The Skeptical OB - Page 8

[Storm Bride]

Originally Posted by DoubleDouble 

I don't want to barge into this thread disrespectfully, but what you describe is what I would call "oh yeah, another one - there I go again". I have those "headaches" pretty often. I've had them for... "decades" sounds too grand, but that's what it is.

I wouldn't wish them on anyone, but... we all have different perspectives.

Of course we do, but you must realize that such headaches are not day-to-day life for most people. I have known two other people who get something very similar (cluster headaches), but they do at least know from experience that the pain will end (although I'd imagine the first one is fairly terrifying). This woman had no idea how long it was going to last, or if it was possibly going to be permanent...and had absolutely no idea going in that she was risking headaches at all.

[UnassistedMomma]

Originally Posted by Storm Bride 

However, basically posting "my baby has this issue because of homebirth", with no details, isn't really a story. It's a warning, and it doesn't contain any information.

Again, a reminder that the woman who posted that Never. Had. A. Homebirth.  That is important to remember in light of her forum-bombings with her warnings.  She never had a homebirth.

[Buzzbuzz]

But, of course, she had midwifery care versus obstetrical care. 

[UnassistedMomma]

I just wish she would clarify exactly what the issue was.  Posterior positioning keeps coming up, but then she says it had nothing to do with that.  The whole thing is kind of strange, and very unclear.

Midwives, depending on their legal status and certifications can work both in and out of hospitals or homes so the 'not an OB' thing isn't enough on it's own to be the issue.  She said birthcenter... but attached or freestanding?

So much that never got clarified. 

[Buzzbuzz]

I don't think its a big mystery -- clearly the baby was oxygen deprived during labor and birth. 

So there are a couple likely scenarios where she could feel harmed by midwifery care -- if the midwives missed the fetal distress and should have transferred her much earlier for a c-section, if the midwives did not have proper equipment and/or training to resus. the baby appropriately or if she feels that in a hospital setting superior monitoring (EFM) would have caught the fetal distress in time to avoid harm.

[Buzzbuzz]

And honestly, I don't blame her for not wanting the whole thing picked over for evidence about how "AHA!  You're wrong, it wasn't the midwifery care you received!" 

While I think you need to be prepared for that if you are going into forums like this one to post, she may have not been ready for the reaction she received or prepared to fully discuss the medical side of it.  And I really can't blame her for that.

[UnassistedMomma]

If she can't or won't say WHY her birth choices were responsible for her son's injury, then she has no business and no right to come into the homebirth forum telling others that homebirth was responsible and that they shouldn't do it.  It's that simple.  This isn't the fearmongering forum, it's the homebirth forum.

[starrlamia]

I think a lot of people like to jump to conclusions or blame something when birth doesnt go exactly as planned. Without having been there, known the person, known their care provider and see the medical charts none of us can come to any conclusions. It is all speculation.

And BTW EFM is not superior monitoring. Numerous studies have shown intermittent monitoring is just as effective as continuous monitoring. In fact EFM increases the risk of false fetal distress and increases use of unneccessary intervention. Using EFM in low risk pregnancies/birth is not evidence based care.

[Buzzbuzz]

Except, of course, here the baby WAS in distress and DID need intervention which the baby did not get.

[Storm Bride]

Originally Posted by starrlamia 

I think a lot of people like to jump to conclusions or blame something when birth doesnt go exactly as planned. Without having been there, known the person, known their care provider and see the medical charts none of us can come to any conclusions. It is all speculation.

I can't speak to the particular case we're discussing here (she may know exactly what happened), but this absolutely true. I've had many people reach all kinds of weird conclusions about why Aaron died, and most of them know nothing about what happened, except that I was attempting a homebirth (most, but not all, know it was a HBA3C) and transferred. Most of them assume that Aaron was in distress when I transferred, or had already died. Both are completely wrong. When he died, the OB didn't know why. The pediatrician didn't know why. The coroner didn't know why. But, there are several people who never so much as saw me or talked to me while I was in labour, who are convinced they know exactly what it was. (I had one woman assume I'd had a uterine rupture, and she was suprised they were "lettting" me go to 40 weeks with dd2.)

[Youngfrankenstein]

Originally Posted by Buzzbuzz 

Except, of course, here the baby WAS in distress and DID need intervention which the baby did not get.

This will sound mean and I don't mean that at all, but I feel like we don't know that at all. 

Can we agree on two things?

#1 This was a birth center birth.

#2 We don't have enough information to make any kind of sweeping statement about it.
 

[starrlamia]

except that has nothing to do with EFM does it? Since studies show intermittent monitoring to be just as safe and effective, that puts the onus on the care provider to monitor and interpret results and not the instrument used to listen.
 

Originally Posted by Buzzbuzz 

Except, of course, here the baby WAS in distress and DID need intervention which the baby did not get.

[kathrineg]

You're confusing the frequency of monitoring with the tool used to do the monitoring. I had intermittent electronic fetal monitoring in the hospital. It doesn't have to be continuous to be EFM.

The research you're referring to compares continuous EFM with intermittent EFM and finds intermittent EFM to be safe with fewer false positives. It doesn't compare EFM with a provider listening and doing the calculations themselves, which seems to me to introduce an element of human error not present with EFM, especially with a fatigued or stressed provider. It also makes it harder for them to consult with another provider.

[ilovetchotchkes]

I really think if you want to get your point across TO ANYONE, the tack you want to take is not one of sensationalism i.e.: LOOK AT ALL THE DEAD BABIES. 

Think "you catch more flies with honey than vinegar". 
 

I think its awful how she showcases the deaths of babies or mothers as more "proof" to her cause. 

I personally don't ever think I'm doing to have a home birth- my husband is not comfortable with it, and truth be told, I'm not really either. Some stuff happened with my son's birth that had he been born at home, G-d only knows what would have happened. I didn't have a c-section but we had some issues that my clever midwife was able to make things happen, not my "ideal" birth but far far FAR from a nightmare or traumatic. But I will never ever tell a woman she shouldn't or can't or that it should be outlawed. In fact, I'm going to have to take precautions because my next one I think will come fast and furious and I may not have time to get to the hospital an hour and change away. I'm going to have to make sure i've got like, chux pads and scissors at the ready just in case I have a unplanned UC! (in fact her exact words were "hon, if you could get him out the way he was, (badly positioned), the next one is gonna come out like a canon ball, so you might wanna get some stuff ready at home" 

And as far as other women's stories? well, I heard way too many stories about how horrible friends' experiences being induced or having a c-section were that I went with the midwifery model of care! so I'm SURE some people would be swayed unfortunately. 

[Buzzbuzz]

:Since studies show intermittent monitoring to be just as safe and effective, that puts the onus on the care provider to monitor and interpret results and not the instrument used to listen."

And doesn't it take an extremely skilled, accurate and careful provider to actually catch decels on a doppler? 
 

[Buzzbuzz]

And doesn't EFM provide information about heart rate variability which cannot be provided by a doppler?

[starrlamia]

sorry i meant continuous, been sick so not articulating well and apparently not reading well either.

buzzbuzz- extremely skilled is subjective, OB's, midwives and nurses are all "extremely skilled" in interpreting fetal heart rates. The problem isnt their training, the problem is the lack of regulation on what fetal heart rates mean and what course of action will be taken, it differs from doctor to doctor and practice to practice.

 In any case, i see no reason to go round and round in circles... have you studied any of this? do you access to studies and read up on what has been found? I was going to do that to prove my points but realized Im not in the mood to do someone else's homework for them.

Originally Posted by kathrineg 

You're confusing the frequency of monitoring with the tool used to do the monitoring. I had intermittent electronic fetal monitoring in the hospital. It doesn't have to be continuous to be EFM.
The research you're referring to compares continuous EFM with intermittent EFM and finds intermittent EFM to be safe with fewer false positives. It doesn't compare EFM with a provider listening and doing the calculations themselves, which seems to me to introduce an element of human error not present with EFM, especially with a fatigued or stressed provider. It also makes it harder for them to consult with another provider.

[mambera]

Originally Posted by starrlamia

And BTW EFM is not superior monitoring. Numerous studies have shown intermittent monitoring is just as effective as continuous monitoring. In fact EFM increases the risk of false fetal distress and increases use of unneccessary intervention. Using EFM in low risk pregnancies/birth is not evidence based care.

That doesn't mean that it might not have been helpful in this case, though.  The poor showing of cEFM on average means it harms more women than it helps - but there's no way to say whether it might or might not have been helpful in a single given case, in retrospect.  Of course we live our lives prospectively so you can't make decisions this way.

Originally Posted by Buzzbuzz

And doesn't it take an extremely skilled, accurate and careful provider to actually catch decels on a doppler?

Well, I guess the evidence overall is telling us that a lot of those late decels maybe weren't so necessary to catch right?

Originally Posted by kathrineg 

You're confusing the frequency of monitoring with the tool used to do the monitoring. I had intermittent electronic fetal monitoring in the hospital. It doesn't have to be continuous to be EFM.
The research you're referring to compares continuous EFM with intermittent EFM and finds intermittent EFM to be safe with fewer false positives. It doesn't compare EFM with a provider listening and doing the calculations themselves, which seems to me to introduce an element of human error not present with EFM, especially with a fatigued or stressed provider. It also makes it harder for them to consult with another provider.

I'm pretty sure there was at least one large study comparing cEFM to intermittent auscultation, finding in favor of IA.  But yeah, IA isn't that practical in a lot of settings bc it is more labor-intensive.

[Buzzbuzz]

"Well, I guess the evidence overall is telling us that a lot of those late decels maybe weren't so necessary to catch right?"

Mambera -- maybe you could tell us what crystal ball you recommend providers use to ensure 100% accuracy in determining whether a baby is slowly suffocating to death in labor?

[IdentityCrisisMama]

Buzzbuzz, I have been appreciating your perspective on this thread and hope I have been respectful...and I know the discussion has been heated but, your last post comes off as really snarky and offensively graphic.  I hope I'm reading it wrong but it comes off as very flippant.