’t ever seen a mom given the choice to have IA instead of EFM in a hospital, or had those risks explained to her. Of course, my experience isn’t demonstrative of all hospitals and all providers, so if someone here has experienced otherwise please share! (and I’d like to know which hospital it is, because I think it’s great to make sure women are as informed as possible)

          • Amazed

            “And I totally agree that women should understand the risks and be able to make the choice for themselves”

            You can start with understanding the risks yourself. Given what you gave shown this far, you’re appallingly misinformed for a doula, aka someone who thinks she’s educated and presents herself as educated. Just FYI, purely elective c-section is SAFEST for the baby. Safest. So you can stop spreading the untruth that a brief short-term respiratory distress is somehow worse than a cord accident or shoulder dystocia leading to permanent damages, or cerbral palsy or Erbs palsy that are pretty much longlife.

          • Daleth

            Just FYI, purely elective c-section is SAFEST for the baby.

            Yes indeed. Here is a published, peer-reviewed study–one of many but this abstract is very thorough so it’s the one I chose–to back that up:

            “Cesarean section on request at 39 weeks: impact on shoulder dystocia, fetal trauma, neonatal encephalopathy, and intrauterine fetal demise.”
            Semin Perinatol. 2006 Oct;30(5):276-87.
            http://www.ncbi.nlm.nih.gov/pubmed/17011400

            Summary:

            “The purpose of this analysis was to determine the impact on specific forms of neonatal morbidity and mortality by allowing women to opt for delivery by elective cesarean section at 39 weeks of gestation….

            Overall, the frequency of significant fetal injury is
            significantly greater with vaginal delivery, especially operative vaginal delivery, than with cesarean section for the nonlaboring woman at 39 weeks EGA or near term when early labor has been established.

            infants born to nonlaboring women delivered by cesarean section had an 83% reduction in the occurrence of moderate or severe encephalopathy. Considering a prevalence of moderate or severe neonatal encephalopathy of 0.38% and applying it to the 3 million deliveries occurring
            at >or=39 weeks EGA in the United States
            annually, 11,400 cases of moderate to severe encephalopathy would occur. The rate of encephalopathy observed in infants delivered by cesarean section would yield approximately 1938 cases. This net difference in moderate to severe
            encephalopathy would represent 9462 cases annually in the United States that could be prevented with elective cesarean section.

            And that’s just the part on encephalopathy. It also looks at brachial plexus palsy and other trauma to the newborn.

          • MJeano

            C-section is SAFEST? So we should just give all women a planned CS in that case? You are going to have a LOT of work ahead of you if you are going to try to convince health professionals, hospitals, and even most OBs that that’s the route we should go. For that matter, why don’t we just go back to what was done in the 50s, with women put under general, strapped down, and babies pulled out with forceps? Wouldn’t have to worry about giving women “options” or caring about their “feelings.”

            The “real studies” you ask for are listed on that site. Go check them out if you are in doubt. And no, a cardiac nurse probably isn’t the best judge on obstetrics, but a nurse researcher with a PhD probably is a pretty good person to synthesize scientific studies. But sounds like you are more qualified, so by all means, go through the studies and tell me all the ways she is wrong.

            And “informing her what an evil thing a c-section is”? You do realize how naive that makes you sound in terms of a doula’s role? Maybe there are doulas out there who would do that, just as there are midwives out there who would underestimate the risks of home birth and OBs who would underestimate the risks of certain interventions, but any doula who preaches about the evils of CS is not a good doula in my book, and any doula I know would not do that. And I don’t think they aren’t acquainted with much of the information I have; believe it or not, pregnant women are extremely capable of finding information on things they want to know more about! I could tell you how I reassured a mom recently before she went in for a C-section, but that’s just an anecdote and doesn’t count anyways.

            BTW, you do realize that the story of Caroline Lovell is a second-hand anecdote? Yet you use that to preach the evils of home birth, don’t you?

          • Amazed

            Yes, SAFEST for the baby. Sorry, MJeano, but if you live in the world of absolutes, the rest of us live in real world where we have to take many things into account, so the fact that it’s SAFEST for the baby isn’t the only thing women take into consideration. There are things like maternal health, the size of the family the mother is planning… all of which doesn’t change the fact that totally elective, unindicated c-section is SAFEST for the baby.

            You do realize the dfference between a coroner’s publicly posted words and the claims of someone like you about something she heard? Or do you think yourself equal to a coroner now?

            I don’t care how naive I look in the eyes of someone as uneducated as you. The fact that you’re a doula terrifies me. As a doula, you shoud know to defer to Dr Amos Grunebaum on the matter of all things obstetric but you don’t, do you, MJeano? Why is that? Perhaps because he conducts studies saying what you desperately don’t want to be true?

          • momofone

            Why would a doula be giving his/her opinion about any medical issue in the first place?

          • MJeano

            You’re not my client. I can have opinions, but that doesn’t mean I share them all with my clients.

          • momofone

            “but any doula who preaches about the evils of CS is not a good doula in my book”

            So what medical issues would it be ok for a doula to preach about? The “to a client” seems implied here.

          • Bombshellrisa

            No doubt pitocin and how evil it is and how it can harm breastfeeding is covered.

          • Amazed

            Only those who intend to have a c-section, I suppose? And intend to let evil doctors give them evil pitocin because tetanic contractions?

          • MJeano

            First of all, I guess I need to explain the tetanic contraction example again since you don’t seem to have gotten that point the first time. Since my “secondhand anecdote” doesn’t seem to be enough, here is a quote taken from the FDA label information for Pitocin:

            “Maternal deaths due to hypertensive episodes, subarachnoid hemorrhage, rupture of the uterus, and fetal deaths due to various causes have been reported associated with the use of parenteral oxytocic drugs for induction of labor or for augmentation in the first and second stages of labor.”

            Dr. Amy used the story of an extremely rare complication to argue that the home birth philosophy killed her, reasoning that because that would only happen at home, it’s home birth philosophy that killed her. To challenge that logic, I gave an example of an extremely rare complication that would only happen in the hospital, and asked whether, by the same logic, that means that hospital philosophy is to blame. You can keep attacking me for that example if you want, but it really just distracts from actually talking about the logic in Dr. Amy’s argument.

            Second, there seems to be a huge misunderstanding about my views on C-sections, given that I have been accused multiple times of preaching about “the evils of Cesareans.” So let me say it more clearly:

            C-sections save lives, and the doctors who perform them save lives.

            But is childbirth so incredibly dangerous that a THIRD of all deliveries require a life-saving procedure? No, absolutely not. Looking at the CS rates and health outcomes of countries around the world, beyond a 19% CS rate, there are no additional benefits for maternal and infant health. So yes, a nearly 33% CS rate is too high. You can disagree with me, but you would also be disagreeing with the ACOG and the Society for Maternal-Fetal Medicine, among many other groups who argue that the rate in the US is too high.

          • Bombshellrisa

            The US has older, sicker women giving birth. We also have more ethnic diversity and a huge gap in access to healthcare. No matter what you may have seen, it’s not going to click with you until you are an older, poor woman of color trying to get care during pregnancy. I think you mean well, but you are coming off as white, privileged and incredibly whiny.

          • MJeano

            Yes, the US does have an appalling and unacceptable gap in access to healthcare and maternal health outcomes, and women are giving birth at older ages. But while it is tempting to attribute the high CS rate to having older, sicker, poorer women, the CS rate is still just as high for white women (above 30%), and even though women considered to be “advanced maternal age” do have even higher CS rates, the rate for women age 20-34 is still above 30%.

          • Bombshellrisa

            The population of women giving birth isn’t limited to young, white women. And please don’t put quotes around advanced maternal age like it’s title made up by OBs to insult women who give birth past their twenties.

          • Roadstergal

            “So we should just give all women a planned CS in that case?”

            You do live in a world wholly devoid of nuance, don’t you? The safety of C/S is one datum among many a woman can use to choose her preferred approach to childbirth. Unless she’s lied to by the NCB folk.

            We say ‘don’t lie to women about the risks of C/S, let them make an informed choice,’ and you say “OMG you’re saying all women should have a C/S!”

            I guess it’s telling. The fact that you’re giving medical advice at all to your ‘clients,’ as a doula, is a bit horrifying.

          • MJeano

            Yes, THANK YOU. Someone is finally agreeing with my main point.

            My main point in the post above is that there IS nuance. Yet everything I’ve been saying has been reduced to “what’s a few dead babies” – would you consider THAT nuance? What I’ve been saying over and over is that there are certain risks to every approach, and those risks must be weighed. What you just said is exactly in line with my point – “The safety of C/S [or insert other option here] is one datum among many a WOMAN can use to choose HER preferred approach to childbirth.”

            And no, not everyone in support of NCB lies. If you say they do, then that right there is being wholly devoid of nuance. For those of you who are going to say that I am just backpedaling: please, I implore you to re-read my post above. Really read it. If you take a minute to understand what I am saying, not just what you *assume* I am saying, you will see that this is the exact point I was making there – childbirth is not devoid of risks, no matter where it takes place, and women need to have choices for what’s best for THEM.

            We could go on for days debating the exact risk for each situation a woman could possibly encounter in childbirth, but now that you finally agree with my main argument, I don’t see the point. I’m glad we can finally agree on this so that I can rest my case.

          • swbarnes2

            Sigh. But all the things you’ve cited to support your claims about the risks of things have been shown to NOT demonstrate what you claim they do. Every paper you cited that failed to distinguish between emergency c-sections and planned ones can NOT honestly be used to claim that planned c-sections are unsafe. You can’t say “I only want people to understand what the risks are” and then mislead about what the risks really are by citing irrelevant papers.

          • Who?

            Caroline Lovell’s death was followed by a police investigation and a coroner’s inquest, the findings of which have just been published. How is an inquest a ‘second hand anecdote’?

            http://www.coronerscourt.vic.gov.au/resources/fe2e0207-dd5a-4558-aade-07e41c368ab9/carolineemilylovell_029312.pdf

          • Who?

            Is increased incidence of respiratory distress in the baby at least sometimes related to the cs being necessary because the baby is already unwell-so it isn’t an increased risk, it is an increased incidence due to the risk that made the cs advisable?

            And don’t people put requests about monitoring in their birth plans? So if you ask for less frequent monitoring, that’s what you get

          • MJeano

            Well, yes, if the baby is already in distress than that would more likely be the reason. But the stats I was just looking at (presented by the ACOG) are for planned CS before labor has begun. One reason is that when the baby is born vaginally, much of the fluid in their lungs is squeezed out of them as they pass through the birth canal, but with a CS they don’t get that squeeze before they are out.

            http://www.acog.org/Resources_And_Publications/Obstetric_Care_Consensus_Series/Safe_Prevention_of_the_Primary_Cesarean_Delivery

            Yes, some people do put requests about monitoring. However, there is a difference between IA and intermittent EFM. The study from the article I posted actually found that intermittent EFM was no better than continuous EFM.

          • Amazed

            You realize that this is an article specifically aimed at the PREVENTION of primary c-section, not a comparison between long-term effects, do you? No one ever denied that a c-section is slightly riskier for the mother. And you seem so focused on the respiratory morbidity which is TEMPORARY without looking at all at shoulder dystocia which sometimes leads to cerebral of Erbs palsy which are lifelong.

            Let me spell it out for you: the difference in temporary respiratiry morbidity between c-section and vaginal birth is between 1 and 4%, for pregnancies that aren’t divided between purely elective and medically needed c-section. The difference in very permanent newborn death between homebirth and comparable risk hospital births is a few HUNDRED percent. The difference in HIE is 18 TIMES.

            But come on, keep harping on them evil c-sections. Why not?

          • MJeano

            You may want to check your math: 1-4% respiratory morbidity in CS is not 1-4% higher – it is potentially over 4 hundred percent higher (since the rate in VD is listed as <1%, we don't know exactly; e.g. if it is .5%, the rate would be 2-8 100 percent higher). And the difference in death is not a "few" hundred percent – it is 100% percent. I'm not denying that mortality is more permanent than respiratory distress, but please, get your math right.

            Also, it's funny how you point out that shoulder dystocia can sometimes lead to lifelong CP, but dismiss respiratory distress as just temporary. It is the lack of oxygen and subsequent brain damage, which is SOMETIMES associated with shoulder distocia (though there are ways to get the baby unstuck quickly w/out a CS), that can lead to CP; lack of oxygen is pretty much always associated with respiratory distress, so by your logic, respiratory distress can also lead to lifelong problems

          • Amazed

            You’re right, of course. That’s what one gets when posting in haste right before going to sleep. So, a few times higher mortality rate against a temporary respiratory morbidity rate that the very authors just note without thinking it this big of a deal since in their text they state, “However, for most pregnancies, which are low-risk, cesarean delivery
            appears to pose greater risk of maternal morbidity and mortality than
            vaginal delivery” without mentioning the baby. That’s your invention.

            You compare respiratory distress when the team works like mad to get this suffocating baby out so they can intubate and take measures to short respiratory distress that is being managed since the moment it happens? Dead God.

          • swbarnes2

            That ACOG thing isn’t limited to planned c-sections. Did you even read it? The Canadian study cited in it says that the difference in deaths between planned C-sections and vaginal delivery was nonsignificant. Their first two suggestions for reducing the primary C-section rate; more ECV, and TOLs for twins if the first is positioned correctly. Neither of which should be done outside of a hospital, so how does that support your desire for more homebirths?

          • moto_librarian

            And yet my unmedicated, vaginally born first child spent two days in the NICU for TTN! You do know that babies born at early term are generally more prone to TTN, right? It’s not just a complication of c-section.

          • MJeano

            Never said they weren’t more prone, and never said there are never complications from vaginal delivery. There is at least one commenter on here who has suggested that prelabor planned CS is safest for babies, yet any time you are planning a CS, there is a risk of accidental late preterm birth, and those babies are more at risk for certain problems like TTN. Yes, you can have preterm or early term birth even when you go into labor on your own, but when you start planning CS before the baby initiates labor on his own, there is a risk you could be taking him out before he’s ready. Sometimes that risk is outweighed by the risk of keeping the baby in, but it’s something to consider with planned CS.

          • BeatriceC

            Once again you show you clearly have no idea what you’re talking about. Statistical significance is a thing, of course, but trying to use big words you don’t understand doesn’t make you appear smart. Instead it makes you look like you’re grasping at straws to those of us who actually do understand what those words and concepts mean. The difference in mortality and morbidity for both maternal and fetal/neonatal outcomes between hospital and out of hospital birth is unquestionable. There’s a clear (and very large) statistical significance in every single proper study ever conducted in the US (in other countries where the educational requirements for midwives is higher, the difference is still significant, though smaller). In order to construct a hypothesis test to even begin to shed doubt on that, one would have to set an alpha error so high and beta error so low that even the fact that the earth is round would be called into question.

          • MJeano

            So I use a term that indicates I do have a shred of knowledge about scientific research, and you chalk it up to “appearing smart”? Give me a break. Can you provide links to “every single proper study” you mention? I’m still waiting for someone to post a study demonstrating differences in maternal mortality. The reason that’s so hard to find is that the incidence of maternal mortality is so low, in both hospital and home birth, that it is hard to get population sizes with enough power to evaluate the differences. Though in one article, Dr. Tuteur ignores the statistics and says that because one mom died in a home birth in a large study, and none died at the hospital, that it shows home birth is more dangerous. But since you know what you’re talking about, I shouldn’t need to explain why that is a problematic conclusion to draw. (BTW, I found a large study that found not a single maternal death in over 16k home births, but there was one death at the hospital. However, that doesn’t show that hospital birth is more dangerous than home birth.)

          • Amazed

            Please don’t guys. Whenever someone points at a study showing what MJeano doesn’t want to hear, she ignores it. Don’t waste your time. She’ll just start talking about respiratory distress from a long shoulder dystocia as being the same as respiratory distress from a planned, purely elective c-section.

          • Daleth

            MJeano, I’d be interested to hear your take on the peer-reviewed study I posted below (here’s the link, or you can just scroll to my post to see the link and an excerpt from the study):

            http://www.ncbi.nlm.nih.gov/pubmed/17011400

          • The Computer Ate My Nym

            You do realize that none of your links are to primary research, right? if you’re going to claim that the differences is not significant, statistically or clinically, you’re going to have to point to the original data that shows a lack of significant difference and use it to justify your claim. What p-value are you using to determine significance? What test was used to determine that p-value? Was it the appropriate test for the situation? Do you realize that you’ve stepped into a nest of vipers, physicians, and epidemiologists here?

          • MJeano

            Yes, the links were for secondary sources, but they include references to the primary studies. If you would like to look at certain ones and double check the stats, by all means, be my guest.

          • Daleth

            How many midwives are even doing IA in a safe and useful way? Here’s an interesting study published last year:

            “It was observed that deliveries of many unexpectedly asphyxiated infants occurred despite rigorously performed and documented IA compliant with the guidelines. This triggered a reappraisal of the robustness of IA leading to this focused review supplemented by two anonymized cases. It concludes that the current methodology of IA may be flawed in that it poses a risk of missing many or most late (pathological) FHR decelerations, one of the foremost goals of IA. This is because many late decelerations reach their nadir before the end of the contraction.”

            https://www.ncbi.nlm.nih.gov/pubmed/26566404

          • MJeano

            That was interesting to read, thank you for posting. I had actually come across something from a few years earlier also suggesting that the guidelines be revised such that IA be done for 60s before and after each of 3 cxns every 30 min. (http://www.ncbi.nlm.nih.gov/pubmed/20701496).

            However, despite those two cases, the article still points out that large RTCs have confirmed that IA is as safe as CTG and reduces CS:

            “The National Institute for Health and Clinical Excellence, UK (NICE, 2014) strongly recommends IA for up to 45% of all labors because it has been shown to reduce the operative intervention and is generally regarded to be safe for the babies [1].”…”A systematic review of randomized controlled trials (RCTs) reported that IA is as good as continuous CTG in the low risk labors [7]”

            So when looking at controlled trials (the “gold standard” for research), IA has been found to be on par with EFM in terms of safety for babies (and better in terms of reducing operative delivery). If IA can be improved to prevent any asphyxia as with the amended guidelines I mentioned, then that is something that we should work to change, but 2 anecdotes don’t override multiple RCTs.

            Also interesting to note the article said that “The birth attendants are expected to rigorously adhere to these guidelines and indeed do so,” contradicting what some other commenters have suggested about midwives not monitoring at all or not monitoring correctly because that would be “an intervention”

          • Daleth

            You are wrong that there is “no significant difference in neonatal outcomes.” An analysis of studies covering over 18,000 women in labor–of whom about half got IA and the other half CEFM–found that “electronic fetal monitoring is associated with increased rates of surgical intervention and decreased perinatal mortality due to fetal hypoxia.” Specifically, if you look at the numbers, the babies whose moms had CEFM had almost 60% lower rates of babies who died of hypoxia than the ones whose moms got IA.

            http://journals.lww.com/greenjournal/Abstract/1995/01000/Intrapartum_Electronic_Fetal_Heart_Rate_Monitoring.31.aspx

            Which is kind of the point of CEFM, right?!

            And this other meta-analysis found that there was, as you said, a 49% reduction in the risk of neonatal seizures:
            http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD000063/abstract

            Pointing out that neonatal seizures are rare is like saying babies dying at birth is rare. Yes, that’s true. Is that any consolation to the parents whose babies do die or have seizures (which are an indicator of brain damage)? Are you really willing to let “just a few” babies die or suffer brain damage in order to spare mom the discomfort of a little belt around her belly during labor? Very few mothers would say, when given the choice of “do you want a c-section or a dead or brain damaged baby,” that they’d rather have a dead or brain damaged baby.

          • MJeano

            And when you say “there is monitoring and then there is monitoring” are you referring to intermittent vs. continuous? Because if you had read the evidence you would know that it’s been found that there is no difference in neonatal deaths or cerebral palsy between the two, but continuous monitoring leads to a significantly higher rate of Cesarean (which in itself carries its own risks)

          • Chi

            So I’m guessing you’re one of those people who believes that Cesareans are bad, the C-section rate is too high etc etc etc?

            What is, in your opinion the ‘ideal’ c-section rate? Please do keep in mind that the WHO have admitted that they pulled their number for that very stat out of their proverbial anuses.

            What in your opinion determines an unnecessary c-section?

            Can you look at mothers and babies who had emergency c-sections after the fact and tell us without any shred of doubt that their c-section was unnecessary??

            Unless you’re an obstetrician, chances are you probably can’t.

            C-sections save lives. That is a fact.

          • Charybdis

            Yep, continuous versus intermittent. Continuous gives a much better picture of the overall situation because it is, well, CONTINUOUS and not a stop-motion film of single, intermittent data points.

            There certainly are risks to CS, but there are risks to vaginal delivery as well. The NCB/woo/CPM brigade seems to completely IGNORE the fact that there can be tearing, cervical and vaginal lacerations and pelvic floor damage, all of which continue to be problematic long after the healing period from a CS. And yes, I am aware that just being pregnant can affect the pelvic floor, but the real damage seems to come with the vaginal delivery.

          • moto_librarian

            But we have seen a reduction in HIE and neonatal seizures as a result of EFM! The other thing is that HB midwives rely on doppler for monitoring, not the more sophisticated monitoring belts used in hospitals. It’s far more difficult to detect late decels and variability when using a doppler.

    • Daleth

      can’t we assume that had the midwife assessed her properly and gotten her to the hospital sooner, her life could have been saved? In this case, it was the provider’s failure to accurately asses and treat her quickly enough, not the fact that she was at home.

      No, for two reasons.

      First, in a hospital birth–at least in the US, I can’t speak for other parts of the world–a woman who has just given birth is on electronic monitors that continuously display her blood pressure, breathing rate and heart rate on screens that are visible not only in her room, but at the nurses’ station out in the hall. It is not POSSIBLE to fail to notice that she’s bleeding to death, because her blood pressure will plummet as she hemorrhages and the electronic monitors will sound an alarm.

      That’s part of the reason I’m alive today. After having my twins I had an INTERNAL hemorrhage–only minimal external bleeding; it didn’t look abnormal from the outside. The monitors sounded their alarm and a team of three people came literally RUNNING into my room to save me. They were running because a bad postpartum hemorrhage can kill you in less than ten minutes.

      And second, on top of the fact you can be dead less than ten minutes after the hemorrhage starts, the ONLY way to save your life is to administer IV fluids immediately. Like any hemorrhage that’s bad enough, mine sent me into hypovolemic shock. That is ALWAYS FATAL unless immediately treated with IV fluids. Because I gave birth in the hospital, I was asked if I would consent, before birth, to a heplock (the placement of an IV port in my hand in case they needed to administer fluids, drugs or a blood transfusion). I consented because I know what heplocks are for–they can save your life; if you hemorrhage your veins deflate and it can become difficult or impossible to get an IV into them, so without the heplock you can die even in a hospital.

      Home-birth and birthing center midwives don’t offer heplocks and unless they’re CNMs, which the overwhelming majority of US home birth midwives are not, they don’t even know how to place them. Indeed, people who are deep in the natural childbirth woo often actively discourage women who are giving birth in the hospital from consenting to heplocks, because a heplock is an “intervention” and therefore, in their opinion, is automatically A Bad Thing.

      That “Bad Thing” saved my life. I’m alive, my boys are not motherless, and my husband is not a widower, because I gave birth in the hospital and consented to a heplock.

      • demodocus

        and even professionals can’t always get the vein the first time. My assigned L&D nurse stuck me 3 times unsuccessfully and ended up calling her colleague to help.

    • MaineJen

      If she had been at the hospital, she would not have died because she would not have been sitting in a feces-and-blood-filled pool for an hour, and someone would have noticed that she was losing liters and liters of blood. So yes, I would say the fact that she was at home is what killed her, without a doubt.

      • MJeano

        If she had had a competent provider at home, they would have noticed she was losing liters of blood and she would not have died. Yes, perhaps it is more likely that providers would have noticed at the hospital, but had she had a competent provider at home this problem could have been remedied, at least according to the information presented (can any of us really know since we weren’t there and don’t have access to her medical records??). I think perhaps the issue is that there needs to be more regulation of home birth providers; the simple fact that she was at home in this case wasn’t the reason she died.

        • momofone

          I’m curious–how would this have been remedied at home?

          • Roadstergal

            *crickets*

    • The Computer Ate My Nym

      If a hospital based provider failed to check on a woman who had just given birth for hours, ignored the copious amounts of blood around her, and blown her off when she said, “I’m dying”, there would be multiple parties investigating the event. The husband would not be able to get back into his house because it would be surrounded by salivating malpractice lawyers. The hospital would be trying to figure out what they had to do to ensure that this NEVER happened again and how much they were going to pay out. They would never even consider fighting the lawsuit when they were so obviously at fault. New protocols would be in place. The L and D ward would likely be closed until they were. The OB or midwife who did it might as well just give up and become a used car salesperson because they’re never working medicine again. This would be a “fall on your sword” situation for the doctor, the hospital, and probably a fair number of ancillary staff.

      So, what’s the homebirth community doing to improve safety and make sure that such a thing never happens again?

    • Wombat

      It’s both.

      If this mother had been closer/sooner to the hospital, she might’ve had a chance. Closer is homebirth’s fault, sooner is both the midwife and homebirth’s fault.

      If this same situation of provider ignorance or uncaring happened in the hospital (barring the fact that it’s incredibly less likely due to actual education and a team enviroment), there would be tons of other doctors available for hubby/wife to easily seek out, and eventually alarms to show the initially wrong doctor that they were initially wrong. Then once they changed their mind (as this midwife did by finally calling EMS) she would be right there much more ready to be possibly saved.

      The hospital doctor in that case would absolutely still be negligent (and would be treated as such, not borderline supported because other doctors fear for their sham of a proffession) but hospital birth would be there as what it is: a safety net.

      So yes, negligent, incompetent midwife. No safety net was the seal on the deal, though.

    • MJeano

      Okay, I think it’s time to take a step back and look at the big picture. This could go on for days.

      There was a large, recent study published looking at out of hospital vs. hospital births in the state of Oregon. This study found that fetal death for planned out-of-hospital birth was twice that for planned hospital births:

      “After hospital transfers were reclassified as belonging to the planned out-of-hospital birth category, the rate of fetal death was higher (though not quite reaching the level of significance) among out-of-hospital births than among in-hospital births (2.4 vs. 1.2 deaths per 1000 deliveries, P=0.05). Similarly, rates of perinatal and neonatal death…were higher in the case of planned out-of-hospital births than in the case of planned in-hospital births after reclassification (perinatal death, 3.9 vs. 1.8 deaths per 1000 deliveries, P=0.003; neonatal death, 1.6 vs. 0.6 deaths per 1000 deliveries, P=0.02).”

      http://www.nejm.org/doi/full/10.1056/NEJMsa1501738#t=articleResults

      So yes, according to this study, home birth is riskier for babies. There, I said it. **gasp!** I’m actually surprised no one mentioned this sooner, since it was published 3 months ago, and I’ve known about it for a month or two. Reading this study, I don’t see numbers for maternal death, so I can’t give you numbers on that. But then again, no one else here has posted numbers, so if you have them, please do.

      What I will say, though, is that the rate of fetal death is still relatively low (.24%). Out of 1000 planned home births, 997.6 babies did not die. Does that help the families of the babies that did die? Absolutely not. But based on what people here are saying about home birth, they make it sound as if it’s basically a death trap, which this study shows it’s not.

      But also consider, the risk of maternal death in a CS is 3.7x higher than in a vaginal birth. The rate of CS for planned hospital births in this study was nearly 25%, nearly five times that of a planned home birth (5.3%). Some women feel that the slightly higher chance of perinatal mortality outweighs the even higher chance of a CS and the risks that come with it. Some women may feel the opposite, and that’s fine.

      Are there certain risks that are greater in home birth? Yes. Are there certain risks that are greater in the hospital? Yes. Are there risks in crossing the street? In driving a car? Yes, and yes. Are all these risks relatively rare? Yes.

      You can find stories of women traumatized by their home birth, just as you can find women traumatized by their hospital birth. You can find stories of women who had the most beautiful, empowering hospital birth, just as you can find stories of women who had beautiful and empowering home births. What happened to Caroline Lovell should not have happened. Her midwife should not be practicing anymore.

      Let me also make some things clear, because I realize that people are making assumptions based one what I’m saying that aren’t true. I do not think that hospitals are terrible. I work in hospitals, and probably will for most of my career. C-sections do save lives, and childbirth is safer because we have them and other interventions. Yes, I think the CS rate is too high, but thank god we have them when they’re needed. Yes, there are risks to Pitocin, and that’s why it’s classified as a high-alert medication. Yes, those risks are rare, and yes it is a necessary tool sometimes, but I also think that using it 50% of the time is too much. You can disagree if you want.

      Women should be able to choose where to give birth, and if they choose a home birth, they should have access to a provider that is adequately trained, will make sure that she is low-risk enough for a home birth, and who will do everything in her power to make sure that her birth is as safe as possible, including monitoring and transferring when needed. Believe it or not, there are home birth midwives who meet this criteria, unlike Caroline Lovell’s midwife. Some women will feel safer and more comfortable birthing at home, and as long as they meet certain criteria, they should have that option. Some women will feel safer with the safety net that a hospital provides, and they, too, should have that option. I am in no way arguing that everyone *should* have a home birth, though I feel as if people here are misconstruing my words so that it seems I am arguing that.

      You may think that I am so entrenched in “woo” that I don’t know my ass from my elbow. Go ahead and tar and feather me for suggesting something contrary to what you believe. I’m pretty sure at this point I could say the earth is round and someone would find some way to criticize me for it.

      • MaineJen

        Reframing the argument: check

      • KeeperOfTheBooks

        But do the CS numbers account for the fact that a lot of really high-risk moms are going to have them and will therefore have them in a hospital?
        One of our local hospitals has a nearly-50% CS rate. Based on this, a lot of the local woo-ites say you should never, ever go there. What they don’t take into account is that it’s *the* major regional NICU/children’s/high-risk hospital. A lot of women who deliver there aren’t even local: they’ll be transferred there in the hopes of giving their micro-preemies another few days or weeks in utero for whatever reason. If your baby has been diagnosed with spina bifida, you really, REALLY want to have your baby there. Congenital heart/lung/kidney/GI defects? Ditto. Our state has a huge amount of very rural territory, and the hospitals out there will often very wisely say “if we know that there’s something really outside the norm here, far better to medevac mom to Really Big Hospital in Really Big City now than to have a disaster happen here that we can’t do squat about.”
        As it happens, it’s actually one of the more NCB-friendly hospitals around: birthing suites, Jacuzzis, the lot. It’s just that their CS rate is going to look ridiculous if that’s all you look at. On a smaller level, I wouldn’t be at all shocked if that’s the case in a lot of areas.
        One last thing: in the US, we have a lot of serious institutional/societal problems relating to race, poverty, and health. I can’t speak to NZ and if any of those things factor into the numbers there, as my knowledge of NZ is strictly geographical (Pretty hills! Near Australia!) and musical (Kiri te Kanawa FTW!), but here they assuredly do. Those who choose homebirth are generally white, reasonably well-off, and of good health. (Aside, of course, from the lunatics with a history of placenta accrete in their attempts at VBAMC and whose idiot midwives take them on anyway, but I digress.) It’s not really accurate to compare someone like that to someone who will deliver in a hospital because, among many, MANY other reasons, it’s all she can afford, didn’t get much (if any) prenatal care, has limited access to even remotely healthy food, and so on.

        • demodocus

          If i go into labor this week, I have to go to a rinky-dink suburban hospital where they would no doubt transfer my not-pregnant-enough butt to the big hospital with the level 3 NICU. I’m guessing Rinky-Dink has a much lower c-section rate than Biggie, but Biggie has free duolas. I can have hydrotherapy either way. Oh, contain my excitement.
          (Our insurance was bought out and changes hands on Friday, so after that I go straight to the big one.)

          • KeeperOfTheBooks

            I admit that one of the things I love about where I live is having Ginormous Children’s Hospital so close by. It was a major factor in my decision to try for a VBAC, as it happens. I wouldn’t be willing to risk a VBAC in a small suburban hospital, but suffice to say that if something, God forbid, does go wrong, kidlet and I quite literally couldn’t be in better hands. (Needless to say, the VBAC plan is subject to kidlet and my doing well and that still seeming like a good idea as my due date approaches.)

          • Who?

            I’m sure you’ve thought of this already, but hold on until Friday!!!

            The expected launch date is still a little way off though?

          • demodocus

            a long way off, Mid-June, but i was a preemie so i’m cognizant (sp?) of the possibility. My sister says it’s not allowed “because 1 in the family is enough”

        • MJeano

          You bring up a totally valid point. The numbers came from the ACOG, and the study where they got their maternal mortality rates said it excluded maternal deaths that were due to antenatal morbidities.

          http://www.acog.org/Resources_And_Publications/Obstetric_Care_Consensus_Series/Safe_Prevention_of_the_Primary_Cesarean_Delivery

          Another study also excluded those with obstetric or medical comorbidities and found a threefold increase in maternal death rate in CD vs VD.

          http://www.ncbi.nlm.nih.gov/pubmed/20492373

          • KeeperOfTheBooks

            Yes, but that was in Canada, not the US–unless we’re talking about different studies? “A large population-based study from Canada found that the risk of severe maternal morbidities––defined as hemorrhage that requires hysterectomy or transfusion, uterine rupture, anesthetic complications, shock, cardiac arrest, acute renal failure, assisted ventilation, venous thromboembolism, major infection, or in-hospital wound disruption or hematoma––was increased threefold for cesarean delivery as compared with vaginal delivery.”
            I’m also not especially familiar with Canada, but I do know that they have a form of publicly-funded medical system, and hear that they have both a) much better educated homebirth midwives than we do (university-trained vs a high school diploma and a few dozen births) and b) a very strict riskout policy. Based on the publicly-funded medical system, they’re not going to have a large medically-underserved (or just plain unserved) population like we do here, and while I’ve heard (again, anecdotally) that there are issues in the way that the native peoples have been treated, I’ll hazard a guess that the public medical system helps a bit to equalize that aspect, at least.

          • MJeano

            You’re preaching to the choir about Canada having better healthcare system than we do – many European countries do, too. And I think it is a great idea to make home birth safer if we can with more stringent requirements.

            However, home birth midwives are not the ones performing the cesareans, so that wouldn’t explain the threefold difference in mortality rate compared to vaginal.

          • Daleth

            No, it wasn’t even in Canada… it was in India!

          • Daleth

            Read closely: the Canadian study you posted said, “The risk of antepartum CD differed from intrapartum CD (OR 1.73 vs OR 4.86). There was a significantly increased risk of maternal death from complications of anesthesia, puerperal infection and venous
            thromboembolism.”

            In other words, if you distinguish between planned c-sections and emergency c-sections (ones done because something has gone terribly wrong in labor), you can see that there is a big, big difference in how dangerous they are (1.73 for prelabor ones, and almost THREE TIMES higher at 4.86 for emergency ones).

            The increased risk of death in CS due to complications of anesthesia is probably because more CS in Canada are done with general anesthesia. Spinal blocks and epidurals–a.k.a. regional anesthesia–are the normal mode of anesthesia for c-sections in the US. Either you get a planned CS with a spinal block, or you’re laboring with an epidural and when you turn out to need a CS the anesthesiologist simply tops up the dose to give you enough pain relief for the CS. That doesn’t kill people. What kills people is general anesthesia–the kind where you get intubated and totally knocked out. There are basically only two situations where general anesthesia is used during a c-section:

            (1) a crash c-section where you have to get the baby out in minutes to save its life and mom doesn’t already have an epidural–there’s no time to do a spinal block or epidural; those take 20-30 minutes from start to finish while general anesthesia works in under 5 minutes.

            (2) the mother has spinal issues that make her a bad candidate for a spinal block or epidural–scoliosis, for instance. This is rare.

            Since this was a Canadian study and the rates of epidural use there are only about 56% (vs. 80+% in the US), they automatically are going to have more emergency intrapartum CS done with general anesthesia.

          • Daleth

            As for the ACOG study, US studies do not distinguish between prelabor/early labor CS and emergency CS done when something goes wrong in labor. Although the numbers are different–surgery of any kind is more dangerous in India than in the US, etc.–an emergency CS is inherently at least somewhat more dangerous than a planned one, for a bunch of reasons: the risk of needing general anesthesia; the risk that your medical team may be exhausted, if say you’ve been in labor a while and it’s the end of their shift; the risk that you are exhausted, dehydrated, weakened by blood loss etc.; and whatever complications caused you to need the emergency CS.

            That’s where the UK study I posted comes in so handy. In the UK hospitals DO break their CS stats down by whether it was an emergency or not. And it turns out that a planned prelabor or very early labor CS is 20% less likely to kill mothers than attempting vaginal birth is!

          • MJeano

            As for the ACOG study, all those CS were planned prelabor. So no, the reasons you listed don’t apply. And c’mon, risk of medical team being exhausted? Nowadays most docs work in shifts, not on-call for their patient. So it’s just as likely that the OB or anesthesiologist just got on their shift as it is that they’ve been on it for a long time.

          • Amazed

            Pre-labour doesn’t mean not medically indicated. A planned prelabour section for breech is still medically indicated. When my friend got her second c-section prelabour because of preeclampsia, she was still in great danger, as was her baby. And c-sections for placenta previa and placenta accreta are literally always made pre-labour, unless labour catches everyone by surprise.

          • momofone

            My son was born by prelabor c-section due to calcification of the placenta that was identified through BPP. It was medically indicated, and we were fortunate to have an OB–an actual professional with training and expertise–rather than a birth hobbyist telling us babies aren’t library books and that we should wait until he was ready to come earthside, whatever the fuck that even means.

      • The Bofa on the Sofa

        What I will say, though, is that the rate of fetal death is still relatively low (.24%). Out of 1000 planned home births, 997.6 babies did not die. Does that help the families of the babies that did die? Absolutely not. But based on what people here are saying about home birth, they make it sound as if it’s basically a death trap, which this study shows it’s not.

        How do you feel about drunk driving?

        The risk of someone dying in a drunk driving accident is about 2//million drunk drives. That 2 includes either the driver, passengers or even someone in another car.

        That means that out of 1 million people who get in a car and drive drunk, 2 people die. Someone is 1000 times less likely to die than the home birth.

        I’ve provided this scenario in the past: an expecting couple goes to a party, and she is at term. Her husband has a few drinks, and is legally drunk. She goes into labor and they go to the hospital. He drives.

        In this scenario, she is 50 times more likely to die in childbirth than she is to die in a car accident. Using that “1.2 per thousand” risk of death that you report in your comment, that means that their baby is about twice as likely to die in childbirth than her husband is to get into an accident OR even get a DUI.

        Do you consider drunk driving to be a “death trap”? It is consider so bad that people want to do things like imposing a death sentence for first time offenders (ok, I know that is extreme). Yet drunk driving is a hell of a lot safer than childbirth.

        The problem with drunk driving is not the absolute risk, it is the prevalence. So your dismissal of the risks of homebirth comes from hiding behind it’s lack of prevalence. If homebirth were as prevalent as drunk driving, it would be a serious epidemic. It’s only because no one does it that it can be dismissed as no big risk. But then again, Russian roulette is also generally safe, too. Most people survive it.

        • Amazed

          “It’s only because no one does it that it can be dismissed as no big risk”

          Listening to MJeano, I’m curious if she’d send her kid to a school where 1.2 of the students would die for sure. That was about the number of students in my school – about 550 or 600. It was a very good school as well. Gave me a good background for the uni, let alone helped me get in there at all.

          Pretty sure my mom wouldn’t have enrolled me there if she knew that 1 of the students would die. Would MJeano enroll her kid there? It’s like homebirth, you know. It has some advantages and unlike homebirth, they’re quite longterm ones.

          • The Bofa on the Sofa

            What if airlines had a 1, 2/1000 fatality rate? 1/1000 planes crash.

            How about something less dramaric. How about, for every 5 flights that take off, 1 passenger dies. That’s less than 2/1000.

            Would you get on a plane in that case?

          • fiftyfifty1

            But some women feeeeeeeeeeeeel safer at home.

          • Bombshellrisa

            And those lights they use in the hospital are too damn bright, the doctors refuse to work by candlelight. It must be because they want to ruin my birth experience!

        • Valerie

          What about drunk driving with a baby and without a carseat? Car seats are about 70% effective in preventing death. So, back of the envelope, it’s still much less additional additional risk than one takes on by having a planned home birth.

          Or holding an infant unrestrained on your lap while riding a motorcycle? The odds of getting in a crash on that specific trip are pretty low- in 2013, the injury rate was 434 per one hundred million miles traveled. So you could ride something like 300 miles to get the same additional risk incurred by home birth, assuming an accident bad enough to injure an adult would kill an infant.

          Yeah, our understanding of risk is pretty bad if we think all these things are too unsafe to consider, but we think of home birth as an option that is safe enough. We go through considerable inconvenience strapping kids in car seats on a regular basis to mitigate a much smaller risk, but somehow the perceived advantages of home birth trump the additional risk to the baby. It’s not logically consistent.

          • swbarnes2

            There was a post here about that…in 1975, presumably before widespread use of carseats, the death toll for infants was 6 in a million. So WAY smaller than the chancing of dying in childbirth.

          • The Bofa on the Sofa

            And that’s not even a meaningful comparison, because (I suspect ) that 6 per million is per year. Considering how much driving people did, what would be the death rate per drive, for example?

          • Jenny Higgs
          • Who?

            I’m getting to work on that bestseller-it could be a murder mystery in which promising authors meet sticky ends.

        • MJeano

          Not that it really matters anyways, but where did you get your numbers for drunk driving? According to the Bureau of Transportation Statistics it is 60x more frequent (1 death/8,380 drunk driving incidences) than the 2/million you mention. Just calls into question the accuracy of your numbers and claims in general

          • MaineJen

            Compare 2/1000 (homebirth perinatal mortality) with 1/8380. Which is more dangerous?

          • The Bofa on the Sofa

            From the US DOT estimate that there are 27000 miles driven drunk for every DUI in the US.

            I used an estimate of 8 miles per drunk drive.

            But OK, say my numbers are wrong. Use your value. 1/8380. You dismissed 2.4/1000 as small. 1/8380 is 10 times smaller.

            Now, answer the question. How do you feel about drunk driving?

      • The Bofa on the Sofa

        BTW, you think 0.24% is a small risk of death?

        Can you think of anything else you do in life that has that large of a risk of death? I’ve already explained that drunk driving doesn’t. Sky diving doesn’t (it’s about 3/million). Scuba diving is the same as sky diving.

        Crossing the street? Get real.

        Climbing Mount Everest has a fatality rate of about 1.2%, so is only about 5 times greater than the risk you are ignoring. Racing NASCAR is probably about the same (0.24%).

        Sky diving and scuba diving are such high risk activities that life insurance won’t cover them, and they are hundreds of times less risky than childbirth.

        • Bombshellrisa

          http://www.spencergreenberg.com/2013/10/which-risks-of-dying-are-worth-taking/#.Vvmqt3i9LCR
          I found this the other day and thought of you. There are so many things that on the surface sound so dangerous, yet are many times safer than home birth.

        • MJeano

          It’s interesting that everyone here is choosing to focus only on the increased risk of perinatal death in home birth, not the increased risk of maternal death in a CS, which is more likely in a hospital. You could flip your argument around and say that giving birth in a hospital is a much riskier undertaking for the mother.

          • Azuran

            Does your number for higher CS risk take into consideration the fact that higher risk women are more likely to have a C-section? Like obese women, women with medical conditions such as diabetes, or women who are suffering emergency situations such as uterine ruptures, abruption or pre-exclampsia?

            Compare the maternal death rates of women in home birth and the death rates following pre-labor c-section of healthy women, you’ll probably notice that the home birth death rate is much higher.

          • MJeano

            That’s the statistic I’ve been waiting for someone to post. If you have that stat, please share

          • Amazed

            … so you can ignore it the way you did the studies other people posted?

          • Who?

            Mother is an adult, she gets to choose. The baby is a conscript. Quite apart from the whole ‘mother protecting her chicks’ thing, I prefer to lead from the front, not put those who I am responsible for in the firing line.

            Others disagree.

          • Daleth

            It’s interesting that everyone here is choosing to focus only on the increased risk of perinatal death in home birth, not the increased risk of maternal death in a CS, which is more likely in a hospital.

            Can you point to any research on that? I’m guessing not. As it turns out, a prelabor or early-labor c-section is about 20% LESS likely to kill the mother than attempting a vaginal birth. So says a study of more than two MILLION women (every birth in the UK over a three-year period). And that’s ALL births in the UK, including the high-risk moms.

            Here’s an article about that study:
            http://www.telegraph.co.uk/news/uknews/1584671/Women-choosing-caesarean-have-low-death-rate.html

            The c-sections in which mothers die are almost always emergency or “crash” c-sections, which are done when mom is already absolutely exhausted and weakened by labor, and there are usually additional risk factors: obesity, pre-eclampsia etc.

          • The Bofa on the Sofa

            It’s interesting that everyone here is choosing to focus only on the increased risk of perinatal death in home birth

            Um, YOU were the one who brought up perinatal death in home birth, and then promptly dismissed it because the absolute rate is small.

            I addressed your assertion that the absolute rate was small, which you completely ignored.

          • moto_librarian

            And what about maternal morbidities related to vaginal birth, MJeano? I have my first appointment with a pelvic medicine specialist in a few weeks to discuss serious problems from a rectocele. Since I just turned 38, we can’t exactly blame old age; vaginal birth is the culprit. I know that I’m almost certainly looking at reconstructive surgery since I can’t fully empty my bowels without splinting. It’s interesting that nobody had anything to say about this particular complication. You hear about stress urinary incontinence, and I had that for awhile too, but was able to retrain my pelvic floor in physiotherapy to fix that. Do you have any idea of how embarrassing and depressing it is to deal with this on a daily basis, let alone contemplate surgery?

          • Amazed

            But with a c-section, you CAN’T LIFT ANYTHING HEAVIER THAN YOUR BABY FOR SIX WEEKS! At least, that’s the kind of comparison she made about oxygen deprivation from a shoulder dystocia and respiratory problems that even the authors of the study she’s citing didn’t find this bad since they only say maternal mortality and morbidity is worse for c-sections.

            She doesn’t seem able to distinguish between the severity of the complications. What do we expect of someone who cites a c-section study from India anyway?

          • Roadstergal

            I had no idea the sorts of things that could happen as the result of vaginal delivery until I started reading this site. Nobody talks about it, nobody discusses the long-term risks of that wonderful natural birth. Now that I have, I’m not surprised at the quote from the UK OB who said that if she gave proper informed consent to women, lots more of them would ask for a C/S than do currently. (I am, however, horrified that her decision based on that was to NOT INFORM WOMEN of the risks and benefits of each, wanting to keep the babies coming out vaginally, hell or high water.)

            And I’m really sorry you’re having to go through that. 🙁

      • Amazed

        “But based on what people here are saying about home birth, they make it
        sound as if it’s basically a death trap, which this study shows it’s
        not.”

        What an irony coming from the mouth of someone who went to such lengths to present c-sections and hospitals as death traps, even going as far as comparing the death of a newborn with the titanic contractions she heard second hand that didn’t kill anyone.

        Keep backpedaling like crazy. It would have been fun to watch you twist but since you’re in position to influence women with the untruths you preach, it’s terriying.

        • MJeano

          No, I am not trying to prevent CS and hospitals as death traps. I just said that those complications are pretty rare. You’re the one who interpreted an example of a (rare) risk that would only happen in a hospital as saying that hospitals are death traps.

          And my “untruths”? What am I saying that’s not true? Please, list all the untruths I’ve said and give me scientific evidence to refute each one. Then maybe I won’t kill any more babies with my woo woo voodoo.

          • Amazed

            Nope. I gave you a list of studies already, although I shouldn’t be the one doing this. As a doula, you should have been acquainted with them already if you insist women should be informed and you’re one of the people informing them. You didn’t bother to comment. I am not giving you studies to ignore again.

            Literally every insinuation you’ve ever made here is wrong. A lie. I deemed it untruthful yesterday because I had to give you the benefit of doubt. But since you didn’t bother discussing the studies that you demanded, no doubt thinking I was talking off my ass the way you do, I now call them lies.

          • Roadstergal

            When someone quotes actual studies and numbers, she ignores the response. Typical.

            She’s particularly been ignoring Daleth’s to-the-point posts.

          • Amazed

            She’s been ignoring them, hasn’t she? Go to her reply to me about c-section respiratory distress being temporary while shoulder dystocia can lead to lifelong damage. She says that by this logic, c-section can lead to lifelong damage since – respiatory distress. JAw-dropping. And that’s someone who has the ear of actual mothers. WTF?

      • Bombshellrisa

        You need to adjust your stats to reflect injuries to laboring women and babies as a direct result of birth setting (home or free standing birth center).

        • MJeano

          My original point was that it’s hard to point to the birth setting as the cause of death. There are risks *associated* with birth setting. Direct cause from setting – hard to prove.

          • Bombshellrisa

            My point was that if you want to discuss safety in out of hospital births, it would be wrong to focus only on death.

          • MJeano

            What else should we focus on?

          • Who?

            How about: brain injuries and other outcomes of hypoxia; injuries to the baby like broken arms and shoulders; injuries to the mother’s body esp pelvic floor.

          • Bombshellrisa

            Injuries to both women and babies. The fact that even if a midwife has malpractice insurance, the payout often doesn’t come close to the bills the family will be faced with including long term care for a child with complex needs.

          • MJeano

            Ok, if we are going to talk injuries to women, there are a whole lot more side effects and complications related to CS.

          • Amazed

            Which no one ever denied. The thing is, those things are far less common than death and brain damage to homebirth babies. But as you say, 2 in 1000 is such a small number and brain damage should not be taken into consideration at all, so let’s all hug and sing kimbaya.

          • Roadstergal

            Citation for that, please – equivalent-risk women, planned pre-labor C/S vs planned VB, immediate and long-term damage (pick your poison – incontinence, prolapse, pelvic floor damage requiring surgery, etc).

            Even when you don’t control for risk, as Daleth pointed out, UK data on a huge dataset suggests that prelabor C/S is safer in terms of maternal mortality.

          • MJeano

            It was already listed in the ACOG link, but here is the study:
            http://www.ncbi.nlm.nih.gov/pubmed/17296957

            They found CS had increased risk of, cardiac arrest, wound hematoma, hysterectomy, major puerperal infection, anesthetic complications, venous thromboembolism and hemorrhage requiring hysterectomy.

          • swbarnes2

            Yes, but also “The difference in the rate of in-hospital maternal death between the 2 groups was nonsignificant (p = 0.87).” And that paper didn’t bother including any morbidities like needing pelvic floor surgery. They just had a list of what morbidities they were looking for, and they didn’t include that.

            “Several limitations were inherent to this retrospective cohort study. First, although we endeavoured to select women without labour for the low-risk elective cesarean group by using a validated and published algorithm,23,24 we estimate that 16%–17% of these women might have experienced labour that was not recorded in this database. Some of these women would have planned cesarean delivery and entered labour before the scheduled cesarean, and then undergone emergency cesarean delivery — a reflection of the real-world situation around planned cesarean delivery. However, some may have been planning a vaginal delivery but underwent emergency cesarean section for obstetric indications that are not coded by the medical records abstractor. Such misclassification of subjects may have biased the results against the planned cesarean delivery group…Finally, our restriction to low-risk women and those without pregnancy complications may have favoured the planned vaginal group somewhat.”

          • Roadstergal

            The groups weren’t equivalent – women who got a C/S for breech vs women with uncomplicated pregnancies with a successful VD. They even admit at the end that inherent uterine pathology is “more prevalent in women with breech presentation,” admit that their algorithm did not effectively exclude women who had a TOL and an emergency C/S, and note that they did not control for significant confounders such as maternal obesity (and “parity, height, prepregnancy weight and weight gain in pregnancy”).

            And even after all that, the ‘planned C/S’ breech group still reduced the risk of hemhorrage requiring transfusion, uterine rupture, and obstetric shock compare to overall low-risk VD. Not exactly a clear negative.

          • Amazed

            “Among women in the planned vaginal delivery group, those who had a
            spontaneous vaginal delivery (77.9%) or an instrumental
            vaginal delivery (13.9%) were less likely to suffer
            death or serious morbidity, compared with those who delivered by
            emergency
            cesarean (8.2%)”

            What a surprise! Emergency c-section corresponds to greater risk of death or serious morbidity compared to spontaneous vaginal delivery! Now, who would have ever thought that?!

          • Amazed

            Ah yes, women who carried breech babies aka women who didn’t. Aka, medically indicated c-sections against low-risk vaginal deliveries.

            Repeat after me, MJeano: Prelabour section doesn’t equal medically unindicated. Now, repeat it three more times. Did you finally get it?

            When are we to expect your contribution discussing the study showing that purely elective c-sections are SAFEST for babies? Or any of the studies many of us so kindly referred you to?

      • Who?

        The earth is spherical(ish) not ’round’.

        Again, your choice of words interests me. You seem to be all about ‘feelings’. Where women ‘feel’ safer is an important issue for you-not where they are, in fact, safer. I hate the dentist, despite more than 40 years of happy experiences in the dental chair. Does that stop me going to the dentist? Did it mean I didn’t take my kids to the dentist? No and no. The best choice isn’t always the fun choice.

        Your position seems to boil down to ‘what’s a few dead babies so long as women have the choice to birth where they like’. Let’s never forget that the dead babies are conscripts in this scenario, and the birth hobbyist industry seeks to bury them twice by hiding their stories.

        Caroline Lovell tossed the dice and lost. Why not acknowledge that openly rather than trying to divert, distract and obfuscate?

        If you’re going to support homebirth, don’t hide the bodies.

        • MJeano

          I do think women’s psychological well-being (aka “feelings) should be considered. We can agree to disagree on that one. Where they actually *are* safer is what’s up for debate now.

          And the dentist analogy is not an equivalent situation. In your example, you are choosing between dental care at the dentist, or no dental care. What I am advocating for is the choice between maternity care at home or birth center, or maternity care in the hospital. Would you prefer to see an oral surgeon in a hospital for your dental care, or go to your local dentist’s office?

          Ok, Caroline Lovell tossed the dice and lost. I’ve said all along her midwife was incompetent and that should have been prevented.

          And hiding the bodies, really? I just showed you the bodies. All 1.2/1000 of them

          • Bombshellrisa

            People attempt versions of dental care at home using home remedies and essential oils because the dentist’s office scares them so much.

          • Who?

            One of my friends, who is a gp, is terrified of the dentist. She loads up on valium before her regular appointments. The dentist is fine with it, she’s better than fine with it, and her teeth get looked after.

          • Who?

            Perhaps we disagree on what might best serve a woman with concerns about her psychological well-being: I don’t agree that going to someone who’s payday depends on keeping her scared is a good way to improve things.

            As to the dentist, that depends. For something complex, give me hospital; for something simple, give me the local office. I’ll go where the expert ie the dentist, recommends. That would be my preference, since if they are working on me I want them comfortable.

            So your position boils down to the birth hobbyist chestnut: what’s a few dead babies. Very nice.

          • MJeano

            You don’t think it’s good for women to go to someone who’s payday depends on keeping women scared. Just like some OBs who scare women with all the complications that they could possibly ever face to keep them coming to the hospital and maintain their paycheck. I think a midwife’s paycheck depends more on helping the woman feel less scared about birth. But wait, that’s just a bunch of “woo”

            As for the dentist analogy, that’s exactly the rationale some use for justifying going to a midwife and/or birth center. For normal, low-risk pregnancies, go to a midwife who is trained in normal birth (including emergencies that CAN come up in low risk women, just like dentists can handle complications of simple procedures). For more complex cases, go to an OB at the hospital. That’s the model used by some European countries like the Netherlands

          • Who?

            Yes, those big scary doctors the hobbyists rush to for help when it all goes to pieces. And then blame when everyone isn’t perfectly well in the wash-up.

            Helping someone be less scared by lying to them about what can and can’t be delivered is despicable.

            If we knew which pregnancies were going to go wrong and in what way, there would be a lot less drama. Incidentally, many birth hobbyists encourage women to refuse testing that would help identify problems early. It’s only simple when it’s over.

          • The Computer Ate My Nym

            Um…what? I don’t know about other countries, but the US is not oversupplied with OBs. One of the reasons midwives became popular was because OBs were so overworked that they were trying to get patients to go elsewhere. OBs don’t have to “scare” women into going to the hospital or seeing them, they’ve got plenty of work already. Midwives, now, especially non-CNMs, i.e. those who aren’t qualified enough to get credentialed at real hospitals, they have to do what they can to keep their businesses going. Including lying to women about how “safe” home birth is.

          • Roadstergal

            “OBs don’t have to “scare” women into going to the hospital or seeing them”

            To be fair, I’m scared of pregnancy and cervical cancer, so the OB gets my business for birth control and Pap smears. Probably not what Jeano meant, though. :p

          • fiftyfifty1

            “For normal, low-risk pregnancies, go to a midwife who is trained in normal birth (including emergencies that CAN come up in low risk women”

            Well, by your definition, midwives are NOT trained in normal birth then. Many types of emergencies CAN (and do) come up in low risk women in labor. And midwives can do nothing, or next to nothing, about most of them.

          • MJeano

            I beg to differ. According to the ACNM at least, their core competencies include “Deviations from normal and appropriate interventions, including management of complications, abnormal intrapartum events, and emergencies,” and for the newborn, “Emergency management including resuscitation, stabilization, and consultation and referral as needed.” No, they can’t do EVERYTHING, but they can do a hell of a lot more than “next to nothing.”

            Just off the top of my head, some things they are trained to handle – shoulder distocia, breech (most hospitals don’t allow vaginal breech but they are still trained should there be an unexpected breech), hemorrhage, retained placenta, prolapsed uterus, unresponsive newborn, cord prolapse (this is almost always an emergency CS but there are life-saving measures that can be done until it is performed), etc., etc.

          • swbarnes2

            According to the CDC WONDER database, CNMs not in hospitals still have higher death rates than CNM in hospitals. (There are a lot of settings that will yield this result, I limited to 37+ weeks, 2500+ grams, O and P class deaths) Why is that, if they are able to, say, do infant resus just as well as a team that trains and drills in a hospital?

          • fiftyfifty1

            Shoulder dystocia: a minor shoulder dystocia may be resolved by a solo midwife, but a more severe one takes a team.

            Breech: There are a lot of “unexpected breech” births in the hands of homebirth midwives. And the death rate at home is appalling.

            Hemorrhage: midwives at home can do uterine massage. Or give a a shot of pit ( if CNMs). All other causes except tone (e.g. retained tissue, bleeding tears, clotting abnormalities etc.) are totally beyond what they can do.

            Retained placenta: At home = out of luck. Even in the hospital a manual extraction means the OB will be called in. Because you can’t manually extract a placenta that is adhered, and then it’s the OR or death.

            Prolapsed uterus: Inverted uterus–> tidal wave of blood. A solo midwife would be *very* lucky to be able to replace this. And if she did, she still needs to transport to the hospital immediately.

            Unresponsive newborn: Babies born at home are at a 19x greater chance of having 1 minute and 5 minute APGARs of zero! And when this does occur, a solo midwife is much less effective than a trained team.

            Cord prolapse: The solution is emergency CS. How is a midwife going to provide that.
            So yep, next to nothing.

          • moto_librarian

            Even if a midwife can manage these things at home (and anything other than an easily-resolved dystocia and minor pph related to atony would pretty much be all that they could handle well), there’s nothing said about the fact that they have no way to provide real pain relief during these crises. A manual exam of the uterus is unbelievably painful. I had several large clots removed, and I’m betting that was similar to having pieces of retained placenta removed. Prolapsed or inverted uterus – I can’t even imagine. At least you know in the hospital that they will get you pain relief as soon as possible. If I’d had a heplock, I wouldn’t have been in misery for so long, but at least I didn’t have to sit through a transfer too.

          • Amazed

            MJeano seems to be absent right now, so I’ll answer you for her: at least you didn’t have your birth medicalized more than what was needed to save your life.

          • corblimeybot

            I know this comment is a few months old. But I wanted to make an anecdotal note that I know two homebirthers who had a whoopsie-daisy breech. Their midwives claimed ignorance. Did they really not know? Did they know, but lied? Hard to say which is worse.

          • Amazed

            So you mean that when a midwife sees shoulder dystocia, she doesn’t call a code but she sets out to handle it alone or with only one other midwife? For real?

            Haemorrage? On their own?

            Ratained placenta? Are you kidding me?

            You’re just wrong about so many things. I believe that you have seen them. There are practitioners who commit malpractice and with homeborth midwives, it’s seldom prosecuted unless shit, fan and so on. Doesn’t mean that they were qualified to handle those cases and that their patients were anything other than lucky.

          • moto_librarian

            So CNMs delivered both of my sons. In the hospital. My first labor and delivery is illustrative of precisely why I freestanding birth centers and home births can never be as safe as the hospital. I went into labor at 38 + 3 after SROM. Contractions did not begin until 6 hours later, and we left for the hospital about 3 hours later. I started transition during the car ride. When we checked into L&D, I was dilated to 9 cm. No heplock, no pitocin, only intermittent EFM to make sure the baby wasn’t in distress. I pushed in every position imaginable, and drank Sprite between contractions. Our son was delivered after roughly 90 minutes of pushing. And then I started bleeding. Heavily. My CNM began a manual exam of my uterus while the L&D nurse gave me a shot of pitocin (remember, no I.V. access). I had cytotec inserted rectally. The room began to fill up with people. The pain was so bad that I was weaving in and out of consciousness, and I honestly thought that I might be dying. My husband ultimately gave consent for me to be taken back to surgery for repair of a probable cervical laceration, but he consented for me to have a hysterectomy if necessary to stop the bleeding. I still remember the bliss of fentanyl running into my newly-run I.V. before I closed my eyes as they wheeled me down the hallway to the O.R. I was fortunate. My laceration was repairable, and my pph stopped once it was clamped. I still nearly required a blood transfusion (had my hematocrit dropped one more point, they would have transfused). I was so weak that I passed out on the toilet the night after I gave birth. I was in a wheelchair for the first 24 hours after delivery because I was too weak to stand, and it took me several months to recover. The experience was terrifying, and we very nearly didn’t have another child because of it.

            I know that I would have died had I given birth at home. I was losing blood at an incredible rate. The best thing that a midwife could have done at home would be to give pitocin and call for LifeFlight. This was after a completely uncomplicated pregnancy. One or even two midwives wouldn’t have been adequate to save me, and since our son was experiencing TTN, who would have been caring for him?

          • Who?

            So-it could be okay, but apart from some cases of your first two examples, all the midwife can do is hold the ground, and maybe stop things getting any worse, while anyone else to hand rushes around organising ambulances, paramedics and a hospital transfer. Then comes putting the seriously ill mother/baby/both into the hands of the ‘evil doctors’ who, mother has been told, are only a last resort. And whoever is sick is getting sicker every second.

            How do you think mother’s ‘psychological health’ is right about then? Assuming she’s not dying and otherwise occupied?

            My guess is she’s blaming herself, because we know the rallying cry of the birth hobbyist: ‘this was your choice.’

            And let’s pause and reflect a moment on the heart attack, car accident, workplace injury who has to wait for emergency transport and care while this happens.

          • Roadstergal

            What’s the transfer rate for low-risk primps in the UK? About half?

          • swbarnes2

            According to the UK Birthplace study, yeah, about 45% of primips transfer. But while supposedly all homebirths are “low risk” in practice, homebirthing midwives do take on breeches and other high risk patients, so I don’t think we can say that that’s the “low risk” transfer rate.

          • Amazed

            Yes. A bunch of woo indeed. The vast majority of women want obstetricians and hospitals. OBs are in too great abundance of patients, not shortage. It’s very telling that when you look for an obstetrician in your third trimester, it’s hard to find one. When you want a midwife, you can interview as many as you want and you can be choosy into how you “fit” with her. She will always have enough room in her schedule to fit a new mother to be. Not too busy a schedule, yet it’s somehow obstetricians who need women to come to hospitals? Come on!

          • The Bofa on the Sofa

            Yeah. OBs are too busy to spend any time with patients, and just move on from patient to patient as fast as they can. Midwives have the time to have appointments last for an hour to create personal relationships.

            But OBs are the ones who need to do things to keep patients coming to the hospital.

            I wish these guys could get their stories straight.

          • Amazed

            And I can wish I had hair like Cindy Crawford after hairdressers had had their go at her.

            They’ll never get their stories straight since each of the thinks she’s different and doesn’t recognize herself as a birth hobbyist, so they each point at different (often repeating) reasons to distrust OBs and hospitals. Equally ridiculous, though.

          • KeeperOfTheBooks

            The Netherlands? Where high-risk patients of OBs have better outcomes than low-risk homebirth patients of midwives? That Netherlands?

          • Roadstergal

            It’s amazing to think, isn’t it? The safest way to have a baby in the Netherlands is to be just high-risk enough to be risked out of midwife care.

            You have a textbook low-risk pregnancy, your friend has gestational diabetes. Her baby is less likely to die.

          • Amazed

            Yeah, the very same one. The one that is, you know, having its homebirth rate constantly lowered in the wake of the studies you point out.

          • momofone

            I think having their babies die based on some birth junkie’s instructions is probably pretty hard on a person’s psychological well-being.

      • swbarnes2

        Where are you getting your statistic for maternal death in C/S? And are you correcting for the fact that the women most likely to die in them are the ones who are getting C/S BECAUSE they are so sick they need the pregnancy to end NOW?

        If a woman’s body is collapsing under the stress of the pregnancy, and a C-section isn’t timely enough to save her, a vaginal birth certainly would not have.

        Caroline Lovell WANTED a midwife who was NOT adequately trained enough to say “You are too high risk, so nope.” If CPMs wanted more training, they would get it. If homebirthing mothers wanted well-trained birth attendants, they’d go to hospitals.

        • MJeano

          The statistics came from the ACOG. The study referenced for those numbers excluded deaths due to antenatal morbidities. Another study also excluded obstetric comorbidities and found a threefold increase in maternal death in CD vs VD.

          http://www.acog.org/Resources_And_Publications/Obstetric_Care_Consensus_Series/Safe_Prevention_of_the_Primary_Cesarean_Delivery

          http://www.ncbi.nlm.nih.gov/pubmed/20492373

          • Amazed

            India? India?! I thought Australia and US were first world countries. Why are you pointing at a study from India?

            If we’re going to talk India, perhaps you should go to Jeevan’s blog. It’s here, in the blogroll. Just so you know what’s happening in India before you raise it as a valid comparison.

          • fiftyfifty1

            Seriously? You are citing a study from India? Where they look at medical records from Indian hospitals retrospectively and if a preexisting maternal health problem is not listed, they assume there was none? And you believe that “excluded obstetric comorbidities”?

            You are going to have to do better.

          • MJeano

            Ok, ignore the second study if you want. The first link is info provided by the ACOG (American College of Obstetrics and Gynecology), and the study was conducted in a first-world country. That one actually found a higher rate, btw.

            I expect you will find some reason to reject that one, too, though. Because, you know, the ACOG doesn’t know what they’re talking about.

          • MJeano

            Here’s a study from the Netherlands that found a 3.25x higher risk as a direct result of CS:

            http://onlinelibrary.wiley.com/doi/10.1111/j.1600-0412.1997.tb07987.x/abstract

          • Bombshellrisa

            The Netherlands…where high risk woman treated by OBs have better outcomes than low risk women treated by midwives.

          • MJeano

            Can you provide a link to the study where you found that stat?

          • Bombshellrisa

            http://onlinelibrary.wiley.com/doi/10.1111/1471-0528.13084/abstract
            Dr Amy did a piece on it http://www.skepticalob.com/2014/09/awesome-dutch-midwives-kill-just-as-many-babies-in-the-hospital-as-at-home.html
            “..the combined intrapartum/neonatal death rates for both groups was higher than would be expected for a group of low risk women in midwifery care. Indeed, it is higher than the intpartum/neonatal death rate of 0.74/1000 (nullips) and 0.46 (multips) previously reported for HIGH risk patients under the care of Dutch obstetricians.”

          • The Computer Ate My Nym

            Again, in 1983-1992. Also, their absolute death rates were appallingly high. 53 deaths per 100,000 c-sections? Something wrong there. I note that, among other things, the c-section rate appears to be less than 10%, suggesting that c-sections are delayed until the patient is in very bad shape and therefore more likely to die.

          • MJeano

            So you automatically assume that a 10% CS rate means the patient is in bad shape? Not just that they aren’t nearly as quick as we are to medicalize birth? I know of hospital midwifery practices in the US that have 5-10% CS rates, and no their patients are not in “very bad shape and therefore more likely to die” once they do have one.

          • MaineJen

            MJeano: only healthy women are referred to midwifery practices rather than OBs, right? So naturally, those women are going to be healthier, with fewer complications. Leading to fewer C sections.

            I’ve learned that a “high c section rate” doesn’t mean the doctors at a certain hospital are knife-happy, it just means they take on more high risk cases.

            If we tried to take that 10% c section rate and graft it onto the entire maternity population (much like the baby-friendly initiative has been grafted, cookie cutter-like, onto all mothers at a BFH), it would be a disaster. There is no ideal rate. You have to take it case by case.

          • swbarnes2

            There was a post about this on this site; empirically, country-wide C-section rates below 19% was associated with higher rates of maternal death. Also, you should know that the Netherlands has a very high home birth rate, (About 30% when this paper was written, about 25 years ago) so their hospitals are going to have more homebirth disasters.

            And again, not a lot of women are choosing “vaginal or C-section” alone. If a woman has to choose between something like “10% chance of baby dying, 1/100,000 chance of me dying, or 0.5% chance of baby dying, 1/10,000 of me dying”, most women will unhesitatingly chose the former. At home, it might be “50% chance of baby dying as we race to the hospital hoping to get the C-section in time, or stay put and stick with vaginal delivery, and baby dies 100%, and maybe mother dies too”.

          • momofone

            “Medicalize birth.” I think I just hit bingo.

          • MJeano

            Congrats…Yeah, I do think that birth is often (not always) over-medicalized. Haven’t we pretty much established that opinion already?

          • Roadstergal

            We have indeed. And do I think the Dutch midwives you admire under-medicalize it, given that babies die in their care in childbirth at a higher rate than the babies of high-risk women under OB care in the same country. Oh, well, agree to disagree on the ‘which is a bigger tragedy, a heplock or an empty crib’ issue.

          • Who?

            Okay.

            So let’s assume birth is over-medicalised. And note that means more people are alive and well than would be if it was ‘under medicalised’.

            Why does it matter? Apart, of course, from your bottom line.

          • momofone

            Opinions don’t have to be established; they’re opinions. Facts would be established.

          • Amy Tuteur, MD

            So you oppose preventive medicine? Obstetrics is, after all, only preventive medicine. Do you oppose blood pressure checks, Pap smears and colonoscopies as well?

          • Roadstergal

            Are numbers available for the US for that time period?

            That paper was not terribly useful. It brayed in the Conclusion about how great the low-risk-women-see-midwives system is at preventing cesareans (the ‘what’s a few dead babies compared to preventing C/S’ system), but it didn’t break out the C/Ss according to pre-labor vs emergent, whether the women were classified as low- or high-risk, how many were home-birth transfers, anything else that would help you interpret the data usefully. They just looked at maternal deaths and glanced backwards.

            And it compared overall VB risk of death to overall C/S risk of death, not balancing by risk or any other factors.

            And no mention of the risk of death to the baby.

            (Tangentially, the Dutch head of our group was trying to explain something incredibly painful she had recently gone through to me, and the only thing she could compare it to was childbirth. And all I could think was, oh man, they don’t give you anything useful for that over there, do they…)

          • swbarnes2

            Well, sure, cutting someone open is riskier than not cutting them open, but if any number of things are going wrong, the baby dies unless they get it out by C-section. At home, the baby just dies, and maybe mother does too. At the hospital, a C-section gives them both an excellent chance of living.

          • The Computer Ate My Nym

            The first link is not to a peer reviewed study, but it does contain a lot of information derived from peer reviewed studies, with references. In particular, I note that the data from which the maternal mortality statistics were derived were from the 1990s and early 2000s. Are they even still relevant? DVT prophylaxis, for example, has gotten a lot more sophisticated than it was in 1991. I leave it to the OBs to comment on whether c-section techniques and monitoring have changed during the past 2 decades or not, but strongly suspect that they have.

          • swbarnes2

            As far as I can see, the ACOG maternal mortality figures are derived from a French study, which did NOT eliminate deaths that happened because of complications that occurred DURING delivery. So sure, a catastrophe happens IN LABOR, they do a C-section, but that was a response to the sh*t hitting the fan, not the cause of it.

            Look in the citations, to citation #4, “Maternal death in the 21st century”

            ” Four deaths were felt to have been directly caused by cesarean delivery. In 3 cases (all primary cesareans), death was due to hemorrhage from bleeding vessels injured during surgery. In 1 case of repeat cesarean delivery, death was due to sepsis secondary to surgical injury to the bowel during the operation. Two deaths were felt to be causally related to vaginal delivery. In contrast, in 12 cases of death related to preeclampsia,… death was felt to have been potentially preventable had a cesarean delivery or an earlier cesarean delivery been performed. In 20 of 58 deaths associated with cesarean delivery (35%), the operative procedure was a perimortem procedure performed following maternal cardiac arrest. None of these deaths was attributable to the cesarean itself…We conclude that most maternal deaths in the United States are not preventable”

          • The Computer Ate My Nym

            Even assuming that the standard of care in India is similar to in the US, the odds ratio for planned (antepartum) c-section was 1.73 and no confidence intervals were given. They could easily overlap with 1. Sorry, I wasn’t able to get full text so can’t say anything more definite.

      • SporkParade

        You are forgetting something very basic, namely, the difference between relative and absolute risk. It’s reasonable to believe that C-sections are riskier for the mother than vaginal delivery, even though most of the difference is likely due to the factors that contribute to it being a C-section situation in the first place. However, childbirth in general is much more dangerous for the fetus than for the mother. So the trade-off in choosing home versus hospital isn’t between similar risks to fetus and mother. It’s marginally increasing the risk to the mother at the expense of a much bigger increase of risk to the fetus.

        • Who?

          Prepare to be told that it’s only about 1 in a thousand more babies who die, so what’s your problem?

        • Roadstergal

          What’s really lacking is the study of long-term risks to the mom of C/S vs VB. They could do it in the UK; they had good enough numbers to show that planned prelabor (prelabour?) C/S was safer in terms of mortality than planned VB, despite not balancing the groups for risk. They could look at sexual function, incontinence, operations to rebuild the pelvic floor – but I bet if they did, it would make C/S look like a pretty good option, and the UK midwives are Not Having That.

          • Amazed

            Again, who was the wise man who, in the wake of a study on incontinence after a vaginal birth said, “But you didn’t ask the women if they MIND being incontinent?” DeClerk or Odent?

  • Lyra

    I gave birth at the hospital. About 30 minutes after birth, I too uttered the words “I think I am dying.” I had internal hemorrhaging, can’t remember exactly what happened. The nurse called the doctor as soon as I said those words and I was rushed into treatment and surgery. I am here typing these words because the hospital staff gave me instantaneous care because they could. I have no lasting complications. I was able to have baby #2 and labeled high risk so that I would get excellent and more detailed care. Had no issues with the second birth, they had me do vaginal but in an OR just in case. Hospitals are where all babies should be born, unless the mother has a death wish.

    • Susan

      Impending sense of doom scares the S*** out of good nurses

      • Megan

        And good doctors.

      • Lyra

        The nurse I uttered those words to came to my room after I was stabilized and awake to apologize for not noticing something wrong with me sooner. I told her she isn’t psychic, that if the machines weren’t making bad noises and I didn’t look like there was something wrong, how was she supposed to know? She obviously got me medical attention in time and I was alive because she did something. I felt so sorry for her for feeling guilty. Personally, I saw her as amazing. Nurses are awesome people.

      • Margo

        And midwives too.

        • The Bofa on the Sofa

          Clearly not all

          • Margo

            Yep clearly not all, mores the pity.

          • MichelleJo

            If you call a CPM a midwife. They are not, and the fact that they call themselves midwives doesn’t change that.

          • The Bofa on the Sofa

            The monster who is the subject of this post is/was not a CPM. Yet, the fear of impending doom didn’t bother her.

            Granted, Susan did qualify it as “good” but that just begs the question of what makes them good.

          • MichelleJo

            I didn’t realize that.

          • Phascogale

            Well you probably want to amend that to university trained midwives (which happens in a few countries) or CNM’s. And ones that take their job seriously and do it well.

          • guest

            “Good” is the key word.

  • Roadstergal

    I mentioned this in the other thread, but – an hour in the tub with the baby? Stewing in a cooling gazpacho of blood, amniotic fluid, feces, who knows what else?

    I mean, even if both parties had come out alive, how on earth would this be anything other than a disgusting, uncomfortable experience? How is _this_ the epitome of what home birth has to offer?

    • Sean Jungian

      But BONDING.

    • CSN0116

      And cold! I think those tubs just inflate, they don’t self-heat or maintain temp :/

      If only “bonding” (which I believe 100,000,000% cannot and will never happen during the hour after birth. I actually believe that ‘immediate skin-to-skin’ does absolutely nothing except tickle *mom’s* psyche and make *her* feel good.) weren’t so hyped up, mom would have stood up minutes after giving birth and the bleeding you have been discovered.

      • Sean Jungian

        I agree. Maybe some miniscule benefits, but mostly to make the adult feel good. I of course wanted to hold my baby right away – but it wasn’t skin-to-skin, and he even had a hat on!!! HORRORS! And they took him away briefly for cleanup, etc., let his dad hold him a bit.

      • Dr Kitty

        Waterbirth has never appealed to me.
        I can’t even take baths when I’m pregnant, because I like it HOT.
        If I’m not pink and sweaty, I’m not enjoying it. Even my husband won’t share a tub with me because I like it too warm.
        Spending hours in lukewarm water is not appealing.

        • Roadstergal

          “No man is an island.” A pregnant woman in a bath, however…

          (Sorry, I’m slightly delusional from too little sleep and had a mental image that delighted me.)

          • Dr Kitty

            It is rather nice being heavily pregnant in a bath and watching the baby move, but I can only stick “normal” temperatures for a few minutes.
            Even now, I take #2 into the very warm kiddie pool while #1 has a swimming lesson, and my teeth are chattering after thirty minutes.

          • BeatriceC

            We have this beautiful, large pool in our back yard. I never use it. It’s far too cold and the heater is original to the house, which was built in 1965. It works, but it’s incredibly inefficient and expensive to use, so we don’t heat the pool. What I would use, if it were to be repaired, is the equally lovely hot tub a few feet away from the pool. Unfortunately, critters got to the plumbing so we have to dig it up and repair it before we can fill it again. It’s on the way-too-long list of things that need to be repaired around here.

        • BeatriceC

          MrC and I have rather intense temperature negotiations in the occasional event that we shower together. If I don’t come out practically burned, it wasn’t hot enough. He disagrees.

          • Charybdis

            I’m the same way. With water pressure intensity as well. Our showerhead allows you to change from the whole showerhead spraying water to a smaller, more forceful inner circle spraying water. I love the more intense spray, as it is penetrates and rinses my THICK hair better, plus it feels better to me. DH, on the other hand, claims he is “delicate” and the more forceful spray is not comfortable.

    • namaste863

      I found a photo where the whole fam climbed in. The water was red. Completely, completely gross. Especially when you consider the fact that they probably weren’t the first to use said tub, and I’m guessing no one thought to sterilize it.

  • Heidi

    Even if the midwife thought it was “just” a panic attack, I still don’t get why she nor the husband called an ambulance. When I worked in the ER, we took panic attacks seriously. Firstly, we confirmed with vitals and an EKG that it wasn’t something else, but even when it was a confirmed panic attack, the patient was still treated. A mental health problem was still a health problem.

    • Sue

      This is what concerns me about midwifery training being separated from nursing. A midwife who is a specialist nurse will learn these skills from a wide range of settings, because hemorrhagic shock is (thankfully) rare in the post-partum setting.

    • AirPlant

      And on a purely practical level, a mother having a panic attack is not going to do much in the way of bonding. And just being practical, you don’t want somebody in the middle of a panic attack holding a smooshy newborn, particularly if they are holding them over a pool of water where they might drown.

  • Sean Jungian

    How did the whole “healing birth” idea get going, anyway? Was there a popular book written about it? How did the idea that having a subsequent vaginal birth at home would “heal” a woman from a supposedly traumatic birth event take shape?

    • yentavegan

      it was a marketing tool used by lay midwives.

    • mostlyclueless

      I understand it. My first birth was the worst experience of my life. When I hear people tell joyful birth stories, I desperately wish that could have been me, and I hope that the next time I give birth I can experience at least some fraction of that. I won’t take any risks with my baby’s life to achieve it, but wanting it is easy enough to understand, I think.

      I’m sure a lot of people here will disagree with this, but I think childbirth is a powerful, transformative experience. There is no greater dividing line in my life than the line between my life before and after having my daughter. Moving cross-country, graduating college, defending my PhD, marrying my husband — all of these were significant, life-altering, identity-defining experiences — but none transformed me as powerfully as becoming a parent did.

      I think it’s ok, and normal, to want that transformation to be a memory you can look back on with pride and joy instead of fear and shame. I’ll never cross over from non-parent to parent again, but I think it would be healing and in some way it would be permanently part of my identity to have that joyful birth experience that I didn’t get the first time.

      Again, I wouldn’t jeopardize my baby’s health to get it — but I completely understand the desire.

      • Sean Jungian

        I don’t mean that I can’t understand why a woman would want a better, more joyful experience when giving birth, because of course I can understand that.

        What I mean is, how did it become such a prevalent idea that an unmedicated home vaginal birth would somehow “reverse” a poor/disappointing/traumatic previous experience? How did it become so popular? Who was pushing this idea initially, and why?

        It’s just not a clearly logical progression of ideas, to my mind.

        • mostlyclueless

          I don’t know why unmedicated home births became the standard, but it makes perfect sense to me that if you had a bad experience with something once, having a good experience with it the second time would mitigate the pain from the first bad experience. Getting back up on the horse, so to speak.

          • guest

            Yes, a second chance. And a sense of “practice makes perfect.” Not that a second birth is guaranteed to be better than a first – not at all! But having gone through it once, it can feel like you’d have more control – if not of the total physical birth, of how you understand and process it, because you’ll know which parts are like the last time (familiar) and which aren’t.

            I would like another go, except for not wanting any more children. I would still choose a hospital birth. I might or might not go back to my midwives (CNMs, very competent with good relationships with the doctors). I might or might not choose MRCS (if a doctor approved me for a VBAC). But I would like the chance to do it again and have more confidence and a more coherent experience.

            But it’s not a big deal to me that I won’t get it. What I really need is for someone close to me who lives close by to have a new baby so I can snuggle it. I’m feeling very strong urges to snorgle a newborn lately. But I’m afraid to even ask new moms unless they are very close friends or family of mine.

        • Erin

          Because the dialogue goes something like this:

          Your birth would have been natural and perfect if “male” doctors hadn’t intervened in some fashion and since consultant who thinks you are committing infanticide won’t be at your home birth, he can’t ruin it for you.

          I’ve had people tell me that my pelvis shape (not optimal) and my husband’s family tendency to produce big headed babies (turns out that regardless of baby size, heads seem to be on the 85th or larger percentiles) didn’t cause my section. Doctors did. Their narrative gets a bit thrown my case because my waters went of their accord before labour started and also because no one intervened until around hour 60 by which stage I was in labour and over 5cms plus I pushed. But I can see how some women get sucked in because I nearly did. Ended up here instead but it could have gone the other way.

          My trauma group is full of people planning healing births. Trying to point out if birth was that “easy” they wouldn’t be in a birth trauma group usually falls on deaf ears.

        • Margo

          Ask the women who decided, on their own, not swayed by hype re Homebirth, why they chose a Homebirth following a less joyful birth elsewhere. They may or may not give you an answer that you or I can understand, but it makes sense for them, and that I think is all that matters, their decision to home birth makes sense to them on many many different levels. Where they might/do get let down is when a health professional fails to keep them safe, if and when an emergency arises, much like even in hospital, sometimes, health professionals get it wrong and signs of impending danger to mum and baby are not recognised. I have worked with women having birth at home because the previous experience was not up to their expectation, whatever that expectation was….even if the outcome was live baby and mum, for them something was missing and in pursuit of that something missing they choose to find an alternative way…Homebirth….a choice they make, I believe, in pursuit of healing their psyche …..and, I have heard women postnatally state they felt healed, blessed, whatever words they use to express their feelings re birth. It’s complicated on so many levels. We need to look at why women find hospital, the without doubt safest venue for birth when an emergency occurs, choose not to avail themselves of that option. What are we doing wrong/unsatisfactorily in the hospital setting that turns a woman to seek other choices.

        • I think it’s because it can seem like the NCB people are the only ones not saying “at least your baby is healthy” in response to women feeling traumatized. I mean, I know that the outcome is what matters. I am eternally grateful to the people who saved my son’s life when he was born. Of course his health is all that matters. But I will never think of his birth without thinking of him blue, not breathing, hurried off to NICU. The silence when he didn’t cry. The pain right before they knocked me out with Ketamine. The long, hard recovery after an inverted T and a lot of blood loss. That stuff was BAD. It was hard to deal with, and when I got pregnant again it started coming back in waves of anxiety that I really didn’t expect. If I was more woo-curious, and if I didn’t know for a fact that my uterus is a battlefield, I might have been susceptible to someone starting with the eminently true “that was awful and you are clearly freaking out” and then trying to lead me by the hand to the less-defensible “and the answer is VBAC,” or the reprehensible “and the answer is HBAC.” As it was I had a “healing” scheduled C section.

      • CSN0116

        I am an extremely unemotional, detached person, so it’s hard for me to identify with the empowering/transforming stuff. In fact, I don’t comprehend it at all, BUT I can see how and why others might feel these things.

        However, making those feelings central to an event (birth) is where I just get lost all over again. Especially an event so dangerous and so unpredictable. I’d rather gain feelings like empowerment from something I can actually dictate and control, so that in the end I can say that I actually owned it. If something goes wrong (or right) that I had complete control over, then it’s on me and I can bask in my glory or failure.

        I’ve also given birth many ways haha – cesarean under general anesthesia, medicated vaginal and un-medicated vaginal. I was very scared and very traumatized every time. Birth is an incredibly physically and emotionally traumatizing thing to experience. It is the most extreme function your body can really perform. I was waiting on the *safe* arrival of something I wanted and loved more than anything – and I was powerless to control it or predict how it would end. It was never until the birth was all over and the baby was checked that I felt any sense of relief or enjoyment. I was scared fucking shitless every time. I couldn’t imagine mustering anything that even remotely resembles empowerment from that. But maybe I was doing it wrong? lol

      • BeatriceC

        But where did those feelings that birth had to be a certain way come from? It’s certainly not “natural”, as women have been both joyfully anticipating and fearing childbirth since the dawn of time. It’s only been since obstetric care has made a good outcome almost guaranteed that we’ve begun to look at childbirth as a positive experience. Throughout history, most women were just relieved both they and the baby made it through the process alive.

        As for rituals surrounding birth; there have been those. Most cultures have some sort of naming ceremony a week or so after birth, when it became apparent that the baby had a decent chance of survival. There’s the Jewish Bris, the Catholic (and some protestant denominations) infant baptism, and various other ceremonies from different cultures throughout history.

        What would happen if women weren’t sold a bill of goods about childbirth. What if we were honestly educated about how much childbirth hurts, and how it’s fraught with complications, then educated as to what interventions can save our lives and the lives of our babies when those complications happen? What if we were told the real, honest rate of these various complications in the era before modern obstetric care? Maybe, just maybe, instead of being disappointed that our bodies “failed us”, we’d be appreciative of the technology that gave us our healthy babies, and could deal better with the recovery from traumatic births. But until people stop lying to women about what childbirth is really like, and start telling them the truth, these disappointments are going to happen.

        • mostlyclueless

          I think you’re touching on a lot of different topics here…I think one can be educated and flexible about birth and still have a horrible, terrible, no-good experience, and be upset about that. I did. I knew what I was getting myself into giving birth and while I knew anything was possible, I certainly hoped for an uncomplicated, generally positive experience. I didn’t get that. I’m grateful that my daughter and I survived, but I still hope that my next time giving birth goes better.

          That said, I absolutely, 100% agree with people being honest about what childbirth really is like and erasing the narrative that you just need to have a good attitude and you’ll have a good time.

          • BeatriceC

            I think you just illustrated the point I’m trying to make. I’m terrible with words. That’s why I’m a mathematician. Well, that and I’m lazy.

            Anyway, you had a terrible experience, but you knew what you were getting into and were able to come through saying “that sucked and hopefully it’ll be better the next time”, without declaring yourself a failure or blaming everything but the shitty way our bodies evolved. You’re not going on and on about how you were deprived and you just don’t love your kid as much because it wasn’t a textbook perfect birth with angels singing and flowers spontaneously blooming in midair above you.

          • mostlyclueless

            But I still feel sad when I think about how awful my daughter’s birth was, and scared of going through something like that again.

            My only point is that it’s ok for the process to matter to people, it’s an important life experience.

          • Megan

            FWIW, I agree with you. There is a distinction between wanting the process to go well/be pleasant and valuing it over the outcome of having delusions about how the process could be.

            My repeat CS this time around was a much more pleasant experience than my first delivery. I am happy it was pleasant. That doesn’t mean I’d value that experience over having a healthy baby or think that means birth is sunshine and rainbows all the time. I’m just happy it went well.

          • CSN0116

            So what experience would vindicate you? I don’t know what went wrong with your daughter’s birth. But what process are you looking for …in a perfect world?

        • Amazed

          Yeah, that’s it, isn’t it? They want to give birth like women did “in the good ole days” but carrying their own 21st century mentality of the process being sacred, joyous and oh so empowering. They deny that was ever the case or they say even if it was, that was because of poor hygiene and women being scared into fearing birth. At least women of the good ole days had the common sense to strive for the highest medical care their setting had to offer. It was midwives and natural not because it was sacred, special and empowering but because there simply wasn’t anything better. Homebirthers look down their noses at the better – and no one can convince me that they don’t know it’s better, else they wouldn’t be screeching how close they live to the hospital that could pick their beloved midwives’ shit. Oh and be sued for not being able to turn time back and undo said shit.

      • CSN0116

        Additional thought: I think I could have calmed and enjoyed birth had it been painless (which some people achieve with properly timed and placed epidurals) while still having my wits about me – clear head, conscious, aware. If alllll of that could come together with an uneventful birth, then *that* would give me joy and have the potential of empowering me 🙂

        But that ^^^ above is damn near unheard of lol :/

        • Sean Jungian

          I don’t know – that pretty much describes my experience. It wasn’t *painless* but it was probably as close to painless as you can get and still be awake. It was uncomfortable, certainly. I don’t recall feeling any transcendent joy or really any emotions at all while laboring and giving birth other than being tired and just wanting it to be done already so I could meet my son.

          Now afterward, yes, I was VERY happy, joyful – it was done and he was healthy.

          Anyway, I just have had a hard time understanding how one particular moment like that starts to overshadow everything else. But I suppose it’s like how people only care about the wedding and don’t think much about the marriage afterward.

        • Rosalind Dalefield

          Two words: Fentanyl epidural.

      • KeeperOfTheBooks

        I kind of identify with what you’re saying here. For me, DD’s birth wasn’t at all traumatizing, but the next 10 months or so were. (Various recovery problems, rabid lactivism combined with no supply, suicidal PPD, etc.) I’m looking forward to the current baby’s birth in part because it would be nice to experience a baby’s first year positively, rather than as a vague blur of pain and fear and wanting to kill myself all the time. I’d like to genuinely enjoy those laughs and milestones and whatnot, to snuggle a baby during feeds while not stressing out of my mind about *how* baby’s being fed or if baby’s getting enough, to remember more than one or two moments over 10 months. Ten months! I can’t remember the first time she crawled; no idea when she walked for the first time; can’t remember her saying “mama” for the first time.
        This time, thanks to antidepressants and more realistic expectations, I’m hoping that won’t be the case. It won’t eliminate the bad or nonexistent memories of DD’s babyhood, but having things go better would be healing, in a way. I didn’t really bond with DD until she was about a year old because of the depression; it would be nice to feel loving to my baby, rather than angry/resentful.

    • namaste863

      It’s rather silly, isn’t it? Then again, my attitude towards my own life and kids is that a live, healthy me and bub is the goal (Sane would be nice, too, but with a newborn, I’m not going to stand in a bread line and ask for toast.) If things go off on an unexpected track, then it goes off on an unexpected track. So what if it doesn’t go exactly the way I’d pictured it? If it takes an intervention or two, well, then that’s what it takes. Hooray that they’re available and that I have access to them. But that’s just me.

      • KeeperOfTheBooks

        You’re not the only one. At my first prenatal appointment for this pregnancy, my OB asked if I had any “goals” for my birth. I said, “That I walk out of the hospital holding a baby, both of us as healthy as possible.”

      • Sean Jungian

        I’ve found a previous post by Dr. Amy that addresses this subject, and she names Ina May Gaskin. So I suppose that’s a place to start.

        Personally, my “birth experience” (if we are calling it that) was…fine. Okay. I hated being pregnant, went into labor and was uncomfortable, went to the hospital, labored some more, and then I wasn’t pregnant anymore. No emergency last-minute things. It was fine. But where did we get this idea that it is supposed to be, as @mostlyclueless:disqus posits, a transcendent transformative experience?

        Maybe I didn’t ponder it enough or something. I joined BabyCenter, followed along. I went to my prenatal appointments. I had an unremarkable pregnancy and an unremarkable birth, And that was more than OK with me, all I wanted was to get through it with a healthy baby and a minimum of pain, so in that sense I got what I wanted.

        The transformation came AFTER giving birth, when I met my son; conversely, I could say it happened DURING pregnancy, as I was coming to grips with becoming a parent. But just the birth event itself? I don’t know how so much importance got assigned to it, and it does seem kind of foolish to me.

        • The Bofa on the Sofa

          I’ve said it before: HAVING A BABY is a transformative event. It’s pretty amazing, if you think about it – one moment, you don’t have baby, and then, suddenly, you have this new little person who is going to depend on you to grow up. It’s amazing, especially with the first. You go from not being a parent, to suddenly, you are a parent. It’s an incredible transformative event.

          And it has NOTHING to do about how it happens. It can be a vaginal birth. It can be a c-section. It can be flying to a hospital 2000 miles away to get the baby you are adopting. It’s all transformative.

          • mostlyclueless

            I know I’m not going to change any minds here but I can completely understand why the process matters to some people. As humans we tend to mark major transitions in our lives with objectively “pointless” ceremonies. When we get married, we have a wedding. When we graduate, we have a ceremony. I think it’s a deep part of our psychology — every culture that I know of, going back to the beginning of time, has had ceremonies to mark major transitions in life. Labor is (usually) a long, drawn out process that, I think, serves that role for a lot of parents — it marks the transition between having that baby and not having that baby, and it’s a deeply emotional time.

            It’s ok to say that how the baby gets into the world doesn’t matter to you. But it does matter to a lot of people, and I don’t think they’re stupid or missing the point.

            I come to this blog because I am a scientist and I see SO much misinformation about pregnancy, childbirth, parenting, etc. that makes me irate. But I think it’s really important not to have a knee-jerk reaction and say exactly the opposite of whatever the NCB advocates say — i.e., just because “they” say that childbirth is an important and moving experience doesn’t mean we have to shoot back “no it’s not, the process doesn’t matter AT ALL.” The process of bringing my daughter into the world was massively important to me and those memories will stay with me with great clarity for the rest of my life.

          • Susan

            I agree and I bet most people who post here would too. I care very much about my patient’s having a good experience where her personal priorities and values are respected and she feels safe, not just physically but emotionally. Not being invested in one right way but supporting any safe choices, and even respecting the patient’s right to decline something that is in her best interest, is part of good ethical care. Also, when people feel respected and that their needs are being met it builds trust and they are more likely to listen. Plus, it’s just the right way to treat other people!

          • Roadstergal

            “It’s ok to say that how the baby gets into the world doesn’t matter to you. But it does matter to a lot of people, and I don’t think they’re stupid or missing the point.”

            But the point is that it’s not a process that’s under their control*. Making something so unpredictable matter so much… I mean, that just doesn’t seem reasonable. Like trying to make someone love you. You can do what you can, but there’s a lot of it that’s not up to you.

            And the most reasonable way to make it under your control is to have a pre-labor C/S when you hit viability, but that seems a very rare way for women who had a bad experience to ‘take control.’

          • mostlyclueless

            If my husband stopped loving me, I’d be devastated, and if someone tried to tell me that I should stop feeling feelings about it because it’s beyond my control, that would be salt in the wound.

            It’s ok to be upset about bad things that happen to you beyond your control. It’s ok to be upset about a bad birth experience, even if you got a healthy, live baby out of it.

          • Roadstergal

            Hm, I think the disconnect in this conversation is that I’m not talking about ‘feeling feelings,’ but about ‘this process has to go a certain way or it doesn’t count and I need a mulligan where it goes the right way.’

          • Amazed

            Of course it’s ok. Problem only comes when you’re so upset about a bad birth that you place yourself and your next baby into a far greater danger because you think this time you’ll get a better birth. You might. Especially if the traumatic birth was your first. But you’ll never get a safer birth out of hospital.

          • Erin

            How it happens does have an effect though if like me you end up so ill it takes you six months to accept that said baby is your baby and a further six to get to the point that picking them up doesn’t make you feel like someone has a hand in your chest, crushing your heart.

            I know my experience was unlucky and hopefully rare but it didn’t so much transform my life as delete a year of it.

            So I can easily understand why a woman who feels similarly about her experience might get lost in the process rather than the outcome. When the process is your sticking point, your nightmare that keeps you up at night frantically trying to get control then seeing beyond it is virtually impossible, and anyone who disagrees is the enemy.

            I’ve come to the sensible conclusion of no more children because I can’t control the process but even so I still have the odd “what if I did x or y” thought.

          • Dr Kitty

            Erin, I know you had wanted more children, but given your awful experience, that seems entirely reasonable. I hope you’re OK with it.

          • Erin

            Okay is a relative term. Will I feel guilty for the rest of my life, probably. Has it damaged my relationship with my husband and his family, absolutely. Do I feel like punching people when they ask when we’re thinking about the next one, yep. Am I bitter about it, very.

            However despite all that, it’s still the lesser of the two evils. Unfortunately (for me)all my friends are planning their second/third this year and that’s when I think it’s going to get pretty unbearable.

          • PeggySue

            I hope you get more support from your husband as time goes on, though I don’t know if that’s possible. You have been through hell.

          • Erin

            He has been hugely supportive. He spent most of the first year working from home to support me (his employers are amazing), he has literally pulled me back from the precipice (we live near cliffs and the sea) more times than I care to remember. The problem lies in that he can’t understand why I can’t have another, can’t understand why I’m so terrified because he thinks I’m way stronger than I actually am.

            His family see one child whilst you have a working uterus as child abuse. If my sister in law can have more after a fourth degree tear, I’m being selfish and weak.

          • Tiffany Aching

            I’m so sorry for what you’ve been through. I don’t know if that helps but I’ve never imagined my life with more than one child, and I didn’t realize that a family of 3 could be seen as something unnatural. Maybe it is a cultural thing because I don’t think that an only child is something that is frowned upon here in France. I am completely sure that an only child can be perfectly happy with the company of his ou her schoolmates and cousins (and from what you’re telling about you sister-in-law, your kid will have several :)).

          • Sean Jungian

            Anecdotally speaking, I think of course it depends partly on where you live and the norms there.

            When I lived in Seattle, it was very common for mothers to be older like me (I was 37 when I had my son) and to just have one.

            When I lived in Louisiana, it was very ODD to people that I was so old and had a child, and that I only had one. I was often mistaken for his grandmother.

            In the rural Midwestern area I live in now, it is pretty standard for women to be slightly older (mid-to-late 20s and into early 30s) and to have 3 or 4 children. I’m still an anomaly here having an only child, and people still mistake me for his grandmother.

            Yet in my age cohort – my friends in my hometown from high school – about 25% of us have had only children, and the rest evenly divided between two and none. This is of a pool of about 100 people (men and women).

          • Tiffany Aching

            It is very true, for cultural and also very practical reasons : I live in Paris where real estate is insane so it is very difficult to have a large family if you’re not very rich ; people often move out of Paris after their second child… so obviously a lot those who stay decide to stop after the first.

          • Hiro

            Hey, me too! (The “live in Paris” bit) I’ll bet you we know each other glancingly somehow or have at least crossed paths. When I read this comment I was thrilled to realise there was another SOB reader/commenter near-by. I’m very happy to know this! 🙂

          • Irène Delse

            Oh, but that makes three of us, then! I live in Paris too. That’s amazing. ^^

          • Hiro

            Hooray! This comforts me. Perhaps we’ve met and never known it 🙂 Are you a knitter?

          • Irène Delse

            No, not a knitter, alas. But a book addict ^^

          • Tiffany Aching

            Hi ! I think Irene Delse who also comments here is French too :). Birth woo and is probably not as much developed here in France (and I really believe we have our healthcare system to thank for that) but it definitely gains traction if I am to believe what I hear from my friends (I a 35, college-educated, and work in the media sector, so kind of the demographic “target” of the woo-sellers).

          • Hiro

            We’re around the same age, you and I. Do you knit? If you do then we most definitely probably know each other somehow!

            I think the birth-woo is definitely growing. When I moved here I was very surprised how deeply entrenched homeopathy was, and on the whole the naturalistic fallacy is very very popular here. My mother in law is on the far left, and when we met she was already very “médecine douce” but now she’s more and more vocally anti-vax.

            When I fell pregnant I was prepared for busy-bodies and well meaning ‘advice’ (I work in retail so there’s no end of people and their assorted, Very Important, opinions) but I was surprised by how much of it was birth-woo. I didn’t think that it was that popular amongst my friends here in France.

          • Tiffany Aching

            Aha, I like to think Inknow how to knit but apart from the occasional scarf every 5 yerars or so I don.t really.
            Homeopathy is very mainstream here, and you can find it at every pharmacy, which make people believe it is legitimate. It is very often given to children for thing like teething, colics or bruises with a “what’s the harm” attitude. Personally I’ve always wondered how being given medicine for every little thing shapes our relationship to drugs – maybe our use of homeopathy is the reason why people feel cheated when they have a cold and the doctor simply tells them to rest and drink plenty of fluids. My former GP, whom I liked very much, told me once that people sometimes refused to pay if she did not write them a prescription for something. Sometimes she didn’t have the will to fight and wrote a prescription for homeopathy…

          • Tiffany Aching

            Hi ! i think Irene Delse who also comments here is French too. Birth woo is as much developed here (and I really think we have our healthcare system to thank for that) but it is definitely gaining traction if I am to believe what I hear from my friends (I am 35, college-educated, work in the media so kind of the demographic “target” of woo-sellers). In my opinion it is only a matter of time before we get our very own “Business of being born” (thank God Marie-Monique Robin is past he childbearing years).

          • Dr Kitty

            It does suck.
            But families come in all sorts of shapes.
            And if yours is just the three of you, so be it. You’ll be fine. One child has lots of benefits.

            We have a six year gap between #1 and #2, which was four years longer than we wanted (multiple early pregnancy losses, new job, lost coils…) I have perfected a tight smile when anyone comments about it, because no one knows the full story. I’m a lot more open here than I am in real life. For a long time ai thought we would only have one. It was fine.

            It is still early days, you might feel able to contemplate another pregnancy in five years, who knows.
            But really, who cares. You need to be the best wife to your husband, the best mother to your son and the best version of you you can be, not a vessel for more babies.

          • Erin

            I’m an only child and I hated it. Okay my parents fought all the time, my mother used me to discuss details of their fighting you really shouldn’t share with a child and my father had a job which meant moving house and country every 3 years. I think all those negative experiences put me in the mindset from a very early age if there were going to be children, it was always a plural and I hate the fact that circumstances out of my control mean that won’t happen. In a strange sense, actually being incapable of having another would be easier to deal with than choosing not to try because then it wouldn’t feel like a choice.
            In five years I’ll be over 40 and whilst the Irish Catholic side of my family tree is full of babies born to Mothers over 40, I really don’t want that myself. Self imposed limits I know but it would have been this year or next or never.
            Weird isn’t it. You lot know stuff about me that I couldn’t even tell the Psychologist who was meant to be helping with my PTSD. The internet has it’s uses. Typing is somehow a lot less personal than talking.

          • demodocus

            *imaginary hugs* Physically incapable can be easier to explain. ‘Course my usual explanation of “inconvenient scarring” could also work for you with nosy acquaintances . Usually, I don’t have to explain *where* the scarring is.

          • Erin

            Then they start suggesting fertility treatments.

            Yay for nosy acquaintances.

          • demodocus

            You have particularly persistant ones. You must be so thrilled. yay.

          • Erin

            Surrounded by quite a lot of long term breastfeeders, home birthers and SAHMs (although I’m currently the latter too).

            Makes for interesting toddler groups. I mean I’d rather wrestle an angry jellyfish than eat placenta and the only thing I can tolerate floating in the tub with me is my son’s plastic lifeboat crewed by a pirate octopus but I’m mostly the odd one out.

          • demodocus

            We should form our own group, lol.

          • BeatriceC

            “Weird isn’t it. You lot know stuff about me that I couldn’t even tell the Psychologist who was meant to be helping with my PTSD. The internet has it’s uses. Typing is somehow a lot less personal than talking.”

            I know exactly what you mean. I often times have an easier time typing things out on a discussion forum than I have telling my therapist or the people closest to me. Maybe it’s the anonymity of the internet. Maybe it’s that typing it out you have the ability to read what you’ve written and carefully edit what you’ve said before you hit “post”, which you can’t do when you’re talking to somebody in person. I don’t know, but sometimes it’s just easier to share those deep, dark personal experiences in this format than in others.

          • DelphiniumFalcon

            This. ^

            That and as I have to study faces very keenly to discern emotions since it’s not an innate skill for me, when I’m in such a vulnerable place every facial twitch looks judgemental. You can’t see the expressions of people on the internet.

            That’s been one of my biggest hurdles in therapy is finding a therapist that doesn’t automatically trigger my “omg they’re judging me so harshly right now” default reaction I have when severely depressed. So typing things out without that judgmental look helps.

          • Chi

            I said the same thing up thread a little.

          • Daleth

            Why haven’t you told your therapist this yet? I know from experience that it can be very hard to share our deepest-darkest with a therapist, but it is the key to healing.

          • Erin

            Stopped seeing her. She wanted to discuss my admittedly dysfunctional childhood and the rape. I don’t. I just wanted help disassociating my son from the rape trauma which I re-experienced during his arrival. Apparently I couldn’t have one without the other.

            On the NHS I can’t see anyone else as she is an expert on rape trauma…which I wont talk about beyond the abstract and whilst we could afford to pay privately since I can’t guarantee I’d talk about anything useful, I’d rather spend the 100 pounds a session on things which are useful.

            I’m still at the “I deserve this” stage and until I find a way through that, not sure that I’m capable of letting someone in.

          • Anna

            Where I live a one child family is very typical. I would say the majority of families are one child, a lesser part have two children and three children families are VERY rare. Even frowned upon by some) Which is not a view I share though. Just to make it clear that it’s more about the cultural background and/or religious beliefs, not one type of family being better or worse. A happy family is all that counts.

          • Chi

            To be honest, I find typing easier than talking. I’m a great talker, but when I try to explain my feelings, I tend to trip over my words and ramble a lot.

            When I type, I find it cathartic because it gives my feelings a tangible form that I can SEE (if that makes sense) and thus deal with more easily. It’s a lot harder to denote ‘tone’, but I can lay things out more logically and if I really don’t like what I ‘say’, I can take it back with the delete button.

            You can’t do that with talking.

            Plus with the anonymity of the internet, you can reach out, put yourself out there without the risk of anyone knowing who you are in the real world and judging you for it. People will still judge you here too, but it’s easier to ignore, especially since a lot of websites/forums have a ‘block’ feature.

            I feel for you. You went through a truly shitty situation and though it doesn’t feel like it, you really are doing the very best you can. I hope you don’t let anyone make you feel like you are doing otherwise. You have a right to your feelings, you have a right to not want to do ANYTHING to risk putting yourself in that situation again.

            And you have the right, to give yourself the time you need to heal. However long it takes.

            Nothing can compare with the trauma you’ve endured, but you’re not alone. I suffer from clinical depression and anxiety. Before I had my daughter, there were days where I couldn’t bring myself to get out of bed. Some days it’s still hard to get out of bed, but my daughter is depending on me to make sure she gets what she needs each day.

            I say it again. You are doing the very best you can. Don’t ever feel like that’s not enough.

          • MichelleJo

            This is my experience, not my opinion. If there is something that you cannot possibly do again, with me it was a repeat of the pregnancy I had just completed, then all other ifs and buts are your mind tormenting you. If something is not possible, it is not possible. Which is why I wanted to take immediate action to irreversibly prevent another pregnancy, and not wait because I may feel differently with time With time, you lose the ability to feel the intensity of the pain, and you start questioning your choice. Even doing something where there is a chance that you will have to do what you cannot, doesn’t come into question. And it doesn’t matter if you have ten children or one. From what you’ve written here, you definitely cannot go through that again. And you are pretty clear about that. So what everyone might say, and the chance that had you done things differently it might not have happened are irrelevant. Short of being prophetic, you cannot possibly get pregnant knowing that it will not happen. And from my experience, once you’ve set it in stone, what’s done is done, and you won’t look back.

          • Erin

            Unfortunately if I could get my tubes tied, I could also try for another baby.

            Thanks to the unfortunate circumstances surrounding my son’s arrival, hospitals and operating theatres have become triggers for a pre existing trauma and I’m terrified that going anywhere either would put me right back.

            Glad it worked for you, no sex is starting to get a bit depressing.

          • Kq

            What about essure? It’s nonsurgical

          • Erin

            You still have to go to hospital, in my case the same one my son was born in for it in this country. Plus my GP is not keen to refer for any sort of permanent procedure because he thinks my judgement and decision making ability is understandably flawed at the moment when it comes to baby related stuff.
            The Psychiatrist whose “care” I’m under agrees.
            Although if I have another baby neither of them have an issue with it being done at the same time as a repeat section…

          • Charybdis

            Hmmm…..Have you considered an IUD? The insertion is uncomfortable, but is is an office procedure, a lot like a regular GYN exam, with Pap smear. The Mirena is hormonal (localized to the uterus, it isn’t like taking the pill) and lasts up to 5 years. Paragard (the copper one) is good for up to 10 years. The Mirena also has the potential bonus of causing your period to stop, because of the thinning of the uterine surface. I think I spot for maybe a couple of days each year. I love my Mirena.

            They are kind of the best of both worlds…temporarily permanent, if you will. As long as they are in place, they keep you from becoming pregnant, but they are easily removed if you do want to get pregnant at some time in the future. Nothing to remember to take or time, you just have to check for the “tail” once a month or so.

            A blunt, frank conversation with your doctor about your situation and maybe some specialty medication for the insertion (valium or similar, or maybe the stuff they use for colonoscopy where you don’t remember the procedure or the conscious sedation used for other procedures). It could take the “holy shit, I don’t EVER want to get pregnant again” worry off your mind, so it would be one less plate to keep spinning.

            I really, *really* wish there was something I could do to help you; even if was only taking you out to lunch or to the spa for a mani/pedi, or both….LUNCH and a MANI/PEDI. Or babysit so you could do whatever you wanted to do. Hang in there.

          • MichelleJo

            Erin, I see your problem, and why what worked for me isn’t an option for you. But the fact remains that you cannot have another baby, and that is true even at the expense of your marriage. Of course your marriage is of extreme importance, so you need a solution that can prevent you becoming pregnant, but doesn’t preclude living a normal married life. You really are in an impossible situation, but I still think there has got to be someone out there with a solution. Often, the way you present the problem affects the advice given. I don’t know that you haven’t done this, but the question has to be asked as succinctly and clear as possible, stripped down to the bare bones so the dilemma is completely clear. I would say that the question is, what are the option/s for a woman who cannot undergo surgery and cannot become pregnant when she is in an active marriage. Those two cannots are absolutes, you are not asking for a solution to enable either of those options. Although I do work in the health field, it is in a different field and it is not a question that can be poised to me. There are plenty of professionals on this board however who have the knowledge to consider the problem, or knowledge of someone else who could. And wherever you live, try and hunt down someone who you can present the question to. I really feel for you, and wish you the relief of complete of mind very, very soon.

          • Chi

            You are not alone in getting angry/resentful about being asked when the next one is coming.

            My birth wasn’t traumatic. In fact aside from a couple of decels here and there and the need for an episiotomy, it was pretty textbook.

            My two cousins (whom I’ve always had a pretty close bond with) also got pregnant around the same time and they each had theirs a few months after me.

            My youngest cousin is due in April with her second (my daughter turns 2 in April) and her sister is likely trying for her second. Several of the women who were in my antenatal class have also had or are pregnant with their second child.

            And so EVERYONE keeps asking me when I’m having my second and I am getting VERY sick of it. Yes, I DO want another child but I’m a very practical individual and there are several factors we need to sort out before we are even READY to have the second child:

            -We are currently renting a 3-bedroom house. My daughter has one room, my hubby and I have the master bedroom and my younger brother boards with us in the 3rd bedroom. It’s because he boards with us and pays rent that we are able to comfortably live on a single income.

            -Therefore in order to even have ROOM for a second child, we’d either have to kick my brother out and lose that income, or move to a bigger house. Which would probably mean more rent and hubby has said that if we have to move, he would rather us move into a house we are going to own.

            -In order to own our own house, we first need to clear out some personal debt, which we are about 4-5 years away from doing.

            -I would like to try and lose some weight before I get pregnant again. Which is turning into a real struggle between depression and me injuring myself (right now I’ve sprained the MCL in my right knee).

            So we are about 4 years away from even being ready to TRY for the next child. I just wish people could accept that and stop asking, because it really does irritate me. How is it any of their business?

          • Erin

            It’s not. I refused a glass of wine the other day (headache) and assumptions were made. It’s frustrating to say the least.

          • CSN0116

            Oh, my. That sounds terrible. I cannot fathom 🙁

          • Stephanie

            Erin, a bad delivery can change family planning in an instant. This is my mother’s story, and mine. You aren’t alone. My parents hadn’t planned to on my brother being the youngest of the family until he nearly died, almost taking my mother out with him during his birth. When I was pregnant with my first, my mom explained that not only did she not love my brother for a long time, she couldn’t look at him without having a panic attack for the first 6 months, never mind hold him. My aunt had to come stay with us to take care of him. My mother touched him for the first time when he was 7 months old. It took her a long time to put herself back together. And she started to love the person he was despite how he came into this world. To this day, they have a very close bond. He’s 25 now.
            I also had a bad delivery and hard recovery with my second, and didn’t like my daughter for a while afterwards. Though my husband and I had planned on more children, for 5 years, we were certain we were done. My husband still gets queasy when he thinks about what happened. Then I found this site, and learned about maternal request c-sections. It took another 2 years before I was ready again. I’m now expecting, and have a meeting with our obgyn to discuss my MRCS in 2 weeks. It took a lot of time, and a lot of therapy for my husband and I to be ready. My children will be 11 and 8 when this one is born.
            You seem resigned about your choice to have no more children. It’s okay to postpone the decision until you’re ready to make it. Give yourself time to heal before making the final decision. It may not change the outcome, but at least you will be confident its the right one for you. The next child conversation does not have to happen now. I know it’s hard when everyone else is building your family and you are still gluing yourself back together.

          • Rosalind Dalefield

            The idea that a woman has control of childbirth is false and I believe it leads many women to be far more traumatised by their experience than they would have been if they had just been told ‘You will be at the mercy of your smooth muscle, your pelvis dimensions and other factors you cannot control’.

      • BeatriceC

        “Sane would be nice, too,”

        My life is crazy-busy, with three teenagers, two of whom have major medical problems. Then throw in the healthy one with his long list of sports and music activities, and things just go nuts. It was even worse before I met MrC and had a partner to deal with all this. People would often ask me how I dealt with it all. My usual remark is “once you realize that sanity is actually optional for a happy, fulfilling life, it becomes much easier to manage.”

        • namaste863

          Hahaha! I hear you! When I was in undergrad (Psychology) I came across a cartoon, “The Top Ten Signs of Therapist Burnout.” My favorite item was

          You realize that your floridly psychotic patient, who is picking invisible flowers out of mid air, is probably having more fun in life than you are

        • Rachele Willoughby

          Chatting with a lovely lady at the WalMart fabric counter on a rare solo outing:

          “Do you homeschool? I don’t know why but, you look like a homeschooler.”

          “It’s the dark circles. And the crazed look…”

          • Rachele Willoughby

            Of course, my first thought was, “Crap. Did I forget to brush my hair again?”

          • BeatriceC

            Or my teeth. And did I manage to put on matching shoes today? Did I forget a bra again? When was the last time I changed my shirt?

            These are all questions asked by homeschool moms and mothers of infants.

    • FEDUP MD

      If anything, I had a healing elective c-section. My first emergency c-section under crash anesthesia due to inadequate spinal (yup, that means I felt them cut me open) was ….let’s say…. Not fun. Especially when the kiddo had birth depression (but is now fine). Healing for me was skipping all the worry about VBAC and ensuring I had a pain free delivery, was conscious for the birth, and had a healthy kid. But I guess that’s not cool to day to these ladies. 🙂

      • Megan

        That’s exactly how I feel about my repeat elective CS. It was awesome.

      • Me too. The first one was awful, the second one was great.

      • Rosalind Dalefield

        I had a healing second forceps delivery. Lift-out versus rotation, both of us treated really well, baby bright and alert versus requiring resuscitation and depressed for >24 h.

      • Amy M

        Well, the second birth, 12 minutes after the first, was definitely easier and faster….but didn’t do anything to heal the tear that happened with Twin A.

    • Chant de la Mer

      I don’t know where the general idea comes from but I do have personal experience with wanting a “healing” birth. My first pregnancy happened when I was 18/19 and I was desperately unhappy about the whole thing and despised the whole experience and then the birth was mildly traumatic as my son was over 9 lbs and had a very large head, plus it was incredibly painful and I had no access to any pain relief beyond Demerol which was frankly useless.
      So my second pregnancy, 10 years later, was planned as much as you can plan it out. I had a completely different experience and it was rather healing to experience pregnancy again in a healthy mental state as well as helping me recast my memories in a more positive light as I did love my first son and ended up bonding deeply to him. The second delivery was even rather healing as I got an epidural and it was wonderful!
      However I guess you could say that I wasn’t looking for a “healing” birth more of a healing experience of becoming a mom. And not because of anything I’d heard about, just my own history of trauma which was more about my poor mental health in my first pregnancy.
      So TLDR: yeah I was seeking a healing birth in a way but only because I was so messed up the first time and my healing birth definitely just involved not being scared out of my mind and excited about the baby and that involved the full amount of care available.

  • MaeveClifford

    This has been eating at me, so I’m just going to ask you guys, though I apologize for the hijack: Through an online forum I know a woman who is planning a HBAC of twins. This birth will occur less than two years after her first delivery, also of twins (ART was involved). She has declined most prenatal testing. I’m just so terrified for her babies. Every time she posts about her plans, I get a knot in the pit of my stomach. What can I possibly say? I don’t get the impression that ANYTHING I say will change her mind. She posted an apology letter — to her body — on her blog, for the induction and resultant cesarian. She lambasts medical personnel for playing “the dead baby card.” What can be done? I want to scream every time she talks about what SHE wants from the birth. I am hoping against hope that her NHS midwife is really, really good. I am hoping everything goes smoothly. I’m hoping that I don’t get myself banned when I snap and tell her she’s selfish for putting an ambulance on stand-by just so she can get the perfect, healing birth, nevermind what’s best for those babies. *Ahem*. Anyway. What the heck do I do?

    • demodocus

      i have to completely ignore certain threads on my Ravelry due date group, and none of them are taking as big a risk as that.

    • yugaya

      HBAC of twins with no adequate prenatal care to determine if there are any additional risk factors? All you can do is prey that she gets to take her vagina victory lap with both babies unharmed and alive in her arms.

    • mostlyclueless

      The most likely outcome for her is that she’ll get an emergency transfer to the hospital and some competent staff will clean up her idiot midwife’s mess. I doubt there’s anything you can say to change her mind.

      • MaeveClifford

        To be fair to the midwife, this woman has basically strongarmed the NHS. They have to provide a nurse midwife, even if the patient is going AMA by doing a homebirth with those risk factors. I’m hoping the midwife was picked because she’s good with recalcitrant patients, and didn’t insert herself into the situation because she’s a glory hog. If this was the US, I’d have no faith whatsoever in the birth junky CPM was involved. Just hoping the nursing training will count for something here.

        • Amy Tuteur, MD

          It happened in Australia.

          • MaeveClifford

            Sorry if that was confusing, Dr. Amy, I was replying to a tangent I posted about an upcoming UK HBAC of twins, not Caroline Lovell’s horrifying homebirth death. Demanuele gets no defense from me!

            I’m just hoping the mum I’m talking about has a better outcome.

        • mostlyclueless

          I was too quick to judge the midwife, then. Hopefully she will transfer at the first sign of trouble (that sign being a woman with a previous cesarean in active labor with twins.)

    • Erin

      I don’t think there is anything you can do. I know of one person whose healing birth got her a child who is severely disabled (HIE) and apparently that’s a better outcome than a repeat section. Some people are lost to reason.

      • Sean Jungian

        And these are the same people who will turn around and declare that you’re too selfish if you don’t even TRY to breastfeed.

        • MaineJen

          I believe the correct term is “shit mom.” You’re a “shit mom” if you don’t try to breastfeed, but you’re a heroic warrior if you almost kill your baby trying to have a home birth against all sane medical advice. Makes perfect sense…

        • MaeveClifford

          She’s convinced the cesarian ruined her breastfeeding chances with her previous twins.

          • Amy M

            Oh of course it was that, not that breastfeeding multiples is difficult for most people.

          • Sean Jungian

            Now I’ve heard everything. Holy moly.

      • Dr Kitty

        That’s hard for me to understand.
        By the end of my recent pregnancy, ERCS was the only acceptable outcome. I just wasn’t willing to gamble with my baby’s IQ or my pelvic floor.

        Raising a child with a severe disability is so hard. I wouldn’t choose it for myself, and I’d take every measure to avoid it. By choosing ERCS I DID take every step to avoid it.

        Maybe I’m crazy, but the seven days of discomfort after my CS were so worth it. I know that CS isn’t always an easy or straightforward recovery, but HIE is a lifetime of care for a child who should have been healthy. No contest in my eyes.

        • Erin

          It’s hard for me too and you know my reaction to my section. I’d like to think that if the worst happened and I found myself pregnant again, that despite everything I’d be brave enough to put my child first.

          That’s the thing, even with what happened to me, I’d take a year of anguish, misery and suicidal thoughts over inflicting any sort of injury or avoidable pain on my child.

          I clearly suck at this motherhood lark.

    • CSN0116

      With limited prenatal testing does she even know the chorionicity of the twins?!

      Ironic thought of the day #2: Will use ART to achieve pregnancy. Will demonize medicine upon delivery of said pregnancy.

      • demodocus

        doesn’t make sense to *me* but then i always assumed one healed *from* giving birth not *by* giving birth.

        • momofone

          It’s like healing from a traumatic car accident by ramming your car into a pole.

          • Roadstergal

            And not getting those unkind EMTs involved the second time.

          • Azuran

            Ah yes, the EMTs were just so annoying after my car crash. They ruined the whole experience by treating my injuries and asking me repeatedly what day we were, what’s my name and who’s the president.

          • Roadstergal

            “I woke her up twice in the middle of the night
            To ask what her name was, and where she might live
            To ask how many fingers she saw in this light
            To ask if she might know what gives?”

            Only The Song Survives, the only song I’m aware of about a concussion – as someone who has had two of ’em, I rather like it.

      • Madtowngirl

        It’s really an odd phenomenon. There seems to be a small subset of women who conceive via ART, who get completely swept into the woo/natural crap. Several women on my forum did. The only thing I can come up with is that it’s some way that they feel they can “take back control” of their bodies.

        • CSN0116

          Whatever. Just thank science and move the fuck on…

          There’s just narcissism fucking EVERYWHERE.

          • The Great Queen Spider

            I think you’ve hit the crux of the issue. These ladies only seem to care about themselves, to feel “empowered,” not rational.

      • MaeveClifford

        Since they put back two embryos, pretty sure she just assumes they are fraternal.

        She’s gay, so infertility wasn’t an issue, and she got pregnant the first IVF cycle with both the previous twins and these. Plus her pregnancy went very well until ~38 wks. I think the cesarian is, to her, the one imperfection, in an otherwise picture-perfect family building experience, and she can get it back with a perfect homebirth.

        But yes, I absolutely agree with you. I actually know (in real life this time) a woman who lost both her ovaries to cancer, and just managed to get some embryos frozen before losing her fertility. She’s posted a few things on facebook about maybe wanting to try a homebirth. In that case I rushed in all HONEY NO. I will vehemently do so again if necessary. Multiple abdominal surgeries, nulliparous, BMI over 30, AMA, and just the complications I know about. I’m hoping once she actually goes through the implantation process, she realizes how hard-won and precious few those embryos are.

        I just think for some women, homebirth is seen as a vindication of their wholeness? Maybe they couldn’t get pregnant “the old fashioned way,” but they’re not broken, they are able to “accomplish” this womanly feat of pushing a baby out “the old fashioned way.” Also, some may feel that life owes them one. They had to deal with all that strife getting pregnant so they “should” be rewarded with a perfect, easy, empowering birth at the end of it all. None of it is rational, but as a spectator, that’s the kind of emotion I’m picking up.

        • Daleth

          Omg that’s so scary and insane. I went through every intervention known to man to finally have my twins, and once I found out they were mono-di twins (we put back one embryo and he decided he wanted a brother!), I got risked out of the hospital midwifery group I was with and ended up choosing a cesarean delivery. I heard of another assisted-reproduction mother who chose a cesarean because to her it “felt like a police escort through the most dangerous part of the process,” and I totally agreed!

          • Amy M

            Ha! I had that same thing happen to me, Daleth—put back one embryo, got two babies out of the deal. 🙂 I was given a choice at one point, probably before we even knew there were twins, to pick a CNM or an OB for my prenatal care/pregnancy management. I chose an OB right away, because I figured it was safer in case anything went wrong—made the right choice there for sure.

    • Valerie

      The other commenters are probably right, that you can’t say anything to change her mind (especially in a forum… a conversation in person is better). There just aren’t magic words to say to break people out of delusions. I’ve had some success asking people if they care if what they believe is true (not about homebirth- about religious or political beliefs). I remind them our brains are wired in such a way that our beliefs are subconsciously biased by internal factors (eg is it comforting? does it feel right? does this confirm my existing belief?) instead of objective information from the outside world. If you care if your beliefs (eg my babies will be healthier if born at home, it is better for me psychologically, etc) are based in reality, you need to try to disprove them. It sounds like your friend hasn’t even assessed these- she can’t know the risks of herself having twins at home if she hasn’t seen a doctor, but she could easily look up that even the most homebirth-friendly health systems do not recommend homebirth VBACs for twins because of the added risk. The risks exist whether or not she makes herself aware of them- this is objectively and obviously true, but she might not have considered it.

      But yeah, it depends on your relationship to her, if she values your input, and if she’s able to even consider that she might be wrong. I have a hard time keeping silent when I perceive that my silence is implicit agreement, so if I were in your shoes, I’d probably say something privately if I thought there was any chance she might reconsider (and I was willing to lose her friendship if she reacted poorly).

    • Francesca Violi

      Beside pointing out what Valerie mentioned (twin deliveries + previous section being risked out from homebirth by every Health system), I would ask questions like: “wow, so your midwife must be very experienced, how many twins has she deliveried at home already? ” I bet the answer would be none, or a very very small number. I would then ask (in polite words) if she is feeling at ease with her babies being the training ship for this practitioner.

  • Madtowngirl

    This is absolutely horrific.

  • Commander30

    “The dreadful irony is that had Lovell given birth unassisted, she might be alive today. When she told her husband she was dying, he may have called an ambulance to summon real medical professionals.”

    Homebirth is horrifyingly dangerous, but this just proves that the “right” (more like wrong) midwife can make it even MORE dangerous. That is frightening

  • Daleth

    This monster should be in jail. But let’s pause for a moment to consider the delusional thinking that led Caroline Lovell to make this choice. When I read her letter, quoted above, I had to stop reading and just stare for a second when I got to this sentence: “…as a homebirthing mother I will have no choice but to have an unassisted birth at home as this is the place I want to birth my children.”

    No choice? You’ll have no choice but to give birth unassisted? Wait, why do you have no choice? …Oh… because home is where you want to give birth? WTF?!?! Let me translate: “If you outlaw people helping me do the dangerous thing I want to do, then I will have no choice but to do what I want to do alone, because I want to do what I want to do.”

    That IS a choice. It’s called “choosing something dangerous because you care more about having a shot at your ideal birthing experience than you care about safety.”

    • CSN0116

      Yes, sophomoric. The way a 14-year-old would rationalize “choice”.

    • Sean Jungian

      I noticed that too. Definitely Caroline Lovell was a true believer and chose Demanuele at least partially because she also was a radical true believer.

  • Francesca Violi

    “Had Ms Demanuele turned on the lights, Coroner White said she may have noticed the pool had turned a reddish brown” Now this sentence really gave me the creeps…I mean, I believed that assessing the blood loss was one of the most important things ever, for any midwife – exactly for catching the occasional serious haemorrage: and these midwives let their patient inside a water pool for one hour, in the DARKNESS! Without ever thinking of checking how much blood she was loosing! Unbelievable.

    • StephanieA

      At my facility we check mom’s bleeding every 15 minutes for an hour immediately after birth. The thought of just not checking at all is mind boggling.

      • Daleth

        My hemorrhage was internal. I would have died if it hadn’t been discovered–as it was I went into hypovolemic shock–and the only reason it was discovered is because I gave birth in the hospital and was on continual monitoring, so they noticed when my blood pressure started plummeting.

        • Margo

          Yep, and in a Homebirth, attended by midwives who care about safety you would expect to be checked for bleeding etc, same as in hospital, this is what is so frustrating for midwives who follow procedures to maintain safety…that there are practioners who do their own thing, for want of a better expression, who take undue risks. It is totally unacceptable behaviour and needs to stop. However, taking away the choice of Homebirth altogether is not the correct course of action either.

          • Daleth

            Yes, it’s beyond frustrating, it’s horrifying.

            But home birth midwives would not have detected my hemorrhage unless they happened to take my blood pressure at the right time (if they take it at 15-minute intervals, that’s long enough for me to have died of hypovolemic shock). Mine was detected because I was on continuous monitoring as I lay there in recovery, and alarms went off when my BP plummeted, causing a team of three people (I believe it was two doctors and a nurse) to come bursting in, literally running across the room, to save me.

            And even if a home birth midwife could timely detect this, they wouldn’t have been able to do anything to stop me from dying. The only way to prevent death in a person who’s going into hypovolemic shock is to administer immediate IV fluids. I, fortunately, had a heplock in my hand so the team that ran in to save me just popped an IV bag of fluids into it. I don’t know what else they did because I was so disoriented, freezing and panicky, but I understand they worked on me for a good ten minutes at least. My husband and mother-in-law, who were there, report that the doctors discussed whether I needed a transfusion, but I stabilized with just the fluids so they apparently decided not to take the risk. If I had needed one, though, there were bags of my type of blood right there in the room, ready to be popped into my IV.

            And this is exactly why hospital birth is inherently safer than home birth or birthing-center birth.

    • AA

      Midwifery of this type is not about patient care (and they don’t call them “patients” anyways…they are clients). It’s about ritual.

  • namaste863

    Oh, she’s an acolyte of Lisa Barrett. That explains everything.

    • Petanque

      By the way, I haven’t heard a single peep from the infamous Lisa Barrett for a year or so – she used to be nattering all over the internet, has she gone to ground?

  • moto_librarian

    I have to wonder how much Lovell’s bipolar disorder played into her decision making. Even if she wasn’t in crisis, her state of mind may have had an impact. We all know what the NCB culture is like – they cheer on even the most dangerous of situations, and anyone who dares to question dangerous advice is booted out of the echo chamber. Midwives like Demanuele reinforce the idea that it obviously can’t be that dangerous, or she wouldn’t attend the birth, and they also are skilled at the art of manipulation.

    I feel so sorry for her children, her husband, and her mother. She knew that she was dying, and the people she trusted ignored her, writing her pleas off as an anxiety attack. Demanuelle should be in prison for this.

    • Daleth

      I cannot believe her husband didn’t call an ambulance after she asked him to. (If indeed that’s what happened–I read one article saying that she asked him and said she was dying.)

  • yugaya

    This same midwife presided over three deaths in 18 months:

    -2011 death, she refused to transfer newborn for several hours: “More information about the 2011 death emerged in statements from the baby boy’s parents that were tendered to court by Slater and Gordon lawyer Michael Magazanik on Wednesday.

    The mother, who cannot be named, said in her statement that Ms Demanuele ignored her requests for an ambulance during the labour.”She told me an ambulance would be expensive as I would not be regarded as a medical emergency,” she said. Her husband intervened after two separate requests over three hours were ignored and called emergency services. The baby arrived at the Royal Women’s Hospital without a heartbeat and was stillborn.”

    – Midwife Gay Demanuele picked up Caroline Lovell as client only days
    after attending the funeral of that baby. Caroline Lovell gave birth and
    died in January 2012. Same midwife again refused to call the ambulance when Caroline requested.

    – 2012 death, the midwife again refused to transfer: “The un-named mother of the baby boy born stillborn claimed Ms Demanuele told her hospitals were “patriarchal” and doctors were “more concerned with timing and shifts and schedules than with the mothers” when they were planning her birth.“Gaye said hospitals placed no value on allowing the mother to have a natural experience,” the woman said.

    The woman was overdue with her baby when she finally gave birth in her home having been allowed to carry on for “so far” under the care of Ms
    Demanuele. The woman said in her statement that Ms Demanuele
    repeatedly refused to allow her to go to hospital during the homebirth,
    despite her feeling increasingly unsafe.”

    There is always a pattern to how these monsters operate, and usually a trail of dead bodies too. Gay Demanuele was not even suspended over any of these deaths, and only handed in her license after the third one in June 2012 to prevent being investigated by AHPRA.

    • Sarah

      What the actual f? How do people keep choosing a midwife with that kind of history? Was she misrepresenting her abysmal success rate? My heart is absolutely breaking here.

      • Sean Jungian

        I think the radical fanaticism of this particular midwife is actually what sold the mother on choosing her. The mother knew that the midwife would not question her and would approve her home birth (when she was actually high-risk and probably would not have been approved by a more practical and circumspect, non-zealot midwife).

    • namaste863

      Inexcusable. The only conclusion I can draw is that this crazy bitch doesn’t give a rat’s ass if babies and/or mothers live or die, as long as the pre-approved script is followed. She belongs in prison.

    • Daleth

      Never mind being suspended, how is she not in JAIL?!

      • Azuran

        Because, unlike any other medical intervention out there, birth has this sacred magical place where you can do whatever you want and there are not consequences because ‘bodily autonomy!!!!!’

        • Daleth

          The bodily autonomy argument is DOA the second Mrs. Lovell requested an ambulance.

          • Azuran

            But I don’t think that midwive is ever going to see the inside of a prison. Do we know of any other homebirth midwive who ended up in prison for killing their patients?

          • AA

            Prison, no, jail for a few days, yes (rare)

    • MaineJen

      Refused to call an ambulance 3 times (that we know of). Who else is willing to bet this had more to do with the fact that Demanuele might get into trouble than with the expense?

      • Sean Jungian

        I haven’t read it that way at all, but it’s possible. Something to consider. She did run back to Lovell’s house and get rid of all the evidence afterward.

    • PrimaryCareDoc

      It would be unusual for an OB to have more than one death of a full-term, healthy baby or a mother in a CAREER. This murderer has 3 in 18 months??? Unbelievable.

  • namaste863

    Let me get this straight- LOSING FUCKING CONSCIOUSNESS isn’t an indicator that something is seriously wrong?! How is that even possible? How is the patient passing out not alarming as hell?! And on that note, how could the “Midwife” have possibly not noticed that Ms. Lovell’s blood was in the pool, and not in her circulatory system where it belonged?! How in God’s name did she not think to herself “Houson, we have a problem!?”

    • Sean Jungian

      No, she was just anxious! Didn’t know what she was thinking, asking for the ambulance, just crying wolf! The poor dear was all jumbled up from childbirth and hormones, naturally, she didn’t know what she was saying. Demanuele was there to make sure the mother followed through on her commitment to home birth.

      • Petanque

        Exactly, she was there to “knit in the corner and protect the space”, i.e. prevent anyone from doing anything helpful at all.

  • CSN0116

    This stuff is just like the stories I hear of ignorant teens killing themselves over stunts. They often film it. There was chugging gallons of water (kids died and got hurt); the cinnamon challenge (kids died and got hurt); unsafe planking (kids died and got hurt); synthetic marijuana (kids died and got hurt).

    I could go on. But they were all fads …challenges. Except ignorant TEENAGERS fell for the risk and lost. Brains not fully developed to assess risk vs gain.

    These homebirthers seem to be acting in very similar ways (even filming it!), but developmentally, they should be well beyond this contagious, look at me, I know better than authority, it won’t happen to me behavior.

    And my ironic thought of day: One should not formula feed due to miniscule risks that cannot be seen, but one should risk homebirth which carries the very visible risk of maim and death. Okie dokie, got it 😉

  • guest

    Criminal, uncaring.

  • Squillo

    Despite these damning findings, I’ve already seen homebirth advocates declaring on line that it wasn’t homebirth that killed Ms. Lovell, it was Gaye Demanuele’s malpractice.

    Even if that were true, they cannot deny the bald facts of the case, which show that homebirth, and the pernicious culture that has grown up around it, make the malpractice that killed Lovell not only possible, but inevitable.

    • Sean Jungian

      Rest assured, they will find a way to shift blame from Demanuele and onto the “medical establishment”.

      “If only traditional medicine and trauma hadn’t terrified Lovell so much, this would not have happened!”

      • Daleth

        “If only traditional medicine and trauma hadn’t terrified Lovell so much, this would not have happened!”

        No, let me rephrase: “If only Mrs. Lovell had been braver and used more common sense, this would not have happened.”

        If it turns out (someone who knows, please post) that she had a truly horrific, traumatizing first birth and that the horror and trauma were the fault of hospital staff and/or policies (as opposed to being the fault of her body for hemorrhaging–as I understand she hemorrhaged after her first child was born), then I will take that rephrasing above back and apologize.

        But my understanding is that she just had a fairly run-of-the-mill first birth experience that she personally found traumatic and that she then chose to blame that trauma on “the medical establishment.” Ergo, she decided to avoid “the medical establishment,” when a wiser approach would have been to get therapy or whatever else could help her heal from the trauma (shamanic healing? Acupuncture? Whatever works).

  • The Bofa on the Sofa

    Consider the two stories

    Just over an hour after Zahra was born in a birth pool, Ms Bourne said Ms Lovell was light-headed and hyperventilating, telling her midwives she was dying and needed to go to hospital.,,

    “Gaye and I also made efforts to calm and reassure Caroline.”

    Five minutes later, Ms Lovell became pale, cold and unresponsive and an ambulance was called.

    When Ms Lovell tried to get out of the pool, she fainted. After regaining consciousness, Ms Lovell said she feared she was dying and asked for an ambulance to be called. Ms Demanuele did not call an ambulance. Later, Ms Lovell collapsed again. Ms Demanuele started CPR and an ambulance was called.

    After an hour in the pool, she wasn’t “light-headed and hyperventilating.” She fucking fainted!!!! And AFTER SHE FAINTED, they “made efforts to calm and reassure” her. They didn’t call the ambulance until she passed out TWICE! And are you sure about that 5 minutes? Was it really only 5 minutes before she collapsed again?

    How can she not recognize that fainting an hour after birth isn’t a “variation of normal”? Is she that ignorant of physiology? Oh wait, don’t answer that…

    Yeah, you stand up too fast and you can faint. And if there are no accompanying factors, such as notable blood loss, observation might be the appropriate approach. Moreover, in those cases, the patient is going to be more defensive – “I’m ok!” A lady at church just did that a couple of weeks ago – was bent over, stood up too fast and passed out. But then, her response was, “I’m ok!”, not “I’m dying!”

    And even after insisting that she was ok, I wasn’t comfortable with it, and pressed her on it more – has this happened before? Are you prone to such things? You might want to have that checked out.

    But what do I know, I’m just a lay person and not an edumacted midwife.

    • moto_librarian

      The night after my first delivery, I passed out on the toilet. I was in the hospital, being closely monitored after a pph and surgery to repair a cervical laceration, but it was still a big fucking deal. I remember coming to and seeing at least four people, plus my husband, surrounding me in the tiny hospital bathroom. They determined that the fainting was from a combination of blood loss and hunger (I hadn’t eaten anything in nearly 14 hours), but they took it seriously. That Lovell’s midwives ignored this totally is beyond incompetence – it’s criminal.

    • SporkParade

      I’ve passed out getting out of a hot tub due to the rapid change in temperature combined with a tendency towards low blood pressure. Then again, when that happened, the people around responded quickly with water and pretzels. And I hadn’t just gone through a trying medical event.

    • Amazed

      A few years ago, I passed out opening the door of my mom’s flat, in full view of my mom, her 5 or 6 yo student and the neighbour next door who my mum had been visiting. Scared the shit out of the kid. I woke up with a raging headache in my bed. No one had called an ambulance. The neighbour said that I would be fine and I was. The rub it, the neighbour is a doctor. A real one, that is. Something about the headache and the blood pressure. I always feel bad when I’m caffeine deprived. I just overdid myself this time. Combined with the summer heat, that proved swoon-worthy.

      I hadn’t just been through a demanding medical event involving blood, though. And when I was involved in a car crash, same neighbour didn’t just have a look at me and recommend something to calm my anxiety. She had a look at me as we waited for the ambulance.

      • The Bofa on the Sofa

        The question is: when you woke up, and they said, “Are you ok?” did you say, “Yeah, I think so” or did you say, “No, I feel like I’m dying”

        if you said the latter and they still didn’t call the ambulance, then there would be a problem.

        • Amazed

          Indeed. It defies belief that Caroline Lovell said she was dying and they still waited for her to faint before they did something.

          It would have defied belief. Sadly, it doesn’t. We’re talking about someone who is a negligent provider by the very fact that she attends homebirths. All her personal failings are just additions to this major telling sign.

          • The Bofa on the Sofa

            It defies belief that Caroline Lovell said she was dying and they still waited for her to faint

            …a second time!

  • Amy M

    This makes me wonder about the midwife (and all the midwives we read about after they’ve killed someone): she must REALLY have thought that Caroline Lovell would be ok and not recognized the danger, because even a rogue homebirth midwife doesn’t want a death on her hands. Even if she thinks she’s likely to get away with it—it would still lead to awkward questions at the very least. Otherwise, she’s some kind of psycho, who knew exactly what was going on and just let it happen.

    • Sean Jungian

      She has the absolute confidence of a true believer – a zealot, in truth. She had just had a baby die at a homebirth she attended 5 months prior.

      To be sure, the mother was no naive, trusting soul that was duped, either. She went to Demanuele BECAUSE she was high-risk and not eligible for home birth with anyone even a bit more practical.

      Two zealots at work and now two motherless children.

      Demanuele had actually forfeited her midwife’s license. There was no way she’d have ever willingly intervened in the birth, that was the specific reason she was chosen as midwife. I am willing to wager that she and the mother had discussed this a lot prior to the birth – that no matter what, she was to keep the mother home and away from those evil medical practitioners.

      This was as much a radical statement by both the mother and the midwife as it was anything else.

      • Elisabetta Aurora

        If the mother was that stupid, I’m sort of just glad that this time it wasn’t the baby who died. I know that’s horrible of me to say.

        • Sean Jungian

          I should be clear that I am reading between the lines of the news stories I’ve read, I do not know what Lovell’s criteria were for choosing this midwife.

        • Heidi_storage

          Well, it’s horrible anyone died, and her family will be devastated, but I don’t think it’s wrong to be glad that the defenseless child didn’t die.

    • Charybdis

      How can you be THAT, I don’t know, DELUSIONAL, that you think someone who has had a significant physical trauma/exertion, has passed out and is bleeding just needs a hug, a pat on the head or hand and a “there, there, luv. You’re just fine”? How can you not be the least bit concerned about the patient’s physical appearance and how she says she’s dying? “You’re dying? I don’t think so, hon. Let’s unpack that emotion and talk about how you’re feeling for a bit and see if it clears things up and you feel better”.

      And I know “don’t blame the victim”, but if the NCB/homebirth folks are so gung-ho about refusing anything medical, then why, oh why on earth do they go running to the evil, evil doctors, hospitals and EMT’s when things go sideways? If you “trust birth” and “trust your body” and “trust your midwife”, then why are the medical people the last resort? I mean, if you trusted enough to give the hospital and OB’s the finger to prove “your body is made for this” then why do you go running to them wanting them to fix it all?

      Oh, the midwife didn’t have any cinnamon candy to blow in the mother’s face. That totes would have fixed it all.

      • Sean Jungian

        “How can you be THAT, I don’t know, DELUSIONAL, that you think someone who has had a significant physical trauma/exertion, has passed out and is bleeding just needs a hug, a pat on the head or hand and a “there, there, luv. You’re just fine”?

        Woah, woah, woah, there! She gave her a homeopathic remedy for anxiety! You act like she did NOTHING.

        /sarcasm if it isn’t obvious

        • Charybdis

          Shepherd’s purse of a chunk of placenta to suck on?

          • Sean Jungian

            Blaaaahahaha. Maybe some Thieves’ Oil woulda worked.

      • Amy Tuteur, MD

        But she apparently gave her Rescue Remedy so she was “treating” her.

        • Charybdis

          Oh, then that’s okay then. She was obviously working her ass off to make sure everybody made it through alive. /sarcasm.

          I don’t hold with many, if any of the alternative health *therapies/treatments*. However, I don’t have a problem with people using some of them in conjunction with actual medical treatment if it is not contraindicated. Like, if it makes you feel better to have a EO warmer going with lavender oil in it because you like the smell, or it helps you relax and/or focus, then knock yourself out. But don’t suggest I use it as the only thing to treat a migraine. Or if you enjoy a cup of chamomile tea with honey to deal with stress and it helps you calm down and get a grip; great. Don’t recommend it to me if I’m in the midst of a panic attack or claim that it is just as effective, if not more so, than a valium or xanax.

          Why not sip some water from that vase of flowers over there? It’ll do just as much good as the flower essences in the Rescue Remedy.

          • J.B.

            For some flowers the vase water is poisonous…

    • LaMont

      I mean, yeah, it does seem like they believe that women will be fine regardless of all evidence. The only reason people rely on medicalization (or faint, or bleed) is *because* they are afraid, not because there’s any reason to intervene. If only women hadn’t been steeped in hypervigilant “modernity and safety”, they’d realize the pain and everything else is fine. That’s my understanding anyway…

    • mostlyclueless

      Think about how many times she was in a similar situation and the mom lived. Why would this time be any different?

      That’s the problem with the way midwives evaluate risk. “I did this risky thing 99 times already, so the 100th will be safe, too!”