Reply turned post, Academic thoughts on VBAC style

One of my favorite new blogs, Academic OB/GYN, has an interesting post up called Ten Thoughts on VBAC. I encourage you to read the entire post and comment thread. I was especially interested in #7 and #10, which said:

The single most important thing we can do to deal with VBAC issues is to not have them at all, by avoiding the first cesarean section. Many cesareans are absolutely necessary, but when possible we should achieve vaginal deliveries. I’m willing to push some grey cases that others might deliver by cesarean. Sometimes that means being more patients with a slow labor. Sometimes that means operative vaginal delivery. Because of that, more of my patients will have easy multiparous second labors rather than having to worry about VBAC issues. There is a receiver operator curve for cesarean necessity. Most OBs should push their needle a little towards “specificity”.

Here is my reply:

Thanks for a thoughtful post on a controversial issue.

When I selected an article on VBAC for our medical school ob/gyn interest group journal club, our faculty sponsor said we shouldn’t even waste our time, since no one is doing them any more. That is certainly true for our area, where most practices and hospitals refuse to allow trial of labor attempts for VBACs. We are hardly rural. I know of an ophthalmologist who had to hire a concierge obstetrician and pay $10,000 up front to get any obsterician to attend her VBAC. She had one prior successful spontaneous vaginal delivery and a cesarean for twins. Practice patterns are obviously not the same everywhere, especially when it comes to obstetrics. She had her cesarean in another part of the country, and was assured by her obstetrician that she would be a fine candidate for a future VBAC attempt. If she hadn’t moved, it probably wouldn’t have been an issue.

I have another local friend whose physician refused to attend a VBAC attempt she requested (her prior pregnancy ended in preeclampsia, a failed induction and a cesarean at full term). When she showed up a few days before her scheduled cesarean in spontaneous labor, they sectioned her anyway, even though an article in that month’s Green Journal found that emergent cesarean after onset of labor to be the most expensive choice in their study of VBAC with the worst maternal and fetal morbidity. Why not let her attempt the trial of labor, especially since she expressly asked to be able to do so, and prominent medical opinion found it to be not only a reasonable choice, but an easily defensible one?

And, the area primary cesarean rate, which is above 45% in most hospitals, means that less of our primips are “successful” at an attempted vaginal delivery (I put “success” in quotes because I think a safe delivery, even if by cesarean section, is still “successful”) than even the conservative estimates you quote as “success” rates for VBAC attempts in the original post in point #7. (I have usually read of a “success” rate of about 75% in several articles, but outcomes vary.)

But, ACOG’s Practice Bulletin on VBAC says women who are good candidates should be offered a trial of labor. And, practice patterns vary in different parts of the country, and many physicians and hospitals still offer VBACs, and the current literature seems to consider it to be a reasonable option and continues to publish articles on VBAC. But, when I did a history on a woman switching care to a midwife in her third trimester, she said her doctor told her he’d refer her to a psychiatrist before he’d let her attempt a VBAC. So, there’s obviously a wide range in opinions on how to interpret the risks.

This article on explaining obstetrical risk by Lyerly et al is one of my favorite articles I have read on the topic. It states that “Although rates of delivery-related perinatal death are indistinguishable between VBAC and primary vaginal delivery, there is a genuine differential in the rate of uterine rupture–related hypoxicischemic encephalopathy. Such perinatal morbidity is indeed devastating. It is also extremely rare. In a recent large prospective study, the probability of this outcome was 0.00046 in infants whose mothers underwent a VBAC trial at term compared with no cases in infants whose mothers underwent repeat cesarean delivery.” (Emphasis mine)

I think that indicated that there is some validity to the argument that anywhere that it is safe to allow a premip to labor and deliver, it should be safe to allow a good candidate to attempt a VBAC. However, some may disagree about where it is safe to deliver at all. Some may find the risk of a home birth not only acceptable but preferable to a medicalized birth experience. Others may only be comfortable with a delivery at a facility with on site 24 hour anesthesia and obstetricians, and a Level IIIC NICU.

I don’t want to paint all obstetricians with one brush, but neither do I want to disregard the possibility that out of hospital births can be safe. Well managed out of hospital births may have risks similar to real obstetrical care in many hospitals, which unfortunately is not always evidence based care optimizing good outcomes. But, women are not always given an unbiased view of true risk, whether it be the risks of a HBAC or the risks of an induced, augmented VBAC attempt or the risks of repeat cesareans. The Lyerly article concludes that “[T]hese tendencies in the perception, communication, and management of risk can lead to care that is neither evidence-based nor patient-centered, often to the detriment of both women and infants” when discussing the way obstetricians present these risks. I think the natural birth community can probably be equally possible of have members on the fringes who would de-emphasize the risks of a home birth VBAC or an unassisted VBAC.

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47 Comments

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47 responses to “Reply turned post, Academic thoughts on VBAC style

  1. I just want you to know that my hospital does VBACs and if the Doctor is not comfortable with the VBAC they will still do it if the patient request because if they deny, they will get in huge trouble with the hospital. We do VBACs so we do them for anyone who is a candidate and wants a VBAC. I have noticed that many women come into the hospital in good active labor and would be great candidates but do not want to VBAC. I used to tell them, “Hey why not try? At any point you can change your mind. If the baby comes out easy it is bonuses all around. If you end up with a c-section, you still have not lost anything but a few hours. Then I explain how some labor is good for babies lungs and the studies that have found that out. Wouldn’t it be funny if our Docs started saying, “I am sorry, we are a VBAC hospital, we cannot do your repeat elective c-section.” Of course they would never do that because it is totally unfair to folks who do want a ERCS.

    I do worry about the homebirth VBACS. It is distressing to think women have to resort to that. The whole health care delivery system needs an overhaul. First I think we should have a ceremony and set fire to the Jacho scholars….But that is just me.

    • MomTFH

      As long as there are not significant barriers to her VBAC attempt, I am comfortable with doctors opting out of certain procedures they are uncomfortable with. However, the wave of refusing VBAC attempts is a significant problem for many women in various geographic regions.

      I wonder about the way risk is being presented to women when so many physicians are refusing to allow VBAC attempts. When even one doctor refuses, in that individual interaction the woman is giving a strong and somewhat questionable message. When the risk is so small, why are so many physicians refusing to allow them?

      • Just ran across your blog and wanted to say thank you. Your questions are good ones. The fact is that the risk for a VBAC in the worst case scenario is less than 3 percent. In the setting of spontaneous labor it is considerably less and in a monitored hospital bed the likelihood for a “catastrophic” outcome is vanishingly small. Not zero, but very very low.

        This of course begs the question of how patients are being counseled. I cannot speak for other OBGYNs but I have been (frankly) horrified by the answers of some OBGYN residents and medical students when I ask what the risk for uterine rupture is with VBAC. Many times their answer is off by a factor of 10 or 20. And psychologically, these are people who (when they begin practice) will likely not offer VBAC. Which is sad, since we all know the increased risk for complications with CS and since up to 80% of women with one CS can attempt a VBAC.

        Many physicians are clearly not offering VBAC due to financial rather than medical or legal considerations. It’s a trend that we all need to try and reverse for obvious reasons.

  2. FInally, a physician (well, two of you!) saying what I have been screaming for years now: If you don’t want to do VBACs, STOP DOING SO MANY G-DAMN C-SECTIONS!

    Of course, this will require a massive overhaul of the system since I think many C-sections are simply a result of poor labor management. I know mine was. Some of us just don’t have bodies that babies fall right out of, and hobbling us with EFM, epidurals, Pit, in bed on our backs, and forced pushing, is not what our bodies need to get those babies out. Many Cesareans happen because the hospital system tries to squeeze everyone through a one-size-fits-all routine. And if you don’t make it, it’s off to the OR with you.

    I’ll take the risks of an HBAC over a RCS any day of the week. I knew I wouldn’t get my VBAC in a hospital. Even if they’d “let” me do whatever, I would have shut down just by walking in there. Not an environment conducive to relaxing and opening up and getting “in the zone.” My home midwives actually knew me, knew my body, and knew what to do to help my baby be born. I was not just a vagina without a face to them. They did so many things, throughout pregnancy and labor and after the birth, that the midwives at the hospital never even thought of, knew about, or mentioned to me at all, all to ensure that I had the best possible chance at a VBAC. I had concurrent care with the hospital midwives as well, to cover all my bases for insurance purposes, and it was depressingly stark how it just seemed like they DID NOT CARE about me. They went home to dinner and forgot I existed, not knowing my name unless they read it off a chart. My home midwives and I are good friends to this day. That is the central flaw of a mass-output system. There is no time for individualization of labor management, and women like me desperately need more personalized care.

  3. tj

    Despite the fact that my OB for my first birth was an ass and my labor was 26 1/2 hrs long, I’m glad he didn’t rush me off for a section. It probably would have interfered with his schedule as he told my nurse that 2pm was too late in the day to start pitocin.

    My friend had an induction start at 8am. At 3pm, her doctor called her for failure to progress and took her back for a section. I couldn’t believe that.

    • MomTFH

      Yes, as Amy Romano has said on Science and Sensibility, and I have written about recently, the decision making from the beginning of an induction to the end can be really problematic.

  4. Pingback: Weekly News Round-Up, 12/20 « Women’s Health News

  5. Thanks for the link and your comments! We need to reduce primary cesareans when we can, and also provide VBAC support whenever it is possible. There are a lot of reasons that some doctors are not comfortable with VBAC, and the biggest is the threat of litigation due to a unexpected bad outcome. Tort reform, perhaps even specifically directed at VBAC, is needed as part of a resolution to this issue.

  6. Chiming in just to say thanks for another great post. I haven’t had nearly the time I’ve wanted lately for comments on blogs (much less attention given to my own blog), but I really love all your reply-turned-posts, and this one in particular. I’ve been thinking a lot about how risk is perceived (am neck-deep in writing about why women choose home births and how they perceive safety for OB Myths, which explains my relative lack of blogging). I’m finding the aspect of perceived risks to be about the most fascinating thing I’ve written about. There’s much more in that body of literature about how we can improve maternity care overall than anywhere else I’ve looked.

    Thanks so much for bringing to light that Lyerly article. It really is the article that keeps on giving, isn’t it?!

    Anyway, great post! Keep em coming!

    • Just wanted to chime in and echo your comments regarding how risk is communicated and how it is received. What I’ve found is that there are multiple different ways to communicate risk and (perhaps just as many ways) to receive such information. It’s a two way street and problems can occur when the recipient and communicator are not on the same wavelength.

      I certainly see this when counseling patients regarding all types of screening tests.

      I’ll be interested to read your thoughts on risk perception.

      • MomTFH

        I have thoughts! I wrote a little bit about it here, but that is just the tip of the iceberg. Prenatal screening can be really problematic. High false positives in some screening tests can be emotionally devastating to a patient, especially if the physician and staff communicate risk poorly.

        I know of a couple who called off their baby shower and told everyone they were getting a 20 wk termination over a “positive” quad screen – a high AFP level. And this was AFTER I personally warned them about the poor specificity of the test. Then, this couple who had told me they weren’t going to get amnio (prior to the quad screen) got an amnio, and of course, the amnio results were within normal range.

        I have heard of a woman passing out at work and hitting her head on the desk because someone from her OB office called and told her her fetus has tested positive for Down’s syndrome. Not only was this incorrect, it was, again, just a quad screen result, not a diagnostic result, but they hadn’t even told the patient what the test was screening for until they called with the results. Every subsequent pregnancy she got the same low AFP, and then a “normal” amnio. Every pregnancy she got the amnio anyway.

        Same thing with gestational diabetes screening. UpToDate is currently full of information about how unreproducible the results are for the initial challenge test screening and the GTT, and how there aren’t universally adopted thresholds. But, how many women have been bumped up to “high risk” by a GTT test, and then possibly even sectioned due to possible fetal macrosomia? I don’t even want a baby getting unnecessary heel sticks after every feeding, which is protocol in some places if the mother had GD. Especially if it subtly tells a new mother that her child will be hurt every time she attempts breastfeeding. It’s not worth it if it’s due to an imprecise diagnosis. I have another set of friends, the husband is a medical student, and the mother has a PhD in psychology. She got a positive challenge test screen, and had a “freak out” (their words, not mine).

        These are anecdotal studies, but I have read research about the anxiety these screening tests cause women.

  7. MomTFH:

    If you’re so sure of your position, let’s have a debate. Let’s set out all the evidence on both sides and let women decide for themselves. You do want women to have ALL the information, right? Are you are very confident in your position, right? And you are absolutely sure that you’ve mastered both the medical and legal literature on the topic, right?

    So when shall we start our debate? We can host is jointly on both sites. That way everyone can be sure that nothing is deleted or excerpted incorrectly.

    I’m ready. How about you?

    Amy Tuteur

    • MomTFH

      Dr. Amy, I think we have already debated several times recently. I have no interest in reading posts on your site or organizing an official debate between us.

      If I thought we simply had different points of view, that would be one thing. I actually have a history in competitive debate. I find it incredibly aggravating to have my specific relevant points ignored, while you make new new straw women arguments or other logical fallacies and thrown them out to see what sticks. In a real debate, there would be a judge or judges that would keep track of the individual arguments. Unanswered arguments are considered to be wins for the person who brought them up, they don’t just go away when they’re ignored. Assertions have to be supported by evidence. Judges know when you mischaracterize your opponent’s arguments. (“You say anything that happens in nature is good, so a three day protracted labor in the jungle that ends in a fetal demise and a fistula must be “normal” and good in your eyes!”) New arguments with no link to original points cannot be introduced at the end. Debaters were penalized for personal attacks (like calling DoctorJen “grandiose”) and references could be read by the judges to ensure proper quoting.

      I am not amused by a moving target, and don’t think arguing with you is an exercise in getting closer to the truth about good maternity care. I think it is an exercise in frustration that involves me ducking poo being thrown at me.

      What would even be the premise we would be debating? Here is my point of view: the perinatal period should involve women centered, evidence based care that balances her autonomy and individual health concerns. Are you willing to take up the opposite position?

      • In other words, you’re prepared to criticize me in a forum where everyone will agree with you (your site), but you don’t dare appear in a forum where your claims would be publicized and analyzed by people who are not guaranteed to be friendly (my site).

        I’m not surprised.

        • MomTFH

          No, all of our prior debates have occurred on third party sites. So, I have dared to appear in several fora head to head with you recently in which my claims can be publicized and analyzed by people who are not guaranteed to be friendly.

          In fact, here are five recent examples:
          1, 2, 3, 4, and the current post you are replying to.

          I would love for people to compare our debating skills on those posts. Repost them on your blog.

          Instantly mischaracterizing me will not convince me that this would be a civil debate.

          First of all, you would have to agree not to do what you just did. Past behavior is most indicative of future behavior, so I am not hopeful on that front. Take a step back, Dr. Amy. You just called me yellow. Please.

          Secondly, I would only agree to debate with a moderator.

          Thirdly, I would only agree to debate the position I already put forward: the perinatal period should involve women centered, evidence based care that balances her autonomy and individual health concerns.

          Are you willing to take up the opposite position?

          • “all of our prior debates have occurred on third party sites”

            They have occurred on “natural” childbirth sites, not on medical sites.

            “I would only agree to debate the position I already put forward: the perinatal period should involve women centered, evidence based care that balances her autonomy and individual health concerns.”

            That’s like being challenged to debate the merits of the war in Afghanistan and responding that you are only willing to debate “peace is better than war”? No one would disagree on the over-arching theme, but many people would disagree on the details. In other words it is a meaningless debate.

            Frankly, I think that obstetricians already provide woman centered, evidence based care that balances autonomy and individual health concerns. Unfortunately, “natural” childbirth advocates have no idea what the evidence shows and therefore mistakenly believe that obstetrics isn’t evidence based.

            I’m interested in the evidence: the risks of VBAC, the safety of homebirth, etc. Are you willing to debate the evidence?

  8. MomTFH

    Dr. Amy, that is not what you said. And, Dr. Fogelson would probably not take too kindly to his site, Academic Ob/Gyn, being labeled “not a medical site”.

    I have no interest in debating a moving target who continues to insult me. Are you saying I am a “natural” advocate who has no idea what the evidence shows and is mistaken about the current state of obstetrics? I think I have shown that I am quite familiar with the evidence, and was at a birth this week. When was the last time you attended a birth?

    If you can’t even invite me without being disingenuous, I have no interest in furthering this conversation.

    • MomTFH

      Speaking of the post and comment thread at Dr. Fogelson’s site, it seems to me that you just agreed with him on there today that the tiny risk of fetal death for a VBAC was an acceptable risk. So, I think we agree on that. It also seems to me that he gently corrected you in the way you present these risks as isolated and independent of the proven risks of the intervention, a repeat cesarean section. He didn’t seem to have the same corrections to the long comment I posted.

      As for the safety of homebirth, we all know you don’t accept the outcomes of any published study on homebirth. So, there is no use in debating the ample evidence of its safety, since you don’t accept the validity of any of it.

      Debate over.

    • Hmm? My site is intended to be medical in nature, but lots of midwives and doulas keep coming there for dialog, so I’m game. I don’t agree with it all, but dialog is always good.

      • If you all want to debate with a moderator, I’d be happy to record a podcast between both of you and moderate under particular rules. I wouldn’t say a thing. I’m sure it would get lots of hits!

      • No comments were deleted or edited on my site, so I’m not sure why the type of blog would matter. All exchanges between Amy and MomTFH are remain as they were originally submitted. It’s an open forum and all were welcome to participate.

  9. “Debate over”

    Debate DUCKED!

    The mere fact that you think attending a delivery gives you any credibility is breathtakingly naive. You won’t debate because you don’t want to be embarrassed. It’s just that simple.

    • MomTFH

      Dr. Amy, I think I have made myself clear. I won’t debate you unless you agree to be civil, and you still insist on calling me names. I am not naive nor afraid to be embarrassed. I just don’t choose to be taunted by someone who has no interest in a civil debate of evidence.

      See you on the blogs. This conversation is over.

      Edited to add: If you discuss this in the future, please link to this conversation so people can see why I refuse to debate you, instead of calling me “yellow”.

  10. DW

    Dr. Amy has some anger management issues.

    • MomTFH

      I agree. That interaction left me feeling like a just went through a professional wrestling style “I’m going to take you dowwwwwnnn!” kind of taunting challenge, as opposed to an invitation to a civil debate.

  11. Liv

    MomTFH-

    I got to your blog through the kerfuffle at unnessecarean.com – and I have to say you’re one of my new favorite bloggers.

    As to the Amy trainwreck, at first I really enjoyed the foray into “exactly how crazy, how quickly can one person’s comments become” territory. Watching you and the other posters rip apart her logical fallacies, false statements, angry rantings, and just general nonsense was quite entertaining. I wish now we could all get back to our regularly scheduled blogs though.

    I’ve realized that engaging in any kind of “debate” with her is utterly fruitless and always will be. It’s like trying to argue evolution with creationists. You can present all the facts, evidence, data, scientific studies you want and argue with the most reasoned logic ever, but it just will. not. make. a difference. You can’t use facts, reason, and logic with someone who is arguing from ideology, belief, and faith. You just can’t. Facts and evidence don’t mean anything to their position.

    Her posts come off as the batshit crazy rantings of someone with a pathological need to defend her position no matter what the reality is. She’s the kind of person who, if told by 50 people that she smells bad, would insist there was something wrong with each and every person’s olfactory sense rather than concede that yes, she does in fact stink.

    In fact, she comes off as so over-the-top hostile and illogical that I’m starting to think – and I’m not joking – that she’s actually a homebirth advocate satirizing the current state of obstetrical care in this country. Kind of like the Stephen Colbert of the birth world. I mean seriously, I just don’t see how her rantings and her steadfast refusal to accept facts and evidence when presented to her – repeatedly, clearly, unequivocally – can be anything other than a joke. She’s a pitch-perfect send-up of the stereotypical arrogant, hostile, can’t-be-bothered-with-evidence-when-I’ve-got-my-opinion,this-is-who-gives-all-drs-a-bad-name, bulldozer of an OB with a god complex you’ve ever run into.

  12. “I just don’t see how her rantings and her steadfast refusal to accept facts and evidence”

    What facts? What evidence? No one has presented any evidence. Perhaps people don’t understand what scientific evidence is.

    In presenting scientific evidence, you cite the paper, and the relevant quotes. Then you compare that to what other papers on the subject show.

    Here’s what scientific evidence ISN’T: It is not a list of articles. It is not the abstract from a paper you have never read. It is not Henci Goer’s personal opinion about a paper. And it most certainly is not your opinion, your personal experience, your best friend’s experience, etc.

    The sad fact is that with I doubt even one of you has read a single paper from beginning to end (with the possible exception of MomTFH) and most of you have only heard of the papers you’ve been told support your own point of view.

    I haven’t seen anyone do that. If I’ve missed it, please point it out to me.

    That’s why I offered to debate the EVIDENCE.

    • MomTFH

      It is comments like these that make it clear to everyone but you why no one wants to debate you.

      Look back on all of our interactions, and see who was quoting evidence, and who was only reading abstracts. After interacting with me, hell, after merely reading the above post this comment thread is a response to, how can you even insinuate I have never read an article from beginning to end? The POSSIBLE exception? Can you stop insulting me?

      I have done it. Copy and paste all of our replies on the five posts I have linked to on your blog, and explain how your reasoning and responses were more evidence based, more coherent, and lacking in personal anecdotes or plays on emotion. There’s your debate, Dr. Amy. I would hate to ask anyone to wade through the 200+ replies on the mess you made of this comment thread, but whenever DoctorJen or I used evidence, and we did it often, you would 1. ignore it 2. misquote it and then 3. call us names.

      Do what I said. Copy and paste all of our comments, in their entirety, with no edits, omissions or additions, from the five threads I links to above, throw in DoctorJen’s and yours if you are a glutton for reality, and let the sympathetic public read them on your blog.

      Link to it here.

      I would thoroughly enjoy following the use of evidence and the individual arguments as they are dropped. I would love for your readers to see you construct straw man arguments and bravely destroy them while ignoring our real answers to your comments.

      Otherwise, do not darken the doorstep of my blog again.

  13. Liv

    Dr. Amy Tuteur, MD, you sly, sly dog! You really are a brilliant satirist! Your cutting posts really do an amazing job of highlighting the absurdist position of arguing that ob care is purely evidence-based – and do it in a way that no mere straight posting could do. You are absolutely effective in your strategy of taking the most unrealistically over-the-top position in order to point out its ridiculousness.

    The haughty condescension dripping from your posts as you insult the understanding and mental capacity of every person you “don’t agree” *wink wink* with? Thereby dismissing anything anyone has to say as irrelevant because they just “don’t understand”? Brilliant!

    The sparkling irony of a doctor (not a scientist) telling posters – including a PhD chemist – that they have never read – not to mention understand – scientific papers? Even more brilliant!!!

    The wholesale ignoring of the numerous scientific studies that have been brought to your attention, both here and on other blogs? The most brilliant stroke of all.

    Really, I tip my hat to you. Your latest entry of biting satirical wit perfectly illustrates the graceful ducking of reality and parrying of the real issue in favor of obfuscation and oblique personal attacks.

    Well played post, madam, well played.

  14. I notice that you haven’t pointed out a single example citing a paper, the relevant quotes and comparing it to other papers on the topic.

    All you words are merely camouflage for the fact that you couldn’t find a single example.

    • MomTFH

      I just linked to an entire comment thread where I did it, and so did DoctorJen, a practicing physician that you treated appallingly. And that is just one of five. I will delete all further comments on the subject. Do what I asked comparing all of our replies on that thread and the others, instead of misrepresenting them, if you expect me to allow this conversation to continue in my space.

      You have continually disrespected me, insulted me, called me names, and ignored my requests for civility. I already gave you the benefit of the doubt by arguing with you WITH evidence on these five threads, evidence you routinely ignored or misquoted.

      Prove to me that you can debate evidence without slinging insults. I have been shown 5 times, plus this comment thread, that you can’t. Until that time comes, this conversation is still closed.

      I am sick of repeating myself and I am sad it has come to this, but I will delete any further comments of yours. It is sad and difficult for me to treat someone I should have respect for and be able to learn from like this. But, you are being a bully, and I refuse to let that happen in my space.

      I have made it clear what it would take from you to debate me:

      1. Civility
      2. A moderator
      3. A resolution on evidence based medicine, which is all that I support.

      You have shown you are not interested in any of these things.

      Please leave me alone.

      • Bring it on. I offer Academic OB/GYN podcast as the grounds. I’ll just moderate and keep time limits. Debate over comment threads is problematic, as both sides know.

        • MomTFH

          This is an interesting proposition (and, to tell you the truth, you were the person I had in mind as an ideal moderator).

          Let’s think this out over email and see if we can do this.

  15. AGZ

    NOW do you think that Dr. Amy might have forgotten to take her meds? Or that she is simply a borg and not a human?

    (and this is coming from somebody is on meds–I am not making fun of anyone with mental health disorders at all, just being real)

  16. IsntItIronic

    Bet you a dollar she takes it to her blog now, going “Ha ha ha! Stupid MomTFH! Look how awesome I am and what a loser she is! I win again!”

    I mean, not that I would waste a mouse click going to find out. If I want to poison my brain I’ll just pour Drano in my ear.

    I’d like to second the Stephen Colbert idea, but I want to do naughty things to Stephen Colbert and I can’t ever, ever, associate that hotness with the smug Amy mug that I so desperately long to roundhouse kick across the room Chuck Norris style.

    • MomTFH

      I wish she was as funny as Stephen Colbert. I can totally see wanting to do naughty things with him.

      I don’t want to kick Dr. Amy. Sometimes I want to take her keyboard away and replace it with a stack of articles on ethics.

  17. Pingback: Reply turned post, participatory medical education style « Mom’s Tinfoil Hat

  18. BornFreeMom

    Very interesting post. As a homebirth advocate I’d like to see more doctors listen to the wishes of their healthy patients.

  19. aly

    Dr. Amy is a lunatic (the dead baby bs takes the cake… seriously sick). I wouldn’t bother debating her. And while I like Dr. Fogelson, he seems to be somewhat of an Amy fan (particularly not calling her on her breach of ethics). I don’t think she is capable of the three conditions. Good on deleting her!

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