The Cynical O.B.
I was really excited to see a blog called “The Skeptical O.B.” Having read The Thinking Woman’s Guide to a Better Birth, I knew that standard O.B. practices are often more about intuition and tradition than evidence-based medicine. I thought it would be so cool to see an actual O.B. looking at the risk/benefit analysis on interventions like induction, epidural, and c-section.
Whoops! Boy is my face red. The blog could better be named, “The Hidebound Ideologue Against Natural Birth.” Now, I am interested in skepticism of natural birth practices as well as hospital practices. You don’t automatically get a pass from me because you’re doing something crunchy. But god damn, Amy Tuteur is so vituperative, condescending, and obnoxious in her approach, and so obviously devoted to propping up standard hospital practices, that I can’t read her blog even if it might offer some interesting info on homebirth safety or midwifery guilds run amok.
Amy typically storms into each post with a haughty and self-assured stance, declaring her position to be self-evidently correct and everyone else to be feeble-minded. Most recently, she announced “The largest, most comprehensive study ever done of homebirth has released its results and there’s nothing left to argue about: homebirth increases the risk of perinatal death.” The study she’s citing though, states almost the opposite take-home message in its Conclusions:
The results support a policy of offering healthy women with low risk pregnancies a choice of birth setting. Women planning birth in a midwifery unit and multiparous women planning birth at home experience fewer interventions than those planning birth in an obstetric unit with no impact on perinatal outcomes. For nulliparous women, planned home births also have fewer interventions but have poorer perinatal outcomes.
In my experience of her work, this is representative. She is the opposite of a skeptic – she decides on her position, and then twists and cherry-picks evidence to support it. It also doesn’t help matters that she is absolutely vile and superior to any commenter who dares to question her pronouncements and offer counter-evidence. In other circumstances, I’d be very interested in her information about the Midwives Alliance of North America keeping their statistics on births secret, and appearing to require almost a loyalty oath before giving someone access to it. But a.) I don’t trust her to give me all the information, and b.) I don’t want to don a bile-proof jumpsuit to wade through her excoriating commenters who offer other perspectives.
This was such a wasted opportunity. In my opinion, all birth practices need a good review based on the most recent evidence available. Honestly, I probably agree with Dr. Amy on a lot of things. I think unassisted childbirth is a terrifying new trend that exposes mothers and babies to too much risk. But I think that it’s useful to look at the hospital practices and insurance structure that drive women to birth without any attendant whatsoever, and try to reform our institutions so mothers can feel safe and secure in a hospital, or have access to a well-trained, licensed midwife. Dr. Amy thinks the answer is to sneer and call these mothers fools.
Posted on November 28, 2011, in Birth, Health, Skepticism and tagged natural childbirth, skeptical o.b.. Bookmark the permalink. 16 Comments.
You summed my thoughts when I found out she was going to be a contributor to Science Based Medicine. I didn’t know of her until she started writing for SBM and I was disappointed. As you know, she no longer writes for them which is not surprising.
YES. THANK YOU. I just found this blog tonight, and I totally heart you. I was so psyched to see a blog called “The Skeptical OB” as well!! I found that one a few weeks ago. Then I read a few posts and I was like, “Aaaaall right, I’m out.”
It seems like there’s someone at Skepchick now who’s going to be looking more at pregnancy and birth: http://skepchick.org/2012/01/shiny-new-skepchic/ I’m psyched for that.
You said here exactly what I’ve been thinking. I’d be able to focus on some valid complaints about MANA, etc., if it weren’t for how offputting all of the sneering is.
I recently came across Amy Tuteur page too. I was considering writing a review of it like you have here but I think you have said exactly what I was thinking. She is very bad at being a sceptic.
“but have poorer perinatal outcomes”
I think you missed the point of your quote: yes, the moms like the birth experience better, but it comes at an increased risk to the baby.
I think Dr. Amy is just furious about this unneccessary risk and mad that many midwives downplay the risk to unsuspecting new mothers who might have chosen differently if they had known more. If I were an expert in something (being a Harvard trained MD does qualify a person as an expert and watching a few births does not), I might be fuirious to see facts misrepresented in a dangerous way too!
Exactly! The quote in here is not being interpreted correctly! If you read the entire study you will understand that yes, nulliparous moms have less interventions and c–sections but more of their babies die than nulliparous HIGH RISK babies under Ob hospital care. As a doula who runs a doula training program I have seen it all,including beautiful natural labors where the baby was oxygen deprived and either died or experienced brain damage. The study shows clearly that for first time low risk moms birthing at home there is a significantly higher risk of death than for a high risk mom birthing in the hospital.
I have seen many a beautiful home birth and many beautiful hospital births. And I have seen things go very very wrong very very fast both in hospitals and at home. The difference is we must admit if something goes wrong you and your baby have a higher likelihood of surviving in the hospital. And yes I am a doula and childbirth educator and saying this.
People don’t think about the #s in perspective. They can hear a quote such as “there is only a 3% risk of something going wrong” and they think “oh that is a low risk!”. But the truth is you are entering a lottery with high stakes!!! That 97% means that 3 of every 100 will have serious consequencess and we cannot predict if you will be one of those 3.
When you put numbers in perspective a d think that you or your baby could be one of the three it feels a lot different than simply “oh its just a 3% risk”.
But yes when everything goes well home births are beautiful. But Dr Amy’s skepticism is well founded. I became a doula and childbirth educator because I was passionate about natur birth. Now I understand it is about rational choices moment by moment given whatever your particular circumstances are. But the reality is low risk first time moms and babies are at higher risk at home births than high risk first time moms in a hospital. Second time low risk moms however fare pretty well at home. I encourage people to read the whole study or even the whole conclusion rather than making a decision based on a small excerpt. Especially if you are considering the level of risk to your baby’s life, it is probably wise to check out the full study. I am a firm believer in freedom of choice and if someone wants to roll the dice it is their perogatice but they should know the full risks and benefits. Yes it can be more pleasant with less interventions. But with a higher risk of death.
Apologize for typos writing from my cell phone!
Hi Kirsten, thanks for reading and commenting.
I completely agree that first-time mothers must be informed about the higher risk to babies when a nulliparous woman gives birth at home. But do please note that for women who have already given birth at least once, the hospital is just as risky for newborns as homebirth is.
Dr. Amy is just as guilty of misrepresenting the facts of this study as any midwives who may handwave the higher risk for the babies of first-time moms.
I also do believe that only the mother can decide how to balance incremental statistical perinatal risks with her interest in having fewer interventions. Obviously I have my own opinions about such things (see my post on unassisted childbirth) but I do think it is legitimately for the mother to decide if a risk to her baby is great enough to overcome her own interest in a comfortable and respectful birthing experience. It cannot be taken as read that every mother must endure any hardship, as long as it increases the chance of a healthy baby. Many may choose to do so, but mothers do also have legitimate interests in their own well-being, even if it’s “only” emotional well-being.
i also suggest that it is legitimate for a person to decide either way between preparing for the worst case but rare scenario, or the most likely scenario.
It’s a shame you don’t have a donate button! I’d definitely donate to this fantastic blog! I suppose for now i’ll
settle for bookmarking and adding your RSS feed to my Google account.
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I tried… I really tied to read Dr. Amy’s blogs but I couldn’t… they are painful and biased. She doesn’t support any evidence based practice or proper research. Her work is used to to fulfill her own ideas…. Come on… she is not even practicing medicine anymore… Tuteur is a former clinical instructor at Harvard Medical School. She left the practice of medicine to raise her four children !!! How can she properly inform people if she is not working on the field!!!
Kirsten, I would hardly call Amy an expert. She only practiced medicine for 6 years. (and whether 4 of those 6 years were part of her residency is not shared with us.) She no longer holds a valid medical license (yet still uses the preface “Dr.” and refers to herself as an OB, and does give the unspoken impression that she still practices.) Many would say she was still a rookie when she either quit or was removed from being able to practice medicine. The real details of why Amy left medicine and no longer holds a valid medical license are shrouded in the veil of secrecy of the AMA and ACOG. It seems highly unlikely that someone would attend medical school, slog through residency, only to practice for 6 years and then stay home with children indefinitely. Plus, she looks much too old to still have young children who need minute to minute care left at home.
Most seasoned midwives have attended myriad more births than Amy ever did, and it’s doubtful she ever saw a truly natural birth. Vaginal birth alone does not always qualify as natural although many people interchange vaginal and natural when talking about birth experiences.
She attacks, belittles and mocks anyone who disagrees with her, even attacks people who have had no contact with her by having minions troll parenting message boards looking for home birth gone wrong stories, especially still born baby stories and then bombards the grieving mother with unwanted attention.
I’d also love to give the write of this blog a tip, if there were a place to do so. This was a well written fair article. Although I hate to give Amy any more attention than the little she already gets, I felt I had to comment.
i believe she once mentioned that she had 2 special needs children which, if true, gives a more legitimate picture as to why she left medicine. and her status is that she is still allowed to use the term dr- if you check the state registry it explains the different statuses. anyway i find her personal credentials not nearly as important as the twisted logic she uses.
link to the bmj article doesn’t work anymore. can you fix it or has it become unavailable?
ki, I can still bring up the BMJ article myself, but for what it’s worth here’s a link to the PubMed summary: http://www.ncbi.nlm.nih.gov/pubmed?term=bmj%5BJour%5D+AND+2011%5Bpdat%5D+AND+planned+place+of+birth&TransSchema=title&cmd=detailssearch
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