As a medical student and a feminist interested in women’s health, women’s reproductive health is of utmost importance to me. Obviously abortion rights are important, but equally important is the issue of childbirth. My college senior thesis in Women’s Studies was on Childbirth and Women’s Choices, and since then I’ve sought to continually refine my views.

My latest endeavor was to read some opinions by Amy Tuteur, MD, who calls herself “The Skeptical OB.” The label “skeptic” has become akin to the “I’m not a racist” disclaimer. If someone feels the need to clarify that they’re not a racist, chances are that they are a racist! Similarly, the term “skeptic” is used by many bloggers as if to prove that they’re searching for the truth, when it’s evident from they’re writing that they’re only skeptical about things outside of their ideology. Anyways, Dr. Tuteur is a hoot! When you read her blogposts and her responses to the comments on her posts, the strongest impression you’ll get won’t be about childbirth, but that Amy is FULL OF HERSELF! I can go on and on about the stupidity of some of her comments, but you can go judge for yourself.

I’m glad I read through some of her absurd articles though, as it helped me refine my thoughts on pregnancy and childbirth once more. The American maternity healthcare system is plain dysfunctional. As with many other aspects of our healthcare system, we spend wayyy to much without getting any benefits over other developed countries who spend less. For more on that, you can read articles by Jennifer Block or Marsden Wagner. Until recently, I vehemently criticized the overuse of C-sections, epidurals and medical inductions in American obstetrics on the grounds that it causes higher morbidity and mortality in women. I also firmly believed that home births for low risk mothers are as safe as hospital births, so it was perfectly okay to promote. Those opinions remain true, but it is the focus of the argument that I’m refining after reading crazy OB’s blog.

You see, Dr. Tuteur can’t get over the fact that the study of home births in North America showed that babies are 3 times more likely to die during a home birth than a hospital birth. Sounds terrifying, doesn’t it? That’s until you consider how TINY the absolute risks are for babies of low-risk mothers dying at all. The risks in this particular study were ~0.7% for hospital births and ~2.1% for home births. The authors of the study explained that because the risks are so small, it fluctuates between values of 1 to 3%, therefore, direct comparisons between the values are not appropriate. One can only comment on how similar the values are. Now of course to understand such nuances you have to understand research methodology, but Dr. Amy is not a researcher. Her agenda as an OB is to protect her trade and outlaw options like home birth that would give legitimacy to midwives.

Another thing she’s vehemently against is water birth. She cites a 1999 study that concluded that out of 4030 deliveries in water, 35 babies had serious problems, of whom 3 died. Here is the authors’ conclusion: “Perinatal mortality is not substantially higher among babies delivered in water than among those born to low risk women who delivered conventionally. The data are compatible with a small increase or decrease in perinatal mortality for babies delivered in water.” But Dr. Tuteurs conclusion is that because the water in the tub is contaminated with fecal bacteria and meconium, etc, and because a small number of babies aspirate the water before being pulled out, water births are not safe: “Babies should not be born underwater. There is no benefit to the baby, only risk, including the risk of fresh water drowning and aspirating fecally contaminated water.” When a commenter points out that the water births were safe for the vast majority of cases, Amy points out that “First of all 99.55% doesn’t mean it is safe; it’s means that it is dangerous.” RIGHT. I’d like to see her use the same arguments for use of the epidural or elective inductions – they don’t have any benefits for the baby, but only potential risks, so therefore should not be used! But of course if her logic was consistent then she wouldn’t be able to justify the virtues of American obstetrics.

Her absurd articles made me realize one thing, that sometimes because of the frustrations of dealing with the American OB system, feminist activists exaggerate their claims a bit. Jennifer Block acknowledged how the benefits of breast feeding is sometimes promoted based on fear or promise of a super-baby, rather than the simple acknowledgment that breast milk is best for baby and mom, do it if you can. I’ve held very strong opinions on how unnecessary Cesareans have 3x the risk of maternal mortality than vaginal births and additional risks to the baby, and also how C-section rates over 15% for a country is correlated with increased maternal mortality as determined by WHO. But the thing is, the absolute risks of dying from C-sections in a developed country  is pretty low, so my opinions about doing a natural birth in order to avoid that have seemed as extreme as Dr. Amy’s claims about home births and water births.

My issues with American obstetrics now focuses more on the wasteful spending and unnecessary use of gadgets as well as the lack of options for birthing women. Hopefully, as we’re moving towards better health insurance, cost effectiveness will become more important. Women should know that even if they’re low risk, there’s a chance of unforeseen complications in childbirth that many require hospital care, especially for the baby. Hence they need to take that into account when planning a home birth that’s more than 30 minutes away from a hospital. Women should know the small risks to the baby specific to water birth. And they should also know that there are risks to the mother and baby in every obstetric intervention, so the benefits might not justify the risks if these interventions are used without medical indication.

Is there any choice in life without risk? No. Some people are totally repulsed by the small risk to the baby during water birth. Fine, don’t take that risk. OBs like to say that epidurals are completely safe. Yet there’s a very small risk of paralysis or even death. If you’re fine with that, take that risk. In developed countries at least, there are numerous safe options available for childbirth. Each woman decides which ones she wants to take. I realize that many women will take the risks that I won’t take, but using fear tactics and selective skepticism is not a useful approach. Though, to birth activists’ credit, even if their rhetoric is biased, they’re not out there to outlaw certain birth choices as some crazy OBs are.

Readers might be wondering why I haven’t linked Amy’s blog articles. That’s because I want to limit the interference from trolls to my blog. You can either google her name, “skeptical OB,” “home birth debate,” or find her articles on the “science based medicine” blog (prime source of trolls on health issues).

And here’s another very meaningful article by Jill at Unnecesarean.