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Jul072012

The SOB

Home birth: Increasingly Popular, But Dangerous” in the Daily Beast by Michelle Goldberg started the hoopla.

For many parents, home birth is a transcendent experience, and they’re profoundly grateful to have been able to have their babies on their own terms. Yet as the number of such births grows, so does the number of tragedies—and those stories tend to be left out of soft-focus lifestyle features. Now a small but growing number of people whose home deliveries have gone horribly awry have started speaking out, some of them on a blog, Hurt by Homebirth, set up by former Harvard Medical School instructor Amy Tuteur. “These people are beating themselves up over this,” says Tuteur, perhaps the country’s fiercest critic of the home-birth subculture. “They did it because they thought it was safe, and it wasn’t safe.”

Out of 39 paragraphs, Dr. Amy Tuteur (the Skeptical OB) is quoted in four and mentioned in a fifth, yet the afterquakes have, almost exclusively, have centered around including Tuteur as a source for Goldberg’s article.

In fact, in The Slate, Jennifer Block’s piece entitled, “How to Scare Women: Did a Daily Beast story on the dangers of home birth rely too heavily on the views of one activist?” contains 16 paragraphs and Tuteur is highlighted in ten of those, not including the obvious reference to her in the title.

Goldberg's reliance on Tuteur is an interesting choice. Also known as “Dr. Amy,” Tuteur let her medical license lapse in 2003 and created the blog Home Birth Debate in 2006, which she used to advocate for her position, which is basically: Home birth kills babies. “Even the studies that claim to show that home birth is as safe as hospital birth actually show the opposite,” she'd frequently post in response to a challenge, smearing the researchers of those studies in dedicated blog posts and igniting flame wars in the comments section. On other sites, including Nature and RH Reality Check, her comments have been flagged and removed for being defamatory or basically spam.

The back and forth continues with Goldberg defending her original piece with “Michelle Goldberg Answers a Critic’s Distortions of Her Home-Birth Argument”, naming Tuteur in nine of the 21 paragraphs.

Let’s start with her primary criticism—my use of Dr. Amy Tuteur, a figure anathema to the home-birth community, as a source. Now, I think Block overstates my reliance on Tuteur; there’s a difference between agreeing with her after doing my own research and repeating a “Tuteur talking point,” as Block accuses me of doing. But leave that aside, and let me explain why I’m not convinced by Block’s attempts to impeach Tuteur’s expertise.

So, why am I up at 2am counting paragraphs in tit-for-tat articles? First, because I cannot believe the energy spent on Dr. Amy… so many people arguing for or against her as a source. It’d be amusing if it weren’t such a serious topic. It’s really important for people to know that Dr. Amy isn’t going anywhere and that she will continue to be used as a source protesting Certified Professional Midwives and much of home birth. I know women who begin reading an article or post and if Tuteur is mentioned, abruptly end their reading session. Dr. Amy has been a source in over a dozen articles, from the Los Angeles Times, the New York Times and Time.com; it’s unlikely she’s going anywhere.

Something else you’re unlikely to see again is the debate about using Tuteur as a credible source. I just don’t see Newsweek debating the Times of London about whether she should be believed or not. I have the distinct feeling this back and forth of the last few days will be a rarity and limited to smallish, women-oriented ezines. Large magazines don’t have time for such nit-picking and have editors to determine whether a source is adequate or not before they ever make it to print. Apparently, Tuteur has passed muster more than once.

I wonder if the detractors think if they make enough noise, Dr. Amy won’t be used as a source anymore. I believe the louder they become, the more often she will be quoted, clearly annoying the home birth contingent; the press loves conflict.

As much as Dr. Amy Tuteur makes some people crazy, she has proven she is not a force to ignore. While I have issues with her delivery and am unsure about all she professes as fact, the woman has things to say that need to be heard and she’s going to be heard, whether we like it or not. Instead of trying to make her go away, how about we find people who can argue with/speak out against what she says in the same articles. And for crying in a bucket, debating statistics is not the way to do it! If you haven’t figured it out yet, the stats’ results are in the eye of the beholder, so finding alternative discussions is crucial. One of my favorite topics is why women want an out-of-hospital birth in the first place. And then it needs to move quickly to choosing safe home birth midwives. I believe until we have clear, fantastic midwifery education and a way for them/us to learn the advanced skills necessary for out-of-hospital births, we’re fighting a losing battle. Dr. Amy has the information about CPMs down to a sound bite; we better have an answer about them/us when asked.

I see people trying to shut Amy Tuteur up like trying to put out brushfires when the wildfire is just down the street. She isn’t going away. Deal with it.

NOW what are we going to do?

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Reader Comments (15)

Here is my biggest problem with articles such as these. Homebirth is NOT as cut and dry as homebirth CPMs v. hospital birth. At this very moment in NC, women are fighting to keep their homebirth CNMs (a homebirth attendant Dr. Amy claims to support) legal to attend births. Where are we left in the crossfire? Our CNMs have been smeared by the anti-homebirth brush OBs such as Amy Tuteur are wielding, leaving us without a safe, legal option for homebirth in our state.

July 7, 2012 | Unregistered CommenterJulia

I am profoundly uncomfortable with all the Amy-bashing that goes on. Granted, the woman is strident, vocal, and opinionated, but what the heck?, since when are we all supposed to be shrinking violets? I suspect that she makes people profoundly uncomfortable because she zeroes in on all the stress points in midwifery care like a homing missile. Uneven/inadequate training? Check! Lack of accountability? Check! Absence of informed consent, good backup, timely transport? Check, check, check! She pushes people to address issues they'd rather gloss over. And THAT in my opionion is why she is so reviled.

July 7, 2012 | Unregistered Commentermarti

Well said Marti; for those reasons exactly is why she makes the midwives uncomfortable lol ;)

July 7, 2012 | Unregistered CommenterChristy

I've been reading Dr. Tuteur's SOB blog for some time now. I have learned a lot, although I do not agree with everything she says or the way she says it. She is clear, informative, and makes some VERY compelling, hard-to-dismiss points, though. Although I have had some horrible hospital births and used to be more in favor of home births, I am much less now. My desire is to see how I can improve hospital births and midwifery care in general as an aspiring future Certified Nurse Midwife. Furthermore, I support home birth choices in a limited way and am always happy when women I know have good outcomes with home births. I will remain a follower of Dr. Tuteur's blog, though, because not only she, but her frequent ob/gyn commenters add excellent points and info to discussions in their threads.

July 7, 2012 | Unregistered CommenterLaura

It's not about Dr. Tuteur. It's about FACTS. And the facts are very clear: having a baby at home is dangerous. Jennifer Block cannot address these facts [does she even understand them?] so she resorts to ad hominem attacks which is really quite beyond the pale. Dr. Tuteur has offered to publicly debate Ms. Block; but Ms. Block simply attempts to smear Dr. Tuteur even more.

Let's forget personalities, and just look at the statistics. MANA has not [probably cannot] release the statistics it's collected for close to two decades, but there are now stats from a number of states [Colorado and Oregon among them] which are irrefutable. There is NO way homebirth can be as safe as hospital birth in the US. I'm not going to write an essay describing the reasons why. But isn't it about time we certified-nurse midwives devoted our energies to [1] pressing for legislation that will make the CNM the sine qua non for midwifery, [2] working on informing women so that they make INTELLIGENT choices, and [3] improving the birth experience in hospital for mother and baby so that the homebirth alternative stops being an alternative at all?

July 8, 2012 | Unregistered CommenterAntigonos CNM

Antigonos,
I resent your implication that if I were properly "informed," only then could I make an "INTELLIGENT" choice, and that choice would be to birth in the hospital. You assume that I am uninformed and that my choice is unintelligent. Wow.

I was planning a homebirth with a highly experienced CNM (not CPM or any other set of letters--an actual CNM, just like you). Then she lost her backup doctor (so did the other half a dozen women he was supervising) and no one will take her on in this political climate. So now I am planning a birth center birth at least in part because I really resent the assumption (by the medical board) that if they take away my safe, legal homebirth choice, then I'll have to go to the hospital. I freely admit that this is not a rational place from which to make a decision. But when virulent anti-homebirth politics messes with the birth plans of a woman who's 31 weeks pregnant, I'm afraid my "informed," "INTELLIGENT" decision-making skills are superseded by my frustration with the attitudes of people like you.

July 8, 2012 | Unregistered CommenterAmelia

Dr. Amy makes me uncomfortable because she uses words like "moron", and "Idiot" when describing women. She sends her "Raptors" (as they call themselves) after blogs of women whose babies have just died, or posts screenshots of Facebook pages of people discussing issues not only limited to where they choose to give birth but their parenting choices as well. Cruel language is not only tolerated, it's encouraged.

This is not professional or credible behavior, it is organized online bullying. Having been at the crap end of that stick, I know how scary it is, and I can't imagine that if she had found the absolute Holy Grail of Truth about birth that any person would validate her bullying behavior by arguing that she knows something WORTH being treated so badly.

I agree with NGM that Dr. Amy has very valid things to say. The information she has shared has caused me to think hard about my choice to become a midwife and how I will go about that, and so much more. Unfortunately, her delivery is that of a 9 year old girl with an inferiority complex. It's disgusting to watch. I like being challenged, I love debate. The skills I have that she, and many of her followers lack, is tact, compassion, and objectivity.

Have strong opinions, be direct, be firm! But cruelty is not warranted and should not be tolerated.

July 8, 2012 | Unregistered CommenterKristina Kruzan

Dear Amelia, giving birth in a free-standing birth center is only marginally better than delivering at home, from a standpoint of safety.

The vast majority of births are uncomplicated. But it is a bit like Russian Roulette, because when something goes wrong, it tends to go wrong FAST, and there simply is no time to spare. Babies' brains begin to die within minutes when oxygen is cut off; one-third of a mother's blood supply passes through the uterine artery each minute. Perfectly normal women can, in a matter of minutes, develop severe eclampsia and begin to convulse. I've seen it all: and I've seen the results. Want me to continue with the list?

In the meantime, either at home or in a free-standing birth center, where the option of a Caesarean doesn't exist, nor is there a pediatrician and NICU, or even a doctor in residence, the only possibility is transfer. From the initial call to the emergency services until the OR is, on the average, 45 minutes even when the hospital is "only 5 minutes away". Do you want to risk it? I wish you good luck if you do.

You take umbrage at my use of the word "intelligent". I can't tell you the number of times I have had to explain the differences in midwifery education, even having to answer questions like "I see you are a Certified Nurse Midwife. Does that mean you are a real nurse?" You may have done some research; but there are a LOT of women out there who know nothing about the various kinds of midwives, or any of the risks involved in giving birth.

Incidentally, just two days ago an intelligent friend of mine, gravida 4, para 3, all perfect pregnancies and births [3000-3500 gm], arrived at her hospital at the beginning of labor [40 wks +2] feeling fine. Her BP was 200/110, protein 4+, 3+ hyperreflexia, and only "a little swelling in my legs". EFM was non-reactive, she had a C/S, and the baby is now OK, having spent a couple of days on observation, as she weighs only 2400 gm. "I never thought it would happen to me -- according to my reading, pre-eclampsia usually happens with first births or very old mothers" she told me.

July 9, 2012 | Unregistered CommenterAntigonos CNM

The biggest issue I have with Block and others who argue Dr Tuteur's legitimacy is this....do her years of education and practice as an OB suddenly go away as soon as she stops practicing?

Lots of NCBers are more than happy to tout "stats" by Ina May, and random homebirth advocate bloggers, but more often than not, those people have ZERO relevant education or background at all. How is it that a CPM is apparently more educated in birth than an OB? Would all of that hate go away if she renewed her medical license? I doubt it. Many women haven't grown out of school yard insults....since they can't argue her stats, her arguments, or her spelling or grammar, they argue that she's irrelevant. If she renewed her license, what would be next? Would they make fun of her hair, call her fat, call her old, in attempts to discredit her?

The fact is the some people just cannot handle when someone points out that something they believe in is wrong or a decision they made is based on lies or half-truths. It makes them defensive. Dr Tuteur does speak in a harsh tone that is off-putting to a lot of people, but would anyone listen better if she spoke like an earth-mother? No. Because she's still saying things that people just don't want to hear. But that's not HER fault. It's the person reading who would rather believe in an ideology rather than actual scientific fact. If science makes you uncomfortable, then you better walk away from that computer or cell phone....those things were made by SCIENCE and FACTUAL INFORMATION!

July 9, 2012 | Unregistered CommenterOlivia

"Dr. Amy makes me uncomfortable because she uses words like "moron", and "Idiot" when describing women. She sends her "Raptors" (as they call themselves) after blogs of women whose babies have just died, or posts screenshots of Facebook pages of people discussing issues not only limited to where they choose to give birth but their parenting choices as well. Cruel language is not only tolerated, it's encouraged."

THIS is exactly why I cannot, WILL NOT, ever take anything that woman has to say seriously. And it absolutely BAFFLES me that people would say, "oh, so what if her delivery is such-and-such, she makes good points!" Um, since when is it okay to run around the internet flat out abusing and torturing other women? Since when is that simply a "delivery" method? How can anyone tolerate the way she treats women? For the record, I had a homebirth with TWO CNMs in attendance (the kind "Dr." Amy supposedly approves of) so WHY has she spend the better part of two years writing NONSTOP posts about me, calling me every name in the book, harassing me, belittling me, and oh, did I mention, calling me names? What did I ever do to her? NOTHING. She's an abuser. Plain and simple. I cannot take anyone seriously who either supports that, or even simply overlooks it.

July 10, 2012 | Unregistered CommenterTheFeministBreeder

Dear Feminist Breeder:

This isn't about Amy Tuteur. Or about me. Or about anyone who holds a particular position. IT IS ABOUT FACTS. Home birth is, depending on the study and the statistics available, from three to 6 times more dangerous at home than in hospital. Fortunately, in terms of the absolute number of infants dying, since home birth is less than 1% of the total, the number is small. That doesn't justify indulging in a dangerous practice, however.

Anecdotes aren't data. If you don't want to believe Dr. Tuteur, go to the primary sources, such as the statistics from Oregon and Colorado, which aren't motivated by any special interest group.

Dr. Tuteur has made it clear, btw, that she will engage with anyone who seriously wants to debate with her and can produce statistics that refute her premise. So far, no one has taken up the challenge, probably because they can't.

July 10, 2012 | Unregistered CommenterAntigonos CNM

What I can't understand is when blogs, like say from BBC, question "who gets to set the parameters for what anyone considers high risk?". Well the existing research does for starters. The OBs and CNMs get to understand the risks and determine if they want to take on those risks. A CNM may transfer care to an OB who may then transfer care to an MFM. But homebirthers and CPMs will take on any "variation of normal", aka high risks, that they think they are comfortable delivering at home. Well the studies from Canada, UK, and the Netherlands use 1) nurse equivalent trained, licensed, and insured midwifes, 2) who risk out patients, even FTM (50%transfer rates), 3) have doctor/hospital back with low threshold to transfer. BUT, articles like this show that places like the Netherlands, even with strict parameters don't have as good of outcomes as the homebirth advocates preach that they do!

http://www.bmj.com/content/341/bmj.c5639.full

Conclusions: Infants of pregnant women at low risk whose labour started in primary care under the supervision of a midwife in the Netherlands had a higher risk of delivery related perinatal death and the same risk of admission to the NICU compared with infants of pregnant women at high risk whose labour started in secondary care under the supervision of an obstetrician.

http://www.ranzcog.edu.au/publications/oandg-magazine/doc_view/762-16-trouble-in-paradise.html

So if the Netherlands has one of the highest perinatal mortalities of Europe, how can the undereducated, unlicensed, uninsured high risk patient seeking CPMs fare??? 

Homebirthers want to refuse OBs interventions and will threaten battery if the OB insists. Well, the OB can refuse to induce a VBAC, version for breech, and potentially transfer care to the MFM if she doesn't want to do the VBAC or vaginal breech because the woman is refusing cesarean. The CNM can refuse to stay at home with the high risk patient if it is out of their comfort zone. Homebirthers are wise to the new ACOG recommendations regarding VBACs, but what are ACOGs recommendations for HBACs?

<last paragraph deleted for extremely nasty comments>

July 14, 2012 | Unregistered CommenterCaptain Obvious

Wow. I'm not sure how to respond to The Feminist Breeder in a way that is not inflammatory. I'll just say that her own behavior on the Web and Twitter has been, for want of a better phrase, that of a Mean Girl. I'm thinking of her recent attack on Stillbirthday, as well as her reported penchant for intervening in the labors of strangers when she sees from her Twitter feed that a c-section is being contemplated. I am, to put it mildly, surprised that she seems to find herself above reproach.

July 14, 2012 | Unregistered Commentermarti

@Marti - There was no "attack" on StillBirthday and I do NOT "intervene" in other people's twitter labors. You can not like me all you want, but please stop with the lies. I made ONE comment to a dad THREE years ago on Twitter (2009) and never have since. My twitter feed is there for anyone to see and confirm that. And my problem with StillBirthday is purely a professional one. Moms that I know PERSONALLY (in my real life, women who've been in my home) are complaining that they've been attacked and abused by StillBirthday mentors after a loss and it's no surprise because she hires Dr. Amy cronies as the mentors. I never said a single thing about Heidi personally (didn't even know who she was) even though she wrote an entire blog post full of absolute lies and fabrications about me. She stalks my facebook page under multiple fake accounts and spreads more lies. I don't spend my time doing that crap to people, I'm too busy working and raising my family to track people all over the internet to hate on them like some of y'all do. There's no excuse for the PERSONAL attacks. NONE. I don't agree with Heidi's business model, but I left her PERSONAL life and family completely out of my complaint. Take a lesson.

July 15, 2012 | Unregistered CommenterTheFeministBreeder

quod erat demonstrandum

July 30, 2012 | Unregistered CommenterMarti

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