From Em:
Well, your blog has paid off. The ball is rolling, and I believe that more women will make the effort to study the risks for themselves. Also, have you seen all the relligious entries on Jenny Hatch's blog? Obviously all negated by the lies she is spreading.
From Susanne:
The "paid hack for ACOG" is particularly amusing. Could you find a bunch of women more naive about the real world than that? Hello, if ACOG wanted to put forth a big PR push against homebirth, they would hire a PR firm and just go do it, already. They'd have their people on every morning talk show, Oprah, the major newspapers, the major blog sites ... They wouldn't rely on a small blog (sorry, Amy).
Further evidence that these women just don't know how the big-girl world works. It's like the people who forward emails "from Microsoft," as if Microsoft doesn't have a retinue of PR professionals on staff and the editor of the NYTimes on speed-dial and needs to rely on forwarded emails to pass along a message.
From Mama Liberty:
"Hello, if ACOG wanted to put forth a big PR push against homebirth, they would hire a PR firm and just go do it, already."
No they wouldn't, Susanne. If they did that, somebody would have a decent antitrust case. Actually, I wish they would do that, come to think of it.
Regarding the topic at hand, I personally can't stand MDC or the censorship over there. Women should consider the different points of view regarding homebirth, including the critical ones.
From Susanne:
"Hello, if ACOG wanted to put forth a big PR push against homebirth, they would hire a PR firm and just go do it, already."
No they wouldn't, Susanne. If they did that, somebody would have a decent antitrust case. Actually, I wish they would do that, come to think of it."
Antitrust? Are you serious? How would it fall under antitrust law if they were to hire a PR firm to promote the idea that birth in a hospital with an OB is the safest thing, and/or that they consider homebirth dangerous?
From Amy Tuteur, MD:
For those visiting from MDC, I suggest that you consider this: Most people writing on the thread tell you not to listen to me because ... because ... because ... actually they have no reason why you shouldn't listen to me beyond the fact that that would undermine what they would like to pretend about the safety of homebirth.
Most homebirth advocates are incredibly gullible and easily duped. They wouldn't know what a scientific paper was if it hit them on the head, they don't read the papers, and they wouldn't understand it if they did. They lack the most basic knowledge about science, statistics and even childbirth. Most of what they think they "know" is factually false, and they don't have a clue.
Why do they believe what they believe? Because Henci Goer or Ina May or Michel Odent has filter and pre-digested the data to advance THEIR agenda. Most homebirth advocates have never made any attempt (nor do they know how to make any attempt) to independtly verify the mistruths, half truths and outright deceptions of homebirth advocacy.
It's pretty easy to tell that this is the case, because those who are counselling ignoring this site don't present any numbers, citations or data of any kind to support their position. That's not surprising since they have no idea what the numbers, citations and actual data show. Instead, they quote books written for laypeople which have never undergone scientific scrutiny of any kind.
I will also point out that professional homebirth advocates (with one major exception) have not even attempted to dispute any factual points that I have made. The exception is Johnson and Daviss in regard to their BMJ 2005. They are well aware that my criticism of their study completely undercuts their claims. They have already acknowledged that I am correct on two critical points: they left the neonatal mortality rate for 2000 out of their paper and tried to compare homebirth to hospital birth in decades prior to 2000 and my calculation of the neonatal mortality rate for low risk hospital birth in 2000 is 0.9/1000 (much lower than the risk that they claimed for hospital birth).
I appreciate their acknowledgement, but they ruin it with an outright falsehood. They claim that the data was not available in 2004 when they submitted the paper, even though the date of publication of the data was a full 2 years before. Then, having acknowledged that they deliberately used the wrong data for comparison, thereby making homebirth look better in comparison, they attempt to change their calculations of their own data to lower them from what they originally claimed. So we are supposed to believe that now that they recognize that the hospital neonatal death rate in 2000 was much lower than they claimed, they suddenly realized that the homebirth neonatal death rate they they calculated was actually lower than they announced.
The key point is this: The only people who believe that the scientific evidence shows homebirth to be as safe as hospital birth are homebirth advocates themselves, most of whom have never even read the papers in question.
I encourage everyone to read the papers for themselves and to think about what they actually say, not simply accept other people's word for it.
From Amy Tuteur, MD:
By the way, nashvillemidwife offers the perfect example of what I am talking about. She directs people to a page on her website where she has copied the bibliographies of other homebirth advocates. I'd be willing to bet that she hasn't read a single one of the papers from start to finish, and has no idea what they say. She thinks that the mere existence of a list of scientific papers proves something. Read the papers; they do not say what she thinks they say.
From Kneelingwoman:
I just posted again on the last post, if anyone was actually wanting an answer to the questions they posed to me. Amy, do you remember what you wrote about "cults" a bit back? You are dealing with a cult. Yup....I am saying it. I don't want anyone to think that I object to the basic conversation regarding these issues; I object only to the "armchair" evaluations and guess work about how a given family will or ought to, grieve or work through these losses and I also know that we are not isolated here; these conversations and words can be read by suffering family members and cause real hurt. The UC death you outline is exactly the situation that I have been writing about in my own practice of midwifery the last few years. These women have bought into the lie about the "always" safety of birth and because the midwife seems to have signed on for "benign neglect" in this case ie. agreeing to the kind of "ala carte" midwifery I've spoken of on my blog ie. a heart tone here and urine dipstick there but nothing the mom doesn't "think" she needs ( and if you suggest otherwise; you are a MEDwife traitor to the "birth is safe" Midwifery mantra ) you have a psychological dynamic of denial as the primary operating system for the entire relationship! The midwife, having signed on for this nonsense, is stuck with maintaining the schtick and then, when it looks like something actually needs to be done differently, she can't hit reverse and tell the woman that the 'trust birth' think isn't quite working out! I've "been there, done that", as the young people say. My only saving grace was that I couldn't make myself sit on something that concerned me so I've always spoken up. Sometimes, that has been fine but, in recent years, and in greater numbers, it has not been fine. I am suddenly a "controlling, medical monster" trying to 'wreck' a woman's birth! But no babies have died in my care so, I'll settle for that peace of mind anyway.
Amy, I don't know if I'm hearing a concern in your mind that the women who regularly read or post on MDC are never going to "listen" to you but, the tide is turning and the only thing that I personally would do differently would be to tone down the heavy, critical "rhetoric" about the average midwife/homebirth parents' lack of knowledge about science, stats, childbirth etc. If they are coming over here to read anything at all; some part of them knows that there is a lack in their knowledge base! Just rest on that and continue and perhaps give a little tutorial somewhere; on a website perhaps? A little "Statistics for Dummies" minicourse......be well everyone.
From Lisa Kestler:
I am a former Respiratory Therapist who worked in the NICU and high risk labor and delivery. I am now a senior midwife student. I know how to read scientific research and I do keep up with it. And what I know from reading and observing from my time spent working in the hospital is that the safest and healthiest place for a mom to give birth is at home with a midwife. I have seen a mom lose her life due to hospital mistakes. I have also witnessed babies permanently injured and some that died due to hospital neglect and errors. Those babies might be alive today if their moms had stayed at home. Dr. Amy has a vendetta aganist midwives. She does not give unbiased information.
From Amy Tuteur, MD:
Lisa Kestler:
"And what I know from reading"
Since you are so knowledgeable, you should have no trouble citing the specific data (numbers please) to confirm your claims. I look forward to discussing the citations.
From LadyinRed:
Wow, the "mamas" over at MDC are having a hey day telling each other how horrible Dr. Amy is and chastising their errant groupie for straying to this site. They really are afraid of one of their sheeple learning the truth about HB.
K, I'm not normally so catty, but crap like this gets to me.
Earlier today, I entered "Homebirth Debate" into my search engine and by far and large the results were angry HBAs spouting off vitriol at Dr Amy. It made for interesting reading, until one blogger commented that everyone who comments on this blog is paid to do so. Yeah. I'm not holding my breath waiting for a pay check.
From LadyinRed:
Lisa
The plural of anecdote is not evidence. You state that you have seen babies suffer and women die due to hospital incompetence. That is an anecdote. I have a friend who has had three homebirths. Two went off fine and the third was a disaster in which my friend and her baby came with in a hair's breadth of death. She had to be transferred to hospital due to massive bleeding and the baby wasn't breathing well and suffered some problems. My Aunt had a home birth last year. The midwife left an hour after the baby was born. When the father checked on the baby a few hours later, the boy wasn't breathing. They rushed him to the hosptial where he was resusitated and given a blood transfusion and diagnosed with a liver disorder. He also came very close to death. Those are my anecdotes. Do they trump yours?
From Susanne:
"And what I know from reading and observing from my time spent working in the hospital is that the safest and healthiest place for a mom to give birth is at home with a midwife. I have seen a mom lose her life due to hospital mistakes. I have also witnessed babies permanently injured and some that died due to hospital neglect and errors. Those babies might be alive today if their moms had stayed at home."
Just because you have seen some preventable things in a hospital doesn't make home safer, you know. That's not how it works.
From Lori:
Oops posted this in the wrong thread initially....
What a shock! Many of the posts and threads have been taken down! With this as a message:
I have removed several posts which violated the User Agreement. Please do not link to or discuss sites which are actively hostile to Mothering Magazine or MDC. Please PM me with any questions. Thank you.
I just love people who can't handle an intelligent debate and decide instead to shut out any conflicting information. No wonder I get hives when I go over there.
From Kneelingwoman:
LadyinRed: Does "K" mean me? Crap like this gets to me too; that's why I'm not participating in it any longer. Retirement from practice is the most honest, real way for me to give my "nonviolent protest" some legs.
From LadyinRed:
KW
No sorry, "K" was short for "Ok".
From nashvillemidwife:
"nashvillemidwife offers the perfect example of what I am talking about... I'd be willing to bet that she hasn't read a single one of the papers from start to finish"
You'd lose that one. I've read all but those I've noted I've not been able to obtain. Maybe it's time to admit you know absolutely nothing about me.
From Amy Tuteur, MD:
nashvillemidwife:
"I've read all but those I've noted I've not been able to obtain."
Don't bother to make up ridiculous claims; you can save that for other homebirth advocates who might actually believe a fabrication like that.
If you read them, you wouldn't cite them because they don't show that homebirth is as safe as hospital birth. Your entire page on safety is nothing more than a bunch of junk and you don't even know it.
Johnson and Daviss: Actually shows homebirth to have a neonatal death rate almost TRIPLE the low risk neonatal death rate in the hospital in 2000.
Janssen et al: Janssen was forced to publicly acknowledge in a subsequent issue of CMAJ that her study does NOT show homebirth to be as safe as hospital birth.
Murphy and Fullerton: Actually shows that homebirth has a higher death rate than hospital birth.
Olsen: Is an outdated meta-analysis that shows nothing.
I could go on and on, but I think everyone gets the point. You have literally no idea what these articles say. You copied them out of the back of a book.
Here's a thought: Read the studies. Learn some basic science and statistics. Analyze the studies to see if the conclusions are supported by the data. This is one of the primary problems with direct entry midwifery. Direct entry midwives parrot what they are told by others. They don't independently assess the research; most don't even know how.
From A Sarah:
LadyInRed: "until one blogger commented that everyone who comments on this blog is paid to do so. "
zomg, seriously? Okay, that is hilarious.
But, wait, I thought we were all Dr. Amy? Snort.
From Dianne:
one blogger commented that everyone who comments on this blog is paid to do so.
Really? Can I have a raise? Snide comments don't write themselves, you know.
From Susanne:
Ah, but does Amy offer a 401K plan and health benefits?
From A Sarah:
OH MY GOSH IT'S TRUE!
"And her little circle of paid harpies who sit around all day in her comment section, mocking and pointing the finger of scorn at mothers who want to give birth holistically really should get a life. Yet I really can't fault them. If someone was PAYING me a hefty sum to dump on homebirth ALL OVER THE WEB, I might be tempted...no what am I saying....Dr. Amy, you just keep on, keepin on. YOU are the gift that keeps on giving."
From http://www.naturalfamilyblog.com...ves/
001306.html
From Alex:
I'm not paid to comment on Amy's blog, but I might be a shill for Big Pharma. That sounds like a great gig to me--getting paid to mock online dissent against Big Pharma and Big OB, while I sit around in my pajamas and drink coffee. Sure beats nights, weekends, and call time as an RN.
From A Sarah:
I'm a paid shill for Big Theology.
Also, Big Anti-Racism.
And, inasmuch as I poke around the fatosphere, I guess that makes me a shill for Big Big as well.
From Squillo:
Susanne:
"Ah, but does Amy offer a 401K plan and health benefits?"
Yes, but the formulary only includes Cytotec and Pitocin.
From Kneelingwoman:
Oh, o.k. I confess: Midwifery really doesn't pay well and then Amy offered me this gig........you guys aren't serious are you?
From Katie:
Dude, posting here paid for my last vacation!
I love conspiracy theories....
From Esther:
Dammit, Amy, you told me my check was in the mail two weeks ago. Where is it?!
Pshaw...she pays up slower than ZOG*, even.
(*ZOG=Zionist Occupation Gov't).
From An MDC Mom:
I'm the one at MDC who posted the story of my baby brother that died after an emergency c-section. It was clear medical malpractice, it was a "normal" hospital delivery until about 7 cm and then it all went down hill and they waited too long to fix it.
You know why Amy rubs me the wrong way? She lumps every homebirthing woman together in the same ignorant stereotype. I have a great CNM who of course knows how to run an IV since she was a L&D nurse. I have all the tests, including ultrasound, and regular prenatal appointments. When I had PROM with my last baby I was started on antibiotics and my labor was induced on day three using "natural" methods. My daughter was born 4 hours later and was perfect.
I had antibiotic shots when I tested strep-b + with my 3rd baby. Baby always visits the Ped. within a day of being born.
We're not all dumb or careless. I love being able to give birth at home but I love my babies more and we all know that if anything ever starts to get suspicious we transfer immediately. I respect my body but I also respect Drs and the fact that sometimes they are needed.
From sarahz:
I think what MDC objects to is the unethical exploitation of women who have experienced the tragedy of infant loss. It violates the User Agreement.
Is there a similar watch on BabyCenter for hospital birth loss stories?
From Amy Tuteur, MD:
sarahz:
"I think what MDC objects to is the unethical exploitation of women who have experienced the tragedy of infant loss."
That's not what they write when they lock a thread. They say that they delete threads that do not support homebirth and they delete threads that criticize MDC.
From Amy Tuteur, MD:
An MDC Mom:
"It was clear medical malpractice"
I am very sorry to hear about the tragedy.
Medical malpractice occurs at home, too. Indeed, there is no reason to believe that it occurs at a different rate than in the hospital; it may even occur more frequently.
No one is suggesting that the hospital is perfect. The key point is that even though the hospital is known to be imperfect, even though there is a risk of both iatrogenic complications and malpractice, the risk of preventable neonatal death is still HIGHER at home.
From Sailorman:
Hey folks, have you seen this?
http://www.theonion.com/content/
...rth_how_morally
From Amy Tuteur, MD:
Look! Jenny Hatch has published an "apology" on her website:
"It was very wrong of me to write publicly that you were whoring for pharmaceutical companies however much I might assume and/or suspect that such a thing could be happening on your blog and in chat rooms."
From Susanne:
Dammit, Jenny! Mama needs a new pair of shoes ...
From Chris:
Amy I was recently at a conference and the speaker was chating about Meta Analysis. She said Meta Analysis takes all the studies and lumps them together so that if 1 or 2 studies are done poorly it skews the whole result. She referred to studies done before 1980 that indicate EFM has an increase risk of C-section and all the studies done after 1980 say the opposite. The latter studies had way more people in the study group. I hear a lot of HBA folks sighting that EFM will increase your risk of C-section.
What is you take on Meta Analysis? I know many of the HBA's site them. I am unclear what exactly a Meta Analysis is. I also think the Statistics for Dummies would be a good idea for me.
From Amy Tuteur, MD:
Chris:
"I am unclear what exactly a Meta Analysis is."
A lot of studies suffer from the problem that they did not include enough people to accurately study what they are supposedly studying. For example, since neonatal mortality is measured per thousand, you must have thousands of women in each arm of a homebirth study (in the homebirth group and in the hospital group) in order for the study to give accurate results about homebirth safety.
A meta analysis attempts to get around this problem by pooling the results of multiple studies. That can yield a valid result if all the studies were done in the same way. However, it won't give valid results if the individual studies differ in important respects. For example, a homebirth meta analysis might pool the results of 10 studies so that the homebirth arm will have 2000 women. So far, so good. However, if the hospital group is some studies contained low risk patients, and in other studies included high risk patients, the hospital group is no longer comparable to the homebirth group.
If all the studies in a meta analysis are excellent, than the results of the meta analysis should be valid. However, if even one study is done poorly, it generally means that the meta analysis cannot yield valid results.
From Sailorman:
A meta-analysis is a study of studies.
(a meta-meta-analysis would be a study of meta-analyses 
Meta-analyses can be good, because they allow the researcher to combine study populations to attempt to ferret out significant differences which were not apparent in the individual studies. This benefit usually happens when you either have a bunch of conflicting or inconsistent studies, or when you have a bunch of studies with small sample size and consistent results.
Meta-analyses are bad, however, because they rely on the skill and ethics of the researcher to properly choose studies, assign variables, and "weight" the importance of the various factors that support the test.
They are also bad because they tend not to have the original data, which makes it more difficult to ascertain the skill and ethics of the author. they are an extra step away from the raw data: every step you tale away from the aw data is less accurate in some respects.
From Chris:
Thanks. That was helpful.
From Sailorman:
oops, for got my conclusion:
In the hands of skilled and ethical researchers, meta-analyses can be great tools.
In the hands of unskilled and/or unethical researchers, meta-analyses can be a tempting opportunity to fudge, which isn't as obvious because the underlying data is less available and the underlying statistics are more complex.
If you think it's hard to explain why a STUDY is bad, it is even more complex to explain it with reference to a meta-analysis.
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