Yes, you read that right. Doctors often wonder if they can trust their patients.

Most patients want a trusting relationship with their doctor and they assume that the only issue is whether the doctor is trustworthy. However, a lot of the problems in the contemporary doctor-patient relationship stem from the fact that doctors cannot be sure they should believe their patients. Patients insist that they are educated, that they want to manage their care and that they want treatment plan A. Yet when treatment plan A does not work out, they are unhappy with the doctor. He or she should have explained it better or been more aggressive or refused to go along with their plan.

Don’t believe me? Here’s an excerpt article by a professional journalist detailing her years of infertility treatment, Not giving up hope for a biological baby:

My first doctor in Santa Monica, Calif., was thoughtful and attentive, with an Ed Harris sort of look and a kindly, if somewhat passive, approach. The fertility practice he was part of had wonderful nurses, a sleek, minimalist aesthetic and a reputation for a celebrity clientele.

My second doctor was in Arizona, a blowhard with pictures of his success stories (i.e., babies) insensitively plastered on the walls of his tacky Southwest-décor office. (Please don’t make infertile women look at photos of other people’s kids, I wanted to scream.) After keeping me waiting for 45 minutes, his first words on hearing my history with the L.A. doc were that I should have done a single round of IVF instead of the seven inseminations — I would have been more likely to get pregnant, he said. Very helpful, I thought, since I can’t actually turn back time. I disliked him immediately.

But who do I think was the better doctor for me? Probably Dr. Arizona. The truth is, in retrospect, I should have had a doctor who was much more aggressive. Though I had no history of any sort of physical problem, I believe I should have started drugs much sooner, and my L.A. doctor should have tried to make a case for IVF rather than simply swallow my (admittedly defiant) declarative that I would not do anything high-tech…

I said I’d never do IVF. Never. That was when I was 37, when it wasn’t so much that I had hope as that I had no doubt that this would work. It wasn’t even a question in my mind…

So the patient ignored the advice of her doctor and told him that she would not follow his recommendation ever, under any circumstances. Instead she asked for, and received, the treatment that she wanted.

She was wrong. Now she knows that, but her doctor knew that at the time. In retrospect, does she blame herself? No, her doctor should have been “much more aggressive” and he should have argued with her rather than “swallow” her clear, unambiguous refusal to accept his treatment plan. At no point does it occur to Ms. Parch that this is her fault and that she bears sole responsibility for what happened.

These situations happen quite often. Patients make demands or refuse treatments because they believe that they are “educated” about their options and they are in the best position to decide what is most likely to work. Now just imagine the same situation playing out with a baby’s life at stake. The doctor recommends a C-section or an induction and the patient refuses. Should the doctor just accept that refusal? What happens when the baby is harmed or dies? Typically what happens is that the patient blames the doctor in exactly the same way that this journalist blames her doctor. She refuses to accept responsibility for the results of the decision that she made.

Patients complain that doctors do not respect their decisions, but how can you respect a decision if the patient refuses to take responsibility for it?

This piece first appeared in September 2009.

I’ve written repeatedly about the foolishness of a “hard stop” policy banning elective deliveries (by induction or scheduled C-section) before 39 weeks. In Oops, reducing early elective delivery leads to more deaths, I reported on a paper that demonstrated that:

… The reduction in early elective delivery reduced NICU admissions, reduced both the induction rate and the C-section rate, and … presumably reduced costs. However, these benefits were achieved at a very steep price. The stillbirth rate increased from 2.5 to 9.1 per 10,000 term pregnancies. Instead of 3 stillbirths between 37-39 weeks among 12,000 patients, there were 11 stillbirths between 37-39 weeks among a similar number of patients after reduction in early elective deliveries.

You didn’t need a crystal ball to realize beforehand that a reduction in early elective delivery will INEVITABLY lead to an increase in perinatal deaths. Based on everything we know about stillbirth at term, any reduction in morbidity due to delivery before 39 weeks will INEVITABLY be accompanied by increasing mortality.

It appears that even the prime movers behind a “hard stop” policy banning early elective deliveries have finally realized their mistake. In a paper aptly entitled Oversight of elective early term deliveries: avoiding unintended consequences, authors Clark, Meyers and Perlin recognize that they embraced a “hard stop” policy without thinking through the consequences. Of note, the authors are employees of the Hospital Corporation of America, and a major motivation behind the policy was an effort to reduce short term costs.

… The position of the Hospital Corporation of America, as a primary driving force behind these changes, and our experience with such care improvement efforts in well over 1 million deliveries during the past 5 years suggest some areas of significant concern in the implementation of this policy and a number of practical remedies. A review of these issues may assist interested parties in helping patients reap the benefits of this practice change, while avoiding the associated perils.

The first problem with the policy is that many people have deliberately misinterpreted it as a ban on any deliveries before 39 weeks. The authors are at pains to clarify that the policy ONLY applies to a subset of early deliveries, those undertaken for purely social purposes:

It cannot be over emphasized that the campaign to reduce early term deliveries applies only to purely elective procedures. In this discussion, elective refers only to those scheduled deliveries that are performed without a valid medical indication. Many clinical conditions exist in which the well-described risks of early term or even preterm delivery are outweighed by the benefits of delivery to mother or child… Our concern is that a misinterpretation both of our policies and of the nature of our specialty’s opposition to purely elective early term deliveries may result in inappropriate reluctance to deliver women who are at risk for serious complications…

Bans on early elective delivery are meant to reduce perinatal morbidity, but NOT at the expense of increasing perinatal mortality:

… Accepting the risk of such morbidity in select individual cases in which the dangers of continuing the pregnancy because of valid medical complications is significant is often the best choice. Thus, it is incumbent on any entity that promotes a reduction in early term delivery to make it clear that the target practice is early term delivery without medical indication, not generic early term delivery, and that occasional indicated early term or preterm delivery remains an important part of good obstetric care (my emphasis).

The authors had previously recognized the importance of early delivery in a variety of situations, and had attempted to create criteria to differentiate between indicated and unindicated early deliveries. They now recognize that their criteria are not based on hard data.

… How close must the blood pressure be to 160/110 mm Hg level to justify delivery at 37 weeks gestation or even before? How poorly controlled must the diabetes mellitus of a noncompliant patient be to justify delivery at 38 weeks’ gestation? In the absence of hard data to guide the clinician, physician judgment and informed consent will continue to play a major role in such cases. Any facility that uses the “hard stop” approach must have in place the availability of an easy-to-access chain of command 24 hours a day to resolve such issues.

And:

… [I]t is critical to realize that, because the Joint Commission definitions for indicated early term deliveries are based on diagnosis-related group (DRG) codes and because many valid indications for early term delivery exist that do not have such a code, the rate of “elective” early term delivery for any institution will never be and should never be consistently zero. There is no code for a multiparous woman whose most recent labor lasted 10 minutes and who lives 1 hour from the hospital. Yet, when that patient is seen at 37-38 weeks’ gestation with a cervix that is dilated 4 cm, delivery is clearly indicated, not elective. Similarly, there is no DRG code for “history of a classic cesarean section delivery,” yet such women should be delivered routinely at <39 weeks' gestation. Numerous other examples exist.

In other words, “soft” indications, comprising borderline cases and based on the clinical judgment of the obstetrician, are real indications. I’m glad that the authors acknowledge this, but their recommendations for addressing it are poor. There should no barriers to clinicians exercising their judgment, and calling for permission is a barrier. Rather, clinicians should have to justify their decisions retrospectively, presenting evidence to other obstetricians as to why they felt the early delivery was indicated.

Finally, the authors address the “elephant in the room,” the insurance companies who push for short term savings at the expense of infant lives:

… Although a retrospective review of early term deliveries with nonpayment for those without a valid indication has been proposed, the aforementioned discussion suggests that this is a particularly bad idea, with the potential to promote bad practice and catastrophic outcomes… [N]o evidence exists to validate the appropriateness of off-site, post-hoc reviews to determine payment when dealing with deliveries that possibly were elective… Knowledge of the potential for such oversight error and its associated financial penalties establishes for the clinician and facility a perverse incentive to delay delivery when delivery may be in the best interest of the mother and baby, with potentially catastrophic results…

The authors insist that they still support a “hard stop” policy:

… The observations presented here do not represent any weakening of our commitment to the elimination of elective deliveries at <39 weeks' gestation.

However, their caveats belie their claim and they ought to change their terminology to reflect that. They should make it clear that they are talking about purely social indications by explicitly naming the policy a ban on purely social indications for early deliveries. Elective early deliveries for ANY other indication, including soft indications, are necessary, often life saving, and should not require permission.

I have a question for homebirth advocates.

Imagine this scenario:

A woman, after reviewing the evidence from both sides, after carefully considering the increased risks, and after deciding that she is willing to accept the responsibility for the outcome, decides to … smoke cigarettes during pregnancy.

This situation happens all the time. In 2012, just about everyone knows that cigarette smoking increases the risk of pregnancy complications. However, smokers will accurately point out that most women who smoke during pregnancy do not have smoking related complications, that smoking provides both pleasure and concrete benefits such as relaxation and increased concentration, and that women are entitled to make healthcare choices about their own bodies. In addition, there are scientists who assert, and who have testified under oath, that the harms from smoking have been dramatically exaggerated.

So if a woman claims to have made a knowledgeable decision to smoke cigarettes during pregnancy, and is aware of the potential consequences, does that mean it’s okay for her to smoke during pregnancy? Would you support her in that decision? Would you admire her for doing her own “research” and refusing to simply follow her doctor’s advice? Would you consider her brave and clever for listening to tobacco executives instead of her doctor? Why not? After all, the increase in perinatal mortality attributable to smoking in pregnancy is less than increase in perinatal mortality attributable to homebirth.

According to Adverse health effects of prenatal and postnatal tobacco smoke exposure on children, Hofhuis et al., Arch Dis Child 2003;88:1086–1090:

Smoking during pregnancy may be responsible for … a 150% increase in overall perinatal mortality.

Compare that to the overall increase in perinatal mortality attributable to homebirth of anywhere from 200% – 600% (latest CDC figures).

Consider the arguments:

The absolute number of deaths is relatively small since the US perinatal mortality rate is relatively low.

A woman has a right to control her own body. If she’s willing to accept the increased risk associated with smoking for both herself and her baby, no one should prevent her from doing so and no one should condemn her for her decision.

Smoking provides benefits like relaxation, pleasure and increased concentration on a day to day basis. Giving up smoking would mean hardship for 9 full months, whereas, for those who find hospitals unpleasant, giving birth there lasts a day or two at most.

Doctors don’t know everything. They play the dead baby card all the time when it comes to smoking and pregnancy, yet the overwhelming majority of women who smoke during pregnancy have babies who are completely healthy.

Tobacco is natural. It’s a plant just like the herbs given out like candy by homebirth midwives.

There’s more to pregnancy and birth than a live baby. The mother’s experience is important, too.

The bottom line is that every argument advanced in support of homebirth can be used to justify smoking in pregnancy. So I’m looking forward to homebirth advocates explaining to me why risking a baby’s life by smoking during pregnancy is anathema, but risking a baby’s life at homebirth is something to brag about.

It’s not surprisingly that as homebirth edges into the mainstream, we are seeing an increasing number of homebirth deaths, almost all of which are preventable. But even I am shocked at finding 6 homebirth loss mothers in one place. Their stories are a cautionary tale for anyone who likes to pretend that homebirth is safe or that homebirth midwives are remotely qualified.

Consider:

1. Dejah

… The decision to have a homebirth is not one I made lightly.

A part of me wants to focus on the politics of homebirth, to whip out a bullet list of why I chose homebirth for my second pregnancy. Why it was the safest choice for me, and why my care was better than anything I could have received in an OB’s office.

And another part of me wants to describe what I felt during the car ride to the hospital – the 10 minutes-away-We’ll-get-there-in-plenty-of-time-if-any-issues-arise hospital – after my baby’s heartrate dropped suddenly during labor…

And I want to describe what it like upon returning home from the hospital after my daughter, Sunrise, was stillborn, to the place where everything had been set up for her arrival. It felt like a tomb…

But most of all, I want to describe the look that I noticed when people learned my daughter was stillborn. It was a look that said, “Of course your child died. You planned a homebirth.”

2. Laura

I can identify with what you are going through. We chose a birthing center with midwife care for the birth of our first child. I have a million reasons why I made that decision, but now they seem less important than they once did. We were transferre to the hospital, and at this point we still thought everything would be okay. It wasn’t. I will always wonder if we’d been in the hospital the whole time if they would have noticed her drop in heartrate faster, and gotten her out faster, and if she’d be okay. I feel like everyone is judging me and my decision, as though I wouldn’t have made the best possible choices for my child. But this birthing center and midwife had never lost a baby before my daughter.

3. Merry

I chose a vba3c for Freddie. I knew the risks and I knew they were slight. I didn’t rupture, I was monitored, he seemed fine, there was no meconium, no heartbeat drop, no signs of distress. No obvious cord trauma even. But he was critically low on oxygen when he was born and didn’t breathe…

4. Lisa

… [M]y daughter was born at home, [but] the complications that arose following her birth were devastating and I came home without my daughter too, to the room that she was born in, with everything there… but her. I have also seen the ugly face of homebirth advocacy that wants to make us the exception, and an excusable exception…

5. Megan

Today last year my son Titus died in the last minutes of childbirth at home due to a severe shoulder dystocia. He was stuck very bad and his chord was being pinched. The midwife could not get him out in time. The ambulance and emt’s were there in minutes but he could not be resesitated. I rarely tell people we had a home birth because in their minds it is my fault. After we lost our son, my own father called and used the words, “I tried to warn you.” I even got a nasty letter from my grandma. People have no idea how this adds to our grief. I blame myself every minute of everyday and I do not need people to add to that burden. I woke up this morning on his first birthday in the bed I labored and gave birth to him in, but never nursed him or held him alive…

6. Jeanette

My youngest daughter was born at home after a perfectly normal, robustly healthy pregnancy, and a pretty darn fab labour and delivery, but she collapsed shortly after birth and died in the hospital six hours after she was born. Everyone involved agreed that she would have died no matter where or how she was born, (and we had an official investigation including detectives and the coroners office.)

Still, though, despite that, there are those that have said that they would never consider a home birth because of what happened to Florence, there are even family members who have mentioned to us how unsafe they thought home birth was. People still think we messed up…I don’t know how to correct them, and I’m hurt and insulted by them.

Florence’s birth was perfect, and it gives me peace to know she was born at home, caught by her Daddy and loved. I just wish it could’ve been for a longer life time.

And this:

Jocelyn

… While homebirth was not an option for me (it is illegal for midwives to attend homebirths in my state), I very much desired a natural birth with my first child, a son, Everett. I read and researched, and decided that avoiding induction was my best choice for avoiding an induction [sic], and to that end, was 40 weeks 5 days when I learned my sweet boy had died inside of me. I felt (and still feel sometimes) so foolish and stupid for letting my pregnancy go so long. I had been so confident in my body’s ability to birth my child; I felt humiliated and like a failure when he died. If I had just induced at 39.5 weeks like so many others do, my boy would probably be here today …

In each case, “trusting birth” led to a dead baby. For women contemplating homebirth, ask yourself:

Is my birth “experience” worth the life time of this kind of searing pain, heartache and endless regrets?

Six ordinary women accepted the mistruths, half truths and outright lies that characterize homebirth advocacy and paid for their gullibility with their babies lives. A seventh believed that it was more important to avoid a C-section than to have an induction and her baby died, too.

Choose homebirth, and that could be you.

Correction: I received an email that Merry’s son Freddie was born in a hospital. I was able to find her blog and read the birth story. As far as I can determine, she chose a provider and hospital willing to support her decision for a vaginal birth:

This is the story of Freddie’s birth, one of the most amazing experiences of my life. It is also, sadly, the story of the first of his 11 days of life. His birth was, I believe, a successful VBA3C. You have to decide for yourself whether successful is the right word…

What I will never know, what is really cruel, is I don’t know whether he would be alive if I’d had my ‘easy option’ elective section a week earlier. That is very hard. I’ve been told that had that been my first labour, there would have been no question of anything but a natural delivery – but he wasn’t my first and I had a choice. And maybe, I don’t know, maybe I made the wrong choice. I just don’t know. I don’t think so but I can’t ever know.

I recently came across an excellent paper on the vaccine-autism debacle. The paper is Sick With Fear, Popular Challenges to Scientific Authority in the Vaccine Controversies of the 21st Century. The paper was recently presented at a conference on health policy and won a prize for original research. Amazingly, it was written by an undergraduate.

The paper is terrific on many levels, but the part I found most interesting was Watkin’s explanation of why people are more likely to accept medical information from lay people than from actual medical experts. She’s talking about the vaccine-autism misinformation, but it applies equally to natural childbirth and homebirth, indeed almost every aspect of pseudoscience in medicine:

When dealing with such elusive issues, who can one trust? Doctors? The government? Friends? What is interesting about the vaccine-autism controversy of the last 30 years is the public’s faith in anecdotes and word-of-mouth. Searching for confirmation of their fears, Americans willingly believed the fear mongering of stricken mothers and celebrities, and ignored the mountain of research published in the scientific community…

Why? Watkins suggests that it has to do with Americans’ lack of understanding of science, primarily the result of:

… the poor quality of science education in America. American science education is embarrassingly weak: according to the Third International Mathematics and Science Study, American students rank below their counterparts in 17 other countries, and the National Science Teachers Association reported in 2003 that barely a quarter of high school graduates scored high enough on the ACT to succeed in a first-year college science course…

That leads to the “othering” of scientists:

Without satisfactory science education, the scientific community becomes inaccessible and elite. In America, there is a great deal of “othering” of scientists and experts because Americans are not educated enough to feel confident in scientific circles. Americans were willing to turn against the scientific community in the vaccine controversy because there was already distance established between experts and average Americans… (my emphasis)

Moreover, the average person, lacking understanding of science, relies heavily on journalists:

Because the majority of Americans are scientifically illiterate, news outlets are how most people learn about scientific breakthroughs. News outlets, however, do not always bear the duty to report the facts responsibly…

The quest for journalistic “balance” has contributed to the widespread misunderstanding of scientific issues:

[A] flaw in the relationship between science and journalism is the philosophy that there are always two sides to a story. Scientific evidence formed a bounty of evidence against the claim that vaccines cause autism. Regardless, Rolling Stone still published Kennedy’s article on the “other side” of the controversy in 2005 (an article so flawed that Salon.com, who posted it online in tandem with Rolling Stone, removed it from their archives in 2011). In cases like the vaccine debate, there is only one side. The stories of mothers’ woes and vague suspected corruption are not valid arguments to counter experimental data and research. By representing “both sides,” the popular media led the public to think there was room for doubt about the issue.

These same problems contribute to the widespread, but totally erroneous beliefs in the purported superiority of natural childbirth and the purported safety of homebirth. Far from being “educated,” the average NCB or homebirth supporter doesn’t understand enough science to accurately evaluate the information. Most advocates don’t know any obstetricians personally and are therefore easily susceptible to conspiracy theories about them. Finally, irresponsible journalists (like those at Consumer Reports) present the “other side” of the overwhelming scientific evidence in support of the liberal use of interventions in modern obstetrics.

The story of NCB and homebirth in the US, like the story of the vaccine debacle, is not about science. It’s fundamentally about ignorance of science, bias against scientists, and a mainstream media that is more concerned about writing “balanced” articles than about presenting the truth.

What’s next Consumer Reports? An evaluation of the Prius by the oil industry? How about an exposition on lung cancer by the tobacco industry? Maybe a review of breast implants by the silicone manufacturers of America?

Any of those would be appropriate after the “evaluation” of modern obstetric practice by the natural childbirth industry.

The recent piece What to reject when you’re expecting was copied wholesale from the promotional literature of the multi-billion dollar natural childbirth industry whose primary product is doubt about modern obstetrics.

The piece is filled with mistruths, half truths and outright lies, but what else can you expect when you ask industry to write about the competition? Just about every word in the piece is factually false, with the possible exception of “and” and “the.”

Consumer Reports should be profoundly embarrassed, not merely because they repeated lies, but because of the “sources” they used.

Consider their “general resources”:

Baby Friendly USA – a lactivist group.
Centering Healthcare Institute-a group that promotes multiperson medical appointments .
Childbirth Connection – the premier lobbying organization for the natural childbirth industry.
Health4Mom – a consumer site.
March of Dimes- an organization struggling to maintain its relevance in a world where polio is being driven out of existence.

Notice anything missing? There’s nothing from OBSTETRICIANS. You remember them: the people who actually provide obstetric care.

And that’s why the piece is filled with misinformation. There are so many egregious errors that it is impossible to detail them all.

Consider the first paragraph:

Despite a health-care system that outspends those in the rest of the world, infants and mothers fare worse in the U.S. than in many other industrialized nations. The infant mortality rate in Canada is 25 percent lower than it is in the U.S.; the Japanese rate, more than 60 percent lower. According to the World Health Organization, America ranks behind 41 other countries in preventing mothers from dying during childbirth.

1. Infant mortality is the wrong statistic. It encompasses deaths from birth to one year of age and is a measure of pediatric care. According to the World Health Organization, perinatal mortality (late stillbirths+deaths from birth to 28 days) is the best measure of obstetric care, and according to the WHO, the US has one of the best perinatal mortality rates in the world. [Neonatal and Perinatal Mortality Country, Regional and Global Estimates, World Health Organization, 2006]

2. Inter country comparisons of infant and neonatal mortality are invalid because many countries exclude premature babies from their statistics. This is a deliberate attempt to artificially improve mortality statistics because the gullible, like the folks at Consumer Reports, aren’t even aware of the manipulation.

Here’s a handy chart that illustrates the manipulation:

The top line represents crude neonatal mortality rates ranked in rising order. The bottom line represents corrected rates. Note that after correction, instead of the US having the highest rate of neonatal mortality, it has one of the lowest rates. [Influence of definition based versus pragmatic birth registration on international comparisons of perinatal and infant mortality: population based retrospective study, BMJ 2012;344:e746]

3. Most of the purported “increase” in US maternal mortality is accounted for by expanding the definition of maternal deaths to include more conditions and a longer post deliver time period (up to a year). Those changes in definition occurred in 1999 and 2003. [Changes in Pregnancy Mortality Ascertainment: United States, 1999–2005, Obstetrics & Gynecology: July 2011, Volume 118, Issue 1, pp 104-110]

4. African descent is one of the biggest risk factors for infant/neonatal/perinatal mortality as well as maternal mortality. Most of the countries that do better than us on international rankings are “whiter.” Japan, for example, has the lowest proportion of women of African descent among the countries that purported rank higher than us in mortality statistics, while the US has the highest of any first world country.

In other words, the entire premise of the article, that the US outspends other countries but has poorer obstetric outcomes is flat out false. But that’s not surprising. The natural childbirth industry has been parroting this falsehood for years. What is surprising, and disappointing, is that Consumer Reports fell for a series of self-serving lies.

Is there anything more selfish and self absorbed than planning an unassisted homebirth? It’s hard to imagine that there is.

This mother, like all mothers who plan a UC (unassisted childbirth) is criminally negligent, and ought to be charged.

According to the local paper:

The Wood brothers from Rensselaerville both work EMS for the Albany County Sheriff’s Office. They were the first and second people to arrive at a home after a call came in about complications during a home birth early Monday morning.

Brian Wood, the unit coordinator, says the mother and her husband had a planned home birth. The mother first delivered a healthy baby girl, but shortly afterwards the mother was on her way to the bathroom when she started to deliver a second baby. She told EMS she didn’t realize she was pregnant with twins.

That baby was not breathing and had sustained other complications during delivery. Records from the sheriff’s office show the baby was born without a heart beat.

The mother shared the story on Mothering.com under the absurd title, 4th UC, unexpected twins (warning: transfer). A baby was born without a heartbeat and appears to have suffered permanent brain damage and this self absorbed narcissist thinks the traumatic part of her story is the hospital transfer.

Short story – this was my 7th pregnancy, after three UCs and three miscarriages. It’s been a tough pregnancy, with a lot of early bleeding. I found a local midwifery firm to do a “non-diagnostic” ultrasound at 24 weeks to rule out twins. They could only find one. As I run a small store and am constantly with lots of people, there was lots of remarks about my size. In hindsight, I probably should have tried to get another ultrasound.

No, in hindsight, and in foresight, she should have had prenatal care from an obstetrician or certified nurse midwife.

I’d been having gentle prelabor for about a month, when I decided last Sunday that this was the real thing. Once we got home, though, it wasn’t really progressing, and I felt comfortable enough to go to bed. Slept for about two hours, finally got up again around 2:30, clearly in active labor…

About 45 minutes later … I sat down on the toilet and my water broke. I reached down and caught a small butt, with two legs to quickly follow. One more push and my daughter was out, pink and crying. Yelling for my bewildered husband, I headed to our living room. Easiest birth ever …

Sure, that’s because she trusted birth and trusted her mommy intuition. Wait, what?

… I was a bit surprised that my placenta didn’t arrive. An hour passed, then an hour an a half and the afterpains I thought I was feeling magnified. Finally, again on the toilet, I tried pushing a little and something popped and lots of clear fluid poured out. Starting to worry a bit, I reached up and felt another butt, then legs slipped out. And then stopped. I screamed for my husband that there was another baby. I tried again to push his head out, but nothing happened. I changed positions, while my husband called 911, and tried pushing again…

The ambulance arrived:

My son was not breathing, and not responsive, but was pink and looked good. I started rescue breathing – and the paramedics arrived. Literally, I think it was no more than 10 minutes from the time we realized we had another baby coming and their arrival. They immediately got a heartbeat, and intubated him…

The mother was transported to the hospital, too, for excessive bleeding, and promptly signed herself out AMA (against medical advice).

… This has to be one of the worst experiences – so see your newborn covered in tubes, on a ventilator, unresponsive. We were grateful that he was stable, at least.

How about guilty it was all your fault?

Because of the prompt response on the skill of the emergency responders, the baby will soon be well enough to go home, but he is not unscathed.

We had a discharge plan for Friday – they had taken him off the Phenobarb and everything had been completed except for a final EEG. As it turned out, the EEG was deemed abnormal, so they have him back on Phenabarb, and have renewed their insistence that he is at risk for seizures…

So, I’ve been spending lots of time with his twin camped out in NICU, nursing and pumping for him. I agreed to bottle feed for several feedings a day, with a formula supplement added to help him gain weight. Anything to get him home…

He’s still a lot sleepier than his sister, which concerns me…

Now she’s concerned? It would have been a lot more helpful, and far less traumatic for everyone if had put her babies’ wellbeing ahead of her bragging rights and delivered with an obstetrician or CNM in a hospital.

Like most mothers who have, through their own negligence and ignorance, allowed their own babies to be injured or killed at homebirth, she is aggressively ignoring the important things and obsessing about the trivial. She’s more concerned about the sedation from the phenobarb than the seizures from the brain damage. She’s more concerned about his ability to breastfeed than about the handicaps he is likely to face.

The worst part, though, is that it is so unnecessary. We live in a time and place where birth injuries can be prevented and yet some women are so blindingly stupid and self absorbed that they think their “birth experience” is more important than their babies’ brain function or even their very lives.

The following is a guest post written by a pediatric emergency medicine physician practicing in the United States:

I am a Pediatric Emergency Medicine doctor. I am also the mother of two children. I work in a hospital that has a pediatric emergency department that treats only children and is distinct from a general ED that sees all ages. My job is to take care of any and every ill kid that comes through the door.

For all those homebirth advocates who live “only 5 minutes from the hospital”:

Could you hold your breath from the time you call an ambulance to the time you make it into the operating room at your local hospital?

If you can’t, what makes you think your baby can?

On this Mother’s Day, as the mother of 4 children who are in college (one just about to start), graduate school and out in the workforce, I am struck by the fact that we are obsessed with the wrong questions. We ask of other mothers:

Do they breastfeed?
Did they have natural childbirth?
Did they have vaginal deliveries?
Do they use cloth diapers?
Do they have a family bed?
Do they “wear” their babies?

I can assure you that my children could not care less about any of these aspects of their childhoods. They have never asked, never praised or complained, never expressed any interest at all.

In truth, we already know how meaningless these questions are. Think of your own mother. Is your relationship loving, fraught or both? Does the quality of your relationship have anything, anything at all, to do with how she parented you when you were an infant? Or does it depend on how she treated you when you were a child, a teenager, an adult? Do you even know if and how long she breastfed you, if she used cloth diapers, whether she “wore” you? Do you care? Or do you care far more about whether she accepts you for who you are, and does not try to change you into who she is?

Let’s stop asking questions about our mothering that don’t matter and start asking the questions that do matter:

Do you love your children?
Do you let them know it?
Do you accept them for who they or do you try to change them into who you want them to be?
Do you acknowledge and praise their interests, strengths and talents or do you try to channel them toward your interests and talents?
Do you recognize their learning and personality challenges and help them meet them?
Do you spend the time and effort to properly discipline your children so they show kindness and consideration to others?
Do you expect (and provide support if necessary for) them to reach their full academic potential?
Do you provide support and encouragement for them to pursue the sports and hobbies that they want to pursue?
Do you get to know their friends?
Do you accept their choices in lifestyle, marriage, parenting, even when those choices differ from yours?
Do you recognize that they are people, different and separate from you and treat them with the respect that all people deserve?

Let’s stop asking the wrong questions and start asking the right ones. It makes absolutely no difference to our children how we answer the wrong questions (that’s why they are the wrong questions), but it makes all the difference in the world how we answer the right ones.