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Monday
Sep052011

37 Percent

Continuing from the blog piece entitled “Your Home Birth is Not a Feminist Statement” by a research scientist “named” Isis, she makes this comment: 

Even more interesting, up to 37% of home births result in emergency transport to a hospital.” 

In Science-Based Medicine, the August 3, 2010 post by Harriet Hall, “Home Birth Safety,” talks about the infamous Wax Study’s contention that 37% primip homebirths transport to the hospital, saying: 

“Having delivered a lot of babies myself and having seen normal low-risk deliveries turn to disaster in a heartbeat, I would never have considered having my own babies at home, and I would personally be very frightened to attend a home birth, especially if there was a 37% chance of it ending with a nerve-wracking rush to the hospital. I would rather see babies born within easy reach of a C-section and other lifesaving interventions.” 

To clarify what the Wax Study says: 

“However, such investigations likely underestimate the risks associated with planned home birth, as up to 9% of parous (women with one previous delivery [presuming vaginal] and 37% of nulliparous (women who’ve never had a baby [presuming vaginal]) women intending home birth require intrapartum transfer to hospital.” 

Homebirth midwives move women to the hospital two ways: via transfer and via transport. I’ve been very careful to make the distinction and if the writers above would have, it would make things clearer for their readers. The Wax Study doesn’t clarify which transfers are emergency and which are not, but they should have. 

My definition of transfer is it’s a get-in-the-car-and-head-to-the-hospital type of trip, whereas a transport is a call-the-ambulance,-it’s-an-emergency (and not even necessarily a life and death emergency!) experience. Note the huge difference between the two? Life and death emergencies are rare even when transports might not be. I cannot imagine there being a 37% transport rate anywhere in the US. 

To point out once again, if the Wax Study were exactly correct (and that’s highly debatable, but not for me to do so as I am not a statistician), “up to 9%” of women who’ve had a baby before and “(up to) 37%... require intrapartum transfer to hospital.” Looking at most bloggers and reporters around the Net, one would think the entirety of homebirthers in “first world” countries have a 37% emergency transport rate. Not true! 

Even I, with a higher transfer/transport (combined) rate than many midwives (who report about a 10% transfer rate, with a 1% emergency transport rate) did not have “emergency transport(s) to a hospital” at 37%. I will acknowledge, however, that my combined transfers and transports fell in almost exact line with what the Wax Study; about 10% for multips and about 40% for primips. I can hear homebirth advocates gasping, but I feel vindicated by the statistics stated in the study/studies. Remember, some definitions of “intrapartum” include from one to four hours postpartum; the Wax Study does not state their definition of intrapartum, but seems to include several postpartum (post-placental delivery) indications for transfer/transport. 

Before reviewing my own stats several months after closing my homebirth practice January 1 of this year, I felt that people’s shock at the 37% was unwarranted. I would never have guessed my own rates would be that high, but thought, instead of being horrified by the number, midwives should be applauded for seeing the changes from low-risk to higher/high-risk in labor and immediately postpartum. Isn’t that what a midwife is for? To assess the risk and move the woman to the hospital? Personally, I would love to believe there was a nearly 40% recognition of a woman’s need to be in the hospital. That way, the hospital is not receiving what they so frequently call “train wrecks,” but are  seeing the women long before an absolute crisis occurs. 

The 37% number is bandied about like it’s a demonstration that that percentage of women should have been risked out of a home in the first place, but I see it as an acknowledgement that 37% of all women who start out low-risk might be transported during labor or the birth. I do not believe just because a woman moves to the hospital she automatically shifts to high risk. It merely says she has moved out of the realm of a straightforward homebirth. Hospitals are places for far more than emergencies. 

(Some) Reasons women might transfer (in a car, unless mom requests ambulance) from home to hospital during labor (the types of situations the Wax Study would include… from my memory, then checked with my Standards of Care): 

-         Continuous vomiting

-         Fever or even just the mom’s temp increasing over time

-         Prolonged rupture of membranes

-         Abnormal bleeding

-         Active HSV genital lesion

-         Exhaustion

-         Fear (of home/situation/gut instinct)

-         Increasing blood pressure

-         Prolonged labor

-         Prolonged pushing

-         Mal-position of the baby

-         Thick meconium upon rupture of membranes 

(Some) Reasons women might transport (in an emergency, via ambulance) from home to hospital (again, the types of transports the Wax Study would include): 

(From the Medical Board of California’s Standards of Care -) 

-         “Prolapsed umbilical cord

-         Uncontrolled hemorrhage

-         Preeclampsia or eclampsia

-         Severe abdominal pain inconsistent with normal labor

-         Chorioamnionitis

-         Ominous fetal heart rate pattern or other manifestation of fetal distress

-         Seizures or unconsciousness in mother

-         Evidence of maternal shock

-         Presentation not compatible with spontaneous vaginal delivery

-         Any other condition or symptom which could threaten the life of the mother, fetus or neonate as assessed by the licensed midwife exercising ordinary skill or knowledge.”

-         Retained placenta or placental fragments 

Two questionable intrapartum reasons from the Standards’ list are “laceration requiring repair outside the scope of practice or practice policies of the individual midwife” and “neonate with unstable vital signs.” I say questionable because they could be considered postpartum reasons versus intrapartum reasons, depending on whose definition you’re using. 

Can I tell you how many times I (and others) have transferred for something that resolved mid-trip and the thought, “We could have stayed home after all!”? My mantra for transferring/transporting to the hospital is: I’d rather be told “You didn’t need to come in,” than “Why the hell didn’t you come in sooner?” While moving into the hospital can create hardship for the families, most specifically, financially, I hope they would rather be there and not need to be than staying at home and needing to be in the hospital. It’s totally a judgment call… one that takes a great deal of experience to tell the difference. Even with experience, I know I erred on the side of caution. Too many midwives become complacent, thinking they know better than the law and don’t transfer or transport for reasons they would expect another midwife to transfer/transport for. Yet, when someone has a bad outcome, interestingly, rates of getting a mom or baby to the hospital go up. What made the difference? Complacency went down. 

One of the most common questions a midwife is asked during an interview is how often she transports. Instead of looking for a midwife who transports only a very few women a year, women must take her years of experience into consideration. I’d even go so far as to say the newer the midwife, the higher her transport rate should be. Unless she is meticulously within the understood limitations in most midwifery communities: no breeches, twins, older moms, VBACs, etc., her rate will be higher than a more seasoned midwife. Sure, the limitations are controversial, but they are there for a reason; they increase a woman’s risk of moving out of the realm of normal, whether during pregnancy or the birth. With experience, the midwife might expand her competency in variations of such pregnancies. This, of course, begs the question: “Where will she get the experience if she’s not doing them?” The answer is: “By attending births with midwives who have more experience,” or even by being in the hospital where the safety net is standing by. On-the-job training is unacceptable for midwives. 

And who wants to be the practice client for an inexperienced midwife, especially with a complicated pregnancy or with the upcoming birth? If you say, “Me,” I worry about your motivations for a homebirth. If you say, “Not me!” I applaud you. I know I wouldn’t let someone practice on my body or baby… without the supervision of a very experienced midwife. 

Instead of being ashamed of higher rates of transfers and transports, I hope midwives will now be proud of their statistics because they can accurately demonstrate her appreciation for mid-labor, birth and postpartum movement from low-risk to higher-risk. Isn’t that what we hire her for in the first place?

Reader Comments (24)

I agree wholeheartedly! I always think of midwives like life guards. I know how to swim. I have done it many time before (G6P6) but you never know when you might get a cramp(need to leave home or receive more intervention @ the hospital). I want someone at my birth that can recognize when I need to be pulled from the water either figuratively or literally.

I think my own issue with MD vs CNM is that if a CNM told me I needed to go to higher care I wouldn't doubt them. They do not stand to gain anything infact often time from an insurance standpoint they will lose money on a transport/transfer. If an MD told me I needed higher care I always question their motives because often times higher care means better pay from the insurance company.

September 5, 2011 | Unregistered CommenterRachael

I say the transfer rate represents also midwives giving women a chance to birth at home. Some will need to transfer, but it cannot be known in the beginning. I think of my labors and births, I had meconium all 7 times, that could have meant transfer according to the non-emergency list. I also had babies stuck at 9cm with a lip that didn't move for hours. I may have given up with frustration. I did, in the last two births, end up with pit after and comments about a bit too much bleeding. No one said PPH, but I was on an IV and not allowed to eat forever after. Those may have been transfers too.

I'd rather trust my midwife than trust my body/my birth. And yes, better safe than sorry.

Blessings!

September 5, 2011 | Unregistered CommenterDawn

I think I could just cut and paste my comment from your last blog post into this one. :)

Some advocates are kind of guilty of doing the same thing OB's often do: tell us "every woman is different, every pregnancy is different!" and then proceed to treat them the same way. You just never know, and I'd rather have someone who is supporting me, but to a point: without wanting to take added risk that might really put me and the baby in danger. Unfortunately what that dumbass Isis doesn't realize is that OB's do this all the time in hospitals, yet they too have the tools to save you from their own overuse of interventions. When she looks at 37 percent point blank she doesn't bother to see *why,* which as you say, can make a big difference. Also - when you mention maternal exhaustion, pain relief can also be a reason for transport. A laboring mom may easily decide, after a long labor, that an epidural might just be what she needs. That is certainly not indicative of an "emergency" OR a "train wreck." *eyeroll*

September 5, 2011 | Unregistered CommenterThe Deranged Housewife

I will admit here that I DO take comfort knowing that my midwives have an OVERALL transfer rate of around 17.1%. (I've never asked them to split up those numbers between primips and multips...would be interesting to see.) I DO take comfort in the fact that they are very forthcoming with their statistics, including a "fact sheet" delineating the factors contributing to each of these transfers, and the frequency that each of these factors (pre-eclampsia, prematurity, fetal distress, postpartum hemorrhage, etc.) have occurred over their 30 years of practice. (It's an 8-person midwifery practice, where one senior and one junior midwife attends EVERY birth.) And while there is no formal relationship between my midwives and any local hospitals (a risk of choosing home birth--THIS I KNOW), I DO take comfort in knowing that they've done enough transfers that they have a relatively good informal working relationship with a hospital 10 minutes away from my home.

To me, having this information was all part of my journey toward an informed decision to birth at home.

September 5, 2011 | Unregistered CommenterKristen

Transfer statistics, like the C/S rates of individual doctors, are completely worthless. There are doctors who specialize in high risk or premature births; others who will pass them on to those specialists. Obviously one cannot extrapolate C/S statistics "from an average" in that situation.

[1] Homebirth patients in the US do not conform to uniform standards. A CNM who only accepts really low risk women will undoubtedly not need to go to hospital to the extent that some birth junkie who attempts every kind of high risk birth in the home will. The very high rate of complications due to an "untried pelvis" was the reason, btw, that in the UK when I was there, primips were not allowed homebirths.We had to adhere to extremely strict protocols, or lost our licenses. Birth, in too many places in the US, is a free-for-all where the "midwife" might not even recognize a major complication when she encountered it.

[2] There are places where ambulance transfer is impossible; there are places where, even for fairly mild complications, they might be the ONLY way to get to hospital, so that the method a woman gets to hospital cannot be an accurate indication of anything.

Therefore, I don't think there is ANY extant study which means anything as to midwife safety.

September 5, 2011 | Unregistered CommenterAntigonos

Antigonos: Re: your #2 above, the inability for a woman to get to the hospital without an ambulance is not my experience and certainly is not the experience of the great majority of Americans.

Re: #1, Someday, I'll list why I transferred/transported clients, but you can be sure it wasn't because I was taking on clients that were high-risk in the first place... except maybe the woman who was going to UC and I begged her to let me be there. Last time I ever did that! Shoulder dystocia to massive postpartum hemorrhage, it was a total medical debacle that, blessedly ended with a live mom and baby... through the grace of God. That was a transport waiting to happen. But, for the most part, I didn't take clients like that on and shit just happened... as it does in birth, even normal birth. Of course, most were transFERs, not transPORTs; life and death was extremely rare.

September 5, 2011 | Registered CommenterNavelgazing Midwife

My first birth, which was a hospital birth, likely would have been a transfer if I'd attempted it out of hospital. I had an increasing pattern of late decels, which turned out to be from an occult cord prolapse -- only discovered as the baby was crowning. Maternal oxygen helped resolve the decels, but they kept having to turn it up. It's possible that if I'd been at home and not epiduralized, positional changes would have gotten her head off the cord and there would have been no problem. But if they hadn't? I'd hope that the midwife would have transferred me.

As it was, I had a vaginal delivery (the cord was cut on the perineum), my daughter's Apgar scores were 9 and 9, and I actually had no clue that there was a problem until her 2 week checkup when my OB told me it was the first occult prolapse she'd ever seen where she was the doctor in charge. If my labor hadn't been moving so fast, she probably would have sectioned me based on the strip; while I was very happy to avoid a section, if my labor hadn't been so fast, she possibly would have been right to! A baby that can handle four and a half hours of labor on a prolapsed cord can't necessarily handle twenty hours of labor on a prolapsed cord.

When I told the story of my first birth to the midwives I chose to attend my OOH second birth, they both agreed that they'd have transferred me if changing positions didn't stop the decels. "That's what we call a pink flag," they said. "We don't wait for red flags before we transfer." They had about a 30% transfer rate for primips and about a 5% transfer rate for multips. They also had an official relationship with one hospital in the area and good unofficial relationships with all the others, which makes the situation much easier to manage.

September 5, 2011 | Unregistered CommenterKathryn T.

Your distinction between transfer and transport is very illuminating. I can't tell you the number of birth stories I have read where the midwife suggests or even insists on transfer via car and I can't figure out why the heck no one called an ambulance!

This helps explain why some midwives might prefer (for their stats) to push for transfer rather than transport.

September 6, 2011 | Unregistered CommenterJane

As an aspiring midwife, I really like your take on this. It really emphasizes that midwives are capable of assessing risk, which is a major complaint of those who are against home births (assuming that by giving birth at home, you have no idea of the risks involved).

Also, as for the ambulance transport - in Southwestern PA, access to the hospitals is difficult for those on medical assistance (Medicaid). While moms will go to a satellite clinic for care, the hospital can be as much as 25 miles away. Moms can only get to the hospital by ambulance when they go into labor if no one has a car. Bus service in the outlying areas is sporadic or non-existant or often requires multiple transfers (as much as a 2+ hour trip to the hospital). And if a mother is scheduled for a cesarean or induction at a time when buses aren't running (many are scheduled between 3am and 7am), they have NO options - ambulances are not available.

September 6, 2011 | Unregistered CommenterStacey

I totally agree that a midwife should not be getting on the job trainng. When I was researching plastic surgery, I came across a doctor who said it's better to have the last surgery by a student under the care of an advisor (sorry, I don't know the correct med school names), than to have the first surgery they do all on their own...no matter how great of student they had been.
But when is enough training, enough? Is it a number of births? A list of certain conditions? A time frame? How DO you know if a midwife has had all the training YOU need her to have? Is it even possible to come up with a comprehensive list of "what ifs"?

September 6, 2011 | Unregistered CommenterTracyKM

Tracy, those are great questions... and ones I'm trying to answer. There are many more midwives more qualified than I to figure out when enough is enough, but I figure I can have my say, too, right? I love the advice of the anesthesiologist... brilliantly correct.

Thanks for bringing these things up!

September 6, 2011 | Registered CommenterNavelgazing Midwife

I was comparing this in my mind with what Dr. James Brew said about his practice. This was only a small subset of his practice and after some years he turned it over to a CNM home birth practice, of which he was the back-up doctor as their employee.

He wrote in The Home Birth Book, 1976, that over the years he had planned 423 home deliveries, and of these, 389 babies were actually delivered at home. He seems to be including both women that were risked out later in their pregnancies, and transfers during birth in these figures, but I can't quite tell.

He states, " Of the 389, only one gave serious bleeding problems and had to be moved to a hospital at the last minute." (What last minute? After the birth, one would presume.) He goes on to say "I had one prolapsed cord, and the case came out well with a healthy baby."

423-389=34. Even if he transfered all of the 34 in labor, that is only 8%.
Would this reflect his greater confidence as an experienced OB?

At the first NAPSAC conference in 1976, Jan Epstein CNM
gave an analysis of the first 71 deliveries of Maternity Center Associates in Bethesda. There were 37 primips and 32 multips. 14 women, or 20%, were transferred to the hospital, 2 multips and 12 primips. One multip went to the hospital because she was in premature labor and had a C section because the baby was in distress. The other had prolonged rupture of membranes with meconium, but did deliver spontaneously in the hospital.

Of the 12 primips, the most significant thing was that 5 of them had unengaged heads after they had been in labor (presumably she means in active labor) for 3 or 4 hours. Of that group, 4 had C sections and one delivered spontaneously. Of the remaining 7, 2 had fetal distress, of which one was delivered by forceps, and one spontaneously. Another had meconium when membranes ruptured, baby delivered spontaneously but had respiratory distress. Another simply had prolonged rupture of membranes but delivered spontaneously. The last 3 had prolonged 2nd stage (she doesn't say what was considered 'prolonged') and 2 required outlet forceps. In the end all the mothers and babies were healthy.

Interesting that only 7% of 71 women who appeared to be low risk enough to plan a home delivery, wound up having a C section.

I don't think women and babies are really any different now than then.
I suppose the best thing is to have a care provider who transfers few women because he/she really knows which of seemingly dangerous situations are really dangerous. The worse would be to have one that transferred few because she/he was overconfident . It is definitely better to have someone who doesn't take chances with your life and your baby's life, and a care provider shouldn't do anything he/she believes is taking a chance. Obviously not every person's beliefs about what is "taking a chance" can be true in an absolute sense, because they differ so much.

I don't know what conclusion to reach.
Susan Peterson

September 6, 2011 | Unregistered CommenterSusan Peterson

Women *are* very different now than they were 30+ years ago. They are much, MUCH fatter, which gives us insulin resistance, gestational diabetes and other metabolic changes that absolutely affect pregnancies, labors, births and postpartum issues.

Food is different.

People don't move/walk/exercise nearly as much as we did back then.

Yes, women *are* different.

September 6, 2011 | Registered CommenterNavelgazing Midwife

NGM - thanks for your wise comments. I fully support your management of risk - you need to anticipate it rather than react to disasters. If, in retrospect, nothing really went wrong, then that is something to celebrate! So much worse to be looking back thinking "I should have done soemthing sooner."

There is an aspect of labor and delivery that many people don't seem to understand - that you can have a perfectly healthy pregnancy, do everything "right", eat well, etc etc, but then have an unforseen machanical complication during delivery ( ie stuck baby or hemorrhage). Of course, this is now more common because of the weight issue you have explained.

I admire your mature approach to this area.

September 7, 2011 | Unregistered CommenterSue

I am asking, thinking out loud, not declaring, ok? But I think we need to look at how much and in what ways women are different, and in what ways they are not.

Did we really walk more in the 1970's? Everyone had TV and a car then also. Most people spent their adolescence sitting in high school and college then also. There was actually less opportunity for women to participate in sports.

Yet we are fatter, or at least I hear we are. I wonder if someone could do a retrospective search of records, say from places like Maternity Center Associates, and find out the numbers on the BMI of women seeking home birth, then and now.

Another change is, women having babies are older. No women in my Lamaze class of six first time mothers was past her early twenties, and one was 19. This might be the biggest difference, and again, it would be good to have it all laid out.

However I do think there is also a change in the internalized expectations about birth. The Unnecessarian published a 1940's film for women waiting for their births, about the call to the doctor, the hospital, and so on. It was terrible...and yet there was
an expectation of vaginal birth underlying it which was conveyed by the complete lack of any other possibility even being addressed. (At that time, a doctor or hospital would be investigated for having a C section rate above 5%.)

Someone once said at one of the conferences I went to that there is no birth which is not affected by culture. All births take place within a context of cultural expectations; there is no "natural" for human beings which does not involve cultural context. I think that besides looking at physiological changes (weight, age, fitness level) , we would have to look at what changes in beliefs and cultural expectations people have. I think it is easy for us to see how the changed beliefs and expectations of OB's have changed birth outcomes. I also think our own beliefs and expectations have changed them.

I don't know how to tease out what is due to pure physiology, and what is expectation, and expectation affecting physiology. But this is the kind of question you have always addressed on this blog.

Susan Peterson

September 7, 2011 | Unregistered CommenterSusan Peterson

Jane,

The reason why some emergency transfers are done via car, at least for the CNM's and CPM's that I trust, is it can be much faster than waiting for an ambulance. Sometimes paramedics have no training in maternity transfers, and simply don't know how to help. They can actually slow down the process. If you have a woman who has a prolapsed cord, or thick meconium, you get in the car and go as fast as you can.

September 9, 2011 | Unregistered CommenterCrowbabies

NM,
My midwives have a transfer rate of about 37% but all except 1% of that is due to moms transferring because they can't handle the pain. The majority of these are first time moms. I think its reflects well on my midwives that they transfer this often for pain. If they will go to the hospital because mom wants an epidural, they will certainly go if moms are showing warning signs.
I have to ask you something- talk to you about something. I agree with a lot what you say but what I disagree with is your support of Dr. Amy and her followers. Those people will never bring about any positive changes because they are so angry, cruel, judgmental and hateful. i don't believe for a second that they actually care or want to bring about changes in midwifery or stricter laws. If those things actually happened and homebirth became safer, what would they have to bitch about anymore? There would be nothing for them to do and they would no longer be able to judge others in order to feel better about themselves. No, they don't want positive changes. All of this began because they want to pretend that they are better mothers, better people and get some sort of sick satisfaction out of putting people down. Unless you agree with them, they think they are better than you. They bully others into joining their group because if you disagree you are stupid and selfish and nobody wants to be those things. It's very manipulative. It saddens me that you would help them and make them appear more legitimate. I know you know the truth about those people. They are not doing anything positive for women. The only ones it serves are those who are bitter about their own births and want someone to blame. That is the only "good" that comes from SOB. I really hope you will consider what I am trying to convey to you. Don't help in their destruction and hate.

September 11, 2011 | Unregistered CommenterNoname

And where do you find this support? I don't talk about her unless I absolutely have to. I've posted a handful of times on that site (and the previous one, combined). I most certainly don't refer to her posts or link to her site. This comment is the most I've talked about her in print E-VER (since the moratorium on discussing her years ago).

That she thinks I'm on her side is her perception and I have nothing to do with that. I think what I think, independent of her. I don't dialogue with her privately or publicly.

I don't even want to discuss my private viewpoint of her, but it isn't in great light.

But I *have* recently said we can no longer ignore her because she is in the press more and more. We *must* address what she says to the press because our potential clients are going to read these things and ask questions; we will need to answer them.

None of that can remotely be construed as support.

September 11, 2011 | Registered CommenterNavelgazing Midwife

Good to hear. She and others definitely make it out like you are backing them up.

September 11, 2011 | Unregistered CommenterNoname

I remember when I was interviewing homebirth midwives and I asked every one, "What is your transfer rate?" One looked me in the eye and said, "It's as high as it needs to be." And I hired her.

September 16, 2011 | Unregistered Commenterhwar

I am, for the record, a supporter of Dr. Tuteur.

I want to see a US which ONLY licenses CNMs, establishes educational standards [including continuing education] for qualification, requires keeping full records and registers of births which must be periodically reviewed, establishes strict criteria for who is eligible for a homebirth. One of those criteria has got to be rapid availability of emergency care [ambulance service as well as proximity to a full facility hospital. Further, there have to be legal penalties for anyone who, with premeditation, attends a birth who is not licensed to do so [after all, very occasionally the patient has an exceptionally rapid labor and an assistant should not be penalized in that case.] Further, all CNMs should be required to carry malpractice insurance.

The necessary legislation needs to be established and enforced on a Federal level, or there will be no reliability as women in one state might be vulnerable to any quack out there while in another state, the care is excellent [moreover, "midwives" who are prosecuted will simply change their addresses].

The current situation in the US horrifies me. I have been a CNM for 40 years and the free-for-all that obtains in the US as regards midwives in general and home births in particular is incomprehensible in Europe, the UK, and Israel [where I live and practice]. The sheer number of homebirth catastrophes and the complete unwillingness of women who claim to be midwives to restrict themselves to low-risk patients, and to admit that they haven't a clue what they are doing is appalling. HBAC after two or more C/Ss? Sure, why not! Breech? Why not? You say you were refused by a CNM? I'll deliver you even though you have been told you're a high risk patient! Birthin's normal, man! I'm experienced -- done maybe a couple hundred births. [Compare that with a hospital-based midwife who does perhaps a thousand or more a year] I am both a midwife and a "medwife" and damned proud of it. I can, within certain limits, practice autonomously, or if necessary, in conjunction with an OB/GYN so that I can, and do, care for ALL pregnant women, not just those deemed "low risk". IMHO, it is what all women who want to be midwives ought to aspire to.

Dr. Tuteur can be sarcastic. But the ignorance she is fighting is almost beyond belief. What she wants, and what I want, is a well-educated, well-regulated PROFESSION, not a club for birth junkies. Reading NGM's posts for several years now I am impressed by the high level of your knowledge, Barbara, and have to say that in comparison with a great deal else I've read online, you are head and shoulders above most DEMs.

September 17, 2011 | Unregistered CommenterAntigonos

Thanks, Antigonos (I think ;) ). Have you *seen* the crap I'm getting over some kind press over there at SOB's house? It ain't pretty, but, most certainly, not unexpected. What's a midwife to do? *wink*

While I have you here, let's chat for a second about your saying I have/had an almost pathological fear/hate of cesareans and I take *extreme* exception to that. I know that my attitude towards cesareans over the last 28.5 years has been one of the most balanced and understanding of the life-saving aspects of them.

I *have* been sympathetic towards women who feel they were traumatized by cesareans, but that's been true of women who also feel they've been traumatized by their vaginal births. Sympathy, I hope, isn't a pathological reaction to another's pain and internal suffering.

I've skimmed my posts and can't figure out where you feel I was anti-cesarean at all... I am nowhere *near* the level of cesarean-aversion as many ICANers, but I support them as a part of their process towards healing. Anger is, as Kubler-Ross enumerated decades ago, a healthy part of healing.

Anyway, thought I'd bring this up since when I read you saying this, I am baffled and really don't want people to think I've changed all that much from when I started writing this blog several years ago. I don't believe I have; I'm just a whole lot louder about it now.

September 17, 2011 | Registered CommenterNavelgazing Midwife

What about your post entitled "The Ripping Apart of Natural Birth"? You start out by criticizing a woman who is irritated by assumptions that she was traumatized by her c-section.

September 21, 2011 | Unregistered CommenterAnne

I've read, and re-read, what you say you think I wrote and I can't see what you're saying I said. (I hope that makes some sense.)

What I was complaining/talking about was that women weren't being able to tell their stories, good or bad. In fact, the first ltwo paragraphs after the quote sums up the theme of the piece:

"It’s startling to me she lied about why she had a cesarean. That really is a sad commentary on the state of affairs in post-birth communication.

"Or really, is it? I’ve listened for years to women who were birth-traumatized (not just by cesareans, but they are certainly part of many women’s picture) say how they lied about their births, putting on plastic smiles and saying, 'Everything was fine,' or 'It was great!' when, in fact, it was very far from either of those things."

So, if you want to expound on what you heard me saying, I'm all ears.

And, reading through the piece, there *are* changes in my thoughts and attitudes about certain aspects of NCB. A woman's prerogative?

September 21, 2011 | Registered CommenterNavelgazing Midwife

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