Tuesday, December 8, 2009

Open Letter to "Dr" Amy Tuteur

I must admit, I do follow your blog, because I find it comical and slightly amusing, but one question has really been plaguing me for a while now, and as I am sure you chronically google your own name on a daily basis I am sure you will eventually stumble upon this.

Your primary subject to post about is home birth and midwives, when there are so many more important issues taking place in the obstetric community, and the maternity care system in The United States today. As someone who previously practiced medicine in this system, I would assume you would have seen the serious flaws that we are facing in the hospital birth system which makes up for over 90% of the births that take place in our country.
First, the cesarean section numbers. The amount of women and babies that are being subjected to unnecessary cesarean sections, early cesarean sections, complications from cesarean sections in post partum periods, as well as in future pregnancies. Why not discuss all of this?
Or what about the premature birth rates which are being increased by not only cesarean sections before 40 weeks gestation, but the amount of labor inductions taking place also. Whether for medical or non medical reasons. Shouldn't there be stricter guidelines in these practices to help ensure lower premature babies, or lower neo natal death rates since our country is ranking horribly in that?

What about the amount of women who are dying through this current maternity care system. Not just the women who die from home birth, or unassisted births but the women who are dying in our hospitals, sometimes victim to the number of interventions women are being put through in the current drive-thru type birthing system we are currently seeing?

Why not address the real issues that are killing mothers and babies at higher rates than the hand full of home birth horrors? Is it a personal vendetta or is your only concern to try and slander home birth as much as possible since you can't practice medicine anymore anyways?

I am sure you will either call me out to a debate or simply ignore everything I have said, but I only hope I can plant a seed as to what the real problem in our country is.

Signed,
2 Time Cesarean Section Mother & Advocate

20 comments:

Wendy Martijn said...

BRAVO!

Amy Tuteur, MD said...

"there are so many more important issues taking place in the obstetric community"

You don't consider the preventable deaths of homebirth babies to be important?

I realize that you'd rather that no one focused on the fact that homebirth increases the neonatal death rate, but don't you think you are being a bit transparent in practically begging me to look the other way.

Here’s an interesting new data point:

According to their own newsletter, the licensed homebirth midwives of Colorado have a truly horrifying perinatal death rate of 8/1000! Karen Robinson, CPM, the President of the Colorado Midwifery Association, writes:

“In looking back over the past couple years of statistics, I see that there were 5 perinatal deaths reported each year for 2006 and 2007. This represents a perinatal death rate of 8 per 1000 for those two years, and that is too high for the low-risk population we serve. The state perinatal mortality rate for all births from 2003 to 2007 was 6.4 per 1000.”

In other words, the perinatal death rate of LICENSED homebirth midwives in Colorado, caring for low risk patients, exceeded the perinatal death rate of 6.4/1000 for the entire state (all races, all gestational ages, all birth weights, 2003-2007)! Homebirth was the most dangerous form of planned birth by far.

Ms. Robinson continues:

“I don’t believe we have a poor perinatal mortality rate, but if solid data shows we do, then I will be at the forefront of the effort to improve our practices and lower the perinatal mortality rate for homebirth in Colorado.”

If she’s going to be at the forefront, then she had better get out there. The just published statistics for the year 2008 are even worse. Last year, licensed Colorado midwives had a perinatal mortality rate at homebirth of 8.6/1000 (7 deaths among 806 patients). These numbers are nothing short of horrifying.

I also find it interesting that Ms. Robinson doesn’t “believe” the data. That is the typical response of many homebirth advocates.

Curiously, these statistics are not mentioned on the website of the Colorado Midwifery Association. The state is aware that perinatal data rate for homebirth is extraordinarily high. The midwives themselves are aware that the perinatal mortality rate for homebirth is extraordinarily high. The only people who haven’t been informed, it seems, are the patients.

How can a woman in Colorado make an informed decision about homebirth with a licensed midwife if she has no idea that the homebirth death rate exceeds not only that for low risk births, but exceeds the rate that includes high risk births as well?

Cesarean Epidemic said...

I read that already today, and if I had a comment for it, I would have replied on your blog where you wrote about it. But I can't say I am surprised that you completely ignored every valid point I brought up.

Thanks for proving my point!

Amy Tuteur, MD said...

I wasn't aware that you had brought up any valid points.

Cesarean Epidemic said...

Your sarcasm only makes you look like you have nothing intelligent to say. I brought up several valid points, all regarding births that are taking place day in and day out in hospitals, such as the growing cesarean section rates, but like your typical diversion type attitude, you tried to make it about home birth again.

None of my questions were about or regarding home birth in any way shape or form.

Andrea said...

I want to see any OB's website or information page that has their C-section rate, non-medical induction rate and all mortality rates! You can't find it!
You can't even call an office and get that information! you get put on hold until you give up...at least with the midwives they had it available somewhere and said they needed to address the issue. How many OBs are publishing writing that says they need to address the sky high c-section rates? NONE

Louise said...

Dr. Amy appears to be making a mountain out of a statistical molehill. If there had been 1 fewer perinatal death in only 1 of the two years mentioned, then the homebirth stats would have been statistically identical to the overall stats for Colorado. If there had been one fewer death in each of those years then the homebirth perinatal death rate would be lower than the overall perinatal death rate. Anyone who works with statistics will know that 5 is too few perinatal death cases to make a solid case for a difference in rates. On the other hand, there are enough c-section cases, including unnecessary and premature cases, to discern the statistical patterns in the original blog post - which Dr. Amy doesn't bother to address.

Cesarean Epidemic said...

Louise, Dr. Amy will not address anything that pertains to Hospital Births. She only will address home births and this is the whole point of why I wrote this letter to begin with.

Brooke said...

Very good point Louise!

Anne said...

It really would be a refreshing change of pace to see what she would do to address the practices that drive women away from the hospital in the first place.

Jodi said...

Also, I have it on good authority from a homebirthing mom in Colorado that there is a large community of home birthing Christian Scientists who will not accept medical intervention should an emergency arise. What precentage of the 8 deaths were because of religious convictions?

BirthSense said...

Dr. Amy, not being privy to the Colorado midwives newsletter, I am wondering if they gave any description of the perinatal deaths?
For example, would a fetal demise discovered at onset of labor be counted in this number? A baby with lethal anomalies? I would like more information about these deaths.

Anonymous said...

Well I guess we can add this to the growing stack of "watch Dr. Amy squirm, beat down strawmen, selectively answer questions and throw stink bombs to avoid the real discussion" evidence.

Ok srsly, I'm bored already, it's not fun watching someone prove their own stereotype. Let's go find someone with new and fun tricks to try and twist the debate.

Anne said...

Very, very interesting, Jodi.

Amy Tuteur, MD said...

"not being privy to the Colorado midwives newsletter, I am wondering if they gave any description of the perinatal deaths?"

Perinatal death usually means deaths from 28 weeks of pregnancy to 28 days of life. You can find the midwifery newsletter as well as links to the midwifery statistics collected by the state here:

The horrifying death toll of homebirth in Colorado

Cesarean Epidemic said...

And what about the cesarean section rate in the United States?
What about the elective induction rates?
What about the United States Maternal Mortality rates and neonatal death rates?
I mean, because they are incredibly high, yet the vast majority, over 97% of births in our country take place INSIDE hospitals.

How do you make excuses for that?

Suzanne said...

I am less familiar with Colorado statistics so can't comment on that, but when my homebirth midwives (in Virginia) were discussing worst-case scenarios, I asked them how common it was to lose a mom or a baby. They told me that in 25 years of midwifery, they had never lost a mom or a baby, and had never even had to transfer a mother to the hospital mid-labor for life-threatening causes (95% of their transfers were because the mom wanted an epidural). So I guess picking one state where there were 8 deaths and making claims about the safety nation-wide of homebirths seems either ignorant or self-serving.

Kate said...

What a childish little woman you are, Dr. Amy. To ignore very valid points raised in response to your own, just because you can. It speaks volumes to your cowardly and juvenile persona. Continue hiding behind your computer screen and keyboard. No woman (or person) in her right mind would give credence to anything you have to say in your one-sided commentary. Obviously, it can't be called a discussion, as that would be a back-and-forth conversation between adults, which you're clearly incapable of.

Having just witnessed a birth this past weekend, it is CLEAR to me that anyone claiming hospital birth is safer than home birth (for normal, healthy pregnancies) is uneducated and ignorant. I watched a completely healthy, normal, pregnant woman go from laboring on her own to being bullied into pitocin, because she wasn't progressing as quickly as the doctor would have liked. This was after THREE hours of natural labor. Count them--one, two three. Ridiculous. The pitocin/intensity it caused then lead to an epidural. The epidural to bed restriction. Bed restriction to slowed labor. Slowed labor to, "Well, lady, it looks like you can't have this baby on your own, so now it's time for a cesarean!" Keep in mind, this ALL took place in less than 12 hours. As if something is wrong with a woman who can't give birth in less than that time? Please. Anyway, the cesarean and pain meds that followed lead to less-than-successful breast feeding. Not to mention the fluid in the baby's lungs that's presenting problems (which could have been avoided had she been allowed to be born through the vaginal canal). And the cascade continues...

When I look back at that, besides being outraged, I count at least 6 things that could have been avoided had she given birth at home (and those are the BIG things, as I left out all the little things). Been allowed to labor in her own time and efficiently, by moving about, squatting, walking, eating, drinking, swaying, dancing, soaking in the tub, rocking back and forth on all fours... I could go on.

But, of course, Dr. Amy would have people believe that the hospital is the SAFEST place to have a baby. When, in actuality, it's people like her who like to control normal, healthy pregnancies and births, deeming it an illness to be cured and treating mothers as if their bodies are unfit, that interfere and cause infant and maternal mortality through their unnecessary interventions.

/rant

::gets off soapbox::

Marty Wallace said...

Yeah, Kate!!!!

Marty Wallace said...

Yay, Kate!!!!!