Ask Dr. Amy

Here are questions that have come to my mind that I would like Dr. Amy, or anyone else who knows the answer to them, to answer. Most of them I’ve previously asked, but I’ve either gotten no answer, or have not gotten a satisfactory answer. Some of them I may be asking for the first time.

1. Since a “debate” is supposedly honest and fair, isn’t it unfair to have you being the “moderator” of the Homebirth Debate blog/website? Isn’t that rather like Michael Savage or Michael Moore running a political debate? or like Adolph Hitler, Joseph Stalin or Mao Tse-tung running a religious debate?

2. Since a “debate” is supposedly honest and fair, isn’t it dishonest of you to delete comments with which you disagree?

3. Why do you delete so many comments? I’ve personally had so many of my comments deleted that I made a habit of saving my posts, so I could quickly re-post them. And I’ve heard from many others who likewise have had their comments deleted once posted. About how many comments per day do you delete, anyway? Why? — Is it because you can’t answer them?

4. Why do you require home-birth advocates to back up everything they say, when you and your minions rarely do? In fact, I’ve almost never seen you quote any study or link to any study which indicates what you say — you basically say, “Believe me, I’m a doctor,” whereas when we make similar claims, you say we have to cite sources before you believe us. Isn’t that an untenable double standard?

5. When home-birth advocates do back up what they say, with studies published in notable journals such as ACOG’s Green Journal, why do you then say that we don’t have the right to quote such studies, and demean our understanding of plain, written English?

6. Why do you take so many things out of context? For instance, back in December or early January, which was about the last time I took you up on your blog, I had just started this blog, and you checked it out, pulled a fragment of a sentence about breech birth out of what I had written, and mocked me on your blog, though what I had said was backed up by recent research: what you left out was “in the absence of these factors” but kept in “breech birth is safe.”

7. When I posted a few breech birth studies from the 80s on your blog, you said that was too old, and that many larger and more current studies showed the reverse. What are they? I’ve found many studies, from the year 2000 and onward, that demonstrate that automatic C-section is not evidenced-based. Where are the studies you mentioned?

8. Is the current 30% C-section rate outrageous or not? You said it was in a comment on another blog a couple of years ago — do you still hold to that opinion? Why or why not?

9. Should women be allowed to try to give birth vaginally after a previous Cesarean? Why or why not?

10. If yes, then why do you not start a blog on “VBAC debate”, like you have on homebirth? — afraid too many MDs and OBs will get on, and you can’t shut them up by saying, “I’ve got a medical degree and you don’t, so you have to believe everything I say”?

11. Is there anything that ACOG has said that you disagree with?

12. Are the following low-risk or high-risk: breech vaginal births, post-term births, and twins?

13. Why do you insist on saying that the mortality rate reported in the Johnson & Daviss study is neonatal, when it is a combined neonatal and intrapartum?

14. Are intrapartum deaths reported in government statistics? If so, where?

15. Are not intrapartum deaths a subset of stillbirths, in that the baby died during labor was born dead?

16. What is the intrapartum death rate for the year 2000? Or any year? I require facts, not surmises.

17. When a lethal fetal anomaly is discovered during pregnancy, what percentage of mothers have an abortion and/or preterm induction? (many people report a 95% termination rate for cases such as Down Syndrome and other fetal anomalies, which would significantly alter the rate of lethal anomalies in babies born at or after 37 weeks)

18. Is it not true that there are significant difficulties in reconciling prospective and retrospective studies, such as the BMJ study and the government vital statistics report?

19. Is it not true that one of the deaths in the J&D study was to a non-white woman, so it (and all other non-white births) must be excluded when attempting to compare it to neonatal death rate among white women in the National Vital Statistics Report?

20. Is the intrapartum mortality rate or the neonatal mortality rate presented in the prospective J&D study statistically significant, when compared to the retrospective NVSR? (please provide your reasoning and calculations)

21. Are the numbers from the CDC 2003-2004 statistically significant, or should other calculations be used to determine statistical significance?

22. In this post of mine, I showed that, according to the CDC 2003-2004 statistics, women who gave birth at home had 3.5 times the rate of babies with 4 lethal birth defects at 37+ weeks, compared to women who had a CNM in the hospital: 0.21/1000 vs. 0.06/1000. You said that could “easily be due to chance,” in a comment. Does that not mean that there are calculations and other things that must be done to determine if the overall death rate is also not “easily due to chance”?

23. Considering that the home-birth set had over 3x the number of babies with 4 selected lethal birth defects, why don’t you ever mention that when you launch into your diatribes against home-birth, but instead act as if it is statistically significant, never delving into the causes of death?

24. In the CDC stats, there are some 20 neonatal deaths attributed to factors with codes beginning with Q. Is it not a fact that sometimes babies die of these conditions even when born in the hospital? — that some of these conditions may be so severe that no amount of medical care can save severely affected babies?

25. Is it not necessary to know the severity of these cases, in order to determine whether these Q-coded deaths could have been prevented by immediate medical care, in order to say that the deaths of these babies was “preventable”?

26. There are several inaccuracies or at least questionable entries in the CDC stats — “other midwife” being the birth attendant at a hospital; CNMs performing C-sections, etc. — what happened? Several thousand typos? Shouldn’t the inaccuracies be questioned and verified before being quoted as being statistically significant? Isn’t it possible that some of the deaths were coded wrong? If so, that wouldn’t change the hospital statistics too much, since there are about 8 million births over the course of the two years; but there are only about 40,000 home-births in that same time, so one death in the home-birth group would make a bigger change than it would in the hospital-birth group.

27. While most births will occur before the end of 42 weeks, even without medical intervention, some women do not naturally go into labor at this time. Since the CDC stats group all births that occur from the start of week 42 until… whenever — it’s not listed — could be 50 weeks as far as we know — all in one category, isn’t it possible that there were some babies who had moved into the high-risk category for being post-dates, post-term, and/or post-mature, and probably should have “risked out” of home birth, yet were born at home? Wouldn’t that skew the results for babies born just in the term period?

28. In ACOG’s statement on the Supreme Court’s decision to uphold the Partial-Birth Abortion ban, Douglas W. Laube, MD, MEd, ACOG president, is quoted as saying: “It leaves no doubt that women’s health in America is perceived as being of little consequence…. We have seen a steady erosion of women’s reproductive rights in this country. The Supreme Court’s action today, though stunning, in many ways isn’t surprising given the current culture in which scientific knowledge frequently takes a back seat to subjective opinion.” Why is it that ACOG is so concerned about a woman’s right to legally end the life of the child she carries in her womb, but stands against her right to legally give birth to that child in the manner of her choosing?

29. ACOG has placed “‘Lay’ Midwives and Home Birth” in the second spot of its State Legislative Issues 2008 — why? You say it’s because of “safety” concerns. I think that’s a load of bull, and I’ll tell you why: the numbers just don’t add up. Even if your grossly inaccurate figures about the “excess rate of preventable mortality” were correct, which they’re not, at most, outlawing home birth completely would potentially save 80 babies’ lives per year. Maternal smoking and unmarried mothers are each associated with approximately 4/1000 greater neonatal mortality, and affect 400,000+ and 1.3 million+ babies, respectively, per year, or over 7500 dead babies that would have lived had their mothers not smoked or been married (I know these categories are not mutually exclusive, so there is undoubtedly some overlap).

30. I assume you’re a member of ACOG — could you tell them that on the page I just linked to, that they need a spell-check and/or an editor? I’d point out the error to you, but it’s pretty obvious.

31. You’ve complained about “defensive medicine” and the high C-section rate being due to OBs unwilling to take chances with letting labor continue normally; but the current laws make that reality. In a post you had a couple of months ago about C-section rates, in the ensuing discussion, the topic turned to this topic. Susanne complained that midwives just complained about the high C-section rate while making no efforts at altering legislation, and sneered at them for not helping. I don’t mean to sound sarcastic, but does ACOG really need the help of midwifery organizations such as NARM and MANA?

32. Has any midwifery organization tried to block legislation that is designed to make the malpractice system more fair or generous to doctors?

33. Doesn’t ACOG have something like 50,000 members who are all doctors and therefore probably earn at least six figures every year? Do they need the help of midwives, who are a fraction of the number, and make a fraction of the income, in order to pass this legislation?

34. If midwifery organizations hop on board with the medical liability reform, and throw their huge financial resources (one source said that a Wisconsin midwifery organization had a grand total of $3,000 for its lobbying budget, when the bill finally passed, but I guess every penny counts!) into the ring, would ACOG support home-birth midwives with their legislation, or at least not try to block it? After all, if midwifery organizations didn’t have to fight for survival, they would have more resources to help their brother obstetricians.

35. Why is it that promoting laws banning CPMs and home-birth is #2 on ACOG’s legislative agenda, when it affects so few people, while defensive medicine — particularly the outrageous C-section rate and the medically inappropriate forced repeat C-section instead of allowing VBACs — is way down at #5, under “medical liability reform”?

36. Previously, you’ve said that a 30% C-section rate is at least twice what it ought to be. How did you arrive at that conclusion? Do you still hold to that conclusion? Why or why not?


3 Responses

  1. You rock, Kathy! 🙂

  2. […] 1, 2008 by Kathy Several weeks ago, somebody on Dr. Amy’s blog derogatorily linked to my Ask Dr. Amy post, so I checked out the thread and left a comment. Naturally, in her short comment about it, Dr. […]

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