tag:blogger.com,1999:blog-276887422024-03-08T15:25:29.990-05:00Homebirth DebateAmy Tuteur, MDhttp://www.blogger.com/profile/08496583576036722794noreply@blogger.comBlogger620125tag:blogger.com,1999:blog-27688742.post-74089291468098530892009-04-06T10:50:00.002-04:002009-04-06T10:55:26.995-04:00The Skeptical OB<script type="text/javascript" src="http://cdn.widgetserver.com/syndication/subscriber/InsertWidget.js"></script><script>if (WIDGETBOX) WIDGETBOX.renderWidget('3d8abcf4-3a0d-4c17-a939-d4f5486c0365');</script><noscript>Get the <a href="http://www.widgetbox.com/widget/the-skeptical-ob-atuteur">The Skeptical OB</a> widget and many other <a href="http://www.widgetbox.com/">great free widgets</a> at <a href="http://www.widgetbox.com">Widgetbox</a>!</noscript><br /><br />I've moved my new blog to my own site where there is no need to register in order to comment. Everyone is welcome.Amy Tuteur, MDhttp://www.blogger.com/profile/08496583576036722794noreply@blogger.com45tag:blogger.com,1999:blog-27688742.post-64214513241707918922009-02-27T17:26:00.000-05:002009-02-27T17:27:29.500-05:00How to tell if a homebirth midwife is a quackThe Brewer diet is the flat earth theory of homebirth midwifery. It's been discredited in every possible way, but just like the flat earthers can "see" that the earth is flat, the Brewer diet supporters can "see" that it works.<br /><br />If there is anything that definitively marks a homebirth midwife as a quack, it is belief in the Brewer diet.Amy Tuteur, MDhttp://www.blogger.com/profile/08496583576036722794noreply@blogger.com6tag:blogger.com,1999:blog-27688742.post-86223374564037521272009-02-19T07:13:00.001-05:002009-02-19T07:14:32.099-05:00Continuing the discussionI've been on a temporary hiatus, but others have continued the discussion. I received e-mail requests to open a new thread for member convenience in posting. Here it is.Amy Tuteur, MDhttp://www.blogger.com/profile/08496583576036722794noreply@blogger.com0tag:blogger.com,1999:blog-27688742.post-86134684537317259542009-01-27T09:49:00.002-05:002009-01-27T09:54:19.912-05:00CDC study does NOT show bed sharing is dangerous for infantsIt really irks me that the CDC has claimed that a new study on accidental infant suffocation shows that bed sharing increases the risk that an infant will suffocate. The study itself shows nothing of the kind. It merely reflects a change in the reporting criteria for infant death. You can read my rant at <a href="http://open.salon.com/content.php?cid=93512">CDC study does NOT show bed sharing is dangerous</a>. Feel free to comment here or there.Amy Tuteur, MDhttp://www.blogger.com/profile/08496583576036722794noreply@blogger.com1tag:blogger.com,1999:blog-27688742.post-64683992852001754022009-01-11T23:01:00.003-05:002009-01-11T23:18:07.787-05:00Failure to rescueI'd like to propose a new way of thinking about preventable death at homebirth. A more accurate description might be "failure to rescue."<br /><br />This phrase is used in analyzing quality of care in various aspects of medicine. It refers to the deaths that could have been prevented, either by more careful monitoring to recognize an emergency, providing appropriate care, or providing appropriate care in a timely fashion.<br /><br />Not all homebirth deaths represent a failure to rescue. Some are caused by abnormalities incompatible with life. However, most homebirth deaths are caused by failure to rescue and it is easy to see how that happens. First, by the very nature of homebirth, it is impossible to provide appropriate care for an immediately life threatening emergency. Cord prolapse, massive abruption, and fetal bradycardia will result in perinatal death in the majority of cases. Simply by choosing homebirth, parents ensure that no one will be able to rescue a baby in immediate danger of death.<br /><br />The lackadaisical monitoring, and the minimal knowledge base of most direct entry midwives dramatically increases the risk of failure to rescue due to failure to recognize the problem. That's why there are unanticipated homebirth deaths. The midwife has literally no idea that the baby is in serious trouble and therefore does nothing to prevent the death. A dead baby drops into her hands, a situation that is virtually inconceivable in a hospital setting.<br /><br />The third type of failure to rescue, inability to provide appropriate care , is also more common at homebirth. Even if a DEM recognizes a problem, she often cannot handle it appropriately, and more importantly, she lacks the knowledge and equipment to perform the expert neonatal resuscitation that may be needed. Problems in this category include shoulder dystocia and breech with trapped head or nuchal arms. Most of these babies will simply die at home.<br /><br />The key advantage of the hospital is the ability to rescue babies who need to be rescued. Parents choosing homebirth are simply betting that their baby will not need rescue. Unfortunately, if it does, the baby will most likely die as a result of failure to rescue.Amy Tuteur, MDhttp://www.blogger.com/profile/08496583576036722794noreply@blogger.com1tag:blogger.com,1999:blog-27688742.post-18610603861182418062009-01-06T09:58:00.002-05:002009-01-06T10:02:28.376-05:00"Internet Crack for Crazy Mamaz"A send up of MDC:<blockquote>Truth be told, www.mothering.com is a festering cesspool of what can only be described as insane MAMAZ who put their children and the children of others at risk every single day because they essentially enjoy engaging in a pissing match over who can be crunchier.</blockquote> Read and enjoy the full post at the author's <a href="http://nearlyserious.blogspot.com/2009/01/internet-destination-for-crazy-mamaz.html">website</a>.Amy Tuteur, MDhttp://www.blogger.com/profile/08496583576036722794noreply@blogger.com0tag:blogger.com,1999:blog-27688742.post-69039320903627449212009-01-03T10:27:00.002-05:002009-01-03T10:31:14.893-05:00A lactivism project I can get behindWhat are the folks at Facebook thinking? Why are they labeling as obscene photos of mothers nursing their children?<br /><br />I strongly support the protests of Facebook's nursing mothers. I blogged about it on OpenSalon:<br /><br /><a href="http://open.salon.com/content.php?cid=73739">100,000 women demand more breasts on Facebook</a>Amy Tuteur, MDhttp://www.blogger.com/profile/08496583576036722794noreply@blogger.com0tag:blogger.com,1999:blog-27688742.post-85360945904244400962008-12-29T17:50:00.002-05:002008-12-29T18:07:11.135-05:00"we all know natural birth is pretty much like trying to push a football through the eye of a needle"From <a href="http://www.theage.com.au/opinion/orgasmic-birth-and-other-old-midwives-tales-20081229-76sd.html?page=1">Orgasmic birth and other old midwives' tales</a> written by a homebirther Avril Moore in the Australian publication The Age: <br /><br />On Ina May Gaskin: <blockquote>Curious to see what her contemporary take on modern birthing practices would reveal, I logged on to www.orgasmicbirth.com, only to discover a much greyer Gaskin still expounding — "it is possible to have an ecstatic birth — in fact, it is the best natural high that I know of".<br /><br />... [H]aving delivered three children vaginally (two at home and one in a labour ward) and having experienced an orgasm, I can confidently report there is nothing remotely similar between them.<br /><br />If ever there was a reason for women to be suspicious of natural childbirth, it is the "orgasmic" vaginal delivery and "placenta-eating" claptrap that is trotted out every time home birth is put back on the health service agenda.</blockquote> On the role of men in the natural childbirth movement: <blockquote>What a paradox that this "woman-centred" approach to birth, all dressed up to empower labouring mothers, remains unapologetic in its deference to men. Gaskin's book was dedicated to her husband, spiritual leader and "head honcho" of the notorious "farm", Stephen, whom she claims taught her everything she knows about midwifery, including "respect for the life force and how to move psychic energy".<br /><br />A similar misguided adulation surrounded Melbourne's two sagely home-birth doctors (replete with beards and sandals) during the '70s and '80s.<br /><br />Their entourage of pregnant patients, "birth helpers" and midwives became such blind devotees that they were utterly bereft when one practitioner after the other was deregistered or suspended for malpractice.</blockquote> On the effect of Gaskin and her campaign for "orgasmic" birth: <blockquote>This stereotype promoted by Gaskin on the Orgasmic Birth website is exactly what drives women into the arms of their scalpel-wielding obstetricians, not to mention encouraging a good dose of post-natal depression due to profound disappointment with their labour.</blockquote> On the reality of birth: <blockquote>But please, let's get real, and stop equating this choice with some hokey idea of "ecstasy" when we all know natural birth is pretty much like trying to push a football through the eye of a needle — imagine that, fellas, whenever you're having an orgasm.</blockquote>I couldn't have said it better myself.Amy Tuteur, MDhttp://www.blogger.com/profile/08496583576036722794noreply@blogger.com9tag:blogger.com,1999:blog-27688742.post-16285176839564345982008-12-27T19:41:00.004-05:002008-12-27T20:25:29.958-05:00MacDorman studies further undermined by new dataHomebirth and "natural" childbirth advocates like to claim that Cesarean section increases the risk of neonatal death almost 3 fold, based on the findings of Marian MacDorman and colleagues. What they do not realize is that MacDorman herself has already revised this claim drastically downwards, and that even then, the conclusions are false.<br /><br />In September 2006, MacDorman et al. published (and heavily publicized with interviews to the lay press) a <a href="http://www3.interscience.wiley.com/journal/118622106/abstract">paper</a> that purported to show that Cesarean section increases the risk of neonatal death almost 3 fold. MacDorman et al. compared outcomes of C-sections with "no indicated risk" (a blank space on the risk section of the birth certificate) with outcomes from vaginal deliveries with "no indicated risk" and found that the neonatal death rate was higher in the C-section group. However, MacDorman neglected to mention that it is well known that the risk section of the birth certificate is often left blank even when there are serious risk factors and complications. Indeed, in 50% or more of serious risk factors (heart disease, kidney disease, etc.) the space is left blank. So their assumption that "no indicated risk" means no risk is completely unjustified.<br /><br />In the follow up paper <a href="http://www3.interscience.wiley.com/journal/119404656/abstract?CRETRY=1&SRETRY=0"> Neonatal Mortality for Primary Cesarean and Vaginal Births to Low-Risk Women: Application of an "Intention-to-Treat" Model</a>, MacDorman et al. use the same dataset, known to be flawed and incomplete, but applied a better form of analysis. Using this new, more accurate statistical analysis, MacDorman et al. went back and reviewed their incomplete, flawed dataset. <blockquote>...In the most conservative model, the adjusted odds ratio for neonatal mortality was 1.6 (95% CI 1.35–2.11) for cesareans with no labor complications or procedures, compared with planned vaginal deliveries. Conclusions: The finding that cesarean deliveries with no labor complications or procedures remained at a 69 percent higher risk of neonatal mortality than planned vaginal deliveries is important, given the rapid increase in the number of primary cesarean deliveries without a reported medical indication.</blockquote>MacDorman et al. adjusted their claim downward by a substantially amount. Instead of their original claim that C-section increases the risk of neonatal death by 200%, they now find that C-section increases the rate of neonatal death by only 69%. Yet even then, they failed to acknowledge the most significant flaw in the paper. MacDorman and colleagues <i>assumed</i> that a birth certificate that listed no risk factors for C-section indicated that there really were no risk factors. A large body of data on the accuracy of birth certificates had long ago shown that more than 50% of cases of major risk factors were never listed on the birth certificate and that, therefore, their assumption was completely unjustified.<br /><br />In the January issue of Obstetrics and Gynecology there is a new paper that adds to the mountain of evidence demonstrating that it is impossible to determine C-section risk factors merely by looking at birth certificates. According to <a href="http://journals.lww.com/greenjournal/Abstract/2009/01000/Cesarean_Delivery_Among_Women_With_Low_Risk.8.aspx">Cesarean Delivery Among Women With Low-Risk Pregnancies: A Comparison of Birth Certificates and Hospital Discharge Data</a>: <blockquote> Among 40,932 women with primary cesarean deliveries and no risk indicated on the birth certificate, 35,761 (87.4%) had a risk identified in the hospital discharge data. The overall agreement between data sources on the presence of any risk indicator was low (κ=0.18). Among primary cesarean deliveries, the percentage without indicated risk was 58.3% when using birth certificate data alone and 3.9% when using hospital discharge data in combination with the birth certificate.<br /><br />CONCLUSION: Using birth certificate information alone overestimated the proportion of women who had no-indicated-risk cesarean deliveries in Georgia. Evidence of many indications for cesarean delivery can be found only in the hospital discharge data. The construct of no indicated risk as determined from birth certificates should be interpreted with caution, and the use of linked data should be considered whenever possible.</blockquote> In other words, virtually all women who had primary C-sections but had no risk factors on the birth certificate, actually did have risk factors. In the case of the MacDorman study, the authors reported that there were 469 deaths out of 271,179 births to women who had primary C-sections and no risks documented on the birth certificate. Yet if 87% of the birth certificates were inaccurate, that means that over 235,000 were wrongly placed in this category, thoroughly invalidating the results of the study.<br /><br />The bottom line is that there is no evidence that C-section increases the risk of neonatal death in this study or in any other study to date.Amy Tuteur, MDhttp://www.blogger.com/profile/08496583576036722794noreply@blogger.com0tag:blogger.com,1999:blog-27688742.post-64291391605949547102008-12-25T16:47:00.000-05:002008-12-25T16:48:40.534-05:00Happy HolidaysWishing everyone happy holidays!Amy Tuteur, MDhttp://www.blogger.com/profile/08496583576036722794noreply@blogger.com0tag:blogger.com,1999:blog-27688742.post-84204746964005058482008-12-17T09:59:00.002-05:002008-12-17T10:21:47.731-05:00IdiotsIs there any limit to the ignorance and idiocy of homebirth midwives? It doesn't seem like it. When presented with a transverse lie, ruptured membranes, and prolapse of the baby's arm, these <a href="http://redspiral.blogspot.com/2008/12/how-we-forget.html">morons</a> tried to "fix it." It was lucky that the cord did not prolapsed along with the arm. <br /><br />Leaving aside the fact that the midwife had so little idea of what she was doing that she failed to diagnose a transverse lie (always undeliverable) at the beginning of labor, she actually moved the mother around, as if that was going to change anything. It is a miracle that she didn't manage to cause the cord to prolapse, and the baby's death. Astoundingly, even in retrospect, the midwife and the doula still don't get it. The doula who was there is still prattling about what a "courageous" warrior the mother was. The mother probably has no clue that the baby survived despite the midwife's ignorant efforts to kill it.<br /><br />Consider: <blockquote>The birth was straight forward, planned homebirth, baby decided to wave, hand hanging out (and grasping!) of mom's vagina ... <br /><br />I knew that when she said she felt fingers in her vagina that we would transport, even before the midwife. The midwife thought it was a nuchal arm, I knew that it wasn't. I watched the midwife do Midwifery and I was impressed with her skill and knowledge and so affirmed that I do NOT want to be a midwife. I used to want to be the keeper of that knowledge ...</blockquote> What knowledge? The midwife could not diagnose a prolapsed arm even when it was waving at her. <blockquote>I have never seen a woman be so willing to try such odd things and she was positively graceful and acrobatic in her flexibility, not only in her spirit but in her body. She walked into the place of her greatest, deepest fears and she cried hard but she didn't run away- the word "Courageous" isn't big enough...<br /><br />I can't say after my cesarean that a cesarean is 'worth it', it sounds trite and small now that I know the true sacrifice a cesarean is. Mothers are warriors and this mama, she fought and fought and her baby and she came through safely, however scarred.</blockquote> "Fought and fought," "scarred"? What? They still dont understand that the only alternative was death for both the baby and the mother. They still have no idea that the worst thing to do in the case of a prolapsed body part is to move the mother around.<br /><br />A prolapsed arm is an emergency. It is a miracle that the baby survived the "care" of this midwife. The midwife had literally no idea what was happening, and probably still doesn't. Direct entry midwives are grossly undereducated and grossly undertrained. What's most amazing about homebirth midwifery is not that the neonatal mortality rate is triple that of hospital birth, it's that the neonatal mortality rate is not even higher.Amy Tuteur, MDhttp://www.blogger.com/profile/08496583576036722794noreply@blogger.com0tag:blogger.com,1999:blog-27688742.post-73364743625486758712008-12-15T21:15:00.004-05:002008-12-15T21:50:22.719-05:00New Wisconsin statistics continue to show high homebirth death rateAt the beginning of the year, I wrote about the neonatal mortality statistics in the state of Wisconsin, which showed that homebirth with a direct entry midwife had a neonatal death rate triple that of low risk hospital birth (at any gestational age) for the years 2000-2006. The state recently updated the its <a href="http://dhs.wisconsin.gov/wish/measures/inf_mort/long_form.html">mortality module query</a> with the statistics from 2007. In addition, it is possible to limit the data to term births and exclude premature births. The new data shows an even greater gap. Homebirth with a DEM in Wisconsin in 2007 had a neonatal mortality rate 8 times that of low risk hospital birth (with a CNM)!<br /><br /><img id="http://www.homebirthdebate.com/wiscneo2007.gif" src="http://www.homebirthdebate.com/wiscneo2007.gif" height="260"><br /><br />This is yet more hard data confirming the increased risk of neonatal death at homebirth attended by a DEM. The real increase in risk is almost certainly greater than that depicted in the table. That's because the true CNM neonatal mortality rate for low risk women is probably lower than the data shows, and the true DEM neonatal mortality rate is almost certainly higher. The CNM neonatal mortality rate is probably lower than the rate depicted because it includes women who are not low risk, since CNMs care for all women anticipating a vaginal delivery. The DEM neonatal mortality rate is almost certainly higher because it does not include emergency transfers of the mother during labor. The attendant recorded on the birth certificate is the attendant who actually delivered the baby, not the attendant who supervised the labor, so all DEM intrapartum transfers are recorded in the MD group, not the DEM group.<br /><br />So here it is: the latest hard evidence that DEM attended homebirth has a rate of neonatal death triple that of hospital birth for low risk women. Is it any wonder that MANA (Midwives Alliance of North America) is concealing their data? It is not surprising, but it is immoral.Amy Tuteur, MDhttp://www.blogger.com/profile/08496583576036722794noreply@blogger.com0tag:blogger.com,1999:blog-27688742.post-24508676372928892942008-12-12T09:20:00.002-05:002008-12-12T09:42:02.485-05:00So much for intuitionAs I've written many times before, intuition is not another "way of knowing." Intuition, as venerated by homebirth advocates, is merely a way to glorify ignorance. Not surprisingly, the very same forums and message boards that promote childbirth intuition are the source of a never ending parade of example that intuition among homebirth advocates is worse than worthless. Of the 14 homebirth deaths thus far on MDC this year, not one mother had any intuition that anything was wrong. Indeed, a number of them ignored known risk factors and even actual warning from their own practitioners.<br /><br />As tragic as these demonstrations of the uselessness of intuition are, a far more impressive example is a story like this, written at 30 weeks of pregnancy: <blockquote>...I'm in an interesting situation: I understand [my husband's] need for wanting to get the pregnancy confirmed and we've found a place nearby that will do ultrasounds. I didn't want to do it before I opened my heart because I felt that it was a dishonor to my spirit ... Now ... I know it means a lot to him and I know it will help bring us closer (with the pregnancy, at least). However, another part of me feels this might take away from the magic of bringing a baby into the world. What are your feelings on this? <br /><br />Also, he is scared of being the only other adult present while I'm giving birth. He seemed very trusting during the pregnancy with our son, but once active labor set in he became very stressed and anxious. He's not as trusting of his own body so it's very challenging for him to have faith that I am very in tune with my intuition/body and will be able to give birth safely and easily... I really would like him to feel comfortable this time around, but I also would like to honor my soul. What would you do in this situation?</blockquote> Followed by: <blockquote>So I went to get an ultrasound yesterday and no baby was detected. The sonographer tried a few times just to make sure. I was in total shock and yet, not, given all the weird circumstances surrounding this "pregnancy". I just can't quite put my head around what has been going on inside of me, though. My intuition has been so strong about being pregnant, coupled with all the usual symptoms, plus weight gain, feeling the "baby" kick on a regular basis (I've been pregnant before, so I know the difference between gas, muscle twitches, my imagination, and a baby kicking), I've had a number of signs in the outer world that I am, in fact, carrying a baby, my abdomen is the only part of me that gained inches, which is an indicator that I'm not simply getting fat, but I never got a positive hpt, I've still been bleeding regularly, and now the ultrasound shows that there is no baby. What the?!?! ...</blockquote>Amy Tuteur, MDhttp://www.blogger.com/profile/08496583576036722794noreply@blogger.com0tag:blogger.com,1999:blog-27688742.post-26911917205452707872008-12-10T21:09:00.002-05:002008-12-10T21:33:18.072-05:00Laura ShanleyThe ABC News website is currently carrying a <a href="http://abcnews.go.com/Health/story?id=6424603&page=1">story</a> about unassisted childbirth (UC). The story is brief and contains some inaccuracies and omissions, but it does convey the basic points about UC. As with any story about UC, it mentions Laura Shanley:<blockquote>Supporters of home birth say the experience of bearing a child is enhanced when kept intensely personal and completely natural.<br /><br />"I felt like I'd touched the eternal, when you look back at your baby and your hands are the first to touch her," Shanley said. "I mean, this experience will carry me through the rest of my life."</blockquote>I left a comment: <blockquote>Shanley, the woman you profile, gave birth to 5 children, not four. One was born unassisted prematurely and died for lack of medical attention. Unassisted childbirth (UC) is an irresponsible stunt, undertaken for no better reason that bragging rights. Indeed, as a cultural construct, UC shares many similarities with "extreme" sports. Advocates emphasize the fact that it is transgressive, is "authentic", values process over outcome, creates a sense of belonging, and produces feelings of empowerment.<br /><br />Unassisted childbirth has no benefit to the baby and poses very serious risks to both the baby and the mother. It involves no particular skill, a belief that no expertise in childbirth is needed, has a prime objective of testing the capacity to endure pain, and risks death as the likely outcome of a mistake. In short, it is nothing more than a stunt.</blockquote>Shanley has posted her own comment: <blockquote>Amy Tuteur - those of us in the homebirth movement are used to your inaccurate and fear-based comments about homebirth. But your statement about my baby is an outright lie. Please provide documentation that my baby died due to a lack of medical care. This is pure speculation on your part, as a coroner stated that my baby died of a congenital heart defect, and would have died regardless of where he had been born..</blockquote> My response: <blockquote>You yourself have written that you knowingly gave birth to a premature baby at home, never called for medical assistance and watched him die. I'm not aware of any cardiac defects that are completely unamenable to treatment of any kind. Prenatal care could have easily revealed the cardiac defect, and appropriate resuscitation and a surgical team available for repair could have been arranged in advance. People need to know that unassisted childbirth kills babies.<br /><br />That's not restricted to your case alone. On the forum run by Mothering Magazine, the UC death rate, according to proud declaration of their members is 8/1000. They don't seem to realize that that rate is 20 times higher than the neonatal death rate for low risk women in the hospital!<br /><br />UC is an irresponsible stunt that kills babies. Some people like to pretend otherwise, but women deserve to know the truth.</blockquote>Amy Tuteur, MDhttp://www.blogger.com/profile/08496583576036722794noreply@blogger.com0tag:blogger.com,1999:blog-27688742.post-45526321710744534582008-12-07T11:01:00.003-05:002008-12-07T11:34:46.720-05:00Fill in the blanksWrite your own post to the homebirth board on MDC. It’s easy. Check below for the required format. For ease in posting, we’ve included a convenient script. You can simply fill in the blanks.<br /><br />Title: <b>Seeking support. WWYD?</b><br /><br />Hi, all,<br /><br />I’ve been seeing a _____ (DEM, CNM, shadow care OB) for this pregnancy. I have a history of ______ (high blood pressure, gestational diabetes, previous C-section, all of the above). Now, I ______ (have gone postdates, have low fluid, have rising blood pressure, all of the above). My ______ (DEM, CNM, shadow care OB) is recommending ______ (NST’s, induction, C-section). She says that I am at increased risk for a stillbirth.<br /><br />WWYD? My intuition tells me that this baby is just fine. I guess I am looking for encouragement to trust myself. I need someone to remind me that my body was designed for birthing my baby and that I can do it!<br /><br /><b>Homebirther Wannabe</b><br />Wife to the greatest man in the world, Mom to 2 furbabies, planning homebirth, cloth diapers, baby wearing, extended nursing and anything else that will piss off my inlaws.<br /><br />Title for outcome #1: <b>My blissful home waterbirth of Latrina K8tee Emiliana</b><br /><br />I got my homebirth! Last night we welcomed our precious daughter Latrina K8tee Emiliana at 2:43 AM. She needed a little help to get going. There was _____ (some thick mec, a shoulder dystocia, difficulty getting started breathing, all of the above). Our midwife was amazing. She called 911 right away even though she was dealing with my (retained placenta, massive postpartum hemorrhage, seizures, all of the above). The EMTs performed ______ (mouth to mouth, ambu-bagging, CPR, all of the above) on Latrina in the ambulance. Fortunately, we live close by the hospital; it only took 30 minutes to get there.<br /><br />My only regret is that I have been separated from Latrina. Dh is unbelievable. He has stayed by Latrina’s side through her transfer to the Children’s Hospital upstate and her ______ (admission to the NICU, intubation, seizures, all of the above). In the meantime, I’ve had ______ (a trip to the OR for retained placenta, several transfusions, a hysterectomy, all of the above). As soon as I stop passing out every time I stand up, I’m going to sign myself out of the hospital against medical advice so I can see Latrina.<br /><br />I just wanted to thank everyone for their support. My _____ (DEM, CNM, shadow care OB) made me doubt myself, but the wonderful mamas here convinced me that I could do it. You were right!<br /><br />Title for outcome #2: <b>Update, warning sensitive (loss)</b><br /><br />I got my home waterbirth. Last night we welcomed our precious angel Latrina K8tee Emiliana at 2:43 AM. There was _____ (some thick mec, a shoulder dystocia, difficulty getting started breathing, all of the above). Our midwife was amazing, but it was not to be. She called 911 right away even though she was dealing with my (retained placenta, massive postpartum hemorrhage, seizures, all of the above). The EMTs performed ______ (mouth to mouth, ambu-bagging, CPR, all of the above) on Latrina in the ambulance. Fortunately, we live close by the hospital; it only took 30 minutes to get there. The doctors and nurses worked for an additional hour trying to save her. I was surprised at how kind they were. The young doctor who told Dh and me of her passing had tears in his eyes.<br /><br />Dh has been unbelievable. He’s stayed by my side for my ______ (trip to the OR for retained placenta, several transfusions, hysterectomy, all of the above). As soon as I stop passing out every time I stand up, I’m going to sign myself out of the hospital against medical advice to begin planning Latrina’s memorial service.<br /><br />I can’t understand why this happened. I _____ (ate right, exercised, thought positive thoughts, all of the above). At least I know that I did everything I could to keep Latrina safe. I am proud of myself and of Latrina. The _______ (DEM, CNM, shadow care OB) thought we couldn’t do it, but with encouragement from the wonderful mamas here, we proved them wrong. <br /><br />I just can't stop thinking: why me?Amy Tuteur, MDhttp://www.blogger.com/profile/08496583576036722794noreply@blogger.com0tag:blogger.com,1999:blog-27688742.post-35747660762517036632008-12-03T20:37:00.002-05:002008-12-03T21:20:45.245-05:00Childbirth and gravityWe all know how important gravity is. When we put a turtleneck on a baby, we want gravity to work with us, not against us. So we all hold our babies upside down over the shirt and let the baby fall through the neck opening, right?<br /><br />Wrong, of course. Yet that is the principle that homebirth and "natural" childbirth advocates invoke when arguing that women should be upright in both the first and second stage of labor. They are absolutely certain, based on no evidence, that gravity provides a powerful and necessary aid to labor.<br /><br />Consider this from Charlotte DeVries of Lamaze: <blockquote>I gained a greater appreciation for gravity when, during my second pregnancy, our midwife listened to my tale of woe about a 36-hour labor and forceps delivery with our first (very big) baby and suggested I become a dedicated walker in the months ahead. "Three things," she said. "It's a positive way to move through your pregnancy, your body will be fitter for labor and birth, and you are cooperating with gravity and getting your baby ready to make its way out." She was right on all three counts for that pregnancy and for the one that followed a couple of years later on the other side of the country. For both births, the day I went into labor I did my regular brisk two-mile loop.<br /><br />...[T]hose long walks can be a time to sort out the needs from the strengths, a time to get acquainted with yourself in a different way, to better listen to your body’s cues when it comes to dealing with the purposeful pain of labor, to grow to trust something as simple as gravity on your birth day.</blockquote> Or how about this gobbledy gook from the <a href="http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1948091">Lamaze Care Practice #5</a>? <blockquote>Upright positions—such as standing, kneeling or squatting—take advantage of gravity to help your baby move down...<br /><br />Respected childbirth educator and author Penny Simkin recommends a "standing supported squat" or "dangle" position, especially for women with a long second stage. In this position, the woman is supported under her arms, putting very little weight on her legs or feet. Her trunk becomes longer, providing more space for the baby to move. Simkin also points out that, in this position, the pelvis can move freely as the baby passes through it.</blockquote> Why is it gobbledy gook? Because it's based on no data at all. "Natural" childbirth advocates simply made it up.<br /><br />There are very few scientific papers on the subject and the ones that exist offer show no difference in outcomes. Consider <a href="http://www.informaworld.com/smpp/content~content=a777726933~db=all">Upright position during the first stage of labor: a randomised controlled trial</a>: <blockquote>The upright position during the first stage of labor did not contribute towards a shorter duration of labor; however, it proved to be a safe and well-accepted option for the women of this study.</blockquote>"Natural" childbirth advocates argue that this is the way that women give birth in nature: <blockquote>Until doctors began using forceps in the 17th century, women were rarely shown giving birth in supine positions (lying on the back). With the support and encouragement of family members and community midwives, laboring women used objects such as posts and ropes to gain leverage during pushing. They often used birthing supports or stools to help them squat, crouch, or kneel.</blockquote> That's not true either.<br /><br />According to <a href="http://www.biomedcentral.com/1471-2393/4/3">Mobility and maternal position during childbirth in Tanzania</a>: <blockquote>...More women were mobile at home after the labour pains started than in the labour ward at each hospital. The greatest difference between mobility at home and in the labour ward was at the district hospital (27.6% compared to 4.5%). However, a surprising finding was the apparent restriction on movement prior to admission to the labour ward; across all hospitals, most women chose to rest with little movement when at home (51.6%), and just 15% said they were mobile at home. Another important finding is that 28.3% of all women who laboured in bed in the labour ward said they wanted to be mobile.</blockquote> In other words, when left to their own wishes, more than half of all women did not want to be mobile in the early stages of labor, and more than 70% did not want to be mobile during active labor. So much for "listening" to your body.<br /><br />We can go beyond the fact that the Lamaze recommendations are not evidenced based, and ask just what physics tells us about the relative contribution of gravity to childbirth. The uterus generates tremendous <a href="http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(01)05632-X/fulltext?_eventId=login">force</a> with each contraction, and more force is applied with coached pushing, and by a woman holding her legs under the knees and pulling them back. The uterus supplies approximately 82 newtons (N) of force. Coach pushing (a Lamaze no-no) with legs adds 47 N and pulling the legs back adds 31 N of additional pushing force for a grand total of 160 N. <br /><br />What would gravity add to the 82 N pushing force of the uterine contractions? For a 7 lb. baby, gravity would add 31 N. In other words, the benefit of gravity is far less than the benefit of coached pushing with legs pulled back. Not only is there no evidence that gravity has a beneficial effect on labor, there is no reason to think that the relatively small force of gravity would have much benefit.<br /><br />This is yet another example, in the endless parade of examples, that "natural" childbirth professionals advocate practices that have no basis in scientific evidence, no basis in scientific reasoning, and are simply made up to appeal to the whims of "natural" childbirth advocates.Amy Tuteur, MDhttp://www.blogger.com/profile/08496583576036722794noreply@blogger.com1tag:blogger.com,1999:blog-27688742.post-79247930218707318552008-12-03T10:38:00.002-05:002008-12-03T10:41:00.443-05:00New Dutch guidelines for epiduralsAccording to <a href="http://www.expatica.com/nl/articles/news/Epidurals-now-standard-practice-in-Dutch-hospitals.html">Expatica</a>, epidurals will now be available at all Dutch hospitals: <blockquote> New guidelines mean women giving birth at any hospitals in the Netherlands can now ask for epidurals.<br /><br />Women can now demand epidurals while giving birth at any hospital in the Netherlands.<br /><br />The change is part of new guidelines issued by the national association of gynaecologists, obstetricians and anaesthetists.<br /><br />Up to now, the Netherlands was one of the few countries where the use of epidurals during labour was not standard practice.</blockquote>Amy Tuteur, MDhttp://www.blogger.com/profile/08496583576036722794noreply@blogger.com1tag:blogger.com,1999:blog-27688742.post-48965699387301481042008-11-30T11:07:00.002-05:002008-11-30T11:40:06.008-05:00"Suffering due to lack of pain relief is an affront to human dignity"Many people believe, and I agree, that easy access to reliable pain relief is a matter of human rights. In the paper <a href="http://www.anesthesia-analgesia.org/cgi/reprint/105/1/205">Pain Management: A Fundamental Human Right</a>, published in the journal Anesthesia and Analgesia, Brennan and colleagues review the ethics of pain relief: <blockquote>The importance of pain relief as the core of the medical ethic is clear. The relief of pain is a classic example of the bioethical principle of beneficence. Central to the good actions of doctors is the relief of pain and suffering. As Post et al. state, "the ethical duty of beneficence is sufficient justification for providers to relieve the pain of those in their care ..." The principle of nonmaleficence prohibits the infliction of harm. Clearly, failing to reasonably treat a patient in pain causes harm; persistent inadequately treated pain has both physical and psychologic effects on the patient. Failing to act is a form of abandonment... [F]or a patient's doctor to ignore the patient's complaint of pain or to refuse to accede to a reasonable request for pain relief arguably contravenes the autonomy of patients and self-determination of their medical care ..."</blockquote> As the authors explain, cultural attitudes have had an large impact on the treatment of pain: <blockquote>Societal attitudes toward pain relief during surgery and childbirth illustrate the complex interactions between cultural concepts of pain, pain relief, and social behavior...<br /><br />...In the case of analgesia for childbirth, there was bitter resistance on religious grounds. Fundamentalists cited the Bible as ordaining that childbirth was a necessarily painful process. Opposing both the church and powerful obstetricians, Queen Victoria requested that James Simpson administer chloroform analgesia for the delivery of her son, thus overcoming powerful negative attitudes that discouraged relief of the pain associated with childbirth...<br /><br />Despite the growing number of initiatives ... to improve pain management, powerful myths (and their proponents) are well entrenched and continue to spread with the ease of an epidemic, independent of any need for logic or rationale. The belief that pain is an inevitable part of the human condition is widespread. The word "patient" itself is derived from the Latin <i>patiens</i>, meaning "one who suffers." Examples of pain<br />myths shared by health professionals and patients alike include the notions that pain is necessary, natural and hence beneficial ...</blockquote> The authors ask: <blockquote>Why has it taken so long to recognize the ethical and legal importance of pain relief? There are complex and overlapping reasons for this delay. For centuries, medical and surgical treatment has emphasized saving the life of the patient rather than ameliorating the patient's pain, particularly when there were few options for the latter... At the same time, entrenched attitudes to pain and its rationalization persist, such as that pain in childbirth is biblically preordained. Redemptive qualities continue to be ascribed to pain ...</blockquote> The question for midwives, and health care managers who discourage the use of pain relief in labor, or set up barriers to easy access to pain relief in labor, is this: If easy access to effective pain relief is a fundamental human right, how can you possibly justify your opposition to the use of pain relief in labor?Amy Tuteur, MDhttp://www.blogger.com/profile/08496583576036722794noreply@blogger.com0tag:blogger.com,1999:blog-27688742.post-11428003806244433442008-11-29T11:35:00.003-05:002008-11-29T11:57:47.027-05:00No epidurals in PolandAccording to <a href="http://www.rhrealitycheck.org/blog/2008/11/14/poland-facing-declining-birth-rates-says-health-plan-wont-cover-anesthetic-during-childbirth">RH Reality Check</a>, the government of Poland plans to stop paying for labor epidurals. The article quotes Polish Ministry of Health Director Ewa Kopacz: <blockquote>Kopacz, in response to the letter of the Polish Gynecological Society, which on behalf of women appealed to the Ministry to refund anesthetization, said that the state budget cannot afford to ensure free anesthetization during childbirth to all Polish women. "Childbirth is a pure physiological process and we, women, were created by nature in such a way as to run certain things in their natural way, therefore to have childbirth run in its natural way with no medicine and anesthetization," said the Minister. According to Kopacz, if anesthetization were provided for free, then hospitals would have to ensure that the services of anesthesiologists are guaranteed for female patients to a much broader extent than it is currently. And there are not enough anesthesiologists in Poland.</blockquote><br />Will "natural" childbirth advocates rush to praise Poland for this innovation? That's unlikely once they learn that this is only the latest effort of the Polish government to control women's bodies for their own purposes. An earlier <a href="http://www.rhrealitycheck.org/blog/2008/09/23/to-track-illegal-abortion-poland-plans-register-pregnant-women">article</a> in RH Reality Check describes Kopacz' plan to register all pregnancies in Poland: <blockquote>If a woman participating in the program does not attend medical checks as previously agreed, it will be the responsibility of a midwife to establish contact with her, Minister Kopacz emphasized. <br /><br />"If we find out that a woman registered in the system is not yet pregnant before her pregnancy due date, it could mean that she has had a miscarriage or she has terminated her pregnancy," said Jakub Gołąb, a spokesman of the Ministry. "That way, we shall receive information about the scope of abortion underground in Poland." Gołąb claimed that the fight against underground or illegal abortion will be an indirect consequence of introducing the program. He could not say whether doctors would be obliged to report to the Ministry and submit all data related to women who declared they had undergone an abortion. We do know that all doctors will be given instructions by the Ministry, according to which - after confirming a woman's pregnancy - they will be obliged to record it in a special register.</blockquote>In other words, the decision of the Polish government to deprive women of choice in regard to pain relief in labor is of a piece with the government decision to deprive women of choice in regard to pregnancy.<br /><br />I, for one, don't find that surprising. The government of Poland may invoke financial reasons to deny women epidurals in labor, but the decision rests on the premise that others can and should control what a women does to her body. They believe that they are entitled to make that decision about epidurals, as well as about abortion. Similarly, "natural" childbirth advocates wish to deny or limit access to epidurals because they believe that they know better than any individual woman what she should do to her body. Ultimately, the decision to discourage or penalize epidural use invokes the same reasoning, the idea that others know better than a woman herself.Amy Tuteur, MDhttp://www.blogger.com/profile/08496583576036722794noreply@blogger.com12tag:blogger.com,1999:blog-27688742.post-83359562268326969242008-11-23T11:21:00.003-05:002008-11-23T12:02:59.236-05:00Homebirth advocacy and immature reasoning abilityOne of the earliest achievements in cognitive development, occurring at approximately 5-6 months of age, is the understanding of object permanence. Babies who are only 3 or 4 months old do not understand object permanence. If you show them a toy, they will reach for it, but if you whisk it behind your back, they will not even attempt to look for it. They do not understand that the object is permanent. If they can no longer see the toy, they believe that the toy no longer exists.<br /><br />Once a baby understands object permanence, he or she recognizes that the object still exists when no longer visible. Hide a little ball in your fist, and the baby will try to pry your fist open to get it.<br /><br />Some people appear to have the same problem with risk that tiny babies have with objects. If they don't see it, they think it doesn't exist. If a safety measure decreases a risk, they actually think that the risk is gone, instead of recognizing that preventive measures hide the appearance of risk.<br /><br />Don't believe me? Check out almost every homebirth and "natural" childbirth advocacy site. They almost always demonstrate immaturity in reasoning. MDC, for example, is a on-going festival of immature and stunted reasoning ability.<br /><br />Homebirth and many "natural" childbirth advocates are generally not well educated and have some serious deficiencies in basic reasoning. They have difficulty understanding things with which they have no direct experience. Indeed, they have so little ability to understand that they actually believe that if they have no experience of a risk, that risk no longer exists. Hence the absolutely perverse insistence, in the face of massive historical and contemporary evidence, that childbirth is inherently safe. Only people who are incredibly stunted in their reasoning ability could come up with the inane motto: Birth, as safe as life gets.<br /><br />In the US today, there are relatively few deaths from postdates or shoulder dystocia, or pre-eclampsia. However, that does not mean that postdates or shoulder dystocia or pre-eclampsia are either rare, or no longer dangerous. They are common and exceedingly dangerous, but bad outcomes are routinely prevented by medical intervention. <br /><br />Over the past two years, at least 24 healthy, term babies of MDC members died from preventable causes at homebirth because the mothers, and the MDC members who encouraged them, could not reason beyond what they could see. Most of these women had never seen death from:<br /><br />breech - but now they've seen 1 baby die unncessarily<br />postdates - but now they've seen 3 babies die unnecessarily and 2 sustain serious anoxic brain damage<br />shoulder dystocia - but now they've seen 2 babies die unnecessarily<br />chorioamnionitis - but now they've seen 1 baby die unnecessarily<br />cord accident - but now they've seen 2 babies die unnecessarily<br />chronic hypertension - but now they've seen 1 baby die unnecessarily<br />uterine rupture - but now they've seen 2 babies die unnecessarily<br />fetal distress - but now they've seen 9 babies die unnecessarily <br /><br />Deaths from fetal distress, breech, postdates and cord accidents are not rare; they're common. Homebirth advocates have not seen or heard of them because modern obstetrics prevents them.<br /><br />The toy is still there even when the tiny baby cannot see it. Similarly, the risk is still there even if the homebirth advocate cannot see it. Asking a homebirth advocate about risk is like asking a tiny baby about object permanence; neither understands that the real world extends far beyond what they can see.Amy Tuteur, MDhttp://www.blogger.com/profile/08496583576036722794noreply@blogger.com0tag:blogger.com,1999:blog-27688742.post-5099425561080788942008-11-22T12:25:00.001-05:002008-11-22T12:25:01.025-05:00MDC homebirths 2008: death #14She fired her OB because he wanted to induce her for postdates. The baby died. <blockquote>My OB is insistent on an induction before I get to 42 weeks ... But when I asked today why we had to schedule an induction for monday, i was told that it would be malpractice for them not to. I then pointed out all our family babies are late, I was #4 and 3 weeks late, and told that that was the 70's and it's just not done that way anymore. I then asked what was the medical necessity for inducing me, and told that it would be medical malpractice to allow a pregnancy to go past 42 weeks. it was like talking to a wall. So I let them schedule me for Monday am- 4:45am- bleah. <br /><br />what if I don't show up? can they fire me? can they just be mad at me, but still manage the pregnancy by monitoring a little longer? will I go to jail for not showing up? <br /><br />I have good feelings that this pregnancy is fine, but that she's (and my body) not ready for birth yet...</blockquote> Her compatriots on MDC encouraged her to risk her baby's life. Consider this from UC advocate Rixa Freeze of "The True Face of Birth": <blockquote>... I would be very hesitant to agree to an induction... No need to interfere because of an arbitrary deadline, especially if that deadline may or may not be very accurate.</blockquote> You were WRONG, Rixa. Do you plan on taking any responsibility for your role in this tragedy?<br /><br />Early this morning, posted by another MDC member: <blockquote>After a long labor, her daughter was finally born this morning (11/20) but it is not the happy ending we all were expecting. <br /><br />Her daughter was born with a head full of black, curly hair, 8 pounds, 5 ounces, and she was born sleeping. <br /><br />... She had a very long back labor and labored as long as she could at home with the midwives. I believe she transferred somewhere around dinner time last night to the hospital for pain relief. She and the baby were doing fine and the heart tones were good upon transfer. It's my understanding that once she arrived at the hospital ht's weren't detected and an US confirmed the baby had passed. She was started on Pit and the baby was born this morning. Txgirl said to let you all know the baby had the cord wrapped twice around her neck and the cord also appeared to be short. She went ahead and consented for an autopsy which may or may not provide more detail of what happened.</blockquote> The baby was not born sleeping. Only live babies can sleep. The baby was born DEAD. Had the mother consented to the induction, the baby would almost certainly be alive today.Amy Tuteur, MDhttp://www.blogger.com/profile/08496583576036722794noreply@blogger.com1tag:blogger.com,1999:blog-27688742.post-48589388341588877812008-11-20T16:11:00.002-05:002008-11-20T16:35:28.328-05:00"Women's Primal Wisdom"Midwifery Today seems to be hiring writers from The Onion. They are starting to parody themselves. Consider <a href="http://www.midwiferytoday.com/articles/RuleOf10.asp">Women's Primal Wisdom</a>" by Lydi Owen, a self-described midwife of 36 years, featured on their homepage. Read it and then try to claim that direct entry midwives are trained in anything, let alone birth.<br /><br />The thesis of the article is that if it happens, it must be normal. I've written about this bit of sophistry <a href="http://homebirthdebate.blogspot.com/2008/07/what-is-normal.html">before</a>: <blockquote>Homebirth advocates like to pretend that almost anything that happens is "normal" simply by virtue of the fact that it happened. Are you still pregnant 3 weeks after your due date? Must be normal, since it happened. Are you in labor and stuck at 8 cm for the past 6 hours? Must be normal, since it has happened to some women in the past, and a few have even gone on to deliver live babies.<br /><br />The corollary of the homebirth fantasy that almost everything is "normal" is the conviction that medical definitions of "normal" are utterly arbitrary and exist merely for the convenience of doctors. Nothing could be further from the truth...</blockquote> The Midwifery Today article is nothing more than an elaboration of that fantasy: <blockquote>There is a rule of labor that forbids a woman to push with contractions until her cervix is completely dilated to 10 cm. Women are warned that to push before this doorway is completely open and out of the way will result in a swollen and/or torn cervix...<br /><br />Doctors, nurses, midwives, doulas and childbirth educators all warn that a swollen cervix will impede labor and increase the chances of tearing the cervix, thus causing hemorrhage. They have been taught that a swollen cervix is easily broken or pulverized. If this is indeed the truth, then why do most women during labor have an irresistible urge to begin bearing down before dilation is complete?<br /><br />Could it be that the instinctual wisdom of our bodies has become our enemy? Is Spirit trying to destroy us instead of guiding us? ...</blockquote> Let's see. Just what instinctual wisdom might the author be talking about?<br /><br />Perhaps, it's the wisdom that prevents any baby from ever being born premature? Can't be that, since premature babies are born every day?<br /><br />Maybe it's the wisdom that leads every woman's body to make just the right amount of oxytocin after delivery so virtually no woman ever dies of postpartum hemorrhage? No, can't be that, since women without access to pitocin die all the time.<br /><br />Ah, it must be the wisdom that makes sure that no baby is ever to big to fit through the bony pelvis? That's not it either, since hundreds of thousands of women are suffering from fistula because their baby was too large to fit.<br /><br />Perhaps it's the wisdom that keeps every woman's blood pressure low? No.<br /><br />I could go on and on, but I think everyone gets the point.<br /><br />There is no "wisdom" involved in childbirth, just like there is no "wisdom" involved in hurricanes. Both are natural phenomena and are therefore subject to the brutal laws of nature, not the magical thinking of undereducated, undertrained "midwives." Nature is arbitrary. Sometimes things work out, and sometimes everybody dies. That's the only "wisdom" of childbirth that's relevant. Any "midwife" who doesn't know that doesn't know much of anything.Amy Tuteur, MDhttp://www.blogger.com/profile/08496583576036722794noreply@blogger.com0tag:blogger.com,1999:blog-27688742.post-38156604428088569172008-11-18T07:53:00.003-05:002008-11-18T08:03:15.314-05:00Is there a connection?There has been a great deal of ferment in the homebirth and "natural" childbirth communities recently about the possible closing of the North Shore Birth Center in Beverly, MA. A statement from the birth center explained:<blockquote> As with other birth centers around the nation, North Shore Birth Center is experiencing a significant rise in the cost of malpractice insurance premiums. As a result, we are currently evaluating the services provided by North Shore Birth Center.</blockquote> It is certainly possible that a general risk in the cost of malpractice insurance for all birth centers may be driving this decision. I wonder, though, if a recent neonatal death at the center, discussed on MDC, may be a factor. Malpractice insurance companies rate doctors and adjust premiums upward based on bad outcomes. If malpractice carriers rate birth centers in the same way, a neonatal death would lead them to raise the premiums to exorbitant levels.<br /><br />If the recent neonatal death were a factor, it would explain the apparently precipitous decision and the inability of the birth center to continue despite public protest. If the protesters want the birth center to remain open in the face of high malpractice premiums, they ought to be raising money to pay the increased malpractice costs, not writing letters and parading around with signs. If there's no money to pay the premiums, protests will have absolutely no effect.Amy Tuteur, MDhttp://www.blogger.com/profile/08496583576036722794noreply@blogger.com0tag:blogger.com,1999:blog-27688742.post-34914353199409886842008-11-17T10:05:00.002-05:002008-11-17T10:13:02.333-05:00"It was the natural part that was traumatic"I wonder if the powers that be at MDC are surprised by posts on the new birth trauma forum. I certainly am. I did not know that there were so many women on MDC who felt traumatized by unmedicated childbirth ... and had the courage to talk about their experiences.<br /><br />A current thread on the birth trauma forum is illuminating. I was struck by this statement in particular:<br /><br />"Anybody who says that c-sections can't be wonderful, healing experiences has never opened themselves up to the possiblity of allowing that to be the case."<br /><br />The comments in response were equally unexpected:<br /><br />"There was no "lesson" I needed to learn from it... well, except maybe to stop thinking I was somehow superior because I educated myself on natural childbirth - and to stop judging other for their choices."<br /><br />"...The pain really blew my mind in a way that I honestly did not expect. I think it's quite presumptive for anyone to assume they know the reasons that a mom would've decided to go for pain relief; the reality is that we all feel it differently and experience it differently and none of us can judge for anyone else what is the right path."<br /><br />"Me too..except mine was a UC, well, both actually....I'll never go through birth again wthout at least having drugs as an option.....even if i ended up with a "bad" hospital experience, like mean nurses or whatever, nothing they could possibly do to me would be nearly as awful as labor..nothing."<br /><br />"Yeah, my body didn't care how well I'd prepared, or my positive attitude towards labor, or all the support I had.<br /><br />It totally beat me."<br /><br />I wonder if the moderators will allow the thread to continue or feel compelled to "lock it for review" to marginalize women who followed the prescribed path to an "empowering" birth and were nevertheless traumatized by the pain.Amy Tuteur, MDhttp://www.blogger.com/profile/08496583576036722794noreply@blogger.com0tag:blogger.com,1999:blog-27688742.post-81992775721450784342008-11-13T15:39:00.002-05:002008-11-13T16:14:06.125-05:00Mothering scrubs evidence of 13 homebirth deathsThere is an article in today's New York Times about homebirth and an accompanying comment section in <a href="http://well.blogs.nytimes.com/2008/11/12/having-baby-at-home/">Well</a>, the Times health blog. I posted comment #7 of the 276 and counting comments: <blockquote>The biggest problem with homebirth is that it has an increased risk of neonatal death. All the existing scientific research to date shows that homebirth has a neonatal death rate approximately TRIPLE that of low risk hospital birth.<br /><br />Even the studies that claim to show that homebirth is safe (such as the widely quoted Johnson and Daviss, BMJ 2005) study, actually show that homebirth increases the risk of neonatal death. Johnson and Daviss found a rate of homebirth death in 2000 of 2.6/1000. The rate for low risk women in the hospital that year was 0.9/1000. Johnson and Daviss simply left that information out of their paper. Johnson is the former Director of Research for the Midwives Alliance of North America (MANA, the trade union for homebirth midwives) and Daviss, his wife, is a homebirth midwife. Johnson and Daviss deceptively compared homebirth in 2000 with hospital birth in a bunch of out of date papers extending back to 1969.<br /><br />Since 2003, the US government has been collecting statistics on homebirth. In 2003-2004, the hospital neonatal death rate for low risk women was 0.37/1000 and the homebirth death rate was 1.15/1000. In fact, the single MOST dangerous form of planned birth in the US is homebirth with a homebirth midwife.<br /><br />Mothering Magazine maintains a message board that promotes homebirth. In the year to date, 13 women have reported preventable deaths of their babies at homebirth, among less than 300 women. That is an appallingly high rate of death.<br /><br />American homebirth midwives are currently hiding their safety statistics from the public. The Midwives Alliance of North America (MANA) the trade union for direct entry midwives has been collecting extensive statistics on the safety of homebirth since 2001. Those statistics have been publicly offered to anyone who can prove they will use them for the "advancement of midwifery". Even then you must sign a legal non-disclosure agreement preventing you from revealing any data to anyone else. It does not take a rocket scientist to suspect that MANA is suppressing its OWN data because it shows that homebirth with a direct entry midwife increases the risk of neonatal death, and possibly the risk of brain damage as well.<br /><br />Homebirth advocates are not honest about the fact that homebirth increases the risk that the baby will die. A woman has the right to choose where to give birth, but unless she understand that homebirth increases the risk of neonatal death by a factor of 3 or more, she is not making an informed decision.</blockquote> Over on MotheringdotCommune, a member posted this excerpt: <blockquote>Mothering Magazine maintains a message board that promotes homebirth. In the year to date, 13 women have reported preventable deaths of their babies at homebirth, among less than 300 women. That is an appallingly high rate of death.</blockquote> The member asked if this were true, and suggested that members keep track of the MDC homebirth statistics in order to determine if homebirth is indeed dangerous.<br /><br />Mothering responded as they typical do, with censorship. Rather than addressing the issue of the 13 preventable neonatal deaths (perhaps more) thus far this year, or denying the claim, they removed the comment and the entire thread for good measure.<br /><br />MotheringdotCommune is probably the single best place to do "research" about the safety of homebirth. Babies of MDC mothers routinely die preventable deaths at homebirth, and the moderators routinely remove any discussions about safety in connection with these deaths. Visit MDC now and you will find that there have been not one, not two, but three preventable homebirth deaths in the past month.<br /><br />There were at least 10 preventable neonatal deaths at homebirth on MDC in 2007 as well as 2 cases of profound anoxic brain damage:<br /><br /><b>Preventable homebirth deaths on MDC 2007</b><br /><br />breech, nuchal arms (arms trapped behind head), brain dead, ventilator disconnected<br /><br />shoulder dystocia, profound brain damage<br /><br />unanticipated anoxic brain damage sustained during labor<br /><br />normal labor, baby dead at birth<br /><br />decelerations during attempted home VBAC, transfer to hospital, uterine rupture, baby dead, massive hemorrhage, hysterectomy<br /><br />postdates, severe meconium aspiration<br /><br />normal labor, baby dead at birth<br /><br />post dates, baby dead at birth<br /><br />unanticipated severe birth asphyxia<br /><br />prolonged ruptured membranes, overwhelming infection<br /><br /><b>Preventable homebirth deaths on MDC so far in 2008 including:</b><br /><br />normal labor, baby dead at birth<br /><br />normal labor, baby dead at birth<br /><br />normal labor, baby dead at birth<br /><br />attempted VBA2C, baby dead at birth<br /><br />unanticipated severe birth asphyxia<br /><br />mother rejected medical care, stillbirth <br /><br />shoulder dystocia<br /><br />transferred for pain relief, severe birth asphyxia<br /><br />cord prolapse<br /><br />normal labor, baby dead at birth<br /><br />abnormal cord vessels, baby hemorrhaged<br /><br />In my entire career, during which I attended the births of over 1000 babies, there was a total of one unanticipated neonatal death in a term baby. MDC has had more than 20 in the past 2 years alone.Amy Tuteur, MDhttp://www.blogger.com/profile/08496583576036722794noreply@blogger.com0