More than 10,000 American women each year choose planned homebirth with a homebirth midwife in the mistaken belief that it is a safe choice. In fact, homebirth with a homebirth midwife is the most dangerous form of planned birth in the US.

In 2003 the US standard birth certificate form was revised to include place of birth and attendant at birth. In both the 2003 and 2004 Linked Birth Infant Death Statistics, mention was made of this data, but it was not included in the reports. Now the CDC has made the entire dataset available for review and the statistics for homebirth are quite remarkable. Homebirth increases the risk of neonatal death to double or triple the neonatal death rate at hospital birth.

As this chart shows, the neonatal mortality rate for DEM (direct entry midwife, another name for homebirth midwife) assisted homebirth is almost double the neonatal mortality rate for hospital birth with an MD. This is all the more remarkable when you consider that the hospital group contains women of all risk levels, with all possible pregnancy complications, and all pre-existing medical conditions. An even better comparison would be with the neonatal mortality rates for CNM assisted hospital birth. The risk profile of CNM hospital patients is slightly higher than that of DEM patients, but CNMs do not care for high risk patients. Compared to CNM assisted hospital birth, DEM assisted homebirth has TRIPLE the neonatal mortality rate.

The chart shows the data for 2003-2004, but the data for 2005 has recently become available. Homebirth death continues to be far higher than death in the hospital for comparable risk women. In 2005 the neonatal death rates were CNM in hospital 0.51/1000, MD in hospital 0.63/1000 and DEM attended homebirth 1.4/1000.

No wonder the Midwives Alliance of North American (MANA), the trade union for homebirth midwives, is suppressing their safety statistics. From 2001-2008, they have collected the single largest repository of data on homebirth. The data is publicly available, but only to those who can prove they will use them for the “advancement” of midwifey, and even then, a legal non-disclosure agreement must be signed as part of the process. MANA’s data almost certainly show that homebirth with a DEM has triple the neonatal mortality rate of hospital birth for comparable risk women in the same year.

What is also notable is that the results are consistent with all existing scientific studies, including the Johnson and Daviss study. Johnson and Daviss actually showed that homebirth with a CPM has a neonatal mortality rate almost triple that of hospital birth for low risk women. The latest statistics are the most recent and most reliable confirmation of that fact.

There really is no question about it. Homebirth with a homebirth midwife dramatically increases the risk of neonatal death.

I’ll be traveling intermittently over the next two weeks, and will occasionally repeat an old column. This article originally appeared on my Open Salon blog in November 2008.

Waiting in the drugstore recently, I was startled by a glimpse of the cover of Cosmopolitan Magazine. No, it was not the display of copious cleavage, nor the breathless tone of the article titles. It was the title of one article in particular: Your Orgasm Face; What He’s Thinking When He Sees It.

As a gynecologist, I’ve had unique opportunity to view the consequences of increasing sexual openness. It appears to be a bonanza for young men, generally at the expense of young women. Men get all the benefits; women carry all the risks. Men get laid, get action, get lucky and women get pregnant, get sexually transmitted diseases, get infertile, get cervical cancer.

And all in exchange for what? Young men are almost always sexually satisfied by their relationships. Young women? Not so much … because young men are often inexperienced lovers more concerned about their own enjoyment than anything else.

The idea that women exist solely for the sexual satisfaction of men is the basis of pornography. What is surprising and depressing is that young women are being encouraged by other women to believe that they exist only for the sexual satisfaction of young men.

Pornography is the objectification of women, generally described as:

Portraying women as physical objects that can be looked at and acted upon, and failing to portray women as subjective beings with thoughts, histories, and emotions. To objectify someone, then, is to reduce someone exclusively to the level of object.

In pornography, the objectification of women is sexual. Women are physical objects that can be looked at and acted upon sexually. They have no thoughts, feelings or needs of their own.

That does not, in itself, mean that pornography is bad. As long as the viewer understands that it is fictional and unrealistic, it can be viewed as nothing more than a sexual outlet. The problem occurs when people begin to believe that it is a realistic depiction of women, and that women do exist only to satisfy the sexual needs of men and have no sexual needs of their own.

The relentless use of sexual imagery to sell products and gain attention can be blamed for giving young women the idea that their role in life is to satisfy the sexual needs of men. It is an unfortunate, and unintended consequence of sexualizing large swaths of contemporary culture. Altogether more disturbing, because it is intended and explicit, is the way that women’s magazines have encouraged women themselves to believe that their chief value is as objects for the sexual gratification of men.

There are many offenders, but Cosmopolitan Magazine tops the list, for its sheer variety and lack of subtlety, if nothing else. The cover of this month’s Cosmo includes articles on Total Body Sex, the Naked Quiz and The Trick that Attracts Hot Guys Like Crazy. But even Cosmo has reached a new low with the featured article Your Orgasm Face; What He’s Thinking When He Sees It.

As if the objectification of women in men’s magazines were not bad enough, encouraging men to believe that women exist only for their sexual pleasure, women’s magazines are emphasizing the point: Not only are your sexual needs and desires irrelevant, ladies, but you will be judged if you dare to express them. What matters about your sexual needs is not their fulfillment, just the effect that your fulfillment has on men’s enjoyment.

Cosmo reminds women that not only are they being judged for sexual attractiveness (evidently the only characteristic of concern) by breast size, weight and facial features, now they are being judged on how they look during sex. You might be pretty, you might be thin, you might be well endowed, and that will convince him to take you to bed. That’s not where it ends, though. He’s still entitled to judge your performance during sex and finding you lacking.

I don’t get it. Why do we tell young women that they are free to be soccer stars or astronauts, and then barrage them with signals that the only thing that really matters is sex? This relentless “pornification” of women violates everything we claim to believe about gender equality.

What does he think about your orgasm face? Why should any woman care? Only someone who believes that she exists for the sexual satisfaction of men would consider the question to have any relevance at all.

I recently read that the prestigious surgery training program at Massachusetts General Hospital is in danger or losing its accreditation. It’s not because it has failed to properly train surgeons, or because of mistakes. The program may lose its accreditation because the trainees, also known as interns and residents, have worked more than the maximum of 80 hours per week. The hospital seems to have clearly violated the rule, but I find myself strangely ambivalent about both the rule and the punishment.

My ambivalence is rather surprising because I suffered under a program that had no limits on hours. As an OB-GYN in training, I spent five months on the surgical service during my internship year. I routinely worked about 105 hours per week, and I was awake for all 105 of those hours. The schedule required each intern to be on call every 3rd night. Therefore, the schedule was arrive at the hospital at 5 AM on the first day, work all day, then through the night on call, meet the rest of the team at 5 AM the next morning and work another full day until 7 PM (38 hours straight). The I would go home to sleep and return at 5 AM the next day and work until about 7 PM (14 hours). The 3rd day was another 14 hour day, and then the cycle would start again.

You don’t know what tired is until you have repeatedly worked shifts of 38 hours. Surprisingly, the long hours results in very few, if any, mistakes, but it turned idealistic medical students into jaded, impatient doctors. And it resulted in some very bizarre episodes. On more than one occasion I fell asleep standing up while holding retractors during surgery. It didn’t matter that much since my job was simply to stand there, but it did result in me getting chastised. One night while checking lab results on the computer, I fell asleep on the keyboard and woke with the imprint of the keys on the side of my face.

My most notable transgression while sleep deprived, though, was when I began hallucinating during surgery when I was one of the surgeons. It was a relatively minor case, and my role was simply to assist, but I kept forgetting where I was and talking to people who were not there. This resulted in gales of laughter from everyone else in the operating room. When the case was finished I was allowed to go home early (5 PM) since I clearly could not be trusted to care for patients.

The system was brutal in the extreme … and yet. And yet it taught me to be a doctor, to take complete responsibility for someone else’s life, and to never give up, no matter how long it took, until the best possible result was achieved. It was drilled into me that the patient came first; my comfort: my hunger, my tiredness was meaningless. All that counted was what the patient needed.

Looking back, I still think that 105 hours per week was too many, but I am honestly not sure if 80 hours a week is enough. At 80 hours per week, the interns and residents are essentially doing shift work, going off regardless of whether the patient is doing well or poorly. It also allows interns and residents to kick the can down the road, to slough of what should be done for the patient today, figuring that the next person can do it tonight. Finally, it is not clear that 80 hours per week allows enough exposure to different patients, different surgeries and differing ways that patients manifest illness and get well.

The surgery program at Massachusetts General Hospital has violated the rules, and if the rules mean anything, the hospital must be reprimanded and possibly punished. The real question, though, is whether 80 hours work weeks lead to better doctors and better patient care, or simply fewer hours.

A new study from Canada, one of the largest of its kind, has confirmed yet again that overweight people live longer. The study, published in the journal Obesity, followed over 11,000 Canadian adults for 12 years. The study found:

Overweight (BMI 25 to <30) was associated with a significantly decreased risk of death (RR = 0.83, P < 0.05). The RR was close to one for obesity class I (BMI 30–35; RR = 0.95, P >0.05). Our results are similar to those from other recent studies … showing that when compared to the acceptable BMI category, overweight appears to be protective against mortality…

Morbid obesity increased the risk of death, but underweight increased it even more:

A significant increased risk of mortality over the 12 years of follow-up was observed for underweight (BMI <18.5; relative risk (RR) = 1.73, P < 0.001) and obesity class II+ (BMI >35; RR = 1.36, P <0.05). In other words, for a woman who is 5’5″ tall, and “ideal” weight is considered to be 114-149 lbs. But those women weighing 150-174 lbs actually lived longer than those weighing less than 150 lbs and women weighing 180-204 lbs lived as long as women of “ideal” weight. Those most at risk for shorter lifespan were women weighing less than 114 pounds. As the authors indicate, this study merely confirms what decades of scientific evidence have already demonstrated. Contrary to the conventional wisdom, overweight people live longer. It’s worth asking: if the scientific evidence shows that overweight is protective, why has it become conventional wisdom that being thin is healthiest? The answer, I believe, is prejudice. Simply put, being overweight is associated with being poor. As I have written in the past, many American predilections are grounded in economic status, and weight is no different. When poor people were thin because they didn’t have enough to eat, being overweight was a sign of status. Similarly, when poor people were tanned because of working outside, white skin was a sign of status. When poor women couldn’t afford anesthesia for childbirth, access to chloroform was a sign of status. Now, of course, status is associated with a midwinter tan (courtesy of a tropical vacation), a commitment to “natural” childbirth, and, especially, being thin. Wealthy people are thin, and celebrities are thin. Indeed, we are so obsessed with being thin as a sign of status that both women’s magazines and celebrity magazines are filled with diets and the tales of people who have successfully lost weight. By implication, the overweight are poor and less desirable. The idea that being thin is healthier also dovetails nicely with another American fantasy: that we can control our health by what we eat. Of course morbid obesity is a serious health problem with potentially deadly consequences. However, simply being overweight is not only safe, but actually appears to be protective compared to “ideal” weight. That’s what the data really show. Thin is in, because it is viewed as a sign of economic status, and an indication of personal rectitude, but it is not justified by the scientific data, nor by the fact that weight is now a proxy for wealth. Like any prejudice, it is not justified at all.

Conventional wisdom about healthcare reform rests on a big lie. Most major proposals for healthcare reform depend for financing in part on the purported savings from preventive care. The problem is that preventive care does not save money.

No less an authority than the Congressional Budget Office has pointed out that both the scientific and the financial literature indicate that preventive care is at best a break-even proposition, and may actually cost money. Members of Congress and proponents of healthcare reform have expressed shock at the CBO’s findings, but it’s not really surprising when you consider what preventive care is, what it can do, and what it costs.

A fundamental lay assumption about health is that all people could be healthy if we simply tried hard enough. That’s a corollary to the American fantasy that we have far more control over our health than we actually do. While personal habits and the environment do have an impact, health is largely beyond our control, depending as it does on genetic factors, natural pathogens like bacteria and viruses, and the inevitable wear and tear of aging. In fact, most people, if they live long enough, are sure to get sick. Thus preventive healthcare, even at its most effective, can only postpone disease or turn fatal diseases into chronic diseases.

The benefits of preventive care to the individual are beyond dispute. It is obviously better to be healthy or at least healthier than to be sick. The benefits to society, on the other hand, must be balanced against the costs of preventive care, and, it turns out, preventive care costs quite a bit.

The CBO explains the different costs of preventive care:

The direct cost of the preventive service;

The cost of treating any adverse reactions to the preventive
service;

The cost of follow-up testing and treatment for patients with positive screening tests; and

The cost of treating unrelated diseases that occur because of an individual’s extended life span. (emphasis in the original)

These costs can vary widely depending on the specific type of preventive care. Consider Pap smears, the test for cervical cancer. Pap smears are relatively inexpensive and have no adverse reactions. However they have a high false positive rate (many more women have abnormal Pap smears than have cervical cancer and pre-cancer). Every woman with an abnormal Pap smear will need to have an intensive follow up exam with special instruments and biopsies of the cervix, but most won’t have the disease. Early cervical cancer is relatively easy to treat successfully, leading to many more years of productive life. Ultimately, of course, a woman cured of cervical cancer will go on to develop other medical problems that will cost money. On balance, though, the costs of prevention are small, and the benefits are large.

On the other hand, diseases like AIDS have a very different cost benefit ratio. HIV testing for the virus is relatively inexpensive, and the follow up testing is not expensive, either. However, the treatment is extraordinarily expensive and it does not cure the disease. It can cost upwards of $10,000 a month for anti-retroviral medication. And the medication merely turns a disease that is fatal in the short term, to a chronic disease that may last years and is often fatal in the long term. The benefits to the patient and his family are, of course, incalculable, but the financial costs are massive.

That does not mean that we should stop HIV testing or other extremely expensive forms of preventive care. We are ethically mandated to provide testing and treatment, even though it costs a considerable amount. It does mean, though, that we must shed out delusions that the “cost savings” of preventive medicine can finance healthcare reform.

Associated Press writer Carla K. Johnson reports:

Legislation pushed by Senate Democrats mentions “prevention” repeatedly. The Senate panel heading up health reform also calls for more research on prevention…

President Barack Obama as recently as April said investing in prevention “will save huge amounts of money in the long term.” And it has become almost an article of faith among Republicans, Democrats and business leaders that prevention reduces health care costs.

But the Congressional Budget Office last week issued a statement on health care overhaul that dismissed the notion that prevention saves money. Prevention “would have clearer positive effects on health than on the federal budget,” the CBO said…

[R]esearcher Peter Neumann of Tufts Medical Center said counting on disease prevention to save money “promises painless solutions to our health cost problems. I don’t think they’re going to be painless and they have to be done.”

Healthcare reform is going to involve extremely difficult financial choices, and the sooner we stop pretending that preventive medicine will minimize the need for such financial choices, the better off we will be.

Medical errors are a very serious problem in the United States, causing harm to tens of thousands of patients each year. A substantial proportion of those problems are actually nursing errors, not really medical errors at all, and many of those are medication errors: wrong dose, wrong medicine, wrong method of administration. And some are truly spectacular failures of judgment.

When I was a chief resident, I admitted Mrs. B who had a history of a near fatal pulmonary embolus (blood clot in the lung) in her first pregnancy. She survived after treatment with anti-coagulants (blood thinners) and went on to have a healthy baby. Mrs. B was advised that if she ever got pregnant again she should call her doctor immediately. That’s because pregnancy is a hypercoagulable state making pregnant women much more likely to develop blood clots. She needed to be started on injectable blood thinners as early in her pregnancy as possible to prevent the development of another embolus.

Most medications have a set dose, or at least a dose based on the patient’s weight. Blood thinners, however, have no set dose. Each patient needs a different amount to achieve the right balance between reducing the risk of blood clots and still retaining enough clotting ability to prevent internal bleeding. The patient was admitted to the hospital to find the correct dose for her.

In the end, the correct dose for Mrs. B turned out to be 5600 units twice a day, a rather large dose. Since heparin came in glass vials containing 1000 units per cc (cubic centimeter), each injection contained more than 5 cc of heparin. It was very painful for the patient to have such a large amount injected each time. Mrs. B reminded me that when she took heparin to treat her pulmonary embolus she used a more concentrated version, 10,000 per cc. She needed only slightly more than ½ cc in each injection, and it was far less painful. I promised her that I would arrange for the more concentrated version of heparin.

It should have been sufficient for me to write the order for 5600 units twice a day using heparin 10,000 units per cc, but mindful of the potential for confusion, I wrote a far more detailed order and attached a note to the chart alerting all the nurses to the change. I emphasized that the patient would be getting the exact same dose of heparin. The only difference is that it was dissolved in a tenth the amount of sterile water.

Imagine my surprise when, sitting outside the nurses station med room, I overheard the following conversation at “report,” the hand over of patients from one nurse to the next.

“Dr. Tuteur changed the heparin order. Remember Mrs. B was getting 5600 units of heparin twice a day? Remember how we gave her heparin from 5 and 6/10th vials of medication? Now the heparin comes in 10,000 units in each vial,” the first nurse reported.

“How do you get 5600 units out of a vial of 10,000 units?” asked the second nurse.

The first nurse breezily replied, “Oh, you can’t. That’s just impossible.”

“So what did you do?” the second nurse inquired.

“I couldn’t figure out what to do, so I gave her the whole bottle!”

The nurse had given Mrs. B a massive overdose of heparin. Had she received another such dose, she probably might have had a stroke or other form of internal hemorrhage. As it was, her blood was so “thinned” that she was not allowed out of bed for 48 hours for fear that she might bump herself and develop a life threatening hemorrhage.

It was just a matter of luck that I overheard the nurses’ conversation. Otherwise, the grievous mistake would not have been discovered until after the patient was desperately ill or dead. It was not simply one error, but a long chain of mistakes: failure to calculate the correct dose (by simple division), failure to ask for clarification when the nurses didn’t understand the order, and the completely inexplicable decision to give the contents of the entire bottle when she couldn’t figure it out.

I wish I could tell you that this was a rare error, but it was not. Many times my patients received too much medication, or received an intravenous medication too quickly, or didn’t get a medication at all. We can put into place systems designed to reduce errors, but if nurses don’t understand how to calculate a dose, and don’t understand that they must always get clarification if they have any doubt, patients will continue to be injured by nursing errors.

Anyone who doubts that God has been created in the image of Man would do well to contemplate God’s supposedly bottomless need for praise. The God of the world’s three monotheistic religions is nothing more than an ancient tyrant writ large, reflecting the social hierarchy of ancient civilizations. God, like a Pharaoh, apparently requires an endless diet of praise, flattery and supplication. Without strenuous and continuous efforts at placation, God, moody and unpredictable, may lash out in ways that cause grievous harm.

The belief that God needs to be praised and flattered is a feature of all three monotheistic religions, but it is most obvious in Fundamentalist Christianity. I was forcibly struck by this fact in reading and writing about a family who recently lost a baby to a potentially preventable cause at a homebirth. During labor, the mother supposedly suffered a rare and often fatal complication, amniotic fluid embolus. Her baby died (though it is not clear whether the baby died before or after the embolus) and the mother ended up intubated in the hospital ICU.

The reaction of the family and its Fundamentalist supporters has been to carefully ignore the multiple disasters that have taken place, and praise God repeatedly and fulsomely for not having killed everyone involved. The mother was “led” by her religious convictions to make a foolish and dangerous choice to give birth at home; she was led by her religious convictions to ignore the signs that something was very wrong; she experienced a rare and devastating complication; the baby is dead; she is fighting for her life in a hospital ICU.

Other people might be angry at these tragic developments, but the family and its coreligionists simply ignore these disasters. No blame can be attributed to God, because God apparently cannot handle, and therefore must never be exposed to, criticism. God must be flattered by insisting that he is always right, no matter how cruel and tragic the outcome. Instead, focus is directed toward the fact that the tragedy has not been a completely unmitigated disaster. God must be praised for “healing” (i.e. not killing) the mother.

God, portrayed as an unreasoning tyrant, and must be placated like an unreasoning tyrant. God is just a bigger version of Pharaoh. Yes, God, you struck down a woman and her unborn child, leaving the woman desperately ill and the child dead, but we are ever so grateful that you, in your endless wisdom and as the result of your praiseworthy judgment, saw fit not to kill the mother, too.

The husband wrote on his wife’s blog:

Praises to Our Lord and the healing Master! [My wife] is truly a miracle of God’s healing power and a testimony of His strength. [She] was quickly treated for AFE (amniotic fluid embolism) when we arrived at the ER on Friday…

I know what the outcomes usually are and that my wife has dodge a bullet but I believe in the power of prayer and have been humbled by so many people praying for my wife. God is so good and is the rock in which our family stands!

God’s healing power? He’s the one who struck her down and killed their son. The fact that he didn’t kill her too is hardly a testimony to his healing power.

This is the same view of religion that is on display at major sporting events, as when a receiver scores a touchdown and then points toward heaven to give credit to God. Now we know why God has no time to address thorny problems like the starving multitudes in Darfur. He is too busy checking out who is praising him and awarding them touchdowns.

This God is a petty God, a narcissist who exists on praise and flattery. There’s no better sign that this God is nothing more than the creation of Man, the figurative equivalent of the carved idols of old. He is in every respect the image of a human tyrant, with all the worst foibles of any human being.

There’s very little that makes me angrier than the unnecessary deaths of babies. That’s why homebirth often makes me very angry indeed.

In the US, most doctors and certified nurse midwives refuse to attend homebirths because of the danger. Therefore, most US homebirths are attended by “direct entry” midwives (DEM), aka certified professional midwives (CPM). These are just fancy names for midwives with no medical training. The statistics on neonatal death at homebirth are so appalling, that Midwives Alliance of North America (MANA), the trade union for homebirth midwives, refuses to release the death statistics to the public; they are available “friends” of midwifery.

American homebirth midwives are grossly undereducated, grossly undertrained, and downright dangerous. The national and state statistics bear this out, but nothing illustrates it better than a real life example. This tragedy was brought to my attention by a commenter who had been following the story on the mother’s website.

Carri, a mother of 8, had been planning an unassisted homebirth. I recently wrote about this appalling stunt and its high death rate (Stuntbirth). Carri had had 4 successful unassisted deliveries and was planning a 5th. As the due date approached, even Carri, as deluded as she was about the safety of unassisted childbirth, could not deny that her uterus was much larger than expected, and she sought the “advice” of Brandi, a CPM, at Central Indiana Home Birth Midwives.

Brandi diagnosed twins (without the aid of ultrasound), and noted elevated blood pressure. She advised the typical homebirth midwives quack “treatment,” a high protein diet, which, not surprisingly, accomplished nothing. As the pregnancy advanced, first one week beyond the due date, then two weeks, then almost three, Brandi counseled waiting for nature to take its course.

And nature did take its course. Carri’s baby is dead, and she is now fighting for her life in an ICU. The presumed cause is an amniotic fluid embolus.

There was only one baby, not two. That’s at the top of the long and horrifying list of mistakes. It is unheard of for a responsible practitioner to diagnose twins when only one baby is present on ultrasound, but Brandi assured Carri that one baby was “hiding” behind the other.

Even more appalling, if possible, is Brandi’s reaction when she heard only one heartbeat. According to Carri (posting on MotheringdotCommune):

One time the midwife gets two heart beats and the last time she just could not find the other and felt okay to let it be because there was active movement …

It would be laughable, were it not deadly. The homebirth midwife “diagnosed” twins, then clung to that delusion even though there was only one baby on ultrasound, and only one heartbeat.

Not surprisingly, someone deluded enough to believe that there were twins when only one baby could be seen was also deluded enough to believe that a clearly pathological pregnancy was normal. Carri measured much larger than expected even though there was only one baby. Almost certainly, there was a massive excess of amniotic fluid (polyhydramnios), both a sign of problems, and a risk factor for future complications (including amniotic fluid embolus). Carri’s abnormally elevated blood pressure was untreated by the quack remedy that was “prescribed.” Pregnancies over 2 weeks past the due date have a dramatically increased risk of stillbirth, as well as life threatening birth complications. The midwife pretended that this was not so.

So now Carri’s baby is dead, and Carri is fighting for her life.

People need to understand American homebirth midwives are a second class of midwives with less education and training than other American and European midwives. The standards for direct entry midwives, in terms of educational requirements and clinical training, are far below those of any other midwives in the industrialized world. American homebirth midwives are, by and large, quacks, and babies are dying as a result.

Addendum: One of the things I find most interesting is how everyone involved understands that the refusal to seek real medical care led to this tragedy. Carri’s family has removed the posts detailing her actions in the weeks leading up to the catastrophe, and MotheringdotCommune has removed the posts by Carri and those responding to her. The baby died possibly because of unassisted birth/homebirth, and now supporters and the family want to remove the evidence.

Jon and Kate Gosselin have announced that they will issue a “life-changing decision” on June 22 during their hit reality TV show, Jon and Kate Plus Eight. The Boston Herald described the commercial airing in advance of the one hour special episode:

“Recently, we’ve made some life-changing decisions – decisions that will affect every member of our family, ones that we hope will bring each of us some peace,” Kate says in the spot.

The promo features giant graphics with phrases like “A family in turmoil” and “A relationship at a crossroads” flashing across the screen.

Here’s what they ought to say, although I know that’s never going to happen. They ought to say:

After deep and soul-searching reflection, and with the aid of our pastor and strong religious faith, we have come to the conclusion that we can no longer continue appearing on television. We have been married for 10 years and recently renewed our vows. We take those vows seriously.

Marriage is a promise to stay together through good and bad. No one needs to promise to stay together when things are good, so in essence, marriage is a promise to stay together and stand by each other when things are not good. As the public is aware, each of us has gone through a period of sadness and confusion. It seems like it might be easier to separate, but marriage is not about taking the easy course.

To honor the unbreakable commitment that we made to each other before our family, friends, and before God, we have regretfully come to the conclusion that we need time and privacy to repair our relationship. We need to concentrate on each other and our family, and a TV show and publicity tours are simply not compatible with what our family needs now.

We love our children more than life itself, and we know that more than anything, more than money or fame, our children need to grow up sheltered under the umbrella of the strong relationship of their father and mother. We want to show our children the true meaning of marriage and commitment. We are willing to forgo the temporary rewards of money and fame for the more lasting rewards that come from putting marriage and family before anything else.

We thank the public for being guests in our home and lives, but there comes a time when the guests must leave. We appreciate the love and concern that so many have show to us, and we hope that everyone will respect our need for privacy at this time. There will be no more TV show, no more books, and no more publicity tours for the foreseeable future.

In truth, this is a financial and emotional sacrifice for us, but marriage and children often require sacrifices of both partners. Although it is a sacrifice, we expect profound rewards: the deepening of our commitment to each other as spouses, friends and parents of eight precious children.

That’s not what they are going to say, of course. They are going to announce a separation, or even a divorce. And they are going to continue to capitalize on the boost in popularity that a troubled marriage has brought them. That’s why they put out press releases, why they are staging a “special episode” and why they are running commercial spots to promote it. They are no longer a family, but merely a business, and business is booming even as their family falls apart.

Surgeons can do amazing things. They can remove an appendix that is about to burst, bypass blocked arteries in the heart, or even carefully excise a tumor from the brain. But surgeons never work alone. They always depend on the human body’s intrinsic abilities, the ability to clot blood, the ability to combat bacteria, and the ability to heal.

A surgeon knows that if he removes a gangrenous appendix the patient will get better, but it isn’t the removal that makes him better. The surgeon assumes that the stitches will stop the bleeding at the site where the appendix was removed, the immune system will clear away the residual infection, and the skin and deeper tissues will heal themselves together again.

I always assumed that, too, until I met the man who wouldn’t stop bleeding.

Met is probably the wrong word, since my first encounter with him occurred while he was under general anesthesia on the operating table. It was early in my internship year and I was called to the operating room to provide assistance during a disaster of major proportions. A young man undergoing a surgical repair of a damaged artery would not stop bleeding. I was called merely to hold the retractors that kept the surgical wound open so that the surgeons could see the area in question. Another intern had been holding them for many hours and I was sent to relieve him.

The surgery, which had been scheduled to last 2-3 hours, had been going on for more than 12 hours with no end in sight. On the wall of the operating room hung the empty plastic bags that had contained the 40 units of blood that had been given to the patient thus far. As I stepped to the table, having gowned and gloved, I could see that the wound was filling with blood as fast as the surgeons could suction it away. One of the surgeons noticed my presence and explained what was going on.

The young man, in his late twenties, had been diagnosed an aneurysm of the main artery feeding one of his legs. An aneurysm is a weakening and ballooning out of a blood vessel wall that will ultimately rupture (and kill the patient) unless surgically repaired. It usually occurs in people over age 60, generally smokers. While the surgeon who had planned the operation had recognized that an aneurysm in a young person is quite unusual, he hadn’t fully considered why this unusual event had occurred. Unfortunately, he quickly found out when he attempted to repair the artery.

The artery in question, indeed all the patient’s arteries, were unusually weak. We later learned that the patient suffered from a rare genetic disease that made his artery walls abnormally thin and weak. At the time, all we could see was that the artery would not hold stitches.

The aneurysm had been excised during the first hour of the surgery. In the subsequent 11 hours, the surgeon, ultimately aided by two colleagues, struggled to close the residual hole in the artery. Yet every time they successfully stitched it closed, one or more of the sutures tore through and a torrent of blood poured from the artery. The situation was truly desperate, and desperate situations call for desperate measures.

It was impossible to close the blood vessel perfectly, as would have been required in any other patient. The decision was made to close the artery as completely as possible and to control the residual bleeding with pressure. Just like you or I might stop the bleeding from a cut by applying pressure, we would try to do the same, except that the pressure would need to be applied inside the body, not outside.

The wound was packed with as much sponge and gauze material as could fit inside, and the incision was left often. The patient was transferred to the intensive care unit with the recognition that either the bleeding would gradually stop or the patient would die. The patient left the operating room 16 hours after he had entered it and the vigil began.

Amazingly, and against all odds, the bleeding slowed and eventually stopped. Although the artery itself was defective, the patient retained the ability to clot blood, and the combination of blood clot and pressure ended the bleeding. No one dared to risk further bleeding by removing the packing, so it was decided that the wound would be left often to heal itself from the bottom up.

And that is precisely what happened. Within several days, the artery healed itself, and we began gently changing the packing each day. It took 3 months for the wound to heal completely, with progress measure by the gradually decreasing amount of gauze sponges that could be fit inside the wound. Initially I would arrive at his bedside each day with a seemingly inexhaustible supply of gauze to replace the old packing. After 3 months, I needed to bring only a large surgical bandage to cover the wound.

Ultimately the patient walked out of the hospital alive, a tribute to the body’s ability to withstand tremendous trauma and to heal itself, even under less than ideal conditions. Unfortunately, the story does not have a happy ending. There was no way to treat underlying genetic defect in his arteries and several years later another aneurysm developed in a different artery. This time the surgeons could not get the bleeding under control no matter what they tried, and the young man eventually bled to death.