Posted by: Ticktock | July 31, 2010

Exclusive Interview: Skeptical OB, Dr. Amy Tuteur

Podcast Beyond Belief had the rare chance to interview “The Skeptical OB”, Dr. Amy Tuteur. This was her first interview for a podcast, so we really appreciate her speaking with us. Below, is part 1 of the transcript of our interview with her…

Colin: Tell us a little bit about yourself?

DrAmy: OK. I finished medical school in 1984. I did my residency and internship at Boston’s Beth Israel Hospital. I practiced for a number of  years before retiring from medicine in the mid-90s. Since then, I’ve worked as a freelance writer on the web on my own web sites. I write primarily about women’s health, particularly pregnancy.

Colin: You are notorious among home birth advocates for being virulently anti alternative birth. Where does this come from… going after alternative labor and delivery?

DrAmy: It’s kind of ironic because the reason that I’m one of the few is is that most obstetricians really don’t take home birth advocates seriously. I’ve done them the honor of taking them seriously on their own terms. I think a lot of the aggression and anger is because usually they’re used to saying what they want to say without anyone questioning them, and now someone’s questioning them and asking for data to support their claims. And they find it very very hard to come up with any data to support what they want to say.

I’ve acquired the reputation in the childbirth community as “she who must not be named”.

Colin: Kind of like Voldemort, right?

DrAmy: I think it gives insight into the way in which home birth, like all forms of alternative health, is a belief system. When you challenge that belief system, people react in a very angry fashion because you’re challenging something very important about themselves. When I discuss pregnancy and child birth, I’m discussing the facts, but when they discuss pregnancy and child birth, for some people, they are discussing their identities, and therefore, it’s very very hard to be questioned on that.

Elyse: One thing that I’ve discovered is that home birth is not only your identity, but it’s the community you identify with. If you have the wrong kind of birth, you could be shunned from social circles for being the wrong kind of Mom. It’s a very emotional subject for some people.

DrAmy: Oh, absolutely. That’s one of things that I find fascinating about it. When I tell people who are unacquainted with the web site that I write about home birth, they say, “Isn’t it easy to exhaust that topic?” But actually, the topic impinges on a lot of things. It’s not just about child birth. It’s about mothering, it’s about how mothers relate to each other and how they want to see themselves. It’s about women and their role in the world. It has implications on feminism, and a lot of what people take for granted about child birth and various parenting philosophies… they’re very surprised about where it comes from. It’s not as enlightened, often, as what they think it is.

John Paul: You were talking about the home birth community needing to verify their claims. What are the claims of the home birthing community, and where do you stand on home birth?

DrAmy: The primary claim is that home birth is as safe or safer as hospital birth, and that is flat out false. There has never been any data that showed that. They just made that up and went with it, and no one really called them to account on it because most obstetricians think they’re full of bologna and don’t even bother to address it. It doesn’t even get on the radar screen of most obstetricians, so it’s kind of shocking when someone like me comes along and says to people, “OK, you say that home birth is as safe or safer than hospital birth, show me the data”.

Then they start scrounging around and many of the studies are out of date, poorly done, or downright misleading. For example the primary study that is used to show the safety of American home birth is the Johnson and Davis study that was published in 2005. That’s the study in which they looked at all the deliveries in the year 2000 that were attended by home birth midwives, specifically certified professional midwives, which are distinct and differently trained than than certified nurse midwives (which is typically what the rest of the world thinks of when they think of midwives).

That study looked at all the home births and it compared the intervention rates for home birth in 2000 with the intervention rates of hospital birth in 2000 and found there were a lot fewer interventions in home birth. And then when it came to mortality, the authors did not compare home birth in 2000 with low-risk hospital birth in 2000; they compared it with a bunch of out of date studies extending back to 1969. And in that way, they were able to conclude that home birth was as safe as hospital birth. The interesting thing about that study was that the primary author, Kenneth Johnson, was the former director of research for the Midwives Alliance of North America, that’s the trade organization for the home birth midwives, and the study was done specifically to claim that home birth was safe. They just manipulated the data so that it would be safer than something. Unfortunately, it wasn’t safer than hospital birth in the same year, which is really what counts.

Colin: Could you tell us the difference between different types of midwives?

DrAmy: Sure. The United States is the only first-world country that has two different kind of midwives. In every other first-world country, midwives are trained through a university training program, they get a college-level degree, they have training in the hospital setting, hands-on training, and in countries where they do home birth, the midwives that do home birth are the same one’s that do hospital birth. So, they’re highly educated and highly trained.

In the United States, we have Certified Nurse Midwives, and they go to nursing school, which is a college degree, and then they do a master’s degree in midwifery. So they have even more training than midwives in other countries. But there were a group of women who decided that they wanted to be midwives, but they didn’t want to get that much training. Not only did they not want to get a masters, but they didn’t want to get a college degree either. So, they set themselves up as midwives, and they made a program for themselves, and they called themselves Direct Entry Midwives.

They weren’t getting much traction with that, and they decided to change their name, and they changed their name to Certified Professional Midwives (CPM), which is very close to and easily confused with CNM. So, most American women don’t realize that there are two different kinds of midwives: there are the fully trained midwives that are Certified Nurse Midwives, and there are CPMs who have less education or training than any midwife in any first-world country. They would not be certified anywhere else. And the fact is they made up their own certification; they certified themselves. There’s no independent body that decided on that degree. They just awarded it to themselves. They’re grossly under-educated, and they’re grossly untrained. That’s reflected in the fact that every study that’s looked at them, and all the national statistics and state statistics that have been collected about their work, shows that they have a neonatal mortality rate approximately triple that of Certified Nurse Midwives.

Colin: Are you against midwives in general, or just these Direct Entry Midwives?

DrAmy: I’m a very strong proponent of Certified Nurse Midwives. Every job I ever had, all the way back to my residence, I worked with Certified Nurse Midwives. I trained with them and backed them up. I think they are fantastic practitioners. They’re well-educated. They’re well-trained. They have excellent statistics if you look at studies done on deliveries done with Certified Nurse Midwives in hospitals. They’re great. They’re absolutely terrific!

But this other group, which are basically self-appointed midwives, are women who have a high school diploma, and they’ve set up midwifery schools. In these midwifery schools, there is very little scientific training. For example, there’s one midwifery school that I’ve written about, Birthingway, and the courses include “flower essences”, “gem energy”, “crystals”, not to mention homeopathy and all that.

So, we’re talking about two very different groups of people, and I think that Direct Entry Midwives should be abolished, which is just what they did in Canada. For a while, they had Direct Entry Midwives in Canada, and then the Canadian government decided they weren’t up to an appropriate standard. They mandated that for a midwife to work in Canada, she must have university level training.

Colin: What about home birth? Do you take a hard-lined stance against home birth? Do you recognize that a person has that choice to make an informed decision about whether to have a home birth?

DrAmy: The risk of home birth is small, but it’s real, and if you want to take that risk – OK, you’re free to take that risk. Everyone’s free to choose their medical care. The problem that I have with the American home birth movement is that they’re not honest with women. They insist that home birth is as safe or safer than hospital birth, and that’s just not the case. So, everyone deserves to make an informed decision about where she chooses to give birth, but you can’t be informed without the facts.

Colin: I’m against the idea of being afraid of the hospital. Some of these ideas that come out of the alternative birthing crowd, saying that hospitals treat birth like a sickness…

Elyse: That it’s a disease. Obstetricians are trained to see problems, and they get bored when they see problems; they see problems that aren’t there.

DrAmy: Right. Well, obstetricians are victims of their own success. This would have never happened 100 years ago, and it doesn’t happen in other countries beside first-world countries. Obstetricians have made birth so safe that people now think that it’s intrinsically safe, and it’s not. Childbirth is dangerous.  It may not be a disease, but it is, and has always been, in every time, place, and culture, one of the leading causes of death for young women. And it has always been the leading cause of death for babies. In the last century, modern obstetrics, at least in the United States, has dropped the neonatal mortality rate by 90% and the maternal mortality rate by 99%.

And now, people are wondering around saying, “Oh, childbirth is not a disease. Obstetricians are all bent out of shape, worrying about complications.” Yeah, that’s what we’re worried about because complications happen a lot, and they only way to deal with them is to be prepared. It sounds good to say that child birth is not a disease, but car accidents are not a disease either and you are just as dead. That’s really the problem!

Colin: My wife had a natural birth. We went to Bradley classes. One of things she was worried about, and at the time I couldn’t answer her… what are the effects of the pitocin and epidural on the baby? Her concern about that moved her toward wanting to have a drug-free birth. So, I wanted to ask you… what are the possible effects? Are those fears valid or have they been tested?

DrAmy: There’s been an unbelievable amount of research on epidurals and pitocin going back decades. The fact of the matter is that a home birth has triple the neonatal mortality rate of a hospital birth with all the hospital accoutrements because the fact of the matter is epidurals aren’t dangerous, they don’t hurt babies. Pitocin is not dangerous. In fact, pitocin is a life-saving medication; it’s saved the lives of tens of thousands of women and babies.

It’s actually a bunch of bologna that epidurals and pitocin are dangerous. If you think about it, who knows the most about child birth? The people who know the most about child birth are people like obstetricians, pediatricians, anesthesiologists. They know a lot about epidurals and pitocin, and nowadays, many of the pediatricians and obstetricians are female, and they aren’t turning down the epidural and they’re not turning down pitocin because they know there’s nothing wrong with it.

Colin: What do you say to mothers who feel empowered by natural birth? Mothers who consider birth to be sacred and life altering?

DrAmy: One of the interesting things is that people have lost perspective on child birth. The concept of something being empowering, that it’s unusual that you would have an unmedicated child birth… the fact of the matter is that 99% of the mothers who have ever lived have had a natural child birth or died trying, and most of the women everyday around the world have had a natural child birth or died trying.

It’s actually no big deal. Anybody can do it. In fact, the big deal is being able to survive without doing it. It’s funny that people have decided that it’s some sort of achievement when it’s the default mode. If you want to avoid pain medication, fine, especially if you don’t need medication there’s no reason to have it. But, the idea that it’s an achievement is like the idea that having a root canal without Novocaine is an achievement. You want to do it, OK good, but I don’t know how it makes you better or different, or makes it a more spiritual experience to do it that way.

Colin: I think you coined a term on your blog… “Sanctimommy“, which I guess are mommies that are sanctimonious about the process of pregnancy and birth. Tell us a little bit about that.

DrAmy: I didn’t coin the term. I read it somewhere else. One of the things that is really interesting about pregnancy and child birth, all sorts of mom things, is that moms are in competition with each other. I don’t know why that it, but they can’t live and let live.

It’s really very unfortunate. It’s actually quite depressing from a feminist point-of-view that the people who should be supporting each other are undermining each other. I remember this from when my children were small. I have four children, who are now in high school and college. I couldn’t go to the playground without somebody saying, “Oh, you let him use a bottle? He’s never going to graduate from high school if you let him drink from a bottle.”

Everybody had all sorts of dire predictions, and it’s interesting from my point-of-view now because the kids are growing up, and I know the same mothers; none of that turned out to pass. Being a good mother has nothing to do with the signal events that are supposedly so important, and it has everything to do with the bond that you form with your child, and being there day in and day out through all the flu and homework and problem with friends, so many harder and complicated things. It’s very unfortunate that some women insist on reducing motherhood to these specific moments, and judging other women based on whether or not they made the pre-approved choices.

John Paul: I wanted to get back to the science just briefly. There was a recent study that was done that was a meta-study…

DrAmy: The “Wax Study“? It was just published? It hasn’t actually been published yet. It’s supposed to be in the September issue, I think, of the American Journal of OBGYN…

Elyse: What is the study?

DrAmy: It’s by Wax and others, and it’s a meta-analysis of international studies. They looked at a number of different studies that compared home birth, and they had a hospital birth group in the same year of comparable risk. In that group of studies, there were two, a study out of Canada and a study out of the Netherlands, that showed that home birth had the same neonatal or perinatal death rate as hospital births, but all the others showed that home birth had a higher neonatal or perinatal  death rate. When they added them all up, home birth came out showing that it had triple the neonatal mortality as hospital birth.

I wanted to love the Wax study because it says what I have said for years, but it’s actually not a perfect study. I can’t say that the criticisms that home birth advocates have been leveling against it aren’t true, because some of them are true. However, I think that from the point-of-view of American women thinking about home birth, there’s some important things to keep in mind. The only places where home birth have ever been shown to be comparable to hospital birth are in Canada and the Netherlands. Both countries are very different than the United States in that the home births are done by very highly trained midwives. The eligibility requirements are very strict. It’s not like the United States where you say, “I’ve decided to have home birth, and now I’m going to have a home birth.” There, you have to qualify or else the midwife isn’t coming to you. They transfer at a very high rate. They have, in the Netherlands particularly, they have a transport system that was designed and dedicated to OB transport. And, it’s a very small country, where nobody’s that far from a hospital.

In contrast to the American idea of trusting births, the Canadian and Dutch midwives don’t trust birth at all: they exclude everybody who could possibly be having a complication, and anybody who seems to have a complication, they transfer them. That’s how they do so well. In contrast, every study  done on American midwives, and the data that the United States government has been collecting since 2003 shows that they have a much higher rate of neonatal mortality than hospital birth for comparable risk women. There’s zero evidence, none, zip, zero, nada, nothing that shows home birth in the United States as safe as hospital birth. Everything shows it to have triple the neonatal mortality rate.

To be continued in Part 2…

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Responses

  1. Thank you so much for posting this! I can’t wait to read Part 2!

    I think women should be able to decide where they want to give birth, but I sure am sick of home-birth women lording over people who choose to give birth in hospitals, as if we’re terrible parents. Ugh.

  2. Thanks for posting this interview.

    Dr. Tuteur is one of the few bloggers I’ve seen address the fact that the U.S. out-of-hospital birth situation is very different from that in other countries where the outcomes appear to be superior.

    She points out two things that have received far too little attention in mainstream discussions of the issue: the differences between CNMs and other midwives, and the fact that there is a treasure trove of data available (the MANA stats) that nobody appears to have seen.

  3. […] This is part 2 of our conversation with Skekptical OB, Dr. Amy Tuteur. Be sure to read Part 1 before you start reading this […]

  4. I will say that while Dr. Amy addresses good points regarding disparity of training and a lack of evidence by folks making positive claims, I find it very difficult to take her seriously. She doesn’t do a good job of separating her opinion from fact, and Podcast Beyond Belief’s hosts seem to simply let it slide.

    Colin asked about possible effects of pitocin and epidurals, and asking if concerns surrounding those effects are reasonable. Instead of responding with what are the agreed upon issues surroudning those two tools, Dr. Amy responds with a blanket “Of course they’re safe! Don’t you trust me? I’m a doctor; I know best.”

    She could have addressed the issues surrounding maternal core temperatures rising with epidurals, or of associated risks of maternal brachycardia (and the fetal distress that accompanies that, the elevated risk of malpresentation of the fetus, infection, allergic reactions, etc. etc. etc. Instead she’s thrown her credibility as a medical source of knowledge right out the window.

    We could have talked about overdosage of pitcoin that is fairly common in aggressive hospital protocols, resulting in hyperstimulation of the uterus, causing fetal distress (resulting in a c/section). We could have talked about failed pitocin induction, or increased uterine rupture rates in unscarred uteri.

    Instead there’s an unchallenged statement of opinion presented as fact, from a source that many people have come to regard as a good place to come for advice and discussion about navigating parenting. It’s irresponsible.

    I usually really enjoy Podcast Beyond Belief but was really disappointed in this latest episode. I’m sure I wouldn’t be quite so dismayed at the lack of reasonable discourse if this wasn’t a field that I work in (one of those pesky doula/CBE/CNM midwifery student learning evidence-based medicine), but it was downright painful for me to hear this interview. I hope that PBB does better fact checking in the future, and doesn’t take simply one woman’s opinion as fact in a contentious field where plenty of misinformation already exists.

  5. Thanks for the feedback, Michelle.

    Sorry that you were disappointed in the interview. We do our best to have conversations with a variety of guests from a wide-spectrum of topics. We try not to debate topics that we are not qualified to challenge, but it’s understandable that you would approach the interview differently as a student studying midwifery.

    We’d be happy to address your complaints on a future episode as a letter to the editor segment once we verify them with an impartial expert. I’m sure you have valid arguments, but I’m not qualified to address them.

    Please also let us know if there’s an evidence-based midwife you would like to see interviewed in a future episode. Labor and delivery are complex topics, and we want to make sure that all sides respecting science are heard.

    Thanks again for commenting.

    Colin

  6. Hey Colin,

    Thank you for responding to my issues. I understand that all of the hosts are approaching this subject as lay people (and certainly, I don’t have the alphabet soup behind my name to be considered an expert), but I do feel as if some of the problems with the interview could have been addressed during the interview. Simply put, bad logic and reasoning were accepted by an expert. “Infant mortality rates are three times as high outside the hospital as in, therefore epidurals and pitocin are obviously safe” should be challenged by anyone trained in basic research and critical thinking skills. That is not how the safety of a particular drug is decided, nor is it how scientific facts are established. Certainly, I would not have expected the hosts to argue specific instances disproving the blanket assertion of safety, but it seems as if it shouldn’t be hard to argue more evidence needs to be presented.

    I’m also curious as to how you decided to invite Dr. Tuteur onto the show — was background investigation done? (She did a stint as a writer at Science-Based Medicine with Harriet Hall — her stint did not last long as she was not able to handle the heat of her opinions-as-fact being challenged.) Did she approach the show? Amongst doctors, she would not have been who I would have considered to present evidenced-based medicine with an OB expert. Dr. Nicholas Fogelson of Academic OB/GYN would certainly have been an improvement, and may have presented a more reasonable interview. I certainly don’t agree always with his interpretation of data, but he’s reasonable, does research well, and can have a discussion without too much fuzzy logic.

    As far as an evidence-based midwife would go, I’d recommend Amy Romano. She blogs at Science and Sensibility. http://www.scienceandsensibility.org/?page_id=2 She’s pretty reliable in being able to separate her opinion and conjecture from fact. She is affiliated with Lamaze International (with whom Dr. Tuteur certainly has issues, but does a fairly good job of staying abreast with current research and does an excellent job disseminating accurate, factual, to the best of our knowledge medical information to “the masses”). She’s well versed in the current issues and research, and provides a good balance between obstetrical tradition and evidenced-based practices.

    Issues with pitocin can be verified from ACOG and the FDA literature. This is the original from the FDA website (although it’s a bit hellish to read)http://www.accessdata.fda.gov/drugsatfda_docs/nda/2002/018261_s021_PITOCIN_LBL.pdf and here’s an easier to read copy http://www.drugs.com/pro/pitocin.html.

    Epidurals are a little harder, because much of the complications that can be associated with that analgesic that comes from governmental bodies is found within the specific cocktail of drugs that a particular anesthesiologist might use. This might be a start: http://www.acog.org/publications/patient_education/bp086.cfm It’s basic patient education on the part of ACOG (The American College of Obstetricians and Gynecologists, or the national body that regulates OB/GYNs and advocates high standards of practice).

    I’m certainly not going to stop listening just because of one unfortunate interview. I think everyone does excellent work, and I really enjoy the brief exposure to topics I’m unfamiliar with. Perhaps this interview will just make me less lazy when it comes to accepting things that are said on your podcast (which is probably a good thing in the long run).

    Best,

    Michelle Bell

    • To be clear, we approached Dr. Amy due to her career as an OB, her impressive credentials, her dogged respect for science, and because she has a unique perspective on alternative birth. I’ve been personally impressed that she was able to change my mind on many things I took for granted as a skeptic who has always supported his wife’s decision to have a natural birth.

      I was aware of Dr. Amy’s controversial history before we interviewed her. Certainly, she has a reputation as an attack dog, but I think that if that tone is backed up by data and experience (such as Dr. Gorski or PZ Myers), it can be persuasive. There can also be a reticence on the part of these attack dogs to give ground to their opponents, even when there are good arguments being leveled against them. However, it did seem that Dr Amy was giving a fair amount of ground during the interview, so I applaud her for that.

      I’ll look into having Amy Romano as a guest. Thanks for the recommendation and your comments!

    • Michelle, while I recognize your point that possibly, we could have been quicker on the draw to ask Dr. Teuter whether there are safety studies on pitocin and epidurals, I personally did not for two reasons.

      First, I know that there are studies that show that an epidural is extremely low risk (although not zero risk, of course) and I know that similar studies have been done for pitocin.

      Second, your characterization of the situation is not completely accurate. If you read the quote, you’ll see that Dr. Teuter starts with the assertion that there has been an “unbelievable” amount of research done on both of these things. So she actually starts by asserting that science has been done that supports her position. She then moves into a more “common sense” argument. What you said happened didn’t happen the way you said it happened.

      Finally, I think that in addition to being open to information that conflicts with things you hear on our podcast (which I certainly am as well) you may want to check your own bias in assessing this interview. Dr. Amy did not, at any time, refer to CNM’s as pesky or problematic in any way. To the contrary, she was very clear that she has nothing but respect for CNM’s and the training they do.

      • Paul, I’m uncertain how to read your critique. Simply put, Dr. Tuteur’s statement that “The fact of the matter is that a home birth has triple the neonatal mortality rate of a hospital birth with all the hospital accoutrements because the fact of the matter is epidurals aren’t dangerous, they don’t hurt babies. Pitocin is not dangerous.” is making a statement that there is ZERO risk and the unbelievable amount of research (by implication) supports that. As you’ve stated above, the consensus is that there is some (low) risk associated with use of these tools. Certainly there will be instances in which the benefits outweigh the risks, but it’s sloppy to allow a medical professional to make statements that are contradicted by evidence.

        Also, regardless of what the science supports (and whether the argument is asserting a scientific discovery), badly formed arguments shouldn’t be allowed to stand from experts. Neonatal mortality rates inside hospitals versus outside the hospital does not prove or imply safety of a particular drug or technique. It’s akin to letting a astrophysicist talk about how the sunspot activity make the earth an oblate spheroid. The end fact (the earth is an oblate spheroid) is correct, but show your work. How you get there DOES matter.

        My statement regarding my background is referencing pesky more to the doula/CBE work instead of my status as a midwifery student. I was drawing from outside references in which Dr. Tuteur has denigrated child birth educators and doulas. My apologies — it was made while I was a bit heated and may have been an unfair representation.

        I guess my biggest issue is that she was permitted to be sloppy, even through post production. I can catch this because I know better, I am training in this field. What about things later on in which I don’t know better? By not challenging or verifying an expert, PBB gives a tacit endorsement to everything s/he says. So in this particular case, you endorsed a lie. It’s akin to interviewing a faith healer and refusing to challenge because you know nothing about faith.

      • I think you’re off target when you say it’s analogous to speaking with a faith healer. Dr. Amy is a Harvard educated OBGYN… not some crackpot that we found on the street. We invite experts to talk about their field of expertise, and their arguments and logic merely represent their own views. People are welcome to disagree with what our guests say, but it’s simply not possible for us to act as a goalie for every statement that a listener might possibly disagree with.

        I think you do your argument a disservice when you put words in Dr. Amy’s mouth that she said or implied that there’s “ZERO” risk. We never allowed Dr. Amy to say that there was “ZERO” risk. We allowed her to say that epidurals and pitocin are not dangerous, which is effectively true. Your logic has been used by Jenny McCarthy’s crowd to say that vaccines are unsafe. Because there’s a 1 in 100,000 risk of a side effect, then all vaccines are unsafe? I mean, you’re welcome to say that Dr. Amy should have mentioned the small risk, but that’s an extra detail that doesn’t necessarily contradict her original point.

        We on the podcast volunteer our time to bring interviews from experts. We are clearly not 60 minutes, meaning that we do not invite guests so that we can nail them to the wall, and also meaning that we’re amateurs and parents – not Scott Pelly. We invite guests that we think skeptic and atheist parents will be interested in hearing from to speak about parenting and science topics that we care about. If we catch our guests providing actual logical fallacies or factual errors, we will do our best to challenge them, but if we miss a detail, it’s not that we’re endorsing a lie. Give me an actual quote where Dr. Amy lied. Which lie that she actually said, and not what you think she implied, did we endorse?

        Really, the appropriate person to confront in this situation is Dr. Amy. She made the comment that you disagree with. Her blog is http://skepticalob.blogspot.com. Overall, her interview was reasonable and fair. You object to some generalities that she made, but I think you may be injecting correlation where none was implied. She was interviewed by three skeptics, none of whom saw the egregious errors in logic that you have imposed on the conversation. And, to be honest, even after you’ve specified, I’m not sure that I agree with you, even after the fact, that Dr. Amy was wrong.

        That all being said, I think it’s important that listeners offer feedback and tell us where they think we went wrong. That’s our only form of peer review. How will you know if there’s some statement in the future that some guest will say that’s not true? You won’t, unless we happen to know the statement is not true, or if someone challenges us in the show notes. We are also happy to issue corrections or apologies when necessary on future episodes.

        The point is that we bring on highly trained, experienced professionals to speak with us because of their qualifications. We do this so that people can have an informed opinion about parenting topics. If our listeners want to investigate more, they are welcome to read the guest’s book, visit their blog, or research the matter further.

      • “is making a statement that there is ZERO risk and the unbelievable amount of research (by implication) supports that.”

        No, Michelle. It really isn’t.

        I take medication every day. It has a risk of side effects. I know that. But that doesn’t make it “dangerous”. “Dangerous” is a subjective term, and when discussing medical procedures of any kind whatsoever, the words “not dangerous” never mean “zero risk”.

        You’re right that we could have, and in a more formal setting, would have, pursued the definition of “unbelievable amount” and perhaps determined what risks do exist in more detail. In general, I trust my audience to understand that “not dangerous” in medical parlance does not equal “zero risk”.

        I do appreciate your feedback. It’s important for us, as interviewers, to get feedback so that we can improve. I’m not arguing that clarification wouldn’t have been helpful, and I’m certainly going to bear that in mind.

        However, your characterization of us as having “endorsed a lie” is a product of your mind, not a product of what was said by anyone on the podcast.

  7. I find it interesting that Amy says she doesn’t understand why moms just can’t “live let and live” and that it is unfortunate that women “aren’t supporting each other but undermining each other.” Isn’t this a bit hypocritical? So far, just about everything I have read from Amy is NOT supportive of mothers choices concerning their bodies and their babies. It seems Amy should be taking her own advice.. at least in my opinion.
    She keeps speaking of these “competitive” and “holier than thou” type women that choose home birth but she seems to be the one that comes off as competitive and superior, with all of us mothers too ignorant and stupid to make an intelligent decision that is not based on wanting to be ” the better mommy.”
    I really think Amy has it all wrong about these mothers and their motives.
    Well, first of all, the statistics that she gets all of her back up from are actually not very accurate as is the case in most statistics and data.
    What this data fails to recognize is that a portion of the women in the home birth category do not do prenatal testing or any ultrasounds during their pregnancies( Amish women do home births just about 100% of the time and do not screen for anything and will often refuse to go to the hospital even if the baby is in serious danger) and therefore may have babies with severe abnormalities and defects and are high risk without knowing it.
    It is more common for Amish women to have children with genetic defects severe enough that the baby wouldn’t survive AND for their babies to have more problems during childbirth because they have so many babies.. risks to the infant increase after the mother’s fifth child.
    Women that don’t do prenatal screening or ultrasounds( and don’t know anything is wrong w/ their baby) are obviously not going to terminate a pregnancy. Women that birth in hospital and do have these tests done are clearly more likely to.
    When you take this out of the equation the results show that the difference is insignificant between a hospital birth and planned home birth.
    I also believe that in at least one of the studies Amy is referring to, they include ALL home births, even those that were unplanned. Clearly, a woman that gives birth at 37 weeks with only her husband in attendance will not have the same outcome as a woman that has carefully prepared and has two experienced midwives by her side.
    The thing about statistics is that either side can always find data that supports their view on the subject.
    That is part of the reason why debates like these ( and many others) go on and on and on..BOTH sides can back up their claims.. so who is to say which one is the more accurate?
    What I do know is this..
    I was raped as teenager and have suffered from post traumatic stress, anxiety and panic attacks as a result. I strongly dislike bright lights and always shower, bath and even go to the bathroom with either the lights off or dimmed.
    I am a very private person and have never had a male OB nor would I want one.
    I do not like needles and have had some traumatic experiences in hospitals where I was poked endlessly as a child ( after an operation kept there for a week)
    and was left with bruises up and down my arms because I have very small and deep veins.
    I am 29 now, in excellent health, strong, fit and pregnant.
    I have had no complications or problems during my pregnancy ( i’m 8 months)
    I eat very well, walk daily, meditate, stretch and I do not smoke.
    I have two midwives and one doula attending my home birth and between the 3 of them they have delivered over 1,500 babies and their results
    are amazing! I could not feel safer or happier about my choice.
    So, knowing these things would Amy still suggest that the right decision,
    the only decision, is for me to go to the hospital?
    Even though there is a good chance that if I go to a hospital I will be put on my back with my feet in stirrups and I will be under bright lights with possibly a male OB or resident coming in to cut me and deliver my baby?
    I am not trying to be over the top here but I have a past and it affects me to this day. I do not need to set myself up to endure anymore emotional trauma.
    And as a victim of rape, can you imagine if Amy got what she wanted and my ability to make a choice was taken away?
    Amy calls herself a feminist. Really??
    Don’t feminists believe that women are intelligent enough and have enough common sense to making the right choices for themselves and those they love?
    I want to give birth in the safety, security, calm and quiet of my own home with just those whom I trust. If an emergency happens to come up, the hospital is less than 5 minutes from my home.
    My point is, there is a story and a reason behind every woman’s choice to birth at home and it is not to be a show off or get attention in the majority of those cases.
    I have told very few people about my birth choices and will probably be shunned by my community for not choosing a hospital birth. Not one friend or family member of mine has ever birthed anywhere but a hospital..
    But it is my choice and that is what matters.
    I hope that Amy finds a better cause to fight than this one.
    Spreading fear among pregnant women is not a positive way to live ones life
    and if she is really concerned about survival and death that much
    she could advocate the use of bicycles over cars, blog about issues such as childhood obesity
    smoking or cancer.
    Then there may actually be a chance she could really save some lives.
    Lets be realistic here, there is probably a greater chance of the baby dying in a car accident on the way home from the hospital than from being born at home.
    It is a silly waste of time to bash woman for making an informed choice.

    • I usually avoid commenting on the home birth threads for a very specific reason. I have actually run into the competitive birth moms, and they annoy me to no end. I have managed to shut them up with this one very true statement: “If I had not been in a hospital both my son and I would have died.”

      I should also note they also don’t care much about listening to the trials and tribulations of dealing with a disabled child.

    • “Spreading fear among pregnant women is not a positive way to live ones life
      and if she is really concerned about survival and death that much”

      I think that you are putting words in Dr. Teuter’s mouth. She stated explicitly that she had no problem with women who choose home birth. She stated explicitly that her only problem was with groups and individuals who misinform women about the true risks of home birth and who attend births without significan medical training. She doesn’t have a problem with Certified Nurse Midwives who attend home births or the women who choose to have home births.

      She did not, at any time, bash any women at all for making an informed choice. She didn’t suggest that the only choice was to go to a hospital. She said that Direct Entry Midwives (CPMs) do not have the training that they need to handle complications if they occur, and that these individuals (the midwives, not the mothers) are misrepresenting themselves. She said that women who try to make other women feel bad for having hospital births are undermining their choice.

      Based on this article, the one year odds of dying in a transport accident of any kind are 1/5,877. This pro-home-birth article puts the odds of dying in a home birth at 1.7/1000. That’s more than 5 times higher… and that doesn’t even factor in the fact that you may take hundreds of car trips in a given year!

      I understand that this is a very sensitive subject. But one thing that we encourage people–including ourselves–to do on Science Based Parenting is to try to be more objective and to think critically. We can’t do that if we misrepresent what people say or misrepresent the facts.

      I personally don’t have any problem at all with any decision that you make that doesn’t harm other people. The purpose of this blog and the podcast is simply to present facts to people who want facts in what we hope is an interesting and informative way.

      • Philosodad, you are absolutely right. She did not do some of the things in this interview that I said she did. After I posted I reread the interview and realized my mistake. She has, however, very clearly stated in past articles, posts, comments, etc. that she does have a huge problem with women that choose home birth. She has implied and even said right out that home birth women are “crazy” and that we basically don’t care that we might kill our babies. She has obviously become a bit more careful about what she says.. perhaps realizing that people will not take someone that states we can’t make our own choices, seriously.
        My apologies for taking her past comments and using them in my post.. for the people that have only read her interview it was not fair to bring up something that they have not read themselves but it really was an honest mistake.
        I keep reading how home birth women are “bashing” other women for giving birth in the hospital.. there is such a small percentage of home birth women that I really wonder how the hospital birthing women are being attacked so often.
        Not only that but a huge portion of home birthers, gave birth in a hospital first themselves.
        My own personal observation is that women that have had really terrible births in the hospital and then vastly different and more positive experiences at home, are sharing their stories.
        That is all. Just sharing their stories out of pure happiness or possibly to help another woman that is searching for answers.
        Why are people getting so defensive about that?
        My question is this.. I have this beautiful baby growing in my belly. I have bonded with her over all her kicks and movements for months. I think about her everyday. My husband and I share tender moments with his hand on my belly thinking and talking about her arrival. We did, after all, create this little being together.
        It is truly awesome.
        So, do people really believe they care more deeply about the life and the safety of my child than I do?
        Than my husband does?
        What is being implied here is that I am either to ignorant, stupid or careless to make a choice involving my baby’s safety.
        I would never tell a mother she is one way or another for choosing to give birth in a hospital. Who am I to tell her what her choice,regarding the baby she has carried for months and months
        should be?
        There is a ton of data and a ton of statistics out there.
        The vast majority of what I have read tells me home birth is safe for me because I am low risk, with a vertex baby and in the care of great midwives.
        I would actually prefer to look at the statistics of the people delivering my baby. If we are going to go by statistics then we really should only go by the statistics of the midwives and OB’s we are choosing.
        Not one baby or mother has died in my midwives care.
        That is good enough for me.
        They have also had no birth injuries, no episiotiomies and
        no instances of PPD.
        My best friend gave birth at a hospital and the experience
        was so horrific ( according to her)
        that after her baby was born she not only had no interest
        in holding her, she didn’t even want to see her.
        She said the drugs they gave her.. which were numerous..
        affected her so strongly, she felt they left in her in state
        of anxiety for months afterwards.
        She also suffered for PPD for an entire year and thought of suicide
        daily. Eventually she went into treatment and was
        separated from her daughter for 6 months.

      • “She has, however, very clearly stated in past articles, posts, comments, etc. that she does have a huge problem with women that choose home birth.”

        I would be surprised if this were the case. If it is the case, I would appreciate it if you would provide a link to such a comment.

        Your friend had a bad experience in a hospital. My family had two wonderful experiences with a hospital. Your midwives have seen few enough children between them that it is not surprising that they have had no deaths, because the death rate is only 1.7 in a thousand. Since each individual has seen less than 1000 births, I would not expect that they would have had a death. In other words, statistically speaking, your birthing team hasn’t seen a significant number of cases.

        The typical CNM or OB/GYN sees many, many, many more births than your team, and has much more experience and training in case of complications. That’s just a fact.

        I don’t have a problem with your decision to have a home birth, but please don’t try to sell me on the idea that it is just as safe as a hospital birth. It is not. The risks are low, but real.

        Telling you the facts is not a judgement. Home birth is less safe, in general, than birth in a hospital or birthing center. That is a fact. Birth with a CPM is less safe than birth with a CNM. That is a fact. These facts are given free of judgement, and you can do with those facts whatever you want without me saying a word. I have no beliefs whatsoever about how you feel about your babies health. I don’t care at all where you give birth.

        But if you try to convince me that the facts are not the facts, I might get a little miffed if you can’t back that up.

    • I should clarify that there was no reason to suspect a problem. It was too late for a C-section when he got stuck. Sometimes bad things happen.

      The next two pregnancies were not a problem, and the third almost ended up with a home birth without planning.

      But having one child with a disability is enough.

      • Chris,
        I am really sorry about what happened to your child.
        You are happy with your decision to give birth in the hospital
        and I support that 100% of course.
        May I ask what the circumstances were though?
        You wrote that your baby got stuck and there was no time
        for a c section so I wonder why you and your baby would have died
        if you were at home. If your baby had shoulder dystocia
        and you had an epidural than that can be very dangerous.
        The easiest and most effective way to deliver a baby with shoulder dystocia is to get the mom on her hands and knees. It sounds
        simple but it works.
        Ina may Gaskin has used this procedure numerous times and has never once had any complications. It has actually been put in medical books ( even though a CPM is the one behind the discovery) because of its effectiveness.
        My midwife delivered an 11 pound baby that got stuck as well and she put her on her hands and knees and the baby was born soon after with no problems. If she had been in the hospital it would have been too late for a section as well and the mom would have very likely had an epidural and would not have been capable of turning around to get on her knees.

      • Emily, how many births have you attended? How many cases of complications have you seen? How many is “numerous”. Could you please provide a citation from any article that I could find on, say PubMed that would support your assertion that this is a safe and accepted procedure?

      • I would call it Big Dutch Head syndrome. It should have been a caesarian. I have never had an epidural. After 90 minutes of pushing and maneuvering with forceps he was finally born with a very pointed head, and I was torn from vagina to anus (which got infected a couple of days later). Forty eight hours later he had seizures (there was some slight bleeding in the brain).

        A few months before my now adult son was born there was a tragedy at a local birthing center. The under trained midwives did not look into the history of the mother. One very important bit they missed was that she did not trust hospitals because her mother died in one in the 1950s while giving birth. Then they failed to monitor her blood pressure. By the time they realized what happened both the mother and baby were dead of a sudden rise of blood pressure (pre-eclampsia). The same thing that killed her mother.

        Now, go back and provide some actual data that home birth can be safe when encountering pre-eclampsia, non-progressing labor, incomplete cervix (which is why a friend had to have complete bed rest for her second and third pregnancy, the first literally dropped out on her kitchen floor at less than six months gestation) and the head (not shoulders) getting stuck.

      • This is why I never participate in these discussions. Too often it is someone who thinks they have done their research making up guesses and excuses as to why it is my fault for having a terrible labor, and a disabled child.

        Love the note on shoulders, when it was difficult getting the head out! Or, that it had to be the epidural! As it turns out my labors progress to fast for an epidural (my last labor was under two hours).

        Oh, and the hospital had to be evil and horrible place! Actually, no. It was the brand new birthing center with couches, a nice bed that turns into a birthing bed, with a tray of supplies that can be wheeled in quickly. Plus a direct elevator to an operating theater in case of a problem (one of the women in my birthing class had to use it, her baby came out fine)… which beats an ambulance ride. They even treated me quite well after my son was taken by ambulance to the local children’s hospital and taking of my stitches from being torn from stem to stern. I also got some lovely treatment at the children’s hospital where he spent his first week (including learning about breast pumps).

        Now go back and get some real research. And I really hope you do not get the first hand experience I had, but don’t think you are immune from bad stuff happening.

  8. To philosodad..
    http://www.inamay.com/?page_id=30
    Also.. how many births have you delivered/attended?
    And if so.. what are your statistics and results.. not just deaths but
    ALL results including birth injuries, use of pitocin, c sections, etc.

    • So how exactly does that help if the head does not emerge?

      Also how does it answer philosodad his questions: Emily, how many births have you attended? How many cases of complications have you seen?

    • Emily, I haven’t attended any births (as a health care provider). That’s why I’m not opining as to what Chris’ OB should have done, or what may have happened in that birth. You are. I am not suggesting that I have superior knowledge to Chris’ birthing team. You are. That is why your experience is relevant to this discussion, and mine is not.

      You’ll note, I’m not offering my opinion about what you should do, or even what it is best for you to do. I’m just presenting facts.

      PubMed is a research tool. It houses peer reviewed articles. The article you reference is not a study. It is not a peer reviewed research paper. However, even if we ignore the weakness of the reference, it doesn’t support your original statement. It is a specific claim of your reference that the use of regional anesthetic (an epidural) does not preclude the use of the Gaskin Maneuver.

  9. Ina May is not the same as Pub Med!!! Try again.

    There are multiple types of epidurals (as stated earlier in the interview- its a technique not a medicine), even “walking” ones.They can be strong (numb) or light (lots of feeling). Plus,they CAN dial down an epidural so you can get all the feeling back if needed. Saying that this miracle of “hands and knees” is impossible with epidurals seems like more NCB nonsense, which Ina is part of.
    I’m no expert, so if there are any REAL citations, I will be happy to change my mind. And no, a CPM statement doesn’t count as science.

    As for home birth, no one says women shouldn’t be able to choose! Even those of us who DO think its retrograde, dangerous, and a little bit crazy, will fight for your right to choose. We just want women to have real info, not something made up.

    Yes, the risk is small overall, but it IS THERE. As long as everyone knows it, no problem. It becomes an issue when NCB’ers run around saying its safer and better at home, which has not proven true in any rigorous study. Again, when an NCB advocate misrepresents data, or hides it all together, it cannot be considered accurate info.

    I can see why its confusing- online there are tons of sites claiming to be right, and most are nonsense. Its hard to pick through it all, so if you just looked at the majority of sites, you WOULD think HB was safer. This doesn’t make it so.

    Last- I’ve heard women ask for C sections because of past sexual abuse, which makes sense. I can understand abuse coloring this decision, as it is a major factor in your mental well being. You CAN get a OB that will deliver your baby, it just takes extra effort to find one, or get to know their back-ups. HB isn’t the only option, but it IS one, of course.

    I am 3 days past MY due date, so this stuff is on my mind 😉 I’ve been getting lots of extra testing (long story), and I personally found the hospital professional and the OB’s skills comforting (labor is terror for me). Everyone is different- but I know what works for ME might not work for others!!!!

    • One thing to remember, don’t let anyone’s story (even mine) scare you. Just remember to breathe (hey, you can actually forget!).

      Note, not everyone gets an epidural. I asked for one, and they sent in the nurse anesthetist to discuss the procedure and options. By the time he finished giving me all the information I needed, I was to dilated! :-/ It happened with both boys! For the youngest, I basically got to the hospital and had my daughter! (part of the two hour labor was spent rousing up two little boys, and getting grandma over to watch them) No time for anything, not even for my husband to get a cup of coffee.

      Oh, yeah… and by the time daughter was born the practice was to send home healthy moms and babes in 24 hours. Not the two days I had with younger son. Really, one thing I do not understand about home birth is why a new mom should be in a house where she knows dishes need to be done, laundry folded and having all those linens to clean!

      (I hired someone to help after second child was born, but I was always following behind her re-doing the job the way I was used to! At least for the third child both boys were in preschool and kindergarten.)

    • I have the real info, thanks.
      Good luck with your pregnancy and congratulations.. enjoy your new baby! 🙂

  10. Chris, Philosodad and Staceyjw….. Here is your PUBMED…

    http://www.ncbi.nlm.nih.gov/pubmed/9610468

    Do you have anything to say now?

    • So you have a reading comprehension problem, or do not understand basic anatomy? The head must come out before the shoulder. If the head is stuck, then the shoulders are not the issue.

      • This is my last time posting on here because I think the rudeness is totally unnecessary.. and I definitely don’t need any negativity in my life right now, being that I am about to have a baby. Honestly, I am sorry if i offended anyone with what I wrote.. my whole point was to open people’s minds to home birth. It is fine if you don’t want to do it yourself but why the bashing? I never said that you had shoulder dystocia or you had an epidural or that you are responsible for what happened to your child. I was simply putting some possibilities out there… that is it.
        You know, it is very hard not to get defensive when people are being so rude. I mean you wrote that your baby and you would have died if you had been at home but then you state very clearly that your baby was sent to the hospital via ambulance. If your baby was born at home.. the same would have happened. That is what home birthers are always saying. If something goes wrong.. you go to the hospital. I have a hospital literally 5 minutes from my home.
        Honestly, it seems that the angry and competitive women in this whole debate are NOT the woman that give birth at home or give birth naturally. And it is also not all the women that gave birth in a hospital. It is the ones that are very unhappy with their own experience or are simply competitive themselves that seem to take some huge offense in woman that have positive experiences. Be happy for them. People that are happy with themselves are not constantly trying to belittle others all the time. I read these stories of women having such happy and positive births and I am HAPPY for them. Why should we not be????

      • “I think the rudeness is totally unnecessary..”

        Totally rich coming from the person who made wild ass guesses on the nature of the life threatening circumstances surrounding my first baby.

        My son was sent to another hospital that specialized in children two days after his very difficult birth due to seizures. Newsflash: there are hospitals devoted to taking care of infants and children.

        If I had him at home he would have died in the birth canal, and I would have also perished. Again I question your reading comprehension.

        Good luck with your birth, and I really hope nothing happens. But in the future you will learn that we who have had children, dealt with disabilities and deal with teenagers get irritated when we get lectured by someone who is still only pregnant.

        Great, you mastered the first part… Now comes the more difficult part. Like today, I am nursing a hypochondriac teenage daughter who had her wisdom teeth removed yesterday. I guess you won’t be around to tell that instead of antibiotics, cold packs and pain medication she should get on her hand and knees as “all fours” helps everything.

        Also, in the future if you come across a mother with a disabled child do not, and really mean do not ask if she did anything on your list of bad things. You sound lots like Meryl Dorey of the AVN… and that is not good. Here is another judgmental person, LH, trying the same idiocy:
        http://leftbrainrightbrain.co.uk/2010/08/the-california-pertussis-outbreak-of-2010/#comment-93472

  11. Oh.. and it is not impossible to get on all fours after an epidural but it is much more difficult.. if you read my original link.. which is the EXACT same study that pubmed used… the article continues to say that with an experienced team well trained in the maneuver, it is POSSIBLE to get a woman who has had an epidural on all fours.. that is NO guarantee however.
    So, from that alone.. if your baby has shoulder dystocia.. it appears that it may actually be more safe to be at home where you would not have had an epidural and your midwife would be specifically trained in this procedure ( as my midwife is).

    You believe in your facts and I believe in mine. It is as simple as that.

    • I wouldn’t know anything about epidurals because I have never had one!

    • You before: “If she had been in the hospital it would have been too late for a section as well and the mom would have very likely had an epidural and would not have been capable of turning around to get on her knees.”

      This turns out not to be true. It isn’t a matter of believing in your facts and me believing in mine. I haven’t claimed that anything you said wasn’t true, I asked you for evidence. You provided that evidence. I saw that the evidence does not support your original assertion.

      Your new assertion is that because some maneuver is safe and effective, according to a single study, birth at home is safer if your baby should happen to have shoulder dystocia.

      Again, this isn’t a question of facts. It’s a question of whether or not you are making things up. First, Certified Professional Midwives are not required to be specifically trained in the Gaskin procedure, because there is no uniform training requirement across the US. So your assertion that your midwife would be specifically trained in this procedure is false. Second, you are assuming that OB/GYNs and CNMs are not trained in this maneuver. This may or may not be the case, it certainly isn’t evident from an article published in 1998 what the state of obstetrics is is now. Third, your article does not support the assertion that the Gaskin Maneuver is safer than any other maneuver.

      So you see, it isn’t a question of choosing which facts to believe. It’s a matter of not making additional facts up. You made up several facts to come to your conclusion. And the facts you are making up don’t have any relationship to your source.

      For example, the article states that an experienced team can execute the maneuver with an epidural. So where did this team get the experience and training, if the medical community is ignorant of this technique?

      Your assertions continue to be refuted by your source. Doesn’t that make you think?

  12. Dr Amy seems like a really great OB, but she does let her personal biases slide a bit much. I read her blog almost regularly and really enjoy the information she gives out and links to. I think she is very science based. But she can seem a bit overcritical. And she seems to have a very conservative point of view with regard to child rearing that pops it’s head up now and then that I don’t appreciate. But I can get past it as long as the rest of her information is presented as less biased.


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