Despite having found my niche long ago in the medical blogosphere as a skeptic and supporter of science-based medicine, not to mention a scourge of quacks and anti-vaccine activists (no little ego mine!), I rarely, if ever, write about obstetrics. It's always been one area of medicine that I've felt least comfortable with. True, there are some areas of O.B. woo, such as home birth ideology that directly contributes to the deaths of babies, and perhaps I should mention such incidence more often. They are, after all, just as egregious an example of ideology triumphing over science and harming innocents as any cancer quackery.
All of this just serves as an introduction to one of the scariest concepts I've ever come across. I saw it earlier this week on the website of the American Association of Naturopathic Physicians (AANP). It is, in essence, naturopathic obstetrics, or at least naturopathic prenatal care. OK, it's actually naturopathic pre-conception care, but the very title of the post on the AANP blog brought to mind images of naturopaths advising women on prenatal care. At least, that's what I thought when I read Pre-Conception Testing: A Naturopathic Perspective. It's by a naturopath named Sara Thyr, ND, who describes herself as a a naturopathic midwife, who is also president of the American College of Naturopathic Obstetrics and founding member of the American Association of Naturopathic Midwives. Now, there's a scary concept, a naturopathic midwife and naturopathic obstetrics.
So what do naturopaths recommend for pre-conception care? A lot, it turns out. But first, let's see what real doctors (as opposed to fake doctors) recommend for pre-conception care. Science-based recommendations weren't too hard to find on the CDC website and elsewhere, including pamphlets from the American College of Obstetrics and Gynecology. Science-based guidelines emphasize identifying risk factors for bad outcomes such as alcohol abuse and smoking (which should be eliminated if at all possible), anti-epileptic drugs, diabetes, the use of Accutane, the presence of HIV/AIDS (where anti-retroviral therapy can decrease the risk of maternal-fetal transmission). Other interventions include folic acid supplementation, reducing obesity, vaccinating for hepatitis B, testing for maternal phenylketonuria, testing for immunity to varicella and immunizing if the woman is not immune, and adjusting dosages of thyroid hormone replacement in women who require it. Basically, in healthy women, not a lot needs to be done, and in women with certain defined risk factors what needs to be done to reduce the risk of pregnancy loss are fairly straightforward and targeted. This is how Dr. Thyr characterizes these "boring" interventions:
Standard medical testing might include some look at hormones for ovarian function, particularly for women trying to have babies later in their childbearing years. Most will check to see if the woman has antibodies to Rubella and vaccinate her before pregnancy if these levels are low. They might also look at thyroid function, as malfunction of this endocrine gland makes it more difficult to get pregnant and maintain a healthy pregnancy. They may even look at a woman's vitamin D levels, and perhaps if they are very progressive check her folic acid, B12 and complete blood count. Most do not look any deeper, unless a woman is having some difficulty getting pregnant. Even then, they are not looking at all of the factors that go into having babies who are not only healthy at birth, but healthy throughout their lives.
Ah, yes. How often do we hear naturopaths complain that real doctors don't look at "all the factors" or that they don't see everything that naturopaths see. Of course, the reason that real doctors don't see everything naturopaths see is because a lot of what naturopaths see is not based on science. A lot of it is, in fact, pure woo. You'll see what I mean very quickly just by looking at the first thing that Dr. Thyr thinks she has to look at in women looking to become pregnant. In describing it, she manages to betray ignorance of immunology and many other areas of medicine:
What will a naturopathic doctor look at?
Food allergies
Food allergies are a very misunderstood topic, in my opinion. If I ruled the medical world, this test would be as common as a complete blood count (CBC) or thyroid testing. When people have delayed hypersensitivity reactions, they may have some random symptoms, but don't usually know that there is an association between them and the foods they are commonly eating. Undiscovered food allergies are the most common cause of unexplained infertility. And if a woman does end up getting pregnant, she will pass all of these antibodies on to her child. The mother's antibodies are passed on to her children, so if she does not eliminate them as much as possible during pregnancy and breast-feeding, she passes her sensitivities on to her children.
About the only thing that Thyr gets right is that food allergies are indeed a very misunderstood topic. Unfortunately, she's one who's contributing to the misunderstanding by saying that almost everyone should be tested for them. Funny how the committee that produced the CDC recommendations five years ago by poring over the existing medical literature at the time missed food allergies. In fact, the word "allergy," much less food allergy, isn't mentioned even once in the CDC report or in other more recent synthesized recommendations. It couldn't be because there's no evidence that food allergies are a major problem that results in infertility or pregnancy loss, which makes Thyr's blanket assertion that "undiscovered food allergies are the most common cause of unexplained infertility" utterly unsupportable. Does she present any evidence to back up this assertion? Of course not. She's a naturopath. Or, I remind myself, not just a naturopath, but a naturopathic obstetrician/midwife. Apparently, she don't need no steeenkin' science-based guidelines.
It also never ceases to amaze me how naturopaths so frequently criticize physicians who practice SBM for supposedly doing too many tests and using too many interventions, rather than "natural" remedies and diagnosis that doesn't rely on technology. Yet, here we have a naturopath recommending going far beyond normal tests recommended by those nasty, reductionistic physicians. Thyr recommends elimination diets in order to identify foods to which a woman is allegedly allergic, IgG antibody testing, and a variety of other tests. One thing I couldn't help but notice is that she seems to misunderstand how mothers pass antibodies on to their babies. It's true. They do pass antibodies through the placenta to their babies. However, maternal antibodies aren't forever, as Thyr seems to think they are, nor do they result in food sensitivities being passed on from mother to child. Maternal antibodies pass through the placenta and provide protection to the baby for as long as they last, which is usually a few months to as long as a year. In addition, an even bigger misunderstanding on Thyr's part though is this: The only kind of antibody that passes through the placenta to the developing fetus is IgG. Allergies are mediated through IgE. Maternal antibodies can't mediate allergic responses in newborns because they're the wrong kind of antibodies! I mean, seriously, where did this woman learn basic immunology?
Oh, wait. She learned her immunology at a school of naturopathy. Never mind. That explains her ignorance.
There's one thing that's missing from Thyr's initial advice, though. It's something that all naturopaths love and recommend constantly to their patients. Don't worry, however. it's coming, and here it is:
Environmental Toxins
We are all exposed to many environmental toxins every day. Toxins--from pollution while driving or walking down the street, to pesticides and chemicals on our foods, to the plastic liner of the coffee we buy on the way to work, to the perfumes and parabens that are in our body and hair products--are all around us. Some people believe that if they are not working in an oil refinery or carpet factory that they are not exposed to toxins that can be harmful to developing fetuses. Toxic exposure is one area where epigenetics have given us a great deal of information about how we can improve the health of our newborns as well as our entire population. Bisphenol A (BPA) exposure in utero has been linked to men having prostate disease later in life. Phthalates can cause decreased testicular size. Octyphenol is linked to decreased FSH in women and decreased testicular size and function in men. PAH from cigarette smoke exposure while in utero is linked to decreased behavioral scores, ADD and asthma in children.
Ugh. While there are certain exposures that have been linked to problems in pregnancy, as naturopaths are wont to do, Thyr plays the "toxin gambit." Everything is due to toxins, and you have to "detoxify." She also does something that every crank from anti-vaccine loons to homeopaths to naturopaths likes to do; she abuses epigenetics. In real science, epigenetics is the study of gene regulation and heritable changes in gene expression or cell phenotype that are due to mechanisms other than changes in genomic DNA. Such mechanisms can include methylation of DNA or remodeling of chromatin, among other mechanisms. These are the sorts of mechanisms that real scientists mean when they refer to epigenetics. When, for example, a naturopath, homeopath or anti-vaccine activist speaks of epigenetics, she seems to mean magic. Sometimes this magic of which she speaks comes from confusing epigenetics with other forms of gene regulation. Sometimes, this misunderstanding and abuse of epigenetics take on outright Lamarckian overtones, wherein bad lifestyle leads to phenotypic changes in parents that can somehow be passed on to offspring. Indeed, there's more than a little hint of that in sort of magical thinking in Thyr's invocation of food allergies. Either that, or it's just a complete misunderstanding of antibodies and allergies. I'm still not sure which it is.
Finally, Thyr recommends adrenal testing at, in essence, the drop of the hat. If a woman is stressed out or reports insomnia, test her adrenal hormones! While there's no doubt that adrenal dysfunction can cause infertility and pregnancy loss, Thyr seems to see "more subtle" adrenal problems everywhere and in everyone, much as Mojo Nixon sees Elvis everywhere. (The difference, of course, is that Elvis is everywhere, but adrenal problems are not.) It's hard not to suspect that she probably tests almost everyone's adrenal hormones. I did a little Googling about "naturopathic obstetrics" and found a lot that disturbed me. Although Thyr doesn't describe her recommendations this way in her relatively brief post for the AANP blog, what she proposes for a naturopathic preconception work-up certainly resembles what I found at the website of another "naturopathic midwife."I realize that the following information didn't come from Thyr's website. I post it to demonstrate the sorts of things "naturopathic midwives" recommend as "preconception" testing and care. The naturopath in question, Thauna Abrin, recommends "preconception detoxification" for three to six months before attempting to get pregnant. Her "four phase program" includes "environmental and hormonal evaluation" (which sounds a lot like what Thyr described), "nutritional counseling" (which, knowing naturopaths, invariably is only related to science-based nutrition by coincidence), "detoxification" (of course), and "hormone balancing. For "environmental evaluation," Thauna proposes saliva testing for hormones (not standard of care and not validated) and "toxins" (ditto). Her "detoxification" phase is described thusly:
The detoxification program consists of herbal medicines, homeopathic Biotherapeutic Drainage, colonics and/or saunas. These natural medicines gently but effectively remove harmful chemicals and metals from the body's tissues and organs. The detoxification phase will last 2-9 months, depending on the individual.
She also recommends craniosacral therapy for mothers and infants.
When I deal with naturopathy, I tend to stress areas of medicine with which I'm familiar, hence my broadsides at "naturopathic oncology." Every so often, however, I'm reminded that naturopathy has infested every medical specialty, including obstetrics.
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Also, it's always interesting to me that even on their own blog page, the AANP usually codes naturopathy's essential vitalistic science-ejected premise as "naturopathic medicine is based on the belief that the human body has an innate healing ability" while also using the label "national professional society."
Such manipulative opacity!!! NOT professional.
But, AANP has a post (see http://physicianswholisten.blogspot.com/2009/08/letting-nature-heal.html ) [vsc 2011-10-28] where you get the Full Monty: their underlying science-ejectedness complete with a reverent recital of the archaic words of one of their most cherished figures, homeopathy's Hahnemann.
It's very telling when that very post says, via ND and FABNO Schor [naturopathic oncologist!], "as a profession we can be almost cultish in our belief in nature as an all-knowing omnipotent healer."
Quite.
-r.c.
More frightening information from Wikipedia:
Naturopaths ( NDs, NMDs) are tolerated in 16 American states and Washington, DC after going through the motions of getting an education at 7 accredited naturopathic medical schools.
Similarly, Canada allows their activities in 6 provinces.
In the UK, doctors, osteopaths, chiropractors, and nurses may complete 2 years of education to become so entitled.
So, is ND the route for nutritionists/ homeopaths to get doctor cred?
Is this the thread where we tell dead baby jokes?
Ugh. As a veteran of two miscarriages and one high-risk but ultimately successful pregnancy due entirely to science-based interventions, I find pregnancy and childbirth woo especially offensive. I was extremely fortunate to be placed in a cutting-edge treatment program for recurrent miscarriages after my second pregnancy failed. I received pre-conception tests and treatments that are still considered experimental but based on solid scientific research. I hate the idea that someone who's had similar experiences to mine might get taken in by the nonsense this woman is peddling instead of getting real help.
And as for the myths the woo-mongers like to spout about hospital births, one of the first things I said to my parenting class after I gave birth (at 33 weeks) was said was how awesome the obstetric and NICU staff at the hospital were (actually, the very first thing I said was "Get the epidural, you will not regret it." then I raved about the staff). They let my husband, sister and mother attend my labor, I had 24-hour access to my son in the NICU, they taught me how to care for him, sent me a lactation consultant, they were attentive, compassionate, approachable -- I am forever grateful to all of them for what they did for me and my son, who is now about to turn 5 and in perfect health.
Always remember that N.D. stands for "Not a Doctor" and you'll save yourself a lot of grief.
Naturopaths are a bunch of hypocrites. On the one hand its about the "Natural healing ability of the body" and "natural substance" effect non sense while on the other hand its about how the body's "natural healing ability" needs a "natural boost" with their "natural (but artificially manufactured) supplements". So much of "natural" in any argument reeks of unnatural or invokes the super natural.
"Undiscovered food allergies are the most common cause of unexplained infertility."
If the food allergies are "undiscovered" and the infertility is "unexplained", how were you able to "discover" that the food allergies are the most common cause of infertility?
Noticeably missing are the recommendations to check for immunity against Varicella and to provide that vaccine before pregnancy as well as to consider HPV vaccine if the woman isn't already infected. Of course each woman should receive seasonal Influenza vaccine each year...especially important if she is pregnant during the seasonal flu season.
Folic acid supplementation is recommended 3 months before conception for all women to decrease the chance of neural tube defects and is available in prenatal vitamins that should be prescribed to women contemplating a pregnancy.
There is an excellent informative 10 page booklet available on the internet from the ACOG (American Congress of Obstetricians and Gynecologists):
Preconception Care-ACOG District II New York
The booklet discusses other tests, including many STDs that should be diagnosed and treated before conception. The booklet also discusses specific genetic diseases for various groups (Black and Mediterranean-hemoglobinemias) (Ashkenazi Jews-Tay Sachs, Canavan disease, Cystic Fibrosis and other genetic diseases) as well as family histories of genetic disorders. Of course if the woman and her partner are both carriers of these many genetic disorders, then referrals should be made before conception to a geneticist to make an informed decision about actually getting pregnant.
Would any sane woman want to proceed with a pregnancy with a naturopathic midwife who might treat a woman in labor who has been diagnosed with vaginal Group B Strep (GBS) with "natural" ingredients?:
"fresh garlic clove inserted into the vagina for one or two nights will also, most likely, reduce the colonization of the vagina with GBS, with no known side effects, besides garlic breath. But none of the funding agencies or drug companies are interested in providing support for researchâlikely because the product could not be patented. Chlorhexidine vaginal gel or wash reduces GBS colonization, so the idea of using local measures is not too radical. But at this time, a clinical trial in the U.S. to demonstrate efficacy of these topical methods will be almost impossible, given the established standard of care (intrapartum antibiotics) established by the CDC. So garlic experiments to reduce neonatal GBS will have to take place outside of the U.S."
(Source-Midwifery Today-How To Treat A Vaginal Infection With A Clove of Garlic)
I've got a mini-Composer now (6 weeks as of this Sunday) and must say, in light of being a new parent, that I find this kind of quackery much more upsetting now than I might have before.
The simplest refutation of the "OMG toxins" and "natural healing" blithering is to point out that there are now 7 billion humans on the planet, and that the average lifespan in developed countries has almost doubled over the past "toxin"-laden century. At no time before in the history of the species has there been as many of us living as long... and we can prove it.
If naturopathy was so good, then why were lifespans so low when most people had access only to its remedies?
-- Steve
@ Edith Prickly: Congratulations on your successful pregnancy because you had the very best care for your preterm baby.
My daughter lost two pregnancies about twelve years ago and before there were any genes identified/tests available to see if she was a carrier of the genes that caused her brother's rare genetic disorder. Prior to her third pregnancy last year, she was tested and she doesn't have to worry about this particular genetic disorder. Unfortunately she miscarried this conception as well due to Trisomy 16...the most common reason for miscarriage for women who have a history of multiple fetal losses.
If she decides to "try" again, it will be with the assurances that she has prenatal care with an obstetrics group that offers complete and thorough pre-pregnancy, prenatal and intrapartum care.
I get so mad at crap like this. Naturopaths have this Disneyfied perception of nature. They don't seem to realize that nature is harsh. Back before all those real medical interventions that lead to more successful births, the "natural" methods of conception, gestation and birth had a really bad track record of success. The whole process is still horribly risky, with things that we still have trouble dealing with. I'd tell them to go pet a bear, but I'm really rather frightened for the well-being of the bear.
Hubby's youngest son and daughter-in-law chose a midwife (she was associated with an obstetrics practice but the prospective parents would only see doctors in case of visible complications or if there was a problem during delivery) and planned for a home delivery if everything looked "okay."
There were no ultrasounds done, just monitoring of fetal movement and heartbeat with stethoscope. Most pregnancies really seem to progress pretty well, they were both young and healthy. What could go wrong?
She got violently ill one day and found out she lost the baby at eight months' gestation. They couldn't find a specific problem when with Clara Grace after she was delivered, but we also can't be sure that maybe it could have been caught with proper monitoring, intervention done and the baby saved.
Needless to say, when they got pregnant again our daugther-in-law had an OB/Gyn for the entire pregnancy, and their second daughter survived and was born in July. I'm sure that if they were asked their opinion they would encourage being very cautious when it comes to "natural is better."
@lilady - thank you, and I am very sorry to hear about your daughter. Two failures is hard enough, and to have it happen again after so long must have been incredibly traumatic. I wish her a successful outcome if she has the courage to try again.
@Mrs. Woo - I'm very sorry for your daughter-in-law too, and unfortunately that is a perfect example of why even low-risk pregnancies have to be properly monitored. I can't believe she wasn't sent for any ultrasounds at all, that seems incredibly irresponsible. And I have never understood the appeal of home birth. Even if I hadn't been high risk I still would have done a hospital birth. I felt much safer surrounded by trained personnel with access to drugs, monitors (my son had cord compression during labor - not a surprise to me, he was a real "squirmer" in utero) and specialists - I came very close to needing a C-section too.
Really, I hate this flawed inference that natural means good. It's not good, it's not bad - it just is. Nature solves problems by killing off an individual and letting offspring of the more fit ones take over. It worked well enough for millennia, but now we want to do a little more than kill off less fortunate individuals. To do so we have to do "unnatural" things - you know, all that stuff called culture, that makes us anything more than slightly smarter chimps. You want natural? Get back onto trees and get eaten by the leopards!
@Edith Prickly
Thank you. I'm sorry for your losses as well. My son was born with the cord wrapped around his neck three times. If I hadn't had the epidural the speedy way they got him through the birth canal would have been very uncomfortable. I know he would have been in a lot more danger if I hadn't been at a hospital. We were very close to c-section ourselves but they managed to avoid one.
The best we can do is be sure that when we have the opportunity (you are blessed to be in a profession where you can help with that!) to educate all we can. The reason all of these medical practices have become standard is BECAUSE they save lives. It's too bad that it is so easily forgotten in a world where we no longer see the problems that arise from lack of medical intervention.
Thank you for your comments. It seems like congratulations are in order for Composer 99 and Mrs. Woo who have healthy babies in their lives, now.
I have (another) long post held in moderation about garlic treatment for vaginal infections....I couldn't in my wildest dreams make this one up!
From the second site Orac linked:
And:
Have these people even read any history? Heck, have they ever the The Lorax?
Ooops. That's read the The Lorax.
lilady & Mrs. Woo:
I'm sorry for your daughter & daughter-in-law's losses - I know MrsComposer and I would have been devastated if we'd lost the baby at 8 months! (Thanks also for your well wishes, lilady.)
And garlic treatment for vaginal infections...? Eugh.
Actually, garlic doesn't sound that bad...not when you realize that seventy years ago Lysol was being marketed as an aid to feminine freshness.
(I know. Parts of me are cringing).
Naturopaths ( NDs, NMDs) are tolerated in 16 American states and Washington, DC after going through the motions of getting an education at 7 accredited naturopathic medical schools.
Oh, they're tolerated nearly everywhere. Those are the states that elevate them to the clergy.
Edith Prickly and Mrs. Woo
I'd just like to comment that I have had 4 children, all born at home (including one with cord wrapped round his neck 3 times) with no problems. I had no epidurals. I am not a back to nature crank; I was just fortunate to live in UK where giving birth is regarded as a natural function and not an illness. The midwives are highly trained and very competent.I had great ante natal care and was closely monitored and if there HAD been any sign of trouble I would have been sent to the hospital to deliver.
Too many women have been brainwashed into thinking giving birth is tantamount to a liver transplant and cannot be accomplished without anesthetics and major hospital care.
Janice S.,
Congratulations! I am really glad it all worked well for you.
Did it ever occur to you that the women who chose to give birth in hospitals arenât brainwashed â we just prefer to take fewer risks than you? Oh, and please donât try to persuade me that homebirth is just as safe as at a hospital. Whereâs the sterile operating room and blood bank at my house? Whereâs the NICU?
One thing that gets me P'd O about all this is how it casts aspersions on all midwives, including Certified Nurse Midwives, who are highly trained in all aspects of more-or-less normal pregnancy and birth.
My wife (a CNM) worked for many years in a practice based in an academic medical center; all deliveries were in hospital and there were excellent lines of communication with the OB docs. Stuff happened, of course, but the midwifery practice maintained an excellent safety record while being sensitive to patient's concerns and emotional needs. There certainly were many occasions where things went off the rails -- but they were right down the hall from the OR, so crash C-sections were available when needed.
What? The diet among pregnant women has worsened over the past several decades?
I agree that ALL midwives need not be given a bad rap. I love my CNM who referred me for extra ultrasounds, recommended I get some vaccine boosters prior to conception, and only delivers at the hospital. I only live 5 minutes from the hospital (speeding) but 5 minutes of me bleeding out or my baby not breathing is just something I'm unwilling to risk. Thank goodness for modern medicine.
Saliva testing for toxin levels? Yeah, that screams "effective!" at me.
@ Janice S: Well aren't we the smug little breeder, who has had successful deliveries at home. I suggest you check the NHS website for placental abruption...paying particular care to the risks to the mother and the infant and your chances of survival at home should you go into shock from DIC (Disseminated Intravascular Coagulation). BTW, my close colleague is a certified nurse midwife who was educated and practiced midwifery in the U.K. She opted for hospital deliveries for her 3 children here in the United States.
@ palindrom: My long posting STILL in moderation (Orac, are you there...to get it out of moderation?), makes reference to naturopathic nurses, not Certified Nurse Midwives who like your wife delivered babies within the confines of a hospital...with the full support of a slew of specialists available for an emergency Caesarian section, crash cart for resuscitation and blood bank for transfusions.
Except for all the other undiscovered most common causes of uneplained infertility, which she'll make up later in other posts.
Except that IgG is the only antibody that crosses the placenta, and IgE is the one chiefly responsible for allergies. Good thing we're sticking to the vague word "antibodies" so they all look the same.
Explain then, how our population shot up above 2 billion during the dirty days of the industrial revolution? How did pollution-mad Britain steal so much foreign territory? How does India, home to the worst pollution in the world today, have 1.4 billion people and counting living there? If anything, it looks like humans are smog powered.
Denice Walter:
This is not our proudest moment.
@Janice
How much history do you read? Have you any idea how many women used to die in childbirth before modern advances in medicine?
@Janice - I'm happy that your home births worked out well for you and your children, but I have to ask who has really been "brainwashed" here. While I believe that your midwives were competent, you should also consider the possibility that you were just lucky. Yes, childbirth is an all-natural function, but that doesn't mean it's benign. It's incredibly risky, and was a major killer of both women and infants up till relatively recently. In parts of the world where women don't have access to decent medical care it still is a killer. I wonder how they would feel about the idea that homebirth is superior to hospital birth.
As I partly explained above, I NEEDED a hospital birth. Besides my existing risks, I had to be induced at 33 weeks because I was going into pre-eclampsia, and they put me on a pitocin drip so I was into hard labor right away. I went 7 hours without the epidural, and 7 hours with, so I knew exactly what I was missing. Yeah, I did the pain control breathing - and after several hours I was so worn out I was falling asleep between contractions. The epidural reduced my stress, let me sleep and save my strength for the final push.
Maybe you can explain why "Natural" childbirth advocates make such a huge fuss about epidurals? It makes no sense to me why pain relief should be a negative thing. After my labor was over, I had the uncharitable thought that some of the anti-epidural people must be closet sadists. There is nothing inherently ennobling about enduring pain and I see no benefit of going without an epidural apart from bragging rights.
@lilady
You raise a great point. I wouldn't be here if not for those resuccitations and blood transfusions.
Janice, how nice that you were just so lucky. Some of us are not so lucky. My son and I would have died if it were not for being in the hospital (mostly due to his large head being stuck). He spent his first week in life in the hospital because of seizures, I was literally ripped from stem to stern.
The next thing that the happy lucky moms will do is try to blame mothers like Edith Prickly, Mrs. Woo, myself and others for our bad luck. Usually the questions I get are based on my diet, did I have vaccines (no, I had influenza), or something silly like if I looked at the full moon.
One friend I know did have her first child at home without any meds. Except it was not on purpose, her son essentially fell out while she was in her sixth month. She held him during the his entire two minute life as the ambulance was rushing to her house.
Some people tried to blame it on a bike ride she was on the day before, but her aunt suggested she go to obstetrics practice that specialized in high risk pregnancies. She found out she had an incompetent cervix. With good medical care, including spending several weeks of her pregnancies in total bed rest she had two healthy boys. They were premature, but healthy (her last month was in the hospital where she had several ultrasounds to make sure her baby's lungs were developed enough before birth.
So, dear Janice, take your sanctimonious attitude elsewhere. And like Mr. Cunningham suggests, read a bit of history.
lilady@27 - you rock. :)
Edith Prickly:
I wish I knew. I have never had an epidural, and there were still complications with my first baby. I mentioned the difficulties elsewhere (and in a comment in moderation), and some sancti-mommy kept insisting it was because of the epidural I never had. Le sigh.
I have no comment about naturapathic obstetrics but I do support midwifery care, including homebirth in low risk mothers.
By all means - LOOK at the evidence for homebirths.
Outcomes of planned home births with certified professional midwives: large prospective study in North America
Kenneth C Johnson, senior epidemiologist (ken_lcdc_johnson@phac-aspc.gc.ca)1,
Betty-Anne Daviss, project manager2
http://www.bmj.com/content/330/7505/1416.full
When discussing midwifery, it should always be remembered that different countries have different standards and regulations for them; not all midwives are created equal.
As for naturopathy in general, here's a little anecdote. I know some folks online who are from Oregon. At one point they mentioned that naturopaths are so much better than MDs, because anytime they want antibiotics the naturopath just writes them a prescription while the MD asks questions and sometimes tells them antibiotics won't work. File under "wonderful ways to create superbugs."
hornblower:
Two questions:
Why are you posting off topic?
How do you know a pregnancy is low risk?
Sorry if I'm dominating the thread, but this topic has really hit a nerve. The other big reason I hate birth woo is that if I had believed even a fraction of the twaddle about the evils of medicalized childbirth, I would have been a total wreck during the first few weeks of my son's life. He was in the NICU for three weeks and had to be tube-fed (formula first, then pumped breast milk) until his sucking instinct developed. I was allowed to go in and hold him whenever I wanted, but the first few days he was all wired up, so holding him was rather stress-inducing. I had to give up control and put my trust in all those doctors and nurses who did so many "un-natural" things to keep him alive, and they more than rewarded my trust. I can't imagine what it would have been like if I'd had a head full of anti-medical propaganda and natural childbirth woo.
All this puts me in mind of the fairly recent brouhaha (hahaha) over epidural analgesia, in which Harriet Hall had the effrontery to suggest that (as argued in a book by Gilbert Grant) epidurals are often the best and safest way to manage pain during childbirth. She said as much in a review of the book on Amazon, and, well, the piano player stopped and everyone hit the floor. Seems that childbirth is not only magical and sacred, but helping a woman accomplish it without unremitting agony takes all the magic and sacredness out of it. Who knew?
@Janice S - congratulations for the good deliveries and healthy children. Maybe if we hadn't had more difficulty would we be just as cavalier as you are. I know that any mother's hope when pregnant is to have the very best pregnancy and delivery for their child.
@Bethany & Palindrom - the practice that delivered my son had a certified midwife on staff and there were rave reviews (including from many OBs on the staff) about her. However, there were specifications for care that were still in place (including ultrasounds and some screenings, labwork, etc.), but unlike when working with an OB you actually ALWAYS saw the same person, and that was the midwife. She also delivered in the hospital setting only because of the ability to call in surgical staff, etc., for emergencies. If my daughter-in-law had had that kind of situation I would have been more supportive of her choice. The home birth and more limited health screenings made me nervous from the beginning, though. Bad things can always happen.
My daughter-in-law's first baby was in a program which was much different, sadly. It included no ultrasounds and very little testing, just measurement for fetal growth and stethoscope to listen to heartbeats. The practice that delivered my youngest recommended their midwife and she had an excellent record. I'm not condemning all midwives, but between the difficulties at my son's birth (which included the last minute rush of an additional ten people into the room in case of switching to emergency c-section) and the loss of my first granddaughter, I would approach home birth with caution and be sure to be educated about commonplace monitoring and testing for healthy fetal development.
My understanding was that midwives generally advise against home birth for a first delivery, anyway. I have a friend who looked into it and was told she would be better off having a midwife-supported natural birth in a hospital for her first. If that was uneventful, the midwifery practice in question would do a home birth for her second baby (assuming her second pregnancy wasn't high risk).
@lilady - I'm sorry for all your daughter has gone through. Have one aunt and a cousin who have similar miscarriage issues. It is a hard thing for a woman to struggle with something that seems like it should be so 'natural.'
Garlic for vaginal infections? ~shakes head~
Was reading someone's site about healing the other day when looking for decriers of "germ therapy." She said that all that was needed to NEVER get sick was 5 GRAMS of calcium per day (to neutralize your acidic body if you were unwilling to be a raw vegan) with large handfuls of vitamin D to increase absorption. When that failed (interesting that it failed - I should have asked her how often she is sick; I'm sick less than once a year without such craziness) she just had her family drink colloidal silver. I really need to go back into my history and post the link to the gray lady for her...
*oops! germ THEORY
Hey guys...finally my stuck-in-moderation comment is posted at # 7 above. No, I definitely did NOT make up the treatment of vaginal infections with a clove of garlic.
Here we go with two other sedation/analgesia-for-birth stories:
Child #1..my 41 year old daughter was not in position to ever be born vaginally. She was a "shoulder presentation" in the lower part of my uterus. So, in order to do an internal version (get the picture?), I was knocked out with Demerol, Seconal, Scopalamine and Gas. My daughter was the "star of the nursery"...the most alert and active infant there...after all the sedation I received. Had the doctors not performed this lifesaving internal version I would have died and my dead child would have been delivered after my death.
Child #2 was in trouble in utero and I was given an epidural that provided partial analgesia...it was extremely painful to have my uterus swabbed out and irrigated due to the meconium from my baby, after his birth.
Hornblower...How do you know a pregnancy (or a delivery) is low risk?
I just realised that I must've had a very sheltered upbringing, born and raised in Northern Europe, since I had not the faintest idea what a naturopath is supposed to be. I kept on reading that word as neuropathology...
And epigenetic, I don't think that word means what you think it means.
(my emphasis)
Wikipedia tells me that does not, in fact, mean shoving one's head up one's ass for therapeutical purposes, but, still, would it have killed them to chose a name that doesn't sounds like an infantile joke?
Janice wrote:
Illnesses aren't natural?
I can't believe they would suggest craniosacral therapy for an infant? Granted, maybe they do that without blowing the balloons up endonasally, but I was taught to be incredibly careful of my infant's still fragile skull. Hubby heard about it on a radio show run by an ND/chiropractor whose claims for healing included Down syndrome (why that didn't scream "liar" to hubby immediately I'm not sure). According to what I've read "realignment of skull structures rebalances cerebrospinal fluid resulting in improvement."
Seriously? I was actually grateful to have had a badly broken nose years ago - literature says that craniosacral therapy is contraindicated in those cases. I refused to go near the "doctor" anyhow, just in case he'd assure hubby that if it had healed long enough ago blowing balloons up in my nose was still a good idea.
lilady
That was a long pregnancy :)
@ Militant Agnostic: Touche! Daughter was born after a full term pregnancy...nine months...if I recall my nurse's training correctly.
What's scary is that there is currently no scientific information resource on obstetrics. All the medical information has been coming from Amy Tuteur. She is irrational and unconvincing. She originally had a teach-the-controversy style blog that contained links to naturopaths. And for quite a while she refused to list her credentials, despite being asked about them many times.
Well, Amy Tuteur writes a blog. And while this blog has some good science in it, it would still not really be considered a scientific information resource.
Instead of looking online and the University of Google for scientific resource, don't you think actually contacting a real doctor who has trained in obstetrics (like my family doctor) would be better?
Hmm. Well, I looked at Amy Tuteur's blog. Turns out she's an MD/obstetrician who's delivered thousands of babies. As opposed to commenter #50, I found her to be both rational and convincing on the subject of delivering babies and caring for pregnant women.
The wrongheaded ideas that she complains about are very similar to the dumb ideas that anti-vaxers espouse:
This argument sounds a lot like the lame anti-vax illogic that goes, "We practice wonderful hygiene in our house, and therefore our kids will never get pertussis."
One retired doctor is not the same as the entire profession.
Oh, and I might add to #50, that just because you don't like Dr. Tuteur, that does not automatically make naturopathic obstetrics better.
She is a doctor? Oh boy i am about to get my phd degree... i dont want to live on this planet anymore...
Quelle surprise, a couple of very common canards emerge in the comments:
1. The Un-Patentable Remedy
Courtesy of lilady(*), who is describing some OB-quackery du jour, we see some midwifes whinging about how no one will test their proposed clove-of-garlic remedy for group B streptococcus colonization:
I can see why no one would want to market cloves of garlic. On the other hand, a topical paste with garlic, perhaps with a standardized consistency, dosage, and some fancy packaging, would be a great product made by some quack supplement company. Maybe even patentable. Still quackery, though. But I really don't see where the Midwifery Today folks are coming from.
2. The "Natural" Fallacy
Courtesy of Janice S. in comment #22, we get the natural fallacy:
As has been amply established here on Respectul Insolence and elsewhere, natural is not necessarily the same as good. Pregnancy and childbirth is fraught with peril (the Wikipedia article on obstretics has a good summary of some of the potential complications). This Wiki article points to resources (specifically, an article in the 2007 Australian and New Zealand Journal of Obstretics and Gynaecology) suggesting maternal mortality rates as high as 25 per 1,000 births and infant mortality rates ranging from 50 to 200+ per 1,000 in pre-modern polities (the article suggests ancient Roman society may have had infant mortality of up to 300 per 1,000 births).
----------
(*) I should be clear and emphasize that lilady is not, in fact, endorsing vaginally-inserted cloves of garlic, merely relaying the existence of said quackery to the rest of us (in the words of Dave Barry, she is not making this up).
All "Natural" midwives should be made to walk through old cemeteries, and read the headstones of the multiple babies from one family, and the women "of childbearing age".
And then they should consider talking to the manufacturer about a recall notice on the female pelvis....Intelligent Design ...not.
@ Composer99: In addition to Dave Barry, I also stated the obvious "I have (another) long post held in moderation about garlic treatment for vaginal infections....I couldn't in my wildest dreams make this one up!"
Posted by: lilady | October 28, 2011 2:00 PM
In case anyone is interested...from the same website:
Garlic protocol:
* Break a clove off of a bulb of garlic and peel off the paper-like cover. Cut in half. Sew a string thru it for easy retrieval.
* Put a fresh half in your vagina in the evening before you go to sleep. Most women taste garlic in their mouths as soon as it is in their vagina, so it is less pleasant to treat while awake.
* In the morning, the garlic may come out when you poop. If not, many women find it is easiest to take it out on the toilet. Circle the vagina with a finger, till you find it. It cannot enter the uterus through the cervix. It cannot get lost, but it can get pushed into the pocket between the cervix and the vaginal wall.
* Most people will taste the garlic as long as it is in there. So if you still taste it, it is probably still in there. Most women have trouble getting it out the first time.
* For easy retrieval, sew a string through the middle of the clove before you put it in. You don't want to get irritated. Be gentle. Don't scratch yourself with long nails
Sounds yummy, but if I am going to "offend" with garlic breath I would prefer to have eaten it in some delectable Mediterranean dish.
TheLastInuit:
If you are referring to Dr. Tuteur, then yes, she practiced as a honest to goodness real medical doctor.
But if you are referring to the subject of this article, Sara Thyr, well, she is not a doctor. You see, the "ND" behind her name means "Not a Doctor."
My friend, the accupuncturist, stopped playing with those needles after a good 4 hours of active labor..labor convinced her that what she had been preaching and poking about pain control was crap...
and another thing that bugs me: (Orac or HH did a great post regarding)why women choose to "experience" labor pains when safe and effective pain control options are available..
@ mary: Some women...and I do mean only some women...may have an inherent inner structure to go through labor relatively quickly and without any medication. Then too, is the multipara woman who plans (or not plans) pregnancies close together, who seem to have much easier and quicker labors I have a friend who had her first child at age 37, she felt as though she "might be in labor", delayed her departure to the hospital and gave birth on the gurney that was taking her into the delivery room, 10 minutes after her arrival at the hospital.
There is absolutely no reason for not providing adequate analgesic pain relief with the most modern of fetal status monitoring that is available today.
Don't get me started on the whiny women who were denied the "experience of labor" because their condition and the infant's status warranted a C-Section, that resulted in a healthy infant.
I think it's a feminine form of machismo. I've heard women say that they experienced enough pain that they could "keep up with all the other mothers." The impression I have is that you aren't a real woman until you've suffered through drug-free labor.
FWIW, I think it's silly, but as long as the baby isn't at risk (as is the case with the goofy naturopathic and birthing nonsense), they can be silly.
@lilady,
Yes, one of my aunties had labor and delivery exactly as you describe (did you know my auntie? :-) ). Her first child was born on a gurney in the hospital lobby! Labor started, they waited before leaving the house, and baby was born very quickly. They had to induce her subsequent children because they were very afraid that a baby would be born in a car or some other suboptimal location.
As someone who had the "experience of labor," I can say that I was dreaming of transporter technology that would gently beam baby out of me. Now wouldn't that be lovely?
I personally wouldn't care to give birth not in a hospital setting. There's too much at risk and too many things that could go wrong - I'd prefer to have a surgical team ready if the crap hits the fan.
My first child was born sans epidural and after a 4 hour 10 minute labour. 11 minutes for pushing and they had to catch her before she hit the floor.
My second - 18 hours of nonprogressing labor with a resultant c-section. He had wedged his head sideways into my pelvic girdle - the heart monitor which is normally on top of the head was just above his ear.
I don't trust the woo of ND's - and most of the conversations I've had with them lately haven't ended well. Point out the obvious errors in their reasoning and they get quite snarky, demanding to see my educational credentials and so forth.
Janice-
Birth IS a natural function. But it's a natural function with a high chance of killing the baby or the mom when left to its own devices! It is meaningless to say it's "not an illness"- I mean, what does that even mean? Lots of things are natural and still deadly. It's easy to feel smug when things go well and luck is on your side.
But I wouldn't get too smug about the UK- your stats regarding obstetric care (perinatal/neonatal mortality) suck, and the situation with MWs isn't great. Unless you think denying moms the care they need and want, and killing people is great. I guess you not hear about the large amounts of preventable deaths at the hands of MWs who are obsessed with "normal birth" (hospital too!)? its all over the news, Im sure you couldnt miss it.
Home birth is not safe, you just got lucky. Im also not sure why you felt you had to mention you didn't have pain meds- do you think this makes you better? Why would anyone care if you skipped pain meds, as millions of other women don't get to have them either. I am glad I had access to them, as Im not a martyr. for most moms, birth is very painful, and there is zero reason to endure it- you don't get a gold star for this you know.....
Orac- thank you for mentioning this. We need more sane voices on childbirth woo, as it's getting to an all time high and is extremely harmful. The push for "normal" KILLS people, and HB is killing healthy babies everyday. This woo infects even those who don't go all the way to HB, by making them think its good to suffer (ie: no epidural), and giving them reams of guilt if things don't go exactly as planned.
What is scary is that in some states, NDs can WRITE PRESCRIPTIONS. Yikes. Good thing they prefer woo, the damage they could do with a pad and pen is a frightening though.
Orac -
You really need to get respectful and insolent about the "homeopathic Biotherapeutic Drainage that is mentioned.
It uses the "Unda Number" remedies http://whatishealing.com/UndaNumbers.htm
From the article by Thyr:
"Testing should look at the antibody IgG, as this one is most responsible for delayed hypersensitivity reactions"
This just shows how incompetent naturopaths are. The can't even get basic immunology right. Delayed-type hypersensitivity is Cell-mediated, not Antibody-mediated.
She also seems to confuse allergies with the other hypersensitivity types. Allergy is type I. The rest (type II, III and delayed-type) are not allergic reactions.
Yes, Amy Tuteur is an OB, so attempt at ad hominem failed. Moreover, she is actually very Oracian in her treatment of the "natural childbirth" movement - in fact, there is a lot of overlap in the readership of the blogs because they are very similar (hi Squillo and Allie! VBP here!)
As for this topic:
Someone above claimed how the Johnson paper showed that low-risk homebirth is "just as safe" as hospital birth. While that is what the authors claimed, that's not what the paper showed. They made that claim based on comparing homebirth mortality rates in 2000ish with hospital mortality rates back to 1980. If you compare data from 2000 alone (which they had) the homebirth perinatal mortality rate was 3 times higher than the hospital. For comparable low-risk births.
More recent data is even more dramatic. Recent data from South Australia, which uses a professional level midwife (comparable to the US CNM) show that homebirths are 17 times more likely to end up in death than hospital births (amazingly, even hospital birthing centers with a midwife were something like 3 times more likely to result in death). Similarly, data from Missouri indicates that rates of deaths in homebirths are 11 times those of hospitals. In that case, there was far less control of the attendant, and it included CNMs but also CPMs (the diploma mill version of midwife) and even OBs.
Former Australian midwife is currently facing a coroner's inquisition for her role in a homebirth death. This woman has had at least FIVE homebirth deaths in her hands in the last 5 years. Given that she attends on the order of 20 - 25 births per year, that puts her fatality rate at around 5%. She is a combination of reckless (doing homebirths for high risk) and incompetent.
@ Tsu Dho Nimh: The link you provided is a "gem". So if I read it correctly, the body need cleansing with some vegetables and flower petals along with a heavy metal...lead, before you can start the hyper-diluted homeopathic medicine.
I love the disclaimer beneath:
"Due to government and FDA regulations the following must be stated: These statements have not been evaluated by the Food and Drug Administration.
The information provided is not a substitute for professional medical opinion. It is provided for informational and educational purposes only."
That's it??? So what does the disclaimer mean when all these cleansers are still being prescribed along with homeopathic "medicines".
I guess this is Tea Party and Libertarian politics at work.
"Keep government out of peoples lives!!!"
In addition to lilady's discussion of shoving garlic cloves up your hoo-ha to stop bacteria infection, there is this one:
in the event of post-partum hemmoraging, the recommended treatment: eat your placenta. Preferably raw. (I'm not making this up)
In fact, there are midwives that sell "encapsulated placenta" for this purpose. That's right, "placenta supplements"
@MMMindy
I think I just threw up in my mouth a little bit.
That's seriously disgusting.
I think I just threw up in my mouth a little bit.
That's seriously disgusting.
You probably don't want to look at this cake, then.
Marry Me, Mindy@68: Did the studies you cite break down the homebirth figures into planned and unplanned homebirths? There are many reasons for an unplanned home birth - premature labour, a young girl hiding her pregnancy and so on - and they all carry high risk factors and outcomes that will skew any statistics that don't take them into account.
Sophia - these are all referring to attended births, so they are completely intentional
@Tsu dho Nimh: That link is the worst load of garbage that I have read in a while.
While all of it is garbage, some of the worst is:
Weak EM fields will destroy the meds but repeated exposure to ionizing radiation will not?
So is this homeo-pathetic grammar now?
@ Valerie
What about a fully external pregnancy, in uterine replicators?
(copyright Lois McMaster Bujold, in her Vorkosigan novels)
@ Narad...that really is a cake...isn't it.
I think that domestic cats eat the placentas of their kittens. The also sever, by chewing, their kittens' umbilical cords.
I wouldn't recommend this for humans.
"I wouldn't recommend this for humans."
But see? This is exactly why there are people out there who think we SHOULD be doing it. Because, you know, mother sows eat their placenta, so therefore people should, too.
It's all so obvious!
@ Marry Me, Mindy:
"Because, you know, mother sows eat their placenta, so therefore people should, too.
It's all so obvious!"
Mother sows give birth in pig pens. Cats give birth in birthing boxes. It's all so obvious!
"Mother sows give birth in pig pens. Cats give birth in birthing boxes. It's all so obvious!"
No, those are evil interventions. In the wild, sows will run off into a secluded area in the woods to birth.
And indeed, there are some who claim that women should do the same thing. They should go away to a secluded place and give birth all alone.
I was just fortunate to live in UK where giving birth is regarded as a natural function and not an illness.
This "not an illness" line is parroted by natural-birth types all the time. It's a cliche, a bad one... and your statement is not true. Birth is natural. So is dying. The severe preeclampsia in my first pregnancy was natural. So whatever is "natural" is not relevant. A normal, low risk pregnancy is not an illness, but it can turn into one (see my preeclampsia, again). That's why we watch them closely.
For that matter, I've also given birth on the NHS. The minute anything goes wrong, you're booted up to the consultant obstetrician. I've heard people fuming about getting risked out "for nothing" (and heard of a few midwives who did nothing to disabuse them of that perception). I live in the US now, but if I were to return to the UK, I would never be allowed into midwifery led care again. Officially, my two previous caesareans are enough, no matter what some people will tell you about VBAC just being another birth.
I will say that home birth on the NHS is safer than it is in the USA, not least because they will risk you out and they will transfer you. 10% of births in my in-laws' area take place at home. The official line in the UK (including RCOG) is that planned home birth is an acceptable choice for low risk women. This is supposed to be a science based blog: horrible anecdotes may affect us emotionally, but they're not how we make medical decisions. Disasters can happen anywhere. An individual disaster doesn't teach us much about the general case.
Mary and Valerie,
I'm the kind of wimp who takes a pill for almost every toothache and headache. I had four births without any anesthesia. For all of them, I had on again off again contractions for weeks before I gave birth (as close as 5 minutes apart 2 weeks before they were actually born). My first child was born after 4 hours of consistent labor and two others after less than an hour of labor. Labor was hard, but not unremitting, because there was always a gap between the contractions and when the contractions hit, I was able to cope with them. At the point where I couldn't cope with them any more, I was actually in transition and my body started pushing soon afterwards. The last thing I wanted was to have a needle stuck in my back and a drip and being unable to move about. As soon as my baby was born, and the placenta was out, there were no after-effects. My sister-in-law, who had an epidural, had a terrible headache for a week after the birth of her child. I'm not saying labor pains good, epidural bad, but there are risks and benefits and each woman makes the decision based on how she sees them.
I'm also not being smug. With my third child, my labor went on for nearly 8 hours. It wasn't something I could cope with like the others. I was ready for an epidural and would likely have had one if, at that moment, my cervix hadn't suddenly fully dilated. Women have different labors and some of them can cope easily with the contractions. There's absolutely nothing masochistic about it. However, I think that it's very wrong for natural childbirth advocates to criticize women who decide to have medication for pain in childbirth. They're not standing in that woman's shoes.
@MMM
"Because, you know, mother sows eat their placenta, so therefore people should, too."
A commenter actually used that argument on a local news site here. I attempted a reply but my heart had sunk too low.
The HB woo is strong in my part of the world, and friends of mine encouraged me to birth my daughter that way. Luckily for me and my daughter I didn't subscribe to that as she came a month early and was in the wrong position. 18 hours and 2 epidurals later, my daughter was delivered via emergency c-section. I am very, very grateful for the modern medical interventions that delivered my daughter to me in perfect health. She was alert, took to feeding straight away and has been hale and hearty ever since (even despite the evil toxic vaccinations!).
@ Alexis: I understand what you are saying about "risking you out". But, are you referring to home births, births in a hospital or an adjacent wing of the hospital...attended by nurse-midwifes?
There are some instances where being at home a few miles from the hospital, can put a "typically proceeding" woman in labor and her baby at great risk. Conditions such as placental abruption, DIC, and cord prolapse, can occur rather quickly and dramatically. Being any distance away from the hospital, decrease the chance of survival of the woman, her child or both of them.
I think we are all on the same page here that a medically trained person (nurse-midwife or obstetrician) should be assisting in the birth. Naturopathic practitioners have no place in modern, safe obstetric care.
Scatty and Hinterlander: As you both stated in your excellent postings, every woman is different and every birth is different. No one, certainly not another "mommy" should impose their opinions about analgesia on another "mommy". We are, after all, concerned about healthy outcomes for mom and the baby.
lilady: All three. THe NHS is an integrated system. I got booted up to consultant at booking-in (and in my case, saw a high risk obstetrician for all my antenatal visits), so I never got to experience midwife-led care at all, but as I understand it, all patients are booked in through the community midwifery team. They may divvy patients up based on planned place of birth so the midwives who handle home births get familiar with their prospective clients before delivery, but they all work with the OBs and under the same guidelines.
Yes, there are specific cases where being out of the hospital will kill you. However, the studies in countries where home birth is well regulated (Canada and the Netherlands) show that on aggregate, mortality is about the same. (Yes, I'm aware that in the latter case, that's clouded by the fact that hospital stats are nothing to boast about, either.) I will never home birth, but I'm not sure that making decisions based on very rare possibilities is the best course of action. Giving birth in the hospital also has some risks, and when we're talking very rare ones, it becomes a question of tradeoffs. I don't think the increased likelihood of CS (with its attendant risks) is so terrible, but perhaps someone would prefer to die at home of DIC than in a hospital from a rare surgical complication. All sorts of things might happen; the question is how frequently different complications occur and how they stack up.
@MMM
Also, fun little FYI, did you know that when cats and dogs miscarry, they eat the fetuses as well as the placentas? And sometimes, even when puppies and kittens are born alive, new moms can get a little to enthusiastic with the placenta-eating, and just go ahead and eat the newborn as well?
Back when I was a vet tech, I met an owner who only found out her dog was pregnant when she found it chewing on a dead puppy in the yard. Spay and neuter your pets, ladies and gentlemen!
Thank you for letting readers know just how little midwives and other "fake doctors" understand. Midwives and other supporters of dietary supplements or herbal remedies really can cause harm. Your article hit home for me because my grandmother is suffering from a very rare muscular degenerative disease, which may have been caused by zinc supplements that were- unfortunately- recommended to her by what you call a fake doctor. If a single supplement taken later in life can have such harmful effects I can only imagine the effects unregulated, but "natural" supplements could have on babies. The thought scares me!
Some supplements are being linked with cancer: http://www.medindia.net/news/Vitamin-Supplements-Can-Cause-Cancer-Warns….
If that isn't enough to encourage readers to go to a real doctor read this article about how some supplements negatively affect body regulation:http://www.livestrong.com/article/37166-negative-effects-muscle-supplem…
craniosacral therapy ? I had to look it up. I thought it had something to do with putting one's head in a bag. Come to think of it, that might be safer than having some fool shove my head around and massage my (now closed) cranial sutures.
K2L2 @88 -- Once again, I'd like to emphasize that not all midwives are created equal. Certified nurse midwives are not the same as so-called "lay midwives". My wife is a CNM and she practices in close collaboration with excellent MDs at a tertiary-care medical center. She doesn't use woo, but she does listen carefully to her patients. She'd never foist some unproven supplement on a patient.
@ K2L2: I'm so sorry that your grandmother was taken in by one of these scam artists. If you check the NIH ODS (National Institutes of Health Office of Dietary Supplement), you will find some great information on dietary needs and the risks associated with taking certain supplements.
@ DLC: In addition to "slumming" at the AoA website I also "slum"...and sometimes post under my 'nym...at that "wretched hive of scummery" (Huffington Post).
One of their alternative medicine blogger wrote an article on "Craniosacral Therapy for Kids". I, in turn, "investigated" the credentials for the world-renowned therapist who provides this therapy for newborns...and posted a rather scathing rebuttal to this woo that could really injure a newborn.
@ palindrom: I love CNMs who provide excellent care to women. You must be very proud of Mrs. palindrom.
Orac, I salute you for day after day facing this idiocy and writing about it without losing your sanity. I couldn't do it.
@Marry me, Mindy - do you have a citation for the South Australian data you mention? I'd be interested to read the full study. Thanks!
CSALocal - not a "study" but a report, linked and summarized here
http://skepticalob.blogspot.com/2011/10/s-australia-homebirth-death-rat…
Is "Biotherapeutic Drainage" peeing? If so, is "homeopathic Biotherapeutic Drainage" peeing after drinking a couple of gallons of of water, so the pee is colorless and, presumably, peeless?
I forget where I read this, but the bit about "Pregnancy is natural" reminded me of it:
Guy 1: He died of natural causes.
Guy 2: Natural causes?!? His neck was broken!
Guy 1: I think it's very natural to die after your neck is broken.
I had a look at Doc Amy's site, and would like to note that there is a major confounding factor. Basically SA (and WA) are states that have one major city only, a few smaller cities and towns, and a truly huge area of desert, scrub and gigantic cattle stations. They have a relatively large number of Aboriginal people living in, frankly, 3rd world conditions. Which is to our shame, but it still means that a fair proportion of the homebirth and birth centre data is likely to mean desert birth, or our equivalent of the US native reservation. Not strictly comparable with a homebirth in a city with a good ambulance service and hospitals.
And seriously, you lot have never heard the garlic woo before?? I get told about it constantly, along with echinacea, though usually it's for respiratory infections and you're supposed to eat it, not shove it up your vag! I think there's even a very small grain of truth, in that garlic is a mild anti-bacterial agent.
So does honey, supposedly - I wonder which one is less nasty.
Honey AND yoghurt. Add some tahini, nom nom, oh wait... that's breakfast, not medicine. Or perhaps a sex practice from AbFab.
Manuka honey. It's a shrub, man.
Cath the Canberra Cook:
Splort! Okay, that was a fake spit take. Thankfully I was not consuming any liquids when I read that.
Cath the Canberra Cook is giving me flashbacks to a time several decades ago when yoghurt as a treatment for thrush was common in the milieu of student flats I occupied with various like-minded friends. One learned to knock on doors before entering rooms, or else be confronted with gymnastic scenes of head-standing yoghurt application that would have made for an amusing but NSFW situation comedy.
Cath the Canberra Cook, that's a really good point. We have a similar situation in the remoter parts of British Columbia, Canada. The level of medical care (along with the standard of living) available on First Nations reservations is often extremely poor, to the point where it's embarrassing to admit that these conditions exist in a first world country like ours. The local medical centre is often just a double-wide trailer, and serves a vast area with an overworked skeleton staff.
Plus, there have been many cases where the skeleton staff are extraordinarily judgmental about and racist towards their patients, which tends to reduce medical compliance. Not saying this of every health care worker in these underserved communities, as I'm sure many work very hard and have the best intentions. But I'd say the minority who treat their patients like garbage are still a statistically significant minority.
Women whose pregnancies have been identified as high risk are taken down to towns with proper hospitals a few weeks before their due dates and put up in motels at the health service's expense (it's both cheaper and has a better medical outcome than medevac-ing them by helicopter when things start to go horribly wrong). Women with low-risk pregnancies are pretty much on their own, and home birth may well be the least lousy option for them. Unfortunately, like i said before, in such remote areas, medevac helicopters aren't a gimme if a low-risk pregnancy suddenly turns into an abruption or something.
It's hardly surprising that statistically speaking, First Nations women and neonates in Canada have the worst birth outcomes of any group of Canadians. But I suspect quite a few of these are home births because it's the least bad option, not home birth in spite of a safe hospital birht being ten minutes' ambulance ride away.
First: hi, Cath! I haven't been on TET in so long and I miss you!
This will be a short comment because I'm not very good at typing on the iPad yet.
The idea of naturopathic obstetrics scares me, and I AM a certified nurse-midwife (though not practicing any longer). I did not do home births but had many friends who did. And I've had a few battles with Dr. Tuteur (sorry if I spelled it wrong) because she is anti-midwife, even if they practice with physicians and deliver in hospitals. (After she called me a "doctor wannabe" I no longer read her blog).
The issue is this: 90+% of the time, a woman could deliver alone. But no one can predict the ones who will have problems. No good midwife would insist or allow her patient to insist on a home birth if complications were foreseen. Unfortunately, some do. Some women refuse pain medication. Some refuse in-labor transport.
I personally feel that we could do a lot better with prenatal care and with respecting a woman's choices. A planned home birth, attended by trained people, is better than an unattended one. The model in many European countries is far better (and their home birth stats are better too). Not every woman requires all the modern technology. All women do not need (or want!) ultrasounds, fetal monitoring, epidurals. These are all good; don't get me wrong. But they are not necessities for every woman.
I know the USA lawsuit mentality, and understand why people think they way they do. I'm just saying there are more sides to the story.
(Disclaimer:2 births, no epidurals due to pathological and illogical fear of needles going into my back. Yes, I had monitoring, pain meds, and other interventions due to pre-eclampsia. But every intervention, as long as no emergency existed, was discussed between my doctor and me and agreed upon. I was not told - nor would I have tolerated a "my way or the highway" attitude.)
I think the current trend, at least in affluent areas, is towards birthing centers where women can get the best of both worlds -- a "homey" birthing atmosphere, respect of your views and opinions and desires for birth, and also a couple of ORs and a NICU for when the $4!7 hits the fan. This is a good trend. I had both of my babies in a hospital, attended by a family practice doc whose demeanor is, honestly, like a cross between a midwife, a pediatrician, and a squirrel on crack. She's hilarious, and has enough energy for about three or four people. (I've never met a harder-working individual, either. Overtime all the time, and nary a complaint.) She's also a damn good doctor. She makes it a point of pride never to miss a birth for one of her patients -- even if it becomes a c-section. She assists the OB surgeon in that case, and is able to begin her pediatrics duties immediately. (Well, she waited a little while with my second; my second needed to be resuscitated, and that job is always taken by the NICU nurses who are on standby during the c-section in case of $4!7 hitting the fan in the baby department.)
Birth is natural. Pregnancy is natural. Neither are illnesses. However, it is astounding how many illnesses and injuries they can cause between them, in both the mother and the child. Anyone who thinks we should do it unassisted because it's "natural" is humbly invited to observe the aphid. Female aphids are one of those rare insects which give live birth. Unluckily, they are not equipped with a birth canal. They only have one litter of babies in their lives for the simple reason that birth is lethal to them. Every time. The babies actually eat their way out. Yum. Actually, birth is fatal in a lot of species.
Another thing they're humbly invited to review is the welfare and status of women in societies which only birth their babies the natural way. It is no coincidence that these cultures regard women as cursed. I'm not talking about some kooky tribal community. These are not marginal societies. Our own predecessors believed that. (Read the Bible sometime. Really read it.) Many Buddhists believe it; in Tibet, many believe that if you are really nasty in this life, you'll come back a rabbit, or a bug, or something like that. But if you REALLY screwed up, you'll come back as a woman. A bug is a step up from that. And why have so many cultures felt that way? They saw how difficult it was for a woman to have a baby. In a just world, women would only die so often in childbirth if they were either evil or disposable, or both. In any case, it probably wouldn't be smart to get too attached to them. Sort of like your livestock, really. And as much as it horrifies me, being a woman myself, I can't ignore the natural, common-sense logic of it.
Which is precisely why I am opposed to using natural, common-sense logic when the stakes are high.
I had my first child in a midwife practice housed inside a hospital. All the other mothers in my prenatal class/cohort ended up being carted into the hospital proper for delivery because of very conservative criteria for determining when delivery by midwife was inappropriate. The only reason I didn't go too was that my daughter shot out too fast, although there were some scary minutes when she was in distress. My son was born a month premature in hospital hospital (so to speak) by an ob/gyn (midwives only did home births where I had moved, and I was not at all keen on that). My conclusion after both of these experiences was that you need to be INSIDE a hospital when you are giving birth if you possibly can. Things can go wrong very, very fast. That said, I much preferred the midwife prenatal care which had all the ob/gyn components (relatively woo-free too I might add) but was more inquisitive, concerned, and reassuring than the rather indifferent care from the ob/gyn practice. Interestingly during and after labor, I'd give the vote to the ob/gyn crew, who gave me beta-blockers, were much more accommodating to letting my son stay in the nursery while I rested in my room, and were far more relaxed about any difficulties with nursing. Paradoxically, because they just saw pregnancy as a condition and not an "experience" they were not judgmental about using pain medication, or having the baby spend some time away so the mother can have some alone time, and best of all, there was no haranguing and brow-beating about nursing and other aspects of post-natal care. I applaud all efforts to make women enthusiastic partners in their pregnancy and childbirth care (this is I think part of Janice's point from early on in the thread). This did not happen enough a generation or so ago. That said, there is no reason not to avail oneself of all the benefits of medical care that exist today.