I’m actually kind of curious about this book, being a history major and all.  But I understand your point.  Although I hope the distance of time would blunt that affect a bit.

My mom, having given birth in Evil Socialist Poland, and having known otherwise only German Ob/Guns and birthing practices, didn’t understand at all why this home-birth movement even existed, because it seemed so dangerous to her.

It took some explaining (including showing the scenes from Mad Men of Betty Draper giving birth) of the weirdly macho, chauvinistic “you don’t know what you want; I’m the doctor, and I know what’s best for you” attitude of hospitals and their doctors (like accusing women in labor of being unfit mothers because they didn’t want a C-section, and taking their newborn away from them) for her to understand why some women just feel too damn disenfranchised to give birth in the hospital.

She didn’t change her mind about homebirthing (and rightly so, since it CAN be incredibly dangerous, especially in compination with cultish beliefs/behaviors), but agreed with me that the introduction of birthing centers was an excellent idea, and combines the benefits of a midwife with the availability of doctors and hospital equipment in emergency situations.

Generally the rule of thumb among mad scientists is that deciding to be drastically unethical tends to ruin your ability to do science.  Like tobacco messing up your ability to smell, unethicality messes up your ability to assess experimental parameters to the sufficient level for good results. 

For instance, if you need to aquire a batch of dead women who were 9 month pregnant, going out yourself and, uh, “aquiring” the corpses tends to introduce complications to your experiment such as the need for secrecy (which, of course eliminates the most useful aspect of a scientific society), secure facilities that might be ill suited to your vivisectional needs, and cultivates a hostile atmosphere in town/gown relationships that may interrupt your concentration. 

So, um, leave it to the *pros* to aquire the bodies you need. 

http://www.amazon.com/Hollow-Fields-Omnibus-Madeleine-Rosca/dp/1934876720/ref=sr_1_1?ie=UTF8&s=books&qid=1265758431&sr=1-1

What’s the deal with exclaiming repeatedly that OMG they might have killed more women than Jack the Ripper?! Jack the Ripper killed five women, for fuck’s sake, and the name wasvery likely not coined by Jack himself.

  Obstetricians in the US used female slaves—-without their consent, and without anasthesia.

  Medicine at the time in London still included bleeding and humors—-and omitted the washing of hands. The mortality rate had to be horrifying, and then there’s the fact that pregnant women often get murdered.

Shah8, I need that book.  It sounds awesome.

I was going to bring up the fact that while many doctors/vivisectionists in London during that period did not go out and collect bodies themselves, Burke and Hare did exist, and did murder people to sell to the medical school. 

Do I think these particular doctors killed anyone themselves?  No.  Absolutely not.  Could they have convinced themselves that bodysnatchers like Burke and Hare were acquiring bodies legitimately when they weren’t?  Yeah… I can see that, but I don’t know. 

Sorry, I just remembered about Burke and Hare. 

But yes, I agree that somewhat that the fact that this book exists will catch the fancy of some folks, without them actually reading it or being able to weigh the evidence themselves.

What’s the deal with exclaiming repeatedly that OMG they might have killed more women than Jack the Ripper?! Jack the Ripper killed five women, for fuck’s sake, and the name wasvery likely not coined by Jack himself.

It’s worth noting that Jack the Ripper was never caught.  And because he was never caught, it’s very likely that he continued killing thereafter.  However, because the authorities didn’t want to pour fuel on the panic fire that was quickly heating up, Scotland Yard just stopped calling future murders “Ripper Murders” because a) they couldn’t figure out which dead prostitute was killed by the famous serial killer and which was just killed by an irate pimp and b) it meant they weren’t going to be endlessly harped on as failures in police work.

All that said, if your argument has to go back over a century before you approach your point, there’s a good chance you don’t have an argument.  Might as well use Sweeney Todd as a justification to outlaw shaving and baking.

You don’t have to go very far back into history to see the what ‘natural’ childbirth—without the benefit of hindsight granted by modern medicine—was like.  Flipping through mid-century issues of Chatelaine for an unrelated project once netted me a terrifying article advising women in farming communities what they should be doing to make childbirth safer.  Suggestions included things like “disinfect the scrap paper and rags that will be cushioning the mother to absorb blood by leaving it in a very low oven overnight, and keep these folded in linen cloth ready for the day of birth” and “if your husband has had three previous wives die in childbirth, don’t give birth in the same bed, with the same mattress and linens, as they did: it is not clean”.

Childbirth isn’t hugely dangerous—if it happens under reasonably sterile conditions, and there are no complications, and the mother is in good health and has enough help to rest and recuperate afterwards.  Painful and messy and stressful, but not likely to kill.  Of course, sterile conditions are pretty artificial, and complications are perfectly natural.  The first days of a child’s life are pretty labour-intensive, and that recuperation period can involve nasty infections (both local and manifesting in childbed fever), general exhaustion from the blood loss, and the strain of having the body try to readjust.  “For every child, a tooth” and “I would rather go to the front lines of battle three times than give birth once” and all that.  Modern medicine has made giving birth fairly routine, but it was once like playing russian roulette, so I’d say doctors have helped a lot more women than they’ve hurt.

Did you read the article in JRSM (J R Soc Med 2010: 103: 46–50)?  The author, Shelton, basically looks at the number of cadavers these anatomists procured during a fairly short period, considers the mortality rate of pregnant women at late stages of pregnancy compared to the population size, and concludes that it’s statistically very unlikely that they were able to get all of their cadavers by licit means (either acquired shortly after death or through grave robbing, which was a common practice at the time).  There just weren’t quite that many women dying with undelivered, nine-month pregnancies, and it’s extremely unlikely that they would have been able to locate that many with random grave-digging (as death and burials weren’t often publicized).  Shelton also quotes a really provocative note one of the doctors left about an assistant of the other:
“Dr MacKenzie being then an assistant to
the late Dr Smellie, the procuring and dissecting this
woman without Dr Smellie’s knowledge, was the
cause of a separation between them, for the leading
steps to such a discovery could not be kept a secret.
The winter following, Dr MacKenzie began to teach
midwifery in the Borough of Southwark.” (qtd. on 50)
This suggests, at the very least, that MacKenzie discovered something unsavory about how these bodies were being procured, bad enough that it needed to be kept secret and would cause him to leave his employer’s practice.

It’s an interesting read, anyway, and not remotely anti-scientific.  Of course reporting on research is famously awful, so who knows what version of this paper will show up in the general public.

Oo, I should probably add also that Shelton’s agenda (aside from his likely interest in publishing a provocative article that will be widely read!) is not to say that obstetrics is useless and science is full of murderers.  He seems more to be arguing that -if- so-called founding fathers were involved in such unethical practices, we might want to reconsider how much respect and adulation we give them.  And that seems like a reasonable thought—I don’t see any reason to award undue respect to murderers (if in fact they were) simply to protect the good name of Science.

“Generally the rule of thumb among mad scientists is that deciding to be drastically unethical tends to ruin your ability to do science.”

The history of science is littered with incidents displaying a shocking lack of ethics or humanity.  Of course, even assuming that these doctors did precisely what it’s alleged they did, there’s little point in belaboring it now because a) ethics and practical morality are evolving rather than static, b) the scope and methodology of policing is evolving rather than static, and c) this is why we have IRBs, oversight committees, ethics boards, and trade associations.  I mean, okay, a couple doctors and their hired serial killers got away with slaughtering their way through the slums’ maternity wards because we didn’t know what street lights or fingerprints were back then.  Trying to transpose that onto a modern branch of science doesn’t even qualify as tenuous.  It’s like trying to impugn the criminal justice system because back the in day, you could get hanged for looking like a thief.

Well, I *was* joking and making a reference, but generally it *is* true that sociopathic behavior tends to make for bad science anyways, independent of the nastiness of your typical Mengeles.

And because he was never caught, it’s very likely that he continued killing thereafter.

How in fuck do you get that? “Not being caught” does not lead to the ‘continued killing’ conclusion.  He wasn’t caught. We don’t know who he was. Therefore, we cannot say what he likely did or did not.

The way he killed was pretty specific and notable; it would have been noticed.  Paranoid theories about the cops suppressing the truth always amuse me, because they suppose that the cops of the time were far more sophisticated than they revealed themselves to be, as well as far more intelligent.

Nor was Jack the Ripper the Duke of Clarence—-or Dr. Montague J. Druit. “Could have been” is useless.

Whoa dude!  Fat acceptance vs. lose-weight-for-health, and midwifery vs. OB care, all in one day??  bold.

OB as currently practiced is hardly evidence-based, ‘scientific’ medicine, but you do make some good points, but you should have set up the micro-trend in ‘unassisted childbirth’ or ‘freebirthing’ as the opposite of OB care, rather than midwife-based care which often complements OB care and which typically follows the same basic model of care (unless you are talking specifically about lay midwifery, in which case you should have specified).

Sorry, there should be a period after ‘points’ and the following word should start a new sentence…me tired…

Serial killers almost always kill again if they aren’t caught—either that or they die without being caught.

Ex., there is a theory with a fair amount of at least circumstantial evidence that the Zodiac killer was actually the Unabomber. Another ecample—the BTK (Bind, Torture, Kill) Killer in Kansas stopped for twenty years, and then sent a note to the police saying he was going to kill again and was thankfully caught.

They like the “high” it gives them, and it’s like an addiction for them.

”And because he was never caught, it’s very likely that he continued killing thereafter”

Well, not caught for being “Saucy Jacky”, but how do you know he wasn’t hanged as a pickpocket or committed to a insane asylum because of Syphilis or something

<i>”… or that Lizzy Borden was framed.” <i>

Wasn’t she aquitted?

ladybronwyn,

If you read both Majikthise and Amy Tuteur’s comment carefully, you’ll notice this:

—maternal mortality rates ~ 1%

—over 200,000 births per year, meaning

—> 2000 women died in childbirth/year

—[as per Shelton] ~4-5 cadavers/year, for a total of 20 (1750-54) and <2/year for a total of 12 more (1766-74) [32 in all/12 years]

If you look just at the numbers it’s evident that Shelton’s conclusion (very unlikely that they were able to get all of their cadavers by licit means) is pure speculation.

As to the “provocative note”:

Shelton claims the following passage, written in 1818, is a smoking gun. The author was describing a plate in Smellie’s atlas that features twins:

Smellie died in 1763 and 55 years later, some guy claimed that an associate of Smellie’s obtained the corpse by unspecified (but presumably sketchy) means without Smellie’s knowledge. This is supposed to be a smoking gun? Really?

Thanks for the link, Amanda.

I spent most of the day analyzing the original paper. I’m here to tell you the author shamelessly oversells his case, even if you buy his empirical assumptions about how many women died of natural causes during childbirth or the final month of their pregnancy in greater London in the mid-18th century. By the author’s reckoning, the doctors based their respective treatises on about 32 cadavers, amassed over a total of 13 years. That’s not an astronomical number of cadavers in and of itself. That works out to about 5 cases per year on average during their very busiest years. Most years it’s less than two cases a year. By the author’s own estimate 200 women a year died in childbirth in greater London during that era. It’s not a priori suspicious that these doctors might score up to 5 a year, in a good year, if they knew where to look.

The author also asks us to accept the premise that cadavers only came from grave robbers who plundered at random or harvested people who died in poorhouses (where relatively few pregnant women died). That’s an absurd assumption. These two doctors were rich, famous practicing obstetricians. Is it so bizarre to think that these guys and their colleagues knew which graves to rob, or that they had other ways of getting access to bodies (like straight up bribery, or clandestine autopsies explained as failed treatments, or whatever)? As ginmar says, dead women were a pretty common feature of mid-18th-century obstetrics, even when doctors weren’t trying to kill anyone.

The author is the one who brings up the Jack the Ripper comparison, so it’s only fair to debunk his claim. He claims these doctors were responsible for the deaths of 30-40 women, which is more than JTR, one of the most notorious serial killers in history.

She was acquitted, but there’s still the argument that she was framed for the murders historically-speaking.

“If you look just at the numbers it’s evident that Shelton’s conclusion (very unlikely that they were able to get all of their cadavers by licit means) is pure speculation.”

And illicit means could include something as relatively innocuous as bribing undertakers or gravediggers to send a runner when they had a corpse that fit their needs.  It’s kind of like you can get illicit organ harvesting nowadays without necessarily having doctors behaving unethically or immorally towards live patients.

The incidence of puerperal fever was higher during the 18th century because the standard of cleanliness was much lower.  There were numerous cases of child bed fever that could be traced from the doctor’s failure to wash his hands after an autopsy.  There is really no reason to suppose that Dr. Hunter or Dr. Smellie murdered anyone.  If they were cutting up corpses they were carrying the germs back to their patients who were dying of puerperal fever, leading to them having more corpses to cut up, so that during periods when they weren’t cutting up corpses the death rate among their patients would have fallen.

My bet is that if they bribed anyone, it was vicars. That’s what I would do if I needed a steady supply of “special” cadavers. The vicars would know everyone who was buried in their churchyards and probably everyone in the congregation who was sick and or pregnant. If you paid for the new roof on the parsonage, I bet you could get an amazing amount of useful information out of the average vicar.

G Porgey, this is an excellent hypothesis:

If they were cutting up corpses they were carrying the germs back to their patients who were dying of puerperal fever, leading to them having more corpses to cut up, so that during periods when they weren’t cutting up corpses the death rate among their patients would have fallen.

That would explain why these doctors might have had a higher death rate than the national/citywide averages cited by the study author. Probably only a tiny fraction of doctors did autopsies in those days, seeing as it was a huge hassle.

Is it so bizarre to think that these guys and their colleagues knew which graves to rob, or that they had other ways of getting access to bodies (like straight up bribery, or clandestine autopsies explained as failed treatments, or whatever)?

Just wanted to emphasize Lindsay’s point.  Unethical =/= murder, and there were plenty of shady ways short of murder to obtain corpses.

I’m also not sure where this vision of grave robbers grabbing corpses at complete random comes from.  Of course the grave robbers had help on the inside and information about which graves they should hit to get the best specimens.  According to Wikipedia, they would send “grieving” women into poorhouses to claim bodies that they claimed were their dead relatives.  This was a very lucrative business and the people who went into it were not stupid.

Hmmm…

1)  Especially given the times and Euro context, the fact that the two doctors were able to make useful scientific discoveries is a prima facie point in favor of the idea that they were mostly on the up-and-up.  With no ethics commitees and no systematic evaluation tools like statistics and reference tools and guides, it’s very easy lead yourself astray into nonsensibility.  Which is why ethics ain’t a joke in science.  It is true now, and it was even more true then.

2)  Contra Lindsay, there most certainly was both a tradition of absolute immorality (as a matter of preference) by sociopathic well off would-be scientists trying to create the water of immortality or something equally…marginal, and there was very much a willingness of your average superstitious townfolk to believe that what you’re doing was against God, and mix in more easily understood crimes like murder for her precious bodily fluids…  Even deep into the various intellectual revolutions, the changes were always surrounded by utter absence of enlightenment.  It’s quite easy to believe that unwilling victims were aquired for their research.  It’s also quite easy to believe that the scientists got caught up in a quagmire of local body taboos doing innocuous stuff.  So it’s really hard to say one way or another whether bad things happened.  It *is* pretty darn irrelevant, and yeah, I agree with Lindsay that the author of the story is mostly just spinning bullshit for a little spicey trauma.

”She was acquitted, but there’s still the argument that she was framed for the murders historically-speaking.”

Ah, I see what your saying

I agree that that’s a silly argument, (even for people who think she was innocent)
Why would you frame a member of the upper class when there was an Irish maid handy?
The first prime suspect was the maid, she was the prime suspect because she was poor and Irish and papist, so she must be guilty of something

Amanda, I cannot comment on the OB allegations, but I want to make two points:

Amy Tuteur is infamous among those who advocate for better treatment of women in birth (by allowing autonomy to homebirth, the midwifery model of care, reducing the c-section rate that appears to be driven far more by hospital convenience than by need, and many other issues surrounding women’s rights in labor and birth) for being, to put it mildly, obnoxiously trollish; she has a definite agenda, and no matter how many bloggers confront her with studies, documented facts, and evidence, steadfastly maintains that any birth not done by OBs in a hospital amounts to attempted murder.

Another is that when discussind midwifery/birth practice, you should be aware that this area is a huge, and growing, arm of pro-choice and feminist issues, and the disturbing history of obstetrics is one rife with mistreatment and bad practice.

I highly, highly recommend you and your readers spend some time at blogs like Science and Sensibility (http://www.scienceandsensibility.org/) for an understanding of how *modern* midwifery is evidence-based and complements the ethical practice of obstetrics, not a “cultish” approach or a way of mommy-blaming for the vast majority of those involved.

As per death-in-childbirth rates in the 19th century and before, they were highly influenced by a) malnutrition (women with rickets or other issues would have twisted pelvises and die in childbirth) and b) infection—which is why death rates in maternity hospitals were *much* higher than those in homes, because doctors would not wash their hands after examing sick patients or corpses before doing vaginal exams on postpartum women, spreading “puerpal fever” and killing many women.  Google Ignatz Semmelweis, an Austrian OB who realized what was happening but was not listened to, for more on this topic. 

Obstetrics is a valuable branch of medicine and saves lives—but midwifery is not opposed to it, or its opposite. It has, however, historically been perceived as a threat to obstetrics in terms of customers, and midwives persecuted or outlawed for that reason.  There are still states where women are not legally able to use midwives, not because they were killing women, but because they were taking away business.

Anybody who entertains the notion that the Zodiac Killer was the unabomber is a moron, frankly.  A bomber is a totally different kind of killer than a guy who confronts people and stabs them, amongst other things.  Ted Kazcinsky was a socially-backward paranoid schizophrenic who lived in a cabin the woods. Yet somehow he had a total personality transplant from his earlier days when he was capable of approaching people? There’s a fair amount of evidence—most of it from Dennis RAder’s own mouth-that th reason he came out of retirement was because the Unabomber, the OK City bombing, and 9/11 made him miss the attention.

Serial killers almost always kill again if they aren’t caught—either that or they die without being caught.

    And some of them just kill as often as they want to, then stop.  Some of them want to be caught. After all, what’s the point of arousing fear in the population if nobody knows its you?

 
A lot of these guys work their way up the chain of violence till they get to killing people. They don’t appear out of nowhere.  Jack the Ripper’s been so sensationalized over the years that people have lost sight of what he actually did. He could have been a butcher, for pete’s sake. None of what he did required much skill.

I used to believe Lizzie Borden was innocent, but then I read Ann Jones’ dissection of the case in Women Who Kill. She contrasted Borden’s treatment with that of Bridget Durgen, an Irish maid who very likely should have been acquitted by reason of insanity, and points out how Lizzie changed her story many times, and how it didn’t make sense in the first place.  Somebody crept into the house at nine AM in the morning and chopped Abigail Borden to death, then waited for Andrew to return home, somehow, which he didn’t usually do? The wife died first; the husband was later. The amount of rage in the killing suggested it was personal. Again…not the crime of some wandering low life. Lizzie Borden’s crime fits in with all the other OJ Simpson-style murders where some asshole wants to free themselves of a relative or a spouse or whatever and tries to stage the scene.  Burglars don’t usually stab or hack people dozens of times; they want to get in, get the loot, and get out. Lizzie Burden, criminally speaking, is the grandmother of all those domestic homicides where some horny dentist wants to boink his mistress without the messiness of a divorce—-so he kills his wife and stages it.

Just a nit: probably not vicars—remember that many parish livings were by appointment and influence—but vergers (responsible for the management of a parish, more or less), the guys who were hired to dig graves, yeah, pretty much anybody at the sharp end of the shovel would be happy to receive a gratuity in a country where the charge for a single visit to a rich client by a famous physician would be a year’s wages for an ordinary laborer.

Oh, wait.

Emjaybee, there’s some evidence that opposition to abortion sprang from the fear that doctors had that women would go to other women for ‘childbed’ issues once women started entering medical schools. In any event, it served an excuse to stomp on midwives.

It’s worth noting that Jack the Ripper was never caught.  And because he was never caught, it’s very likely that he continued killing thereafter.  However, because the authorities didn’t want to pour fuel on the panic fire that was quickly heating up, Scotland Yard just stopped calling future murders “Ripper Murders” because a) they couldn’t figure out which dead prostitute was killed by the famous serial killer and which was just killed by an irate pimp and b) it meant they weren’t going to be endlessly harped on as failures in police work.

It’s been a couple of years since I did any reading on Jack the Ripper, but I do remember there was also the suggestion that later murderers mutilated their victims in the style of the Ripper to throw off investigation. (I assume this is something I found in my independent reading, as the book I was assigned was Cornwell’s Portrait of a Killer, an extremely shoddy piece of work that should never have made it past manuscript.)

“Jack the Ripper killed five women, for fuck’s sake…”

...which is an off day for Cheney…

Rebecca, Cornwell bought up several paintings by the guy she wanted to nail for being the Ripper, in the hope that the book would make his stuff more valuable. It didn’t.

  Donald Rumbelow’s book is much better—and much less overheated.

”…not the crime of some wandering low life. … Burglars don’t usually stab or hack people dozens of times…”

I thought that most “Lizzie was innocent” theories pointed the finger at Andrew’s brother (or cousin, I forget which) because Andrew stood in the way of his running the family business

Still fits the “domestic homicides where some horny dentist wants to boink his mistress without the messiness of a divorce” model though

It’s been ages since I even looked up any of that stuff, so I’m kind of….Andrew had a brother? Living?

  I just read a book about, well, a horny dentist who wanted to boink his mistress(es) without losing everytihng in a divorce. He claimed a burglar had broken into his house at five AM (with two cars in the driveway), using a ladder but leaving no footprints, and strangling first his wife (to death) and then attempting to do so to himself—-from behind. Yet the marks on his neck were on the back of his neck. His brother eventually killed himself out of guilt over finding out what happened and not telling the authories about it.

I’d put Sam Shepherd, Jeffery MacDonald, and God only knows who else in that category.  It’s impossible to keep up. White guys are especially bad at this. They seem to think they’ll be believed just because they’re white guys.

Oh, wait, sorry: they seem to think they should be believed just because they’re white guys.

Rebecca, Cornwell bought up several paintings by the guy she wanted to nail for being the Ripper, in the hope that the book would make his stuff more valuable. It didn’t.

And the amount of evidence against the guy that she ignores, and the ridiculous far-fetched things she comes up with to support it being him…it is a bad book.

Basically, emjaybee said everything I was going to say.

Yeah, and stuff like the Rumbelow book or other far less publicized studies of the case gets ignored.

  I tried reading it once. I think I lasted a few pages. I just couldn’t stand it. 

  But TV programs on the subject are even worse.  Is there any direct evidence, for example, for any of these theories? Nah, but it could have happened!

And there was incredible abuse in the early years of medicine. The man honored as the father of modern gynecology in the United States is Marion Sims, most famous for developing the correct surgical procedure to repair fistulas. To get there, he performed dozens of operations without anesthesia on his slaves. One woman had more than 30 surgeries without anesthesia. These were REAL operations on REAL medical problems. The women who were his research subjects actually had fistulas, and it’s a terrible, terrible condition, and the world is better off for having the technique to repair it. BUT ... what he did still is absolutely horrific.

The notion of “Oh, doctors would never do that!” just doesn’t apply in the 18th and 19th centuries, if it even really applies in our times.

”They seem to think they’ll be believed just because they’re white guys. “

Well, usually we are

”It’s been ages since I even looked up any of that stuff, so I’m kind of…”
Same here,
...Andrew had a brother? Living?
Maybe it was cousin? In-law? Nephew? … or maybe even business partner?
But your right, random stranger just dosent make sense

Which is not to say the accusations against these doctors are valid. I’m not really in a position to assess the claim. Just saying, this is a time period about which you don’t have to stretch that much to believe something horrific is true.

One more nitpick - the biggest reasons for the drop in maternal mortality are better maternal nutrition and delaying first pregnancies until later teen/early 20s. Which is not to say that C-sections cannot be absolutely necessary and life-saving. They are, though they probably save the lives of a lot more babies than they do of mothers. But adequate nutrition - starting before puberty - saves far more lives every year than anything doctors (or midwives) do.

”To get there, he performed dozens of operations without anesthesia on his slaves. One woman had more than 30 surgeries without anesthesia. “

Wow, How did he avoid death from shock? 
Anesthesia was what allowed surgeons to kill their patients with Sepsis days later rather then shock after a few minutes of cutting

”They are, though they probably save the lives of a lot more babies than they do of mothers.. “

A book called “Age of Agony” mentioned the celebrity of the only woman in 18th cen London who survived a C-Section

That’s a good question, Jeff. These were operations for fistula, so they didn’t involve cutting into the abdomen. I don’t know if that makes a difference in terms of likelihood of shock. Myself, I was wondering how he managed to do so many operations without her dying of an infection. My understanding is that a lot of his patients did die of infections and other causes, so ... maybe she was just really damn tough?

A bunch of you are bringing up the work of J Marion Sims, a South Carolina OB/GYN who is told to be the first to repair a vesicovaginal fistula successfully.  He did operate on slave women, and most likely it was with minimal to no anesthesia, though ether had been invented by that time. 

It is interesting how his legacy is different in different places.  On the West Coast, he is often maligned for unethical research practices, and even compared to Nazi physicians.  In South Carolina, where I practice, he is often lauded for his efforts to advance gynecology and for his desire to find a way to help women with vesicovaginal fistulae, which certainly is a terrible affliction.  Perhaps both perspectives are have some truth to them.

As to the original post -

You’re right that a lot of folks have rejected the allopathic medical model of obstetrics, and have embraced midwifery and homebirth as a superior alternative.  As an obstetrician, I think there are a lot of strengths to the medical model, and also some weaknesses.  The pure midwifery and homebirth models also have strengths and weaknesses.  I think proponents of both sides at times demonize the other, and often ignore what evidence there is to support either set of practices.  Midwives and homebirthers tend to be more prevalent on the internet, perhaps creating an appearance of greater support for that line of thought than actually exists throughout the general population. Most likely this is because most OB/GYN physicians are too damned busy to be blogging.  I’m also too damned busy, but I just blog instead of sleeping enough.  In some cases the supporters of homebirth and midwifery are psuedoscientific or completely unscientific in their reasoning, but some bloggers are quite reasonable in their arguments and support their views with evidence when possible. 

Patients will choose what system they want to deliver a baby in.  In my opinion, midwivery is a great model when practiced in some kind of collaboration with obstetrics, or at least with a strong backup relationship. 

Nicholas Fogelson, MD

”These were operations for fistula, so they didn’t involve cutting into the abdomen. I don’t know if that makes a difference in terms of likelihood of shock “

Im not a doctor, so I wouldnt know, but I wouldn’t think it would make much of a difference, Barron Larrey advised that more then 3 min of probing for a bullet or 2 min amputating a limb you might as well stop because your patient wouldn’t survive
I would guess that anything delicate like fistulas would take long enough for shock

“maybe she was just really damn tough?”
must be

emjaybee @27, yes, it’s fair to point out that midwifery isn’t by definition opposed to either science or obstetrical practice; but c’mon. There is also a large and loud segment of the midwifery/homebirth advocacy community that is anti-science, that is Childbirth Is Natural And Doctors Kill You, and in some cases is strongly influenced by social conservatives and the idea that women are supposed to be in the home for all things, including childbirth. (And unfortunately, which ignores the profound effect on standard medical practices that midwifery has had - birthing centers and walking during childbirth and doulas didn’t come about because Jesus told ACOG to get busy on it - but the paranoid wing isn’t going to give an inch on believing that an OB’s only goal is to cut pregnant women open and dance on their sticky intestines.)

emjabee @ 27 said most of the important points, so I’ll ramble a bit.

I live in NYC and I’m using a midwife when I give birth in July because I’m British, and in the UK your continuous care is with a midwife unless you’re a high-risk case, when you will be referred to a consultant who’s an OB-GYN. During the birth, you work with midwives (who can and do give all kinds of pain relief) unless something goes wrong, at which point an OB-GYN comes in. 
Before I got pregnant in the USA I’d never, ever thought of midwives as being somehow opposed to obstetrics in this idealogical way. To my mind, midwives are very specialist nurses who work with women who are on track to have a normal, uncomplicated birth. As that’s what I’m aiming for, I’m going to work with a midwife, but in a hospital where an OB-GYN can come running in if I need a c-section or have a grim post-partum haemorrhage or something. As I don’t anticipate things going wrong, I’m not signing up straight away for the slicey-dicey, don’t-panic I’ll-take-care-of-it professionals. I want the brisk, knowledgeable, don’t-panic-you-can-do-this ones. Different focuses in different nations, perhaps?

Also, in the UK midwives run maternity wards, and most women give birth in hospital (though you can have a homebirth on the NHS - again, with two midwives, two specialist medical personnel, present). When women started giving birth in hospitals, midwives were there to work with and for them. This seems to be the model in most European cultures, I didn’t understand that midwives didn’t run the show in the USA until I started researching this.  It does seem that in the USA midwives are in some kind of struggle against OB-GYNs for customers, or something. That seems to be the issue, rather than ideology, to me. The whole ‘customer’ thing. 

I had no clue that midwifery was seen as quaint or un-medical until I told a couple of colleagues how much I liked my midwife at the 12 week scan, only to hear them echo “A midwife?!” as if I’d said “And the baby will be delivered by a wizard! And a toad!”
I mean, they’re specialized nurses, ffs! They’re not anti-medicine or anti-science! But again, I speak as a foreigner, and one from a country without a loud, rabid, quiverfull-esque movement. When I think of the midwives I’ve met, I think of profoundly feminist individuals (quite a few men are midwives in the UK) who love their jobs. In hospitals, helping women give birth… Perhaps I can’t see the way that social conservatives have co-opted midwifery to Keep Women Down, or at least, out of the hands of filthy smutty doctors. . .

Now, freebirthing - that’s something else entirely, that seems to stem from an anti-science basis is deeply disturbing. But midwives administer pain relief, they do all medical checks - I mean, they’re nurses! So, yes, I don’t understand the midwives vs OB-GYNs thing at all - to any mind but the American one, these are two different professions who work alongside each other with a common goal, like a general practitioner and a surgical specialist -  not professional rivals.

Eeeeek - a massive rant for my first comment ever, and after years of happily lurking, too! Back to the shadows with me…

mythago, I’m not sure what your point is. There are midwives like that. There also are OBs who seriously believe that every woman should have a prophylactic C-section at 39 weeks. How’s about we not cast either one as typical of their profession? In the interests of avoiding strawmen and all that.

“And the baby will be delivered by a wizard! And a toad!”

Just as long as it’s an evidence-based toad.

When hospitals started delivering babies, they encountered a lot of Puerperal Fever. Dr. Ignatz Semmelweis studied these cases and said that doctors should start washing their hands. I have to wonder if these early deaths due to ignorance are included in the death toll.

Blackcurrants - As I understand it, the American midwifery admittance qualifications are very different from those in the UK or other Western countries, and they don’t always have admitting privileges at hospitals.  I’ve read stories of failed homebirths being dumped by their midwives at A&E;, and homeopathy and crystals featuring in midwifery training.

I read Dr Amy’s blog and while she can have a caustic style, she’s mainly wound up about the anti-science elements of the natural childbirth movement (and of the religious right, and the anti vaccination crowd).  I think part of respecting women’s choices needs to be doing women the service of providing expert medical treatment based on soundly tested information. It’s a shame that the holders of that knowledge have a bad history of treatment of women, but that doesn’t necessarily negate its value or imply that rejecting it helps women.

Shelton’s basic assumptions seems a little off. Until the Registration of Deaths Act of 1837 maternal mortality was not required to be recorded or reported. Statistics prior to the Act are based upon extrapolations from parish records—- which are notoriously biased. Secondly, we know that 18th century surgeons scavenged bodies where they could, and did not rely explicitly upon graves. The Tyburn riots against surgeons of the mid-18th century—in which poor citizens objected to surgeons carrying off the corpses of their friends and relatives from the gallows—suggests that physicians would acquire bodies from a number of sources. It’s logical to assume that a wealth physician would have little trouble acquiring specific corpses from a large population of poorer people.

Amanda, I tend to agree with you that there is an anti-science—or anti-medicine—bent to these types of stories. In the mid-80s I remember hearing people in the anti-choice world claiming that women never die in childbirth and, thus, there was never any medical need for termination.

I’ve read stories of failed homebirths being dumped by their midwives at A&E;

This is a common complaint about homebirths, but let me ask you a question. If a homebirth is not going well and the midwife things the mother needs medical attention, would you want her to keep the patient at home? Or should she go to the hospital? If it was me, I sure as hell hope my midwife would take me to the hospital. That would be doing her job.

And just a note about terminology. Some midwives are CNMs - Certified Nurse Midwives. They are registered nurses with master’s degrees in midwifery. Many of them practice at hospitals. Most free-standing birth centers are run by CNMs. Many of them worked as L&D;nurses before becoming midwives. Some of them do homebirths. Most of them don’t. (For the few I’ve talked to about it, it’s not because they don’t think it’s safe but because it has more to do with regulatory and insurance issues.)

LPMs are licensed professional midwives. They generally go to midwifery school but often don’t have other nursing education or are not required to. Standards vary a lot from state to state. This type of license is not available in all states, essentially making this type of midwifery illegal. I’d guess they do most of the homebirths. They almost never have hospital privileges, though some of them will stay with a client who transfers in a doula capacity or will work as a doula for a client who prefers or requires a hospital birth. In some hospitals, they aren’t allowed in.

DEMs are direct entry midwives. They train through apprenticeships. The crunchier you are, the more likely you are to prefer this kind of midwife as less tainted by the medical system.

A big problem with the discussion is that midwife can describe any of these types of practioners and there’s a big difference between them.

Trouble, you’re mixing up apples and oranges. “Midwife” is a term that can mean all sorts of things—it’s like “doctor” in that way, actually. But professional, accredited midwives, known as Certified Nurse Midwives or CNMs in the United States, are highly trained nurses. Homeopathy and crystals are no more a part of their curriculum than they are a part of the curriculum at any nursing school, and they don’t “dump” homebirth clients when things go badly—they’d lose their license if they did. (And yes, they do often have admitting privileges.)

“In the mid-80s I remember hearing people in the anti-choice world claiming that women never die in childbirth and, thus, there was never any medical need for termination.”

On the other hand, if you force women to accept science- based methods of child birthing, then you imply that women don’t have full control over their own bodies, which is a dangerous precedent.  An interesting conundrum.  On the other, other hand, you would avoid a return to a sort of medievalism where women die needlessly in childbirth out of their own ignorance.

If you take a step back, you assume that people are individual human beings, free to make their own choices.  Taking into account the maxim that women are poeple, and that, and according to our moral definitions fetuses are not, then there is no discussion in the matter.  Women are people, and if so, must be free to make their own choices. 

Unlike the vaccination issue, where the achievement of herd immunity against a pathogen implies a moral obligation on all individuals, I feel there is no collective moral responsibility in this matter.

@ ema

Point and point, it is definitely very far from a triumph of solid evidence and argumentation. 

I do still think that the article is much more about the politics of academia (incentives to publish, to be well-known, to be cited and discussed) than about trying to stoke some kind of anti-scientific backlash.  Again, that doesn’t mean it won’t be used by other folks to attack science-based medicine (“Look! This one dude says a doctor was a murderer!  Therefore doctors are evil and can’t be trusted!”) but I really think Shelton’s game is more straight-up interest in publishing something provocative and controversial to boost his career.  And it’s all too true that quality of research and evidence often has little to do with that—look at Freakonomics. :\

On the other hand, if you force women to accept science- based methods of child birthing, then you imply that women don’t have full control over their own bodies, which is a dangerous precedent.

This is very true. What is also very true is that plenty of modern obstetrics is not based on science. What drives me up the wall about so many of these discussions and the reason I should just check out now is this persistent, insistent assumption that it is the women going to doctors who like science and the woman going to the midwife who doesn’t. Why do I prefer midwives? Because I only want to get induced if there is a medical indication, not because my doctor is going on vacation. So am I going against “science-based methods of child birthing”? Or was my friend’s OB?

That seems to be the issue, rather than ideology, to me. The whole ‘customer’ thing.

Welcome to for-profit medicine.  We spend a lot of time complaining about how we’re getting gouged by the insurance companies, but medical personnel do plenty of gouging themselves.  If I have to hear one more goddamned commercial for the lap band, I’m going to kick in my TV.

(Yes, that’s right—surgeons advertise on TV to get patients to come in and have surgeries they may not need.  It’s really fucked up.)

A big problem with the discussion is that midwife can describe any of these types of practioners and there’s a big difference between them.

That is definitely one of the major problems with this discussion whenever it comes up, because some people’s experience with midwives is nurse-midwives and some people’s experience is the crunchy-granola chick down the street who declared herself a midwife and set up shop.  It varies so much from state to state that half the time you can’t even be sure what kind people are talking about.

If not for the stupid competition between midwives and doctors, states could clear things up with proper licensing (personally, I would strongly prefer it to be nurse-midwives, though I suppose you could have some lower classifications as you have other nurse classifications below RNs).  Heck, even from a profit point of view, you’d think that an OB-GYN would love to run a birthing center staffed by nurse-midwives where the OB-GYN only needs to consult and stand by for emergencies.

In my country (which isn’t the US) midwives are exclusively registered and have undergone education equivalent to nursing training - there are no CNMs and DEMs and so on.  You know you’re getting competent care because if they’re not competent, they get inquired into and deregistered.  Most prenatal care is given by midwives, with obstetricians becoming involved in the case of complications, or if you want to pay $5000 and go private.

I don’t know how US patients tell what sort of qualifications their midwives have - how they can pick the oranges from the apples.  It seems to me as if that’s a problem.

It’s a shame that the holders of that knowledge have a bad history of treatment of women, but that doesn’t necessarily negate its value or imply that rejecting it helps women.

While I don’t disagree with you at all, I wish there were some way to express the idea that medicine is still fairly male-dominated without completely ignoring the huge number of female doctors/nurses/hospital administrators/etc. (You aren’t doing this, particularly; it’s a general complaint. :p) I feel like people often forget that a good chunk of the people being blamed for “a bad history of treatment of women” are women.

Female doctors don’t really *have* enough of a history of treating women to have a “bad history” I think… The medical world has changed pretty dramatically and I don’t think it’s necessarily useful to allow attitudes from the past to carry into the present. Do lots of male (and some female) doctors patronize patients (especially female ones?) Sure. But I can find a man to patronize me anywhere; it’s not limited to doctors. (More likely to be a doctor during childbirth? Yeah, probably.)

Sure, there are lots of problems in medicine as practiced nowadays (and doctors are even responsible for a few of them!) but treating doctors like the monolithic “The Man” just means that people won’t bother discerning between the good ones and bad ones, and it fosters an overall dislike of medicine and science that I think is *really* unhelpful.

Aaah, I went to sleep straight after blaspheming and missed out on some great stuff - Seems like Chinonga answered a lot of my questions, though. My midwife is a CNM (one of the first to have admitting privileges in a hospital in NYC, in fact, and she’s been practicing for 30 years - so she’s pretty feminist and fabulous)  - I had no idea that anyone with a dirty basin could set up shop as a midwife - that does explain a lot of the reactions I’m getting.
Incidentally, I looked at homebirth midwives in my area, and they’re all CNMs, too. I don’t understand the mindset of people who’d go for a non-medical professional ‘midwife’ any more than I understand the mindset of people who’d go straight to an OB-GYN for an expected uncomplicated birth….
So I guess this thread Isn’t About Me, then The rest of this comment is a ramble that is probably not relevant, and I will try to shrink:

A lot of my attitudes towards giving birth were inflected by my big, extended (and actually, not at all crunchy) family. My sister, and sister-in-law, gave birth without any interventions in hospital. My other sister-in-law gave birth without any complication at home, with two midwives (CNM equivalents) with her, who, in her words, “Basically drank tea and ate cake all the time, which was fine, since I didn’t seem to need anything.”  I wonder how much the rush to get the best specialized interventionist care in the US (i.e. “I must have a surgeon to do this with in case something goes wrong!”) is because we only see birth pathologized on TV, or hear about horror stories from friends and relatives. The fact that the majority of the medical and lay people view birth as a problem women have, which must be solved, rather than an experience women undergo, during which they must be supported - is a feminist issue.  Some births aren’t straightforward, and that’s why it’s great living now and not 100 or 200 years earlier. Modern medicine is awesome. I’ve also no truck with making women feel guilty for their birth choices - just as I’ve no truck with making women feel guilty for ANY of their reproductive choices. But the point is that the choice should be *there* - the choice to aim for a straightforward birth with a midwife should be available to women, and often, it is a choice that’s hard to find.  And I wonder, if women aren’t informed about the choices they have (because they might choose the model that makes the hospital/insurance co. less $$$) - then do they really have them?

One of the benefits of the midwifery model, to me, is that it normalizes a daunting (because you *know* it’s going to hurt like hell) prospect. And someone who thinks you’re going to manage fine is going to at least let you try. I didn’t want an OB-GYN (which would have been so much easier on my insurance!) because I didn’t want to feel on the clock while labouring, I dreaded the sensation that I was counting down until they said “right this is taking too long, you need a C-section.”  My midwife’s faith in my body and my ability to give birth makes me feel like an adult, capable and - yes- empowered. I had *not* got that vibe from the OB-GYNs (male and female) that I could have used. Obviously, if the shit hits the fan I’m going to want to be cut open rather than die, thank you very much. But I don’t want a C-section or an episiotomy because it’s more convenient for my caregiver, because I’ll take longer to recover, and it’ll hurt a hell of a lot more afterwards, when I’m at home alone with a newborn. All of these seem to be feminist concerns to me: choices in childbirth care, information about the models available, information about recovery times and WHY certain proceedures are carried out (and if you want to talk about ‘Doctors with unscientific practices’, then let’s talk episiotomy!) and if/when/how you can refuse them. After all, women are people, and so women should have control over their bodies, and be informed about them.

“I don’t know how US patients tell what sort of qualifications their midwives have - how they can pick the oranges from the apples.  It seems to me as if that’s a problem.”

Our evidence-based toads are also registered, licensed, etc. by the state.  It’s not exactly the wild west over here.  Representing yourself as an OB-GYN when you’re an RN or a CPM when you dropped out of nursing school halfway through is a prosecutable offense, as is practicing medicine without a license.  The only place where you can act like an MD when you are in point of fact a DVM appears to be the FDA’s women’s medicine division.  The biggest problem seems to arise in states where home-births or midwives of any stripe are essentially illegal, so you’re stuck personally doing the background check on your midwife is you choose to have an off-the-radar homebirth, and the only option for shutting down bad ones is the all-or-nothing approach which will dissuade a lot of legitimately wronged patients from filing a criminal complaint.

I don’t know how US patients tell what sort of qualifications their midwives have - how they can pick the oranges from the apples.

You look at their business card. It’s really not that complicated.

“even if I’m flat-out not wiling to legally force them to go to a hospital.”

Well, we don’t make you go to the doctor if you have diabetes and aren’t doing anything about it, or if you have cancer and aren’t doing anything about it, or if you have a raging MRSA infection and aren’t doing anything about it, or if you’ve been injured in an accident and decline to give consent for treatment.  It’s actually quite rare for us to pack people up and cart them off to the hospital against their wishes, except in cases where those people happen to have full uteruses, in which case we’re oh-so-strangely willing to drive a bulldozer straight through any expectation of obtaining the patient’s consent before doing whatever the doctor in charge thinks ought to be done.  Being flat-out not willing to legally force medical intervention on a pregnant woman just because she’s a pregnant woman is still a pretty radical stance.

For myself, even if it wasn’t a human rights issue, it would still be a numbers game.  Giving birth without any professional attendance at all is a pretty bad idea.  But it’s a pretty bad idea right there on the face of it, so you’re not going to have very many people doing it.  Of the people who do it, the majority are probably going to be fine or fine-ish.  The minority who aren’t are going to have at least a portion of cases where the catastrophic whatever lands them in the hospital, which will be able to help them.  So we’re not really dealing with a huge amount of harm, and that harm is going to be individual and voluntarily-risked.  Giving doctors and hospitals a green light to trample on the standard of informed consent so long as pregnant women are involved stands to negatively impact—quite frequently profoundly so—every woman in the country who becomes pregnant on a systemic level.

and nowadays you see women feeling guilt tripped if they want pain relief, or thinking they failed if they have a C-section

I was listening to NPR over the weekend and there was an interesting conversation with Randi Hutter Epstein, author of Get Me Out: A History of Childbirth from the Garden of Eden to the Sperm Bank and she said that we’re living in the age of extremes right now: that on the one side you have people who passionately believe that natural childbirth without any sort of pain management or “medical” intervention is the way that it needs to be done and C-sections will give your baby brain damage, and on the other side you have people who believe that we’ve perfected the drugs and that anyone who doesn’t want to get completely doped up and have their vulva sliced up is some sort of caveman hippie.

It sounded about right.

Yikes, purpleshoes, that last article is completely petrifying!
I think the final paragraph explains a lot.  ”... as Vyckie Garrison noted, her Quiverfull convictions led her to desire total reliance on, and trust in, God, neglecting her own instincts and health in favor of obedience and submission.”
When I think about a midwifery-lead model of childbirth care, I envision one which gives me more information, more power, and more choices - not “shut up and submit to suffering like God intended, evil and fallen woman!” Yuck, yuck, and double-yuck.  But I do now understand why people conflate midwifery and freebirthing.  I am so woo-free (and naive) that I’d never thought of an anti-feminist midwifeish birth model.  SO naive!

I giggled a bit about the anti-statist stuff - my appreciation of midwives is tied in to my appreciation of my (socialist/fascist/Kenyan) NATIONAL Health Service, which does a respectable job of caring for women.  For example, the NHS investigates every maternal death that happens in the UK and presents a report called “Why Mothers Die”  (here’s one) which aims to improve care and prevent such events from re-occurring. The USA doesn’t even keep records, so I think I’ll stay in the “Statist” camp for that stuff.

Two things:

One, almost anything in history is full of racist, sexist, classist nastinest.  Shall we throw out agriculture because slaves were used in cotton fields a good bit of the past?  Welcome to history; it ain’t pretty.  Turn a historical stone and you’ll find un-pretty stuff like the “father of gyn.”  Whether I believe this particular story is beside the point (er, it first falters with the idea that dead pregnant women would have been hard to come by during that era), but if you start trying to throw out anything with a sordid past, you will land yourself back in the Stone Age (or before) right damn quick.

Two, there is a middle ground between ob-gyns and midwives: many family medicine doctors deliver babies too.  Most are not surgeons, so c-sections are a last resort, not a first thought.  Which is not to denigrate either obs or midwives - only to say that there are many, many options out there for pregnant women, even in states where midwives are not recognized.

It always struck me that the Ripper murders get so much attention because they are officially unsolved, and therefore act as a blank slate on which we can project all of our paranoid illusions regarding the Victorian era. In contrast, we rarely hear of Henry Holmes who had 9 confirmed murders, confessed to 27, with a few dozen more suspected. Holmes likewise was neck deep body-selling. The primary reason is that like most serial killers, Holmes was otherwise a middle-class nobody from a small and ordinary city. My pet theory regarding the Ripper is that he also was an obscure and middle-class nobody who likely was stopped by one of the dozens of mundane and middle-class ailments and accidents that could happen to someone in industrial London.

Well, while it’s not All About ME, years before I was married and had any intention of getting pregnant, I made sure my OB/GYNs were all female and had very low c-section rates (less than 5% when the national average is now 20-30%). 

They’re also very tech-savvy and totally into letting you schedule your birth for induction if you want.  They think you’re a little crazy if you want to go all natural with no pain meds (seeing as they’re all mothers as well), but they’ll support you that way as well.  The only thing they won’t do is a water birth, and I think that has more to do with the hospital than their practice.

Every woman should be able to have that kind of choice, and part of having the choice is investigating the options/doctors and picking one that respects your views on the matter.  I didn’t even want a GYN who had a high c-section rate b/c who knows what other things s/he does for her/his own convenience?

But another problem is that your insurance constrains your doctor choice.  If you don’t live in a big city with a wide choice, you might get stuck with a not-so-great doctor who will cut you if you haven’t “progressed” fast enough for the doctor’s taste because there aren’t as many options and your insurance won’t cover different docs.

One of the problems here is that at some point during the process there are two patients rather than one, and if a woman intends her pregnancy to end with the live birth of a healthy-as-feasible infant there are some ethical duties, I think, that that intention imposes on her and on medical practitioners. Of course, I’m not at all sure that those duties are enforceable before the fact, and in general doctors’ attempts to enforce them have been a complete mess (last time I read up, which was quite a while ago, every case where doctors got court orders for a hospital C-section and the mother evaded the order, birth was uneventful. Which had a lot to do with those orders being largely against pregnant women who poor, members of an ethnic minority, or both.)

Back to the original issue, I don’t think that the urban-legend/FoxNews version of this story even has to be “early gynecologists were evil, so stay away from doctors and contraception”. All it needs to be successful for the right wing is to convey the general idea that scientists are icky and amoral, and that being pure of heart will beat evidence-based thinking every time.

I have to say that it’s hard to understand the pressure and all the decisions that a pregnant woman faces until you are in the situation yourself.  I’m at 6 mos, and I went into it with a pretty laissez-faire attitude at first.  I went to an OB that a friend recommended, and she was fine, but my partner and I left feeling a bit, well, overlooked.  Every question we had (and we didn’t have many) was met with a “don’t worry, you’ll be fine” answer.  I didn’t want blanket reassurances, I wanted information.  When we decided to switch hospitals, that forced us to switch doctors.  When we had our first exam with the new practice, which was a combo OB/midwife team, we were stunned at the difference!  Our first meeting lasted over an hour, with a full explanation of all kinds of things we never even knew to ask about.  They were up front that they practiced “evidence-based medicine” which reassured me that there was little tolerance for woo-woo, but they also used words like “your body will know what to do” and “here are a range of options”. 

You might think as I did, before getting knocked up, that most doctors in this day and age would treat birth like a normal process, but you would be wrong. And standing up to a professional, especially if it’s your first, is really tough. So I caution those who think that we’ve moved to a point when obstetrics is now automatically a parent-friendly field.  There have been great strides, but without the natural childbirth movement pushing against the medical establishment, I’d still be looking at a birth while strapped to a table in stirrups with my partner pacing by the door.  Of course natural childbirth people can go too far and be anti-science, but don’t let the vocal fringe convince you that the opposite then must be true, that the field of obstetrics as it is commonly practiced is the best thing since sliced bread. Most of us are just looking for a happy middle ground.

“Google Ignatz Semmelweis, an Austrian OB who realized what was happening but was not listened to, for more on this topic.”

emjaybee illustrates the distressing lack of knowledge of homebirth advocates and their tendency to make up “facts” to suit themselves. The “story” of Semmelweis is a classic among homebirth fabricators. The claim is that doctors, ignoring the work of the Viennese physician Ignaz Semmelweis, continued to spread disease by failing to wash their hands even after learning the true cause of sepsis. There’s a big problem with the story, though; it’s made it up.

The medical historian Irvine Loudon, in the paper “I. Ignaz Phillip Semmelweis’ studies of death in childbirth”, has described what really happened.

”In 1846, Ignaz Phillip Semmelweis … was appointed to … the Vienna Maternity Hospital, which was divided into two clinics. Doctors and medical students were taught in the first clinic, midwives in the second … The alarmingly high mortality in the first clinic had defied explanation until Semmelweis … Each day started with the carrying out of post-mortems on women who had died of puerperal fever. Then, without washing their hands, the pupils went straight to the maternity wards where they were required, as part of their training, to undertake vaginal examinations on all the women. The pupil midwives in the second clinic did not, of course, carry out post-mortem examinations, and did not undertake routine vaginal examinations.

This was many years before the role of bacteria in diseases was discovered, and Semmelweis suggested that the training procedures of the first clinic resulted in the transfer from the corpses of what he first called ‘morbid matter’ ... In 1847, he therefore introduced a system whereby the students were required to wash their hands in chloride of lime before entering the maternity ward. The result was dramatic. In 1848, the maternal mortality rate in the first clinic fell to 12.7 in the first clinic compared with 13.3 in the second clinic. The process of admission to the two clinics on alternate days produced, by accident rather than design, a controlled trial, and the large numbers of deliveries ... mean that chance could confidently be excluded as a possible explanation for the differences observed.”

Why didn’t more people listen. Probably because Semmelweis refused to publish his findings:

“...Although urged by his friends to publish, he waited for thirteen years before he published his treatise, ‘The Etiology, Concept, and Prophylaxis of Childbed Fever’, which is dated 1861 but was actually published in 1860. The treatise of over 500 pages contains passages of great clarity interspersed with lengthy, muddled, repetitive, and bellicose passages in which he attacks his critics. No wonder that it has often been referred to as ‘the often-quoted but seldom-read treatise of Semmelweis’. When he wrote the treatise, Semmelweis was probably in the early stages of a mental illness that led to his admission to a lunatic asylum in the summer of 1865, where he died a fortnight later…”

Moreover, the notion that Semmelweis was a tragic hero whose great work was ignored is wrong:

“...But most of the claims made about him in the twentieth century - that he was the first to discover that puerperal fever was contagious, that he abolished puerperal fever (or that if he did not, it was because of the stupidity of his contemporaries), and that his treatise is one of the greatest works in nineteenth-century medicine - are sheer nonsense…”

So the claims that doctors deliberately refused to wash their hands long after Semmelweis’ great discovery had become common knowledge is “sheer nonsense.”  Moreover homebirth advocates fail to mention that midwives did not wash their hands, either. Did midwives know about hand washing? No. Did midwives understand the germ theory of disease. No.  Did midwivess perhaps discover the germ theory of disease and correct the error of the doctors? No. How did midwives learn about the germ theory of disease and the importance of handwashing? Doctors told them.

Homebirth advocates are entitled to their own opinions, but they aren’t entitled to their own “facts.”

Amy, emjaybee might have relayed the story inaccurately, but you have no reason to lay those inaccuracies at the feet of midwifery or even homebirth advocates.  I heard an even more inflammatory telling of the story from a bio-statistician working in the field of public health.  I suspect that it’s one of those stories that’s been embellished for dramatic purposes since entering into popular literature.

“but you have no reason to lay those inaccuracies at the feet of midwifery or even homebirth advocates”

They are not the only people who have “rewritten” the history of Semmelweis to suit themselves, but they are among the most active in propagating the fiction. No doubt emjaybee picked it up from a natural childbirth or homebirth publication or website.

Amy, none of what you say contradicts the fact that Semmelweis discovered the problem and reduced mortality but no one followed him.  Okay so he didn’t publish - so the others weren’t actively evil in ignoring the new science (though this could have been assumed even without knowing this part of the story - people are rarely actively evil).  You’d think a discovery this big would spread like wild fire…?  And what in the world do his later mental problems have to do with anything?

In the same vein, what does midwives knowing about germs have to do with anything?  They had fewer casualties and deaths before doctors figured out they should wash their hands. 

I’ve never heard anyone claiming the things you seem to be arguing against and nothing in what you say seems to argue against well qualified midwives assisting in childbirth until and unless there is a serious problem for with an obgyn needs to be called.

“You’d think a discovery this big would spread like wild fire…?”

How?

“They had fewer casualties and deaths before doctors figured out they should wash their hands.”

Sure, at the Viennese Maternity Hospital, and only because they did not do autopsies. It certainly wasn’t because midwives washed their hands. That tells us nothing about the relative safety of midwifery and obstetrics.

“you seem to be arguing against and nothing in what you say seems to argue against well qualified midwives assisting in childbirth until and unless there is a serious problem for with an obgyn needs to be called”

Yes, certified nurse midwives (CNMs) are qualified.

Homebirth midwives, on the other hand, are neither well educated, nor well trained. American homebirth midwives have less education and training than ANY midwives in the industrialized world. They would not qualify for licensure in any other first world country.

Most of what passes for “knowledge” among homebirth midwives and homebirth advocates is factually false, just like the made up story about Semmelweis.

Seriously, doctors deliberately refuse to wash their hands now.  How is it possible that they didn’t refuse in Semmelweis’s day? 

Western Medicine has a fantastic quantity of stupid associated with OB/GYN and hatred of women in general.  It’s best for a woman who doesn’t want to be abused by the dominant culture currently running to be aware of this, so they’ll see it coming when their doctor recommends the unnecessary c-section after overruling the nurses and midwives on earlier care.

“Western Medicine has a fantastic quantity of stupid associated with OB/GYN”

Really? And yet the ONLY places in the world with low levels of neonatal and maternal mortality are those that use modern obstetrics.

How do you explain the fact that American neonatal mortality has dropped 90% and maternal mortality has dropped 99% in the past 100 years? Before claiming that it was due to “public health measures” be sure to check out the leading causes of neonatal and maternal mortality 100 years ago so you can understand why public health measures had nothing to do with it.

“Say what?! My HOMEBIRTH midwife is a CNM with 15 yrs exerpience, and was a labor/delivery RN for 10 yrs before that. That is hardly uneducated.”

Clearly, she must have been lying to you.  Any truly qualified CNM would never consent to a homebirth.  Though you do see an interesting sort of quantum qualification for, say, the GP who delivered me at my mother’s homebirth.  He was completely unqualified in that instance, but eminently qualified when he delivered my younger siblings at a free-standing center.  His degree and experience either existed or did not depending on what physical space the laboring mother he was attending inhabited. 

True story.

Olivia—the facts are irrelevant.  No doctor should ever be questioned, and the fact that OB-GYN practice has changed massively in the past 20 years should never be noticed, because it of course never means that there was anything bad before.

“Western Medicine has a fantastic quantity of stupid associated with OB/GYN”

Really? And yet the ONLY places in the world with low levels of neonatal and maternal mortality are those that use modern obstetrics.

These two statements are not opposed to each other. Modern medical practice is a really great servant, but an overweeningly arrogant, miserable master. And in few places is this clearer than OB/GYN, where a lot of practitioners (albeit far fewer than in previous decades) pretty clearly have unresolved issues about women. Aggressive management of care is a necessity in most medical settings, but even harder to accomplish when a woman is pregnant and (in the US at least) her body is considered more or less public property.

I know I read the Semmelweis story in some random potted history of medicine, with no reference to home birth at all. I expect many/most people did. And I’m afraid that Amy’s style of making unsupported slurs may tend to confirm the fears (that doctors and other advocates of science-based medicine are arrogant, paranoid, unwilling to listen but wiling to bend the facts) of exactly the people she might most like to convince.

The biggest problem seems to arise in states where home-births or midwives of any stripe are essentially illegal, so you’re stuck personally doing the background check on your midwife is you choose to have an off-the-radar homebirth, and the only option for shutting down bad ones is the all-or-nothing approach which will dissuade a lot of legitimately wronged patients from filing a criminal complaint.

Yep.

You also see a big connection between people choosing unassisted birth and homebirth midwifery being illegal. There are women who absolutely will not go to the hospital, and they would prefer a midwife, but if they can’t hire one because of their state’s laws, they’ll go it alone.

What I’d really like to see is more stringent and more uniform standards for LPMs across the states, homebirth being legal in every state, and doctors and midwives working together to develop good transfer procedures.

That wouldn’t eliminate unassisted birth and it wouldn’t eliminate bad midwives, anymore than medical school and licensing eliminates bad docs, but it would be a big improvement from our current situation.

(My own comfort level is with CNMs, but I think you could have a good education/licensing program for LPMs and probably some states already do and could serve as models. And yeah - a midwife has to tell you what her qualifications are - the CNM or LPM or DEM is right after their name -  so it’s not that hard if you do some basic research to know what you’re getting. It’s certainly not any harder and might be easier than figuring out if your doc is one who shares your values or not.)

“No doctor should ever be questioned, and the fact that OB-GYN practice has changed massively in the past 20 years should never be noticed, because it of course never means that there was anything bad before.”

The fact that current practice is being seriously reviewed in places like Cali, where maternal mortality is ticking back up even amongst theoretically non-neglected white populations, should especially not be noticed.

Really? And yet the ONLY places in the world with low levels of neonatal and maternal mortality are those that use modern obstetrics.

There also are ways to make use of modern obstetrics other than the current American medical system. Throughout Europe, you see much higher use of midwives, much higher rates of home birth, much lower C-section rates, AND much lower maternal and infant mortality than in the United States.

The choices aren’t between “everything is perfect now and could never get any better” and “science will kill you.”

“And in few places is this clearer than OB/GYN”

If that’s so obvious, you should have lots of examples. Let’s see 10 examples of the “fantastic quantity of stupid” in OB-GYN and an explanation of why modern obstetrics could be so strikingly successful despite them….

“infant mortality”

But infant mortality is the wrong statistic. It is a measure of pediatric care. The best measure of obstetric care (according to the World Health Organization) is perinatal mortality. And the US has one of the lowest rates of perinatal mortality in the world, lower than Denmark, the UK and the Netherlands. Indeed, the European country with the highest rate of homebirth also has the highest perinatal mortality.

Um, information has been known to spread through people talking.  Radical concept.  Presumably those friends who were urging him to publish could have drawn other doctor’s attention to his amazing discovery.  I still don’t understand why you keep calling the story false - by what you say it’s true but incomplete.  Okay great, good to hear more information but it doesn’t destroy the point in the least.  Maybe you think the point is that “we” think doctors are evil and murderous - but um, no, no one thinks that. 

Also, no one on here is arguing for home births with midwives that are untrained.

Also no one here (or anywhere) is arguing that the past 100 years haven’t led to medical advances that have drastically reduced deaths in childbirth.  So why in the world are you bringing that up as some kind of argument?

Are you engaging in argument with us or with the people inside your head?

And the US has one of the lowest rates of perinatal mortality in the world, lower than Denmark, the UK and the Netherlands. Indeed, the European country with the highest rate of homebirth also has the highest perinatal mortality.

Since you didn’t include a cite, that means you’re not telling the truth.  And, of course:

http://apps.who.int/whosis/data/Search.jsp

Location   Neonatal mortality rate (per 1 000 live births)
United States of America   4.0
Andorra   2.0
Austria   3.0
Belgium   2.0
Denmark   3.0
Finland   2.0
France   2.0
Germany   3.0
Iceland   1.0
Ireland   4.0
Luxembourg   3.0
Netherlands   3.0
Norway   2.0
Portugal   3.0
San Marino   2.0
Spain   2.0
Sweden   2.0
Switzerland   3.0
United Kingdom   3.0

(Fetal mortality data is not available, but your argument hinges on neonatal mortality.)

Go back to RedState, thanks.

Threads on this topic always drive me nuts for one specific reason.  All those OB/GYNs who don’t practice evidence-based medicine, who don’t make their policies on inductions/c-sections clear at the outset, who don’t support their patients’ wishes regarding pain management or lack thereof?  Those are BAD DOCTORS.  There are good OB/GYNs in the U.S.  I’d go so far as to say that *most* American OBs are good doctors.  You just don’t hear about them as much because satisfied patients are a lot less likely to talk/blog about their experiences.

It sucks that our current insurance system limits patients’ choices and ability to change providers mid-pregnancy.  It also sucks that malpractice rates have driven so many OBs out of practice, which further reduces patient choice.  A bad doc is one thing; a bad doc you can’t get away from is hellish.

However, bad doctors exist in every specialty.  Can we work to change the system and report/stop giving business to the bad docs without indicting the entire profession?

Ok, looking into this further, the US appears to have a massively lower rate of reported “stillbirths” than Western European countries.  This is almost certainly a reporting issue, as countries in Western Europe do a much better job of tracking and supporting women in pregnancies than the US.

Leely—the problem is that the good doctors seem so adamant about protecting the bad ones.

“Fetal mortality data is not available, but your argument hinges on neonatal mortality”

Of course it’s available. Just because you didn’t find it doesn’t mean it isn’t available.

World Health Organization report Perinatal and Neonatal Mortality 2006 (http://www.who.int/making_pregnancy_safer/publications/neonatal.pdf)

Leely; most proponents of reforming childbirth in the US (and elsewhere) are not arguing that OBs are evil. Not one major group of midwives, rights advocates, or lay activists is categorically anti-OB, and all of them…even ICAN, which concerns itself with the abuse of c/secs—states clearly and repeatedly that obstetrics practiced ethically saves lives. There are good reasons for c/section, and there are good obstetricians. If you spend any time, whatsoever, on the sites that discuss these issues, you will see this fact repeated constantly. The point you want them to make is *already being made.*

But advocacy groups and advocates, by definition, address *problems*, and therefore that is their focus.

Leely, of course there are good OBs, but they are often limited by working in a “bad” system. ACOG, hospital policies, insurance companies, and OB education based on constant machine monitering, averages, and the comfort of doctors (such as almost always requiring women to push while on her back)...A good doctor can only do so much if they are willing to buck the system.

I’m totally with you on insurance companies doing nothing but ill.  But other than that, I’m not so sure the entire system is broken.  Especially this view of OB education - I know a bunch of med school professors (who are OB/GYNs) and they’re all concerned with the same things that have been brought up on this thread, including bringing down the c-section rate and encouraging CNM programs.

re: Lizzie Borden

Oh!  Oh!  Big true crime fan here and since we’re already off topic… I’ve always been a big fan of the “older sister did it” theory.  Her alibi was never verified, it was pretty shaky anyway, and Lizzie can still be guilty because it works best as a conspiracy between the two of them.

Ok, looking into this further, the US appears to have a massively lower rate of reported “stillbirths” than Western European countries.  This is almost certainly a reporting issue, as countries in Western Europe do a much better job of tracking and supporting women in pregnancies than the US.

Oh, Christ - here we go again with Dickhead Wingnut Factoid #419

“The Noble USA tries to save every little one of the precious babies while the Evil Europeans drop their mistakes in the dumpster, cackling, and never record them.  That’s why Evil European child mortality LOOKS so much better than We Noble Americans.”

Let’s see 10 examples of the “fantastic quantity of stupid” in OB-GYN and an explanation of why modern obstetrics could be so strikingly successful despite them….

With the examples already given on this thread plus cases like Samantha Burton, we could probably get more than ten.

You got me switched PiatoR—I was saying that tracking of “stillbirths” would be higher in Western Europe, because there would be fewer people suffering miscarriages without medical attention.

Dr. Tuteur:  here’s a simple one—why the hell did it ever become standard practice for women to give birth on their backs, thus forcing them to fight gravity?  How can you take seriously claims of awesomeness for a profession which institutionalized such a profoundly stupid practice?

“With the examples already given on this thread”

In other words, you can’t think of ten examples. I’m not surprised. Although complaining about obstetrics is common, most people complaining have a stunning lack of specifics.

“why the hell did it ever become standard practice for women to give birth on their backs, thus forcing them to fight gravity?”

We all know how important gravity is. When we put a turtleneck on a baby, we want gravity to work with us, not against us. So we all hold our babies upside down over the shirt and let the baby fall through the neck opening, right?

Wrong, of course. Yet that is the principle that “natural” childbirth advocates invoke when arguing that women should be upright in both the first and second stage of labor. They are absolutely certain, based on no evidence, that gravity provides a powerful and necessary aid to labor.

Regarding gravity in labor:

Lawrence A, et al. Maternal positions and mobility during first stage of labor. Cochrane Database of Systematic Reviews. Issue 2, 2009.

http://www.cochrane.org/reviews/en/ab003934.html

The lead author said: “The physiological advantages of upright positions and mobility include the effective use of gravity, which aids in the descent of the baby’s head. As the head is applied more directly and evenly against the cervix, the regularity, frequency, strength and therefore efficiency of uterine contractions are intensified.”

In other words, you can’t think of ten examples. I’m not surprised. Although complaining about obstetrics is common, most people complaining have a stunning lack of specifics.

Dude, the burden of proof isn’t on people who don’t want to use a service. If I* don’t want to go to an OB/GYN because I’m afraid that s/he’ll confine me to hospital for three months with no way to support my children, or that I will be pressured or forced to have a C-section, it’s not like there’s no evidence of that, but more to the point, it’s my body.

*hypothetical I

Who puts turtlenecks on babies? That’s why they invented snaps! And of course, childbirth is *just* like putting clothes on a squirmy infant. Srsly, you are undermining your arguments here, Dr. Amy.  It’s one thing to say that the overall contribution of obstetrics to maternal and fetal health has been positive (I’ll grant that) and it’s another thing to say that being upright and moving during labor is a practice “based on no evidence” or that there haven’t been numerous examples of bad experiences with OBs already given. We’re not saying that OBs are a force of evil in the world, we’re just pointing out that there’s room for improvement. Denying and defending bad practices (you must lie down during labor!) just strengthens my point.

Also, I’m fairly sure my vagina doesn’t have sleeves.

“The lead author said: “The physiological advantages of upright positions and mobility include the effective use of gravity, which aids in the descent of the baby’s head. As the head is applied more directly and evenly against the cervix, the regularity, frequency, strength and therefore efficiency of uterine contractions are intensified.”

That’s what the authors thought, but you neglected to quote what they found when they reviewedscientific literature:

” The review authors identified 21 controlled studies from a number of countries that randomly assigned a total of 3706 women to upright or recumbent positions in the first stage of labour. Nine of the studies included only women who were giving birth to their first baby. The length of the second stage of labour and the numbers of women who achieved spontaneous vaginal deliveries or required assisted deliveries and augmentation were similar between groups, where reported. Use of opioid analgesia was no different, although women randomised to upright positions were less likely to have epidural analgesia. In those studies specifically examining position and mobility for women receiving epidural analgesia (five trials, 1176 women), an upright or recumbent position did not change the length of the first stage of labour (time from epidural insertion to complete cervical dilatation) or rates of spontaneous vaginal, assisted and caesarean delivery. Little information was given on maternal satisfaction or outcomes for babies.”

Ya know, as an FP doc trained in a pretty crunchy place among midwives (and with attendings who happen to be married to midwives as supervisors), I’ve picked up a few different birthing positions to suggest to patients.  Ya know what?  Most look at me like I’m crazy and crawl back to bed and lie on their back.  Take from that what you may, but some people just don’t find it comfortable to be standing, squatting, lying on their side, kneeling on all fours, or whatnot when they’re contracting.  Some really dig all the variations in labor positions, most - I’ve noticed - really don’t.  Many find that flat-on-the-back is just kind of the most comfortable for them.  Gravity or whatnot be damned, ‘cause honestly, gravity really got nothing against the push of contracting uterus.  If people wanna stand on their heads that’s fine with me as long as they’re not gonna fall over, but pretending that back down isn’t a natural position for a lot of women to labor in is a little silly.

You got me switched PiatoR—I was saying that tracking of “stillbirths” would be higher in Western Europe, because there would be fewer people suffering miscarriages without medical attention.
Comment #113: Punditus Maximus on 02/10 at 06:57 PM

Most countries (including those in Europe) differentiate between stillbirths and miscarriages.  A miscarriage is a pregnancy loss that occurs before the 20-24th week (the definition varies by country), and a stillbirth is defined as any fetal death that occurs from the 20-24th week on.  So while many women in the U.S. (and Europe) suffer miscarriages without medical attention (especially since some of those women won’t even know they were ever pregnant), I doubt there are many people in the U.S. who expel a 24-week fetus without medical attention.  I’m sure it happens, but I doubt it happens enough to skew the statistics.  So I don’t think that argument holds up very well.

That’s interesting, skylanda. It’s also the exact opposite of my own experience and that of every friend of mine who’s had a baby.

Apparently, Dr. Tuteur’s role on this thread is to provide a real-life demonstration of why the anti-science fringe in the homebirth movement is getting so much attention instead of the majority who simply want to reform the system to improve outcomes for the patients: because the medical establishment will not listen and will not engage in this argument with good faith.  They just want to hurl invective and call their critics stupid. Sigh.

Already she has denied the validity of being upright and active during birth*; in an attempt at sleight of hand she conflated American obstetrics with Western European obstetrics because she knows that our practices when singled out actually show that the standard of care lags behind the rest of Western Europe in this area; she has refused to address still common practices like episiotomy, which some OBs use as a matter of routine than necessity; she studiously ignored the comment about the Florida woman held hostage in a hospital because the economic and parental demands of her life made bedrest unfeasible and where the woman miscarried her fetus alone anyway; she studiously ignores comments about OBs scheduling inductions and c-sections for THEIR CONVENIENCE and not for medical cause. Indeed, she has placed the onus on us to prove that American obstetrics needs reform rather than make a legitimate case of how these practices are actually evidence-based and best practice.

Somewhere, doctors like Tuteur have forgotten that the women being treated matter. That their ability to recover quickly and with as little damage to their bodies is as important as delivering a healthy baby, and that many of the current practices of OBs actually create MORE risk to the mother and baby than is justifiable.  They think that is reasonable to put women in the position of choosing a freebirth or an at-home VBAC because of ridiculous hospital policies (on VBAC especially) and state laws about midwives, rather than finding a way to evolve a complimentary system of midwifery/obstetrics. Apparently, it is worth some women dying or having their babies die because a woman is afraid to go to a hospital if it coerces the rest of us into complying with the current system. 

*I had a back labor and would never have been able to do this drug-free if confined to my back as the pain was excruciating. Being able to move around and change position as needed helped with pain management and made labor very manageable without pain relief.  Most women I know found back-lying incredibly painful and opted for side-lying if they were confined to their bed during labor. More women would probably be able to wait on an epidural if they understood the effectiveness of position changes during labor, but it makes them so much more difficult to manage if they aren’t immediately hooked up to some drugs and confined to a bed.

** I should note that my non-profit work focuses on mothers, so I have A LOT of anecdata about local obstetrics (plus all the time I spent individually researching these issues and reading peer-reviewed studies), in addition to surveys that place my metro area in 49th place for maternal/neonatal outcomes.

How do you explain the fact that American neonatal mortality has dropped 90% and maternal mortality has dropped 99% in the past 100 years?

Because one can manage to do amazing things with technology and yet still display a fantastic amount of stupid?

Says the girl who lived past her 12th birthday due to modern western science - unlike the great uncle who had the same congenital heart defect - but still fucking hates most of the doctors I’ve gone to.  Ever.

In fact, I’d say this attitude is a big part of the problem.  I am not a car with a broken part.  The job involves more than just changing my oil or fixing what is broken.  The fact that I still “run” is not, in and of itself, an absolute rebuttal to the idea that stupid still abounds in the medical community.

“Midwives and homebirthers tend to be more prevalent on the internet, perhaps creating an appearance of greater support for that line of thought than actually exists throughout the general population. Most likely this is because most OB/GYN physicians are too damned busy to be blogging.  I’m also too damned busy, but I just blog instead of sleeping enough.” 

I’m surprised no one else picked up on this from comment #45. Why don’t obstetricians blog in general? Ever considered that there’s no need for obstetrics rights advocates? It would be like an MRA blog. What would be the incentive for pushing for social change when you can do whatever you want and people just put up with it?

I sense some Nice Guy (TM) vibes here. We’re just nice people who are trying to save babies and moms. Please stop getting mad at us about caesarian rates and other anti-woman, pro-obstetrician practices. Can’t you see we’re just nice people?

LOL.

Ah… I think its really because most doctors aren’t all that tech saavy, and maybe just want to do their jobs. 

We get so maligned.  There are lots of good points, but in reality most OB/GYNs try do as few cesareans as possible.  Some things get in the way, but for the most part we have the same ideals.  We can’t please everybody apparently, and thankfully there are midwives out there for the folks that prefer them.