In the wake of a Downton Abbey episode in which a main character lost her life to eclampsia, Lamaze has suddenly discovered it.

The recent episode of “Downton Abbey” brought much needed attention to the maternal health issue of pre-eclampsia. Why is it we rely on fiction for permission to get real? … How do we encourage each other and the next generation of maternal health advocates to harness the undeniable power of media but not become part of a social construction of maternal mortality as not real?

Why do we rely on fiction? Because organizations like Lamaze refuse to discuss pregnancy complications.

According to The Pre-eclampsia Foundation:

Thousands of women and babies die or get very sick each year from a dangerous condition called preeclampsia, a life-threatening disorder that occurs only during pregnancy and the postpartum period. Preeclampsia and related disorders such as HELLP syndrome and eclampsia are most often characterized by a rapid rise in blood pressure that can lead to seizure, stroke, multiple organ failure and death of the mother and/or baby.

Pre-eclampsia can come on silently. That’s because the leading symptom is high blood pressure and most women have no idea their blood pressure is high unless it is measured. Other signs include swelling, protein in the urine and hyperreflexia (exaggerated reflexes in response to testing with a reflex hammer). Complications of pre-eclampsia include seizures (which means that the dsease has progressed to eclampsia), stroke, liver abnormalities, destruction of red blood cells and lack of platelets.

Pre-eclampsia is more common in first pregnancies, but can happen in any pregnancy. Since the disease is extremely serious, relatively common, and poses a risk to all pregnant women, you would think that any organization or author purporting to advise women on healthy pregnancy and childbirth would mention and then emphasize the signs and symptoms of pre-eclampsia. You would be wrong.

Consider Lamaze International. On their entire website, I could find not a single page devoted to one of the major killers of women and babies. Indeed, rather than educating women about pregnancy complications, Lamaze downplays complications into invisibility.

An evolving body of research repeatedly shows the danger of interfering without a valid reason in the natural processes of pregnancy, birth, and breastfeeding. Any intervention, no matter how simple it seems, may disrupt the normal process and create problems that, in turn, must be managed with more interventions. All interventions have side effects that can be risky for both mothers and babies.

Actually, they go further than that by giving the back of the hand to the majority of prenatal tests.

Many of these newer tests were created to diagnose problems in high-risk pregnancies. But with the increased medicalization of pregnancy, they have become routine for healthy women with no known risks. This does not mean that every test is right for everyone, however, or that they are risk-free themselves. There may be a problem that prenatal testing doesn’t show, or a problem may not exist even if the test suggests it does. Results that are unclear or even misleading can plague your peace of mind and decrease your confidence. The barrage of tests can also make you feel like your health-care provider knows everything there is to know about your pregnancy, which is not the case.

Lamaze is not alone. Henci Goer wrote a 500 page book entitled Optimal Care in Childbirth. How many pages did she devote to pre-eclampsia and eclampsia. Zero!

In both cases, the neglect of pre-eclampsia is inexcusable, but it could be worse. Many natural childbirth and homebirth advocacy books and website peddle the lie that pre-eclampsia can be prevented with diet? There is not a shred of scientific evidence that diet has any impact on pre-eclampsia but that doesn’t stop NCB and homebirth advocates from blaring dangerous falsehoods.

Why won’t NCB organizations and authors even mention pre-eclampsia until forced to do so by a fictional television program. I suspect three reasons:

1. There is no money to be made by midwives, doulas and childbirth educators from women who have pregnancy complications. All three ignore anyone who isn’t likely to pay them.

2. Natural childbirth rests on the bedrock lie that childbirth is inherently safe. Childbirth is actually inherently dangerous and pre-eclampsia/eclampsia is one of the reasons why; therefore, it must be ignored.

3. NCB advocates fetishize process over outcome. The ultimate birth for an NCB advocate is one that involves no interventions, not one that results in a healthy baby. Pre-eclampsia “ruins” NCB perfection; better to pretend that it doesn’t exist.

The Science and Sensibility piece which discovers pre-eclampsia includes an interview with a volunteer at The Pre-eclampsia Foundation. Asked what she would recommend to childbirth educators and doulas, Jennifer Carney answers:

Really, I think it comes down to trusting that the moms you are helping can handle the information that they NEED to know. I was alone. If I had known that these symptoms could mean eclampsia or preeclampsia, I might have been able to save myself from the seizures – which would have also likely saved me from the ARDS and pneumonia. My ICU stay might have not happened. My son was going to be born early – but if I had gone to my doctor or called an ambulance myself, it might not have been so close a call. It’s not my fault that I didn’t know – but it could have been tragic.

Know the signs and symptoms. Know that a woman with severe PE might be having cognitive issues – confusion, and vision problems. Don’t ask her to drive. Don’t downplay distress. And take complaints of headaches, upper quadrant pain, nausea, diarrhea, shoulder pain, visual disturbances, and a general feeling that something is “off” seriously. And if you have a client or patient that experiences something like this, please follow up and ask about mental health issues. Be careful not to ask questions that can be answered with the words: “I’m fine”. Dig deeper.

Pre-eclampsia/eclampsia is a killer of women and babies. It is not uncommon, and it can be easily diagnosed by basic testing. While women cannot diagnose pre-eclampsia themselves, there are signs they can look for and bring to the attention of their providers before pre-eclampsia turns deadly. Of course they can only do that if they know about pre-eclampsia.

It is a damning indictment of NCB organizations like Lamaze that they downplay and ignore common, life threatening pregnancy complications. If you can’t rely on them to provide basic information to save the life of a pregnant woman, you can’t rely on them for accurate information on anything.

Here’s the homebirth website,
Here are the people,
Open the homepage,
Look at the sheeple.

“Sheeple” is a derogatory term thrown about by homebirth and natural childbirth advocates to imply that women who consult and heed the advice of obstetricians are blind, unthinking followers. However, when it comes to sheeple, homebirth and NCB advocates have it precisely backward. It is they who are sheeple, blindly following leaders of the cult like homebirth and NCB movements, lacking the knowledge base to question the lies they are told, and putting the lives of their babies at risk for no better reason than bragging rights.

Consider the following comment, typical of the homebirth advocates who regularly parachute into the blog to chastise and “educate” the rest of us:

Babies Die. It happens in hospitals and it happens at home or in transit. The only difference is that the world looks down on you if your baby died during a homebirth. Then it turns from pity to the fact that you deserved to have your baby die because you chose to have them at home. That attitude does nothing to bridge the gap between home birth and hospital birth. After reading your blog for a few days now, I have come to the conclusion that you are just as harsh, in your face, and rude as you claim all the homebirth advocates to be. This kind of behavior only feeds the hate that is out there already. You posting pictures that were taken from a website in which parents gather together and post to help support each other and then use it to say “SEE! I Told You So.” is truly disgusting. There seems to be nothing sacred to you and people like you. You are all correct and everyone else is wrong.

I’ve seen these sentences, in a various combinations, literally thousands of time. They are lifted wholesale from homebirth and NCB websites and message boards where the ignorant inspire other ignorant women to believe nonsense. I would hope that anyone with a modicum of intelligence would learn to question the nonsense, but they rarely do. That’s because they are not independent thinkers; they have no original ideas. They lack even the most basic knowledge of science, statistics and childbirth to make any independent assessment of anything. They are cult members hoping to enhance their reputation among other cult members.

Let’s parse the comment for the components of their foolishness.

1. Babies Die. It happens in hospitals and it happens at home or in transit.

Duh. Of course babies die. Childbirth is inherently dangerous. The issue is not that babies die in both places but how the rates of death compare. Homebirth advocates have a serious problem with basic arithmetic. Apparently most of them were day dreaming in the 4th grade when they were supposed to be learning abut rates.

Approximately 12 people die from poisonous snake bite in the US each year. Approximately 520 women die from pregnancy and childbirth related causes each year. By the “reasoning” of homebirth advocates, pregnancy is more than 40 TIMES more dangerous than poisonous snake bites. Wow, who knew that pregnancy was so dangerous?

What’s wrong with this “reasoning”?

Comparing absolute numbers is inappropriate. The only valid comparison is that of rates. Rate, in this case, is the absolute number of people who died from the cause divided by the number of people who could have been exposed to the cause. Approximately 8,000 people are bitten by venomous snakes each year for a death rate of 1.5/1000. Approximately 4 million women are pregnant each year, for a death rate of 0.13/1000 (equivalent to 13/100,000). In other words, snake bite is 12 times more dangerous than pregnancy.

2. The only difference is that the world looks down on you if your baby died during a homebirth.

No the difference is that most babies who die at home did not have to die. They died for lack of access to life-saving emergency procedures (like C-sections) and personnel (obstetricians, anesthesiologists and neonatologists) who could have saved them. Babies who die in the hospital probably would not have lived regardless of where they were born because they die in spite of access to life-saving emergency procedures.

It’s the difference between babies who die in car accidents because they weren’t buckled into carseats and babies who die despite being buckled into carseats. That babies die in both situations does not change the fact that buckling a baby into a carseat means taking every precaution, while letting your baby sit unsecured in a moving car is the height of irresponsibility.

3. That attitude does nothing to bridge the gap between home birth and hospital birth.

So what? My attitude does nothing to bridge the gap between women who secure their babies in carseats and women who don’t, either. I’m not trying to “bridge the gap”; I’m trying to introduce homebirth advocates to the dangers of homebirth through the use of basic logic, basic statistics or stories and pictures that bring the death toll of homebirth into vivid view.

4. This kind of behavior only feeds the hate that is out there already.

Do you think I care? Your “hate” is like the “hate” of my children when they were small and didn’t get their way. I’m not here to have you like me. I’m here to force you to face unpleasant truths, and give up comforting lies. The fact that people hate me simply emphasizes their dread that I am right and they risked or even sacrificed their babies’ lives for no better reason than an experience.

5. You posting pictures that were taken from a website in which parents gather together and post to help support each other …

Proving yet again that homebirth advocates can’t be bothered to read simple English before leaping to conclusions. The Hurt by Homebirth website is MY website, created in response to requests from homebirth loss parents who selflessly share their pain so no other parent has to walk in their shoes. How did the commentor “know” what I had supposedly done. Some other homebirth advocate told her and she believed it unquestioningly.

6. You are all correct and everyone else is wrong.

No, I, in my capacity as an expert with decades of training, experience and command of the obstetric literature are much more likely to be correct than homebirth advocates who are a fringe group full of women lacking basic knowledge of any relevant discipline. I represent the overwhelming majority of obstetricians, of doctors of all specialties and of American women who would never risk the life of their babies on the say-so of the icons of the homebirth movement, who speak mostly nonsense.

My blog is a testament to the fact that women who choose hospital birth recognize the value of professional expertise, but are also eager to learn and capable of reading the scientific literature, debating the merits of various points of view and holding a self-image strong enough to withstand even the most vile comments of homebirth and NCB advocates.

Who are the real sheeple? Homebirth advocates, of course, who believe things not because they make sense or because they are said by experts by because they choose to unthinkingly follow the nonsense of other lay people as ignorant as themselves.

ATTENTION PARENTS AND FUTURE PARENTS! Homebirth advocates and homebirth midwives do not want you to know about the incredible fear and horror you and your baby may feel during homebirth, or the soul crushing grief and guilt you may experience for the rest of your life because your baby was permanently injured or died, all because you believed the crap spewed forth on websites like Birth of a New Earth.

The following photos comes from Hurt by Homebirth, a website that exists for the sole purpose of allowing homebirth loss mothers to tell their stories.

The world of homebirth advocacy is a vast echo chamber where ignorant women praise other ignorant women for being “educated.” It is a world where fragile women go to boost their self-esteem with unrestricted plaudits for even the most irresponsible decisions. It is a world where women actually risk their babies’ deaths for the admiration of their equally uneducated peers.

In other words, it is not the real world.

Perhaps that explains why homebirth advocates react with utter incredulity when the real world gets involved.

They are shocked, shocked to learn that when they publish their stories of loss, or neonatal injury to the entire population of the world, other people read them. Why don’t they keep them private? Because they are seeking praise and validation for the irresponsible decisions that led to the deaths or injuries of their babies. Evidently, the praise and validation they get from the homebirth advocates that they know personally is not enough. They need more and they actually think they will get it by telling the entire world of their choices and the hideous outcomes.

They cannot believe that there could be any other response to a homebirth loss or injury than praise for the mother who is now bereaved or facing permanent injury to her child, often as a direct results of her own decisions. That, despite the fact that the mother has often been begged by her parents, in-laws, and friends to give birth in a hospital where lifesaving equipment and the personnel who know how to use it are available.

Occasionally, they react the way that any sensible person would, and make their blog private. Generally, they do not, because you can’t get praise from strangers if they aren’t able to read your story.

Here’s what they need to keep in mind:

The overwhelming majority of people think that homebirth is irresponsible. They aren’t impressed with your decision; they are appalled. They don’t think you are educated; they think you are ignorant. They are very sorry that your baby died or was injured, but they think you bear some, if not all, responsibility for the tragedy that didn’t have to happen.

If you don’t want to know what the majority of people think about your choice, don’t publish your story to the entire world. No one is going to respect your “privacy” when you clearly have no respect for it, eagerly abandoning privacy in a desperate attempt to gain validation.

Harsh? Maybe, but that’s nothing compared to the suffering of the babies whose lives were sacrificed unnecessarily or who will have to live with permanent brain impairment or other injury.

An ongoing discussion in my Facebook group about the reliability of specific scientific papers purporting to show the benefits of natural childbirth reminds me yet again that most people are deeply confused about statistics.

For laypeople, part of the problem is the fact that the word “statistics” has more than one meaning. Used colloquially, statistics can refer to data. The technical meaning of the term is different. According to the American Statistical Association:

Statistics is the science of learning from data, and of measuring, controlling, and communicating uncertainty …

Statistics can be divided into descriptive statistics and inferential statistics. Descriptive statistics are, as the name implies, descriptive. A classic example of descriptive statistics is an average. If someone drives 10 miles an hour for 1 hour, 20 miles an hour for 1 hour and 30 miles an hour for one hour, the average speed is 20 miles an hour. Descriptive statistics are extremely useful, yielding everything from RBIs in baseball, to class medians in college courses, to standard deviations that allow us to determine how much a specific result differs from the majority of results.

When we talk about scientific papers, however, we are referring to inferential statistics. Once again the name is apt. Inferential statistics allows us to make predictions about large groups or populations by looking at a small subset. For example, we might look at the long term outcomes of smoking among 10,000 people in order to make predictions about the impact of smoking on the tens of millions of people who smoke. The key value of inferential statistics is that it tells us which observations can be extrapolated to large populations and which cannot.

Most individual observations cannot be extrapolated to large populations because they represent a random result. For example, you might meet a woman named Esmerelda who has five daughters. You cannot infer from that that all women named Esmerelda will have five daughters, will have only daughters or will have children at all. And that brings us to the first and most basic element of inferential statistics. You must have collected a large group of individual observations before you can extrapolate to the general population. Why? Because inferential statistics tell us that unless we prove otherwise, any set of observations is likely to reflect random variation, and will not be reproduced in another set of similar observations.

How many individual observations do you need before you can draw an inference from a data set? The answer can be determined by statistical power, which is short hand way of identifying the power of a set of observations to yield an accurate prediction about any population. Consider coin tossing. Imagine that you toss a coin 6 times and it lands heads 2 times and tails 4 times. Can you infer that tossing a coin results in heads 1/3 of the time? No you cannot, because the result you obtained was purely random. You need many more observations for the study to have enough power to yield an accurate inference. If you tossed a coin 2 million times and got heads 999,999 times and tails 1,000,001 times, you would be entitled to infer that coin tosses yield heads half the time and tails the other half.

Determining whether a study includes enough observations to draw inferences is beyond the scope of this post, but, as a general matter, the less likely you are to see a specific result, the more observations you need to reach valid conclusions. If a study looks at neonatal deaths at homebirth, and neonatal deaths are typically measure per 1000, you are going to need several thousand observations or more to draw valid conclusions. There are exceptions to this rule, since it isn’t the number of observations alone that determines whether a study is adequately powered. However, as a general matter, if a study contains only a few dozen observations, it is underpowered and you cannot make ANY inferences regarding the results.

Most midwifery studies are grossly underpowered. If you look at the C-section rates among 20 women who employed doulas during labor and compared that to the C-section rate of 20 women who did not employ doulas, you can generate descriptive statistics such as the average C-section rate in each group. However, you cannot draw ANY conclusions about the impact of doulas on C-section rates, because the few observations you have generated are not necessarily representative of a real difference in C-section rates caused by employing a doula. When a study is underpowered, the results are simply random and tell us nothing.

A second basic element of inferential statistics is statistical significance. A study may be adequately powered, yet the results may still be insufficient for us to draw conclusions. Consider a study that compares the neonatal death rate of 10,000 women who had homebirths with 10,000 women who had hospital births. Suppose that 11 babies in the homebirth group died and 10 babies in the hospital group died. Does that mean that homebirth is 10% more dangerous than hospital birth. No, it doesn’t not, because although the results of the two groups are different, performing the appropriate statistical test will show that the difference is not statistically significant. Determining which is the correct test of statistical significance and performing it can be complicated, but the underlying concept is simple. When a result is not statistically significant, it means that it is likely that it happened by random and therefore does not reflect a true difference. If a result is not statistically significant, the result has no predictive value. In other words, it is meaningless.

A third basic concept of inferential statistics is that you must be sure that you are comparing like with like. Suppose you are comparing breastfeeding rates at a hospital with the “baby friendly” designation to one that lacks the designation. In order to draw a valid conclusion, you must be sure that the women who give birth at the baby friendly hospital are similar to the women who give birth in the other hospital. If it turns out that the baby friendly hospital is located in a wealthy suburb, where almost all the women are married, well educated and relatively well off and the hospital that is not baby friendly is in the inner city, serves a population of teen mothers who are uneducated and impoverished, you are not going to be able to draw any conclusions about whether the baby friendly designation improves breastfeeding rates even if the baby friendly hospital has a statistically significant increase in rates and even if the study is adequately powered. That’s because there are other factors, known as confounding factors, that may be responsible for the observed difference and the baby friendly designation may have nothing to do with it at all.

Obviously this is a grossly oversimplified view of inferential statistics, but it does suggest several things that lay people can look for when trying to determine if the conclusions of a study are valid.

Does the study involve lots of people in each group? If not, the study is underpowered and the results are meaningless.

Are the differences between the two groups statistically significant? If not, the results are meaningless.

Did the authors compared groups that are similar except for the one variable under investigation? If the two group differ appreciably, the results are meaningless.

Just by looking at these three factors, lay people can easily discard much of the homebirth and natural childbirth literature as invalid.

A new study of birth centers, published yesterday, is being hailed by midwifery advocates. While it does demonstrate that giving birth in birth centers accredited by the American Association of Birth Centers is safe, it does NOT show that birth centers have a lower C-section rate than hospital care for comparable risk women, and therefore, it does NOT show that increasing birth center births would save millions of dollars.

The study is Outcomes of Care in Birth Centers: Demonstration of a Durable Model, by Stapleton, Osbourne and Illuzi.

The study found that birth in accredited birth centers was very safe:

There were no maternal deaths. The intrapartum fetal mortality rate for women admitted to the birth center in labor was 0.47/1000. The neonatal mortality rate was 0.40/1000 excluding anomalies.

This is comparable to death rates for low risk hospital birth.

So far, so good. Then the authors, in their efforts to promote birth centers, go far beyond the data. They claim:

The cesarean birth rate in this cohort was 6% versus the estimated rate of 25% for similarly low-risk women in a hospital setting.21 Had this same group of 15,574 low-risk women been cared for in a hospital, an additional 2934 cesarean births could be expected. The Medicare facility reimbursement for an uncomplicated cesarean birth in a hospital in 2011 was $4465.49 Given the increased payments for facility services for cesarean birth compared with vaginal birth in the hospital, the lower cesarean birth rate potentially saved an additional $4,487,524. In total, one could expect a potential savings in costs for facility services of more than $30 million for these 15,574 births.

But the C-section rate for comparable risk births in the hospital is NOT 25%. It is far lower, in the range of 4-8%. Indeed, I’m not sure where they even got their estimate of a 25% C-section rate for comparable risk births since does not appear in the reference specifically cited to support this number.

The first rule of scientific comparisons is to compare like to like. Therefore, when looking for the appropriate comparison group for women who give birth in accredited birth centers, we must restrict the group to low risk women, with single babies, at term, without intrauterine growth retardation. Furthermore, we must exclude from the comparison group any women who have pre-existing medical problems or pregnancy complications, since they would be excluded from delivering at the birth center.

In addition, we must take into account that women choose to deliver in a birth center are a self-selected group who differ markedly from the general population. They are more likely to be white, married and well educated and they are far less likely to smoke, drink alcohol or be obese.

What is the appropriate comparison group? It’s women who choose to deliver in the hospital with a CNM. There are a number of studies performed in the past 2 decades that look at outcomes for women who delivered with CNMs in a hospital. The C-section rate in that group ranges from 4-8%. Moreover, women who give birth in the hospital have access to pain relief, something that most women want.

There is no particular benefit to delivering in a birth center with a CNM as compared to delivering in a hospital with a CNM. There’s no decrease in C-section rate, and no savings from C-sections that were avoided. If the same group of 15,574 low-risk women had been cared for in a hospital by CNM, an additional 2934 cesarean births would NOT have been expected. Indeed, no additional C-sections would have been expected.

So while this paper makes an excellent argument for the safety of accredited birth centers that employ strict eligibility criteria, it does NOT show that birth centers reduce the C-section rate or save money by doing so.

Homebirth advocates have a terrible propensity for promiscuous use of language. By that I mean the use and abuse of language for the express purpose of drawing attention. Such is the case with the use of the term rape as in the currently fashionable accusation of “birth rape”. It’s not rape, it has nothing to do with rape, and it is a grievous insult to those women who have experience the horror of rape.

Even homebirth advocates recognize that abusing the term “rape” in this way is not winning friends for their cause. Hence, the latest iteration of “the obstetrician didn’t do exactly what I wanted” is “obstetric violence.” Apparently, if you are a homebirth advocate, having your feelings hurt is the equivalent of “violence.” That, of course, is ridiculous.

However, there is such a thing as obstetric violence and it is perpetrated by homebirth advocates on babies.

Babies do not ask to be conceived. If a woman decides to conceive a baby and carry it to term, she has a moral obligation to care for the health and well being of that baby. She has a moral obligation to feed it and change it, and clothe it, and put it in a carseat when she takes the baby with her to the grocery store. She also has a moral obligation not to risk its life.

Obstetric violence toward babies involves real violence, injury and death, not hurt feelings. Over the years I have written about women whose babies have died hideous deaths at homebirth.

These include breech babies whose heads were entrapped while their bodies dangled outside their mother’s vagina, and who died long before they could reach medical help.

They include babies who struggled for hours and suffocated, dropping dead into the hands of unsuspecting homebirth midwives who didn’t appropriately monitor their heart rates.

They include babies who slowly lost brain cells because their heads had delivered, but their shoulders became entrapped.

They include babies who died when they were suddenly extruded into their mother’s abdomen when a uterine incision ruptured and they bled to death long before they could reach a hospital.

They include babies who survived but suffered serious brain injuries leading to lifelong disabilities affecting their ability to move, to reason, to live on their own, to fulfill the potential that they had when labor started.

Who cares about the obstetric violence perpetrated on these babies?

Certainly not homebirth midwives, who never met a risk they couldn’t label as a variation of normal.

Certainly not homebirth advocates, who never heard of a homebirth death that they couldn’t rationalize with the all purpose, and incredibly ugly claim that “some babies are just meant to die.”

Who cares about the obstetric violence perpetrated on these babies? Obstetricians of course. You know, the people who “play the dead baby card” because they are actually worried that your baby could die.

As far as I’m concerned, there’s something very wrong when women claim that hurting their feelings is “violence. There is something very wrong when letting a baby suffocate to death, half the body born, and half still inside the mother is dismissed as inevitable, especially when it was not. And there is something very wrong when the obstetrician cares more about whether your baby lives or dies than you do.

Stop obstetric violence toward babies … have a hospital birth.

As I’ve written many times in the past, there is an apparently irresistible impulse to one-upsmanship among homebirth advocates.

So, for example:

A says, “I had natural childbirth.”
and B says, “Oh, yeah, well I had PAINLESS childbirth”
and C says, “Well, ladies, I can top that. I had an ORGASM during childbirth!”

Evidently the latest iteration is this:

A says, “I had a low risk homebirth and my baby didn’t die”
and B says, “Oh, yeah, well I had a high risk homebirth and my baby didn’t die”
now C says, “Well, ladies, I can top that. I had a high risk homebirth and IT SAVED MY BABY’S LIFE!”

It’s gotten to the point where these women are completely delusional. Last week I wrote about the homebirth advocate who claimed Thank goodness I chose homebirth for the shoulder dystocia that nearly killed my baby.

A woman whose son suffered a severe shoulder dystocia, was born lifeless, waited 25 minutes for an ambulance and had to endure cooling therapy to preserve his brain function and may have sustained developmental impairment is actually crowing that it was the decision to give birth at home that saved his life.

The following story, found on Mothering.com, may actually top it.

The mother had an uncomplicated homebirth, but then had a retained placenta. She was transferred to the hospital for a manual removal of the placenta.

Despite having 6 ultra high-tech ultrasounds in the 2nd and 1 in the 3rd trimesters, 3 OBGYNs (including 1 who hated homebirths and looked for any reason to disqualify you) had ALL missed my son’s life-threatening Velamentous Cord Insertion (VCI).

VCI is when the cord inserts itself into the fetal membranes instead of the placenta. It leaves the blood vessels exposed and most of the time the vessels explode, causing stillbirth. Basically, the cord and placenta are inside-out.

Here, you’re hospitalized immediately after VCI is diagnosed. You get a special CSection at 35 weeks, or whenever labor starts, whichever is first. The CSection is done special to prevent accidental nicking of the exposed vessels.

All 3 OBGYNs agreed that homebirth saved my son’s life. They said that, had I birthed in a hospital, they would have done a CSection for “failure to progress” and wouldn’t have paid close enough attention to realize the VCI, thus killing my son.

Let’s parse these claims:

What is VCI?

The International Vasa Previa Foundation has a page devoted to velamentous cord insertion. All vasa previa involve velamentous cord insertion, but not all VCI are vasa previa. As the mother accurately explained, VCI describes a condition where the blood vessels of the umbilical cord travel across the fetal membranes before inserting into the placenta, instead of inserting directly into the placenta as is typical. Vasa previa happens when the blood vessels of the VCI overly the cervix and are therefore exposed and subject to tearing as the cervix dilates. A ruptured vasa previa causes the baby to exsanguinate within a few minutes.

Is VCI dangerous if there is no vasa previa?

Velamentous cord insertion in the absence of vasa previa usually does not cause problems. If the VCI is above the lower uterine segment, there is little danger that the exposed blood vessels will rupture. You can find an excellent picture of VCI here.

How easy is it to diagnose velamentous cord insertion?

Velamentous insertion has been diagnosed by ultrasonography with a sensitivity of 67% and specificity of 100% in the second trimester;

In one third of cases, VCI is not visible on ultrasound.

What is the treatment if VCI is diagnosed by ultrasound?

If detected, fetal growth may be monitored with ultrasonography in the third trimester. Consider an elective cesarean delivery to avoid a vasa previa rupture or fetal distress if the velamentous insertion is in the lower segment.

In other words, the mother has the story precisely backwards! C-section PREVENTS injury from VCI. It doesn’t cause it.

The idea that a homebirth saved this baby’s life is ludicrous on its face. First, the danger of VCI that does not cross the cervix or lower uterine segment is actually quite small. Second, C-section is the life saving TREATMENT for a worrisome VCI because it reduces the risk of perinatal death to near zero.

I suspect that the mother heard (or pretended to hear) exactly the opposite of what she claims.

No one told her that homebirth saved her baby’s life; they told her that homebirth could have killed her baby. No one told her that C-section would have put her son at risk because C-section does not kill VCI babies; is a treatment for VCI.

They almost certainly told her that she had dodged a bullet. Had the VCI ruptured during homebirth, her baby would have died. This mother is apparently so desperate for extra special bragging rights for her homebirth that she isn’t simply practicing denial. She has actually inverted the admonition of the hospital personnel into praise for herself and her decision. That impulse verges on the delusional.

The announcement of the first pregnancy of Kate, Duchess of Cambridge and future British queen has created a stir in the birth world. Many birth activists have suggested that Kate could set an example by having a home birth and avoiding interventions. Even the British, apparently, forget their own history. In one of the greatest tragedies of the British monarchy, another princess who would have become queen died precisely because everyone around her was afraid of birth interventions.

Princess Charlotte of Wales was the only child of George IV, and grandchild of George III, the king who presided over the American Revolution. Although George III had many sons, and they had dozens of illegitimate children between them, Charlotte was the only legitimate grandchild and was set to inherit the throne. Charlotte was wildly popular, seen as a breath of fresh air compared to her dissolute father and uncles. Her wedding to Prince Leopold, later King of the Belgians, in 1816 was greeted with widespread celebration. That the marriage was a love match, after Charlotte had refused her father’s preferred candidate, added to the feeling of joy. When months later the Palace announced her pregnancy, the public was thrilled.

According to Wikipedia:

Charlotte’s pregnancy was the subject of the most intense public interest. Betting shops quickly set up book on what sex the child would be. Economists calculated that the birth of a princess would raise the stock market by 2.5%; the birth of a prince would raise it 6%. Charlotte spent her time quietly, spending much time sitting for a portrait by Sir Thomas Lawrence.[89] She ate heavily and got little exercise; when her medical team began prenatal care in August 1817, they put her on a strict diet, hoping to reduce the size of the child at birth. The diet, and occasional bleeding, seemed to weaken Charlotte…

Much of Charlotte’s day to day care was undertaken by Sir Richard Croft. Croft was not a physician, but an accoucheur, or male midwife, much in fashion among the well-to-do.

Croft had calculated a due date of October 19, but Charlotte did not go into labor until November 3. Charlotte’s labor was protracted. Although she was fully dilated after 24 hours, she pushed for hour after hour. Today a diagnosis of arrest of descent would have been made and Charlotte would have undergone a C-section or a forceps delivery. She would have given birth to a healthy baby and perhaps complained about her “unnecessarean.”

Of course C-section was not an option then, but Croft had forceps and knew how to employ them. Nonetheless, he hesitated. Forceps were an intervention and could injure the baby, and Croft knew he would be blamed. He allowed Charlotte to push for 24 hours. Reportedly, for the last 6 hours of pushing, the baby’s head (more likely swelling on the top of the baby’s head) was visible. Finally, Charlotte’s son was born — dead. He had died sometime during the long labor. Less than 6 hours later, Charlotte herself was dead, reportedly dying from hypovolemic shock after a postpartum hemorrhage due to uterine atony, almost certainly a direct result of the extremely prolonged labor.

The country was plunged into mourning:

Henry Brougham wrote of the public reaction to Charlotte’s death, “It really was as though every household throughout Great Britain had lost a favourite child.” The whole kingdom went into deep mourning; linen-drapers ran out of black cloth. Even the poor and homeless tied armbands of black on their clothes. The shops closed for two weeks, as did the Royal Exchange, the Law Courts, and the docks. Even gambling dens shut down on the day of her funeral, as a mark of respect. Wrote The Times, “It certainly does not belong to us to repine at the visitations of Providence … there is nothing impious in grieving for that as a calamity.” Mourning was so complete that the makers of ribbons and other fancy goods (which could not be worn during the period of mourning) petitioned the government to shorten the period, fearing they would otherwise go bankrupt.

It is horrifying to contemplate Charlotte’s suffering and more horrifying still to realize that dozens of women around the world die each day for exactly the same reason: protracted labor ending with a stillborn baby and a fatal postpartum hemorrhage. And they die for the exact same reason Charlotte did, lack of interventions, though in their case, the interventions are unavailable, not unused.

Croft, who had hesitated to intervene with forceps, committed suicide several months later.

The “triple obstetric tragedy”—death of child, mother, and practitioner—led to significant changes in obstetric practice, with obstetricians who favoured intervention in protracted labour, including in particular more liberal use of forceps, gaining ground over those who did not.

The death of Princess Charlotte changed the course of British history. The race was on among her uncles, middle aged men, to produce a legitimate heir. That race was ultimately won by the Duke of Kent, whose wife gave birth to the baby girl they named Victoria. Victoria came to the throne in 1837 and reigned for more than 60 years, giving her name to the entire era.

It was said that Leopold never got over his loss, both the loss of his beloved wife and the loss of his access to the British throne. To regain the influence he would have had in Britain, he groomed his nephew, Albert of Saxe-Coburn-Gotha to marry his niece Victoria. The rest, as they say, is history. Albert’s (and therefore Leopold’s influence) changed Europe through his children and grandchildren including Kaiser Wilhelm of Germany, and Alexandra, Czarina of Russia, murdered in the Revolution of 1914. Indeed, his descendants are still on the throne of England to this day. The current Queen Elizabeth is Albert’s great, great, granddaughter.

I suspect that those who are hoping that Kate, the Duchess of Cambridge, will strike a blow for intervention free birth, are doomed to disappointment. The monarchy has “trusted” birth in the past and had cause to profoundly regret that decision.

Actress Kate Winslet was actually so embarrassed about having a C-section for her first child that she lied about it:

When she celebrated the birth of her first baby, she hailed the joys of natural childbirth.

But now, four years on, Kate Winslet has admitted she lied – her daughter Mia was delivered by emergency Caesarean section.

The actress said she wanted to have her naturally and only lied because she believed she was a ‘failure’ for not being able to do so…

She told the U.S. magazine Gotham: ‘I’ve never talked about this – I’ve gone to great pains to cover it up. But Mia was an emergency C-section.

‘I just said that I had a natural birth because I was so completely traumatised by the fact that I hadn’t given birth. I felt like a complete failure.’

I am well aware that many women feel like failures for having a C-section, but I’ve never understood it. Personally, I think C-section mothers should be extra proud of themselves. When offered the choice between risk to their unborn baby, and risk to themselves, they chose taking on the risk in an effort to protect the baby. If that isn’t the essence of motherhood, I don’t know what is.

Consider C-section for breech birth. We tell women that breech vaginal delivery increases the risk of death or serious disability. Why? To the extent that childbirth is “designed,” it is meant to occur with the baby in the head down position. The fetal head is “designed” to bear the stress of banging against the maternal bony pelvis every 2 minutes for hours at a time, is “designed” to distribute the force of uterine contractions most effectively to the cervix in order to open it, is “designed” to change shape (known as molding) to conform to the mother’s pelvis so it can fit through, and is “designed” to be the biggest part of the baby, so that if the head fits, the body almost certainly will follow easily.

Obviously, none of those tasks is fulfilled by the breech. Instead, being born in the breech position makes the baby uniquely vulnerable to permanent injury or death. The head can become trapped because it is bigger than the rest of the body; the entire body can slip through and the head can be jammed up against the mother’s pelvis, it’s oxygen supply obliterated as the umbilical cord is compressed by being trapped between the baby’s body and the bones of the mother’s pelvis. This, not surprisingly, can result in permanent brain damage and/or death.

Make no mistake, the absolute risk that the baby will die from a vaginal breech birth is small, less than 1%, but to me that makes it all the more remarkable that most women carrying breech babies will choose C-section. Faced with the small, but real risk of the baby’s death, most mothers will opt for abdominal surgery with the pain, potentially harder recovery and increased risk of infection or bleeding. In other words, women who choose C-section for breech want to protect their babies from any risk, no matter how small, at the cost of pain and potential suffering to themselves.

The same thing goes for women who consent to C-section for fetal distress. In 2013, the diagnosis of fetal distress is imperfect at best. We know that almost all babies who experience lack of oxygen during labor will give evidence of that on electronic fetal monitoring. In contrast, many babies who appear to be in distress may actually be fine. When a woman consents to a C-section for fetal distress, she is saying in essence: I don’t know whether my baby is truly experiencing oxygen deprivation, but I don’t want to take any chances. Cut me and help the baby; if I’m wrong, it’s a price I’m willing to pay to be sure that my baby is okay.

In other words, its a sign of devotion, not a sign of failure.

Kate Winslet is not alone in her embarrassment, but there is absolutely no reason she or any other mother should ever be embarrassed by having a C-section.

As a mother of four children, let me say “Bravo!”

I never had to face the choice that many C-section mothers do, but I hope that I would have reacted as selflessly as they do.

Can we have a round of applause for C-section mothers? They certainly deserve it!