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Sunday
Sep042011

Suddenly...

… I notice I don’t fit in the Natural Childbirth Community (NBC) anymore. This is probably a “duh” moment for many folks, but it wasn’t until I was invited into a Natural Birth Professionals group in Facebook that I really caught up that I just don’t belong anymore. 

I cannot support the unrealistic and non-evidence-based beliefs of so many of these women. I stuck it out for a couple of days thinking a dissenting opinion could be a good one, but it was obvious peer pressure was the unspoken rule of the road. 

When the topic of the Brewer Diet came up and I said it was pure bunk and could actually cause harm to the kidneys in susceptible women (which I have seen happen first-hand), several women defended it saying so-and-so had preeclampsia in one (or more) pregnancies and then followed the Brewer Diet and miraculously didn’t have preeclampsia in that pregnancy. Another woman said some woman was an “expert” on the Brewer Diet and she was on their faculty. Surprised, I looked to see what college she was the faculty of and it was a non-NARM-accredited “midwifery school.” Can you see me rolling my eyes? I’ve been asked to discuss the Brewer Diet here on several occasions and am sure I’m getting close to expending the time and energy to do so, but that isn’t the purpose of this post. 

This post is to express my dismay at the Natural Birth Advocates (NBAs) and their continued insistence on evidenced-based care and then going completely against what evidence there is! From homeopathy to acupuncture… from not acknowledging anything being too risky to deliver at home to the blasé acceptance of babies dying or being damaged in homebirths… I just can’t take it anymore. 

I may never have another reader again… may be boycotted the way the SOB is, but that’s fine with me. I am not going to tow the party line any more. I don’t know what I would consider myself, but I do need to separate myself from the NBC. 

The Birth Professionals group was one thing, but the cesarean birth my daughter just had was the last piece of patience I had. 

When Meghann got pregnant, we discussed home and hospital birth. I simply did not feel comfortable encouraging a homebirth for my granddaughter and helped her find a wonderful group of CNMs. They were fantastic! Then, on August 31, my daughter went into natural labor and we went to the hospital when it seemed she was in active labor. I’m leaving out a slew of details because I don’t want to tell her story yet, but we were treated like royalty at the hospital, a truly unhindered birth even with tiny bits of technology thrown in (an oxymoron to the NBAs). Meghann and her husband Brian were kind enough to let me chronicle her labor and birth on my Navelgazing Midwife Facebook page and the grand majority of folks were lovely and incredibly supportive. But, when things shifted and it was obvious a cesarean was necessary, a couple of purists felt it was their place to comment… er, judge… what they thought was happening, without the benefit of actually knowing because I wasn’t expressing everything online. 

I paused as things moved to more complicated, thinking, “How will this look to others? A midwife whose UC-born daughter needing a cesarean?” And I hated that I even had to expend an ounce of energy on such a stupid, irrelevant thought. Why should I care one iota what others think? 

Because (too many) others will tear apart her birth story… especially if I wrote her story out, which I am not sure I even want to anymore. Even if I wrote the facts as I know them, her decisions will be picked apart like so much carrion; like I have done to others’ stories myself. 

This acknowledgement that I have dissected other women’s stories is another aspect that lets me know I’ve left the NBC; I am embarrassed and even ashamed that I have hurt other mothers and perhaps tarnished their stories. I pray I won’t ever do that again. 

Just the few negative comments about Meghann’s choosing to have a cesarean after 32 hours of labor and bouts of fetal distress soured me on laying out her birth, knowing criticism will be a side effect of the story here in my blog. 

This morning, I read through the comments and questions on the Natural Birth Professionals page and winced seeing women I simply cannot have civil conversations with anymore. I try to be polite, but their out and out ignorance… and, I’ll just say it… stupidity about what they think birth is supposed to be irks me no end. And the topics? rolling my eyes again How many times can we hear to leave women to labor indefinitely because their body will work it out if left alone? Or that pain relief should be the absolute “last resort” after trying every single idea the judging woman thinks is appropriate? 

I just can’t take it anymore. I’ll have to find a name for myself. I embrace “Medwife” now, but think there’s a place for us middle-of-the-roaders… Realistic Birth Advocates? I kind of like that. It’s taken nearly thirty years to get here, but here I am. And perhaps for the first time, I feel at peace with my place in birth.

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Reader Comments (111)

So Joy, what you're saying is that if you're only virtuous enough to follow the Correct version of the Brewer Diet that magically I wouldn't have had babies big enough to have been harmed or even killed from shoulder dystocia due to their size?

Protein bingeing is protein bingeing is protein bingeing. 100+ grams of protein daily is... PROTEIN BINGEING. There is no way on earth that protein bingeing is going to magically prevent an autoimmune disease with improper angiogenesis. And? I was never at risk for pre-e either, and not at risk for low birth weight. All this did was the equivalent of pouring fertilizer on a sequoia and I had to give birth to babies who were closer to 3 month olds than to newborns. It was inhumane.

Same father for all my kids, approximately the same healthy BMI starting out pregnancy with all of them, and no gestational diabetes. I have never failed a GTT in my life. The only thing done differently was protein bingeing a la Brewer, followed more intensely with the 11 lb kid than the 10 lb kid. And subsequent pregnancies *shockingly* not measuring hugely ahead the whole time! No more giant babies!

If I sound angry, it's probably because I am angry. I am angry that I suffered and my children were put at risk unnecessarily by a diet that brought on macrosomia. And macrosomia isn't safe.

September 8, 2011 | Unregistered CommenterJH

"One of the requirements of scientific research is that it be replicable. Brewer's work hasn't been replicated."

This is another one of those myths and bits of misinformation that has been passed around the internet in recent years.

Dr. Brewer was not the first researcher who was investigating this way of preventing PIH/PE/E/HELLP. In fact, he was replicating the work of many doctors who had done the same work before him. He also had several doctors who replicated it in his own time. So this view of how this syndrome works has been well replicated many, many times over, for at least the past 130 years. I've been told that it is also a principle of research that once something has been researched well, there isn't much reason to research it over and over and over again.

"There is no current evidence (and in the 40 years since his original work was done, you'd think someone would have found something, anything) that diet does anything to affect the incidence and course of pre-eclampsia."

You can take a look at a very abbreviated timeline of some of the research that has been done on this page of my website. Even that abbreviated list has more studies on it than you would imply. Some of it on that incomplete list is as recent as 2006 and 1982.

www dot drbrewerpregnancydiet.com/id80.html

"Current consensus is that a problem in angiogenesis and the invasion of the spiral arteries during the initial development of the placenta plays a role, which has absolutely nothing to do with protein intake later in pregnancy."

As you know, consensus does not good research make. People can agree on an opinion and still be wrong.

Also, you are showing a misunderstanding of the "Brewer" viewpoint here. The "Brewer Diet" does not advocate protein intake only, and it does not advocate protein intake at the late stages of pregnancy only. It advocates a balanced intake of protein, calories, and salt, as well as other nutrients, all throughout the pregnancy, and especially during the second trimester--precisely at the very time that the placenta is going through most of its development, and for that very reason.

"The Brewer diet is bad science. It's illogical. It's never been replicated. What do you have except anecdata to recommend it?"

I disagree with you 100% on every count. It is the best science out there on this issue, since it is based on the physiology that is occurring in the pregnant body and the placenta, throughout the pregnancy. It is completely logical. It has been replicated repeatedly. And fortunately it has ALSO been substantiated thousands of times anecdotally, all over the world.

In addition, the many pieces of this viewpoint (commonly attributed to Brewer but actually the work of many), are taught every day in every med school in the country--the A/V shunt behind the placenta, the blood volume expansion of the mother, the secretion of renin when blood volume becomes abnormally low, etc, etc, etc. The only place where they are lacking is in the putting together of all of those pieces for the understanding of how the syndrome is triggered.

Joy

September 8, 2011 | Unregistered CommenterJoy Jones

"So Joy, what you're saying is that if you're only virtuous enough to follow the Correct version of the Brewer Diet that magically I wouldn't have had babies big enough to have been harmed or even killed from shoulder dystocia due to their size?"

I am saying that virtue or lack of virtue has nothing to do with the issue.

I am saying that magic has nothing to do with the issue. It is simply a matter of following the physiology already present in the placenta and meeting the needs that are already there.

I am saying that many people are taught an inaccurate version of the Brewer Diet, through no fault of their own, and then it does not work for them.

I am saying that there is no way that I can comment on your particular history because there are too many unknowns which are not published here publicly, for me to do that.

I am saying that I am empathetic and sorry that you had that experience.

"Protein bingeing is protein bingeing is protein bingeing. 100+ grams of protein daily is... PROTEIN BINGEING."

I disagree. For pregnancy, this is the precise amount of protein that is necessary for all of the processes that are needing to take place. In addition, the so-called "Brewer Diet" does not focus exclusively or primarily on the protein. It is a balanced diet that focuses on many nutrients, which all work together to make the protein intake safe.

"There is no way on earth that protein bingeing is going to magically prevent an autoimmune disease with improper angiogenesis."

If there is an auto immune component and/or a component of improper angiogenesis, it is a result and a response to the disease process already triggered by the liver disease and inadequate osmotic pressure and low blood volume which is created by the inadequate nutrition which puts the whole PE process in motion.

"And? I was never at risk for pre-e either, and not at risk for low birth weight. All this did was the equivalent of pouring fertilizer on a sequoia and I had to give birth to babies who were closer to 3 month olds than to newborns. It was inhumane. Same father for all my kids, approximately the same healthy BMI starting out pregnancy with all of them, and no gestational diabetes. I have never failed a GTT in my life. The only thing done differently was protein bingeing a la Brewer, followed more intensely with the 11 lb kid than the 10 lb kid. And subsequent pregnancies *shockingly* not measuring hugely ahead the whole time! No more giant babies!"

Unfortunately, any pregnant woman can be at risk for PIH/PE/E/HELLP when her blood volume gets too low relative to where it is supposed to be at any point in her pregnancy. But I am glad that you found a way to have other pregnancies that you are happier with.

"If I sound angry, it's probably because I am angry. I am angry that I suffered and my children were put at risk unnecessarily by a diet that brought on macrosomia. And macrosomia isn't safe."

I am sorry that you suffered, but I do not think that it was the "Brewer Diet" that did it.

September 8, 2011 | Unregistered CommenterJoy Jones

Joy: can you give me the name of a single peer-reviewed study, published in the last, oh, eight years, that supports the Brewer Diet? Because my understanding of Pre-E / PIH is that it stems from an incomplete trophoblastic invasion, it happens before a woman even knows she is pregnant, and good nutrition helps only to the extent that good nutrition helps anyone in rough circumstances.

You keep sending people to your web page, but if you have the cites, surely you can list one here.

September 8, 2011 | Unregistered CommenterKathryn T.

Joy, your misunderstanding of research is a little appalling. You cite no studies published in a peer reviewed journal after 1980. You do recall that in the 1970s it was still quite popular to use bromocriptine, correct? The state of the science has advanced a bit over the past 31 years.

Your citations are almost exclusively of small studies with significant flaws in their design models, several of which would not pass IRB scrutiny and several others of which deal with clinical malnutrition in medically-underserved countries.

You do not understand the difference between citing a non-peer-reviewed book written by Gail Brewer or Tom Brewer and replicating the research results on which you have based your argument.

There is a difference between intuition and science. Consensus is not a bad thing; the Cochrane Review, the gold standard for evidence-based care, is, after all, a consensus agreement on a review of the science. Belief is not the same as evidence.

You seem to have a lot tied up in your faith in Brewer. That's fine. But practicing midwifery based on faith is no better than believing God will protect me from a car crash. There's no evidence there, only belief. We're professionals. We're paid for our professional opinions and skills, not for our beliefs.

September 9, 2011 | Unregistered Commentermeghan

I will post one last time, and then I retire from this conversation. If anyone really wants to know more information about how the Brewer Diet works, they can email me. The address is at the bottom of every page of my website. I will probably not respond to emails which seem to be interested in debating just for the sake of debating, or to emails that are just venting at me.

There are many places on my website where people can find the references to the studies that I have so far. Many more are hopefully coming out within the next couple of years, in another book. But even among the old studies, there is more references of great significance than is being given credit for in these comments.

Here is one case in point....

3 clinics, Contra Costa County, California
2 clinics followed Dr. Brewer's recommendations
1 clinic did not
12 1/2 years
25,000 women
7,000 women seen by Dr. Brewer personally

"toxemia" @ 0.5% with none progressing to eclampsia

"The data showed improvement in every category. There was a period during which the Pittsburgh clinic continued to use conventional methods while I used nutrition in the Richmond and Martinez clinics, so we used the Pittsburgh clinic as a control. The Pittsburgh clinic had 10 times more hypertension in first pregnancies than the Richmond and Martinez clinics. Those findings were published in the Journal of Reproductive Medicine as a preliminary report. (51) A team of eight government researchers spent three years going over 5600 cases. They studied every blood pressure reading, every urinalysis, and every other test recorded on the charts, and they verified our results."

This quote is from an interview in Townsend Letter, which you can view here....

findarticles dot com/p/articles/mi_m0ISW/is_256/ai_n6258848/?tag=mantle_skin;content

Joy

September 9, 2011 | Unregistered CommenterJoy Jones

Don't have a lot of time to write tonight...but frankly I'd like for everyone to dispense with these artificial groups (that means you, SOB, etc etc etc). It's just too easy to create a so-called group, give it a label, and then use that as your straw man. In reality there is no HBA, NBA, NBC, or whatever you want to call it. It's just a collection of individuals who don't belong to an organization, who don't agree on everything, some of whom say wise things and some of whom say stupid things (but of course it's easy to take all the stupid things and use that as representative of all of these made-up groups).

So yeah, down with groups and labels.

Not to mention down with pointing to something someone said on the internet and using that as your punching bag.

Better get to bed...night!

September 10, 2011 | Unregistered CommenterRixa

Barb, I am beyond the moon thrilled for you and I still love you... I just want to add my agreement to Rixa's that we shy away from straw women.

Oh, and to just address two little points in comments:

I have not identified myself as a "natural childbirth advocate", well, ever. For me, that would mean that I feel everyone should have a natural birth. I'm not a homebirth advocate for the same reason.

Is this a semantic thing, or...? Maybe it's just me? I advocate for the ability to make important choices even I would not personally make. Advocating something that needs more respect, recognition, etc. =/= enforcing that something on every individual and her choices.

And what evidence do you have that epidurals actually cause "issues?"

I think this comment-- which goes on to discount epidurals' causing breastfeeding "issues"-- speaks to the general disconnect between most of the (speaking for Americans) population and the quote-unquote NCB community. I honestly am not convinced (though I haven't researched it thoroughly) that epidurals have a huge direct negative effect on the baby. In fact, of all common interventions, the epidural (in a social/medical vacuum) is probably one of those I see most positively... even though I'm planning a homebirth, etc. crunch crunch.

But what's interesting to me is, many folks, when defending what are essentially routine epidurals, will say they have no effect on the baby. Well, I don't believe that's even possible, but of all possible effects, I would be willing to say the direct effect on the baby is probably the least proven and least concerning effect of epidurals. What gets me, though, is that (the implied direct effect of DRUGS ON BABY) is supposed to be women's only concern, so as long as that can be allayed, go for it! Or as long as we can convince you there are none, then what are you trying to do? Win some sort of martyr medal?

And I have seen some "mainstream" women be a bit uneasy about DRUGS ON BABY but be reassured when they are told that the drugs won't have any effect. So it's out there.

The whole thing is a bit of a weird... red herring? smokescreen? disconnect? for me. IDK if I'm making any sense here, but I guess I'm trying to tease this out. The answer to the above comment is a huge laundry list of "issues" that don't deserve scare quotes and that tend to come with any serious, invasive medical procedure and some pretty hardcore drugs. Added to that, demonstrable effects on labor-- some of which can be positive-- but some of which can be negative. That doesn't mean A) ALL women will experience all of the negative effects, nor does it mean that B) it's not worth the risk in some/many cases.

It is what it is, but a sarcastic challenge that implies there is no evidence that a serious medical procedure involving narcotics causes any issues would almost be laughable if it didn't have an underpinning of something more complex... The idea that women only care (or only should care) about their babies and not themselves, future pregnancies, etc... And not even that, but that women only care about or can understand DIRECT effects of interventions on their babies. YKWIM? It's just a phenomenon I've noted... I kind of cringe when I see the occasional NCB-advocate saying self-righteous things about how SHE would never DRUG her baby... Because it's a little specious IMO. And same goes for those who poo-poo NCB by saying that the drugs have no effect on the baby so what's the big deal? DRUG ME UP!

It's like... we're not even talking about the real issues here. And I think that's by (subconscious) design.... Actually, I think the whole pain thing is a sort of misdirection-- not that pain doesn't exist, of course, but the way it shapes 99% of the "conversation" outside of tiny niches like this one... but that's for another day.

Hmmmm... I guess I can't make a short comment. :P

September 13, 2011 | Unregistered CommenterDreamy

lol, what following you might lose with NCB you have gained with Dr. Amy's sychophantic followers. Congrats! HA!

MEDwife is reserved, from my mindseye definition books, for a midwife who is so obsessed with the given establishment's (be it natural or medical) protocol that they are willing to ignore women's personal autonomy to do whatever they believe is "best" for women in a paternilistic fashion, much the same as a crappy doctor might. Be it for or against intervention. ---I---- had a medwife.

As far as your daughter's birth I'm not gonna judge... Your daughter thought about and accepted her interventions according to you.. but SHE is the only one who can tell anyone (not necessarily us as I am not really interested in it unless she wishes to talk about to me specifically (very unlikely).. but herself, her hubby, etc.) whether or not she felt her autonomy was respected or not... I won't respect YOUR - you the mama/grandma who was there - opinion any more than I'd respect my mom's opinion of the whole thing that happened with me.

Personally.. My GUT reaction to -MY- birth was one of strength and coping and even thankfulness towards the people who inflicted me with great harm. 2 weeks later I was realizing that I was suffering from PTSD symptoms and then would be classified as a big hot mess. A year later I was a HUGE hot mess. The truth is somewhere in the middle.

What sort of mama/Grandma would you be if you let your daughter get her autonomy walked all over? Or stood by and GASP let your daughter be harmed ?!

What sort of husband was my husband who let his wife get his autonomy walked all over?

TYPICAL.

I think it is TYPICAL to let women have their autonomy walked all over. In hospitals, and yep.. at home.

It's also typical to be a person who watches their loved one get hurt INEVITABLY. It is sad, but, people get hurt. If she is hurt, it is probably not your fault and could have been inevitable.. But respect the hurt if it's there.

The urge to be controlling with how pregnant women act is almost like some sort of societal mental disorder and most people suffer from it. The few that don't are baffled by why other people think they should get to control what pregnant/birthing women do with THEIR bodies.

Likewise, the urge to tell someone that is hurt.. that they "are not hurt, just be happy/positive" is also like some sort of societal mental disorder and most people seem to suffer from it. IT is like, being "hurt" by something is some sort of disease that other people can catch and you must GET OVER IT AS SOON AS POSSIBLE.

(mind you, I'm not saying she is hurt at all. Just. It's possible. I don't think it is rude/bad/in any way uncalled for to point that out? People tend to be ASSHOLES after all).

IF you somehow helped your daughter through the system and her autonomy was truly respected, congratulations to you.. and her. Really. REALLY. I think a lot of people are in denial about how much they are not consulted about decisions "made for them for their best interest by someone "with more education!"" and how that could kill them or their children in a "fluke" (HAHAHAHA!) medical "error". ((the statistics do not pan out here for just "listening to the experts"... the odds of a medical error murdering you are rather high, one of the top killers in the U.S., actually ))

I have called a homebirth midwife a medwife. I have called an LLL leader a b (I'm an LLL leader).. and I have called a fellow homebirth mother a sheep.. my exact wording after saying she was a sheep was "maybe it's a different breed but BAAAHHH is your language of choice".. I've also had a lot of choice words for folks who seem to think mainstream unquestioning of anyone who is an "expert" = epitome of all existence and I am an idiot.

The middle of the road is looking mighty fine to me, too.

I highly doubt you will publish this but at least you'll probably read it. Preference actually as this was kinda meant for you, anyway :)

September 14, 2011 | Unregistered CommenterEnilea

Enilea:

You're right. I'm NOT publishing your comment. I'm of the belief that schizophrenic rants don't need to find the light of day here on my blog.

'Nuff said.

September 15, 2011 | Registered CommenterNavelgazing Midwife

.... I worried how you'd receive what I wrote to you.. but.. wow!

I'm not a schizophrenic.

There's a chance I could -become- schizophrenic eventually. I'm a bit of an odd thinker, also been diagnosed as on the spectrum of autistic.... but.... really? You're rude.

I'm a real person. With real feelings. You're obviously a narrow-minded bigot and you could've replied to me in my REAL e-mail address rather than writing that here.

My post was not really that inflammatory,but, I really just wanted you to read it... because I wanted you to stop for a second and remember that YOUR perception of events and HER perception of events are going to be different.. and will change based on circumstances around her..

My husband SINCERELY, SINCERELY did not believe that I was egregiously acted upon by having my objections to penetration and other acts - ignored and simply looked upon as an incompetent (because I had a fever? was in labor?) person saying no.

I was saying no in an educated manner in my mind.

Your daughter said yes.. but.. what I want to talk to you about briefly, I expect you not to share.

I was molested. I said yes, a lot. I even lied for him, and defended him against authorities. But, I did not know any better. Later in life, I realized my mistake.

THAT is how a lot of birthing women feel. Even if things are necessary - because - they are done in a manner that is now how they wished/displayed/said or simply rights are violated in the process.... And, I resonate with that.

If that is some sort of craziness off into left field for most people, then, whatever.

All I was trying to tell you was that I thought people jumping on the other side might be making too smokey and emotional issue or conundrum she might have.. make her just say to herself "don't whine about this, it's not important" (I did that as a little girl, and as an adult.. it's a shame really). Really, saying what you're feeling -when you're feeling it- and having it dealt with can stop a lot of focusing on it later.. but.. eh..

I'm apparently the crazy there (the there being over THERE at SkepOB) and now apparently the crazy here. And thoroughly Un-welcome at both. Gotcha. Noted. :) If you have anything else incredibly rude to point out, please direct it at my e-mail.. which is a real one that is listed here. Thanks.

September 19, 2011 | Unregistered CommenterEnilea

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