Not the Ducks – A Perfectly Natural Home Birth


There are problems with “liberals” we have our own set of issues with skepticism. So while I am more likely to argue about Evolution with a conservative, I am more likely to argue about quackery and anti-GMO stuff with liberals.

And none are as emblematic of this issue as the Huffington Post who have a piece up by Ruth Fowler Iorio entitled New Mom’s Uncensored Photos Reveal The Beautiful, Messy Reality Of Home Birth.

It’s got photos of her birth and her tweets. So you have been warned.

And I must say Huffington Post’s really fucked up on this.

Home Births is a hidden form of quackery. Wreathed in the language of female empowerment, bad statistics and anti-medical quackery home births have a rather deadly toll that is often not widely advertised.

My “personal” anti-Obstetric nemesis is Mayer Eisenstein. A reknowned home and natural birth advocate. And a real doctor to boot. Mayer is brought out when the Natural and Home Birthers want a real doctor.

But the fact is that Mayer is a quack. A deadly quack. His untrained staff were responsible for a much higher mortality rate in his birthing centre. A staunch anti-vaccination advocate, Mayer in one case refused to give the Anti-Rh injection to a Rh -ve mother resulting in the death of her child. There are other children who have suffered birth injuries that were easily avoidable. Mayer has stopped arguing with me, because it’s impossible to argue when your foundation is shaky and your practice was quackery incarnate.

To point out how shady he was? He had a Medical Insurance from someone in Barbados and said Insurance was miniscule compared to what it should have cost to get coverage. In addition? During the trial for one of the deaths, he claimed the mother murdered her own child. He also blamed her anger for the cause of the child’s death.

Mayer is a shit head.

He isn’t the only one. There are PROUD Home Birth Midwives who list deadly complications of pregnancy which they claim to have handled (My personal favourite? A midwife claimed she could deal with a case of Surprise Twins, Placenta Praevia and Pregnancy Induced Hypertension. 3 major issues with standard birth, two of which are indications for C-Section and one for strict medical intervention and preparation for C-Section.)

The entire dialogue boils down to “Home Births aren’t deadly, look at how few people die in home births”.

Never mind the fact that the most honest Home Birth Statistics show equal efficacy to Hospitals (remember, Doctors deal with more complications and if a Home Birth goes wrong the patient is sent to the hospital and falls on the Doctor’s stats).

Truly honest stats show a greater risk in home birth with anywhere from double to triple the risk of mortality and morbidity. If we combine anti-medicine quackery that normally associates itself with home birth such as the unwillingness to vaccinate (Rubella), untried supplements, no Vitamin K injections and anti-vaccination the number of complications spirals.

And for Huffington Post to portray this as “good” rather than “here is a person who thinks body autonomy means making idiotic statements. You want to do this to yourself then do so, but don’t pretend for one moment it is a better choice.

So let us look at why Huffington Post’s coverage is faulty, dangerous and harmful.

It’s the Cobbler’s Pose. If you are going to do yoga and show off your Yoga Powers at least get the name right. Yoga Out!

The quackery is a package deal. From the dubious benefits to lamaze to the power of Yoga (dear Quacks, Traditionally yoga was NOT for women. Women would not be allowed to participate in it fully. So to claim the mystical powers of Indian Callisthenics to give women mystical Hindu Birth Relaxation is nonsensical. I have never heard of Indian women in India doing stuff like this. I fear this is another thing that is incredibly embellished.

Just remember this tweet.

And you can move around with an IV in you. You cannot move around if you have a spinal anaesthetic because if you do you can get anaesthetic to rise above the level of administration causing respiratory arrest. It’s why you are asked to “stay still”.

Birthworkers? Seriously?

It amazes me that Home Birth Midwives are considered experienced when most would have LESS experience than me and I would never consider myself an expert. I know enough to realise that there is a vast amount of knowledge I lack. The home birthers do  not realise this. Now I have no problem with a hospital or a birth centre delivery IF the Birth Centre is equipped to handle an Emergency Case (AKA it can do an ER C-Section).

This is not something to be proud of.

Because Drinking Helps With Pregnancy

You do realise that the baby is still plugged into your circulation and any alcohol is going to hit the baby too? Teensy Tinsy Livers Can’t Deal With Whisky. It’s not an advisable method of pain control.

Also? I dislike the bath idea of birth for one reason. You cannot properly calculate blood loss and this is something to keep in mind here.

Wait that looks like a hospital…

So drugs are bad until birth but after it,it’s all good?

Are your alarm bells ringing? Because the cutesy photo isn’t what you should be paying attention to. It’s he caption.

All the blood?

Remember what I said about bathtubs that make assessment of blood loss inaccurate and a guessing game (since bathtubs don’t have the same volume, depth and colour so assessment of blood loss by rough colourimetry is inaccurate.

There is no such position as Occidental Posterior. That just means “Western Buttock”. What she probably meant is Occipital Posterior. Now you CAN deliver from the Occipito-Posterior position.

I am going to assume this was either a third or fourth position Occipito-Posterior presentation.

This often causes a longer pregnancy resulting in a larger baby to deliver. In addition the water breaks earlier. In this particular case (if you read the HuffPo Article) you can see a Start-Stop labour pattern with possible increased stages of labour.

Now in these cases episiotomies, vacuum/forceps and C-sections may all be required particular since the major issue of the pregnancy is the lack of progress of delivery and the presenting diameters and movements of the foetal head not being “ideal”. In an ideal world you deliver through extension. Flex your neck if you will and imagine your head being delivered by the extension of the head rather than by your body being forced through the gap.

Another issue is that you can have an arrest during the “turning” of the body and this is called a transverse lie.

This difficulty results in dystocia. The simple method of solving this is the usage of Obstetric tools such as the outlet forceps, ventouse and an episiotomy. The midwife has none of these things.

Shoulder Dystocia requires C-Section. In this the foetal movement during delivery has resulted in the shoulder being presented after the head resulting in the baby getting stuck. Remember how we imagined the head in extension? Try doing that same move with one shoulder behind a bar.

Now here is the thing. C-section is simple and the least traumatic way to deliver the child. But sometimes we are presented with no other method of safe delivery because the Obstetrician lacks medical equipment.

Some maneuvers can be attempted but these increase the risk of fracture of humerus or clavicle. In some cases in order to save the child and the mother the baby’s clavicle is intentionally fractured in a direction away from the foetal lung (to prevent punctures) which allows the shoulder to disengage. An immediate episiotomy can facilitate this and the immediate delivery and care.

If this is still not possible then the Obs/Gynae reverses the cardinal movements of labour and pushes the foetal head back  then conducts a C-Section.

Shoulder dystocia is generally delivered with an episiotomy because a cut is better than a tear. A cut heals better, more evenly and stronger. It scars less. In addition there are less complications to the perineum where a tear can damage the floor of the pelvis causing permanent disability and illness.

But this is when things started going wrong (more wrong?).

She had a retained placenta which was mishandled. The treatment is oxcytocin (one of those horrid “chemicals” we use in labour that makes it progress so much more easier but at the alleged cost of reducing the womanhood of the mother since for Birth to Be Real it Must Be a Struggle) which helps the detachment of the placenta. If it does not detach the placenta MUST be removed under ANAESTHETIC Coverage by a trained Obs/Gynae.

In severe cases such as placenta accreta (the infiltration of the placenta into the muscle layer of the uterus, the removal is impossible and the haemorrhage is life threatening requiring a hysterectomy).

A retained placenta causes massive bleeding, something more noticed outside a birthing pool unless it’s a birthing pool that the mother entered immediately prior birth (You can see the plumes of blood I suppose).

This may have been preventable and certainly you will find no Home Birth Midwife claiming this as a success of medicine but the success of their quackery. What resulted was a massive effort and a vast amount of medical technology being utilised to save this woman’s life despite her poor choices and her reliance on a quack.

Birth is not mysterious or primal, we have literally hammered out it’s greatest secrets into nearly every single medical student out there. Any one of us can tell you how the physiology of birth takes place. By making it seem mysterious and primal you are excusing inferior care because you refuse to look at it critically. At no point has this person gone “Hang on, the doctors would have fixed all of this and solved all these issues with less pain, quicker and with less distress to me and the baby and I may not have required so many units of blood to survive”.

This cost Ruth Iorio 2 days in the hospital, Fentanyl and Blood Transfusions with the associated risks involved with those things which are far more than simply going to the hospital in the first place.

For starters? One of the big jokes in all of this is the Fentanyl. Pain was good during childbirth, now that the price has to be paid for no medicine and untrained uneducated quacks “Fentanyl is Perfectly Fine”. Now that isn’t the big joke. The big joke is something doctors know about Fentanyl. See the homebirthers claim the pain meds given during labour harm the foetus. The amount given and the amount reaching the foetus is a very miniscule amount. Now bear in mind Iorio thought you can sit in a tub for a few hours and drink Whiskey. Because Ethanol is perfectly safe for babies? And secondly? Fentanyl is excreted in  breast milk. While harmless to the foetus it’s a bigger dose than what the foetus would have gotten had she had one of those horrible epidurals.

Compared to what her midwife, assistant and doula did the real heavy lifting done here to save her life and make sure Nye had a mother was done by the EMTs, the Nurses and Doctors, The Hospital Equipment and the horrid agency reducing fentanyl and blood transfusions that required 2 days of care not to mention the antibiotics that helped prevent her from falling sick to a native infection.

The amount of medicine that has gone into keeping Iorio alive is frankly astronomical.

To put it into perspective? Each bag of blood is a sizeable risk for my patients, Iorio lives in such a paradise that a blood transfusion is not considered major. I donate my own blood because I know it’s a more certain source of blood. A home birth resulting in this would have probably resulted in the death of the mother. I have seen mothers bleeding out like this before and believe me Iorio is lucky to have a strong medical infrastructure and trained staff to treat her.

My patients have little to no choices, Iorio had all the choices in the world and picked an inferior one while insisting that the inferior choice is superior. The Home Birthers may keep their home births for all I care if they are honest about it. I would see it as no different from the radical scarring and the large piercings that people want. Something I consider harmful but it’s their personal choice and they accept the risks. No person who scars and brands themselves would ever claim that their art isn’t harmful and filled with risks. The Home Birth dialogue may be entirely about the mothers but it is a faux dialogue entrenched in the language of feminism but requires it’s women to give up hard won medical coverage and advances in order to belong to some sort of elite club forged by inferior obstetric care on purpose.

The entire dialogue of the Home Birth Movement is designed to hide complications and deaths and ostracise mothers who have had bad experiences while embellishing the achievements of it’s proponents while denigrating the achievements of Obs/Gynae..

People who have no choice in this matter desperately want hospital care for their pregnancies.

The agency of women is not dictated by the survival of the pregnancy any more than it’s dictated by having a baby. What matters most is the health of the mother and the health of the child and it is clear that the morbidity and mortality of home birth is three to four times higher in mothers of equal health status.

I will say this to you honestly. I would be a terrible person to pick to deliver your child. Every delivery I have done is under the guidance of a trained Obs/Gynae, the few I did solo I had the benefit of knowing I could call for help and it would arrive in seconds and be ready to take over in minutes and that I was competent enough to maintain the mother. I cannot do Obs/Gynae, it’s really not my forte.

I would never dream of claiming expertise the way these HB Midwives do.

The agency of women is not tied to the survival of the ordeal of pregnancy any more than it’s tied to having a baby. You are not more womanly for surviving the ministrations of people who cannot even understand why they are not qualified to do what they do.

It is fitting that in all of this Iorio thanked her midwives more than the people who saved her life.

Comments

  1. busterggi says

    “dubious benefits to lamaze”

    Well it did provide my ex & me a few hours a week that we had to treat one another decently.

  2. sceptinurse says

    Ugh. I can’t believe this happened locally. Or maybe I can, Santa Monica has a high proportion of nut cases.

    My daughter delivered at UCLA. Each time there I was impressed with how professional the staff was and how much agency the patient had. Her last birth was with a Nurse Midwife and was truly a great experience, no drugs, no IV, fetal monitoring sporadically, birth chair in the room to use, and all that pesky equipment at hand in case something went wrong. The only real advantage a home birth would have added would have been that she wouldn’t have had to get up and go to the hospital. To me that hardly seems to be be a reasonable trade off.

  3. says

    Why do people regard “no pain management” as something to aim for?
    Godsdamn, I would have been so glad if I my babies had given me the time to get an epidural (I’m a quick birther. If you are paid per baby I’m the person you want to treat. Only that you’re late, I’m done)
    Folks, you wouldn’t talk about the fantastic wisdom tooth extraction with no pain killer either.

  4. angharad says

    Well I was aiming for no pain management, but that was largely because I haven’t yet met an anaesthetic that doesn’t make me as sick as a dog. Also I’ve done birth both fast and slow and fast by far sucked the most…

  5. A. Noyd says

    Giliell (#5)

    I only get annoyed when folks post “we had a wonderful unmedicated natural birth” as if they now expected a cookie and some praise.

    And as if they hope all the women who did opt for drugs get dragged for a few miles behind a galloping horse.

  6. Tigger_the_Wing, Back home =^_^= says

    Ugh, when I had my first three in the 80s, the pain relief that was available really did make me sick, and epidurals were so new that people like me with spinal arthritis weren’t considered good candidates; but by the time I had the twins in the 90s, epidurals were routine and safe – so of course I opted for one. Especially as it made the prospect of an emergency Cæsarian less daunting, as I would already be hooked up to a source of anæsthetic! As for some pain relief getting through the placenta(s) – why shouldn’t they get some pain relief too?

    I know how suddenly pregnancy and labour can go horribly wrong.

    All were born in (three different) hospitals in Kent. All my labours were fast and I had problems with all of them; there is no way even the highly professional nurse-midwives of the NHS would have had the resources to cope, and we lived 40 minutes away from the nearest hospital for the first three, 30 minutes away for the last (which my husband somehow reduced to 20 when I went into premature labour!).

    My first, born three weeks early, was facing the wrong way. Even so, it only took 3 1/2 hours to deliver him. Initial trials of gas-and-air just made me sick and woozy, with no pain relief, so I had to do it without any.

    Number two (in a different hospital) came out a month early, unexpectedly feet-first and so was an emergency forceps delivery, with no pain relief (no time). Another 3 1/2 hour labour, I was already in hospital (ten days being monitored and on a drip to prevent labour, because of premature rupture of membranes). He had a large head – there is no way we would have both survived a home birth.

    The worst, by far, was the third (in the same hospital as the second); not just the pregnancy, during which I had spent many weeks on a pre-natal ward attached to a drip to stop premature labour; or even the labour itself, although that was bad enough – just 115 minutes from start to finish, I was given a shot of pethidine when they broke open the sac, five minutes before she was born with the cord wrapped around her neck. The real problem was afterwards.

    After half a week I was sent home despite the fact that I had rock-bottom blood pressure due to retained placenta and internal bleeding. Modern scanning would have spotted what was invisible in 1984 – my daughter had been one of twins and, although her twin had died early in pregnancy, the second placenta had continued to grow, and had torn away and blocked the cervix. I had only been home a couple of days when it shifted; I was rushed back into hospital with blood literally pumping out with every heartbeat. According to the doctors who operated on me, I all but died and needed a LOT of blood (my deepest gratitude goes to all the selfless people who donate blood!)

    After that, having the twins nine years later after a 4 1/2 hour labour was a comparative doddle. Only comparative, mind. Pre-eclampsia; premature labour; being six weeks early, the first twin didn’t have mature lungs and had to be rushed to an incubator; the second was tiny and turned sideways immediately after his brother was born; he had to be manually turned and came out feet-first (which is why there is an eighteen minute difference in their birth times). I spent quite a lot of that pregnancy in hospital, too.

    I acknowledge that the hospitals could have done a lot better, even given the poor tools available to them back then. Too many people trusted wrong information on my notes instead of doing their own examination, for instance. But even so, they were there to put things right when they went wrong, for whatever reason. So it’s about time that proper statistics are kept – someone being rushed into emergency because of an attempted home birth that went wrong should have that (and the name(s) of the midwive(s) involved) mentioned prominently on their notes.

    Why anyone thinks that pregnancy and labour are better done ‘naturally’, I’ll never understand.

    The point of going through all those months of pregnancy should be, surely, that you want to be a parent – not that you want to go through labour! That is just an unpleasant, but necessary, step. But there are people (and, believe me, there were plenty of those around in the ‘olden days’ too, they just didn’t have the internet to spread their nonsense) who would persuade an expectant mother that labour is the most important rite of passage that she can ever go through – and I have met women in their fifties and sixties who are STILL resentful that their labour – three or four decades ago – didn’t follow, exactly, their highly optimistic ‘birth plans’. Their entire lives, ruined – RUINED, I say! – by necessary medical interventions that saved their lives, and the lives of their babies.

    With these people, it’s almost as if the baby were an unfortunate side-effect of the actual Important Bizniss of pregnancy and labour, the TRUE purpose of which was to turn a Gurl into a Womyn, show how Strong she is, how IN TUNE with Mother Nature, and produce a yummy placenta.

  7. says

    I tried a midwife because I was told that I would be in control, but it was a lie. It was extremely important to me bc of my history of sexual abuse. I was terrified of having things done to me without permission in the hospital, and the NCB crowd convinced me that midwives didn’t do that sort of thing.

    I was forced into vaginal exams and touched inappropriately during one of the forced exams during my labor. I filed a police report. I found a pattern of negligence at the birth center and sued. The midwifery community does nothing about these kinds of patient abuses. Its a horrible thing. I’ve contacted just about everyone I could think of try and get this place to take accountability for what I was left with afterwards.I was lied to about the midwifery model of care and now have PTSD from the negligence. I’ve had to do about a year of therapy to deal with it all. I am really lucky no one was hurt physically. I am pretty certain that a background like mine (previous abuse, history of body image problems, heavy into feminism) is something midwives prey upon to line their pockets. I was super vulnerable, I think most first time moms are. You don’t really know what is going to happen when you go into labor, and midwives are good at providing false assurance.

    If you want to see the true colors of a profession, look at how they deal with mistakes. Midwives support each other, not grieving families. NARM plays hide and seek with mothers after they bury their children.

    http://shameonbetterbirth.wordpress.com/
    My story is in the top corner. I’m running exhomebirthers and safermidwiferyutah wordpress blogs as well.

    as for the PPH home birth above- I kind of wish people would give this mom some time to process everything. A lot of people are running around calling her stupid, as though a belief system falls all at once instead of piece by piece. It is very hard to take responsibility for having made a poor choice too, there is a lot of guilt involved in realizing how much danger you put your baby in. I feel for her. I just hope she draws the conclusion that direct entry midwives are not educated enough to deal with births.

  8. estraven says

    Well, i had a terrible hospital experience, which, had I not been so young and naive at the time, I could have changed (I really don’t think the forceps were called for). Then I had a little better experience with my second, but no, the doctors and nurses wouldn’t listen to me about my previous experience as to fetal heartbeats etc.. So I swore if I had another birth, it would be at home. And I think I would have done it. Had complications arisen, though, in that imaginary scenario, I would have gone to the hospital.

    My daughter gave birth to her second child at an alternative birthing center, where she had an 11 pound 4 ounce baby boy without any drugs and with a very skilled (licensed) midwife, not an obstetrician. She did not feel comfortable using pain medication of any kind during birth. That was her choice and it was not to prove anything but because she thought it would be better for her soon-to-be baby.

    I know a lot of women who have had home births with no disasters and many midwives and doulas who have attended many successful home births. I also know many happy moms who had to have caesarians. One needs to have some common sense about these matters and not be all verklempt if things don’t go the way one has planned and hoped for.

  9. says

    skeptifem 9: I am so sorry for all of the awfulness preceding and subsequent to your giving birth. And thanks for calling attention to the humanity of the woman in Avi’s OP. My initial response was anger, which makes it easy forget that virtually all of us have held wrong and dangerous beliefs at one time or another. It takes time and work and openness and commitment and opportunity to shed them. Not everyone has those things.

Trackbacks

  1. […] An ambulance is as much a part of the birthing process as a fire engine is a part of cooking. And if Midwives  were such experts why would they call for an ambulance to take the baby to the same people they demonise? Hospitals are terrible! They don’t wash hands and they like torturing babies with needles, unless something is going wrong in which case hospitals are great and filled with stellar people who will save lives. […]

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