Friday, May 26, 2006

Competitive mothering

Opinion alert: The following is my opinion. I have no references to offer in its defense.

It seems to me that discussions about homebirth and natural childbirth are often driven by competitive mothering. Other women sense that and are really angered by it.

Competetive mothering is hardly exclusive to homebirth and natural childbirth. It is a pervasive feature of mothering among women of all philosophies. I remember when my children were small, I could not go to the playground without some mother spying one of my children and remarking with apparent sympathy and regret: "Still wearing diapers. That's too bad. My Sam was toilet trained before his first birthday." or "Isn't it a shame that you didn't get much sleep last night because one of your children woke up with nightmares and you brought him into bed with you. I'm afraid that this will go on and on until you put your foot down and teach him to comfort himself in his own bed." I would think to myself: Yeah, right. If I'm going to put my foot down anywhere, it'll be on your smug face.

Mothering is a very difficult job and one of the most difficult things about it is that you don't know how you're doing until your children are much older, and maybe not even then. This engenders tremendous insecurity in mothers and they try to compensate by arbitrarily selecting some practice or practices and insisting that doing them a certain way automatically assures that they are a good mother. So refusing to give a child a pacifier, or early toilet training, or banning TV are elevated to the level of sacred duties. If you do it that way, you are a great mother and if you don't you are bad.

Natural childbirth (and homebirth as a variant of it) are often wielded by women in the same way. That's why there is fierce insistence that natural childbirth isn't just a "choice", it the safest, best choice that a good mother can make, and anyone who doesn't make that choice is by definition a "bad" mother. There is really no evidence that natural childbirth is better for babies, but you aren't going to get certain advocates to acknowledge that. Often they need to believe it, just like other mothers need to believe that early toilet training or banning TV automatically elevates you above the mothers who do neither.

Labels:

33 Old Comments:

"There is really no evidence that natural childbirth is better for babies"

This is a no-brainer. Until the medical benefits (including calming a mother who cannot dilate because she is too stressed out) outweigh the risks of the medication and all the interventions that must be added with the medication, un-medicated is going to be safer.

You take the baby and give it the inherant risks of childbirth (none of which medication fixes), add the risks of medication and co-interventions, and that equals more risk.

By Anonymous Christine, at 9:28 AM  

Actually, there's some theory that there is more balance than that.

I think it's widely agreed upon that some things like certain types of general anethesia, and some doses of IV opiates, will have a direct effect on the baby. That is to say: They make it into the fetal bloodstream in measurable quantities.

So sometimes your baby ends up being sleepier which does worry some people. Those are extremely simple to fix (naloxone, for example) but do require doing "yet more" to the baby, which also worries some people.

I'd note, however, that LONG TERM there appears to be no difference at all in infants who have been birthed naturally. This suggests that it's not especially "bad" insofar as we're using the normal definition of "bad for your baby."

Epidurals unlike IVs do NOT cross the blood brain barrier, and thus CANNOT directly effect the infant. The only connection is through the bloodstream. To be more blunt: If someone says "my baby was sleepy because I got an epidural and the drugs made him sleepy" then they are (unintentionally, perhaps) simply not telling the truth. An epidural CANNOT cause a sleepy baby by "acting like a drug on the baby."

By Blogger sailorman, at 9:51 AM  

yes I have seen competitive mothering- there is also such a thing as supportive mothering and community. Isolation is not a new mother's friend, I think in looking at primitive populations of people women shared more labor, were around each other more learned through subtleties - if you at any given time were seeing other women getting their daily chores done and caring for their children at the same time there is a ton of education in what you see like positioning and breastfeeding styles without even having to think about it, and many types of problem solving.
years ago when my children were young, I went to LLL I went to several groups in the area where I lived- one group the leaders were very educated and took that approach to problems and the whys and where-fors of breastfeeding but these women also trusted us as a group and opened up so that we could all tell our own stories so we learned from each other- there were other groups in that area- and one in particular stood out to me in character it was a group of fairly well off women who hardly talked science or logic at all and it did seem that much of what they did was on a social and sometimes competitive fashion - everything from strollers, diapers, vacations- and they breastfed and they practiced non-violent parenting that was great and despite their competitive undertone they did have some answers to things that I learned from - but I do remember vividly that first reaction I had to seeing this social set in action- it was quite a shock- each mother has a personality and style and that is just how some people do things. What works best for them may or may not work for me and mine- take what you can use and leave the rest.

By Anonymous Anonymous, at 10:07 AM  

------------------------------------------

sailorman-
there is plasma clearance of epidural drugs- it may be hard to get something into the spinal fluid and brainstem via the blood stream but it needs to be cleaned up and exits into the blood stream

also there are other effects--

Am J Perinatol. 2002 Apr;19(3):119-26.

Effect of maternal epidural analgesia on fetal intrapartum oxygen saturation.

East CE, Colditz PB.

Perinatal Research Centre, The University of Queensland, Royal Women's Hospital
and Health Services District, Brisbane, Australia.

The use of maternal epidural analgesia in labor may be associated with
nonreassuring fetal heart rate (FHR) patterns. Fetal oxygen saturation (FSpO2)
monitoring may improve assessment of fetal well-being during this time. Mean
FSpO2 values were compared over seven 5-minute epochs: 5 minutes prior to an
epidural event (combined insertion of epidural/top-up epidural analgesia and
infusion pump bolus), to 30 minutes following the event, including possible
effects of maternal position and FHR pattern on FSpO2 values. Mean FSpO2 values
were significantly different between the 5 minutes prior (49.5%) versus 16-20
minutes (44.3%, p <0.05), 21-25 minutes (43%, p <0.01), and 26-30 minutes
(43.8%, p <0.05) epochs; and 6-10 minutes (48.3%) versus 21-25 minutes (43%, p
<0.05) epochs, but were not influenced by FHR pattern or maternal position.
There were no differences in mean FSpO2 values following administration of an
epidural infusion bolus. We conclude that fetal oxygenation was affected
following initial or top-up epidural analgesia and that fetal intrapartum pulse
oximetry may be useful in assessing fetal status following these events.

Publication Types:
Clinical Trial

PMID: 12012286 [PubMed - indexed for MEDLINE]
-------------------------------------------------------------------------------
Am J Obstet Gynecol. 2002 May;186(5 Suppl Nature):S31-68.

Comment in:
Am J Obstet Gynecol. 2002 May;186(5 Suppl Nature):S78-80.

Unintended effects of epidural analgesia during labor: a systematic review.

Lieberman E, O'donoghue C.

Center for Perinatal Research, Department of Obstetrics and Gynecology, Brigham
and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.

Epidural analgesia is used by more than half of laboring women, yet there is no
consensus about what unintended effects it causes. To evaluate the state of our
knowledge, we performed a systematic review of the literature examining the
unintended maternal, fetal, and neonatal effects of epidural analgesia used for
pain relief in labor by low-risk women. Our review included randomized and
observational studies appearing in peer review journals since 1980.Much of the
evidence is equivocal. Existing randomized trials are either small or do not
allow clear interpretation of the data because of problems with protocol
compliance. In addition, few observational studies control for the confounding
factors that result because women who request epidural are different from women
who do not.There is considerable variation in the association of epidural with
some outcomes, particularly those that are heavily practice-based. Despite this
variation, there is sufficient evidence to conclude that epidural is associated
with a lower rate of spontaneous vaginal delivery, a higher rate of instrumental
vaginal delivery and longer labors, particularly in nulliparous women. Women
receiving epidural are also more likely to have intrapartum fever and their
infants are more likely to be evaluated and treated for suspected sepsis. There
is insufficient evidence to determine whether epidural does or does not tend to
increase the risk of cesarean delivery or fetal malposition. Adverse effects on
the fetus may occur in the subset of women who are febrile.Women should be
informed of unintended effects of epidural clearly supported by the evidence,
especially since epidural use is almost always an elective procedure. Further
research is needed to advance our understanding of the unintended effects of
epidural. Improved information would permit women to make truly informed
decisions about the use of pain relief during labor.

Publication Types:
Review

PMID: 12011872 [PubMed - indexed for MEDLINE]
--

By Anonymous Anonymous, at 10:48 AM  

I agree with your opinion on competitive mothering. It is very annoying, and I'm not sure why we women do it.

And I'm sure there is some faction of that in the natural vs mainstream birthing arena. In fact, I've gotten some very nasty comments myself from women when they learned I planned/had a drug free birth. I'm sure that goes both ways sometimes.

But I think it's too easy to dismiss the whole idea of natural birth by calling it 'competitive mothering' and leaving it at that.

We need to look deeper than the surface competition that may exist.

By Anonymous Anonymous, at 10:54 AM  

I will oversimplify it in a Dr. Laura kind of way since she said it on a radio show recently: Women personalize everything. No one need say anything directly to a woman for her to draw a personalized conclusion. Some random examples from things I've seen/heard in all of these so called debates on mothering where nothing direct was ever said but the woman on the other side "heard it":

- You're breastfeeding therefore I'm a bad mother who wants her baby to have allergies, attachment disorders, and a low SAT score leading to Yale rejection.

- You've experienced unmedicated birth, great but I'm not a martyr or looking for a gold medal

- She has a career so she thinks I'm wasting my life at home playing house

- She's a home schooler so that means I'm committed to substandard education

- She drives a Volvo which means I obviously don't care about car safety for my family.

- You don't vaccinate your kids and I am slowly killing her kids with toxins and risking autism.

- She does the family bed and because mine is in a crib, I put my sleep ahead of my baby's need for security.

The small statements of what women do for themselves or their families should be enough, but for a reason elusive to me (insecurity as inspiration to compete?) we take that and run with it making another woman's life all about us and the decisions we make.

By Anonymous MetroMidwife, at 11:51 AM  

"So sometimes your baby ends up being sleepier which does worry some people. Those are extremely simple to fix (naloxone, for example) but do require doing "yet more" to the baby, which also worries some people."

That's the typical medical community's answer - give more drugs to fix the side effects of the drugs they just gave. Here's the point I'm making. In the absence of medical problems, Having NO drugs is always going to be less risky than having drugs. Period. Whether the risk to baby comes from the risk to mom, direct influence on the baby, or influence on the labor - the risks are always there.

Naloxone includes irregular heartbeat and seizures among its possible side effects. And we know that anytime a drug is given in a hosptial, along with its (usually long) list of possible side effects, there is the possibility of the wrong drug being given, the wrong dose being given, or a particular patient's adverse reaction to that drug.

"I'd note, however, that LONG TERM there appears to be no difference at all in infants who have been birthed naturally."

You started out with "some theory" and have come to a point of "there appears to be." Honestly, it's misleading for Amy to say that there is no evidence that natural childbirth is better for babies when reality tells us that all drugs add risks. And, we certainly don't know for sure that there are no long term effects.

The students I teach come to me to learn natural childbirth techniques because they want to err on the side of caution. Planning a medicated birth (as opposed to using medication if the situation calls for it)includes risks and potential risks they don't need to take when they can manage labor without it.

By Anonymous Christine, at 12:04 PM  

Actually, Christine, I would say that medication can fix things - like being in so much pain that you are stressed and cannot dialate. My sister is this way at home and in the hospital. She has gone days with 5-7 minute apart contractions - being at home most of the time - that only managed to get her to that magic 4 cm dilation they used to require. She always delivered within a very few hours of the epidural.

Last time, when she was induced, and she is often augmented because of the progress of her labor, they started her on the epidural at 2 cm dilation because studies had shown it was safe. It only took 5 hours.

So you tell me, which is safer for mother and baby in this case?

My son who I had with the epidural and all of my children who I had without have faired equally well, including the child born with no medical interventions at all. All breastfed well from day one. Was I a worse mother to my son than to my daughters? Absolutely not.

My choice for natural childbirth was as much or more a personal growth, empowerment thing than it was me thinking it was safer for baby.

I fear that the way some natural birth educators teach their students, if they do 'give in' to needing medication, they will feel guilty and it could contribute to post partum depression.

By Anonymous Amka, at 1:19 PM  

Sorry, back to the topic,

I think we are competitive.

It might be hardwired into us. Once upon a time, our behaviors had a much more direct impact upon the survival of our infants.

In evolution, we often think more in terms of genetic traits being passed down. But clearly, once intelligence is achieved, social evolution is just as important. Everytime a behavior is learned that is superior, what is going to push others into taking up that behavior?

Social competitiveness.

There are several weaknesses in this trait of ours.

a) The competeting behaviors may be equal

b) Rather than support, this encourages isolationism.

It may be that the increase of incidence of this trait is a result of losing the close social structure of extended family and tribes. We move around too much, we are more and more able to take care of survival needs without interacting with others, and natural family structures (primary caregiver and provider pair) are under high stress in this society. All of this leads to the trait of social competitiveness taking precedence over the trait of social support.

By Anonymous Amka, at 1:48 PM  

Amka:

"All of this leads to the trait of social competitiveness taking precedence over the trait of social support."

That's very interesting. I never thought about it that way.

By Blogger Amy Tuteur, MD, at 3:16 PM  

Amy, did you consider how your post, "What Would Baby Think", in which you essentially accused homebirthing mothers of caring more about their own agenda than the possibility of asphyxiating their baby, could contribute to the competitive mothering problem? I know that post made me feel very defensive. When one is put in the position of defending their choice against such an accusation, there is a tendency to want to lash out at the alternative point of view.

By Blogger Mama Liberty, at 11:51 AM  

"Amy, did you consider how your post, "What Would Baby Think", in which you essentially accused homebirthing mothers of caring more about their own agenda than the possibility of asphyxiating their baby, could contribute to the competitive mothering problem?"

As I said when asked about this on another thread, I posted that question in response to a particular statement. Some homebirth advocates said that neonatal mortality was not the only factor to consider when deciding about homebirth. I think my question put the issue into stark relief and made people question whether there is anything even remotely as important the risk of the baby dying.

I thought that it was a particularly apt way of presenting the issue since homebirth advocacy websites and publications imply or actually state that the decision to give birth at home shows that you care MORE about your baby than the average mother. There is often a lot of criticism about potential side effects on the baby of epidurals and other pain relief. Yet, that pales in comparison to the fact that homebirth has consistently been shown to have an excess of preventable neonatal deaths.

As far as asphyxiating is concerned, what do people think happened to those babies who died at homebirths? Most of them slowly asphyxiated.

By Blogger Amy Tuteur, MD, at 2:27 PM  

Fascinating debate -- I started out reading about race and gender and ended up reading about homebirth!

Two annoying, invasive and disrespectful hospital births (including a painful and unrequested episiotemy for a doctor's convenience--I hate being in the tails of a distribution) make me somewhat sympathetic to the concerns of the homebirth crowd--but my methodological predilictions lead me to agree with the assessments of risk and study design raised by Amy, Sailorman and others ;-)

But, if (some) homebirth advocates (or insert the name of any other parenting decision) are motivated by competitive mothering or prior history of sexual assault -- what about the others? Amy -- your blog provides great information -- but why is it worth it to you to advocate for the other extreme? Was it just the bad first experience with a midwife, or is there more to the story? I love stories :-)

By Anonymous median_mom, at 8:15 PM  

OK I care if babies live and have good lives- but I don't care about JUST neonatal mortality because it is a trick, many babies die at a month old and they aren't "saved" they have just saved the hospital a statistic if they die at a month they are part of infant mortality statistics - but they still die from natal/perinatal causes, just later.
People who have babies with anomalies incompatible with life should be able to choose the place of birth and I don't think that it is a bad thing it is not like the hospital is going to make for less suffering for those infants- but the parents may actually have more contact with their infant during it's short life.
I am also wondering if you realize that midwives carry oxygen and ambu bags and suction equipment this is what is used in 99% of all resuscitation efforts

By Anonymous Anonymous, at 9:10 PM  

Median_mom:

"Amy ... but why is it worth it to you to advocate for the other extreme?"

I wonder what makes you say that I am advocating for the other extreme. I am certainly not suggesting that the hospital experience is as good as it could be; far from it. I am only advocating for the truth.

I am not opposed to homebirth. It is a choice that every woman has a right to make. However, every woman deserves accurate, truthful information. Homebirth advocacy websites and publications don't tell women the truth. In fact, I haven't yet found a homebirth advocacy website that is honest about the research.

By Blogger Amy Tuteur, MD, at 9:38 PM  

"it is a trick, many babies die at a month old and they aren't "saved" they have just saved the hospital a statistic if they die at a month they are part of infant mortality statistics - but they still die from natal/perinatal causes, just later."

You know, they keep infant mortality statistics, too. No one is hiding anything. Check out the statistics for infants who die of complications of perinatal causes. You will find that there are no "tricks".

Homebirth is not as safe as hospital birth for obvious reasons. We cannot predict in advance all the complications of labor and delivery that might occur. If they occur and the appropriate personnel and equipment are not present, babies will die.

By Blogger Amy Tuteur, MD, at 9:43 PM  

Amy:

Sorry for calling it extreme--that sounds bad doesn't it! I'm working on a paper on how people make decisions when faced with two competing (and compelling) justifications. So, I would like to justify my lurker's fascination with blog debates by imagining everyone placed on a distribution of behavioral choices.

So, are you willing to humor me some more (in the name of science :-) and reflect further on what led you to start this important discussion? Or, maybe more importantly, how an analysis of the motives (competition, PTSD) of the homebirth advocates fits into the discussion? (Or for homebirth advocates playing along at home, why doctors are characterized as motivated by lawsuits, selfishness, or lack of compassion?)

And I love your respect blog, good stuff :-) One thing is very clear is that you care a lot about your patients and want the best for them -- good for you.

By Anonymous median_mom, at 10:26 PM  

I agree. I am a birth doula/student midwife and you know. I just think you have to respect each persons personal choice. I take care of all my doula mothers the same. NO matter thier choice of place or method of birth. I have had 4 un-medicated births,2 at home but hey, thats MY pesonal choice. I was recently in attendance at a beautiful hospital birth that for me would have been a nightmare, but was this moms best birth.Thats what it is all about. Do I think natural homebirth is best. Well,yes, but i also think you have to support wasch mother in what she deiceds is best for HER. Yu also find this competitive snidess when talking about breastfeeding. Its a shame really that we cant take each of our differences and learn from them so we are collectivley better mothers.

By Anonymous Anonymous, at 11:32 PM  

you have held to the point of neonatal mortality because if you add in infant mortality - home births will not have a higher mortality rate.

By Anonymous Anonymous, at 1:07 AM  

That may be because the infant mortality of hospital births include very prematurely born infants who often come home with a variety of complications from being premature. If THOSE babies had been born at home, they wouldn't have lived more than a few minutes or hours.

The infant deaths ALSO include the infants born into high risk environments.

A teenage mother having her third child isn't going to choose a homebirth. It is likely she won't even have had prenatal care.

Here is a bunch of speculation:

The population of women who are geographically stable and in high stress environments form extended family relationships that rely on supportive mothering to such an extent that leaving said high risk environment is psychologically very difficult. This population sees the tragedies of infant and child death as part of a fate they can't avoid.

By Anonymous Amka, at 10:52 AM  

Median_mom:

"are you willing to humor me some more (in the name of science :-) and reflect further on what led you to start this important discussion? Or, maybe more importantly, how an analysis of the motives (competition, PTSD) of the homebirth advocates fits into the discussion?"

Sure. I started the blog for much the same reason that I wrote my book about childbirth (you can find it on the Ask Dr. Amy website). I believe very strongly that women deserve accurate information about childbirth so they can make informed decisions.

When I was practicing obstetrics, I saw a lot of women who were disappointed in themselves because they had believed that natural childbirth was far less painful than it really is. I think that in some ways, they were less equipped psychologically to deal with the pain because the nature of it was completely unexpected.

I also saw a lot of distrust of doctors that was based on a misunderstanding of the true complications and deaths rates of childbirth before the advent of modern obstetrics.

To tell you the truth, I had not thought very much about the motivations of homebirth advocates before these discussions. I thought it was mostly due to a slavish devotion to all things "natural". I was truly surprised about the connection with PTSD and previous sexual assault. Many of the threads on the board come from musing about what I have learned in these discussions, not from what I believed beforehand.

By Blogger Amy Tuteur, MD, at 12:07 PM  

"you have held to the point of neonatal mortality because if you add in infant mortality - home births will not have a higher mortality rate."

If that were the case, it should be easy to find the statistics to prove it. So far no one has offered anything beyond their opinion (or rather hope) that this is the case. It's just a last ditch effort to avoid confronting the truth that there are no studies that show homebirth to be as safe as hospital birth.

By Blogger Amy Tuteur, MD, at 12:10 PM  

"If that were the case, it should be easy to find the statistics to prove it."

OK, can YOU find studies (notice the plural) that show that hospital birth leads to a lower INFANT mortality rate than home birth? This is the thing I really get stuck on. Countries where midwives and homebirth are normal have LOWER infant mortality rates than the US. Please don't give us the "but they don't have black people" line.

By Blogger Mama Liberty, at 10:47 PM  

"I thought it was mostly due to a slavish devotion to all things "natural". I was truly surprised about the connection with PTSD and previous sexual assault."

Have you considered other reasons as well? I'm curious what you would say to the mothers who have had complications (or perhaps a highly unpleasant experience) in the hospital and go on to have home births. In my case, I tried the hospital twice. My mother mentioned the possibility of a home birth with my first and I quickly dismissed her idea. I experienced the "cascade of interventions" that lead to a sick baby and now a nine year old boy who still feels the effects of what happened at birth. Do you really think it unreasonable for mothers like me to consider what the alternatives might be after such an experience? I'd be curious to know how many homebirth mothers have HAD a previous hospital birth. Most of my friends who have had homebirths have had at least one hosptial birth.

By Blogger Mama Liberty, at 10:57 PM  

Mama Liberty:

"can YOU find studies (notice the plural) that show that hospital birth leads to a lower INFANT mortality rate than home birth? This is the thing I really get stuck on. Countries where midwives and homebirth are normal have LOWER infant mortality rates than the US."

I've already found those studies. All the studies that purport to show the safety of homebirth ACTUALLY show hospital birth to have a lower neonatal mortality rate than homebirth.

As far as the statistics for entire countries are concerned, I've already explained why you cannot assume that midwives are responsible for the lower neonatal death rates. That's because correlation does not mean causation. In other words, just because two factors seem to rise and fall together does NOT mean that one factor causes the other.

For example, the countries with lower neonatal death rates have higher rates of insurance coverage. It is certainly equally plausible to claim that higher insurance coverage is responsible for lower neonatal deaths than it is to claim that higher midwife utilization is responsible for lower neonatal deaths.

See what I mean? Just because two things are related does not mean that one caused the other. You would have to show that there were no other factors of equal or greater importance, like insurance coverage or overall risk rate in the population.

By Blogger Amy Tuteur, MD, at 11:02 AM  

Mama Liberty:

"Do you really think it unreasonable for mothers like me to consider what the alternatives might be after such an experience?"

No, it is not unreasonable. However, it is important to know that despite the many deficiencies of hospitals, a baby born in a hospital has a lower risk of dying that one born at home.

By Blogger Amy Tuteur, MD, at 11:04 AM  

"That's because correlation does not mean causation."

Amy, as someone with an economics background, I'm excruciatingly familiar with the fact that correlation does not mean causation. I also understand that subjects with many confounding variables are hard to understand with absolute certainty. It was amazing to me to watch my professors mathematically "prove" a particular economic theory. The subject of birth is so personal and so complicated, that you can in no way isolate all of the variables that affect the outcomes. You have to make assumptions along the way and arbitrarily assign a value to some variable. We both know that the studies that can be done on this subject are going to be lacking in some way because of the human element. The study of birth aptly fits into the "soft" social sciences. Nothing can be proven with certainty.

I am not convinced when you use a mathematical calculation to prove a particular conclusion that was pre-determined. That is strikingly easy to do. From a logical standpoint, you can come to a conclusion which makes sense, but if your premises are incorrect you have in no way understood "fact" or the truth. You continue to assert that you have proven certain "facts". You have done no such thing. From where I'm sitting, the outcomes for hospital birth versus home birth are very similar. Which leads me to the conclusion that I have to do my best to make decisions based on the evidence, common sense and my prior experiences.

By Blogger Mama Liberty, at 1:02 PM  

"For example, the countries with lower neonatal death rates have higher rates of insurance coverage. It is certainly equally plausible to claim that higher insurance coverage is responsible for lower neonatal deaths than it is to claim that higher midwife utilization is responsible for lower neonatal deaths."

But Amy, you have painted a picture of home birth midwives as so utterly incompetent that if the Midwives Model of Care were commonplace in our country, then babies would be dying right and left. Yes, there are many other factors. But if midwives are so incompetent and home birth as dangerous as you have "proven", then why don't we see story after story from those countries of dead babies and dirty, stupid, incompetent midwives? We don't, because the fact of the matter is that employing midwives and having a good integrated system of home birth are GOOD FOR SOCIETY!!!

By Blogger Mama Liberty, at 1:10 PM  

Yeah, Amka, I said that.

Let me state it again: GIVEN NO MEDICAL INDICATION (a mother who is too stressed to dilate is a medical indication), no drugs will always be less risky than drugs. Even given a medical indication, drugs have risks, but at that point the parents and caregivers have decided that the benefits outweight those risks.

By Anonymous Christine, at 1:22 PM  

OH, and by the way, Amka, some educators do teach their students that if they take drugs they have somehow failed.

Myself and most of the educators I know and respect put medication in the toolbox for labor, for when it's medically indicated or when other techniques are not working. They are aware of the risks and decide for themselves.

By Anonymous Christine, at 1:25 PM  

Mama Liberty:

"But Amy, you have painted a picture of home birth midwives as so utterly incompetent that if the Midwives Model of Care were commonplace in our country, then babies would be dying right and left. Yes, there are many other factors. But if midwives are so incompetent and home birth as dangerous as you have "proven", then why don't we see story after story from those countries of dead babies and dirty, stupid, incompetent midwives?"

Well, I think that's pretty obvious. Most low risk births are going to go smoothly no matter who is present. No one is saying anything about midwives being "dirty, stupid, incompetent". I am saying this: when a serious complication occurs, homebirth midwives are not capable of handling it. That's it, that's all. I'm not accusing them of being bad people. I am saying that they vastly overrate their own competency because they don't realize how limited their knowledge and their skills are.

The homebirth studies that purport to show that homebirth is as safe as hospital birth do nothing of the kind. When there are problems, and there are inevitably problems, babies who could have been saved in the hospital die at home.

By Blogger Amy Tuteur, MD, at 8:24 PM  

"babies who could have been saved in the hospital die at home."

Nobody disputes that some babies who die at home could have been saved in a hospital. Any midwife will tell a mother that this is the main (small) risk of homebirth. But, the reason we choose homebirth anyway is because we believe there is MORE of a chance of having a PERFECTLY HEALTHY BABY who dies or is injured in a hospital. We also believe that our own chances of morbidity and mortality are increased at a hospital.

By Blogger Mama Liberty, at 10:07 AM  

Mama Liverty:

"we believe there is MORE of a chance of having a PERFECTLY HEALTHY BABY who dies or is injured in a hospital"

I know you believe that, but it's not true, and you have provided no evidence to show why anyone else should think it is anything more than your personal belief.

This is the central myth of the homebirth movement and it is a lie.

By Blogger Amy Tuteur, MD, at 12:51 PM