July 10, 2012 | 9:42 AM |

Fierce Views Of Anti-Home-Birth Activist Questioned In Slate

FILED UNDER: Medicine/Science, Personal Health, Politics, childbirth, homebirth, women's health

The home-birth debate rages on. (Chris and Jenni/flickr)

Every time I (or pretty much any other journalist) writes about homebirth, it’s a good bet that a scathing comment about its dangers will be posted by a former ob-gyn who hasn’t practiced medicine in years. Her name is Amy Tuteur, or Dr. Amy, as she’s often called.

At long last (according to some folks), a darker side of Dr. Amy has been unveiled in an excellent piece by Jennifer Block in Slate called “How To Scare Women: Did a Daily Beast story on the dangers of home birth rely too heavily on the views of one activist?”

That activist is, of course, Tuteur, who is extensively quoted in Michelle Goldberg’s Daily Beast story about scary homebirths.

Block writes:

For many parents, home birth is a transcendent experience. … Yet as the number of such births grows, so does the number of tragedies—and those stories tend to be left out of soft-focus lifestyle features. Now a small but growing number of people whose home deliveries have gone horribly awry have started speaking out, some of them on a blog, Hurt by Homebirth, set up by former Harvard Medical School instructor Amy Tuteur. “These people are beating themselves up over this,” says Tuteur, perhaps the country’s fiercest critic of the home-birth subculture. “They did it because they thought it was safe, and it wasn’t safe.”

Goldberg’s reliance on Tuteur is an interesting choice. Also known as “Dr. Amy,” Tuteur let her medical license lapse in 2003 and created the blog Home Birth Debate in 2006, which she used to advocate for her position, which is basically: Home birth kills babies. “Even the studies that claim to show that home birth is as safe as hospital birth actually show the opposite,” she’d frequently post in response to a challenge, smearing the researchers of those studies in dedicated blog posts and igniting flame wars in the comments section. On other sites, including Nature and RH Reality Check, her comments have been flagged and removed for being defamatory or basically spam.

In 2009 Tuteur moved over to her new blog, The Skeptical OB, the name of which is, on the one hand, misleading because she hasn’t been in practice for more than a decade, but is ultimately more appropriate because her old site was never really about debate. She wrote briefly for Open Salon, where she took issue with Amnesty International’s research on maternal mortality, and had a mutual parting with the blog Science Based Medicine (“mutual efforts between the editors and Dr. Tuteur to resolve our differences came to an impasse,” managing editor David Gorski wrote in the announcement). Her prose tends to be inflammatory. “It’s hard to beat homebirth midwives when it comes to stupidity,” she recently blogged on her own site.

In January 2011, Tuteur added a new domain to her brand, Hurt by Home birth, in which she invites guest posts—“and please include pictures if you can”—from tragedy-stricken mothers.

Surely it’s no crime for Tuteur to have her point of view and blog about it. As I mentioned, she is one of the most prolific blog-post-commenters out there. The problem, Block writes, is “when a dogged journalist like Goldberg elevates Tuteur to expert. Tuteur is not a researcher, she’s not currently affiliated with any medical institution, and more importantly, she’s never published any of her kitchen-table calculations on the risks of home birth in any peer-reviewed journal. Yet she presents herself with the authority of a CDC epidemiologist when she writes, “Homebirth increases the risk of neonatal death. All the existing scientific evidence says so.”’

Block quotes Boston University epidemiologist and professor of public health Eugene Declercq, who says it’s challenging to precisely quantify the absolute risk of homebirth. He says: “the outcomes tend to be pretty good…So when Tuteur says no study anywhere has found this, it’s a crock. There are studies that have found good results.” But to really nail it down here in the U.S., he says, we’d need to study tens of thousands of home births, “to be able to find a difference in those rare outcomes.” With a mere 30,000 planned home births happening each year nationwide, “We don’t have enough cases.”

About the author

Blogger, CommonHealth Rachel Zimmerman worked as a staff reporter for The Wall Street Journal for 10 years, most recently covering health and medicine out of the paper’s Boston bureau. Rachel has also written for The New York Times, the (now-defunct) Seattle Post-Intelligencer and the alternative newspaper Willamette Week, in Portland, Ore., among other publications. Rachel co-wrote a book about birth, published by Bantam/Random House, and spent 2008 as a Knight Science Journalism Fellow at MIT. Rachel lives in Cambridge with her husband and two daughters. View all posts by Rachel Zimmerman →

  • MC

    She’s not an expert? She’s a Harvard educated ObGyn. That is EXACTLY what I call an expert on birth. Especially compared to granola blogger mommies and washed up talk show hosts. Talk about an article with an agenda….

  • http://www.facebook.com/teegan.mullins Tee OccupyAustin Mullins-Getti

    Thank you so much for exposing this woman’s unfounded vitrol!
    She has been stealing birth stories with from private blogs, mourning websites, pregnancy and motherhood communities, and more. I’m amazed at her lack of integrity. Shame on you, ex-Dr. Further!

  • SamIam

    “Anyone who brings in the safety of the baby as an argument against homebirth is hostile to both my rights as a parent, and a woman’s right to make decisions about her own body. Mothers are not just vessels. If I make a reasoned choice for my family, that is my business.” Really? When you decide your kids don’t need seatbelts, and you get pulled over, let me know how that goes!

  • Peggyo

    Still looking for that link to the CDC data, Amy. Cannot find it on the CDC Wonder site. Please provide a link.

  • SSR

    Its just sad that there’s this divisiveness around mothers, birth, and breast-feeding that brings out the possibility of black and white right and wrong answers as such heated issues. Every mother and family needs to decide what is best for them, while accepting we are human and may make mistakes some times. I had one child at a birth place associated with a hosptial but not at the hospital, one child as a carefully planned home birth, and my third on the way is planned for a hopsital with midwives and backup doctors. Each time I made a different decision and even changed my mind partway through the pregnancy based on what was happening and my own research. On my first it took two adjustments to my care until I felt I found a good fit, and it worked out perfectly, as did the home birth and I hope the hospital one will be as well.

    What is right for one woman at a given time is her choice and she deserves and needs the right to make that choice in a thoughtful and supported manner. If you are a woman and feel you are being pushed in directions that you are not fundamentally comfortable with, listen to yourself and seek out other opinions to make an informed choice. You are not a statistic you are an individual, while statistics are one source of data they are not the end all be all.

    The real issue is keeping all the options open, safe and readily available, not which type of birth setting is “right”. The idea that there is a right or wrong way to bring a child in to this world is fundamentally flawed. You can have a safe home birth, you can have a wonderful hospital birth but you have to do the work either way to find what is right for you and your baby at that time.

  • PeggyO

    Amy, could you provide a link to the CDC source for the statement of yours: “The latest CDC data shows that homebirth increases the risk of neonatal death by more than 600%.”

    When I search the CDC for a study on homebirth, I find this NCHS data brief  which says that homebirth is on the rise, up 29% from 2004 to 2009. The summary states that 87% of homebirths are planned.

    http://www.cdc.gov/nchs/data/databriefs/db84.htm

    I’m sure you’re aware of the Meta-Analysis of Homebirth done in 2008 that found no difference in outcome between planned homebirth and planned hospital birth. This analysis reviewed the outcomes of six controlled observational studies of 24,092 primarily low-risk pregnant women.

    http://onlinelibrary.wiley.com/doi/10.1111/j.1523-536X.1997.00004.pp.x/abstract

    And, of Peter Schlenzka’s doctoral dissertation at Stanford in which he examined the perinatal outcomes of 816,00 California births and found that both hospital settings and planned out of hospital settings produce the same perinatal outcomes for both low-risk and high-risk births. 

    http://www.vbfree.org/docs/schlenzka.htm

    • Amy Tuteur, MD

      You can find the data for 2007 at the CDC Wonder website.

      The study you cited is from 1997 (therefore out of date) and is from the journal Birth … published by Lamaze International, hardly an unbiased source. Moreover, the data is from other countries.

      As for Schlenzka’s doctoral dissertation, if you’ve come to the point that you are citing unpublished, unverified material, you are scraping the bottom of the barrel.

      Even MANA knows that homebirth with an American homebirth midwife increases the risk of neonatal death. That’s what their own data shows and that’s why they are hiding their own death rates.

      • Guest

         Birth is published by Wiley International, hardly a biased publisher.  http://onlinelibrary.wiley.com/journal/10.1111/%28ISSN%291523-536X

        There is a lot of debate about the risks of many human activities.  If we accept there is some risk of neonatal death at planned home birth and some risk of neonatal death at planned hospital birth — regardless of which risk is higher, which I would argue is dependent on a number of other factors — is the issue really one of self determination and autonomous decision making? 

        Seems like the two sides are getting these issues mixed up. For me, the question is:  Does a woman have the right to decide with whom and in what location she will give birth?

        • Amy Tuteur, MD

          Wiley publishes Birth on behalf of Lamaze International. Obviously, neither Birth nor Lamaze publicizes this fact because they understand that if people knew Birth is an industry funded journal, it would have no credibility.

          Of course a woman has a right to decide where and with whom she will give birth. However, in order to make an informed decision, she must be informed. When professional homebirth advocates refuse to release their death statistics, when they don’t mention the CDC data, when Colorado homebirth midwives hide their appalling death rate in defiance of state law, there is no way anyone choosing homebirth today is making an informed decision.

          Homebirth advocates like to describe me as a fierce activist against homebirth; that’s not really true. I’m a fierce activist for full access to information about the real dangers of homebirth. That’s why people like Jennifer Block try to discredit me. They know they can’t discredit the data. Block didn’t even try to rebut it. They hope (wrongly) that if they throw enough dirt in my direction, it will harm my credibility.

          There are literally thousands of comments on the back and forth pieces between The Daily Beast. All those defending homebirth were already homebirth advocates. I haven’t seen anyone neutral on homebirth or opposed to it say that they were convinced by Block’s collection of ad hominems to change their mind.

          Those who want to believe homebirth is safe are praising her, but everyone else recognizes that she never even addressed my claims (nor did the author of this piece) … because she couldn’t (and Rachel Zimmerman couldn’t either).

          • http://twitter.com/Goddesskittles Princess Skittles

            Lady i get it you had a bad home birthing experince.Many people have had good ones.I think its a waste of time for you to go and spam and try to convince woman that their babies could die if they have it at home which has been proven to be safer that at a hosptital not to mention all the dangers and risks and un nessecary interventions hospitals use.i for one will always be having a home birth when i have a kid far far away from the evil of the hospital ive also witnessed a live homebirth its truly a magical thing when you have the right trusting people

  • http://twitter.com/jen_holloman Jen Holloman

    “For those who aren’t qualified to adjudicate a debate over the construction of proper data sets, evaluating them requires, to some extent, understanding the philosophies of their authors.”

    …….and this is where your true motivations are revealed time and time again, you think we’re ALL stupid. We can’t ALL be stupid that is STATISTICALLY impossible= 100% stupidity of every human in America.

  • http://twitter.com/jen_holloman Jen Holloman

    #amytuteurkitchentablestatistician

  • B2manatees

    Wow.  She got here fast.  How many of them are there???  How big is her army of “this is true because I said it is and your studies are all wrong, wrong, WRONG!!!”?

  • Joesie

    The last paragraph in your opinion piece is very telling. Block quotes Eugene Declercq who says: “the outcomes tend to be pretty good…So when Tuteur says no study anywhere has found this, it’s a crock. There are studies that have found good results.”  Then he starts the next sentence with “But to really nail it down here in the U.S.”. This just leads me to infer that the un-named studies he is referring to that show good outcomes were not conducted in the U.S. but in other countries where homebirths tend to be much more highly regulated and, unlike here in the U.S., homebirth midwives are required to have a much higher level of education before they are licensed. This quote by Declercq appears to me to be very deceptive and meant to mislead.
    Declercq continues with “we’d need to study tens of thousands of home births, “to be able to find a difference in those rare outcomes.” But MANA (Midwive Alliance Of North America) has done extensive studies with their database of over 24,000 planned homebirths but for some reason, they refuse to release the death rates. Why?
    I do not know Declercq but if he is truely an expert in this subject, then his quotes, used by Block to counter Amy Tuteur’s assertions, appear to me to be purposely misleading.

    • Seeking_Peaceful_Solutions

      It has been explained so many times why MANA doesn’t release its data as a collective work that it needs not be repeated.  But for those who still don’t understand.
      MANA collects a wide variety of data.  Data can be sorted in any number of ways. Statistics is one of those things that can be easily manipulated as Amy Tuteur has clearly shown all of us.  

      If you are a researcher and you want to do a study on home birth, or midwives, or any number of other things, you can apply for and receive that data to do your study.  It is a work in progress and they are constantly trying to improve how they collect data and   show the results in a context that makes sense. 

      For example, Hospitals don’t like being portrayed as the place responsible for all the deaths in our country.  But I can show you studies that clearly show that is where most of our country dies.  Does that mean hospitals are responsible for all those deaths.  Absolutely not. 

      On the same lines, Babies die in a variety of places and how you present the data can sway people in a variety of directions.  What anti-home birth activists want is the ability to show that if a baby dies at home then it is obviously the midwife’s fault, thus making them feel their cause is right.

      We need research that identifies what the cause of death was… and if that is in any way related to the place of birth.  Including for the hospitals. 

      Johns Hopkins hospital just lost a lawsuit for 55 million dollars because they failed to do a C-Section in a timely manner.  A woman was brought into the hospital from a home birth by a Certified Nurse Midwife.  She brought the woman in to the hospital in plenty of time to be treated by the staff. Hopkins was found responsible for the injury to the child, and yet the Board of Nursing is still investigating the complaint filed against the Nurse Midwife by Hopkins. Just goes to show that how that injury is reported could any number of things.  It could be reported as a home birth gone bad… or a hospital mistake, or whatever. 

      Amy Tuteur has not been a doctor for a decade.  I feel she has every right to voice her opinion on where the safest place to give birth is. If people choose to ignore her advice then they should still have the right to access the provider of their choice just as Amy had the choice to pick her provider. 

      If the medical associations can choose for women where their babies are born by eliminating choice… Then whats next.  Women should stand up and fight against anything that takes away your rights to educate yourself about a profession and then seeks its advice. 

      If Amy Tuteur and Health Departments or Govt officials have concerns over who we are picking to attend our births… then the best thing to do is not take away our rights… but license and regulate that profession. 

      If I have cancer and I seek out a Naturopath, Chiropractor, or seek natural healing in addition to typical cancer therapy (radiation, chemo, and surgery)… Its not the Department of Healths job to tell me who I MUST go to for treatment, But if they have concerns over alternative health providers being sought after to treat patients then its their obligation to license them and standardize their scope of practice. 

      I am grateful for all the OB’s who are working in a difficult field in tough situations all across our country.  I hope that we can find ways to release them from all the legal burdens that they must work with.  We need to get rid of some of their liability so that families and women can make choices about their bodies and not put the doctor in an unfair position. 

      • Amy Tuteur, MD

        Actually MANA does release their statistics, just not the death rate.

        According to Melissa Cheyney, writing in the pages of the newsletter of NACPM (The National Association of Certified Professional Midwives, the analysis of the data from 2004-2007, comprising over 8800 midwife attended homebirths, is quite comprehensive:

        “Preliminary
        statistics emerging from the 2004-2007 dataset demonstrate the
        importance of a midwifery-dominated maternity system … The rate
        of low five-minute Apgar scores for all intended homebirths, regardless
        of actual place of delivery, is 1.37% (118/8611), and the rate of labor
        occurring before 37 weeks is 1.4% (123/8,758). The spontaneous vaginal
        vertex birth rate (all births where the mother went into labor intending
        to deliver at home minus all non-vertex presentations, cesarean
        sections, forceps and vacuum extraction) is 91.6% (n=8961), the forceps
        rate is 0.2% (18/8,863), and the vacuum extraction rate is 1.1%
        (98/8,863). The cesarean section rate for all women who went into labor
        intending to birth at home is 5.03% (442/8,788), and the rate of low
        birth weight infants(<2500 grams) is 0.93% (81/8743). In addition, we
        have also calculated three types of transport rates: intrapartum
        transports (IP), neonatal transports (NEO), and postpartum transports
        (PP). The IP rate is 10.6% (933/8,807), the NEO rate is 0.8% (69/8807),
        and the PP rate is 1.76% (155/8,807)…"

        But wait! There's something missing. That's right; it's the death rate.
        MANA still refuses to tell us how many of those babies died at the hands
        of homebirth midwives.

        Why?

        It can't be because they don't have that information; they've clearly analyzed the database extensively. It can't be because the MANA Stats are only available to researchers; they've publicly released just about every other facet of the data. I can think of only one reason why they refuse to release the death rate; they don't want American women to know.

        It puts the mendacious arguments advanced by Jennifer Block and Gene Declercq in an ugly light.

        Block quotes Declercq "on why determining the precise risk of home birth in the United States is nearly impossible": “It's all but impossible, certainly in the United States,” says Eugene Declercq … But to really nail it down here in the U.S., he says, we'd need to study tens of thousands of home births, "to be able to find a difference in those rare outcomes.” …

        All but impossible to assemble a database of tens of thousands of homebirths? Both Block and Declercq almost certainly know that such a
        such a database ALREADY EXISTS. The MANA database contains "over 27,000 records and counting."

        So let me offer a public challenge to Gene Declercq:

        Now that you know a database of tens of thousands of births already exists,
        it will be possible for you to "nail down" the death rate at US homebirths. When can we expect you to call MANA and find out the death rate and share it with the rest of us?

  • Jules V.

    And there she is.  Man I wish I had that much time to troll around on the internet. :)  

  • Gigi

    Thanks for the article.  Having commented on the Slate articles, and been overwhelmed by the hostility and hyperbole of the anti-homebirth crowd, I don’t have the energy to add much here.  Just that everyone has a right to their own view of the risks given the facts and research, limited as they are.

    My choices about my medical care, especially those made within the realm of reasonable, are mine to make, as they should be everyone’s.  If I choose to have a homebirth, as an informed choice, that shouldn’t be anyone else’s business.  Most women choose the hospital, which is a fine choice.  To each their own.

    Anyone who brings in the safety of the baby as an argument against homebirth is hostile to both my rights as a parent, and a woman’s right to make decisions about her own body.  Mothers are not just vessels.  If I make a reasoned choice for my family, that is my business.

    Also, if some homebirth advocates make claims that other folk disagree with, that’s called discourse.  I’ve heard lots of dubious and wrong claims come out of both doctors and doula’s mouths.  I understand the reasons for both, and i wouldn’t try to muzzle either.  As a thinking person, I’m not taking anyone’s word for fact, no matter what their qualifications. 

    If we’re worried about the birthing system in the US, as we should be, let’s make it better.  Limiting choice by vilifying homebirth, making more and more things illegal, and making hospital transfers so much more charged and negative, isn’t the way to go.

  • ArmyChick

    You are proof that ANYONE can be a “journalist”.

  • AmyTuteur

    Yes, here I am.

    Is this journalism? I thought journalism involved reporting the facts about an issue, not recycling the ad hominems of professional homebirth advocates who cannot rebut the data.

    Jennifer Block never actually challenged the data that I presented. The latest CDC data shows that homebirth increases the risk of neonatal death by more than 600%. You failed to note (as Block herself did) that the people she quotes are professional homebirth advocates. Gene Declercq for example, was an advisor for The Business of Being Born.

    Moreover, you failed to report Michelle Goldberg’s response in which she excoriates Block for her “bad faith approach.”

    http://www.thedailybeast.com/articles/2012/07/05/michelle-goldberg-answers-a-critic-s-distortions-of-her-home-birth-argument.html

    “It was Tuteur who found serious flaws in a widely-cited study published by home-birth advocates Kenneth C. Johnson and his wife, Betty-Anne Daviss, in the British Medical Journal, that purported to show home birth’s safety. In response, Johnson and Daviss self-published a new analysis with updated data—a tacit admission that Tuteur’s criticisms were valid. (Tuteur, as I explained, disputes the methodology of their new, non-peer reviewed analysis as well.) She is an important voice in this debate, whether Block likes it or not.”

    And:

    “This omission [failing to appropriately identify those she quoted] is typical of Block’s bad-faith approach. So, too, is her treatment of the data on home birth safety. In my piece, I note that very little data about home-birth outcomes in the United States is available, that the existing studies are contradictory. Some show much higher death rates for babies born at home. Others, often conducted by home-birth advocates, do not. For those who aren’t qualified to adjudicate a debate over the construction of proper data sets, evaluating them requires, to some extent, understanding the philosophies of their authors. Thus I think it’s relevant that Johnson and Daviss, whose study on home-birth safety is constantly cited by the home-birth movement, are passionate partisans on its behalf. Daviss, particularly, has an almost spiritual stance towards natural childbirth—in my original piece, I quote her saying that it is “one of the times when you are going to be going into a labyrinth of ecstasy.” This doesn’t mean her numbers are wrong, but it shows us where she’s coming from.”

    And:

    “Women have a right to adhere to the home birth movement’s ideology, and as far as I’m concerned they have a right to have their babies anywhere they choose. But they also have a right to know that giving birth at home has the potential for as much danger and trauma as anything in Block’s book about the horrors of hospitals.  They have a right to weigh the very real risk of an unnecessary C-section against the risk of a dead baby, which is much smaller but, to many mothers, much more grave.

    That’s not trying to scare women. It’s being honest with them.”

    If you’d like to write a piece about the large and growing body of data that shows that homebirth with a non-nurse midwife dramatically increases the risk of neonatal death, feel free to contact me. Of course, if you have already decided that homebirth is “safe” and the data be damned, I’m confident that Jennifer Block will be willing to help you. Oh, wait, she already has.