Reply turned post, whoops, I did it again

OK, I am supposed to be working on my chapter for Our Bodies, Ourselves. But some how I ended up commenting on a comment thread that was being derailed (surprise, surprise) by Dr. Amy. It may OK (or worse, somehow?) because the blog I was posting on was of one of the editors of the book, Amy (no relation to Dr. Amy) Romano’s Science and Sensibility. The original post is by Henci Goer, and is about the woman who coded during labor immediately following her epidural, and she and her baby were “miraculously” saved.

Dr. Amy has, predictably, turned this into a condemnation of homebirth. She also accused another poster of a so called “fallacy” of the “lonely fact”, claiming episiotomy was the only little mistake modern obstetrics has ever made.

I replied. Now, back to work, I swear! *Scurries off*

Dr. Amy, (sigh, can’t believe I am doing this)

“Modern” obstetrics has also had routine high forceps deliveries with an episioproctotomy (what an older academic ob/gyn I know said was the norm when he trained…and he still sees it as an ideal), twilight sleep, DES, thalidomide, enemas, shaving, banning family support from the room…need I go on?

Modern obstetrics is not infallible, and does better when it is examined critically. Dr. Archie Cochrane started what ended up being the Cochrane Database because he thought obstetrics was so poorly based on evidence. It is not infallible. Its history of problems is not a “lonely fact”. Why does examining obstetrics critically scare you so much?

If you are interested in logical fallacies, you should look up “Straw man arguments”. I have mentioned this habit of yours to you previously, a few times.

The original post is about a major complication of epidural (intubation is a big deal) whose absolute risk is higher, yet very similar to that catastrophic (leading to fetal death) uterine rupture during VBAC, which you have repeatedly called too risky.

Who is distorting risks again? Both are absolute risks (of the eligible population) of less than 1 in 1000 (the catastrophic rupture risk is 1 in 2400). Epidurals are a lot more common than VBACs. However, there are other documented medical benefits to trial of labor with VBAC, and other documented risks to repeat cesareans, and other risks to childbirth, period. Is there documented risks to not getting an epidural? Is there documented medical benefit to getting one?

There are a lot more risks to epidural anesthesia than a high blockade. I am not saying they should be banned. I am arguing for it to be treated like an elective medical procedure with risks. It’s not a radical proposal. Why do you have to pretend it is? It should not be a moral crusade on either side.

I have personally sat through several cases of so called “informed consent” for an epidural when the entire explanation of risks was “it won’t hurt you or your baby.” I had an anesthesiologist storm off when I asked how common blood pressure drops are, in his experience. I was honestly trying to reassure the couple, who were there on a homebirth transfer and were terrified of the epidural, and were specifically worried about the blood pressure issue. I expected the anesthesiologist to say he does these all the time, and the women were generally fine. I guess he didn’t want to say that to them. I can’t guess his reasons why.

Look, these are anecdotal stories, but what is your point, Dr. Amy? Obstetrics, doctors, anesthesiologists and midwives are not infallible. Obviously there are different opinions out there on how to improve obstetrics. I know we don’t see eye to eye, but downplaying the very real risks of epidurals is not going to improve obstetrics, especially if it’s only to make it fit in with your point of view to what are acceptable risks (interventions that increase the control balance to the physician) as opposed to unacceptable risks (increasing the autonomy of the patient).

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55 responses to “Reply turned post, whoops, I did it again

  1. Pingback: Tweets that mention Reply turned post, whoops, I did it again « Mom’s Tinfoil Hat -- Topsy.com

  2. I wanted an epidural, and I knew the risks, but only because I was studying birth as a historian! Otherwise “informed consent” would’ve been a joke. Ditto for the vacuum extraction of my first son.

    Add to your list of obstetric procedures not backed by evidence: routine external and internal fetal monitoring. Sure, they have their place, but not necessarily in every birth. (And yes, I’m pretty sure they were left off your list only because it was already plenty wrong!)

    I don’t suppose you’ll ever persuade Dr. Amy, but I for one was grateful for the comparative risk stats of epidurals vs. VBAC. I’m still not clear what’s included as a major complication of epidurals – does a blood pressure drop count, for instance?

    • MomTFH

      You’re right about the continuous fetal monitoring, especially the internal monitoring. The real reason I didn’t bring them up is that many ob/gyns argue that damn the evidence, we clinically know we should use them. In fact, there was an editorial in the Green Journal, I think, that pretty much said that, but I have it on my work computer and I am home. So, I actually thought, well, that’s pretty clear in the literature, but in practice, many ob/gyns would not agree there is a consensus on that practice. Or, that there is, and it’s that continuous EFM is good and necessary.

      I was at a birth recently that was a long, elective primip induction. They decided to break her waters and put in an IUPC after having no trouble at all picking up fetal distress using the external monitor every time they bumped up the pitocin too high. We weren’t having problems keeping her belts on at all or finding the heartbeat, and I had been with her for 48 hours. They ruptured her membranes (she was at barely 1 cm) and put in the IUPC. Then, it proceeded to act up. The baby had crashed recently for the third time, after the epidural. (and, I got to explain to the incredulous father why, after the anesthetist and nurse just told him “the epidural doesn’t affect the baby”, it immediately affected the baby.) Once they got the mom on oxygen, changed her position, and turned off the pit again, they ruptured her and put in the IUPC. Then the contractions disappeared. On the monitor, not in reality. They had no way of telling if this fetus, who had nonreassuring heart tones just twenty minutes before, was having appropriate variability in response to the contractions or not. They tried new cords. They talked about replacing it (and pulling something out of the open amniotic sac and put something else in? Great evidence based medicine there! And remember, this was a low risk mom with no indications for induction, at 39 weeks).

      They called in other nurses. The switched connecting cords and recalibrated it. It gave them problems the whole rest of the labor, which lasted another day and a half. The IUPC and the scalp heart rate monitor cords got in the way when they doctor was concerned about a shoulder dystocia (which didn’t happen). I would have done fine with a hand held monitor, but the baby had already shown decels a few times, and I don’t think they had those there. And, the external monitor was still there. No one considered putting it back on her.

      I was using the numbers from the source Henci used in the original article. I would consider being intubated a pretty serious complication / morbidity of epidurals. That was the only serious complication of epidurals I considered, and compared it to the one major complication of VBAC that is always touted as being the big one: catastrophic rupture leading to fetal hypoxicischemic encephalopathy. There are obviously other risks to both (and other benefits, some arguable). Maternal death due to meningitis would be a big one, but incredibly rare. Here is a letter in a peer reviewed journal from doctors complaining about how an article discussing a very similar case study of cardiorespiratory arrest immediately following an epidural was most likely caused by the epidural, and the original authors argued it was sepsis. No matter what, a woman died. It’s not common. But, it belongs in informed consent, and there needs to be more research on what the absolute risks are of such occurrences.

      As for the blood pressure falling, I think it is pretty typical. I think the vessel tone for the lower body relaxes, and venous return is compromised. That is why they volume load women first with plenty of IV fluid. Sometimes this can be a good thing if a woman’s blood pressure is running a little high, anyway. Most women can take it fairly well, apparently. But, some cases, like my primip mentioned above, have issues.

      Her blood pressure wasn’t that high to begin with, the fetus had already shown signs of being prone to late decels, and they put her on her back right after (which is typical), which also reduces venous return to the heart due to the big uterus compressing the IVC. At full term in labor, I think something like 10% of the blood flow is going to the uterus and placenta (don’t quote me on that number specifically, but it’s a big amount for a normally pear sized organ). So, a simple reduction in blood pressure wouldn’t normally be considered a complication, but it really depends on who is collecting what data and what the consequences of that decrease are. Hypotension leading to so called nonreassuring fetal heart tones would be a complication in my book, (which is one foot in the operating room door for a cesarean if the fetus doesn’t recover well or the physician is scalpel happy defensive) but obviously not as serious as a fetal demise from a catastrophic rupture.

      I am totally cool with your choice of epidural, I hope you know. Not that it matters. But, making an informed choice is a good thing. I am glad you were informed, and you definitely have your eyes open on what true informed consent is.

  3. morigian

    Hurray! Thank you for taking the time that is needed to continually undue the harm that “Dr.Amy” creates with her extremist blog.

  4. mommymichael

    Didn’t anybody tell you that if you feed the strays they stick around? ;P

    • MomTFH

      I know. I know.

      She baited me with that logical fallacy stuff. I guess she liked the tactic when I used it effectively against her. Too bad she is still the one who is committing those fallacies, not the birth advocates.

  5. Twas me that posted the episiotomy comment, and I haven’t wanted to go read the response. Glad that I could read a summary here instead!

    In some ways I regret posting it…I definitely fed the stray, when I’d be attempting instead to engage it in reasonable conversation. She has valuable things to say, underneath all the asymmetric illogicality, and she has me re-examining some of my long-standing beliefs, which is not a bad thing. Just wish she could do it without all the quotation marks and words like “baloney”! It becomes too aggravating to continue.

    • MomTFH

      There’s nothing wrong with a good discussion, and nothing wrong with challenging your beliefs. It’s just like you said, though, it’s a tone issue with her. And a distortion issue.

  6. I think Dr. Amy is in denial of what “probably” from the word “probability” happened with the “Christmas miracle” mom. The first thing I thought of, as I posted myself, was a complication with the epidural. Everyone at work pretty much thought the same thing. As a hospital-based RN, I want to point out that it is not helpful to be a “Monday morning quarterback” when bad things happen in a delivery, but they should certainly be analyzed to learn from. This is why hospitals have M&M reviews, etc. A non-judgmental look at the evidence. There is nothing shameful about having an epidural (I had two!), and I do not think it is shameful when complications occur. What is shameful is denying the risks or not informing the patient of them to begin with.

  7. doctorjen

    I think realityrounds just articulated something that was floating around in my head about the whole risks of epidurals issue. “There is nothing shameful about having an epidural (I had two!), and I do not think it is shameful when complications occur. What is shameful is denying the risks or not informing the patient of them to begin with.”
    I get frustrated with our anesthesia because they get so defensive if clients ask about risks, or express concern about risks that they already know about. I’ve even had an anesthesiologist mad at me because the client asked about the risk of inadvertant spinal tap, and he thought I shouldn’t have even told her that exists. She merely wanted to know what was the protocol for treating this fairly common, fairly easily recognized and treated issue, she was still planning on having the epidural, and he could have easily relieved her fears with a realistic explanation instead of worrying her more with “Who told you that? That barely ever happens, you don’t need to worry about it.”
    I don’t explain risks to scare women out of epidurals, just so they can reasonably know what to expect – and also what things we can do to counteract some of these risks. Informed consent should include risks, benefits, and alternatives, and I don’t understand how providing those can be seen as being judgemental!

    • mommymichael

      Did anybody else see the woman on the internet with the First Live Streaming birth?

      Specifically Doctor Jen, this comment reminds me of her birth because of the anesthesiologist. When he came in, he gave her the pretty general list of risks associated (which were headaches, chills, drop in blood pressure – think those were it..) and then proceeded to tell her “they’re listed on the consent form if you don’t believe me and really want to read it.”

      That’s the point that I stopped watching. They didn’t even check her before giving the epidural. She had her baby soon after. For a mom who had been talking about wanting a natural birth, I bet she could have made it with more encouragement. She was most likely in transition at that point.

      • MomTFH

        Yes, I have known many moms who “give up” right as they reach transition. Many of them think the epidural “opened them up” because they deliver so soon after. *Shakes head*

        On the one hand, I completely understand. Transition is no fun. If someone says “I’ll go without the epidural as long as I can ‘take it’ “, they will most likely get one during transition. But it’s not just due to the pain of the contractions. Many women, especially primips, are surprised by the slow progression of early active labor, and don’t know how much faster it can go once you reach transition. If it took them 6 hours to get from 3 to 6 cm, (and they don’t even know what effacement or station is), they imagine that they will have to wait even longer than that to get to 10 cm, even though they are much more likely to progress more quickly at that point. It’s not the pain, I think, it’s the idea that this process is taking longer than she thought, the idea of facing 8 or more hours of it is unbearable, and they want some sort of control when they are emotionally and physically exhausted.

        As for the streaming birth, I didn’t see it, but I read about it. Her informed consent, while inadequate, was much better than the one I saw most recently. The patient, who was very well informed, asked about the blood patch and the headache issue because she had heard of it, and then the anesthetist blew it off, as if it wasn’t a big deal. Yeah, it happens, we do a little patch, presto chango, you’re fine. But, why wasn’t it mentioned in the first place? No mention of blood pressure drops, even, chills (which she had), intense itching (which she had). Many moms don’t even know that they will be catheterized until it happens! And Maude forbid they get informed consent on that part of the procedure – want to start off early motherhood with a UTI? It may not happen, but a catheter surely increases the risk of one. Why not throw it in to the informed consent?

        I’m fine with moms getting an epidural in transition if that’s really what everyone wants. But, what’s wrong with making sure she has a realistic idea of the rest of her labor, if she was originally intending to forgo the epidural? That’s what a good doula is for, by the way.

        • mommymichael

          during my first homebirth (after 6 hours of back labor), I remember asking for “something.” “isn’t there anything? like an advil?” lmao, would that even work? lol Man imagine how many women could get through labor if it did!! Advil could use it in their marketing!

          It was after that they started bustling around getting things ready. I was incredulous at that fact. Like “how dare you tease.”
          But it was such comfort to have my midwife look me in the eyes and encourage me. asking me to feel inside “what do you feel” to which i replied “a bubble. all i feel is a bubble.” we popped the sac after that and i had a baby!

  8. MomTFH

    Hooray, doctorjen and RR!

    Absolutely. As I said, there should be no moral crusade for or against epidurals. Or many other remotely reasonable health decisions, for that matter. (Such as VBAC trials of labor, or using formula).

    What should happen is an honest discussion of risks and benefits. I am not pretending that these decisions do not happen in a society that isn’t always reasonable or nonjudgmental. But, I am talking especially to the health care professionals here. Risks. Benefits. Informed consent. Practical advice.

    Look, I support it when a Jehovah’s Witness decides they cannot accept a blood transfusion. Is it what I would choose for myself? Of course not. So, how can I complain, “on principle”, about a patient choosing to do what 85% or more birthing women choose in our country – an epidural? It’s really not that risky, in the grand scheme of all things childbirth. It’s a helluva lot better than stadol, IMO. But, women deserve to know what those risks are, so they can decide whether or not it’s something they think is worth it.

    Crusading against informed consent by presenting the real risks of medical procedures and then exaggerating the risks of non-intervention (like, allowing trials of labor for VBAC) is really just arguing for a paternalistic obstetrics system, and is just as bad as arguing against all obstetrical interventions without discretion.

    • And that’s the crux of the Dr. Amy problem – everything is completely black and white. ALL interventions are 100% safe and NOTHING could go wrong. ALL Cesareans are necessary. ALL homebirths kill babies. ALL doctors are saintly public servants. ALL midwives are patchouli-wearing whackadoodles with no credentials. ALL homebirth studies are inherently flawed and therefore wrong. This is as dangerous as saying that ALL doctors are evil, ALL interventions will kill or brain-damage your baby, formula is rat poison, etc.

      Never once acknowledging a shade of gray is a very self-defeating attitude to have. It ultimately deals more blows to the ego than allowing oneself to be seen as slightly more human and not an end-all, be-all savior (hey Jesus, somebody’s stepping on your sandals!).

      • MomTFH

        Yes, good point. I believe it does the opposite of what it is intended to do. If your patient believes you are infallible, not to be questioned, and all interventions are good, what happens when something goes wrong? Luckily, the fetus and mother recovered well from the epidural I discussed above, but what if the fetus did not recover from the decels? What if there was a cesarean due to it (which the mother was firmly against unless there was an emergency) or, even worse, ischemic damage due to the decreased blood flow to the placenta?

        I think the parents, who were no dummies, would be much more likely to sue, since the doctor ORDERED the epidural (which she did in this case, it was not requested), and she, the nurse and the anesthetist proceeded to insist there were no risks to her and the baby. Giving someone realistic expectations of the risks of a procedure makes them patients likely to accept those risks if they, Maude forbid, show up.

        Also, another good point you made, that I made above: It’s just as bad as saying all interventions are evil. Dr. Amy criticizes the all-or-nothing judgment she claims to see perpetuated by straw women everywhere in the birth advocacy community (and which I argue is really only apparent in a few fringe members), yet has no problem having that same type of all-or-nothing attitude about obstetrics.

        • I don’t understand why doctors don’t realize this. They try to twist it as a “you women all want perfect babies!” when in fact THEY’RE the ones promising that perfection, by insisting that interventions have no risks, that Cesareans are safe, etc. When someone tells you that something is 100% safe, and then it goes wrong, who do you blame? The one who lied to you, even if what went wrong was not necessarily their fault.

          My midwives and I had a talk before my HBAC, saying in a nutshell, “We can’t guarantee anything, there are risks, here are what they are, we need to know you understand them.” It was mostly for the contract we signed saying “I agree not to sue you because you have no malpractice insurance, etc.” I’m sure most doctors don’t have that contract, but that full-disclosure kind of conversation definitely needs to be happening with ALL physicians.

          I also don’t understand why doctors would rather put a Cesarean fix-all on any potentially less-than-perfect situation….wouldn’t a better defense be, “We warned her that this complication was possible,” instead of, “Well, we did a Cesarean so we did everything we could!” Sometimes I feel like my idea of logic only makes sense in my own little head.

          • MomTFH

            We have a really smart, ethical physician / professor at my school who is J.D./M.D., and he taught our Medical Jurisprudence class. His attitude is: the best way to prevent a malpractice suit is “Don’t be an asshole”. No kidding, but, not everyone thinks like that.

            When you tell him stories like paternalistic ones above of pressured unnecessary interventions with poor informed consent, he would say “There’s something we call doctors like that: defendant.”

          • Totally random and off-topic, but everytime I see “Jill” on here, I start reading and wonder for a split second if I commented and forgot about it.

          • MomTFH

            Ha, Jill – U, I know! Me too! Except for the forgetting part.

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  10. I’m absolutely swamped with patients today and really have little time for blogging… but I had to just post a quick note to say, Bravo!

    My question for Dr. Amy and others would be simply this. What’s the problem with simply enumerating risks, benefits and alternatives to a patient and allowing her to make her own decision. If you’d like to be fancy, go ahead and quote sources and estimates for what you are counseling. It’s not difficult. In fact, if the patient has a smart phone they can Google the breakdown of alternatives during the informed consent procedure. (I’ve done this. It works pretty well).

    Once upon a time, physicians thought that they were in possession of knowledge that could not be either appreciated or understood by patients and so they adopted a paternalistic manner of dealing with patient questions. Don’t worry, honey, everything will be alright as long as I’m here.

    Pretty sad. The modern practice of medicine has moved beyond these attitudes (thankfully) but their remnants remain in many aspects of obstetrics. The type of informed consent that you describe prior to epidurals is not unusual, and thankfully it is not predominant.

    In the end, it’s clear that physicians who do not accept patients as knowledgeable participants in their own care will find themselves on the wrong side of history.

    Thank you for providing a sane and evidence based counterbalance to our colleagues who insist upon living in the past.

    • MomTFH

      Thanks for taking the time to read and comment.

      “In the end, it’s clear that physicians who do not accept patients as knowledgeable participants in their own care will find themselves on the wrong side of history.”

      I agree, and sure hope we’re right.

  11. “What’s the problem with simply enumerating risks, benefits and alternatives to a patient and allowing her to make her own decision.”

    “Natural” childbirth advocates are well aware that millions of women each year choose epidural for pain relief in labor, yet they are confident that women would make a different choice if they were fully informed.

    Why does that sound familiar? That’s the same argument that the anti-choice forces make about abortion.

    Anti-choice advocates are well aware that more than a million women each year choose abortion, yet they are confident that women would make a different choice if they were fully informed.

    According to the National Pro-Life Alliance:

    “Women’s “right to know” (informed consent) laws … [guarantee] women receive critical information on the risks of abortion, such as infection, hemorrhage, danger to subsequent pregnancies, breast cancer, infertility, psychological consequences, and other dangers.”

    Should we take the anti-choice forces at their word? Are they really interested in making sure women are informed about risks? The Guttmacher Institute, a pro-choice organization that provides information on reproductive health, doesn’t think so. In fact, they believe that anti-choice forces are really interested in “misinformed” consent.

    Anti-choice advocates do not hide their opposition to abortion, but they have learned that the majority of women do not share that opposition. They recognize that a frontal assault on abortion is doomed to failure. They have settled instead on undermining a woman’s right to choose by misinforming her about the “risks” and placing obstacles in her path under the guise of “informed consent.”

    “Natural” childbirth advocates have enthusiastically followed the playbook of anti-choice activists. They recognize that the majority of women do not share their philosophical objection to pain relief in labor. They have acknowledged that a frontal assault on epidurals is doomed to failure. They have settled instead on undermining a women’s right to choose pain relief in labor by misinforming her of the “risks” and placing obstacles in her path under the guise of “informed consent.”

    Such tactics are not merely disingenuous, they are unethical in regard to abortion, and they are unethical in regard to pain relief in labor.

    • MomTFH

      Dr. Amy, I presume.

      1. I never once said less women would choose epidurals if they were told the risks. So, your entire point is called a STRAW MAN argument, again. You are arguing a false claim I never made that is easy to beat, because it is wrong.

      2. The quote you put from the Guttmacher Institute, who I link to in my blogroll, mentions FALSE risks of abortion. Breast cancer? Psychological risks? These have been disproven. The other risks are higher with carrying a pregnancy to term. NOT comparable. I would like accurate informed consent of true absolute risks. Do you have a problem with that?

      3. How dare you come on my blog and intentionally try to stir up strong feelings by taking something I obviously care a lot about, which is being pro-choice, and pretending it has anything to do with what we are talking about.

      4. “Such tactics are not merely disingenuous, they are unethical in regard to abortion, and they are unethical in regard to pain relief in labor.” What tactics? I said: “There are a lot more risks to epidural anesthesia than a high blockade. I am not saying they should be banned. I am arguing for it to be treated like an elective medical procedure with risks. It’s not a radical proposal. Why do you have to pretend it is? It should not be a moral crusade on either side.” How is that a “frontal assault”?

      Are you SERIOUSLY suggesting that informed consent is unethical?

      Please answer these arguments only. If you continue to purposely invent words to put in my mouth and purposely say things to cause a flame war, not to discuss the original point, I will start deleting your posts again. I hate talking to you like a recalcitrant child, but your tactics are not true debate, and I don’t have the time nor patience to put up with this in my own space.

  12. mommymichael

    avoid the urge people. avoid the urge.

  13. “Are you SERIOUSLY suggesting that informed consent is unethical?”

    Please address what I wrote, not what you wish I wrote.

    I wrote than NCB advocates are disingenuous when piously claiming that all they want to do is make sure that women give informed consent. They are just like the anti-choice people who also piously claim that they lobby for “right to know” laws only because they want to make sure that women give informed consent to abortion.

    Just like they are disingenuous about their motives, NCB advocates are disingenuous about their motives. Anti-abortion activists want to discourage abortion and NCB advocates want to discourage epidurals.

    “The quote you put from the Guttmacher Institute, who I link to in my blogroll, mentions FALSE risks of abortion.”

    Yes, and NCB advocates mention FALSE and fabricated “risks” of epidurals. I wrote about this yesterday on my own blog (http://skepticalob.blogspot.com/2010/01/informed-consent-natural-childbirth.html), and I used Penny Simkins’ list of benefits and “risks” of epidural as an example.

    “How dare you come on my blog and intentionally try to stir up strong feelings by taking something I obviously care a lot about, which is being pro-choice, and pretending it has anything to do with what we are talking about.”

    I’m not pretending. I’m pointing out hypocrisy where I see it. You are no more concerned about true informed consent for epidurals than the anti-abortion activists are concerned about true informed consent for abortion.

    And when it comes to hypocrisy, let’s take a look at midwifery consent forms. Consider this consent form from the licensed Colorado direct entry midwives (http://www.dora.state.co.us/midwives/ConsentForms.pdf). They don’t even bother to accurately list risks, and basically try to absolve themselves from malpractice liability.

    Funny how the same people who loudly complain that women don’t receive informed consent in the hospital feel free to be incredibly vague and incomplete in their own consent forms.

    • MomTFH

      I am not mysterious NCB advocates. I am not what you wrote on your blog about Peggy Simkin. I am most certainly not an anti-choice crusader. I am not a Colorado direct entry midwife. (Where did that come from?)

      You are posting on MY thread about MY being disingenuous and unethical. Clearly. I am not putting words in your quotes. You are inventing claims I made, not the other way around.

      Saying “I know you are but what am I” is not debate.

      Show me the quotes where I make false claims about risks. Show me the quotes where I say scaring women with false claims will make less of them choose epidurals. Show me the quotes where I am being a hypocrite.

      All I wrote about is informed consent. How can you say I don’t care about informed consent? I told no less than two commenters that their informed consent of choosing an epidural was A-OK. I said this should not be a moral crusade in my original post.

      This is why I will not debate you.

      You brought up a brand new point about direct entry midwives. One of your pet points, and again, nothing to do with the original argument, but intended to start a flame war. You didn’t answer ONE of the points from the original post. Care to defend your earlier argument about the lonely fact?

      Care to answer the words in my own post about informed consent? Care to stop saying I am lying?

      If you don’t behave, I will delete your next post. I thought I was clear as to what was debate and what was you polluting my space with angry games.

      • MomTFH

        “Show me the quotes where I make false claims about risks. Show me the quotes where I say scaring women with false claims will make less of them choose epidurals. Show me the quotes where I am being a hypocrite.”

        “Care to defend your earlier argument about the lonely fact?

        Care to answer the words in my own post about informed consent?”

        And in response…..*crickets chirping in the silence*

  14. “You are posting on MY thread about MY being disingenuous and unethical.”

    What do you expect when you write about me in a disparaging way?

    Moreover, I was responding to Dr. Onyeije who posed a question to me. You could have let him address the answer, but you chose to do so yourself. You shouldn’t be surprised that I defended my claims.

    • MomTFH

      I expect you to be logical, defend your arguments, and argue mine.

      You did not specifically address Dr. Onyeije at all. You could have replied to his post and made that clear.

      He is a maternal fetal medicine specialist. I didn’t notice you mention them once in your post. Is he the one you were calling disingenuous? Was he the natural birth advocate? Or is he the direct entry midwife? Or Peggy Simkin? Or me? Because he’s a board certified physician with more training than you have.

      I didn’t write about you in a disparaging way. I disagreed with you, and complained about your behavior. In the original post you have repeatedly ignored.

  15. DNV

    Nice pro-life stab. Amy has always reminded me of the pro-life protesters that set up at the park shoving pictures of mutilated fetuses in front of you and your family. They scream “THIS IS A TWELVE WEEK OLD PREBORN BABY! DO YOU WANT TO KILL THIS BABY?!”

    *First of all, it’s probably a picture of a 20 week fetus, so it’s a dishonest plea.
    *Second of all, there are a million circumstances that I won’t presume to understand as a man why a woman might need or want one. Her body, her life, her business.
    *Most importantly, if it weren’t for the paternalistic attitude that Chukwuma describes above, more women would probably understand that sometimes babies die during the pregnancy/birth process. Leave it up to us… we’ll take care of everything. It’s gotten to the point that a doctor feels the need to run around the internet screaming about dead babies and yelling at women. It’s embarrassing.

  16. IsntItIronic

    MomTFH, can I just say how much it fills me with glee to imagine you as a stern Catholic school nun, brandishing her ruler to bloody the knuckles of the naughty girl who keeps snapping gum and passing notes in class. I’m literally eating popcorn while reading this thread. That’s how awesome you are.

  17. It’s already been covered and then some, but I just have to AMEN it again:

    “The original post is about a major complication of epidural (intubation is a big deal) whose absolute risk is higher, yet very similar to that catastrophic (leading to fetal death) uterine rupture during VBAC, which you have repeatedly called too risky.”

    QFT. BRAVISSIMO!

    Not only the post, but this whole comment thread – well, 90% of it – is full of win, win, win. It would take too much time and precious space to just keep quoting and high-fiving everybody who deserves it, but you pretty much know who you are, and you’re all the bomb-diggity.

  18. IsntItIronic

    I heard the epidural theory from Reality Rounds before I saw Henci write about it. I guess I fell for the wrong person! ;)

    So, what is YOUR theory on this mysterious incident, Dr. Amy (or Drs. Fogelson/Onyeije if they are reading)? If Henci is wrong, then what REALLY happened? I’d love to hear any alternate theories.

  19. MomTFH

    Sorry, I had to delete the last few comments from Dr. Amy. I asked her to specifically stick to the arguments in this thread. Instead, she reposted more unrelated material from her own blog and then pretended to speak for other people.

    I am not interested in becoming another platform for you, Dr. Amy, especially if you insist on spamming my comment threads with unrelated material from your own site. This is my blog, and I have been very lenient with allowing you to derail up until now. I think I have been clear and very patient.

  20. IsntItIronic

    Dang, I shoulda seen the “now back to screaming about dead babies!” coming as soon as she briefly distracted us by tossing a bone. Bark bark! And now my foxy nun is back in action with the Ruler of Justice.

    Sorry, I’m watching Scrubs and it’s making me talk like I think I’m a witty twentysomething. I’m not very good at it.

  21. Why do you feel you have to censor comments to remove any information you don’t agree with? Why don’t you trust your readers to make decisions for themselves? Isn’t that being every bit as paternalistic as the doctors you rail about? Do you think your readers aren’t smart enough to make their own decision, so you have to make sure you keep them from seeing anything that doesn’t support your own personal beliefs?

    Why don’t you ask your readers whether they think they can judge for themselves or whether they need you to “protect” them from unpleasant facts?

    • MomTFH

      I made it clear. Several times.

      The comments I deleted were not disagreeing with me. One was an unrelated post about a fetal demise at a homebirth. The other was a comment that Dr. Fogelson supposedly posted on another site about Henci Goer. Then, you posted two almost identical comments again, and I deleted them again.

      I have left up way too many comments from you that are irrelevant and disrespectful. I have a consistent history of not shying from debate on this site.

      Your unrelated comments are not beacons of truth my readers are longing to read. You have your own blog to share your version of the truth.

  22. MomTFH

    I had to delete two more posts from Dr.Amy. Again, this is not a forum for unrelated “dead baby!!” horror stories or a place to post what someone who is not on this thread said about someone else who is not on this thread.

    I am not afraid of the truth. I don’t respond nicely to taunting. I have no problem with healthy intelligent respectful discussion.

    However, I refuse to allow my space to become a second blog for someone whose point of view is so contrary to mine, who is continually disrespectful to me, who ignores my points and shadow boxes with imaginary enemies.

    I am at my mother’s home with my children and would like to go to bed. Dr. Amy, if you have anything else that had nothing to do with this post to copy and paste I’d prefer not staying up to delete it, so please post it on your own blog.

    • “I am not afraid of the truth”

      You’re actions are those of someone who is afraid of the truth.

      If you don’t want to argue with me, don’t write about me. Once you write about me, you are morally bound to let me respond, without deleting my comments.

      I have no obligation to make you look good, and it speaks very poorly of you that you feel justified in deleting the comments that call your claims into question. If you can’t defend your claims, don’t make them.

      • MomTFH

        Your comments are not the “truth”. If they are inappropriate or unrelated to the original post, I will delete them.

        I am not asking you to make me look good. I am asking you to post on topic, appropriate comments. This is my blog and I am fully able to make my own comments policy.

        If I write about you, answer the arguments I wrote (you have seen the original post, right?) and I will not delete your comments.

        If you copy and paste unrelated posts from your own site, or unrelated comments not even authored by yourself, they will be removed.

        Your comments speak poorly of you, and that is why you have the reputation you have. They do not speak poorly of me; they do not speak of me at all, most of the time. That is why they are inappropriate and irrelevant, and will be deleted.

        In fact, this is getting to be a tedious derail from the original topic, and I will delete all further arguments from you about my comments policy.

        You have your own site. You are not entitled to free reign on my site. I am not “morally bound” to let you copy and paste anything on here. Your ideas of morality and ethics are very different from mine, and I am perfectly comfortable with that.

  23. Just wanted to point out that in a previous comment (now deleted, blog owner’s prerogative) Dr. Amy stated that Dr. Fogelson admitted that there is no way the epidural was the cause of this “Christmas miracle” mom’s code. But then he wrote this:

    @Nicholas Fogelson
    I watched the long video in your second quote – she had gotten the epidural, and it contradicted the other source that suggested that she suddenly turned grey. Based on this, high spinal is more of a possibility. And based on that, I may have jumped the gun a bit saying it wasn’t, and I apologize for that.

    Like I stated before, there is nothing shameful about getting an epidural, and there is nothing shameful about adverse events occasionally happening with an epidural. Is it possible for us all to be honest and transparent about these possible complications? Adults need only reply.

  24. mommymichael

    ::snicker:: “morally bound” to not delete comments. That just made my day, and I just came home from my baby shower!

    Sorry to laugh MTH.

  25. Pingback: Reply turned post, blogging civility style « Mom’s Tinfoil Hat

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