Why is Lamaze desperate to pretend homebirth is popular when it’s not?

25327384 - lies damned lies and statistics quotation isolated on white background

In a new post, the folks at Lamaze are crowing about homebirth statistics that purport to demonstrate the “popularity” of homebirth Look at Home Birth Trends – The Results May Surprise You!.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Lamaze is a special interest lobbying group that depends on convincing women that its prescriptions for childbirth are the ones you should buy.[/pullquote]

  • 58% increase in the number of home and birth center births in the period of 2004 to 2014. In 2014, over 56,000 births took place out of the hospital.
  • Since 2004, there has been a rapid increase primarily in the number of white non-Hispanic mothers choosing home birth.
  • By 2014, there is a significant number of states who have home birth rates over 1%, primarily clustered in the Northwest, some of the Midwest and in Maine,Vermont and Pennsylvania.
  • In 2014, Certified Professional Midwives (CPM) attend almost half of all out of hospital births. Certified Nurse Midwives/Certified Midwives (CNM/CM) attend just about one quarter of the out of hospital births. 27% of births were attended by “Others” which probably indicates situations where home birth midwifery is illegal or alegal. Dr. Declercq assures us that the “Others” are not taxi drivers!
  • In 2014, 98% of CPM attended home births were planned to be at home, and 99% of CNM attended home births were planned to occur at home.

They’ve helpfully included a graph to illustrate the trend:

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That looks impressive until you realize that they’ve left out the rate of hospital birth. I’ve added hospital birth and the resulting graph is far less impressive. Indeed, out of hospital birth is an uncommon fringe practice which has grown to become … an uncommon fringe practice.

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Lamaze is so desperate to pretend that homebirth is popular that they’ve included UNPLANNED out of hospital births in the mix. Dr. Gene Declercq insists that the 27% of out of hospital births attended by “Others” were not attended by taxi drivers, but he has absolutely no way to know that. These aren’t even necessarily term births and it is far more likely that those births happened by the side of the road or were attended by EMTS.

That’s doesn’t capture the full extent of Lamaze and Declercq’s duplicity.

First, the death rates are conveniently excluded. The aim is to promote homebirth by convincing women that “everyone” is doing it because it is both safe and delightful. Including the death rates would have been a bummer since a recent study in NEJM showed that PLANNED out of hospital birth at term has double the death rate of comparable risk hospital birth and the best homebirth data, out of Oregon in 2012, show that planned homebirth with a licensed homebirth midwife has a death rate 800% higher than comparable risk hospital birth!

Second, Lamaze has gone on the record as dismissing the bulk of the studies that show that homebirth has a death rate up to 800% higher than hospital birth because they are based on birth certificate data. As recently as March of this year, a Lamaze blogger wailed about Flaws In Recent Home Birth Research May Mislead Parents, Providers. Apparently, parents and providers are supposed to ignore the appalling death rates at homebirth because they are based on birth certificate data and birth certificate data is supposedly unreliable.

Because the number of home births in the U.S. is small, the inclusion of … unplanned, unattended home births in the β€œhome midwife” category is likely to have an appreciable effect on the negative outcomes examined here.

Yet today’s post claims just the opposite about the reliability of birth certificate data.

In 2014, 98% of CPM attended home births were planned to be at home, and 99% of CNM attended home births were planned to occur at home.

Which is it Lamaze? Is birth certificate data unreliable, in which case you should not be making claims about the increased popularity of homebirth, or is it reliable, in which case you must acknowledge the appalling death rate at homebirth?

Let’s leave aside the duplicity for a moment and ask a more fundamental question: why are midwives and other birth workers in general, and Lamaze in particular so desperate to promote homebirth when it is a fringe practice rejected by more than 99% of women? Shouldn’t they be supporting women’s choices, not trying to change them?

Homebirth is exponentially more popular among midwives, birth workers and organizations like Lamaze that represent them than it is among women because the benefits of homebirth accrue to the workers and organizations and the risks are carried nearly entirely by women and babies.

  • Midwives et al. love homebirth because they profit from it; it costs a fortune (as much as $5000 or more out of pocket).
  • They love it because it gives them autonomy to do what they want; there are no safety standards of any kind.
  • They love it because it allows them to worship at the altar of “normal birth” the holy grail of natural childbirth advocacy.
  • They love it because they bear no responsibility for outcomes. Your baby ends up brain damaged or dead? Don’t look to them for help; they don’t bother to carry malpractice insurance to protect mothers and babies because it cuts into their profits.

Lamaze is desperate to pretend homebirth is popular because it is a special interest lobbying group that depends in large part on convincing women that its prescriptions for childbirth are the ones you should buy.

Lamaze couldn’t care less that homebirth kills babies; indeed they actively try to suppress and discredit the growing body of scientific papers that repeatedly demonstrate the deadly risks of homebirth. They figure you’re gullible enough to believe their crude and dishonest attempts to manipulate you. And if your baby is injured or dies as a result? It’s not their problem; it’s yours.

They’ll add your baby’s birth certificate to their statistics to claim that homebirth is popular, and ignore her death because birth certificates are “inaccurate.”

  • mandy jones

    http://www.phdinparenting.com/
    Didn’t know that natural childbirth was possible in hospital until now.

  • mandy

    http://www.phdinparenting.com/
    Didn’t know that natural childcbirth was possible in hospital until now.

  • mandy jones

    Hospitals are for sick people;not for mothers in labour. However natural birth is way too dangerous to do it alone, so I think the best solution is to have all birthcenters be prepared because something can wrong and if they’re not able to make it to the hospital or it’s too far way…I don’t want to say it.They should ought have an OB degree and have emergency medical supplies if needed. I’m saying that all mid-wives and doula should have an ob gyn degree. Another good idea to have give mothers in hospital some freedom and chocies,like what position the bed should be in that is best for her, the baby and doctor.

  • BeatriceC

    Completely off topic: This young lady dropped into our laps today. We were not looking for a new bird, but she was desperate for a home, so we took her in. She’s obviously got some issues with plucking, and is missing a wing, but she’s a sweetie. She’s currently in our spare cage while MrC gets her real cage put together, so forgive the mess in the background.

    http://i301.photobucket.com/albums/nn67/mmsw1/Mobile%20Uploads/IMG_0009_zpsewedaby5.jpg

    • BeatriceC

      Here’s a better picture, and of her good side. The other side is the one with the missing wing, and she’s plucked her chest and her wingless side almost completely bare. Poor baby. Hopefully we can get her feathers back soon (6-12 months).

      http://i301.photobucket.com/albums/nn67/mmsw1/Mobile%20Uploads/IMG_0014_zpst7ommstc.jpg

      • guest

        She’s very pretty, even with her issues. I was hoping someday that I could be a foster person for parrots for our local animal shelter, but unfortunately my new building does not allow any pets except cats (which I am allergic to).

        • BeatriceC

          It was pretty much love at first sight for me. The people had both her and an elderly blue and gold who is in perfect physical shape and has no behavioral issues. Ima finally went up there thinking I’d take that one. The birds were not bonded so separating them is fine. But as soon as I saw this one I was in love. Plus finding a home for a special needs bird is much more difficult than finding one for a healthy bird, so my soft side kicked in. MrC and YK really liked the b&g, and we have the space for two, but I’m worried about having the time for both. We did tell them if they got desperate to call us. The pressure is off a little bit with only one bird, but they still need to find him a new home sooner rather than later.

          • guest

            Yeah, rehoming birds is hard. I don’t have experience with the big parrots, but cockatiels and lovebirds I do very well with, and if the co-op board hadn’t been so unreasonable I was thinking of getting/adopting a small conure some day. I’d *really* like an African Grey. As it is, when my aged lovebird goes, I will probably sneak a canary in as my current cockatiel’s new companion.

          • BeatriceC

            A picture perfect, healthy, but elderly macaw should find a new home, but it might take a while. I made them the offer to call us, and while I would love to have a b&g, I still have to be reasonable about the number of birds I have, so I’m really hoping he finds another home. Scarlett (who I am re-naming Letty, but that will take some time), is going to be a lot of work to rehabilitate, and between my kids and my other birds, I would hesitate to declare I have enough time for another large bird.

            I’m sorry your landlord is being a grouch. Some birds do really well in apartments, even some species that aren’t known for being quiet. Depending on the temperament of the individual bird and the skill of the owner, even the big ones can be trained to learn when it’s okay to sing the song of their people (day time) and when it’s not, and they can learn volume control. If you were near me I’d invite you over to hang out with Scarlett, Leo, Goofy and Cookie once Scarlett settles in a bit.

          • guest

            That would be fun if we were near! I should maybe clarify that the birds I currently have were given a special exception by the co-op board – they are allowed to stay until they die as long as no one complains, but I’m not supposed to get any new birds, ever. When I’ve been here longer and proven myself a good neighbor, I’m hoping we can strike another deal: I’d like permission to keep some kind of non-allergic pet because I think it’s important for kids to grow up with a pet to care for (mine are already learning valuable lessons about caring and gentleness from the birds we have, and they aren’t yet responsible for feeding/cleaning them), and since we can’t have a cat because of my allergies, we should be allowed to have *something.* But my current cockatiel is eleven years old, and my last cockatiel lived to be 27- who knows? Maybe we’ll have moved out by then.

          • BeatriceC

            I kind of figured your current birds were grandfathered in somehow, with the way you described the situation.

            And while ‘tiels are only supposed to live 15-20, I know of a few, including Cookie (age 25) who have lived far longer.

          • guest

            Yeah, and they say lovebirds live 10-15 years, and mine is 16 now. He’s mostly blind with cataracts, but otherwise seems to be doing well.

          • BeatriceC

            I think what it is, is that birds have not been really common as house pets for very long (just a couple generations, really), so we really don’t know what their maximum life spans in captivity really is. In the wild they don’t get optimal nutrition, vet care, nor are they free from predators, so their lives are much shorter. We’ve also not really know what that optimal nutrition is, nor how to treat common bird animals until recently, so earlier generations of house birds didn’t live as long as possible either. Now we’re finding these things out, so their life spans are increasing.

          • guest

            Yep. When we bought my first cockatiel (in the 70s) they told us 10-12 year lifespan, max. They also told us he was a baby. As the years went by and that cockatiel surpassed that lifespan, I also saw books (and later, websites) revising the expectation to 15-20. We don’t wild catch them for pets anymore, and we know how to care for them in captivity better. I had that first cockatiel from age 5 to 30 and I wept when the vet advised he be put down. (He had gout, and developed neurological symptoms they couldn’t do anything for.)

      • Madtowngirl

        She’s beautiful! My parrotlet passed away in January 2015, but she had to have part of her wing removed due to a large tumor. She never flew again, but she lived a full, happy life, anyway. Special needs birds are awesome.

        • BeatriceC

          Aww, poor parrotlet. It’s so hard to lose a beloved animal. I still miss my mastiff and it’s been over two years now.

          There were two big reasons I took Scarlett (Letty) instead of the B&G. First and foremost we just clicked. Secondly, while it’s difficult to rehome any large parrot, the B&G was healthy, no behavior problems and picture perfect (albeit elderly). He would have a much easier time finding a good home than she would.

          • Madtowngirl

            Yea, her passing was completely unexpected and very hard on us. My husband was her “person,” so it was especially difficult for him. But I have a very soft spot for special needs birds now. We’ve talked about adopting another one when my daughter is older.

          • BeatriceC

            I wouldn’t be able to handle Scarlett if my kids were younger, or even if MK was still here with all the attention he requires. She’s the workload of a newborn, with almost as much sleep deprivation. My other birds are trained to wait until about 9AM for breakfast, but she needs attention as soon as the sun comes up and I have trouble going to bed before midnight. She needs somebody with her/at the house at all times right now, and I’m uncomfortable leaving the house empty of any humans until she’s better settled. If I believed in God I would say the timing of all this was divine intervention. If I believed in fate I would say that the cosmos knew this bird and I needed each other. It’s just odd that I randomly found out about this very needy bird who needed a great home in the immediate aftermath of MK leaving. MrC said he thinks that I need her as much as she needs me.

  • Captain Obvious

    Lifelock should make a CPM Homebirth commercial. When a complication occurs at home and the parents and family ask the CPM to do something, she’ll look at them and say something like, well I can’t do anything about the complications, at best I might be able to recognize a problem, and then I have to determine if it’s a significant problem. If after hours of deciding it’s significant I need to get your wife to the hospital where they can manage the problem. Then the narrator speaks, don’t have births with a birth complication monitor, have a birth with someone who can manage birth complications.

    • Susan

      Bravo Captain!

  • Margo

    For some women Lamaze breathing, visualisation techniques,mantras and other mechanisms of coping for want of a better word have proved not to be bollocks.

    • Sarah

      How does this address the argument in the article?

      • Margo

        It doesn’t ….I was responding to the comment re breathing was pointless. I can’t even begin to address some of the points in the article until I have taken a few more deep breaths of my own,as much of the article annoys me, but not wanting to give offence I will wait until I have calmed down a bit more before making any further comment.

        • Sarah

          You’ll want to reply to that comment specifically rather than do a general comment replying to the article, then.

        • Heidi

          But really why do you care if some else thinks it’s bollocks? It’s not like that commenter can come to your house and ban you from panting around visualizing strolling around in a benign wooded area. I think it’s BS myself.

          • Margo

            Hi Heidi, I don’t really care that much, just making a comment that’s all. Personally I found breathing and visualisation useless for me. I just wanted it all to go away, the pain and the fear of the pain getting worse and the fear of how long labour might go on for, no amount of breathing or other stuff helped:the hospital had no epidural facility. In the end I had Pethidine which didn’t do much either, for the pain, except I felt wonderfully removed from the whole labour, which I thought was a good thing, it was the closest I ever came to strolling around a benign wooded area. I am talking about forty plus years ago, but I remember it well.

    • Sue

      Breathing, visualisation and other coping techniques can be used in a hospital birth. They aren’t restricted to the home environment, are they?

      This article is about the Lamaze promotion of a site of birth that is proven to result in higher mortality, breathing techniques notwithstanding.

    • Erin

      And for others, they have contributed to birth trauma because those women were told that doing a specific technique etc would lead to controllable pain…and when it didn’t, when they needed epidurals or interventions ended up blaming themselves for not being “good” enough. My birth trauma group is full of them.

      As for me, my “breathing” control was so good I was repeatedly told I obviously wasn’t in pain, wasn’t in “proper” labour and had to suffer because of that.

      What I’d like is qualifiers added onto a lot of these statements rather than absolutes. If they do help, wonderful but telling women they WILL help is downright dangerous.

      • Margo

        Absolutely qualifiers should be on all information given out, I agree wholeheartedly.

    • Charybdis

      That is true. And if it works for you, knock yourself out with the deep breathing, panting, visualization, repeating mantras and other coping mechanisms. No one is saying you absolutely cannot do any of those. You can do them at home, in the birth pool, at the birth center, in a creek, in the hospital, wherever you are.

      HOWEVER, for a lot of women, those techniques are touted as The Best Pain Control Ever and you DON”T NEED anything but to breathe properly, visualize properly, repeat mantras (my body was made to give birth to a baby. My baby will swim peacefully into the world. My pain is a path to receiving my baby. Stuff like that.) and change positions to have effective pain control. Because if you do all those things properly, then you won’t need medical pain relief.

      Those techniques certainly can help a woman manage pain, but it is presented as an absolute: “Do these things and you WILL control your pain during labor and delivery! You can go unmedicated, because medication during labor will harm you, your baby, your bond with each other and irreversibly and irretrievably damage your Oh So Important Breastfeeding Relationship”.

      Presenting techniques as some of many pain control options is what should happen. But it doesn’t, and that is what we have a problem with.

      • Empliau

        There was a woman on mothering dot com (before I stopped reading, for my mental health) who drank the kool-aid. She made several posts about not being that afraid of labor — she’d done her research, was (obnoxiously) physically fit, much kale — before birth. Her homebirth went disastrously wrong, at least in her mind. In the end, the baby was fine, thank goodness, but the pain of labor was too great and she went to the hospital and got an epidural. Many, many posts after about what had gone wrong, from her partner’s and midwife’s weakness in not powering through her pain to the hospital OB, whom she was totally going to sue. She was absolutely immune (deliberately, so probably afraid to admit) to the simple fact that she needed pain relief. Everything, during and after labor, was someone else’s fault – she was a yoga teacher who ate right and lost baby weight damn near immediately (and posted the photos to prove it). The lie is strong, that if you do everything right, you will get the birth you want.

        ETA: this probably should have gone after Erin’s post.

        • Erin

          My cousin’s wife is currently 7 months pregnant. Her plan is water birth on a Midwife led unit although she had to threaten home birth to get them to agree because of her BMI and it being her first baby. My cousin is terrified something will go wrong but she’s so sure that if she believes in her body, she’ll be fine. Apparently I didn’t have the faith I claim I did otherwise I wouldn’t have ended up with an emcs, PnD and PTSD, although at least she didn’t say that to my face (just to my husband).

          I can see that being her first response if things go badly.

          In terms of the two Birth Trauma groups I’ve been in, the reaction seems to be worse in women who had one or two “easy” vaginal deliveries first and attributed that 100 percent to affirmations/mantras and breathing. Then they have a bad experience despite doing the same things and suddenly their world just shifted under them.

          • Tori

            If I have an “easy” delivery and I have “caused” this, I am worthy of praise. Of course, if I didn’t have an “easy” delivery then I must have caused this also providing an way for guilt and self-blame when a vaginal delivery is given unnecessary importance. The same goes for breastfeeding, conceiving, anything biological really.

            An acquaintance I know with oversupply who had a prem baby attributed her oversupply to expressing 3 hourly after baby was born. Contributing factor maybe, but she likely would have had an oversupply anyway- because that’s the way her body is geared. Lots of mums with prem babies have the opposite happen despite expressing 3 hourly. Mothering a baby in NICU is stressful, exclusive expressing is hard, not everyone responds to a pump, and so on.

            I needed IVF to conceive, had a healthy pregnancy with only complication being baby being large for gestational large, an uneventful induction with a ‘normal’ delivery that had quite manageable pain, and almost no breastmilk. I haven’t ’caused’ any of this to be how it was – it just happened. In some areas I was ‘lucky’ in others not so ‘lucky’. We have so little control over what happens biologically, it causes harm when we use it for head-pats.

      • Fleur

        I know women who have found those kind of pain relief techniques helpful (although they were mostly second-time mothers, so it’s hard to say whether their second experience of childbirth was better because of the techniques or because it wasn’t their first time).

        My problem is with the extent to which breathing techniques etc get oversold as the solution to all childbirth ills. I (very briefly) attended hypnobirthing classes at my local hospital when I was pregnant. The instructor spent the whole first session pushing the message that labour isn’t supposed to hurt, that women only experience pain in labour because television sensationalises childbirth and makes them think it’s going to hurt, and that it will just feel “powerful”, not painful, if you use the visualisation techniques that she spent the rest of the session showing us. Considering that 90 per cent of the women in the class were first time mothers, I really felt that she was setting them up for a fall by doing such a crap job of managing their expectations.

        • guest

          Anyone who tries to tell me in person that labor doesn’t hurt will be promptly punched in the face. And then I’ll explain that getting punched in the face doesn’t really hurt; they’re just conditioned to think it does by the way Hollywood films make it seem so painful with their foley sound effects and whatnot.

    • moto_librarian

      I found some of these techniques helpful during early labor. They did nothing for hard labor, and frankly, I was shocked by how unbelievably ineffective they were.

      My problem with Lamaze and other alternative techniques is this: women are repeatedly told that this is all that they need, and that if they find themselves in severer pain, it is because they haven’t prepared properly or aren’t tough enough for labor. This leads to unnecessary guilt. You don’t know how painful labor will be until you are actually in it. Telling women that they won’t need anesthesia unless they are weak is a terrible message. Yes, Lamaze is enough for a few women. For the majority of us, an epidural is preferable.

  • Susan

    After reading this I have spent an hour pondering what it is about Eugene DeClerque I find so infuriating. I even watched a YouTube of him. I am not sure why he makes me angrier than Ina May, the Food Babe, Michel Odent and Henci Goer combined but anytime I read what he writes I feel pissed off. I think he’s slick and he comes off as seemingly objective when he’s clearly got an agenda. I also hate “experts” on obstetrics who want to tell us how to do our job who have never once been the person who’s performance and decisions in a stressful situation be critical to saving their patient’s life. What a pompous, self satisfied, gaslighting jerk!

  • Platos_Redhaired_Stepchild

    I always suspected lamaze breathing was pointless bollocks.

  • CSN0116

    Existential Question: Why are NCB/EBF/AP/ETC always the car seat nazis? Saw the cutest video of this ~1 year old being cute in the car with dad. Of course she was… FORWARD FACING :-O They came out of the woodwork to gasp in horror and correct “nobody,” as it was a viral video probably shot years ago.

    I don’t much care for the Google physics instruction on impact and internal decapitation… I’m just “shocked” and put off every time the same moms who feel compelled to correct everyone’s parenting take up this cause as well. Ugh. Crunchies obsessed with car seats annoy me.

    • AnnaPDE

      Yeah, the same mum I know who had a home birth won’t let her older kids play with a scooter in the park unless they put a helmet on (which they do in a way that it’s more likely to snap their neck that protect even their scalp let alone brain), and is very insistent on a rear facing seat for the little one well past age 1. Then again she wasn’t overly concerned with the oldest one’s cold sore when the baby was a couple of months old…. Risk assessment 101 should be part of parenting.
      It is a bit of a concern though what magical properties many people ascribe to car seats, seat belts and bike helmets. You get all the stories about the time mom forgot to strap the kid in, and the super-scared extremely cautious driving from the moment she realised to when she could stop to fix it. And then you look at their usual way of driving and can’t help but wonder if they understand that the difference a car seat/seat belt/bike helmet is unlikely to make enough of a difference to save anyone in case of an accident. But hey, it’s all right to text while driving, cut across lanes without looking, and pass cyclists with an inch to spare when the correct PPE is worn, right?

      • Who?

        This is so true! It’s as though people think those things are amulets with protective magic, no matter what. We can all have moments of inattention on the road, or struggle with conditions. I had to drive in quite heavy rain last night, first night drive in rain for quite a while and it took some adjusting to, but there is no substitute for paying attention with a view to avoiding the incident in the first place.

      • Montserrat Blanco

        I have to say that of course safe driving is the most important thing but after working at A&E Department for a few years, helmets and safety belts DO make a HUGE difference. The number of dead or severely injured people wearing safety belts was far less than those without a safety belt.

        I must admit I am a bit of a safety belt nazi and my almost two year old son is rear facing. He is completely vaccinated almost on schedule (one vaccine dose in particular was delayed two months due to medical issues).

        • CSN0116

          So can someone explain to me, physics-speaking, how rear facing is safest for *every* type of accident that can occur – side, rear, and head-on? Because how the body would be catapulted in a head-on versus rear-end versus side-impact collision is totally different in each scenario, yet the rear facing remains constant. How is rear *always* preferable in every scenario? How can it magically limit the catapulting impact in every single direction?

          From what I understand, rear-end collisions are most common, but they’re also the most likely to happen at low speeds, causing less injury. Head-on and side impacts are less common, but far more likely to injure or kill. So does rear-facing a child help them out more so in the most common but least dangerous (rear-end), or the less common but most dangerous (side impact and head-on)? There’s just no way it is best for all three scenarios. It makes no sense to me, physics-speaking…

          • CSN0116

            …never mind. Rear-facing seeks to make the less common, more dangerous crashes safer — head-on and side-impact. It is actually more unsafe to be rear-facing (versus forward-facing) in a rear-end collision, but because most rear-ends are at low speed, it is worth the risk tradeoff, per experts.

          • Margo

            How it was explained to me is that rear facing avoids air bags crushing the occupant of the car seat, should the airbag go off and should the front seat be pushed backwards on impact the occupant of the rear facing seat is less likely to get the front seat doing damage as occupant facing away from impact. All I REALLY know is having hit black ice and flipped my car it was the seat belt that saved me, so I too am a seat belt nazi.

          • CSN0116

            Oh I was a seat belt Nazi long before one saved my life when hit head on by a drunk driver – preaching to the choir there πŸ˜‰ I’m just fascinated by extended rear facing as some tenet of NP, that’s all. Thanks for taking the time to provide me an explanation!

          • Inmara

            I don’t agree with Margo re: air bags, because air bags MUST be deactivated if there is person in carseat riding, no matter where the seat is faced. The crucial part of ERF is to save child from neck injury which would be inevitable in front collision when inertia throws his/her body forward, especially head which is proportionally bigger than adult head (as you mentioned, front-end collisions are the most deadly). Also, many ERF seats have higher sides to protect child in case of side collision (e.g. Klippan Kiss https://www.babylor.com/642-thickbox_default/klippan-kiss-2.jpg )

          • Montserrat Blanco

            It is extremely rare (I have never seen one) to have a rear collision fatal. They are usually at very low speeds. Most fatal collisions happen forward or lateral. The rear facing seats have the same protection for lateral crashes than forward facing ones, so let’s just assume if you get a lateral hit it does not matter if you are rear or forward facing.

            Rear facing in the case of a frontal crash your head and neck goes agaisnt the seat, that is prepared for that, and so your head and spine goes “in block” agaisnt something padded that contains it. It is very difficult to break a bone with such an impact. Then your head and neck will go to the rear of the car, but they will move far less in that movement and the worst that you could hit would be the soft padded car seat.

            In case of a frontal crash forward facing you go first to the seat in front of you full force, and that is usually harder than the side where you seat. The head and neck suffer more and yes, Internal decapitation does exist. Then you do go agaisnt the seat but the impact is much less, and yes, the seat is very protected for that lower energy impact.

            I am not a physics expert at all, but the General Traffic Authority in my country does recommend strongly the use of rear facing car seats until four years old at least. And yes, I do follow their guidelines.

            I do not know how to paste Youtube videos here but you can search and see the klippan triofix recline crash test forward and rear facing and it is quite clear how the head and neck are better protected. It is the same test with exactly the same seat in two different positions, so that is the only change in the test.

        • corblimeybot

          Yeah, I agree. Seatbelts, bike helmets, and car seats aren’t decorative, and they aren’t ineffective talismans or amulets. It kind of blows my mind that anyone has convinced themselves of that.

          One of my closest friends has been a paramedic for a decade. He has some gruesome stories to tell about people who didn’t wear their seatbelts. Lots of “thrown partially through the windshield” and “crushed by car rolling on them” or “catapulted into a tree trunk”. The first death he attended was a teenaged girl who wasn’t wearing her seatbelt, to fatal consequences. And my friend is no alarmist or scaremonger. Far from it, he is pretty chill about most things.

          • Tori

            Seatbelts and helmets are important – in the area where we live I see people riding farm motorbikes without a helmet, sometimes in the road. Despite not being legal on the road, it doesn’t take much for a cow to knock you over in the field, and the road is a dangerous place for a motorbike rider with no helmet no matter how fast you’re driving.

          • AnnaPDE

            Seat belts are great, and so are car seats for kids. Bike helmets… depends. Their protection stats are fine for external injury, but for brains it’s “meh”. Sure, when you ride in a way that you expect falls, wear one (though mtb riders wear different helmets for a reason), but the risk profile is different in your average slow ride to the shops, school or work. The thing is though, that drivers and an unfortunate number of cyclists do treat the helmet as a kind of magical amulet in traffic, as if it helped any when you go *splat* under a truck, and behave in a way no sane person should in traffic. In fact there is research that drivers behave more dangerously around cyclists with helmets than without: they overcompensate for the risks.
            Seat belts are so normal these days that this effect doesn’t feature much any more, but it did show up when e.g. anti-lock brakes were introduced. (There’s a study on Munich taxi drivers on that.)

          • Roadstergal

            “though mtb riders wear different helmets for a reason”

            I wear a MTB full-face when I road bike. Roadies may laugh, but in the mountains up here, it’s easy to go 30+mph on a gentle downhill and 40+ on a good one, and I can get over 20 on the flats. My brain is my main career asset. :p

        • guest

          I’m down for seat belts in cars and helmets while riding bikes, motorcycles, or doing anything high speed. I got concern trolled because I didn’t have my preschooler wearing a helmet on a scooter. I know they’re recommended, but here’s our deal: my son can ride the scooter to the playground, but only if he stays right next to me, going the same speed as me walking. At the playground, he can go fast, but the recommendation is that children *remove* their helmets in playgrounds because of some strangulation incidents. The scooter isn’t raised off the ground by more than a few inches, so my son wouldn’t have any worse injury from falling that he would if he tripped while walking. He could be hit by a car, but so could any pedestrian – what makes the scooter so dangerous at walking speed that he needs a helmet but a child walking next to me doesn’t? Why is the recommendation that kids remove helmets while scooting in playgrounds rather than, say, recommending kids don’t scoot in playgrounds?

          (Yes, he will need a helmet one of these days. We mainly don’t have one because it’s not something I can order online – he needs to try them on for fit, and I haven’t gotten him to a store that sells them yet.)

        • Roadstergal

          Helmets when properly worn. I see so many people wearing helmets that aren’t on their head properly and/or aren’t strapped properly. Drives me nuts, but I’m anal about that. :p

          When I taught the MSF course, I’d invite anyone who didn’t know how to put on a helmet with a D-ring strap to talk to me before the class. Half of the class would end up doing the wackiest shit with the straps, and an overlapping half would be wearing helmets at least one size too big.

          Then the bicycle helmets that are way back just perching on the crown of the head…

          • MI Dawn

            Oh, D-rings…my love and my hate. But I always wore a full-face helmet on the motorcycle!

      • Inmara

        Yes, risk assessment 101 is what many parents lack, and thus it blows my mind that crunchy folk prefers to take huge risk with not vaccinating but insist on the smallest risk with carseats. If they applied the same anti-vaccine logic to car seats, they wouldn’t use them or seatbelts at all, because in very, very few cases not being strapped in a car could actually save your life (like, being thrown out of car which immediately burns down or tumbles in a pond). The same goes with vaccines which in very, very few cases can have serious adverse effects, yet under normal circumstances the risk to contract vaccine preventable disease is much bigger.

        • demodocus

          We know that serious injuries caused by vaccines are extraordinarily rare, but they don’t. Anti-vaxxers think they are really common.

    • corblimeybot

      This is a real thing. One of my acquaintances forward-faced her child a bit earlier than average, and friendships with crunchies were lost when she posted a picture to Facebook. It was absurd.

      • CSN0116

        Oh, it’s absolutely a real thing. Dare I say, it is the one crunchy pre-requisite that actually carries more weight than breast feeding and/or natural birth. There is more ruthless stigma attached to it as well, in my observations.

        Aside of the content of the issue itself – that car seats do save children’s lives – I’m fascinated by the mechanism of exerting a standard of “extended rear facing” as (another) form of maternal judgment.

        Dr. Amy, I know car seat practices aren’t on your radar, but the parallels are fascinating from a theoretical standpoint. Some food for thought πŸ˜‰ I believe we have identified another tenet of NP here.

      • guest

        If they were truly crunchy, they’d be advocating for lifestyles where you don’t take your child in a car, ever (or rarely). After all, that’s both far safer AND better for the environment. But they don’t, because that lifestyle is @#$!ing hard. I just had to push my two older toddlers in a stroller about three miles this weekend in wiltingly hot weather in order to take my son to the hospital emergency room. I couldn’t get anyone to stay with my daughter on short notice, and my son wasn’t sick enough to need an ambulance. The only car service in the city that can show up with two car seats couldn’t get to me soon enough, and although I have a car seat, once we were left at the hospital ER curb, I wouldn’t have any way to push both children in the stroller while carrying the car seat. The kids aren’t quite old enough where I can depend on them to walk even short distances – all it takes is one tantrum and I’m screwed.

        Even when you’re not dealing with an emergency, not having or using a car is a radically different lifestyle and most crunch types are really the modern version of yuppies – they like to feel superior about their child-rearing and environmental concerns, but they also place a very high priority on personal comfort.

        And for the record: I’m not smug about my carlessness. I hate it. If I could afford a car and all the insurance and parking spaces needed to go with it, I’d buy one in an instant. And I would rear face my kids as long as possible, but I wouldn’t lecture anyone else about their choices.

        • demodocus

          I agree with you. it’s one thing if they really do rarely use their cars by choice, but is seems that few do. I get some guff about taking the bus/not having my cell phone on me when my son’s leg was broken at the park. It was faster than calling people to beg for a ride since we were right next to the stop, due in under 10 minutes, and stops right outside the hospital. It’s only the car drivers who say anything, not my fellow transit riders.

          • guest

            It was faster for us to take the subway than to work out childcare for one kid and arrange for a car, that’s for sure.

    • Kelly

      I think it is ridiculous. Internal decapitation is also incredibly rare. I posted a picture of my nine month old in a forward facing seat that is obviously too big for her because my husband put her in her sister’s seat instead of hers. I am so glad that I did not get a single comment from anyone about it. It lets me know that most of the people on my feed are not crunchy and/or they know how to keep their mouths shut.

  • newmom

    Lamaze thinks people should make medical choices based on popularity?The “cinnamon challenge” was popular, stupid and pointless, but still popular.

    When my daughter was born via c-section 2months ago because her heart rate kept dropping to the 60s and wasn’t moving as much as usual, popularity and birth plans(I didn’t have a birth plan) were the furthest thing from my mind. I am so grateful for my doctors, and nurses. I can’t say that my daughter would be alive and well if I had “trusted in birth”.

    I still get a little teary eyed when I think about her birth. It has nothing to do with winning some ridiculous marathon of suffering. It’s because after several years of trying to get pregnant and a miscarriage, we finally got to meet our daughter. Anyway, sorry going off on a tangent.

    • Tori

      The day my son was born was the best day of my life. It would have been the best day of my life however he came out and in fact how he came out isn’t relevant – because he was born! I didn’t have a birth plan either and left that section completely blank in my hospital form booklet. I routinely refer to them as ‘birth preferences’ whenever they come up in conversation too. Congratulations on the birth of your daughter.

      • Margo

        I like that phrase birth preferences. I have always thought birth plans,set in stone,so to speak,just set us up for disappointment.

        • Tori

          Thanks, so do I! I can’t claim credit for it. A family doctor I know routinely crosses out the ‘birth plan’ title in the government issue pregnancy booklet we have – used to keep track of the woman’s health information throughout the pregnancy, and she takes it with her to any health appointments – and writes ‘birth preferences’ instead when he first gives out the booklet at the very first visit.
          Sometimes we hope things will turn out a certain way but have essentially no control over the matter, or our opinions about things such as pain relief change during labour itself, and you’re right, ‘plans’ sets us up for disappointment I think.

    • Fleur

      Congratulations! My daughter is 4 and a half months old, also born by c-section. The day she was born was the best day of my life, until it was superseded by the day of her first smile, the day she looked for me for the first time when I left the room, the day she first laughed in her sleep. I think your daughter is lucky to have a grounded, loving mum who puts her first.

      I have every sympathy for women who have truly frightening childbirth experiences which leave them traumatised (a friend of mine had pretty bad baby blues after a bad labour and a newborn who spent a couple of days in NICU). But feeling devastated because you didn’t get the “birth of your dreams”? That’s like spending the first five years of your marriage sulking because things went wrong on your wedding day.

      • MI Dawn

        “That’s like spending the first five years of your marriage sulking because things went wrong on your wedding day.”

        I know people who do that, too. They don’t enjoy other people’s weddings because theirs was HORRIBLE (i.e. things didn’t go 100% as planned, only 98%). They seem to be the ones who obsess about their child’s birth, also.

        Childbirth was awful. Painful and exhausting. My absolute phobia for things in my back meant I declined an epidural (which, TBH, in the late 1980s and early 1990s weren’t as efficient and well done as they are now). But, you know? I don’t care. I had 2 living, healthy awesome children. Whichever way they were born – if I’d needed a c-section – that was the important thing. Living, healthy, and awesome. (Yeah, I’m not an impartial mother. So sue me. LOL)

  • Taysha

    My biostat professor drilled into us to always look at the y-axis first. If people weren’t showing 100% of the y-axis, it usually meant they had bad data.

    He is proven right daily.

    • BeatriceC

      Your biostats professor was a wise man.

    • Roadstergal

      -Not showing the comparator group on the same axis
      -Using ‘dynamite plots’ (columns +/- SD or SEM)
      -Doing any summary instead of just showing the data points for low ‘n’s
      -Using means on non-normally distributed data
      -Showing p-values without correcting for multiple comparisons
      -Not having separate training and test datasets
      etc, etc… all stuff pseudoscientists love.

      • The Bofa on the Sofa

        …including an inordinate amount of unjustifiable significant figures….

        oh, wait…

      • Taysha

        Well, yeah, but it was a night class and we were 18. He had to keep it simple πŸ˜‰

        • Roadstergal

          Totally, I’m just agreeing and tossing in more of the things that put my hackles up. πŸ™‚

      • Mel

        Because Bonferroni’s correction is SO hard to calculate….. oh, wait……

      • Valerie

        Dynamite plots! Haha. Love it.

      • Sue

        Not to mention that the scale on the y-axis makes such a difference – having tiny gradations makes tiny changes look huge.

  • BeatriceC

    Somewhat shocking MK update: he’s getting that second opinion. In the state where his father lives. I’ve mentioned briefly, but the child has had some emotional problems that were made far worse when his health forced him off the ice. I’ve been absent recently because all hell has broken loose. Saturday my ex husband, his wife, MrC, and I decided that due to MK’s recent and extreme behavior, it would be best for him to live with his father for a while. We booked a flight for the beginning of August. Monday a crisis happened. Authorities are involved and they decided that it would be best of he could go as soon as possible. The airline stepped up and was able to change the flight at no additional cost and he left yesterday. I’m devastated, but my job as his mother is to do everything I can to help him grow into a happy, healthy, productive adult, and if that means letting him go, that’s what I have to do.

    • MI Dawn

      Oh, BeatriceC! How very rough for you, MK, and the rest of the family. Sending lots of internet hugs.

      • BeatriceC

        Thank you. This last week has been hell, but I’m really impressed with my ex-husband and his wife. All those years after we divorced, I never did understand why he left me like he did. It never made sense and certainly didn’t seem anything like something the man I married would do. *This* is the man I married. He didn’t hesitate to take in a troubled teenager with a history of violence and destructive behavior (I’ve had to replace phones, broken widows in the house, the windshield of my car was kicked out, my car has numerous fist sized dents in it and the list goes on). Sonya’s supporting her husband and his son without question even knowing that the child has made serious and patently false allegations against his other step-parent (not going into details on that one). They know everything and they still want him. I really hope they can reach him where I have been unable to.

        • guest

          I hope so too.

          • MI Dawn

            Ditto! I can’t imagine dealing with that, and it’s wonderful that they are willing to step up and try.

        • demodocus

          *hugs*

    • Squillo

      Hope everything goes well and that MK’s health and his outlook improve dramatically.

    • Roadstergal

      Ouch, what an experience. I’m so sorry, but it’s proper mom-ing, above and beyond, to give up control in the best interest of your child. πŸ™ *hug*

    • Deborah

      BeatriceC , this must be an incredibly difficult time for you but I hope you can experience some relief from the constant strain you have been under for so long. Xx

    • Charybdis

      I’m so sorry to hear this. It has to be INCREDIBLY hard on everybody involved and I hope that All The Things get sorted as soon as possible with minimal damage all around. Are OK and YK coping all right with all this? Did MK get to take Leo with him? Was he okay with going back east?

      Aack, sorry about all the questions. I’ve been dumped into my own quagmire of uncertainty and concern with DH. In 3 months, he went from fine to early Stage III Kidney Failure and they have no idea why. That, plus the usual crap life throws at you (car issues, kid issues, being pulled in 80 different directions while trying to maintain my patience, calmness, support DH, etc) has left me cranky, short of temper and altogether out of sorts.

      I propose that those of us who have been through the wringer recently should get to have a spa weekend with massages, mani/pedi’s, facials, good food and a hot cabana boy to bring us outrageous, fruit-filled umbrella drinks as we do absolutely nothing.

      • BeatriceC

        Huge hugs. I’m sorry to hear about your DH. I hope they can figure it out and get some form of recovery going soon!

        As to your questions: He could not take Leo with him. My ex has a houseful of pets including several foster dogs, a few cats of their own and an amazon parrot. They didn’t have the space for another animal, nor did they have the means to acquire an appropriate cage, and I didn’t have the means to send his current cage. He’s not entirely thrilled about this move, but he had no choice. He made choices that led to this and it’s nobody’s fault but his own. The other two kids are mostly okay. They have mixed feelings about all this. They’re sad to see their brother go, but they’re also relieved that the violent outbursts won’t happen anymore. YK was particularly affected by those, and he’s struggling with feelings of guilt for feeling relived. But we’re talking a lot, so he’ll be fine in the end. OK is muddling through. He’s a lot more mature and is handling it all, including the conflicting emotions, a lot better.

        To everybody else, once again I’m just going to say thank you here. It’s been one hell of a week, but it’ll all be okay. Looking back on the last few years, there have been several things that have happened, some of which were insanely stressful and seemed just horrible at the time, that are all lining up to make this experience the least traumatic as it can be. I’m oddly peaceful about it all in some ways. It’s weird.

        • Who?

          Sorry to hear about all this. Hope the change of scene helps all of you. Be kind to yourself.

        • Charybdis

          I get how YK is feeling. One of the best years of my childhood was the year my brother was in a children’s hospital psych unit; I was 12 and he was 13 at the time.. (He has Asperger’s, only diagnosed in the past 10-12 years and at the time, his behavior had gotten out of control and the hospital stay was necessary to find proper medication and coping techniques for him).

          I was SO RELIEVED that he was gone and that we could have a normal rhythm of life without waiting on tenterhooks for the next outburst/meltdown because Mom moved the coffee table. It is a peculiar guilty happiness. But it is OKAY to feel that way, because the source of apprehension, fear, dislike, resignation and other negative thoughts and feelings is gone. The person who is taking up the majority of Mom and Dad’s attention, energy and thought processes has exited stage left and the peace and relief left in the wake of said exit is both wonderful and sad.

          It is somewhat like lancing a boil or popping a pimple. Things had gotten ugly, the treatment was painful and the stuff released was nasty and gross. But once the pressure is off and the inside drained of the infection, then things can start to heal. If it was a particularly deep abcess/boil/pimple, it will heal from the inside out. But things can’t heal without having clean edges, sometimes wounds have to be “freshened” to the point where they are bleeding so that healing can take place.

          Hang in there, all of you.

          • BeatriceC

            Thanks again. You’ve pretty much summed up how everybody feels. So far MK is doing okay with his father. I expected a honeymoon period, and that’s happening, but what I’m really hoping for is that his father, being a different person with a different personality, and without all the history that I have with MK (though there are some issues with the whole being absent for 14 years thing), will be able to reach him. In some ways, Dad being basically a stranger might be working in our favor. Mixed blessing, really.

      • Who?

        So sorry to hear that news. Hope you get some resolution soon. Try to also take care of yourself.

      • demodocus

        *hugs*

      • Empliau

        Or hot cabana girls. Equal opportunity.

        • Charybdis

          Definitely. Hot cabana personnel to schlep the umbrella drinks.

      • Charybdis

        This just keeps getting better. We got results yesterday from the last round of appointments/testing. The “Active Problem” list: Chronic kidney disease, Stage 3, Hypertensive disorder AND Chronic systolic (congestive) heart failure. He’s 47. I can’t think straight right now. What the HELL?!!

        I’m just going to be over there >>>>>>> banging my head against the wall, because it feels so good when I stop.

        • BeatriceC

          Huge hugs. I’m so sorry. I don’t even know what to say, and all I can offer is internet hugs.

        • MI Dawn

          OY! I can’t blame you, but use a pillow. Your DH will need you, bold and unbloodied, to stand by his side through all this.

          Now, we need a street address to send the wine, chocolates, and hugs to.

        • Who?

          So sorry to hear this. What a shock for you both. Agree with MI Dawn, you need a pillow, not only to be able to support him but also as a small kindness to yourself.

          Stay in touch.

      • Margo

        Can we add lots of chocolate to the list.

        • BeatriceC

          No. Because I can’t have it. πŸ˜‰

          Oh, fine. The rest of you can have chocolate. I’ll go pout in a corner.

          • Empliau

            Ice cream and/or the alcoholic tipple of your choice? I am not a big fan of chocolate….

      • The Computer Ate My Nym

        I’m sorry about your DH’s health problems! That spa weekend sounds like an excellent idea.

    • The Computer Ate My Nym

      I’m sorry you and MK (and Mr. C and the other kids and even your ex) are going through this, but I want to reiterate what has already been said: You did the right thing.

  • demodocus

    Hey, that basketball player did a good job helping his wife with their accidental homebirth. Maybe a second career, since he counts as one of the “others”?

    • Stephanie Rotherham

      There’s a joke here, but for the life of me I can’t figure it out…

  • The Bofa on the Sofa

    You know, homebirth only needs to increase in popularity by 500% to make it as popular as the moon landing hoax.

  • MI Dawn

    Dr Amy: your second link is to a post from 9/2013, not from March of 2016. And I find it very interesting that I’m not able to comment on any of the posts. It could, of course, be my computer (I’m using Chrome). But it’s still interesting.

    Also: reading who wrote the 2013 post (Wendy Gordon, CPM) is appalling. Bastyr University – the home of Not-a-Doctor training, has a school of midwifery? That’s just terribly scary to me! I would shudder, as a CNM, to see that syllabus. Britt Hermes has posted her syllibus for her ND training at Bastyr, comparing it to an actual MD training.

    • guest

      The “second link” I clicked on is from December, 2015. What are you referring to?

    • Amy Tuteur, MD

      Lamaze recently republished S&S earlier this year. That’s why many of their posts have two dates.

      • MI Dawn

        Ah..I didn’t know that! I just saw the one posted date.

    • RudyTooty

      A few years ago Seattle Midwifery School (SMS) was folded into Bastyr.
      Not sure why. Either SMS couldn’t financially stand on its own, or Bastyr wanted to train NDs to attend births. NDs from Bastyr who wanted to also be midwives would take courses from SMS. Either way, the schools seemed to need each other – and they combined their programs. I believe there is still the option of training only as a midwife at Bastyr??? Could be wrong.

      Anyway – it’s the same-old, same-old, basically. A CPM education at a “graduate” level.

      http://m.bastyr.edu/seattle-midwifery-school-now-part-bastyr