Podcast Beyond Belief had the rare chance to interview “The Skeptical OB”, Dr. Amy Tuteur. This was her first interview for a podcast, so we really appreciate her speaking with us. Below, is part 1 of the transcript of our interview with her…
Colin: Tell us a little bit about yourself?
DrAmy: OK. I finished medical school in 1984. I did my residency and internship at Boston’s Beth Israel Hospital. I practiced for a number of years before retiring from medicine in the mid-90s. Since then, I’ve worked as a freelance writer on the web on my own web sites. I write primarily about women’s health, particularly pregnancy.
Colin: You are notorious among home birth advocates for being virulently anti alternative birth. Where does this come from… going after alternative labor and delivery?
DrAmy: It’s kind of ironic because the reason that I’m one of the few is is that most obstetricians really don’t take home birth advocates seriously. I’ve done them the honor of taking them seriously on their own terms. I think a lot of the aggression and anger is because usually they’re used to saying what they want to say without anyone questioning them, and now someone’s questioning them and asking for data to support their claims. And they find it very very hard to come up with any data to support what they want to say.
I’ve acquired the reputation in the childbirth community as “she who must not be named”.
Colin: Kind of like Voldemort, right?
DrAmy: I think it gives insight into the way in which home birth, like all forms of alternative health, is a belief system. When you challenge that belief system, people react in a very angry fashion because you’re challenging something very important about themselves. When I discuss pregnancy and child birth, I’m discussing the facts, but when they discuss pregnancy and child birth, for some people, they are discussing their identities, and therefore, it’s very very hard to be questioned on that.
Elyse: One thing that I’ve discovered is that home birth is not only your identity, but it’s the community you identify with. If you have the wrong kind of birth, you could be shunned from social circles for being the wrong kind of Mom. It’s a very emotional subject for some people.
DrAmy: Oh, absolutely. That’s one of things that I find fascinating about it. When I tell people who are unacquainted with the web site that I write about home birth, they say, “Isn’t it easy to exhaust that topic?” But actually, the topic impinges on a lot of things. It’s not just about child birth. It’s about mothering, it’s about how mothers relate to each other and how they want to see themselves. It’s about women and their role in the world. It has implications on feminism, and a lot of what people take for granted about child birth and various parenting philosophies… they’re very surprised about where it comes from. It’s not as enlightened, often, as what they think it is.
John Paul: You were talking about the home birth community needing to verify their claims. What are the claims of the home birthing community, and where do you stand on home birth?
DrAmy: The primary claim is that home birth is as safe or safer as hospital birth, and that is flat out false. There has never been any data that showed that. They just made that up and went with it, and no one really called them to account on it because most obstetricians think they’re full of bologna and don’t even bother to address it. It doesn’t even get on the radar screen of most obstetricians, so it’s kind of shocking when someone like me comes along and says to people, “OK, you say that home birth is as safe or safer than hospital birth, show me the data”.
Then they start scrounging around and many of the studies are out of date, poorly done, or downright misleading. For example the primary study that is used to show the safety of American home birth is the Johnson and Davis study that was published in 2005. That’s the study in which they looked at all the deliveries in the year 2000 that were attended by home birth midwives, specifically certified professional midwives, which are distinct and differently trained than than certified nurse midwives (which is typically what the rest of the world thinks of when they think of midwives).
That study looked at all the home births and it compared the intervention rates for home birth in 2000 with the intervention rates of hospital birth in 2000 and found there were a lot fewer interventions in home birth. And then when it came to mortality, the authors did not compare home birth in 2000 with low-risk hospital birth in 2000; they compared it with a bunch of out of date studies extending back to 1969. And in that way, they were able to conclude that home birth was as safe as hospital birth. The interesting thing about that study was that the primary author, Kenneth Johnson, was the former director of research for the Midwives Alliance of North America, that’s the trade organization for the home birth midwives, and the study was done specifically to claim that home birth was safe. They just manipulated the data so that it would be safer than something. Unfortunately, it wasn’t safer than hospital birth in the same year, which is really what counts.
Colin: Could you tell us the difference between different types of midwives?
DrAmy: Sure. The United States is the only first-world country that has two different kind of midwives. In every other first-world country, midwives are trained through a university training program, they get a college-level degree, they have training in the hospital setting, hands-on training, and in countries where they do home birth, the midwives that do home birth are the same one’s that do hospital birth. So, they’re highly educated and highly trained.
In the United States, we have Certified Nurse Midwives, and they go to nursing school, which is a college degree, and then they do a master’s degree in midwifery. So they have even more training than midwives in other countries. But there were a group of women who decided that they wanted to be midwives, but they didn’t want to get that much training. Not only did they not want to get a masters, but they didn’t want to get a college degree either. So, they set themselves up as midwives, and they made a program for themselves, and they called themselves Direct Entry Midwives.
They weren’t getting much traction with that, and they decided to change their name, and they changed their name to Certified Professional Midwives (CPM), which is very close to and easily confused with CNM. So, most American women don’t realize that there are two different kinds of midwives: there are the fully trained midwives that are Certified Nurse Midwives, and there are CPMs who have less education or training than any midwife in any first-world country. They would not be certified anywhere else. And the fact is they made up their own certification; they certified themselves. There’s no independent body that decided on that degree. They just awarded it to themselves. They’re grossly under-educated, and they’re grossly untrained. That’s reflected in the fact that every study that’s looked at them, and all the national statistics and state statistics that have been collected about their work, shows that they have a neonatal mortality rate approximately triple that of Certified Nurse Midwives.
Colin: Are you against midwives in general, or just these Direct Entry Midwives?
DrAmy: I’m a very strong proponent of Certified Nurse Midwives. Every job I ever had, all the way back to my residence, I worked with Certified Nurse Midwives. I trained with them and backed them up. I think they are fantastic practitioners. They’re well-educated. They’re well-trained. They have excellent statistics if you look at studies done on deliveries done with Certified Nurse Midwives in hospitals. They’re great. They’re absolutely terrific!
But this other group, which are basically self-appointed midwives, are women who have a high school diploma, and they’ve set up midwifery schools. In these midwifery schools, there is very little scientific training. For example, there’s one midwifery school that I’ve written about, Birthingway, and the courses include “flower essences”, “gem energy”, “crystals”, not to mention homeopathy and all that.
So, we’re talking about two very different groups of people, and I think that Direct Entry Midwives should be abolished, which is just what they did in Canada. For a while, they had Direct Entry Midwives in Canada, and then the Canadian government decided they weren’t up to an appropriate standard. They mandated that for a midwife to work in Canada, she must have university level training.
Colin: What about home birth? Do you take a hard-lined stance against home birth? Do you recognize that a person has that choice to make an informed decision about whether to have a home birth?
DrAmy: The risk of home birth is small, but it’s real, and if you want to take that risk – OK, you’re free to take that risk. Everyone’s free to choose their medical care. The problem that I have with the American home birth movement is that they’re not honest with women. They insist that home birth is as safe or safer than hospital birth, and that’s just not the case. So, everyone deserves to make an informed decision about where she chooses to give birth, but you can’t be informed without the facts.
Colin: I’m against the idea of being afraid of the hospital. Some of these ideas that come out of the alternative birthing crowd, saying that hospitals treat birth like a sickness…
Elyse: That it’s a disease. Obstetricians are trained to see problems, and they get bored when they see problems; they see problems that aren’t there.
DrAmy: Right. Well, obstetricians are victims of their own success. This would have never happened 100 years ago, and it doesn’t happen in other countries beside first-world countries. Obstetricians have made birth so safe that people now think that it’s intrinsically safe, and it’s not. Childbirth is dangerous. It may not be a disease, but it is, and has always been, in every time, place, and culture, one of the leading causes of death for young women. And it has always been the leading cause of death for babies. In the last century, modern obstetrics, at least in the United States, has dropped the neonatal mortality rate by 90% and the maternal mortality rate by 99%.
And now, people are wondering around saying, “Oh, childbirth is not a disease. Obstetricians are all bent out of shape, worrying about complications.” Yeah, that’s what we’re worried about because complications happen a lot, and they only way to deal with them is to be prepared. It sounds good to say that child birth is not a disease, but car accidents are not a disease either and you are just as dead. That’s really the problem!
Colin: My wife had a natural birth. We went to Bradley classes. One of things she was worried about, and at the time I couldn’t answer her… what are the effects of the pitocin and epidural on the baby? Her concern about that moved her toward wanting to have a drug-free birth. So, I wanted to ask you… what are the possible effects? Are those fears valid or have they been tested?
DrAmy: There’s been an unbelievable amount of research on epidurals and pitocin going back decades. The fact of the matter is that a home birth has triple the neonatal mortality rate of a hospital birth with all the hospital accoutrements because the fact of the matter is epidurals aren’t dangerous, they don’t hurt babies. Pitocin is not dangerous. In fact, pitocin is a life-saving medication; it’s saved the lives of tens of thousands of women and babies.
It’s actually a bunch of bologna that epidurals and pitocin are dangerous. If you think about it, who knows the most about child birth? The people who know the most about child birth are people like obstetricians, pediatricians, anesthesiologists. They know a lot about epidurals and pitocin, and nowadays, many of the pediatricians and obstetricians are female, and they aren’t turning down the epidural and they’re not turning down pitocin because they know there’s nothing wrong with it.
Colin: What do you say to mothers who feel empowered by natural birth? Mothers who consider birth to be sacred and life altering?
DrAmy: One of the interesting things is that people have lost perspective on child birth. The concept of something being empowering, that it’s unusual that you would have an unmedicated child birth… the fact of the matter is that 99% of the mothers who have ever lived have had a natural child birth or died trying, and most of the women everyday around the world have had a natural child birth or died trying.
It’s actually no big deal. Anybody can do it. In fact, the big deal is being able to survive without doing it. It’s funny that people have decided that it’s some sort of achievement when it’s the default mode. If you want to avoid pain medication, fine, especially if you don’t need medication there’s no reason to have it. But, the idea that it’s an achievement is like the idea that having a root canal without Novocaine is an achievement. You want to do it, OK good, but I don’t know how it makes you better or different, or makes it a more spiritual experience to do it that way.
Colin: I think you coined a term on your blog… “Sanctimommy“, which I guess are mommies that are sanctimonious about the process of pregnancy and birth. Tell us a little bit about that.
DrAmy: I didn’t coin the term. I read it somewhere else. One of the things that is really interesting about pregnancy and child birth, all sorts of mom things, is that moms are in competition with each other. I don’t know why that it, but they can’t live and let live.
It’s really very unfortunate. It’s actually quite depressing from a feminist point-of-view that the people who should be supporting each other are undermining each other. I remember this from when my children were small. I have four children, who are now in high school and college. I couldn’t go to the playground without somebody saying, “Oh, you let him use a bottle? He’s never going to graduate from high school if you let him drink from a bottle.”
Everybody had all sorts of dire predictions, and it’s interesting from my point-of-view now because the kids are growing up, and I know the same mothers; none of that turned out to pass. Being a good mother has nothing to do with the signal events that are supposedly so important, and it has everything to do with the bond that you form with your child, and being there day in and day out through all the flu and homework and problem with friends, so many harder and complicated things. It’s very unfortunate that some women insist on reducing motherhood to these specific moments, and judging other women based on whether or not they made the pre-approved choices.
John Paul: I wanted to get back to the science just briefly. There was a recent study that was done that was a meta-study…
DrAmy: The “Wax Study“? It was just published? It hasn’t actually been published yet. It’s supposed to be in the September issue, I think, of the American Journal of OBGYN…
Elyse: What is the study?
DrAmy: It’s by Wax and others, and it’s a meta-analysis of international studies. They looked at a number of different studies that compared home birth, and they had a hospital birth group in the same year of comparable risk. In that group of studies, there were two, a study out of Canada and a study out of the Netherlands, that showed that home birth had the same neonatal or perinatal death rate as hospital births, but all the others showed that home birth had a higher neonatal or perinatal death rate. When they added them all up, home birth came out showing that it had triple the neonatal mortality as hospital birth.
I wanted to love the Wax study because it says what I have said for years, but it’s actually not a perfect study. I can’t say that the criticisms that home birth advocates have been leveling against it aren’t true, because some of them are true. However, I think that from the point-of-view of American women thinking about home birth, there’s some important things to keep in mind. The only places where home birth have ever been shown to be comparable to hospital birth are in Canada and the Netherlands. Both countries are very different than the United States in that the home births are done by very highly trained midwives. The eligibility requirements are very strict. It’s not like the United States where you say, “I’ve decided to have home birth, and now I’m going to have a home birth.” There, you have to qualify or else the midwife isn’t coming to you. They transfer at a very high rate. They have, in the Netherlands particularly, they have a transport system that was designed and dedicated to OB transport. And, it’s a very small country, where nobody’s that far from a hospital.
In contrast to the American idea of trusting births, the Canadian and Dutch midwives don’t trust birth at all: they exclude everybody who could possibly be having a complication, and anybody who seems to have a complication, they transfer them. That’s how they do so well. In contrast, every study done on American midwives, and the data that the United States government has been collecting since 2003 shows that they have a much higher rate of neonatal mortality than hospital birth for comparable risk women. There’s zero evidence, none, zip, zero, nada, nothing that shows home birth in the United States as safe as hospital birth. Everything shows it to have triple the neonatal mortality rate.
To be continued in Part 2…