Wednesday, May 31, 2006

Boasting

Women who have had a homebirth often boast about it long after the fact. What's up with that?

When I search on the keyword "homebirth", it often comes up in situations that are not about birth. Weight is usually included. A woman will refer to a child as "my homebirthed son, all 9 lb 9 oz of him", as if the fact that she has an ample pelvis is some sort of personal achievement for which she can take credit.

I don't think I've ever seen a woman who gave birth in a hospital make reference to her child as "hospital birthed". I've never seen a woman who had natural childbirth for philosophical reasons refer to her child as "my natural childbirth born daughter", either. It is striking to me that women are shoe-horning references to homebirth in when they discuss a child who may be a toddler or older.

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51 Old Comments:

"I had my last two children at home. My first child was a c/s."
Ta Da... that is what I say.
Then I have to go on and say that for ME going to a hospital birth was more scary. I see nothing to boastful about it. Especially with all the "well my doctor told me_______, so I had a c/s." that I get when I ask!
Want me to boast?
I AVOIDED GETTING UN NECESSARY SURGERY TWICE MORE!!! WOOO HOOO FOR ME!
Oh and thank goodness I live in a somewhat civilized country that has midwifery where OBs HAVE to work with midwives and vise versa!!! Now there is something to boast about! =)

By Anonymous Anonymous, at 9:09 AM  

I used to wonder about that too, and then I had a baby at home four years ago today. :-) It was the most joyful day -- I just didn't know how different it would be from my hospital births. The arrival of a healthy baby is usually joyful, wherever it happens, but I found my homebirth to be surprisingly different.

For my part, saying, "This is my baby who was born at home" was akin to saying as a newlywed, "This is my husband; we were just married in July." It wasn't that I wanted to boast about it. But in both cases the joy that suffused the beginning of our relationship was unforgettable.

By Blogger Jamie, at 9:21 AM  

Perhaps because its a rarity these days to have a non-interventionist homebirth, women are rightly proud that they managed it.

Kinda similar to women who refer to their "breastfed" babies - they are proud of their achievement...yet you seldom hear of women boasting of their bottlefed babies....I have heard many many mothers very proudly stating the weight of their babies - hospital and homebirthed. Its just a thing mothers do - they take great pride in their precious babies.

To achieve something that not many manage IS something to be proud of.

By Anonymous Anonymous, at 9:22 AM  

Wow. Jamie's newlywed analogy was wonderful. How true.

Amy, I think one of the reasons women like to talk about their home birth stories is because they want other women to know that childbirth doesn't have to be a war story, but it can be a love story (to steal from Jamie's analogy). The act of giving birth can be something that is actually enjoyable!

Amy, what do you think the impact would be on society if most women were proud of their childbirth experiences and found that the act of giving birth was actually joyful?

By Blogger Mama Liberty, at 9:57 AM  

Mama Liberty:

"Amy, what do you think the impact would be on society if most women were proud of their childbirth experiences and found that the act of giving birth was actually joyful?"

Aww, c'mon! That statement is demeaning and absurd.

What makes you think that most women are not proud of their childbirth experiences and that giving birth was not a joyful experience for them?

Homebirth advocates may have cornered the market on boasting about birth, but I doubt they've cornered the market on joy. It's pretty presumptuous to suggest otherwise.

By the way, hospital birth is a very new innovation. 99.9% of the women who have ever existed have had natural childbirth at home. Do you think the experience of homebirth advocates is more "joyful" than their experience, too?

By Blogger Amy Tuteur, MD, at 11:01 AM  

"A woman will refer to a child as "my homebirthed son, all 9 lb 9 oz of him", as if the fact that she has an ample pelvis is some sort of personal achievement for which she can take credit."

What is wrong with women being proud of birthing their babies, even "9lb 9oz ones", either at home or in the hospital?

I am very small, and I was told by a doctor with my first pregnancy that I may need a c-section because I may not be big enough to birth my baby. I am proud of myself and my body for birthing both of my large babies, one in the hospital and one at home.

It's not like I introduce my son as "my natural childbirth born at home son." Or my daughter as "my medicated hospital birth daughter." I am proud of birthing my babies, both of them. And I am proud of the fact that my body can do it, regardless of what my first doctor told me. It's not like I walk around boasting about my births, or acting like I am above anyone.

I feel that women should be proud of birthing their babies. If a woman is proud of having a homebirth, good for her. If a woman is proud of having a hospital birth, good for her. Giving birth is a powerful thing that women get to do, and we should all be proud, regardless of where or how our babies are born.

By Anonymous Anonymous, at 11:11 AM  

This comment has been removed by a blog administrator.

By Blogger Mama Liberty, at 11:32 AM  

"What makes you think that most women are not proud of their childbirth experiences and that giving birth was not a joyful experience for them?"

Because when most women have told me their birth stories, they sound more like war stories. Its like they want to one up each other in the horror department. "Oh yeah, well if you think THAT was bad, then listen to this!"

I'm not saying women aren't joyful about their children once they have arrived, but most aren't joyful about the actual experience of giving birth. I love my hospital birthed babies just as much as my home birthed one, but their births were ones I was just happy to be done with. I actually *enjoyed* giving birth to my home born son.

"It's pretty presumptuous to suggest otherwise."

I think you are the one who is generally presumptious in this discussion. There are many of us here who have actually experienced birth in the hospital and at home. We speak from a broader experience. You speak only from one perspective.

By Blogger Mama Liberty, at 11:36 AM  

I don't think there is anything wrong with a woman sharing something she felt joyful and proud of (and I agree with Mama Liberty that sadly, most American women do not think about their births with joy). I do think it's interesting that said pride and joy can be perceived as 'insulting' to someone who did not share that experience. I think it says a lot. We only have strong responses to something if it strikes a nerve. So Amy, as you represent that other side, why exactly does someone else's joy bother you?

By Anonymous maribeth, CNM, at 12:25 PM  

Amy wrote:
"What makes you think that most women are not proud of their childbirth experiences and that giving birth was not a joyful experience for them? "

So with this understanding what are you asking a question for- are you baiting or ????? you have answered your own question most women are deeply connected to their birth experiences--- one study says that women who were interviewed after their births and then re-interviewed more than 20 years later they remembered many/most of the details -- including side things like - the nurse was warm and helpful or ...

By Anonymous Anonymous, at 3:26 PM  

"What is wrong with women being proud of birthing their babies, even "9lb 9oz ones", either at home or in the hospital?"

Because its like being proud of having good digestion. It has nothing to do with you; it's all about good luck. The baby that fit through might not have done so if it were in the occiput posterior or breech. It might have not fit through if you had a pelvic inlet that was of a different shape.

The history of human childbirth is one of evolutionary pressures in opposite directions. It is better for babies to be born with larger heads and therefore more neurologically mature, but at the same time, it is better for women to have a smaller pelvic inlet to be able to run away from predators or even walk upright. It is in the nature of human birth for the last million years or more for there to be a mismatch occasionally between the baby's head and the mother's pelvis. Until very recently, that meant that both of them would die.

No doctor, no matter how smart he or she it, knows in advance whether a baby is going to fit. Sometimes you can make an educated guess, but that's all it is, a guess. Regardless of what your doctor said, your baby was going to fit. Regardless of what you did, your baby was going to fit.

Those millions of unfortunate women through the millenia who have died agonizing three day deaths were not deficient in some way. They were unlucky. That's it; not unskilled, not unwilling, not lacking bravery, not deserving of their horrible fate in any way.

So conversely, when the baby fits, the mother is not the cause; she is not skilled at giving birth, she is not more willing to do what is necessary, she is not braver or more deserving in any way. She is lucky plain and simple.

I was lucky, too, four times in a row. My personal feeling is that when you are lucky, you should give thanks for it, not boast about it.

By Blogger Amy Tuteur, MD, at 3:33 PM  

Maribeth:

"So Amy, as you represent that other side, why exactly does someone else's joy bother you?"

That's not what bothers me, and I have been very clear about it. What bothers me is the PRESUMPTION that homebirth advocates have some kind of MONOPOLY on joy in childbirth. They have a word for that kind of presumption: it's called smugness, and frankly, most people do not find smugness very attractive whether the source is religious, political or (in this case) philosophical.

You want to consider it a personal achievement? Go right ahead. That's what it is, a PERSONAL achievement. It is not an achievement that is necessarily shared or valued by anyone else. In fact, most women do not consider it an achievement at all.

By Blogger Amy Tuteur, MD, at 3:39 PM  

amy,

What makes you think women go around boasting about their births? Do you have a lot of real life contact with mothers who have homebirthed?

I think that the "proudness" of women may be there because of all the doubt and fear put into them.

And to quote you "frankly, most people do not find smugness very attractive whether the source is religious, political or (in this case) philosophical." Well said, this applies not only to homebirthers, but to you as well.

By Anonymous Anonymous, at 3:46 PM  

"It is not an achievement that is necessarily shared or valued by anyone else. In fact, most women do not consider it an achievement at all."

You seem very bitter. Who cares what others consider an "achievement"? Why not be happy for people who are happy with their births? I have never met someone who walks around boasting about their homebirth, and I have been around many homebirthers. Why so much concern with how homebirthers perceive their births? So what if they see it as an accomplishment?

By Anonymous Anonymous, at 4:00 PM  

Why muddy the "debate" with this emotional nonsense? You're playing into the hand of those you wish to discredit and it shows your own competitive maternal side.

By Anonymous Anonymous, at 4:03 PM  

"and it shows your own competitive maternal side."

EXACTLY!

By Anonymous Anonymous, at 4:04 PM  

perhaps it has to do with how you are searching.
If I put in birth stories-- I get many descriptors- and many types of stories including homebirth stories-

By Anonymous Anonymous, at 4:14 PM  

"Why muddy the "debate" with this emotional nonsense?"

Why? Honestly, because this is what people like to debate about. When I post a bunch of statistics that show that neonatal mortality rates for urgent transfers from homebirth are astronomical, very few people have anything to say about it.

When I look at the responses to various posts, I find that people really want to participate in discussions about philosophy more than they want to participate in discussions about statistics. Am I wrong in this assessment?

By Blogger Amy Tuteur, MD, at 4:26 PM  

When I post a bunch of statistics that show that neonatal mortality rates for urgent transfers from homebirth are astronomical, very few people have anything to say about it.

Very few people have anything to say because fuzzy math doesn't make for good conversation.

By Anonymous Anonymous, at 4:38 PM  

Having a birth should not be about the "woman" it should be about a new life entering the world.

I had my children in the hospital. If I had did homebirth one of my children would not be here today. I had complications that were not anticipated. I do not know the medical terms but my child was trapped. His head was through the cervix and I stopped dilating. It was not possible to deliver his shoulders and he was almost a still birth. Had I been at home he would have been.

I don't get this. When we have an option, unlike women many years ago, to have our child in a center where immediate help can be summoned, if needed, we would choose to put our unborn children's life at risk? Seems pretty selfish to me.

By Anonymous Anonymous, at 4:44 PM  

At this point we've 'done' the fuzzy math, And there's nothing left to argue. we've had to agree to disagree over what the research shows. Amy and Sailorman disagree with all the researchers, (except Pang, and I have yet to see them discuss Pang in as much detail as they tear apart the others.) as well as WHO and everybody else. Fine. Amy has said over and over that she sees a small but real increased risk for baby in home birth over hospital birth. (no discussion yet on birth center birth) She want's everyone to see the same small risk. I personally don't see it. But that's OK, it's my decision.

I think digressing to birth rape, and competitiveness and boasting makes it easy to get lots of angry comments, but it doesn't go far in helping prove your point. Maybe the conversation is done? Amy can't win many converts here, and nobody's out changing their websites to reflect her views. I think Amy's time would be better spent, as someone else put it, revising her book...starting with the chapter on episiotomys. She'd have a stronger leg to stand on in any medical department. And my time would be better spent with my family. I think I keep checking back, and many many others in this category as well, because we can't believe some of the pretty astounding things said on this blog. It's great entertainment, that's for sure.

By Anonymous Anonymous, at 5:01 PM  

"I find that people really want to participate in discussions about philosophy more than they want to participate in discussions about statistics. Am I wrong in this assessment?"

You are partially correct. Philosophical discussions are interesting and you generate responses when you bait people.

As for statistics, I'd have some interest in talking more about the numbers, but we are only allowed to talk about the numbers you want to talk about. And they are numbers you "torture" (word courtesy of Marsden Wagner) to say what you want them to say. Have you ever heard the phrase, "statistics don't lie, but liars use statistics"? (Which for the record, I don't believe you are a liar. I just don't believe you have established "fact" here.) You don't generally respond to some of the better points made by people and that is disappointing.

Danielle

By Blogger Mama Liberty, at 6:19 PM  

Danielle:

I disagree. People like to argue and at the beginning they argued a lot about the statistics. Some people, like Jamie are still reading and finding weak points in my arguments and still arguing back. No one is stopping Jamie from posting whatever references she wants to post and many of her comments are very insightful. She also catches my mistakes.

No, people are not afraid to argue with me, and they are certainly not waiting for my permission to use particular numbers or arguments. They've kind of run into a brick wall with some of these numbers and can't figure out what to say next (except for Jamie; she's still working on it and she is still turning up new things that make me rush to look at the literature again).

When it comes to something like the transfer statistics, no one has anything to say. What is there to say, afterall? The numbers tell the story. If people had arguments to make about them or if they had snappy comebacks, they'd make them.

I certainly know enough by now to realize that no one is going to admit anything. I don't expect that. That's partly because for many homebirth advocates, it is about more than the statistics. People are pretty honest about this and they have every right to feel that way.

Philosophy is clearly central to homebirth advocacy, so it is legitimate to discuss it. You may call it baiting, but I call it challenging. I want to challenge the assumptions that homebirth advocates bring to this discussion.

By Blogger Amy Tuteur, MD, at 6:50 PM  

now several times women have said or tried to say to you that you are saying unfair things. and now you admit to it- you are doing so in a skewed way in order to inflame and create a response, because you know that all women are tied to their birth stories
--- read the hospital birthers who have written here with a very very self-righteous tone-- very superior and smug, and you have been very insistent that women are not mistreated or harmed by medical care - if you want to "save" people from homebirth you would be better served to actually show some caring and empathy for women and the choices that they are faced with - give them some actual resources-
I have some questions for you to begin with ---
what do you expect to see during a normal birth- paint me a word picture.

By Anonymous Anonymous, at 7:31 PM  

If the math is "fuzzy," then refute it, as Jamie is working hard to do.
Face it, homebirth advocacy goes beyond philosophy to a status almost like religion. People on this board believe in it, and the more it is argued against using mathematical and scientific tools, the more vehemently it is defended by its advocates (or acolytes?) using ad hominem attacks, anecdotes, high emotion, etc. Which, as Amy says, is fine.

It is fine, but to me it is analogous in many ways to the current cultural debate between advocates of intelligent design and those advocating evolution. Whatever you believe is fine as long as it is not hurting anyone else. And the websites that espouse the belief (not the fact, the belief) that homebirth is as safe as hospital birth, or that the increased risk during homebirth is somehow offset by an avoidance of interventions...these websites are hurting people, because they are disseminating misinformation masquerading as fact.

By Anonymous Joanna, at 8:56 PM  

Amy writes: the PRESUMPTION that homebirth advocates have some kind of MONOPOLY on joy in childbirth

That is reactive to Mama Liberty and my statements -after the fact - not (presumably) what made you post this particular thread. Your insecurity over these issues are transparent, Amy, triggering your knee-jerk reactions and over-generalizations. I repeat: nobody can make you feel badly about something unless that's already there. Do you need to do some birth healing? I know this sounds divisive and flippant, but I actually mean it sincerely.

By Anonymous maribeth, CNM, at 9:23 PM  

When I talk about the birth stories of my children, I am not boasting about the fact that children came out of my body.... I am boasting because my children are wonderful, beautiful, fabulous little people. I am proud of every ounce of them, each strand of hair, every inch of their perfect bodies. I am amazed and in awe of them. I do not say, "here is my hospital birthed child and here is my homebirthed child." However, if the topic comes up I will relay how wonderful the homebirth of my 2nd child was. I am not boasting about myself or even bragging at all.... I am really just talking about how wonderful the whole event was.

As far as the size of the baby goes.... I think this relates to the same stuff that I just said. I have a friend who birthed a 11lb baby and she should be proud, as proud as I am of birthing a 6lb baby. I think we generally are just pleased with the sizes of our kiddos, we are pleased if they are bald or come out with a full head of hair, we are just in love with our little ones! That is the way it should be!!!!

I have had a hospital birth and a homebirth and I don't consider myself smug about the homebirth. I just have seen both sides of the fence and know which one I prefered. I don't consider myself a better/braver/stronger person than a woman who chooses to birth in the hospital and I don't think that most homebirthers do. I made a decision based on what I feel is the healthiest for my family and I assume that they are doing the exact same.

I do find it interesting though how people will take the joy of others and assume that the joyful person is trying to rub someone elses face in it.

By Anonymous Anonymous, at 9:48 PM  

"I had my children in the hospital. If I had did homebirth one of my children would not be here today. I had complications that were not anticipated. I do not know the medical terms but my child was trapped. His head was through the cervix and I stopped dilating. It was not possible to deliver his shoulders and he was almost a still birth. Had I been at home he would have been."

I believe you are trying to talk about a shoulder dystocia. I had the same major complication with my very large son. He was 10lb 6oz, 14.5 inch head, 16 inch chest. I am 5'2, 95lbs normally, 122lbs when he was born. He was a obviously a big baby.

He was born at home though. (Over an intact perineum, and without any broken clavicles). He did require resuscitation (PPV, no chest compressions), and my midwives were well prepared and well trained.

The type of complication you mention happens at home too, you should not just automatically assume your baby would have died. You don't know what the outcome would have been. I could turn it around and say for me that had I been in the hospital my son could have died (happened to a coworkers baby with the same complication in a hospital), or would have suffered long term nerve damage (happened to a friends baby with the same complication in the hospital), or he would have had a broken clavicle and I an episiotomy. Point is, you don't know how it would have played out at home for sure, just as I don't know for sure how it would have played out in the hospital.

By Anonymous Anonymous, at 12:20 AM  

And... many hospital "shoulder dystocias" are not really that. First, a doctor puts traction on the head to facilitate birth of the baby on the same contraction as the head. This can pull the shoulders into a bad position, causing a dystocia. Most midwives wait for the shoulders to turn on their own, at which point a gentle push usually means baby delivers spontaneously (hence the phrase "catching babies" - in this way that's all we need to do). Poor positions, and pushing without real contractions are another way shoulder dystocias are "caused" in the hospital by improper management. You will hear of MANY shoulder dystocias in the hospital, and very few at home (sometimes for the same women!).

By Anonymous maribeth, CNM, at 8:09 AM  

I don't think anyone is in a position to criticize this woman's description of shoulder dystocia and I don't see why you are trying to do so.

50% of shoulder dystocias are in normal size babies, so anyone can have an unanticipated shoulder dystocia. Furthermore, shoulder dystocia is a well known cause of neonatal death and permanent injury, so whether this particular woman had a true shoulder dystocia makes no difference to the fact that a true shoulder dystocia (when the shoulder truly will not pass under the pubic bone) is going to be managed better in a hospital.

By Blogger Amy Tuteur, MD, at 8:46 AM  

"a true shoulder dystocia (when the shoulder truly will not pass under the pubic bone) is going to be managed better in a hospital. "

How so? Where is the proof on this? Such bold information, yet where are the facts?

By Anonymous Anonymous, at 11:24 AM  

"I don't get this. When we have an option, unlike women many years ago, to have our child in a center where immediate help can be summoned, if needed, we would choose to put our unborn children's life at risk? Seems pretty selfish to me. "

Assuming that we are "selfish" is ridiculous, I did not make the choice to have a homebirth in order to be selfish and only think about myself, I did it for multiple reasons, and my son was ALWAYS my top priority. Don't assume you know anything about me and my motives by calling me selfish. Please refer to the competitive mothering thread, you seem to be doing that. Why are mothers so competitive? What are the children being taught?

And how was your baby's shoulder dystocia handled? I am curious. (I am the same poster earlier who mentioned that we had a shoulder dystocia at our homebirth).

By Anonymous Anonymous, at 12:39 PM  

There's one 'invention' that was 'invented' by a midwife. The Gaskin Maneuver, named for the midwife who popularized it, for shoulder dystocia. Much more effective and less intrusive then some of the things OBs do in hospital for shoulder dystocia. (Zavanelli anyone? Shudder!)
Of course, Gaskin didn't invent the maneuver, she learned it from Belizean midwives who had learned it from Mayan midwives.

By Anonymous Anonymous, at 12:43 PM  

"And how was your baby's shoulder dystocia handled? I am curious."

English to English translation: I want to know more so I can criticize you for believing that the doctor or hospital saved your baby.

Everyone is wandering around talking about their own "reality" when it comes to assault in childbirth, and now a woman says that she had a shoulder dystocia and suddently everyone is concerned about precision in language. Ironic, isn't it?

By Blogger Amy Tuteur, MD, at 4:04 PM  

"English to English translation: I want to know more so I can criticize you for believing that the doctor or hospital saved your baby."

Excuse me Amy. Maybe that is the type of person you are, but I am not like that. I am not about to criticize her. I am sincerely curious as I had the exact same complication and it was a very major thing. (And speaking of criticizing, I believe I did not call anyone selfish for their choice as she did).

Wow. You are quite negative. Don't assume that you knew why I was asking. You make such general statement without knowing people, my goodness.

By Anonymous Anonymous, at 4:31 PM  

"Excuse me Amy. Maybe that is the type of person you are, but I am not like that. I am not about to criticize her. I am sincerely curious as I had the exact same complication and it was a very major thing."

Awww, c'mon, at least be honest about what you are doing. Your original response to this woman who claimed hospital saved her baby was:

"you should not just automatically assume your baby would have died. You don't know what the outcome would have been."

So without knowing any of the facts of the case, you accused her of being ignorant of what was going on. It's strains credulity to think that you were inquiring about the facts for any other reason besides using the details to criticize her further.

By Blogger Amy Tuteur, MD, at 4:46 PM  

amy,

"So without knowing any of the facts of the case, you accused her of being ignorant of what was going on. It's strains credulity to think that you were inquiring about the facts for any other reason besides using the details to criticize her further."

No, I was never criticizing her. I was just stating that she does not know for sure her baby would have died at home. I could sit here and say that had I been in the hospital, we would have been "tortured." But that is ridiculous. I don't know how it could have been. Just like it drives me crazy when homebirth advocates say the hospital would have done tortuous things had they been there, it drives me crazy when hospital people say their babies would have died at home (unless it really was something where they needed to be there). I guess when I read her post, I was curious on how it went about and how it was handled. Shoulder dystocias can be handled at home, it may have been handled differently, you don't know. You can't know for sure how it would have worked out at home. And I can't know for sure how it would have worked out for me in the hospital. Maybe the hospital would have gotten my baby out quicker or not, you just don't know.

I am not the type of person to blame the hospital on her shoulder dystocia, or blame her, or criticize her birth. Shoulder dystocias are really hard, and can be very upsetting. I have been there, and I'm not going to criticize someone else's experience. I assure you I was asking out of curiousity, and would not have said anything to criticize her, even though she criticized me.

I did not think I was out of line with my original post. Saying that we are selfish because her baby would have died if she chose a selfish choice as homebirth was not okay with me. Therefore I addressed because I have had a shoulder dystocia.

By Anonymous Anonymous, at 5:00 PM  

Hmmmm.... when a person posts about a negative experience they had in the hospital then they are told they are lying, making it up, using it for shock value, told they need to provide proof, etc. When somebody claims their baby would have died had it not been born in a hospital while also calling all people who make different choices selfish, then they are supposed to just be left alone. No one demands any proof or further explanation. What a fair debate you bring, Amy.

By Anonymous Anonymous, at 5:47 PM  

One of the most severe shoulder dystocias I have been involved in was with a very average sized baby: delivered in OR by a prepared OB. Result: dead baby. Now dont get me wrong - this was SEVERE, every maneouver was tried and this poor wee baby wasnt going to fit. There was NO fault whatsoever.

Sadly some babies die. :(

OTOH midwives AND OBs here do the ALSO course and use the HELPERR pnemonic for managing shoulder dystocia. I am a CNM and have the dubious honour of managing emergencies before the OB gets there - and have handled many SDs. Most resolve with MacRoberts and supra-pubic pressure. Some require the internal maneouvres. In several cases I have deliberately fractured the clavical to reduce the width and deliver a shocked baby.

Most midwives here (NZ) who do homebirths do the ALSO course and can manage SD as well as any OB.

By Anonymous Anonymous, at 6:08 PM  

Amy may be a little sensitive about the topic of shoulder dystocia management in the hospital because she's quite aware of the damage it can cause babies and mothers. Better not get into any specific sinerios, there might be a point proven.

By Anonymous Anonymous, at 6:17 PM  

ALL of us birth professionals are quite aware of shoulder dystocia and the damage it can cause. If we're not, we're total idiots. No need to prove a point. But if you KNEW how many "shoulder dystocias" happen in modern obstetrics, and how little it compares to the recognized "norm" of percentage for dystocias... you'd know there's a problem. I stand by the statement that a great deal of alleged shoulder dystocias are iatrogenic, and I challenge anyone to say otherwise.

By Anonymous maribeth, CNM, at 9:43 PM  

Maribeth:

"I stand by the statement that a great deal of alleged shoulder dystocias are iatrogenic, and I challenge anyone to say otherwise."

No, Maribeth, that's not how science works. You don't "stand by" your statements, you have to offer PROOF.

By Blogger Amy Tuteur, MD, at 10:02 PM  

amy,

You don't always share "proof." When I have asked where your sources are on certain statistics, you never answer me or go back to that point.

By Anonymous Anonymous, at 11:54 PM  

Oh come on, don't you think you're being more than a little unfair?

The only person supporting home birth as safer who actually seems willing to post, discuss, and analyze statistics here is Jamie. That's pretty much it. Some other folks have randomly posted a numbere here and there but almost nobody engages on the hard data except for her.

Every other statistical post, analysis, or similar (very time consuming) detail has been provided by Amy, or occasionally by me.

Before you accuse Amy of shirking the data, try posting some.

By Blogger sailorman, at 8:41 AM  

...that's not how science works. You don't "stand by" your statements, you have to offer PROOF...

This isn't science. This is a blog disguised as a debate. YOU offer proof that no SD in a hospital is caused by manipulations of the head before the shoulders rotate.

By Anonymous Anonymous, at 10:08 AM  

Anonymous 10:08 said...
This isn't science. This is a blog disguised as a debate. YOU offer proof that no SD in a hospital is caused by manipulations of the head before the shoulders rotate.


Um, that really isn't how it works. A "reverse proof" or "proof of the negative" is difficult and time consuming and sometimes impossible.

It's much more effective and quick to prove (or not) that something DOES cause dystocia (or cancer, or gas, or...) than to try to prove that something DOESN'T cause it.

Furthermore, the "proof" you apparently require ("no SD is caused...") is functionally impossible to acheive.

(Don't believe me? Go ahead, try to prove that bending paper clips for fun won't cause cancer, ever. You can test 10 billion people, but it might always be the 10,000,000,001th person who gets cancer.)

"not proven to" is NOT equivalent to "proven not to."

If you're going to attack Amy and claim support from science, it would be helpful if your demands conformed to the realities of science.

By Blogger sailorman, at 12:20 PM  

even when what they do isn't proven scientifically either-- where is the science in putting women to bed in labor?

By Anonymous Anonymous, at 3:16 PM  

The only person supporting home birth as safer who actually seems willing to post, discuss, and analyze statistics here is Jamie.

Thanks to her and Amy! I am happy not to read the numbers of anyone else (sorry Sailor) because it keeps my thoughts straighter to read their ideas.

By Anonymous Anonymous, at 3:55 PM  

I echo that, thanks to Jamie for her tireless, intelligent, thoughtful, activism! I appreciate the energy you've given to this important cause so very much.

Obviously, I don't have proof that iatrogenic shoulder dystocias happen. I never claimed to. I did challenge anyone to say they didn't happen - and surprise, no one did.

No claim of science here! Just anecdote!....

I'll share a recent experience with an OB resident, who observed me catch a baby to a mom in hands and knees position. Head delivered slowly over two contractions. I was hands-off except to keep the moms rectum covered with a hot washcloth. It took a whole contraction to birth the last of baby's head, so there was a lull without contraction. The mom caught her breath, waiting for the next contraction, and I told her to push when she needed to. First the baby's head spontaneously turned all the way to the right, then all the way to the left, copious clear fluid draining out of the baby's mouth the whole time. One side to the other, no one touching the babe, so neat to watch. Baby's color was great and she let out a few little cries.

Soon, mom pushed, and out came the top (posterior) shoulder, followed by the bottom (anterior) shoulder. My hands, three inches away from mom, caught the new baby. Truly a catch, no techniques at all involved. Ten pounds, two ounces, no tears for mom.

The resident was - she told me - changed by these 90 seconds of observation. She did NOT know that babies (especially such a big one) would come without A/P traction to their shoulders. Nor that a head could be out for 90 seconds until delivery and a baby could have apgars of 9 and 9. She did not know that a big baby could be born to a primip without a tear. She did not know that, when left along, the posterior shoulder often delivers before the anterior one.

For me, this is an every day event (okay, really 4 time a week event). But I am not being dishonest when I say that this OB resident was nearly in tears at witnessing a truly spontaneous birth. She has stayed in touch with me, telling me that she has told all her fellow residents about it. Guess what, now we have OB residents applying for internship at our birth center.

I'm not arguing that this would have been a shoulder dystocia in other hands - mom had a great pelvis - but I do want to show that many OBs (not saying all) do NOT get experience in non-interventive birth techniques.

By Anonymous maribeth, CNM, at 8:36 PM  

Thanks Maribeth for that picture. I have serious doubts that Amy really even knows what a natural birth even is. She's certainly not replied to any questions in that department.

By Anonymous Anonymous, at 12:08 AM  

Hmmmmm.... What bothers you about a womans happiness and joy in the most satisfying exsperience in her life? Why would you want us to bottle up our happiness, and hide it, and tell horrific horror stories like all the other main stream hospital birthers?

Ummmmmm...... MAYBE to ease the your guilty conscience when you see all the depressed and unhappy moms that took your advice?

Or maybe, just maaaaybeee it is your "INCOME" you are trying to protect?! You know, that Lexus payment?

You see happy homebirthers are just being themselves, no agendas!

You though on the other hand have HUUUUUUGE agendas, that you are not doing a very good job hiding!

Its always about the money for you, and your kind :-)

By Anonymous Anonymous, at 3:18 AM