Announcing a new podcast, and it involves mold and other environmental hazards: The Mid-Atlantic Center for Children’s Health and the Environment (podcast download link) (entire podcast archive). It seems everyone is busy with jobs and kids, including Elyse saving the world and Jason Bilotta’s inspection business that deals with mold and other damage. Which is a perfect tie in to the interview with Jerome Paulson, MD of the The Mid-Atlantic Center for Children’s Health and the Environment.
It is a very informative hour. Give it a listen! Read the rest of this entry »
The Sex Talk with Heidi Anderson:
Can we discourage sexual assult by learning negotiation techniques from the BDSM community? Heidi previews the talk she’ll be giving at the Momentum conference.
The Brain Game:
How can you throw a ball as hard as you can, and make it stop and return to you, without it hitting anything, and with nothing attached to it?
Stephanie Coontz, author of A Strange Stirring: The Feminine Mystique and American Women at the Dawn of the 1960s. See more about the book here.
More Parenting Within Reason podcasts can be downloaded here.
If you are near Washington, DC check out the exhibits and activities at the National Museum of Health and Medicine. If you can’t (like most of us) see what activities there are for kids at the Neuroscience for Kids website.
On episode 42 of our Parenting Within Reason podcast, we interview Vyckie Garrison, who is the editor and a contributing writer of the blog No Longer Quivering. Vyckie left the Quiverfull movement and writes about her experiences within it. Quiverfull followers believe in letting God plan their families, and they often have ten or more children. (Vyckie had seven.) They also homeschool and instill the idea of submission among wives and daughters, who are brought up as domestic servants and “helpmeets” for their husbands. Vyckie really gave us a wonderful interview. She was very open about her life and her journey away from the Quiverfull movement. Her blog is a fascinating read, especially because the women who write for it break up their posts into continuing episodes that draw the reader in. The stories have completely hooked me.
The Duggars belong to this form of fundamentalist Christianity, and I have not been able to get enough of their show since I learned this. I love watching 19 Kids and Counting, as much as it sort of freaks me out and scares me. I find the kids and the parents totally charming, even when they’re talking about how the earth is 6000 years old. While doing a little procrastinating from another writing project, I came across the video above.
The Quiverfull movement has become a topic of peculiar fascination for me. I first heard about the Christian Patriarchy on Hemant Mehta’s Friendly Atheist blog. He posted several excerpts from Katherine Joyce’s book Quiverfull: Inside the Christian Patriarchy Movement. Geek that I am, I asked for the book as a present, ironically enough, for Mother’s Day.
One of the aspects of Quiverfull that I find the most alarming is that some parents within it adhere to a strict philosophy of child rearing espoused by a couple named Michael and Debbie Pearl, who have published the book, To Train Up a Child. Excerpts can be found here, and this is the passage that is most emblematic of the training method advised by this book:
There is much satisfaction in training up a child. It is easy and challenging. When my children were able to crawl (in the case of one, roll) around the room, I set up training sessions.
Try it yourself. Place an appealing object where they can reach it, maybe in a “No-no” corner or on an apple juice table (That’s where the coffee table once sat). When they spy it and make a dive for it, in a calm voice say, “No, don’t touch it.” They will already be familiar with the “No,” so they will pause, look at you in wonder and then turn around and grab it. Switch their hand once and simultaneously say, “No.” Remember, you are not disciplining, you are training. One spat with a little switch is enough. They will again pull back their hand and consider the relationship between the object, their desire, the command and the little reinforcing pain. It may take several times, but if you are consistent, they will learn to consistently obey, even in your absence.
That’s right. Use a switch on the child when he or she reaches for a toy. Specifically, the Pearls recommend a quarter inch plumbing supply line.
The idea here is that by teaching your child to obey you rather than follow his own natural inclinations, you will instill enough obedience for the child to forego his sinful nature. Obedience is the most important trait according to this thought process. If you can’t obey your parents, you won’t obey God, and you’ll end up in Hell.
Vyckie says she did not practice this particular form of discipline with her kids, but she did emphasize obedience as the highest virtue, and she tells us in the interview how it drained the spirit right out of her children. Once liberated from this dogma, the kids began to flourish and grow as individuals.
Vyckie’s blog has a heartrending series of apologies from parents who feel now that the stress upon obedience wrought psychological damage upon their children. In an especially moving post, one writer speaks of the intense love she felt for her baby and the gratitude she felt upon finding guidance to protect her child:
If I could sum up the message that this book spoke to a young mother who deeply loved her baby, it was this:
“Momma, your baby is a sinner. He/she will try to manipulate you. Things like a child not liking a diaper change and squirming to be free are an example of a sinful will attempting to dominate you. You may think this is a little thing, but it’s huge. Why? Because if you let the child dominate you, the child will win. If the child wins, the child will learn that rebellion pays. The child will then grow up to probably reject God and go to Hell, because a rebellious heart will not want to follow God. So, Momma, never ever let your child win. Your child’s exertion of will [which includes anything you deem unacceptable---grumpiness, for example] is an act of war, and parenting is about the parent winning any and all battles of wills.”
I loved my baby. How grateful, absolutely grateful I felt, that someone was there to show me the way.
The mother then expresses her regret:
I am so very very sorry. Everything I did, I did out of love. But that doesn’t excuse any of it, nor does it take it away. And I am sorry.
I suppose I find this so emotional, because I can relate so well to the ferocity of love that a new mother feels, along with the weight of responsibility for not only keeping this new being alive but somehow instilling virtue and life skills. So many of us feel clueless and turn to books. Who knows? Maybe swaddling will turn out to be totally wrong and I’ll have to regret that one. It’s easy to get misguided as a parent, and we all do the best we can. Sleep training? I’m still torn. I’m sure I got that one wrong, if only because I never quite decided to do it one way or the other. We’re all looking for answers, and the secular parents among us might find the wrong answers, too.
I hope you’ll give episode 42 a listen. It’s a great interview.
It is a busy busy time. Even though kids are off school there seems to be less time for anything. This morning we dragged MathMan from his apartment and made him deal with some financial issues, and The Linguist was awakened from her sleep sometime this afternoon. BigBoy actually took it upon himself to take the bus to the mall and spent the cash he got from his grandmother on video games (note to newcomers: BigBoy has some developmental issues, and this is a big step towards independence… hubby was very worried that BigBoy was not home until he saw him walking towards the front door with a big grin on his face!).
So I am a bit slow to publish something because I am actually reading a very long paper… so there!
So while you are all looking for after Christmas/New Year’s bargains load up your mp3 players with the most recent “Parenting Within Reason” podcasts. Trust me, they are all wonderful! Colin is great at interviewing, and Rob is a great pod producer (and trust me, both take lots of hard work).
Let me introduce a few in the past month or so:
This is the entire album on podcast. Do not miss it… and do buy the album for your kids and play it!
Let Your Geek Shine Through!… The new regular podcast host, Julie (who started the RationalMom blog), reveals ultimate geekhood with a tour of Skywalker Ranch. Awesome! Plus the first part of an interview with Ken Denmead, editor of Wired.com’s Geekdad blog.
That is followed by the continuation of that interview here, which includes book selections from Dale McGowan.
Whatever you do, always check for new podcasts, because they will always be interesting! One future podcast promises an interview with Evan Bernstein, one of the Skeptical Rogues from the Skeptics Guide to the Universe, which should already be on your mp3 playlist!
Edit: The Roundtable with Evan Bernstein is now available. Enjoy!
This is part 2 of our conversation with Skekptical OB, Dr. Amy Tuteur. Be sure to read Part 1 before you start reading this post.
DrAmy: I think it’s an enormous red flag and something that American women need to know about.
The Midwives Alliance of North America, as I said, is the trade organization that represents home birth midwives. They were the ones that collaborated with Johnson and Davis on that BMJ 2005 study. They gave them all the data for the year 2000, and after that study was finished, MANA continued collecting statistics, and has collected statistics to this day.
They are currently sitting on the largest single repository of American home births ever assembled. They have, by their own publicly stated numbers, they have in the range of 20,ooo+ home births. Over the years, in their publications and press releases, they kept promising that this data was going to be released and that it was going to show that home birth with a Certified Professional Midwife was safe.
It was due to be released in 2008; well, first it was going to be released any minute, but nobody could ever get it. Then they said they’d be all done collecting it in 2008, but even before that, they started offering the statistics publicly. According to the midwifery newsletters, you could get access to the statistics if you could prove that you would use it for the benefit for home birth midwifery. They have an elaborate application process, and you have to show who you are, and who you work with, and what you’re going to do with it…
Colin: and whether or not your name is Dr. Amy Tuteur
DrAmy: Yeah, well, I haven’t applied, but you can’t make it any more plain than they made it – you have to use it for the benefit of midwifery. Not for the benefit of patients, by the way, for the benefit of midwifery.
Colin: Has anybody leaked the data to you, have you seen it?
DrAmy: The icing on the cake of that whole thing is that once you’re approved to get the data, the last step is that you have to sign a confidentiality agreement with legal penalties if you let anyone else see the data.
Colin: So, you can’t answer my question…
DrAmy: I haven’t seen it, but I don’t think it takes a rocket scientist to figure out what’s in that data is pretty solid evidence that home birth increases the rate of neonatal death, and that’s why they can’t let it out. They’re pretty up front about the fact that they got it and nobody else can see it. In fact, they invoked something, and you have to give them points for cleverness, they announced that, in retrospect, they’ve decided that this is for “community-based research”.
Community-based research, typically, when that’s used is to get members of the community, the study subjects, to buy into the study. You tell people, for example, that you want to collect their DNA, but you’re not going to use it in any way that will harm them, and that’s why people come forward and be volunteers. But, you don’t ask the doctors. You don’t set it up so that it protects the researchers. You’re supposed to set it up so that it protects the subjects, but they say right in their own publication that they have a responsibility to the midwifery community to make sure that the data is used in ways that the midwifery community would approve of.
JohnP: There’s a lot of anecdotal discussion on blogs and board that have to do with home birth. One thing that is often is brought up is someone will say, “Well, my midwife has done a thousand births and never had a complication.” In your career as an OB, how many births do you think you attended?
DrAmy: Thousands. In OB, when I did a residency, I probably did 20, 30, 40 deliveries a week… for years. You see a massive number. This is the benefit of working in a hospital setting, even when I didn’t do the delivery myself, any interesting case was presented, so you learn a lot more than what you personally see. During the period of time that I was in training, my hospital probably did 30, 40, 50,000 deliveries. Anything that went wrong, or anything that was unusual, I knew about, I learned about it. So, you have an experience that cannot be captured in any other way.
Colin: Did you have home birth transfers? Did you see any issues with those?
DrAmy: Yes. Of course, if somebody transfers there’s always an issue. Home birth midwives are not licensed in Massachusetts and so anybody can call themselves a home birth midwife, and believe me, anybody did. I met people who announced that they were midwives after they had gone to eight births, and other women hired them.
They’re really completely misrepresenting their experience. They don’t even have a tiny fraction of the experience that Certified Nurse Midwives have. Certified Nurse Midwives, some of them, not many, some of them do home births, and they have better statistics on home birth than Direct Entry Midwives. Although, their home birth statistics show that they have double the neonatal mortality at home than they do when they’re working in the hospital. Which only stands to reason because obstetrics is basically preventive medicine. You know about a whole bunch of things that can go wrong, and you don’t want them to go wrong. And if they do go wrong, you want to make sure you know about it so that you can minimize the consequences. An emergency can happen from one second to the next.
I know that all obstetricians say that, and so it sounds kind of cliche, but it’s really really true. I always say that some people drive race cars for excitement and other people deliver babies…
JohnP: Could you give us an example of a situation where something could suddenly or unexpectedly happen that you would need to have training to deal with?
Colin: …A worst case scenario.
DrAmy: There are two major things that they have trouble with at home birth. One is fetal distress, all of a sudden the baby’s heart rate goes down and won’t come back up, and that baby needs to be delivered immediately. It can happen. Usually you have some warning, but every now and then, some baby, for whatever reason the bottom drops out and you need to deliver that baby immediately. In the hospital, you can do a C-section in 10 minutes, but at home, the average transfer time to the hospital is 45 minutes, and that’s before you even get anywhere in the hospital. So, you have serious fetal distress at home and that baby is going to die.
The other thing is that there are babies who are born who need an expert neonatal resuscitation with an incubation. Say there’s a shoulder dystocia, the baby gets stuck. The head comes out, but the shoulder gets stuck. And then it’s a long time before the rest of the body gets delivered. That baby can be really compromised by the time it’s delivered. Without an expert who has training in neonatal resuscitation and has done it many times, and by training I mean somebody who hasn’t just read it in a book or did it on a plastic doll, unless somebody has had training and has equipment and knows how to use it, the baby will die. It’s just that simple. If any of those kind of things go wrong, there’s just no way that the baby will make it to the hospital.
In the Wax study, the deaths that occurred in the home birth group are all related to things like that. The excess deaths are from what they call anoxic injuries when the baby, either for fetal distress or for whatever reasons isn’t getting enough oxygen, and therefore dies.
Colin: I wanted to ask you about more alternative birthing experiences. They seem like they’re more and more out there…
JohnP: Water birth!
Colin: Water birth would be the first one that I wanted to ask about. What is the deal with water birth?
Elyse: Women are crazy about water birth. I know women who are like, “I want to get pregnant just so I can have a water birth.”
DrAmy: I think water births are great for whales and dolphins.
Colin: It’s not natural for humans to have birth in water?
DrAmy: That’s the funny thing about alternative health. It’s supposed to be so natural, and then they do all this stuff that is not natural. For example, what’s so natural about acupuncture? How did that end up in alternative health? Steel needles?
It’s the same thing with water birth. Water birth has existed for 200 years. It was made up by somebody in Russia. Primates aren’t supposed to be born in water. It’s very simple.
Elyse: You mean, we didn’t blow up kiddie pools in the caves?
DrAmy: What’s even worse is that the explanations that are evoked as to why water birth should be safe are complete and utter bologna. One of the things that water birth proponents say is that when the baby is delivered, the baby won’t breathe because of the diving reflex. There is such a thing as the diving reflex. Most higher mammals have a diving reflex. When they’re immersed in very cold water, their heart rate slows down, they won’t gasp or do anything for a while… but ultimately they’ll drown. The diving reflex is elicited by cold water, and the whole thing about water birth is that it’s done in warm water, so it can’t even elicit the diving reflex.
So, that’s a bunch of baloney. If the baby is going to suck in water, it’s going to suck in water, and nothing’s going to stop it. The fact of the matter is that inside the uterus the baby has breathing movements. That’s how the baby’s lung develops. The baby sucks in amniotic fluid and pushes it out again. If there’s not enough amniotic fluid, the baby’s lungs will not develop properly. So the idea that babies don’t inspire, and won’t inspire until you bring them up in the air… that’s just baloney. That’s not true. It’s not surprising that babies have died at water birth because they have sucked in a lung-full of water, which is, by the way, toilet water…
Elyse: It’s filled with blood and poo right?
DrAmy: Exactly. Somebody did a study of what’s in the water at water birth, and it’s appalling. It’s basically toilet water. So, if a baby gets a lung-full of that, that’s bad news. The baby can get pneumonia and die from that. And the other thing is, even if the baby doesn’t suck the water in it’s lungs, if it swallows enough water (because babies are so tiny and because the water is fresh water and doesn’t have electrolytes in it) they will get hyponatremia, their electrolyte concentrations will drop so profoundly that they will die just from that. There are have been a number of water birth deaths related to that.
There are some women who say that laboring in water is very relaxing for them, and laboring in water is fine. Just don’t delivery the baby under water because… would you drop the baby in a toilet when you delivered it?
Elyse: I would, but I don’t really like my kids very much. I’m not a very good Mom.
DrAmy: All you have to do is think about it. What’s in that water? It can’t possibly be that good.
Colin: NO! I don’t want to think about it.
One of my friends had a lotus birth recently. I want to respect their decisions, but it seems really… different.
DrAmy: First of all, one of the things about the competition about child birth is that everybody is trying to one up everyone else. This happens in various areas: somebody says “I had a birth at the hospital”, and somebody else says “I had a better birth because I had a midwife”, and then somebody else says “I didn’t even go to the hospital. I had a home birth”.
The thing with the placenta and the cord is that it used to be “oh, my husband cut the cord”. That was the trump card that you could play at the playground. Then it became, “Oh, we waited to cut the cord so that all the blood could be transferred to the baby”. Now it’s, “We didn’t even cut the cord. We waited for it to rot off.”
Elyse: OH MY GOD!
DrAmy: That’s what they do! They don’t cut the cord, and they carry the baby around with the placenta attached. The reason that they call it “lotus birth” is because the placenta is like a flower, so beautiful.
Elyse: If you go to the hospital, it’s a bio-hazard, right? You can’t even leave with it from the delivery room.
DrAmy: Right. It is a bio-hazard.
Let’s go back to square one. Is it natural? Do you see any other animals with newborns dragging their placenta around? I haven’t seen that. So, it’s completely unnatural. It’s an incredible infection hazard for the baby because it’s dead. The placenta comes out, the blood leaves it – it’s dead. So, now you have this giant dead thing hanging off the baby. You just have to hope that it’s not going to get infected and make the baby really sick or kill it.
There’s a whole lot of that because there’s not only lotus birth; the new thing is unassisted birth. DIY Birth. Don’t have anybody there. That’s just a disaster waiting to happen.
In the area of pain relief, the progression is “I didn’t have an epidural”. And there’s people who say “Well, I didn’t have an epidural, but I didn’t even have any pain. My labor was painless”. And then there are the people who say “Not only was my labor painless, but I had an orgasm when the baby was born”.
Colin: OH NO! That’s not right!!!
DrAmy: Yes. YES!
So, if you step back, you can see the competitiveness of the whole thing. It’s very unfortunate. Saying that you had an orgasm during birth, that’s not going to hurt anybody; if you want to say that, go ahead and say that.
Elyse: It’s going to really really upset your child when they see you wrote it on the internet in fifteen years.
DrAmy: I can only imagine what’s going to happen down the road when people see this. It speaks much more about the competitive nature of mothers than it says anything about child birth. It has nothing to do with child birth; it’s about beating other mothers over the head about what a good mother you are.
Elyse: I’ve gotten into a lot of trouble. I wrote a post on skepchick about the things that pregnant women don’t tell you. I wrote about pooping during child birth, and that your genitals swell, and that you get kicked in the cervix. I got just angry angry responses that I would dare talk about such a thing. I got a lot of angry letters from dads.
I’ve seen the posts in the natural parenting boards that they’re talking about how I don’t understand what a beautiful experience child birth is, and that I’m mourning my birth experience. I just want to say that I’m perfectly happy with my over-medicalized “big pharma” hospital births.
DrAmy: There’s an unbelievable amount of “ostentatious sadness”. They’re always sad for you what a terrible birth you had. People write to my blog all the time and say, “You’re a horrible, terrible person. You must have had four c-sections”. Well, I didn’t. And, “Oh, you must have never had a child birth without anesthesia”. Well, actually, I had a couple of those. They just imagine that anybody who doesn’t make the choices they made are deficient in some way.
Elyse: For me, it was even that I dared say it was unpleasant. People accused me of sterilizing the human race with a blog post. Honestly, that would be an amazing accomplishment, and I kind of wish I did just to say that I did it!
DrAmy: If you think about it… it’ in the bible. It was so incredibly impressive, the agony that child birth is, and that is what it is… agony. There are some people who have easy labors, but they are few and far between. The rest of the people aren’t faking. They are screaming their heads off for a reason. It really really really really hurts. That was so impressive to the ancients that they decided it must be a punishment from god, otherwise how do you explain something so dreadful?
So, they have people turn around now and say, “Oh, it’s just fear that makes it painful.”
Elyse: No, it’s the contractions!
DrAmy: It’s just that baby’s head that makes it painful.
Colin: Do you have any advice for mothers who have decided to do a natural birth and are worried about the pain? Is there any evidence for hypnotism or lamaze?
DrAmy: I always told my patients, “Have an open mind”. Child birth is the only thing where people tell you to decide not to get pain medication before you feel the pain. That doesn’t make sense to me because shouldn’t you know how painful it is before you decide whether or not you’re going to need anything for pain relief? But, people make up their minds and say “I’m not going to have anything. I’m going to try hypno-birthing.”
Most of that stuff does not work. The only thing that works is an epidural. Some things help people. Some people find that the water is soothing. Other people hate it. Some people say that hypno-birthing works for them, but for most women it doesn’t work.
Colin: What about the idea of standing up? They say that lying down makes things harder for women.
DrAmy: There’s really no evidence of that either. If you think about it, if gravity were necessary to have a baby, babies would be falling on the floor all the time, every time a woman stood up. If only! If only standing up made your labor easier.
Which is not to say that you shouldn’t stand up. If you feel comfortable standing up, go ahead and do it. You should labor in whatever position makes you feel comfortable. But, the idea that moving around or standing up is somehow going to make your labor better or shorter… if only!
Colin: Let’s talk about some of the accusations that the alternative birthing advocates make that kind of ring true to me, or at least make me think twice. The first one is that doctors schedule c-sections out of convenience because they don’t want to be there all night long waiting on a baby to be squeezed out. Or that they schedule c-sections for reasons of profit, rather than safety.
DrAmy: In most places where doctors work for health organizations, they don’t make any more money by doing a c-section, and c-section rates are just as high in those places. In fact, if you look at systems like Canada or the UK, where the doctors are all on salary, they have skyrocketing c-sections too. So, it clearly is not the profit motive.
Do some people schedule things for their own convenience? I don’t think there’s any question over that, but I think more commonly women schedule c-sections for their own convenience. My feeling is that a c-section or an induction, those are medical procedures and they should be used for medical indications. And that’s actually what The American College for Obstetrics and Gynecologists says too. You need a medical reason, and convenience is not a medical reason.
Colin: What about the accusation that epidurals and pitocin have a cascading effect, or a domino effect? That one causes the other causes the other, and now… oops, you have a c-section?
Elyse: It’s not that the pitocin or the epidural end up with requiring a c-section, but now that you’ve gotten one intervention, your doctor thinks you now want a c-section.
DrAmy: It certainly can happen like that, but most women who get epidurals don’t get c-sections.
Does it increase your risk? There are big studies that say it doesn’t. What people don’t realize is that epidural is a technique. It depends on how much medication is put in it, and how often medication is put in it, and how often it’s refilled, or whether it’s done continuously. I do think those things have an impact on how labor goes, but you can change them. If somebody has no feeling when it’s time to push, you can turn down the epidural so they can get the feeling back. I always discuss that with my patients beforehand, if you’re not going to make progress with this epidural, we’ll talk about turning it down and you’ll get some of the pain back, but you’ll be able to push better. Those things can have an impact, but you can change the impact.
I will be the first person to say that the c-section rate is completely out of control. There’s absolutely no medical justification for a 33% c-section rate. But what’s driving it is for a large part the medical legal climate. People expect to get a perfect baby, and if they don’t get a perfect baby, they expect that it must be somebody’s fault and that somebody should have to pay for it. And when you’re the obstetrician and you’re looking at a monitor strip and you say, “Well, I don’t know. This baby could be doing OK, but there are some signs that are worrisome to me.” There are no downsides of doing a c-section because the obstetricians primary job is to present a healthy baby to a healthy mother, and a c-section is usually a guaranteed way of accomplishing that.
Colin: I want to ask you about birthing centers. I feel like they’re a good compromise for people who want the comfort of a home but don’t want to feel like they’re in a hospital.
Elyse: But with access to a hospital.
Colin: Right. They have access right there to a hospital but they feel like they’re at home. Are you down with birthing centers?
DrAmy: They have a good safety record. They have an excellent safety record. One of the things about birth centers or CNMs, they are very up to date on research on what is really going on, and what could happen, and they have real concrete plans on how to handle emergencies. The problem with home birth in the US is that they’re all about not having any plans. It’s about trusting birth. When you trust birth and don’t make any plans, the potential for disaster exists. Birth centers, they are a homey atmosphere, they’re much less technological, but the bottom line is that they don’t completely trust birth. They know that things can go wrong and they’re prepared when things do go wrong.
Colin: Thank you so much, Dr. Amy, for speaking with us!
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…
Dr. Stuart Brown, author of PLAY: How it Shapes the Mind, Opens the Imagination and Invigorates the Soul“ answered this question from Jen Schoenleine of Cincinnati, OH on episode 11 of Podcast Beyond Belief.
How can I best encourage my shy child to participate in group play?
That’s a tough one.
I think that a shy child does need a certain amount of protection if they’re temperamentally fearful. Part of the avenue into playing more vigorously can often be through animal play where there’s frolicking (it depends on the age of the child) with a puppy or kitty, where there can be this experience of freedom without being intimidated by a group. And then, often, having a child that’s younger who the shy child can teach about a game may enhance that shy child into becoming less fearful and less intimidated by groups.
But to suddenly thrust a temperamentally shy child into a large group of boisterous players is shock treatment, not fun. Jerome Kagan and some other people have written quite a bit about the help one can give a shy child without overwhelming them.
And there’s nothing wrong with solo play – private fantasy play in a shy child can be very fruitful and very useful. The kid shouldn’t necessarily be criticized or pushed beyond where they’re able to go if they’re temperamentally very very shy.
There is a natural play nature that one can see in any kid, and I think that threading the needle and finding that and allowing that kid to have some joy will allow greater safety and, developmentally, more tendencies to be less fearful as they grow up.