Never Good Enough

I found an article today that made my eye go a bit twitchy. It is called “A family centered cesarean is not a substitute for a fully supported natural birth or VBAC“.

I have no idea why the author thinks they are the authority on what is or isn’t a substitute for a natural birth, I would think that the woman giving birth would have to decide that on her own. I am sure there are mothers that have had a vbac and then a c-section for a later pregnancy. A poll of them would be more useful than just making a blanket statement.

The article is intended to demonize c-sections, as usual. What struck me is that physicians who do not feel comfortable with a “natural” vbac (see: almost none) are still considered bad for offering what is called a family-centered c-section.

And mothers, if when you are discussing your desires for your natural birth with your provider, they immediately start talking about the “family centered cesareans” they offer for mothers like you, please please please recognize this as a red flag, and consider transferring care to a more supportive provider….one whose immediate response is what they can do to facilitate your natural birth and then, only if all other options are exhausted, will perform the most family centered cesarean possible

No matter how much OBGYNs pander to natural child birth advocates, its just never good enough. I think I would do the same thing if I were in the OBGYN’s shoes, just to try and prevent anyone from having a dangerous birth at home.

The reason that most providers require close monitoring and epidural anesthesia for VBAC in the hospital is that the risk of a catastrophic uterine rupture is best managed under those conditions. A life saving c-section can be performed quickly under those conditions. An unmedicated VBAC makes it impossible to catch the problem early, which can result in death for the infant. It can cost the mother her uterus, or her life.

I just wish people like the author of the Birth Blissfully article  had to explain how superior a natural vbac is to women who have suffered a uterine rupture during a vbac. Here is one from baby center:

The room filled with people, they threw the sheet curtain on me, didn’t even have time to hang it up before I heard the doctor say “cutting!”  Thank goodess I had the epidural so there was no time wasted there.  She had my baby out so fast, literally within a minute or so.  DD’s arm and shoulder had went through my rupture into my abdominal cavity.  She was breathing but a little limp – it’s so scary to think that minutes later would’ve been a different story.  They rushed her to the NICU, right by DH who had no idea that she had even been born yet.

It seems that she came pretty close to death, too. She lost 2 pints of blood, had multiple transfusions, and had to stay in the ICU for monitoring. One of the big things people dislike about c-sections is that you may have to spend time away from the baby while getting stitched up, but this mom ended up going days without seeing her daughter because they were both in their respective ICUs and couldn’t visit each other. Here is what she has to say about her decision to vbac:

I spent more time thinking, praying, and researching this vbac decision than any other in my life.  Ironically, it was the worst decision of my life.

I feel the exact same way about my choice to birth out of hospital with direct entry midwives (though luckily I did not have this type of health outcome). I looked into it so much, but sometimes doing research is just assuring yourself that what you want is really what you need. It takes a lot of humility to realize when you are reinforcing your previously held beliefs vs when you are actually trying to get to the truth.

A fully supported VBAC, for this mom, would have meant death or serious injury to mom, baby, or both. A c/section is a fine substitute for that risk, that is probably why the vast majority of moms choose repeat c-section over VBAC when presented with information about risks. It isn’t because women are stupid or uneducated, they just have different priorities than NCB advocates. There is nothing wrong with that.

No, OBs are not accountable

I was reading this post from the skeptical OB today

as you may or may not know, I was banned from the skeptical OB for calling Dr Amy out on being a fence sitter on the issue of date rape. Remember that any time she complains about being “silenced” by home birth bloggers for asking uncomfortable questions. She does the same thing to people who think there isn’t a neutral zone when it comes to rape.

IN this specific post Dr Amy says a survivor of sexual abuse who had several cuts to her perineum done to her body against her will during labor, by an OBGYN isn’t experiencing violence. She doesn’t even condemn the behavior of the OB at any point. She laments a series of home birth deaths in australia, one of the summaries she quotes points out that the mom chose home birth because she had been treated so poorly in the hospital. The only violence in birth is when the baby is injured? Here is as close as she gets to saying anything condemning that horrible physician:

Don’t get me wrong. I’m not claiming that hospital care is perfect. Although there is rarely any violence, there is a great deal of poor and disrespectful treatment.

Beforehand she literally says that the baby being inside the woman fundamentally changes the interaction. She talks as though women are simply vessels for children, and that being such a vessel fundamentally changes the way that a woman would experience having her gentials repeatedly cut against her will. The lack of empathy is very telling. The woman who was cut against her will, over and over, well before crowning, should be comfortable going back to the hospital because Dr Amy is apparently the ultimate authority on what constitutes violence or not. Its laughable, especially from a woman who insists that one must be an expert on a topic in order to have an opinion. Dr Amy goes on and on about the inability of midwives to call out their fellow midwives for negligence and damage done to patients, but here Dr Amy does the same thing and ignores deplorable conduct on the part of a gynecologist.  She goes on to say:

However, the chief victims aren’t Western, white, well off women; the chief victims are the elderly, people of color and those of lower socio-economic status.

For a skeptic she sure has an aversion to actually linking to evidence. Being white and college educated are one axis of privilege, but it doesn’t erase being female. It doesn’t erase the fact that women, regardless of any of their other characteristics, are targets for sexual abuse and violence by virtue of being female. Why anyone would believe that this problem vanishes in the hospital is beyond me. One kind of oppression does not erase the other. Dr Amy’s total ignorance of contemporary feminism and social justice movements is showing once again.

ANYWAY, I wish i could comment so I could let everyone know that NO, you don’t have many avenues for redress if your OBGYN decides to do all kinds of shit to you without your consent. You need a ton of money (enough to pay a lawyer for a lengthy and probably fruitless lawsuit). Medical boards don’t give a damn about this, and the doctor and hospitals have better lawyers than 99% of the population.

Women have many legit reasons for choosing home birth, and this is one of them. A lot of the people in the comments section of the Skeptical OB, who claim there are Very Serious Consequences for physicians who do things against your will, are living in a dream world. In the real world, your word doesn’t matter at all. I know from first hand experience. The issue at hand here is that midwives and home birth do not solve the problem. Horrible attitudes from other people about abuses of women during hospital childbirth (including disbelieving the women, rebranding their experiences as “disrespect” instead of abuse or violence, insisting that they will be compensated despite all evidence, etc) makes a vulnerable population easy pickings for midwives. I know that seeing unauthorized procedures done to patients during my time working in hospitals was instrumental in my decision to have an out of hospital birth. I knew that these doctors were not accountable because they did it all the time. There isn’t anything that holds them accountable for these issues. A suit for battery is unlikely to succeed and is hard to pull off. Ignoring the problems won’t make them go away, and will in fact drive more women to seek care from midwives, who at least pay lip service to how damaging abuse during childbirth can be to patients.

I find this a bit dishonest….

The skeptical OB is complaining about a woman who had a HBAC (home birth after cesarean), whose child ended up with a clavicle fracture.

When I was working at a major hospital in our state, I had free access to treatment protocols for virtually any situation. I read many of the ones that were maternity care related. The protocols for shoulder dystocia (which is what the HBAC mom likely experienced) can be resolved a couple of ways, but the last ditch effort is for a physician to literally break the clavicle on purpose. You can see intentional clavicle fracture as a treatment opinion on this wikipedia article, as well as several other places online.

The only time Dr Amy hints at the fact that physicians use intentional fracture as a last ditch effort is to say that the baby “might have” avoided the fracture in hospital. Its a glaring omission.

Home birth and natural child birth advocates do and say a lot of deplorable things. There is no need to make shit up.

the deaths we don’t hear about

I’ve tried very hard to track home birth deaths (mostly via the internet and news papers), and it is a very difficult task. I know that many women who lost their babies to home birth do not believe the deaths were preventable, and don’t wish to sully the reputation of home birth by sharing their stories in public. There are others who understandably want to keep their grief private for reasons unrelated to choosing a home birth. I’ve had to ignore a lot of the home birth deaths I’ve found because a state and year were not available to properly catalog them on the home birth fatality map

However, there are statistics available to give the public an idea of how many of babies die as a result of home births and natural child birth ideology. 

 MANA (Midwives Alliance of North America) released the results of a non-random survey recently. They call it a “study” when it is nothing of the sort. It is a voluntary survey with less than half of participants staying with the project until its completion. Data was voluntarily reported on 16,000 births. The results of the MANA stats project under-represents the number of home birth related deaths, but I will still use these numbers to give home birth midwives the best chance to prove that their practices are safe.

According to an independent statistician, the results of MANA’s project are as follows:

So, for a comparable group of infants born in the hospital, with congenital abnormalities excluded, the combined neonatal and intrapartum death rate is at most 0.7 per thousand. The combined neonatal and intrapartum death rate for the MANA STATS group, with congenital abnormalities excluded, was 2.06 per thousand, which is significantly higher. (p<.0001, highly statistically significant.)

In other words, the expected number of deaths from causes other than congenital anomalies was at most 12, and the actual number of deaths was 35 (44 with anomalies included). It is clear that home birth substantially increases the risk of neonatal death and of intrapartum death.

According to the CDC the rate of out of hospital birth was 1.36% nationally as of 2012.

According to the CDC 3,952,841 births were registered in the U.S. in 2012.

1.36% of 3,952,841 is 53,759 births. 

If you use MANA’s overly optimistic numbers, 110 babies died at home births in 2102. The rate of death for the same number of babies in the hospital is 38. 110 minus 38 equals 72.

That means at least 72 babies died because they were born at home that year. It is likely more. Midwives who have multiple adverse outcomes likely chose to keep their data to themselves. 

I also know that there is no real tracking of the deaths that are caused by Unassisted Child Birth (also called “free birth”), and that freebirthers are encouraged to lie to authorities if their baby dies. They say they just couldn’t get to the hospital in time. I know that a midwife can make a birth more or less dangerous by being there- sometimes a UC mom will go to the hospital when a midwife would have discouraged doing so, or vice versa. There is no doubt that these deaths are overwhelmingly the result of natural child birth philosophy.

There is not any information on how many midwives failed to attend a birth that ended in death as a result, despite knowing that this can and does happen to mothers. Dreah Louis and Vylette’s mother both lost a baby this way. It does not seem possible for midwives to report on a birth that they weren’t even there for. 

The skeptical OB, who is very good at finding and posting about home birth deaths, only found 23 in 2012. Less than half of the minimum that could be expected.

Some people may be thinking that it is hard to use statistics for a five year period on any given year, but home birth midwifery doesn’t really change. Like all pseudoscience it has no advances, and practitioners believe things are fine the way they are.  

I am sure other people are saying that 72 deaths is too small a number to be concerned about. 34 children died of heat stroke from being left in cars in 2012, and the outrage over the deaths is considerable. The issue with deaths from home birth or being left in cars isn’t the number, its that they were completely preventable, and that parents have a duty to protect their children from preventable deaths. This is just an estimate of a single year, these tragedies are repeated each and every year.

Reading a number doesn’t really do justice to what these deaths mean. I am going to try and represent them visually, by posting 72 pairs of baby shoes. Each pair represents the unfulfilled hopes of parents for their children’s first step, first word, first everything.

baby shoesbaby shoesbaby shoesbaby shoesbaby shoesbaby shoesbaby shoesbaby shoes

 

name changes for negligent midwives

The skeptical OB has an article up about negligent midwives changing their names as to deceive their customers.

It happened to me, too. Ester Werbach now goes by “Nueve Lunas Maternity” on the internet. The Utah Midwive’s Association is well aware of it, and my complaints of sexual misconduct, and continue to support my abuser. They don’t care.

These types of actions also make it impossible for women to research their care provider. If you have a health care provider that has killed negligently, had their license suspended, or otherwise been reprimanded their patients have a right to know. Midwives rob women of the opportunity to know what they are getting into.

Why Birth Centers Are Bullsh!t

safer midwifery utah:

I can think of many reasons someone would not want to give birth at home or the hospital, I am surprised a doula has trouble imagining reasons while regularly working with people who want a NCB. She got one thing right though- there is no difference in risk between a free standing birth center and a home birth.

Originally posted on Doula, Anonymous.:

Now, of-fucking-course, not ALL birth centers are bullshit. There are amazing midwives in amazing birth centers that are bringing healthcare and safety in birth to communities of women who have never known such a luxury.

This post is not about THOSE birth centers.

This post is not to judge mothers who choose to birth in birth centers simply for the jetted tubs or the peace and fucking quiet. If you birthed in a birth center and are triggered by this post: check your shit at the door and calm the hell down. This isn’t about you.

This post is a rant about the for-profit birth resorts that act as a “middle ground” for upper middle class white people who are “too scared” to have home births and don’t want to birth in hospitals.

And all too often it is the woman who desires a home birth, the father who ignorantly…

View original 543 more words

Gloria Lemay: pre-eclampsia is the mother’s fault

If you are unaware of Gloria Lemay, she was an illegal midwife in Canada who defied court injunctions that deemed her a danger to the public. She was involved in an infant death and subsequently sentenced to serve time in prison for her actions.

She still has quite a following in the world of Natural Child Birth, despite having no real qualifications and a ton of documented fuck ups to her name.

The most recent piece of idiocy can be seen on her facebook page. Here is the initial post:

gloria lemay 1

Gloria Lemay remarks that she would “love to see every baby in N America wearing this little message!” The message is “My mommy refused to induce me”. 

Some people rightly pointed out that there legitimate reasons to induce someone, such as pre-eclampsia, which can have serious health consequences (including death) if improperly managed. Here is Gloria’s reply:

gloria lemay 2“When a baby is at risk with “Pre-e” (pregnancy induced hypertension), what has been done to prevent the situation? Over and over, it has been shown that diet plays a key role.

 

The insistence that diet controls pre-eclampsia has absolutely no evidence behind it. A lot of women at the Pre Eclampsia foundation have a lot of anecdotal accounts of following the brewer diet religiously, and then ended up with the condition anyway. Some of them say they got pregnant again because they were confident they could beat pre eclampsia with diet, and in one case the mother almost died as a result. The idea that pre eclampsia is always a case of eating the “wrong” diet caused a lot of the moms on the forum to feel guilty. Lemay continues:

 

Then, if the situation is really out of control with high liver enzymes, is it a good plan to torture the woman/baby with an induction when you already have two ill patients? How is adding synthetic hormones to the situation going to help anything?

 

If you tell women that they are torturing their babies by inducing, you better have some damn good evidence. But there isn’t any. 

As for women being tortured by induction… that doesn’t seem to be what women actually say if you ask them about it.

 

 

There is a very high risk that the induction will end in c/s anyway. I would advise anyone in my own family to go straight to c/s in this situation, avoiding all the drugs, iv’s, of the induction.

 

C-sections include plenty of drugs and IV lines. I have no idea why she thinks she knows better than a physician about induction vs c/s for a case of pre-eclampsia. It is a complicated condition and the mode of delivery is chosen based on a number of different factors. Lemay talks about how horrible c-sections are all the time- perhaps she thinks a woman “deserves” a c-section for eating poorly? Its hard to know. There does seem to be a certain level of vitriol in her answer to a simple question.

 

Inductions are dangerous. Cesareans are dangerous. Ignoring sound dietary practice in pregnancy is dangerous.

 

Saying “x is dangerous” doesn’t really tell me anything about the danger. How dangerous is it? Are all three of those things equally dangerous? 

Lemay is again suggesting that mothers are to blame for eating poorly. I usually try to find a decent amount of evidence before blaming someone for a negative medical outcome. 

 

Birth is as safe as life gets. Medicine is for medical problems but it should be reserved for states of illness, not normal healthy women who have carried a baby to full term. “

 

“Birth is as safe as life gets” is bullshit. It can be pretty dangerous depending on what resources and technology you have available to you. Women still die all the time from complications of child birth, and women like Lemay are only able to ignore that because she is privileged enough to live in a place where obstetric care is very advanced and widely available. It is the same reason she can ignore the effectiveness of vaccination. 

Someone talked about how guilty this discussion made her feel, because she had been induced.

Here is Gloria Lemay’s response:

gloria lemay 3 After telling women they tortured their babies by inducing, which they obviously caused by poor diet or ignorance anyway, she decides to wash her hands of the obvious consequences of making these (extremely judgmental) statements. I don’t know how women are supposed to feel okay about torturing their babies, if they believe what Gloria Lemay has to say about it. In fact it seems pretty unethical of her to excuse people for baby torture, if she genuinely believes induction is an equivalent. 

The guilt heaped on mothers, regardless of the choices they make, is a symptom of a misogynistic society. It isn’t fair to women to add to that. 

 

…a space for people who left NCB

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