Pregnancy & Childbirth

A n3wb in the Childbirth Controversy

I’m new to The Childbirth Controversy.

Until about two weeks ago, the debate raged around me in dark corners of the internet, where angels fear to tread. I bought shwarmas, read Dresden novels, and rolled my eyes watching Supernatural, only vaguely aware that some people had very strong opinions about birth tubs and c-sections. But ever since I started telling the story of Tom’s birth, my eyes have been opened. No matter who I tell it to, there is judgement, repudiation, antagonism, and even hostility. Though some of the comments on the original post certainly qualify, they are by no means exhaustive. We have also heard from the pro “birth experience” side that we should have let the midwives break Renee’s water before transferring, that we didn’t push long enough, and that the c-section was a disappointing failure.

I understand (now) that I stepped into a controversy, and I could have been more clear that a couple of observations were personal experience instead of generalizations. We really did have a doctor who wanted to get us a c-section before a shift change, but had I known how that phrase (almost that exact phrase) is used as a trope to shame women for wanting a c-section–any one that isn’t done only as some horrible last-second intervention (rather than whenever she fucking well WANTS it)–I would have been much more clear about the parts that were actual experience.

However, it still felt as if my post was in many ways commandeered as a battleground in the ongoing debate. People on both sides of the contention reacted to the controversy, and not really to my story.

Let me be absolutely clear about one thing: I feel unquestionably, unequivocally (and even epically) unable to involve myself in the debates themselves. I’m not a doctor. I’m not well informed. I don’t know this fight. It caught me off guard like a minotaur in the hedge maze at Disneyland. I can add neither science nor medicine. Far more educated and informed voices than mine should blog about that aspect of it. I’m glad that my fellow bloggers here at Grounded Parents are much more well informed, working both to increase awareness of the dangers of home birth and to improve midwifery for those who would like a safe option to a hospital.

In my post, I was telling the story of a decision that wasn’t mine to make. It was a decision I would never make. But it was also a decision I had to respect because it was not my body nor my unborn child, and in the end it was a decision with which I found some small amount of peace because we found midwives who seemed more grounded than the woo stereotype.

In telling my story, I picked and chose details that worked with the narrative. I left others out. I hadn’t thought to write a blow-by-blow of the birth experience because that was not the story, and it was within this shadowy ambiguity that I found some people brought their own narrative. Rather than clarify what happened, when, or how, they seemed content to assume.

In the skeptics’ version, the doctor was strenuously telling us we absolutely needed a c-section right that second for the sake of mother and child, and the midwife, standing bodily between them, screamed that the vaginal birth would not be denied. In the natural birth version, the doctor was salivating to do a c-section, scalpels already sharpened and glittering, and the midwife was the solitary voice of reason against the big pharma/medical industry push for expediency, fear of lawsuit, and a bill pushing six figures.

Neither of these stories is true.

I figure maybe it will help if I clarified some details about the event so as to shine a light on those shadowy corners where neither set of assumptions is entirely correct:

  • Every single medical intervention came at the recommendation of the midwives. They were the ones who recommended our transfer to the hospital, recommended the epidural so that Renee could get some sleep, calmed Renee and Will down about the intestinal flora and told them to take the CDC-recommended antibiotics, and backed the second doctor’s recommendation for a c-section. They even told us we might want to skip the vacuum extraction. When the midwife offered to break Renee’s water she actually said she would highly recommend against that option, given the risk factors that had already shown up. The whole reason I liked them at all was because they were not the voice of woo against the doctors and the medicine. That was the entire point of the article.
  • 80 hours of labor includes the time Renee was still watching Elf, holding my hand to her stomach and saying, “Did you feel that?” She only had three-minute contractions for about 8 hours or so (though they were irregular). At that point she was still only at 3cm, so we transferred to the hospital so she could get an epidural and some real sleep. The next day she woke up, ate, and barely noticed her contractions through the epidural until it was time to push. Pushing lasted about four and a half to five hours before the c-section. Fixating on “80 hours!” without finding out the quality of labor involved is problematic.
  • The timber of what happened in that room might be a little hard to appreciate for those who weren’t there. The first doctor made the comment about Renee’s hips almost immediately upon walking in. She told Renee before even introducing herself, “I’m going to let you push for two more hours, and then we gotta think about ‘other options.’ I’m not even sure your hips are wide enough to get a baby out.” Even the hospital nurse looked a little incredulous at that. The midwife shook her head, and looked at us a while later and whispered, “Her hips are wide enough. I promise.”  Renee’s hips are 44 inches wide (normally) and Tom was not particularly big (8 lbs as it turns out). The doctor made the hip comment before she even administered a pelvic exam. (The second doctor disagreed with the assessment and actually laughed at it.)
  • The first doctor said things like “other options,” and “interventions may be needed,” and was really pushy and overbearing about it. However she never explicitly recommended a c-section as urgent. After three hours of pushing she said we needed to “think about interventions.” She did this because it had been three hours and that was “long enough.” Her exact reasoning was that if we didn’t do surgery right away, we could get caught in the doctor’s shift change, and it would be better to do it immediately or wait until after the night shift came on. We asked if there was any medical to reason to rush, and she admitted that there wasn’t. We waited.
  • It is a post hoc fallacy to assume that because we eventually needed a c-section that the first doctor was right all along. There were over three hours (and a more experienced doctor’s assurance that Renee was fine) between that first pressuring comment and the actual c-section.
  • The second doctor had approximately 20 years’ more experience in obstetrics. She was on the night shift because (apparently) more babies actually come out at night.
  • (Many have seemed upset that Renee did not immediately defer to the first doctor. I don’t want to get finger waggy, but that seems a dangerous prejudice to bring to any debate where doctors are involved. Should a patient never ask about the reasons for invasive surgery? Do doctors never make diagnostic mistakes? Do hospitals never have protocols that are not in the patients’ best interests? Do we never want to have patient advocacy or a second opinion? Do we blindly trust anyone with an MD?)
  • The second doctor told us we had time to keep pushing if we wanted and said she would only recommend a c-section if she thought there were serious health risks involved for mom or baby. She left us to do some more pushing.
  • An hour or so later, when Tom’s heart rate had begun to go up to 160 during contractions, and with Renee spiking a fever, the second doctor came in (at the midwife’s behest, I might add), explained to us that it looked like Tom’s head was tilted, and Renee’s contractions were still a little uneven.  We could wait to see if more contractions straightened him out (though Renee was pretty exhausted from her early labor) or we could start thinking about medical interventions. She added that there were some signs of infection and that might be causing the uneven contractions, and that Tom’s heart rate was getting worrisome. We could try for a little longer, but at 170 she was going to strongly recommend we do a c-section.
  • At that point, we didn’t wait any longer. We didn’t wait until Tom’s pulse reached 170.  We didn’t even need “a moment to discuss options.” Tom’s health was all we cared about. We nodded at each other and the choice was made. Renee looked at me as a tear slid down her cheek and said, “My mom had one, and I turned out okay, right?” I squeezed her hand: “You turned out great!” After a quick Hail Mary attempt at a vacuum extraction, Renee was wheeled into surgery.
  • We did take the doctor’s advice. As soon as a doctor actually gave us medical advice. The second doctor respected our birth plan every step of the way, and even apologized when she had to tell us it probably wasn’t going to happen. (We sent her flowers.)

 

I’m new to this debate, and I hope to be blogging 300-400-word articles about blowouts and spit-up by next week. However, I recognize my own culpability in some of the misunderstandings about my story. Though the ad hominem attacks were clearly inexcusable, and as a skeptic I try to be extra careful when framing someone else’s personal narrative within existing polemics, not everyone was rude or presumptuous, and many brought up good points that as a newb to the controversy, I hadn’t considered.

While I would love to see skeptics not jump to conclusions, fall into fallacies, or presume intentions, I realize that I told a story in a way where people with some very strong feelings about the matter might feel the need to advocate. So it seemed like clearing things up–at least for those who read the article in good faith and commented with good intentions–was more appropriate than just changing the subject while the comments piled up.

Perhaps the most troubling thing I’ve encountered, though, isn’t a logical fallacy or conclusion leap. It has been simply the lack appreciation for another person’s decisions. Body autonomy has always been important to me as a feminist, and I would respect Renee’s decision equally if she scheduled her c-section in her first trimester or waited all the way until Tom’s pulse was at 170. For me, even writing about a woman’s experience, choices, and difficulties as my story is problematic, and I’ve tried to make it clear that it’s only my experience for just that reason. I was troubled by her decision. I wouldn’t have made it myself. But rational adults, capable of risk assessment, make decisions all the time that I would not–even about their children.

My biggest problem that I’ve seen in the past month is an enormous contempt for people making informed decisions for themselves. The presumption is that if they make a different choice (from EITHER side) that they clearly weren’t really informed. Flying is by far more safe than driving, but we don’t tell everyone who decides to take a road trip with their kids that they’re acting like toddlers. If someone should have multiple sexual partners, we don’t sanctimoniously tell them that they’re lucky to be alive. Yet for some reason with birth, these strident displays of righteous judgement are considered acceptable. That troubles me deeply.

I am a skeptic. I like modern medicine and CDC guidelines and doctors with lots of letters after their names, and machines that go ping. I was wringing my hands through the entire midwife affair. I’m not exaggerating when I tell you I felt (among the fear and anxiety) some measure of relief when Renee was wheeled off by a doctor and two nurses into an ocean of scrubs-colored green.

Still, if Renee should decide to have a home birth VBAC (against my wishes), I get to go through the whole thing again. But it is her body, and it is her decision.

And I respect that.

I want there to be conversations about midwives’ credentials and medical procedures and the chances of complications in a home birth and midwives requiring more education and being more informed and all that this debate implies, but I also want people to understand that it is perhaps more important when blood is up and hot to be extra careful about their own blinders. I have had my eyes opened to a whole new dimension of parenthood that I didn’t really even know was there, but that conversation seems important enough that it should happen with impeccable intellectual rigor so that it can never be dismissed as just a competing theory with its own confirmation and disconfirmation biases.

But on the brighter side, I know that this is the last controversial topic I’m likely to run into as a parent, and that it’ll be smooth sailing from here on out, and that if there is a minor contention, other parents will be totally respectful about it.  Oh yeah.

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chrisbrecheen

chrisbrecheen

Chris lives with his girlfriend and her husband in a polyamorous family. On Friday Dec 6th, 2013, the married couple had a darling boy. Not "dad" but so much more than "Uncle Chris" he spends much of his time either trying to figure out the boundaries between parent/not-parent or navigating a world ill equipped to deal with non traditional families. When he's not trying to be a grounded parent, he teaches English as a second language and maintains his own blog about writing (chrisbrecheen.blogspot.com).

39 Comments

  1. deERcountry
    January 20, 2014 at 12:31 pm —

    Thank you Chris. I also got pulled into the comments on your original posting, and am still puzzled how quickly it got polarised – especially since I’m not a pro-anything except women’s (and their partners’) informed choice.

    • January 20, 2014 at 1:20 pm —

      Yeah, in retrospect, I think many of those comments were more about the people making them, and it was unwise for me to let them get me so defensive. But I definitely think that body autonomy should be a factor in the discussion about safety.

  2. January 20, 2014 at 12:36 pm —

    Bravo Chris. An excellent clarification of your previous article. The Schmoo’s delivery was remarkably similar. We had planned a Bradley style unmedicated delivery. But after 30 hours of no progress an epidural was recommended so that the Girl and I could both get some sleep. Like Renee’s experience, about a third of that time was sitting on the couch, watching TV and timing contractions. Luckily for our pocketbook the epidural did the trick and after a few hours sleep and some pushing The Girl managed to squeeze out the Schmoo. We were hospital/midwife combo and I’m so happy that Jackie was there. She kept us informed and calmed me down a couple of times.

    Having gone through three of them, I would never judge another parent for making informed decisions about childbirth. As long as the health and safety of the mother and child are not compromised then there is no reason that a certified midwife can’t oversee a birth.

    • January 20, 2014 at 1:22 pm —

      Thanks. Yeah your story DOES sound pretty similar.

      Also, I think “Schmoo” is totally cute!!

  3. January 20, 2014 at 12:57 pm —

    I love this particularly: “Flying is by far more safe than driving, but we don’t tell everyone who decides to take a road trip with their kids that they’re acting like toddlers. If someone should have multiple sexual partners, we don’t sanctimoniously tell them that they’re lucky to be alive. Yet for some reason with birth, these strident displays of righteous judgement are considered acceptable. That troubles me deeply.”

    We had to make some difficult decisions throughout my pregnancy and my sons’ early months that we based on information provided by a variety of medical professionals, and I was (and remain) astounded by how vocally judgmental people can be regarding these decisions. Judging choices another parent made in a specific moment based on their own highly specific situation strikes me as overreaching and unkind.

    • January 20, 2014 at 1:31 pm —

      Totally!!!! It’s been a wake up call to me how entitled people seem to feel about being epicrude to my face.

  4. January 20, 2014 at 8:31 pm —

    As a long time observer of parenthood, and parent myself, I would like to say: parents are single-handedly responsible for ruining their children’s lives forever and causing the inevitable collapse of society, every time they make the tiniest deviation from perfect parenting. Or so I would believe, if I read these sorts of debates on the internet on a regular basis.

    • January 25, 2014 at 4:15 am —

      I think it’s an important debate. It’s not like we’re talking about formula vs. breast milk or whether or not pacifiers are good–there are lives hanging in the balance.

      Which is why I think it’s even more important to be careful to have the debate with intellectual rigor.

      However (looking at your comment below) I’m sorry things took a turn for the ugly.

  5. Alisha Walton
    January 20, 2014 at 9:02 pm —

    …” the last controversial issue then I’ll run into as a parent”…
    Oh Chris. You sweet, naive human. There are more controversies to come. I wish you the best of luck on your parenting journey. Don’t let the haters get you down.

    • January 20, 2014 at 9:07 pm —

      You mean I might have trouble with this post I’m writing about breast feeding in public? :-p

  6. Alisha Walton
    January 20, 2014 at 9:53 pm —

    I live in Santa Cruz where that’s second nature. 😉
    More like how long to breast feed, starting solids, what baby eats, colors baby wears, pacifier weaning, tv watching, and Disney princesses. Theses are just a few off the top of my head. 😉

    • January 20, 2014 at 9:59 pm —

      Because they will become serial killers who can never REALLY love if you do it wrong!

      • January 27, 2014 at 6:47 pm —

        Just wait until you guys start thinking about potty training! More emotional scarring for life!

  7. January 24, 2014 at 6:08 pm —

    “Flying is by far more safe than driving, but we don’t tell everyone who decides to take a road trip with their kids that they’re acting like toddlers.”

    If you are going to quote me, you should include the whole quote instead of changing the meaning by including only part of it. What I wrote was:

    “… You think it was a good thing that the midwife delayed a necessary C-section by an hour because she had absolutely no idea what was necessary or not?

    She and your family behaved like toddlers: “How do you know!” “You can’t make me.” And, like toddlers, you ended being wrong and having to do it anyway.”

    You and your midwife did not accept what you were being told about C-section and decide to press ahead without acknowledging any increased risk. You questioned the doctor’s judgment and motivation, the equivalent of “How do you know?” and “You can’t make me.” And you were wrong.

    The equivalent example would be if someone told you that for your particular case driving was not a safe option, but you decided to ignore that advice because you thought the speaker was wrong and motivated only by personal desires … and then ended up crashing.

    “It is a post hoc fallacy to assume that because we eventually needed a c-section that the first doctor was right all along.”

    No, a post hoc fallacy is something very different. A post hoc fallacy is the claim that because a happened after b, a caused b. The claim that vaccines cause autism is a post hoc fallacy.

    In this situation no one is claiming that the doctor recommending the C-section caused the C-section, merely that when the doctor recommended the C-section, he or she was right, regardless of whether you liked the doctor personally. There is no fallacy involved here.

    Ultimately, your story is the classic story that homebirth advocates tell when things don’t go well, but they’d prefer to pretend that they did. Just like Ruth Iorio tweeted the story of her “safe” homebirth that included a life threatening postpartum hemorrhage, you’ve blogged the story of your “fabulous” midwife who gave the wrong advice and therefore contibuted to what was not a safe outcome. The fact that the baby had to exhibit obvious signs of distress (tachycardia) before the midwife (and therefore the patient) acknowledged the need for a C-section. An extra hour in an infected uterus could have made the difference between a baby who needed to go to the NICU and a baby who didn’t.

    Your story is a classic homebirth story of attempting to shed responsibility for a bad outcome. That’s because, like most homebirth advocates, you were never making informed decisions because you were never informed. You were indoctrinated by reading lay people and listening to self-proclaimed midwives and therefore, you initially rejected out of hand the medical advice of an obstetrician who IS informed about the real risks of childbirth.

    The midwife was wrong. Your partner was wrong. Your attempt to spin this as an unavoidable outcome is wrong. But all of these are the standard modus operandi for homebirth advocates when something bad happens at homebirth.

    • January 24, 2014 at 6:13 pm —

      The fact that you think I’m a “home birth advocate” makes it so stunningly obvious that you didn’t really read the article that I actually laughed out loud. Thank you for that.

    • Rebeka
      January 24, 2014 at 8:44 pm —

      Amy….while it would be so tempting to simply re-iterate my point about who’s really acting like a toddler when they revert to ad hominem attacks, but since you failed to apparently read my comment on the other article, or amusingly, failed to read Chris’ article (I mean, seriously, how can you throw him into ‘those standard modus operandi homebirth advocates’ when he spent the whole article belittling home births and even calling a midwife ‘Lavender’?) Im not sure it’d do much good. But, I do so love to feed the trolls sometime, so here goes more stats:

      – (using the same medical site you used for the Netherlands data) Conclusion regarding North America homebirths: Planned home birth for low risk women in North America using certified professional midwives was associated with lower rates of medical intervention but similar intrapartum and neonatal mortality to that of low risk hospital births in the United States. http://www.bmj.com/content/330/7505/1416

      – Are Caesarian sections overused in North America? According the World Health Organization, yes: http://www.who.int/bulletin/volumes/85/10/06-039289/en/

      – “You questioned the doctor’s judgment and motivation, the equivalent of “How do you know?” and “You can’t make me.” Are you being serious!? So, no one should ever get a second opinion (which, Id like to remind you, Chris and his partner did – and went with the second doctor’s advice?). Aside of the fact that I think that’s crazy talk, shared a personal story already of how it saved my father’s life to question the first doc, and in fact, just about every doc Ive ever been to has happily told me to get a second opinion IN ORDER TO MAKE A BETTER INFORMED DECISION (not less of one!), here’s some info to prove the importance of second opinions: http://onlinelibrary.wiley.com/doi/10.1002/(SICI)1097-0142(19991201)86:11%3C2426::AID-CNCR34%3E3.0.CO;2-3/full which shows not only a significant discrepancy between doctor opinions on the same patient, but also “Beginning in the early 1970s large-scale second surgical opinion programs were mandated in an effort to reduce unwarranted elective surgeries. These programs demonstrated that the need for elective surgery could not be confirmed in 11–19% of cases after a second surgical opinion. The financial benefit averaged $2–4 saved for every $1 spent to obtain the second opinion”. Maybe that’s why insurance companies often insist you get a second opinion before they pay for something. So, ya know, prolly a good thing to get more than one medical opinion and seems like Chris’ family did just that – got two docs advice and then made the informed decision to get a c-section.

      I’d like to take a moment to point out that Im not particularly for or against a type of birth (though Im sure I’ll get labeled as something). I’ve known friends who’ve used both home births and hospital births, had success/not success with both, and just kinda think I’ve got no right telling someone else what to do with their body (gets to be their choice I think). But I think a far more important question ought to be addressed – why the hell is overall pregnancy/mother mortality on the rise in a supposedly industrialized country? Shouldnt that be the bigger issue? http://rhrealitycheck.org/article/2012/07/17/why-are-we-asking-wrong-questions-about-maternity-care/

      • January 25, 2014 at 3:58 am —

        Unfortunately, Rebeka, I have come to understand in the last week and change that name calling and fallacies is sort of Modus Operundi, so I wouldn’t waste too much time actually trying to communicate. You were right to point out that it was this behavior that got her kicked of of SBM, and I noticed immediately that she didn’t seem to have actually READ my story before leaping to conclusions. (An observation compounded by the fact that I’ve taken the time to clarify the details in this post, and yet she’s STILL getting them wrong.) Given that a doctor who has practiced obstetrics longer than she did before quitting her practice, has practiced for years more recently than she has, and longer than both she and our first doctor combined, I’m pretty comfortable with what ended up happening, who my family took medical advice from and why.

        But it does crystalize the idea within my mind that if skepticism on such a “hot” topic is pursued with name calling and fallacies and inattention (or lack of consideration?) to accuracy, it runs a considerable risk of being dismissed as *irrational-but-from-the-other-side.”

        • January 25, 2014 at 9:46 am —

          Now you are making up claims about me. I was not “kicked out” of SBM, no matter how much you wish it were true. Not only was I not kicked out, but years after I left, SBM is still proudly running all my posts. Obviously they didn’t find anything wrong with my scientific claims.

          I will let others determine why you can’t mount a substantive rebuttal to my claims.

          • January 25, 2014 at 1:40 pm

            If that determination involves reading my post, I’m sure they won’t have any trouble with that. 🙂

  8. Rick Castello
    January 24, 2014 at 6:56 pm —

    Doctor Amy, isn’t it terrible how so many women in all those countries other than the United States birth their babies at home?

    • January 24, 2014 at 7:22 pm —

      No, the terrible part is the excess death rate at homebirth. Did you know, for example, that Dutch midwives caring for low risk women (home or hospital) have a higher death rate than Dutch obstetricians caring for HIGH risk women?

      http://www.bmj.com/content/341/bmj.c5639

      Did you know that the Netherlands, the country with the highest rate of homebirth in the industrialized world has one of the highest perinatal mortality rates in W. Europe?

      • January 27, 2014 at 6:44 pm —

        Doctor Amy, it sounds like you’re proposing (please correct me if I’m stating your position incorrectly) that:
        * You believe home births are simply always more dangerous than hospital births
        * You believe that anyone choosing a home birth (whether assisted by individuals with any level of training from doula to certified midwife) is making an irresponsible and unsafe choice for the health of their unborn child

        Is that correct?

        Why not spend your energy building hospitals in places where home births are the only option (or fundraising to do so), instead of snark-baiting blog threads?

        Yes, that was a snarky response, and maybe you do EXACTLY THAT with the rest of your free time not spent snark-baiting.

        Do you?

        • January 27, 2014 at 7:03 pm —

          You’re welcome to have at, Fungible, but this is sort of her thing. It might be better to just ignore her–she’ll go away. She’s an internet celebrity with a single crusade. She hasn’t even held a medical license or published in peer reviewed medical journals in over a decade. She is a blogger who has been kicked out of multiple places that even agree with her medically and scientifically. This is her shtick. It’s really no surprise that even after I clarified things in a second article, she still hasn’t even gotten the FACTS straight. You know what Sinclair said: “It is difficult to get a blogger to understand something, when their page hits depend on their not understanding it.”

          • January 27, 2014 at 7:07 pm

            Hmm. I remember it differently. I thought Sinclair said, “Vorlons are assholes. Let’s go get a beer. Aren’t head-bones cool?”

        • January 27, 2014 at 7:08 pm —

          Ha! I think that was the season earlier. :-p

  9. January 24, 2014 at 7:21 pm —

    Also, Chris, notice you only have “a” partner. Dr. Amy can’t even be bothered to read your bio before she puts on her judgy pants. Impressive research skillz there, doc.

    • January 24, 2014 at 7:33 pm —

      Indeed. I couldn’t have come up with a comment more emblematic of the problems I discussed in the article if I’d written the comment myself.

  10. Rebeka
    January 24, 2014 at 8:10 pm —

    Let’s analyze those deaths, shall we? : http://evolutionaryparenting.com/the-dutch-study-and-maternal-mortality/. Also, please dont make up statistics. Netherlands does NOT have the highest perinatal mortality stats and its ranking is from extreme preterm births, not at birth: http://www.ncbi.nlm.nih.gov/pubmed/23582517

    • January 24, 2014 at 9:00 pm —

      Let’s! The first place to start would be with the correct study! The BMJ has many, many articles. You didn’t look at the one I sited about PERINATAL mortality. You looked at an entirely different study about MATERNAL morbidity, in an entirely different year, by entirely different people.

      How about you start by READING the actual study, not quoting Tracey Cassells on a different study that has nothing to do with perinatal mortality?

      By the way, if you actually read the study I cited, it discusses the unusually high perinatal mortality rate in the Netherlands. Moreover, there’s no point in you denying it, since Dutch midwives have already publicly acknowledged that the Netherlands has one of the highest rates of perinatal mortality in Western Europe. The only people who appear to be ignorant of this fact are homebirth advocates.

      Your response is a perfect example of self-proclaimed “educated” homebirth advocates who have no idea what they are talking about.

      • Rebeka
        January 24, 2014 at 10:55 pm —

        *cries with laughter* Oh, Amy. Apparently my earlier response hasn’t yet posted, but if you saw it you’d be laughing to, because I remarked how I was neither for/against/particularly care one way or the other about home birth vs.hospital birth, but would likely get labeled by you nonetheless. In fact, pretty sure I’d want to have my kid in a hospital, but that’s just my preference, so that comment was really funny. Anywhos.

        To clarify, I did in fact read the study you posted (Im not afraid of getting educated), and then went to see if there was any newer information since yours was dated 2010. Turns out there was – please check out the second link on perinatal mobidity, done late last year, that speaks to my commentary on your misinformation re: Netherlands perinatal morbidity. Its why the link is after that remark – means THATS the right one to click in order to analyze perinatal deaths. First one was speaking to how data was misleading for pregnancy deaths – which is why its an article, not a study – though youre right, I did think it was discussing the same study.

        Now that we’ve got that all cleared up, care to comment on the latest scientific study on perinatal morbidity in the Netherlands?

        • January 25, 2014 at 12:12 am —

          Regarding your first citation from the BMJ:

          The Johnson and Daviss study claimed to show that homebirth with a certified professional midwife (CPM) in 2000 was as safe as hospital birth. There’s just one problem. The authors didn’t compare homebirth in 2000 with low risk hospital birth in 2000 because that would have shown that homebirth with a CPM had a death rate nearly 3X higher. In order to hide that fact, Johnson, the former Director of Research for the Midwives Alliance of North America, and Daviss, his wife and a homebirth midwife, compared CPM attended homebirth in 2000 with a bunch of out of date papers extending back to 1969 when (conveniently) the perinatal death rate was much higher than 2000. Johnson and Daviss have publicly acknowledged that they failed to use the appropriate comparison group.

          2. The WHO recommendation:

          You appear to be unaware that the WHO withdrew that recommendation in 2009, acknowledging that there had never been any data to support it.

          3. The link doesn’t work for the third citation and it’s irrelevant any way. We are not talking about getting a second opinion. We are talking about ignoring the first opinion, being wrong, and having the baby pay a price for being wrong.

          You may never have noticed, but the only people who think homebirth is safe are homebirth advocates. Obstetricians, neonatologists and pediatricians know better. It always amazes me when homebirth advocates think they are more “educated” than the people who actually do the research and care for the patients.

        • January 25, 2014 at 12:29 am —

          “To clarify, I did in fact read the study you posted (Im not afraid of getting educated), and then went to see if there was any newer information since yours was dated 2010. Turns out there was – please check out the second link on perinatal mobidity, done late last year, that speaks to my commentary on your misinformation re: Netherlands perinatal morbidity. Its why the link is after that remark – means THATS the right one to click in order to analyze perinatal deaths. First one was speaking to how data was misleading for pregnancy deaths – which is why its an article, not a study – though youre right, I did think it was discussing the same study.

          Now that we’ve got that all cleared up, care to comment on the latest scientific study on perinatal morbidity in the Netherlands?”

          Yes, now that we’ve cleared up the fact that your first citation had nothing to do with the issue we are discussing, let’s look at the second.

          Some Dutch midwives, notably Ank de Jonge, are still struggling to avoid responsibility for the terrible perinatal mortality rates, let alone improve them.

          For example, in the study that you cite, the conclusion is bizarrely disconnected from the actual findings of the paper. The findings of the study do NOT absolve Dutch midwives and do not address homebirth in any way. Regardless, de Jonge inexplicably concludes that the findings mean that no changes in homebirth policy is necessary.

          How did de Jonge analyze her data and what did she find? de Jonge, like many Dutch midwives, has suddenly discovered that perinatal mortality rates consist of premature babies as well as term babies. Reasoning that premature babies are cared for by doctors, de Jonge set out to show that the poor perinatal mortality rate of the Netherlands can be ascribed to poor care of premature babies. That’s not what she found.

          The Netherlands has one of the worst perinatal mortality rates in Western Europe. What happens when you break the data down by gestational age and compare mortality rates for term pregnancies?

          After restricting the analysis to term births, de Jonge found that the Netherlands has one of the worst perinatal mortality rates in Western Europe, although now they have the sixth worst rate, instead of the third worst rate.

          De Jonge has CONFIRMED the poor perinatal mortality ranking of the Netherlands. She has CONFIRMED that Dutch midwives have poor perinatal mortality rates. She CONFIRMED that the data DO support changes to the Dutch maternity care system. She NEVER LOOKED at homebirth, and therefore she cannot draw ANY conclusions about Dutch homebirth, let alone the conclusion that homebirth is safe.

          Most importantly, in my view de Jonge CONFIRMED that Dutch midwives refuse to accept accountability for their poor perinatal mortality rates. They are not the among the best in Europe. They are among the worst. The sooner they acknowledge reality, the sooner they can start making the improvements that are needed to save babies’ lives.

          Once again, it is only homebirth advocates who claim that homebirth is safe (even when their own data does not support that claim). Everyone else knows better.

  11. January 24, 2014 at 10:49 pm —

    We got some judginess because the bio-mom in our family had an epidural. She’s had major abdominal surgery (not pregnancy-related) in the past, and contractions were becoming hugely painful in intolerable ways. In order not to either implode or beg for a cesarean, she accepted an epidural. And people I know were disappointed.

    She felt real pain in her previous surgery sites through the epidural, mind you. And the kid (as you know) turned out fierce and mighty. In hindsight, I’d say, “We’re fine,” but really it’s “In hindsight … whatever.” Other people’s opinions don’t count in this case.

    I’m glad you and your family turned out okay. I’m glad mom and baby **lived through the process** because that’s not always guaranteed, after that kind of labor and physiological response.

    • January 25, 2014 at 11:49 am —

      I was as surprised about the judgement that goes in the other direction as well. It all seems ridiculously inappropriate. I kind of know *in theory* that other people’s opinions shouldn’t count. The debate should happen at a more macro level. But when people are being particularly horrid, it is harder to pay them no mind.

  12. January 24, 2014 at 10:59 pm —

    Ugh. And it used to be such a lovely comments section too…

  13. Rebeka
    January 25, 2014 at 2:00 am —

    Im impressed…I self-admit that I plan on a hospital birth, I point out that I am not FOR or AGAINST any type of birth. The only reason Im showing you these studies is to hopefully get you to realize that your opinion is not the be all and end all, and to maybe let others choose what they want without having to revert to calling them toddlers for not listening to your ONE opinion versus the bazillion others in this debate. But feel free to keep up the ad hominem attacks, seems to work for you. “If you can’t answer a man’s argument, all is not lost; you can still call him vile names.”

    You realize that the study I showed was using data from the Euro-PERISTAT study? That those ‘midwives’ are in fact have Ph.Ds in Public Health (and two are former nurses?). That their data is supported by the World Health Organization? Id be more surprised but given you are making a living out of denigrating home births (all google searches seemed to wield your blog rants – good job!) Im not. Seriously though! How can you possibly refute and then add complete conjecture to the researchers OWN findings? They did the research, they studied and concluded an informed opinion on what the results meant, and here you are, insisting that they dont know anything and in fact your reality is the right one…oh wait…where have I seen that argument before?

    Sorry, but you can’t just ignore the stats that show the high morbidity rate being attributed to preterm and not full term births and think you’ve won when that kinda guts your argument about midwives involvement in home birthing. You cant simply say ‘theyre wrong to conclude this!’ without having read the damn information yourself and simply choosing to ignore all the facts that DO prove it. You’re supposed to, ya know, prove why YOUR side is better. Unless you cant? But given IM for hospitalized births, Im sure that shouldnt be too difficult. You just might need to expend some more effort not denigrating others opinions and instead justifying your own.

    Oh, and you can’t name call to end the argument, it’s kinda like the whole ‘plus, you’re a nazi!’ remark that just makes me think you really DONT know what you’re talking about and are in fact a troll. I’ll continue this conversation once you can stick to a proper debate format – the ones they teach 5th graders, about pros/cons and not just saying “Jimmy is a poo poo head which is why I should win”.

    • January 25, 2014 at 2:21 am —

      You seem to be a bit confused on the role of a scientific study. Just because something is published in a peer reviewed scientific journal does NOT mean that it is true. It only means that it is worthy of being included in the scientific discussion on the topic. There are bad homebirth papers by doctors (e.g. the Wax study) and there are bad homebirth papers by midwives.

      That’s why journals publish entire papers in the first place, instead of merely publishing the conclusions. The entire paper is published so that readers can evaluate the data for themselves and determine whether the data is the paper support the conclusions of the author. We determine what is true by looking at the totality of the evidence, and almost all the evidence about homebirth shows that it increases perinatal mortality and it increases the risk of permanent brain injury.

      De Jonge has published a variety of lousy papers. Her paper on maternal morbidity is a travesty since she deliberately left out maternal deaths. There was a preventable maternal death in the homebirth group and none in the hospital group. It is ridiculously disingenuous to claim homebirth has fewer maternal bad outcomes while simply ignoring the women who died.

      There are so many bad papers by homebirth advocates because their belief that homebirth is safe is non-falsifiable. In that they are similar to creationists; there are simply no circumstances under which they will acknowledge the validity of evolution regardless of what the evidence shows. Similarly, there are no circumstances in which homebirth advocates will acknowledge the dangers of homebirth regardless of what the evidence shows. And non-falsifiability is a hallmark of pseudoscience.

  14. anonymous
    January 27, 2014 at 1:01 pm —

    You should probably learn the difference between “post hoc” and “post hoc ergo proctor hoc” before you attempt to school people on fallacies. You just made yourself look pretty foolish.

    Some reading comprehension wouldn’t hurt either.

    P.S. I’m pretty sure he was mocking you more than quoting you.

  15. February 22, 2014 at 10:53 pm —

    I think there’s a lot of parenting shame that comes from a poor understanding of statistics. In the case of shaming women for choosing or not choosing the C-section option, we’ll hear all about statistics showing risks related to C-sections. In the case of feeding choices, we’ll hear all about studies that suggest higher IQ if infants are fed one thing vs. another thing. But take any given person, and you’ll find they’re unlikely to find themselves in that average, statistically-neutral situation, where the only thing they need to consider is the p-value of this-or-that study. There are usually a whole bunch of factors to consider – other risks and benefits that need to be weighed. For example, most studies have to correct for income, considering the huge effect of income on health outcomes (especially in the U.S.). But people aren’t “corrected for income” when they go to the grocery store or enter the hospital. I’ve yet to see the scientific study with a tagline that reads “study suggests Joe Schmoe and Suzy Q really missed out by not wearing their baby…”

    This is why I’m hesitant to call out parents on their parenting choices, unless it’s clear that the risks are serious and outweigh any possible benefit (as in the case of anti-vaxxers, or people who refuse life-saving medicine for sick children, etc). It’s shocking, I know, but sometimes people are the best judges of their own circumstances.

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