It’s not Feminism Just Because it Claims to Empower Women

I know of a specific form of quackery aimed solely at women, by women.

Home Births. We aren’t discussing “Natural Birth” which often takes place in a hospital which is also a very quacktastic woo laden field of idiocy masquerading as feminism but at least occurs in a hospital setting so if anything goes wrong help is available. We are talking about home birth which is a more extreme form of that. This is a serious group of people who think your Ob/Gyn is a plot to take away your freedom and that the only option is the ancient methods of birthing as practiced by our ancestors. Which is like suggesting that your dentists is earning money from pulling your teeth and the only way to deny him that is to pull your own teeth out with a door and some string.

Straight up before anyone starts jumping up and down saying “But it’s a woman’s choice”, you have to realise this important thing. Just because you have a stomach doesn’t mean you can make medical decisions about a stomach ulcer. Just because you have a uterus doesn’t make your opinions on childbirth valid. You can have some frankly insane opinions. Home Birth without the support of trained medical professionals (Even Nurse Practitioners operate under the umbrella of a Obstetrician, Paediatrician and an Anaesthesiologist so if things go wrong they can save the baby.) is dangerous. And it shows. You are between three to four times more likely to lose a child in birth with a home delivery.

A lot of people I know defend them. A famous natural birther midwife was Mayer Eisenstein. A lot of antivax love him. The average malpractice suits faced by an Obs/Gynae over their lifetime in the USA is between 2 to 3. Obs/Gynae has a high rate of malpractice suits due to the nature of the event. A lot of it is on the fly and sometimes the child is hurt during the birth. Mayer had 15. Including two cases that I know of where the direct responsibility for mortality and morbidity was his actions. He refused to test for Rh incompatibility which resulted in one dead baby and another suffering from cerebral palsy and mental retardation. This man is treated as a hero. Other midwives proudly tell of “difficult” deliveries they have managed which often ended in the deaths of the child. Mothers who lost kids treat it as an experience akin to fighting a war rather than a serious error in judgement that cost the life of their child.

A lot of people straight up don’t believe me when I say this. I have been accused of misogyny for actually pointing out how mad this is as a practice because I impinge on a woman’s sovereign right to make decisions regarding her genitals. I have even been accused of “rape” because I don’t think these midwives should be allowed to carry on their quackery. It’s a lovely group for classy arguments. But I know you won’t believe me. This is a skeptical place, skeptics demand proof. You want to see the bullshit for yourselves.

Footling Breech Birth has a 10 to 15% mortality rate if done vaginally. Here are people actively defending breech delivery by vagina, mentioning that there are midwives who do it (and therefore encourage it) and actively telling people that they can do it too. In addition breech has a high rate of complication resulting in permanent sequelae for the child.

I can go into the umpteen moronic things these women believe, but I think “Breech Birth is perfectly Safe” is enough for now. Not just breech birth, breech birth done by a bunch of quack midwives with little to no medical equipment at home…

If you want to read more about this. Check out the Skeptical Ob and Skeptoid.

(Fixed bad grammar and Linked to the Skeptical Ob)
(Added link to Skeptoid)

Comments

  1. Zugswang says

    Every time I see something like this coming from my part of the political spectrum, I feel a sudden urge to put my head through the monitor. It’s amazing how easily people can be convinced to act against what is in their best interests.

  2. Tobysgirl says

    What is said here is emphatically not true. Home births attended by a midwife have a far lower incidence of problems than do hospital births. My grandmother had to demand that someone attend my mother when she was giving birth to my sister in a hospital, and a friend of mine has a sister in an institution because of lack of attention paid to her mother during childbirth. Midwives are with mothers every minute and are prepared to escort them to a hospital if necessary.

    And I will point out that the same was true before there were hospitals. A midwife in eighteenth-century Maine who kept a diary knew to keep her patients clean, used a birthing chair, and lost no patients to infection. Actually, women do know a lot more about their bodies than ob/gyns.

  3. says

    My mother’s OB/GYN set up a home birth center at her house. My mom gave birth to my brother and sister there. It makes sense to me to give women the option to give birth someplace other than a hospital, where the risk of infection is high and the stress caused by being in an unfamiliar, uncomfortable environment can slow down labor. It does not make sense to forgo essential medical treatments, to neglect having a backup plan for transport to the hospital, to not have any trained medical professionals on the scene when a woman is giving birth. There is a woo-based way to do home births, but there is also a medically sound way to do home births. It seems like you are conflating the two.

    Similar to what happens with home schooling–the majority of home schoolers do so because they are Christian fundamentalists and do a terrible job of educating their children. But there are those few home schoolers who home school for very valid reasons and provide an excellent education to their children. The existence of the good home schoolers does not negate the criticism of the bad ones, but it is inaccurate to say that all home schoolers are like that.

  4. says

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

    No… I am serious. I have read the science on this. Out of every 3 babies that die in a home delivery, 2 would have survived if the birth took place in a hospital.

    The literature is filled with babies who died of frankly stupid things that any doctor could have stopped. And no, 18th century Maine is a far cry from 2012 “First World Nations”. 18th Century people still didn’t know how disease was caused. And had infant mortality rates in the 100s per 1000 rather than the 4 to 6 that western society has.

    You are quoting a fantasy that a lot of homebirthers use. That somehow a 18th century midwife can match modern medicine and that a Certificate Midwife has the same skill as an obstetrician or a Nurse Practitioner Midwife.

  5. says

    SallyStrange –

    You are confusing a Certificate Midwife (You need to finish highschool for one) versus an obstetrician (A Postgraduate Qualification for another Postgraduate Qualification requiring months of on the job training).

    And a “home birth centre” isn’t a home birth. That’s a birth centre. Most birth centres have access to an obstetrician. A proper birth centre has an ob/gynae and a paediatrician for NICU and anaesthesia on hand for emergencies.

    The risk of infection is lower in hospitals… Are you kidding me?

    The paper I quoted above shows that Midwives of low risk babies had a higher perinatal mortality than high risk babies in the hands of a doctor.

    It’s worth going to a dedicated obstetrics ward rather than indulging in quacks. The literature is clear, the gap in skill is enormous.

  6. Stevarious, Public Health Problem says

    and the stress caused by being in an unfamiliar, uncomfortable environment can slow down labor.

    My son was born in a hospital where the ‘birthing rooms’ were more like comfortable lounges than hospital rooms. All the birthing classes were held in these rooms, there were comfy chairs and low lights and beds and it was all very comfortable and nice. A supreme effort was clearly being made to make the rooms as comfortable and inviting and familiar as possible for the women giving birth in the hospital. This was at a state run hospital in Maryland, twelve years ago.

    My daughter was born in a hospital 3000 miles away three years later, and I remember being amazed that the birthing room in the state hospital in Oakland appeared to be buying furniture from the same company as the one in Maryland. The experience was very similar – in fact, with the severe exhaustion I was suffering from caused by a fourteen hour labor that started after a twelve hour work shift, I frequently had trouble remembering which child’s birth I was actually experiencing. I have very strong memories of the absolutely delicious chocolate milkshakes that came up from the hospital cafeteria, of which she requested (and got!) seven of during our two day stay.

    Neither of these could possibly be described as an uncomfortable environment, and unfamiliarity was mitigated as much as possible by having us in those rooms on a weekly basis for classes and checkups. Granted, this is from a perspective merely peripheral to the whole ‘pushing another human out of an orifice that seems both barely capable of and poorly designed for such a task’ but most of what I’m saying, she said first. (In fact, I just asked her, and she said that both hospital rooms were way more comfortable than her own bedrooms and that both times she was sorry to leave.)

    I realize that anecdotes are not data, but was our experience really so different from the norm? Have things gotten worse in the last decade?

  7. says

    You’re doing yourself a disservice by failing to mention certified and trained midwives, who are health care specialists specializing in pre-natal care and delivery. We’ve had great success with our midwifery program here in Canada (Ontario especially). Midwives wouldn’t dream of trying to manage a breach birth in the home – they’ll make your ass go to the hospital. But for a number of normal deliveries, the home is a better place (in terms of anxiety, which has serious impacts on the birth experience for both mother and child) to be. In the presence of a trained specialist, home births can be safe and effective.

    At any rate, the evidence for a difference between the two (planned home vs. planned hospital) does not seem to be as concrete as you suggest: http://www.ncbi.nlm.nih.gov/pubmed/22972043

  8. says

    I mentioned the Nurse Practitioner Midwife. The NPM is a trained nurse who specialises in midwifery. That’s what you are describing. They have different names in different parts of the world. In the USA many states such as Colorado have CMs or Certified Midwives who are “not the same”. It’s like a high school diploma vs. a post graduate nursing course. Some birthing centres actually have a mix of these and obstetricians. Or force certified midwives to work as part of a hospital system and call for the attending Obs/Gynae and Anaesthetist.

    And the Cochrane data consisted of just 11 people as the article itself says. There are people like the Skeptical OB (http://www.skepticalob.com/) who deal with this sort of quackery almost exclusively. The issue from that article is no inference can be drawn.

    And they are relatively safe. The stats I provided were from Holland. Holland is like the holy grail of homebirther stats. And the stats show that low risk deliveries at home have a higher perinatal mortality than the high risk ones in a hospital. That’s pretty damning even for skilled midwives.

    Even in a low risk pregnancy something can go wrong. You may have poor contractions, you may get a cord wrap, you may get an arm presentation. Just stuff. Really simple stuff.

    I could write an entire article just on types of presentations during birth (But that sounds like a tonne of actual work). It’s not just “Head vs Breech”.

    For example?

    An arm presentation can actually cause a sort of damage called Erb’s palsy. A symptom of the lack of an Obs/Gynae who can deliver with instrument or C-Section.

    Vertex is the textbook presentation. Occiput posterior presentations are usually slower and may require instrument delivery. Brow presentations require C-Section. Face presentations are only delivered normally if the chin is anterior (neck in extension).

    These are the variations in just normal vertex presentations. There are variations in Breech and Shoulder too. It’s a massively complicated subject.

    And this I must point out is Rotation Medicine, Not Specialist Knowledge. If anything they would be more specific (There are 3 other terms involved. Attitude, Position and Lie)

    You are terrified of needles but if you step on a rusty nail you still are going to go get your Tetanus Toxoid shot. Apprehension is reduced if you do your homework, in most first world countries the overall birth load at hospitals isn’t too bad. Go in advance. The Doctor doesn’t mind seeing you and there is no harm in getting comfortable with your hospital.

    TLDR: Unless the midwife is working in a hospital or a dedicated birth centre with the facilities for ER C-Sections the risk is higher at home birth.

  9. Tsu Dho Nimh says

    @2 … Martha Ballard’s diary records one maternal death for every 200 births. Or to put it into the modern reporting style, 500 deaths for each 100,000 births.

    While she had an exceptional record for her time, the current USA rate for maternal deaths is about 20 per 100,000.

  10. says

    There is a problem with many home births, yes, but it lies with allowing midwives to practice even though they are not properly trained medical practitioners. Unfortunately, most US states treat midwivery as an “alternative medicine,” which means it gets very little regulation.

  11. says

    Gregory, a lot of people don’t realise how dangerous they are. Particularly if they are “certified”. Added to which there is another kind of midwife out there who is the real deal.

    It’s like someone calling themselves a Dr. Of Medecine. A lot of people are going to be taken in by the spelling mistake…

  12. laconicsax says

    The Netherlands study you cite is comparing apples to oranges and you’re ignoring important details.

    It isn’t concluding that midwife-assisted births are more dangerous, but that midwives are less able to handle serious, complications–something midwives themselves admit and take precautions for (such as having conservative transport policies and not accepting high-risk patients).

    A low-risk pregnancy is going to be monitored differently than a high risk one. A trained midwife attending a low-risk birth is less likely to begin potentially unnecessary interventions than an OB attending a high-risk birth where interventions are more likely to be necessary. I say potentially unnecessary because, as the data show, the rate of cesarean births is rising dramatically without a corresponding need arising from the birth process.

    A good example of this is the cascade effect resulting from using electronic fetal monitoring, an intervention which has no good evidence of improved outcomes but is correlated with a 40% increase in cesarean section rate. Another good example is epidural analgesia, which has far more negative consequences than positive, including an increase in need for administering pitocin to stimulate contractions (itself having a tendency to result in higher cesarean rates).

    Since you’re a student, ignorance of this and an idealized view of hospital births is understandable and forgivable, but you might want to do a bit more reading on the subject.

  13. Syzorr says

    I find the title to your post “It’s not Feminism Just Because it Claims to Empower Women” rather ironic as just by altering it a little, I can make my point very quickly – “It’s Not Quackery/Woo Just Because You Found An Extremist”

    I feel the need to introduce myself before launching in to my reasoning here as I feel the context may be important to explaining my viewpoint and, also, my experience of the medical system in my own country of New Zealand. My wife has had some of the most difficult pregnancies imaginable – in her first she lost 25kg over the 9 months (15kg in the first 3 months) and nearly died during the C-section, the second we were lucky with and she only got a 3rd degree tear, and with our 3rd (and final) we had to go for another C-section because our little girl wasn’t engaging with the pelvis and there was too much liquid to safely attempt breaking the waters to induce (and, because of the previous tear, we couldn’t safely attempt chemical inducing).

    For us, in all 3 pregnancies, she was classified as high risk and treated accordingly. Without that classification and according extra care, there would have been every chance that, in the first pregnancy, she or my eldest would have been part of similar mortality stats. However, because of the system of registered midwives (here we don’t have the “certified midwife” idiocy) within New Zealand, free public service health care, easy co-operation between midwives and ob/gyns and central national health database.

    Reading the report you provided in #5, I am not about to debate the science but I would happily debate the conclusions you so quickly draw from it as your opinion is erroneous when compared with the results of the study and the conclusions reached by the scientists. Their conclusion is that the health *system* in the Netherlands is failing their wives and mothers when it comes to detecting and monitoring higher risk pregnancies and this is leading to increased mortality when the woman is needing to be moved from primary to secondary care. You have then gone and taken their study and used it, poorly, to validate your opinion that home birth/natural birth is superstitious woo-filled bullshit.

    And I call bullshit on that…

  14. says

    laconicsax -

    “It isn’t concluding that midwife-assisted births are more dangerous, but that midwives are less able to handle serious, complications–something midwives themselves admit and take precautions for (such as having conservative transport policies and not accepting high-risk patients).”

    That’s the very definition of “midwife assisted births being dangerous”. If you read my basic description of different vertex position births you would realise that even low risk pregnancies can become high risk in seconds.

    Conservative Transport Policies require the establishment of Obs/Gynae dedicated ambulances on tap at all times for each midwife. A highly wasteful practice monetarily. Ambulances and their personnel are not cheap to train or even remove from the existing pool for such a personal errand. Your car is not an ambulance. You don’t have the skills of the medics and you really cannot drive the way they do.

    Laconicsax, one of the biggest and daftest arguments being made is the increasing rate of C-Sections. Do you know why American Obs/Gynae hand out C-Sections to the tune of 1 in 3 births?

    All doctors earn wages. There is no reason for them to do a C-Section for money. It is actually more work for them. It’s the difference between someone ordering a burger at a McDonalds or ordering a combo meal. The money to the doctor is the same.

    The first issue is obesity. The USA has an obesity epidemic. Obese women have big babies. Obese women’s pelvises aren’t magically bigger. This goes hand in hand with diabetes which is also very common in the USA and also causes big babies. The second issue is liability.

    A single case of Shoulder Dystocia cost a hospital around 144 million dollars in liability. Why the hell should hospitals not push for C-sections for any case that looks at them funny?

    Legal Risk is entirely on the Doctor and Hospital’s Side. The american system is highly litigious. 10% of your Salary goes to Malpractice insurance. An obstetrician who doesn’t do a C-section takes a massive legal risk. One who does do one does not take a legal risk at all. If you don’t do a C-section and something happens you can lose your license. All someone has to do is say “You should have done a C-Section”.

    Your system is not based on money but risk. And plenty of Midwives play the risk game and get burned for it (As I pointed out, Colorado has a 15 per 1000 mortality rate for it’s midwives. The USA’s NMR rate is less than 5.). It’s just that they don’t care about the risks. They don’t advertise failures. In fact I think it’s the deadliest of the western quackery schools since it’s a kind of quackery we don’t even consider to be dangerous despite the mortality rates because our existing mortality in childbirth is so low.

    Laconicsax again Foetal Monitoring saves lives as does Epidural. The modern C-Section can be done under it. Again there is this ludicrous notion that pain is good and natural for women and that if you can endure this pain light will shoot out of your vagina and you will turn into the best mother in the galaxy. The natural birth literature treats mothers who go through pain-free deliveries as abhorrent monsters who deny themselves pain and the liberation that comes with it. Because Natural Birth is designed by the Yuzhan Vong (WHAT! I liked that plotline!).

    The worst thing I have heard about epidurals is that you lose the ability to move if you take one and that women would rather move and scream and be completely irrational due to the pain. People LOVE mentioning the side effects of epidurals as if they are deadly but fail to forget the side effects of strenuous pregnancy. There have been women who have “strained so hard” that they damage their bladders or have prolapses of uterus. Or rectal prolapses. None of these are good. The entire point of an epidural is it gives women control over their pain and therefore their mind during the birth. It also adds a layer of protection (ER C-Sections can be done under this.)

    If we don’t do elective C-Sections and only do them under recommendation (Because C-sections actually hurt MORE than Vaginal Birth under Epidural. Why? You may be unconscious during the procedure or under local but the anasthesia wears off. You still have been stabbed and that bloody hurts later!) you would get a rate of 20% to 30%. If you reduced Liability you would get a fall in rate.

    There are a lot of misconceptions here. But it does demonstrate how that quackery spreads. (Edit – Some grammar improvements and fixes)

  15. says

    Syzzor –

    This is from New Zealand. I want you to tell me what’s wrong with this paper.

    http://www2.cfpc.ca/local/user/files/%7BF8052A68-D510-401A-B323-0D9DA912C58C%7D/planned%20place%20birthj.1523-536X.2010.00458.x.pdf

    Don’t worry I will explain the answer at the end…

    It has the highest mortality rate out of chiropractic, accupuncture and homeopathy. To put it into perspective? Colorado in 2010 had around 16 deaths per 1000 live births during birth in it’s homebirth cohort.

    The State of Kerala posted in 2007 an IMR (infant mortality rate) of 14 per 1000 live births. The IMR in Kerala (A state in India run by communists with third world medicine) is lower than the just the perinatal mortality in Colorado homebirths. Kerala is remarkable for it’s achievement (India’s IMR is 45 per 1000). If you are having a homebirth in Colorado at the moment you are more likely to lose a child than you are in rural Kerala. That’s not particularly good in any book.

    Are you honestly suggesting that the quacks are so common that they tripled the mortality rate?

    Would you have allowed your wife to go for home birth? (Bear in mind I have kept anecdotes and stories out of this argument). No you wouldn’t. But Home Birth advocates have taken pre-eclampsic women and eclampsic women for home birth.

    The scientists come to two conclusions. Either the dutch are really terrible at determining high and low risk pregancies. Possible but unlikely. The dutch have an excellent medical system and international standards are good. If India can do it so can the Dutch.

    Or that their obstetric system is inherently flawed. The scientists mention that too. What we do know is that if you had those home births in a hospital the change from low risk to high risk care is instantaneous. You literally casually flick a switch under the bed and you get assistance. You don’t lose anything by doing so. You gain security by a massive amount with the same midwives by simply having the procedure in a hospital.

    You don’t waste valuable resources in transit (An ambulance call out is not cheap.). You don’t squander the golden hour of ER care resulting in fewer deaths and fewer sequel. You don’t lose the access to the NICU. A perfectly normal delivery can have low APGAR and need it. You may have to go to the hospital ANYWAYS (Neonatal Jaundice is common enough)… Honestly?

    There are things that go wrong. Little things that can turn into big ones.

    So the answer?

    The article does some fiddling with numbers to massage the figures.

    The mortality given for home births is fine, but they use the wrong denominator for their hospital births. AKA only tertiary care hospitals which is where the most difficult pregancies are dealt with. It’s bound to have the highest mortality rate. This is due to the fact that you cannot determine the quality of a doctor by mortality rate (In some cases really good doctors may have high mortality rates because they take very difficult cases). The tertiary care hospitals in NZ are usually for serious cases.

    You are trying to compare between home birth and hospital birth are you not?

    The figures are astounding. You have a 0.11% mortality rate for home birth. And a 0.03% rate for a hospital one if you work it out. Even in New Zealand the numbers hold true. The PMR in hospitals is a third of the PMR in home birth.

  16. Ysanne says

    Because Natural Birth is designed by the Yuzhan Vong (WHAT! I liked that plotline!).

    I love you for this sentence.
    Also, thanks for pointing out that pain relief during childbirth, (and for that matter, planned C-section) is not the horribly selfish shortcut taken by cowardly, lazy and posh women to the detriment of their child’s well-being that the natural birth fanclub makes it out to be.

  17. laconicsax says

    Avicenna, would you like to cite studies that support your claim that the increase in cesarean births are due to obese women because the increase in cesarean births isn’t restricted to obese America. Also, your subsequent argument that concerns over liability and cost favor cesarean sections would seem to introduce a more ubiquitous factor than the possibility of a woman with a BMI over 30. I’m glad you mentioned the liability issue and I’ll get into that later.

    Would you also like to cite studies that support your claim that electronic fetal monitoring “saves lives?” There’s a Cochrane review that showed no decrease in perinatal death rates AND a significant increase in cesarean sections. That last part is interesting because considering how ubiquitous fetal monitoring has become, it would suggest a possible cause of increased cesarean births…wait…I thought you said it was because of obese patients…

    As for epidurals, known effects are longer labor, increased need for cesarean section (do only obese women get epidurals?) and need for administering Pitocin (another intervention possibly associated with a higher cesarean section rate). The “control over the pain” line is only true when the risks are ignored (eg vaginal birth is a whole hell of a lot less painful than cesarean) and if you ignore the fact that specific types of movement during labor not only reduce pain but help accelerate labor progress. Either way, could you cite some studies demonstrating that epidurals “save lives” as you claim?

    Were you aware that direct involvement of a childbirth educator trained as a doula reduces length of labor as well as the need for epidurals, Pitocin, and cesarean section? Isn’t that odd–having a vocal advocate for the mother results in quicker births with fewer interventions…that can’t be right, can it? I thought that cesareans were the result of obese mothers…having an advocate for the mother doesn’t change her BMI…

    Something absent from your initial post and every subsequent comment is acknowledgement that the mother is a person who needs to be involved in the decisions we’re discussing. You talk about pregnancy and delivery as if the choices and decisions are disassociated from the woman it most directly affects. There’s also a touch of misogyny in your arguments (give women drugs to keep them from being irrational, it’s the fault of women that they need a cesarean, women can’t be trusted, etc.). You might want to take a step back and look at what you’re saying and what it says about you.

    I said that I’d get to the liability issue later, and later is now.

    It’s not terribly ethical for a doctor to let possible monetary issues guide their decisions regarding the health and well-being of their patients. Talk all you want about quackery, but keep in mind that there’s little difference between a doctor who takes kickbacks for over-prescribing medication and one who recommends abdominal surgery to preserve their insurance rate.

    Bottom line: You can’t, in one breath, say that various interventions are always necessary to ensure a safe delivery, and in the next, say that the high rates are the result of doctors and hospitals making decisions designed to reduce their liability.

  18. says

    We’re all agreed that quackery is bad and dangerous.

    What you’ve failed to establish is that there’s a necessary and universal link between home births and quackery.

    There are other options besides home births, like those birthing centers that were mentioned upthread and my mom’s OB’s home birthing center (I don’t recall how much extra equipment they had there. It was a while ago and I was a kid). These are important because giving birth in hospitals has been pretty bad for women for a while. The rise in interest in home birthing in the 60s came directly out of the experiences that women were having, in being drugged unnecessarily, being cut without their consent, and generally being treated like objects rather than people.

    The whole field of birth is fraught with woo of various kinds. Because it’s related to women and pregnant women and everyone (read: dudes) seem to pretty much lose their shit entirely when pregnant women are involved.

    I don’t see any reason why, where home births are dangerous, measures can’t be taken to ensure that they are safe, as safe as childbirth can get anyway. You make a lot of critiques, and that’s great and important and I don’t disagree with much, but your conclusion is not compelling. I don’t think it’s a good idea to give women fewer options about where to give birth. I think it’s a good idea to make sure all of the options are safe and not dangerous. What you’ve given here is a lot of reasons for better regulating midwifery licenses and home birthing, not a reason to cut off home birthing as an option.

    New York State legalized midwifery in the early 1990s. Before then, it was illegal, yet women still sought out midwives for home births. I would wonder what Avicenna’s proposal for enforcing his preference that women never give birth in their homes would be, and whether he thinks it would be any more effective than NYS’ blanket ban.

  19. gwen says

    THANK YOU, THANK YOU, THANK YOU, THANK YOU, THANK YOU, THANK YOU!!
    I can’t thank you enough for discussing this! I am a NICU RN, and I can’t tell you of the neonates transported to our unit by the paramedics nearly dead from a birth that would have been routine in our ‘home birthing’ rooms, in hospital. These infants suffer permanent damage, and there have been avoidable maternal deaths as well.

  20. Syzorr says

    In future Avicenna, please read your own links because it may help avoid hoisting yourself by your own pitard.

    In the conclusion to the NZ paper you link, one of their main points is the following:
    “Although this study was not powered to detect significant differences in neonatal mortality or morbidity, no differences for planned place of birth were noted. Interventions in labor and assisted modes of birth expose women and their babies to additional risks and also come at a financial cost to the health service. It is important, therefore, that interventions are driven by clinical need, are used judiciously, and demonstrate benefit to the mother and her baby.”

    Your current stance to me suggests a person enamored with the trappings of modern medicine who can’t see that medical intervention may not only be unnecessary but also counter-productive for achieving the best results. Your desire to paint the natural birth movement as quackery (and, to a certain degree I can understand that) is causing you to throw the baby out with the bathwater because you are failing to see that our bodies are the way they are now because it has been successful enough for millions of years and that intervention should only be where medically indicated.

    The *only* reason I used personal anecdote was to provide context to my engagement in the discussion because it has been through my experiences with my own family and my wife’s struggle to have vaginal births that my knowledge of the subject has come from. Despite her desire to have said vaginal/”natural” birth, every time it has come to making the right decision for our children we have made the medically sound decision as advised by our midwives and ob/gyns. Apart from some of the hospital midwives (those that are resident in the wards at the hospital), we felt supported through our decision making and at no point was she made to feel invalidated for her desire to give birth naturally. The way you act on your personal beliefs (because that is what they are as you keep proving that you reach conclusions before finishing reading the research) would make me uncomfortable if you had been attending my wife during her pregnancies.

  21. laconicsax says

    Oh, and something I forgot, “third world medicine” combined with “rural” carries a lot of implications including a standard of midwife-attended births rather than obstetrician-attended births and lack of access to adequate facilities to provide the numerous interventions you’ve mentioned (epidural, pitocin, fetal monitoring, etc.)

    Could you say what the standard of care is in Kerala with respect to whether the majority of births are attended by midwives, obstetricians, or both, and what the availability of interventions such as epidurals and electronic fetal monitoring?

    At the very least, could you point me in the right direction to find this out on my own? I spent some time on Kerala DHS’s website, but am not familiar enough with the organizational structure to find this information quickly.

  22. Syzorr says

    Also, as a note considering your argument there. The deaths listed are “neonatal” which does not, as they discuss, necessarily mean it was related to the delivery.

    We have some shocking child abuse statistics in NZ and there could be any number of reasons a child dies in the first 27 days after birth above and beyond the delivery.

    You continue to show your shocking ability to come to a clear understanding of the studies you are citing – and I’m not the medical student here…

  23. says

    Laconica – The increase is across the globe. Including in the UK where childbirth is free. Socialised medicine.

    Now a cynic would say this. There is no profit in C-Sections in the UK. Yet close to 25% (Just a 5% difference, we have better liability coverage than the USA as part of the GMC. Collective Bargaining is Fucking Ace!) of pregnancies end up as C-Sections. There is no monetary drive to increase C-Section. In fact there is a Monetary Drive to DECREASE them because they cost the NHS more money than a standard birth. The Obs/Gynae gets paid the same whether they deliver 3 babies a day by VB or 30 by CB. The hospital balances the books better through VBs than by CBs. So why on earth is it so high? Could it be that people GENUINELY need it.

    We too have a massive obesity epidemic. 60% of us are overweight as adults. 25% are clinically obese. Increasing birthweight are seen across the planet. It’s a basic case of plumbing. If the ball is too big for the pipe it won’t go down it. Child birth’s physiology is amazing but we know that large babies cannot be passed down the birth canal properly. This is well known physiology.

    As for the Cochrane Papers???

    http://download.journals.elsevierhealth.com/pdfs/journals/0002-9378/PIIS0002937811004807.pdf

    “The corrected early neonatal, late neonatal, postneonatal, and infant mortality rates for all subjects were 0.9, 0.5, 1.7, and 3.1 per 1000 births, respectively… The risk of corrected mortality rate was different between those with vs without EFM during the early neonatal period (0.8 vs 1.7 per 1000 births, respectively; P ‹ .001), but not in late (0.5 vs 0.6; P ‹ .402) or postneonatal periods (1.7 vs 1.8; P ‹ .296).” is the line of importance.

    For those who don’t speak medical statistics. Electronic Foetal Monitoring did precisely what you would expect it to do. It cut early neo-natal deaths by 50% (First 7 days). EFM is there to stop deaths from hypoxic conditions. Now, in late neonates this clearly has no effect on mortality.

    Oh and this is one hell of a piece of research. The cohort is 1.7 million live single births. This is the largest piece of research into the efficacy of EFM. 50% drops from a single medical device is phenomenal.

    Epidurals? Funny. My obs/gynae book says the problems with epidurals are hypotension, pain, loss of bladder control, itchy skin, nausea… All temporary. The only one that it is related to is “Back Ache”. And stop it… That whole “Cascade of Interventions malarky” was invented by Ricki fucking Lake. It’s a terrible argument. It’s like quoting an unsuccesful Jerry Springer.

    And Epidural labour progresses at the same pace as normal labour unless you stop turning. Correct procedure for epidurals involves moving from side to side every few minutes to help with the labour. Pitocin is administered by plenty of home birth midwives who don’t have any problems with using it associated with increase C-Sections.

    And Rapid Epidural Top Up For E-C-Section is an actual thing. It’s one of the safety mechanisms available in a hospital birth. Even if you are having a natural child birth in a hospital many of them will place the Epidural line in if something goes wrong.

    With regards to Doulas? Doulas don’t do anything with regards to your BIRTH. In traditional society you had a bunch of women who took care of pregnant women. Rubbed their feet, kept their spirits up and fed them raw stallion hearts… Women do better if they have company. This isn’t rocket science. Men who have visitors during hernia surgery also do better because you do things better if you aren’t happy and aren’t alone. However, a Doula doesn’t interfere with the obstetrician unless she is a quack. No doula in a hospital in their right minds would faff around. However if you look through the anecdotes from mothers who suffered at the hands of this form of quackery you see a lot of the home birth doulas and CMs make decisions (I recall one asking the ambulance to drive longer to a hospital that lets the CM stay with the mother, Another who didn’t transfer all the health details forcing the hospital to waste time redoing basic tests before they proceeded.). A doula is hired willpower. All the doulas in the world cannot untangle a cord or save a RDS or deal with DIC.

    A mother is a person. People however make stupid decisions. Are you honestly suggesting that I am completely within my rights to tell someone that they are stupid if they say “Jee Gosh! I want to drink magic water rather than medicine to treat my deadly deadly disease” but not to tell mothers that they are being stupid for picking a method of birth that is unnecessarily risky. I am perfectly within my rights as a skeptic to question really poor decisions. If they want to be taken seriously as medical practitioners they have to demonstrate that a midwife can match the gold standard of an Obstetrician. If they cannot then they don’t get to be insulted by ducks (QUACK!).

    As for money. HAHAHA! Oh this is amusing. Ethical?

    If a doctor keeps getting caught for malpractice he can be striken from the register. You stop being a doctor. The risk is not “money” the risk is “livelihood”. Why should a doctor risk his livelihood and his money for you? Ethics?

    I pointed out that in the UK where we have better liability coverage and socialised medicine, the rate isn’t that much lower. Obstetricians have repeatedly said that they are unwilling to risk some pregnancies because if they risk it and are wrong they are screwed. Why the fuck are we listening to everyone in the argument except the actual experts. The rate there explains the 25%. The remaining 7% is entirely due to liability risks.

    I mean the alternative is “No Liability”. If the Obs explains why you need an CS and you say “no I want this” then they can simply whip out a form that says “If the VB directly causes morbidity and mortality then the doctor and hospital are not liable. I understand the risks and they have been adequeately explained to me in this condition of ______________. I still wish to proceed with a VB”.

    But you know what? That requires Socialised Medicine to produce a Doctor’s Guild/AMA that has an actual method of protecting doctors from liability. Until then? It’s perfectly ethical to defend your standard of life and career by doing conservative procedures.

  24. says

    Syzorr… Did you read the mathematical shennanigans in that article? Where they compared high level obstetric intervention to Home births to produce an equal mortality rate. Not Hospital vs. Home?

    The conclusion in that paper is INCORRECT. Go do the mathematics yourself. You can check it. The give you hospital mortality and home birth mortality in this cohort. 4 deaths in tertiary care (The best and fanciest and usually reserved for the sickest and weakest) and 2 in home births. To find the rate you need the denominator. 2 divided by total home births and 4 divided by total hospital births.

    Instead they did 4 divided by total tertiary care births. That’s like comparing NICU babies mortality rates to “go home” mortality rates then saying that NICU kills babies and that they would all live if we sent them home.

    The correct amount from that study is a third of the mortality rate. I gave you that paper to see if you can notice the error. I actually mentioned the error in my post myself.

    The actual numbers as produced by a pro-natural birth organisation show that you are three times more likely to lose a child during birth at home. This is using data from a source biased to your point of view. This is from natural birthers themselves. I did not do anything apart from analyse their numbers.

    The millions of years argument is just poor…

    India managed to attain a population of 1.2 billion people despite having a IMR of 70 per 1000 births (It’s better. Its 46 per 1000 now!). If your baby dies it’s not a big deal, you can have more. The same rules as animals. In the west we started valuing each child born to an innordinate level. Saying “We got 7 billion people. I think we need to take some risks” is a very blinded argument to the suffering of those who don’t make it.

    We are trying to create a society that has two to three children that all survive to adulthood. Each child is valuable. I don’t see why we should indulge in practices masquerading as harmless. Your actual argument boils down to “Childbirth is normal, I don’t see why you should have a doctor”. Childbirth for most of history was a brutal issue and was the leading cause of death in both women and everyone else. We still made it. Doesn’t mean we should go back to those days.

  25. says

    I was a breech baby. In a vaginal birth at home, my father,a new doctor, helped move me through the vagina. My head was stuck in my mother’s pelvis. The umbilical cord was around my neck. But I survived. I am grateful to my talented father.

  26. says

    “Oh, and something I forgot, “third world medicine” combined with “rural” carries a lot of implications including a standard of midwife-attended births rather than obstetrician-attended births and lack of access to adequate facilities to provide the numerous interventions you’ve mentioned (epidural, pitocin, fetal monitoring, etc.)”

    The US defines a perinatal death between 28th week to 7 days. This is around 5. Kerala’s is around 12. We do have those things. Kerala’s enforced education policy has ensured that people understand why small families are good. What can you say? Communists if they aren’t corrupt are pretty good at social uplift.

    The standard of care in Kerala is massively inferior to what we have in the UK and USA. They solve their problems through proper family planning. Kerala prefers to use “Rural midwives” for standard cases and they do so in Primary Healthcare Centres unless it’s an emergency. Usually there are nurses and obstetricians at these sites. In many villages when you hit your 32nd to 34th week they just travel with you to the cities or towns to find a government hospital with a Obstetrician who has foetal monitoring. Hospitals have equipment, the issue is “Hordes of Patients make the equipment useless”.

    And seriously? Kerala’s IMR is 15. The USA’s is 6 (including perinatal mortality). The USA’s perinatal mortality is actually one of the lowest in the world considering if you judged it like the best in the world. The USA treats 28 weeks to 7 days as the Exclusive Perinatal Zone (There is a zone II but that is a massive range from 20 weeks to 28 days!). This zone is actually pretty big.

    Oh and in most of India epidurals are quite liked. The ability to not feel pain in childbirth is rather empowering to women who had no choice before. As I said… Yuzhaan Vong rules don’t apply.

    Kerala’s achievement is the provision of sterile fields, education and screening while aborting difficult cases. The pregnancy is directed by doctors not by midwives. The anganwadi scheme is a stopgap, not a model.

  27. Syzorr says

    I had a whole post written but then realized that it was full of bile and rant. There is no hope that what I say will penetrate your mind if I post it in anger without reason.

    However, I can’t just leave the discussion without a parting shot – you are being misogynistic. Whether you are willing to admit it or not, your opinion is blatantly that a woman should have no autonomy over her body during delivery and that she should subjugate herself to the almighty Doctor. Until you can understand why your position is so misogynistic and, hopefully, change it for the better then you will find yourself continually being told so when meeting people, I’m sure.

    And for everyone else, a nice example of why this needs to change brought to you by the fabulous Monty Python:

  28. oursally says

    Mine were both emergency caesarians and if I had delivered at home they would have died. But that’s natural, isn’t it?

    Anyway, think of the mess! You got a brand new baby and your bedroom is full of blood and gunk…

  29. says

    Would you make the claim of misogynist to Dr. Amy? Nope…

    By all means, Go to a well equipped birth centre with your midwife that can handle the emergencies that may occur. Have the most natural childbirth you can there. We can even steriles banana leaves to make dressings these days!

    But please don’t think for a second your house is better than a hospital. You can have the most natural birth you like there but if something goes wrong then you at least have a person who you can fall back on in the vicinity who can do more than the midwife to save a life. NPMs aren’t worse than the Obs because they operate under a system where they can call for the Obs if something goes wrong. Why on earth would you want someone less trained than a NPM to not have this protection is beyond me.

    I can finally Address Sally Strange –

    A normal pregnancy can become an emergency. There is nothing definitive in medicine. You can even die from a simple tonsillitis. You can punch pancreatic cancer in the face and go on to reach 90. Rare but possible!

    We go by best outcomes. There is no way to guarantee safety in a house. Your last ultrasound may be perfect but the “pregnant lady shuffle” into the car may rock the baby into a new position that may not be perfect. The baby does move around a lot! You may not dilate enough. The baby may have a low APGAR. The baby may have neonate jaundice. A vertex presentation may need C-Section if the head is presented forwards. The arm may tangle in the cord. The arm may present first.. So many little issues can occur.

    You are basically cutting down your options to deal with problems by reducing the equipment and the skillset available. Now a proper birth centre may field most cases. I don’t know how good the birth care centre you mentioned was but you mentioned they had an obstetrician so they may genuinely have had the ability to treat a ER-C section. If they meet a basic standard then it’s good. If they are claiming that you can deliver at home and have the same or fewer problems as a hospital or one of these birth centres (There is a distinction, some centres don’t have the Obs/Gynae component at all. Some usually keep Obs/Gynae on locum which is fine if they have the equipment. No foul in making sure which is which) then they are clearly lying to you.

    Think of these places like those fake christian abortion clinics which they set up to give women bad advice.

    Your one seems to be one of the places with a Obs on staff. And hiring NPMs rather than CMs. It’s less home birth and more “you have options but safety”.

  30. anat says

    However, a Doula doesn’t interfere with the obstetrician unless she is a quack

    A doula, among other things, negotiates with the medical team on the woman’s behalf and helps the woman weigh the choices she is offered. As well as helps the woman with activities that promote progress. I wish I could have had one around back in the day. (I didn’t know any, but might have searched if the hospital’s policy had allowed for more than one person to accompany the birthing woman). I needed a second opinion to assess if there was justification to the doctors’ recommendation of pitocin augmentation. I felt they were being manipulative and refused. It worked fine, just the same. And yes, I avoided pain relief – not because pain was good in itself but in order to reduce risk of C-section.

  31. anat says

    Anyway, Avicenna, you are not going to make home-births and demand for low-intervention childbirth go away by ridiculing people who already feel disrespected by medical practitioners. You can lower the demand for out-of-system solutions by listening to what people want and working *with* them within the system and reaching common ground.

  32. says

    Okay.

    There is no part of a home birth that is as safe as hospital or adequately equipped birth centre. This is proven time and time again on the stats from multiple sources including the midwives own source.

    When doctors who did anterior chamber intraocular lens were told that posterior chamber IOLs were superior there was no “meeting halfway”. They changed to posterior IOLs.

    That’s medicine. It’s a science. It’s applied biology, chemistry and physics.

    You wouldn’t ask a teacher to go halfsies with a creationist on biology? Why would you ever ask the medical professions to do that? Are we to hold medicine to a different standard where we aren’t allowed to call out bad science lest people’s feelings get hurt?

    There are so few skeptics in medicine that we have reached a stage where our quacks are considered an equal and opposite mainstream view.

  33. Syzorr says

    Tell you what. When doctors stop prescribing medically unnecessary interventions, then we’ll talk. You’re asking women to trust a profession that continues to marginalize them and that you are choosing to indulge in a stance that prevents them having autonomy over their own bodies and involvement through having an informed decision making process.

    “Trust me, I’m a doctor” no longer has the same weight it once had and the responsibility for that decrease in trust and respectability rests squarely on the professions shoulders because no matter how much of a science medical developments are lab conditions are, in application it is anything but and people should have the right to informed decision making, no matter their gender or medical situation.

  34. says

    In India new born babies are often annointed with cowdung. This obviously has an effect on child mortality that is associated with covering your kid in bacterial soup. Me telling them to knock it off is not cultural imperialism or reducing the autonomy over their bodies. It’s common sense. Now, no one likes to be told that they are being superstitious and ignorant. In fact that’s the problem with CMs. They have to eat humble pie. Which is why they aren’t likely to call for an ambulance and likely to try and fix problems they aren’t qualified or skilled enough to fix. The alternative is eating humble pie. The least tastiest of all pies…

    You are not marginalising women. You are basically making a statement that home births are bad and harmful to women with the appropriate medical papers and information and reasoning. Would you like me to go find some women to tell you that too? Amy and Skeptoid links are both women. In fact I think I am one of the few men who discuss this topic because the rest have all been shouted out or it doesn’t bother them. You can check Dr. Amy’s blog for the people who support her. Few men.

    If you go against this then you aren’t a badass feminist fighting for body rights. You are literally validating a system that harms women and infants.

    And I think I demonstrated the problem here quite well…

    Informed Medical Decisions. You cannot make them. You have repeatedly said things that are incorrect.

    If someone asked you tomorrow whether home birth was safer than birth in a hospital setting what would you say?

    Another more interesting question is this…

    Who informed you?

    Doctors have come to skepticism activism really late. The quacks got here first. We are playing catch up.

  35. angharad says

    That Monty Python clip is exactly what it was like giving birth in Britain in the 60′s and 70′s. My mother routinely had her wishes ignored on things as trivial as whether she wanted to eat or not, but also on major things. With her third child she was given an epidural she didn’t ask for. Any wonder she chose to have home births after that?

    Treating women like intelligent people who can be presented with the pros and cons and make their own decisions? That’s empowering. That’s feminism.

  36. Syzorr says

    After talking to my wife about this she related the anecdote of what her grandmother had asked her mum after the birth:
    “Enjoy the shave ‘n’ gas?”

    Because, you know, pubes are gross, right? (and it’s not like there was an option)

  37. abear says

    Avicenna; Facts are mansplaining and misogynist and Dr. Amy is a gender traitor, at least if they disagree with certain radfem dogma.
    There are different types of feminist and some of them claim to be skeptics, freethinkers, and social justice advocates while in practice they are not using rationality and critical thinking skills. It also seems that many would like an oppressive matriarchy to get payback for all those years of patriarchy.
    The term misogynist is getting thrown around so much lately it is losing its’ original meaning as woman hater and now means anyone that doesn’t jump on board the radfem bandwagon.

  38. Becky says

    I used to be a natural childbirth true believer, and even had two of my children out of hospital with midwives. After having a negative experience with a Certified Professional Midwife — a home birth midwife — I began to do more research and realized that much of what I was told as gospel is simply not correct. For instance, the information about continuous electronic fetal monitoring. It is a falsehood that it has no benefits. It has been consistently found to halve the neonatal seizure rate. Neonatal seizures are markers of hypoxic events, that is, times when the baby is starved of oxygon. The Cochrane review mentioned above does NOT conclude that fetal monitoring is useless. It notes that there is a nonsignificant reduction in mortality, but it also notes that the review may be underpowered to find a difference since perinatal mortality is now so rare. It is in fact quite nuanced, noting concerns about how intermittent monitoring may be implemented in practice, and whether it would in fact be as effective in a real life situation.

    The full text is available for reading: http://apps.who.int/rhl/reviews/langs/CD006066ru.pdf

    Other reviews that looked only at deaths due to hypoxia, rather than all cause perinatal mortality, did find a significant reduction in such deaths. http://www.sciencedirect.com/science/article/pii/002978449400320D

    It absolutely is feminist to argue that women have the right to patient autonomy and informed consent. It isn’t feminist to spread falsehoods about the evidence, as the natural childbirth and home birth movements tend to do. The evidence from the United States pretty consistently shows an increase in perinatal mortality with homebirth. Any woman choosing home birth has a right to this information, but it is obscured by the home birth movement.

    A few studies from the US that shows higher risks with home birth:
    http://journals.lww.com/greenjournal/Fulltext/2002/08000/Outcomes_of_Planned_Home_Births_in_Washington.9.as
    http://www.midwiveswashington.com/wp-content/uploads/2012/04/Missouri-study.pdf
    http://illinoisaap.org/wp-content/uploads/Outcomes-of-midwifery.pdf

    All of these have problems, it is very true. Absolutely. So do the studies showing equivalent risk. The other studies in the US that claim to show good outcomes often do not.
    For instance, this one looked at planned home births with a CNM and found a 2.5 per 1000 intrapartum/neonatal death rate. http://www.homebirthmidwifery.com/images/PDFs/Safety-Outcomes-Study.pdf
    There was no controlled comparison group, but the abstract called this a good outcome. Considering that even high risk women, those going for VBACs, have a 1.3 per 1000 rate in hospital, and planned elective repeat cesareans have a .5 per 1000 rate of perinatal mortality at term (and this number includes term stillbirths, excluded in the home birth study), I disagree with the assessment of this as “good.” I most often see a 1 per 1000 mortality rate cited for first time low risk mothers at term, the risk for second time and subsequent mothers is lower, I believe. Similarly, the famous Johnson and Daviss study did not have a controlled hospital comparison group, but had a mortality rate close to 2 per 1000, which varies based on which deaths they include or exclude.

    In terms of studies from other countries, there are some that show equivalent rates of safeties in countries with highly trained midwives, who are fully integrated into the medical system. On the other hand, there are some problems with these studies, too. One study from the Netherlands shows equivalent mortality in and out of hospital for low risk women with midwives, but as was posted above there is other evidence that the high risk women with OBs actually have lower mortality than the low risk women with midwives, whether at home or in hosptial. And the Netherlands has one of the highest perinatal mortality rates in the Europe, higher than ours. Pretty much equivalent data is found in the UK, but they also have a higher perinatal mortality rate than we do. And there’s a study from Canada showing equivalent outcomes, but it also states outright that it is underpowered to find a difference in mortality, given the low rate of perinatal mortality.

    Women should have choice, but don’t paint the obstetrical community as anti-woman — it is now majority female. Respecting women’s autonomy, giving them accurate information and allowing them to make decisions all while engaging in respectful and evidence based care provided by highly trained and responsible health care providers is a GREAT thing, but it is a great thing for both the woman seeking a natural birth and the one wanting or needing every intervention. I got great, respectful care for all three hospital births, and my birth with Certified Nurse Midwives in a birth center. I can’t say the same for my birth with the CPM. Moreover, as she was licensed nor is there any oversight in my state, I could not file complaints or otherwise report the problems with her care. That’s not feminist. Giving women misinformation, and parading a biological essentialist philosophy as “evidence based” while ignoring half of the evidence is not feminist.

  39. Becky says

    I hope this isn’t a repeat! I wrote a long comment that I think got lost in cyber space. I have two points, the falsehoods that the natural childbirth and homebirth movement spread about the evidence on interventions, and the evidence on homebirth safety in the United States.

    First, many of the supposedly non evidence based interventions do indeed have evidence behind them. For instance, I’ll use the repeated claim above about continual fetal monitoring. It was said that it has no benefits but just increases the cesarean rate. This is constantly repeated. In fact, it is false. Contiuous monitoring does increase the cesarean rate, but it also has benefits. The Cochrane review notes that there is a nonsignficant reduction in all cause mortality, but also notes that the review isn’t sufficiently powered to detect differences due to the low perinatal mortality rate.There is consistently a halving of the risk of neonatal seizures, which are a marker for hypoxic events, that is times when the baby is starved of oxygon. The reviw is nuanced and is worth reading in its entirety, the whole text is available free: http://apps.who.int/rhl/reviews/langs/CD006066ru.pdf
    Another review which also looked specifically at mortality due to hypoxia did find that electronic fetal monitoring more than halved this rate: http://www.sciencedirect.com/science/article/pii/002978449400320D

    A few studies from the US that shows higher risks with home birth:
    http://journals.lww.com/greenjournal/Fulltext/2002/08000/Outcomes_of_Planned_Home_Births_in_Washington.9.as
    http://www.midwiveswashington.com/wp-content/uploads/2012/04/Missouri-study.pdf
    http://illinoisaap.org/wp-content/uploads/Outcomes-of-midwifery.pdf

    All of these have problems, it is very true. Absolutely. So do the studies showing equivalent risk. The other studies in the US that claim to show good outcomes often do not.
    For instance, this one looked at planned home births with a CNM and found a 2.5 per 1000 intrapartum/neonatal death rate. http://www.homebirthmidwifery.com/images/PDFs/Safety-Outcomes-Study.pdf
    There was no controlled comparison group, but the abstract called this a good outcome. Considering that even high risk women, those going for VBACs, have a 1.3 per 1000 rate in hospital, and planned elective repeat cesareans have a .5 per 1000 rate of perinatal mortality at term (and this number includes term stillbirths, excluded in the home birth study), I disagree with the assessment of this as “good.” I most often see a 1 per 1000 mortality rate cited for first time low risk mothers at term, the risk for second time and subsequent mothers is lower, I believe. Similarly, the famous Johnson and Daviss study did not have a controlled hospital comparison group, but had a mortality rate close to 2 per 1000, which varies based on which deaths they include or exclude.

  40. Becky says

    Respecting women’s autonomy and treating them with respect is important for all caregivers. In my experience this did happen in hospital. I realize that the medicolegal climate is negative affecting true choice in some locales, and hopefully this can be changed. The natural childbirth and home birth movements may claim to be about feminism, but too often they conflate a philosophy of biological essentialism with feminism. Women have a right to evidence based, quality care. They have a right to have their decisions respected. They have a right to be provided with good information and high quality, well trained and competent health care providers. This is all true regardless of whether they want a natural birth or want or need multiple interventions. They don’t need to be told that there is only one right way to do things, or that their femininity or goodness as a mother is tied up in how they give birth. They certainly don’t need to be given misinformation, the note above on fetal monitoring is only one small area where I see the natural childbirth movement misrepresent the facts.

    Setting up the obstetrical scientific community as mysognistic because it promotes technology makes no sense, when it is that technology that has dramatically lowered the naturally high mortality rates. The community should always strive to do better, but I think it is doing so.

  41. bobo says

    #36 “That Monty Python clip is exactly what it was like giving birth in Britain in the 60′s and 70′s. My mother routinely had her wishes ignored on things as trivial as whether she wanted to eat or not, but also on major things. With her third child she was given an epidural she didn’t ask for. Any wonder she chose to have home births after that?

    Treating women like intelligent people who can be presented with the pros and cons and make their own decisions? That’s empowering. That’s feminism.”

    ———–

    QFT

    From reading everyone’s posts here, the problem isnt the technology per se, but the way women are treated at hospitals. Provide women with the proper care, and don’t treat them like shit. Sounds easy enough, doesn’t it?

  42. laconicsax says

    Avicenna,

    If you want to dismiss this entire comment as a long ad hominem, feel free to do so.

    This is clearly a subject area which you have no desire to discuss rationally. By cherry-picking data to deliberately misrepresent conclusions of cited studies, you’re engaging in the same sort of intellectual dishonesty as the worst of the anti-vax and alt-med bullshit artists who do the exact same to lend an air of credibility to their dangerous beliefs.

    Additionally, your habit of dodging arguments and questions further belies an unwillingness to discuss. This is your blog, so if that’s your prerogative, that’s fine, but as long as you allow comments, you run the risk of people presenting contrary data. If you’re wondering what I’m talking about, consider this: you talk about the liability risks and associated costs, I addressed that, and you replied by talking about surgical cost and billing. I’ve seen this type of “discussion” before on religious discussion forums and I doubt you’d appreciate the comparison I could make.

    You’ve been presented with data contrary to your preferred beliefs, but your one textbook and overtly misogynistic attitude are all the confirmation your bias needs. Have a wonderful day.

    BTW: Misogynistic attitudes aren’t restricted to men. If you don’t understand that, you’re more ignorant than I feared.

  43. Ysanne says

    Respecting women and their decisions also includes pointing out ill-informed decisions and flawed lines of reasoning. Which is exactly what Avicenna is doing here.
    People should be free to make shitty decisions that get them killed, but on their own responsibility.

  44. Syzorr says

    Thank you laconicsax for saying that much better than I ever could.

    “If someone asked you tomorrow whether home birth was safer than birth in a hospital setting what would you say?” – depends on the situation and medical indications. No one would receive the same answer because it all depends on, either, their history from previous pregnancies or, if their first, whether there were any troubling indicators (such as iron or blood sugar levels), medical and family history.

    “Who informed you?” – thankfully, people with open minds who were willing to discuss all the options. These include some wonderful doctors (GPs and ob/gyns), midwives and advocates of various birthing stripes who were all more than willing to advise us of the various risks associated and happy to allow us to reach our own conclusions.

    “Informed Medical Decisions. You cannot make them. You have repeatedly said things that are incorrect.” – so have you but, thankfully, I am only making medical decisions for myself. You so eloquently make your arrogance and lack of respect for your patients very clear in this statement.

    Your intellectual dishonesty, as laconicsax points out, knows no bounds when attempting to defend your beliefs. You keep on engaging in some of the most common logical fallacy’s (such as appeals to authority) and it is tiresome to attempt to keep up with your gish gallop.

  45. says

    laconicsax -

    I guarantee if you posted any of my data on a pro-home birth site they would ban you. I bet becky (of the three posts! Sorry she tripped the spam filter so I figured you could see both her posts. I didn’t know which to delete!) up there tried to ask questions and was called a Negative Nancy before they banned her.

    I also understand that in arguments like this it is extremely hard to keep anecdotes out. If Nancy is reading this (And is willing to join in), I will probably run a thread for anecdotes.

    1. I did not cherry pick data. I pointed out cherry picking in data. I explained my mathematics. You can verify it yourself. If you compare births in hospitals vs births at home in the New Zealand paper you will get my results. What the paper published was births in high risk pregnancies treated at specialist hospitals vs. birth at home. What the fuck? That’s blatantly incorrect! They are supposed to be comparing home birth vs. hospital birth. Why on earth would they only calculate the riskiest pregnancies? It ignored the vast majority of births that occur at hospitals and instead went for the most specialised and most risky births. And even there the numbers were equal. Meaning your home birth is just as risky as a high risk birth. My mathematics is correct. You can take it to any statistician with my rationale behind it and they will back me up on this. The incidence of mortality in New Zealand is three times higher in home births than in hospitals. My mathematics is as solid as they come. You can replace those figures with anything. Let’s say schools. If you are comparing Home Schooling A with School B, C and D then the denominator for the second group should contain data from schools B, C and D, not just D. You cannot get more rational than mathematics. I have empirically demonstrated using values acquired by midwives themselves and published in their own paper that they are worse. I think the term is… Hoist by their own Petard. The figures are there. Go check them yourself. I am not doing magic. I am encouraging people to go analyse the same document and realise the flaw. This is Mathematics, it is the most rational thing on the planet.

    2. Some of your questions are not relavant to the discussion and weren’t dodged. You may have not liked the answer to a lot of the questions. You straight up ignored papers indicating that you were wrong on the safety of home births. And on the reduction of early neo-nate mortality and morbidity using foetal monitoring. I posted papers to back my stances up from massively reputable sources and even some of your own. You didn’t. In addition Becky there unleashed a wall of text that just hit you for maximum damage. You seriously don’t think size of the baby doesn’t matter for Vaginal Delivery. I think one of the earliest lessons we learn is how square pegs fit in square holes and how small pegs can go through big holes and big pegs cannot go through small holes. The foetal weight is markedly linked to Obesity and Gestational Diabetes. This is basic Obstetrics. Now if you wish to discuss genetics then we can actually point out that the increasing C-Section rate is due to evolution. Small mummies, Big Babies stopped being deadly due to the C-Section in the same way that people with poor eyesight stopped walking off cliffs due to glasses. Many third world nations need fewer C-Sections because they didn’t get these advances weren’t widespread until recently (See Taslima’s birth which would have required a C-Section) but even they see a rise. China’s fascination with them is just weird though. But the rest of the world have rising rates too… So we may just see the loss of a evolutionary pressure due to the surgery allowing us to keep having babies outside the parameters of constraint resulting in a spread of the small hip, big baby genes. Particularly since it meshes well with the industrialisation of western society. Industrialisation actually caused increases in child mortality due to the overcrowding and slum nature of cities. The ones that survive were more like to be “Fat Big Babies”. So the gene may have become more widespread. This is a hypothesis though.

    3. You may see it as morally unethical to not risk a massive amount of money and your job but I bet you wouldn’t risk your job and a million dollars because your customers want you to do things in a risky way. It’s simply not worth your time or your money.

    4. You provided no Data. NONE. Zero. Nada. El Zilcho. The posts are there? Quick someone hit Ctrl + F and confirm this. Maybe my memory has been fried but I am pretty sure that the only person here using peer reviewed papers and statistics was me. I even produced a paper with a cohort of more than a million. That’s as hardcore as data gets. You have produced nothing concrete to back your stances.

    5. I have never seen “textbook” being used as an insult.

    6. If my attitude is misogynistic then fine. Just because you have the XX chromosomes doesn’t mean you get a free ride on quackery that only affects women. As I pointed out… It’s not feminism just because you think it is. It’s a form of quackery that pretends to be feminist and empowering when all it does is kill and maim babies while making anyone who doesn’t also follow it feel like shit. It’s got the highest mortality and morbidity rate of ANY of the quackery fields. It’s not misogynist to point it out.

    It’s common sense.

  46. Becky says

    @anat
    “And yes, I avoided pain relief – not because pain was good in itself but in order to reduce risk of C-section.”

    If you are referring to epidurals, then you are wrong. Epidurals do NOT increase the risk of cesarean. They do somewhat increase the risk for an instrumental delivery.

    http://summaries.cochrane.org/CD000331/epidurals-for-pain-relief-in-labour

    “Epidural analgesia appears to be effective in reducing pain during labour. However, women who use this form of pain relief are at increased risk of having an instrumental delivery. Epidural analgesia had no statistically significant impact on the risk of caesarean section, maternal satisfaction with pain relief and long-term backache and did not appear to have an immediate effect on neonatal status as determined by Apgar scores. Further research may be helpful to evaluate rare but potentially severe adverse effects of epidural analgesia on women in labour and long-term neonatal outcomes.”

    Informed decision making absolutely is important, but if you are making decisions based on the misinformation being spread by the natural childbirth community, then you aren’t making informed decisions. There absolutely are risks AND benefits to epidurals, and every other intervention that is used. Going to a hospital doesn’t mean giving up your autonomy; you still have real decision making power. Talking about the way things were 30 or 40 years ago isn’t an accurate picture of how things are today. If your doctor won’t explain his or her (and more than 50% of OBs are now women) recommendations to you, then find one who will. They exist. My OB spent more time with me and treated me with more respect than my homebirth midwife, and his care was evidence based and safe.

  47. bradleybetts says

    @Tobysgirl

    “Actually, women do know a lot more about their bodies than ob/gyns.”

    No, they do not. Sorry, but your average woman does not know more about her body than a medically trained professional by dint of the simple fact that they inhabit said body. That’s just poor logic. That’s like me claiming I know more about the inner workings of my testes than an andrologist simply because I happen to own a pair.

    Don’t get me wrong, I’m not saying you do not have the right to a home birth if you want it. Of course you have that right. But trying to claim that the average laywoman knows more about her genitals than a gynecologist simply because they happen to own a set of said genitals is just silly.

  48. says

    Syzzor

    I don’t think you answered any of the questions… Let’s try this again…

    1. Out of every 3 babies that die in home birth, 2 could live in the hospital if those births occured there. I assume the same ratio holds true for morbidity too. The logic, the literature and the statistics are clear. Home birth drools… Hospital Birth Rules. The CPMs and their global equivalents have no stats to back up their stances of safety. They don’t brook any discussions.

    2. I do have an open mind. I also have an analytical one. I heard a lot of rather luddite things from the home birth movement. I started seeing a lot of stupid things there. I saw a lot of shaming of women who couldn’t express breast milk or who took epidurals or who vaccinated their children. I was called a misogynist after I took on my first Home Birth/natural Birth dude who killed and crippled more than one patient through his negligence. Negligence so basic that any medical student would have been taught the basics of how to avoid those deaths. He still is practicing and is quite beloved of the medical luddite movements. Oh this shining example of humanity had the audacity to blame the mother and his legal defence tried to pin her for murder. Other CPMs have killed people by their ignorance and dodged the courts because they aren’t tried by a medico-legal court but by a jury. Their governing bodies issue punitive measures that they drag out over ages and accused midwives can still practice. Lawyers are unwilling to sue because they don’t have any insurance. They also don’t mention failures on any of their statistics or pages… I am open minded, but not so much that my brains fall out. So I read around and use the knowledge I gain from my course to help me make my decision. It’s probably better researched than yours.

    3. I have backed all my statements up with papers and common sense. Your medical decision is clearly not informed because you have made many fallacious arguments and stood by them even after I have posted evidence against them. You are not my patient. I do not need to respect you. As I said. There is a massive problem in society where they think medical professionals should respect alternative medical viewpoints while we have no qualms about other scientists calling pseudoscience as bullshit. If you claimed the earth was flat to NASA they wouldn’t be polite.

    4. I am the only person here in this argument who used statistics and peer review. And mathematics that are verifiable. I invited you to go verify it. That’s intellectual HONESTY.

    5. Question? In a court of law if they call an expert witness could you get away with claiming that it’s an “Appeal to Authority”? Nope… Why? Because we are discussing technical data. Technical data requires the appropriate technician. If you want to rewire your house you call an Electrician. Not the Amish or me… I would be lousy at it. Would you ignore the NICU nurse who posted here? She has authoritah. Dr. Amy is perfect for this argument because she has spent a lot of time and effort collating data and documenting the subject. Your argument is you don’t want to read the data because it was done by someone who is technically competent in the field of obstetrics.

    And it’s not a gish gallop. It’s me fielding questions as they come in with rather minute amounts of information. In fact I have only run with three topics. The mortality rate. The EFM reduction of mortality and morbidity. And the correlation between obesity and associated disorders with increasing birth weight. You can throw in a little bit on “Liability insurance in the USA” but that is pertinent to the discussion.

    A gish gallop is a bullshit storm of a thousand points fired off rapidly. I have actually introduced each different point and piece of literature individually.

    It’s tragic. It really is. This is arguably the deadliest form of quackery in the western world and it keeps itself safe by pretending to be feminist. Since the majority of skeptics who are vocal aren’t medical this gets a free pass. In addition since it borrows the terms of feminism people think it really helps women. Male skeptics cannot take a whack at it. Female skeptics don’t want to be smacked by the accusation of anti-feminist.

    And I repeat. The NZ study. Go check the maths. Mortality of Homes vs. Mortality in Hospitals. Then remind me again what intellectual dishonesty is.

  49. anat says

    To Becky:

    If your doctor won’t explain his or her (and more than 50% of OBs are now women) recommendations to you, then find one who will.

    It’s a bit late to switch doctors in the delivery room.

    I gave birth in Israel. You can choose the doctor that will do your prenatal care, you can choose the hospital where you will give birth, but you can’t normally choose the people who will attend to you during your hospital stay. You are treated by whoever is on shift, and if there is a shift change while you are there you get treated by more than one set of people. Also, if the birth is uncomplicated the doctor(s) will only see you once in several hours and will not be present at the birth itself, if there is no indication of complication births are attended by nurse-midwives. So during my labor I was seen by 2 doctors, and at least 3 nurse-midwives, neither of whom I had met before that day. Only reason I didn’t have an episiotomy was because the midwife who was present at the birth was trained elsewhere.

    Some women pay privately for a doctor to do both prenatal and delivery care, but those are usually high-risk pregnancies. So with this background, the doctors who do both prenatal and delivery care tend to be the ones specializing in high-risk care – so I doubt that’s a suitable choice for someone seeking low-intervention care.

    BTW the same day I gave birth a woman died in a different hospital – she was given the wrong salt solution in her infusion. She complained of paralysis, but she was told it was normal with an epidural. To the best of your ability, always read the labels on anything going into your body!

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