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Vitamin K Refusal – The New Anti-Vax

vitamin K molecules

Variations of the vitamin K molecule.

A small but increasing number of parents are refusing vitamin K injections for their newborns, an intervention recommended since 1961. This is yet another example of the difference between a science-based and philosophy-based approach to medicine. Science has given us the tool of knowledge, and in medicine that knowledge can have very practical applications.

The term “vitamin” was coined in 1912 by the Polish biochemist Kazimierz Funk. A vitamin is an organic nutrient that an organism requires in small amounts but cannot synthesize in adequate amounts and therefore must obtain from the diet. Knowledge of specific vitamins, their food source, and their biochemical activity in the body, has allowed medical scientists to cure many serious nutritional diseases, such as scurvy, rickets, and blindness.

The Vitamin K family are derivatives of 2-methyl-1,4-naphthoquinone, a fat-soluble molecule. It is a cofactor necessary for the formation of factors that function in blood clotting and in bone formation. The primary effect of vitamin K deficiency is therefore bleeding. Infants are at risk for vitamin K deficiency because this molecule does not cross the placenta well. Infants are therefore born relatively deficient in vitamin K. Further, breast milk contains little vitamin K (regardless of the mother’s diet) so infants are at risk for vitamin K deficiency until they start eating solid food at around 6 months (see Clay Jones’ post on the topic here).

The standard of care for many decades has been to give all newborns a vitamin K intramuscular injection. This contains enough of the vitamin to cover them for 6 months until they start getting enough vitamin K in their diet.

Without supplementation, there is an incidence of vitamin K deficiency bleeding (VKDB) in the first week of life of 0.25-1.7%. There is also a late VKDB that is more severe but has a lower incidence of 4.4-7.2 per 100,000 live births. Bleeding most commonly occurs in the brain, and when severe it can be devastating and even fatal.

A single injection of vitamin K at birth significantly reduces the risk of VKDB. In fact, it virtually eliminates the risk. Recent studies looking at infants who have VKDB show that most or all of them did not receive vitamin K prophylaxis. This is a simple, safe, and effective preventive measure, essentially just giving a vitamin to newborns, that prevents a common and potentially devastating outcome. Why would anyone refuse such a clear homerun intervention?

As you might suspect – ideology can trump science and reason. A study published this week in Pediatrics by Sahni et. al. found that 0.3% of those in the study refused neonatal vitamin K. Those who did refuse were 14.6 times more likely to also have refused all recommended vaccines up to age 15 months. They were also 4.9 times more likely to have a planned home birth, and 3.6 times more likely to have delivered at a birth center. A New Zealand survey also published this year found that 100% of medical staff, but only 55% of midwives, agreed that all newborns should receive vitamin K.

One way to interpret this data is that there is a pattern of distrust of the medical establishment or distrust of science in general, and reliance upon so-called “alternative” approaches to birth and childcare. In other words, this is a result of ideology trumping science. As a result, there is an increasing incidence of early and late bleeding in infants.

The numbers of refusals are still low, but are rising fast, clustering in certain centers and hospitals. A recent Tennessee abstract found that in one hospital the refusal rate was as high as 3.7%. They also found that:

Of 102 vitamin K refusers surveyed, 47 (46%) responded; 31/47 (66%) identified bleeding as a risk of refusing prophylaxis. The leading reasons for refusal were desire for a natural birthing process (43%) and believing prophylaxis was unnecessary (43%). Hepatitis B vaccine and erythromycin eye ointment were also refused by 65% of respondents.

In other words, an irrational adherence to the naturalistic fallacy was largely to blame. This was possible combined with misinformation, but I have to wonder if the bleeding risk excuse was simply a post-hoc justification and not the true reason for refusal. Further, we see that those who refuse vitamin K also refuse other recommended interventions, including erythromycin eye ointment used to prevent blindness.

Conclusion

In my opinion, what we are seeing here are the downstream effects of the “alternative medicine” philosophy and world-view. Promoters of CAM often instill a general distrust in science and the institution of medicine. They promote dubious treatments with the notion that “natural” (even though poorly defined) is somehow inherently superior, and therefore interventions that seem technological are to be feared.

They have been unfortunately successful in marketing their philosophy. As a result there are parents who refuse for their newborn children safe and effective interventions supported by solid scientific evidence.

Posted in: Science and Medicine

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183 thoughts on “Vitamin K Refusal – The New Anti-Vax

  1. Windriven says:

    “100% of medical staff, but only 55% of midwives, agreed that all newborns should receive vitamin K.”

    Yeah but midwives love babies more than doctors do, so we should trust the midwives’ superior fondness.

    * * *

    As an aside, can mothers in developed countries make it through pregnancy these days with undiagnosed gonorrhea? I’m not suggesting that erythromycin ointment be dropped, just wondering what the NNT is in 21st century America.

    1. mouse says:

      I don’t have the stats windriven, but it’s good to remember that most women who have gonorrhea don’t have symptoms. Also, for various reasons, a good number of women in the U.S. still go without appropriate prenatal care.

      1. KayMarie says:

        Last I saw it the stats of inadequate prenatal visits was something around 5%

        You then add in the ones that even with adequate testing either have a false negative or had a status change between testing and birth….

        Given the seriousness of what happens for some percentage while doing nothing, I think that is what keeps it as a standard of care kind of thing.

        1. Windriven says:

          Yeah, I hadn’t thought about those who don’t get adequate prenatal testing or those infected after testing. And of course mouse is right, gonorrhea is more often asymptomatic in women than in men.

    2. kaitch says:

      I wondered the same, just wish I could remember what I found when I looked it up,I think it was in the order of hundreds..(NNT)

  2. Thomas Kundera says:

    France does not “give all newborns a vitamin K intramuscular injection” at birth, instead they give some K vitamin by oral way at birth and a bit later.
    Shouldn’t be that bad, according to the fact that infantile mortality is twice time lower in France than in the US.

    So a few simple questions:
    - Was an oral substitute proposed to parents refusing the injection method?
    - If not, why?
    - Could it be that the “superiority of scientific medicine” would rather see children die (and say “look, I told you!”), than to compromise with the (I admit, likely irrational) belief of the parents? The same “superiority” that did (and still does) routine circumcision without any medical reason whatsoever (but likely tied to their own beliefs)…

    Thomas.

    1. Windriven says:

      ““superiority of scientific medicine” would rather see children die (and say “look, I told you!””

      Where the hell did that come from? Or this:

      “The same “superiority” that did (and still does) routine circumcision without any medical reason whatsoever”

      I don’t claim to know whether or not oral vitamin K was offered but it is a ridiculous allegation based on nothing but ignorance and bile that scientific medicine is more interested in being right than in helping patients.

      I do know that circumcision is a choice made by parents, not by the medical-industrial complex.

      Is there anything at all in your comment that is based on fact or is it all a product of your overheated imagination and your antipathy to science? You are correct that the infant mortality rate in the US is twice that of France but you fail to realize that the stillbirth rate in France is twice that of the US. The point being that in the US we throw tremendous resources at saving babies that would simply be written off as stillbirths in some other countries. Oh those rotten scientists, trying to save 1kg babies.

      1. Young CC Prof says:

        Saving one-kilo babies is practically routine these days, at least in the USA’s astonishingly good NICUs. In the CDC’s 2010 records, 95% of babies born between 1000 and 1500 grams survived! One-pound babies, now that’s hard, but it’s been done.

      2. EBMOD says:

        “““superiority of scientific medicine” would rather see children die (and say “look, I told you!””

        Where the hell did that come from?”

        Ties in well with the ‘How they see us’ series they have been doing here on SBM. Since the science doesn’t support their view, they have no choice but to go for ad hominem attacks to maintain superiority.

    2. Roadstergal says:

      I would guess, not being in this particular business, that compliance is an issue with multiple doses of oral supplement vs one shot at the hospital. With so many parents claiming to believe that ‘prophylaxis is unnecessary,’ I would doubt that a different route is going to make a difference to their irrational behavior.

      And there are good medical reasons why parents might choose to circumcise, but that’s a discussion for a different post.

      1. WilliamLawrenceUtridge says:

        And there are good medical reasons why parents might choose to circumcise, but that’s a discussion for a different post.

        Just to gleefully throw a match into an open pool of gasoline – no there aren’t :P

      2. Greg says:

        “And there are good medical reasons why parents might choose to circumcise”

        I’ve yet to see any evidence for any such reasons. The best argument’s I’ve seen have basically been about situations that are cured by puberty (i.e. claiming it is cleaner, well, come puberty, won’t be a problem, since many guys tend to masturbate in the shower and telling others to do so for medical reasons won’t be a hard sell)

        1. Windriven says:

          “I’ve yet to see any evidence for any such reasons. ”

          You are looking at this issue with first world eyes.

        2. Harriet Hall says:

          There are medical reasons why parents might choose to circumcise. I covered them at http://www.sciencebasedmedicine.org/circumcision-what-does-science-say/ Opinions differ about how “good” those reasons are. That’s why the American Pediatric Association says there is a small medical benefit but does not recommend universal circumcision and leaves the decision up to parents.

    3. Clay Jones says:

      There is not an FDA approved oral Vitamin K supplement in the United States. We can’t give them an oral supplement in the hospital. Parents for the most part order it online. Such products fall under the scrutiny of DSHEA. Buyer beware. The answer isn’t to make an oral formulation available, it is to educate families and, perhaps more importantly, midwives and obstetricians so that they can begin discussing vitamin K administration early on in the pregnancy.

      Here is a Scientific American article published yesterday on this subject that I was quoted in a few times: http://www.scientificamerican.com/article/more-parents-nixing-anti-bleeding-shots-for-their-newborns/

    4. Sullivanthepoop says:

      No, the oral vitamin K fails at preventing late VKB. Most countries that switched to it switched back to the injected vitamin K because the late bleeds are more dangerous. Also, the oral vitamin K has to be taken every day for months. A lot of parents do not keep up with it well

    5. WilliamLawrenceUtridge says:

      Infant mortality is hard to compare across countries. One of the confounds is that some countries consider an infant that dies within the first month as “infant mortality” while others differentiate between an infant that dies in the womb or during birth from those that die within the first month. The US has horribly bad infant mortality statistics in part because it lumps all those first month (possibly week, I read this on the Sketpical OB a while back and don’t recall the specifics) deaths into the same category. By contrast, it has a very low perinatal mortality rate, since the statistics only count those older than one month as “perinatal”.

      Also, the idea that vitamin K shots somehow skews the stats in a meaningful way is pretty unlikely, considering how low the death rates are given that both countries do supplement vitamin K in newborns.

      Could it be that the “superiority of scientific medicine” would rather see children die (and say “look, I told you!”), than to compromise with the (I admit, likely irrational) belief of the parents? The same “superiority” that did (and still does) routine circumcision without any medical reason whatsoever (but likely tied to their own beliefs)…

      No. Doctors don’t like to see babies die just to prove a point. You’re an asshole to even suggest it.

  3. DevoutCatalyst says:

    Newborn screening is under fire as well. The state parental refusal forms are enlightening, this text is from Michigan’s:

    “I (We) have been fully informed of and fully understand the possible devastating
    consequences to my (our) child’s health, including severe mental and/or physical
    impairment or death resulting from the disorders screened for by the MDCH Newborn Screening (NBS) Program.”

    What kind of parent could sign a form that says that ? CAM causes severe mental impairment in its worst manifestations, and the effects tend to be permanent, rendering the victim into an oppositionally defiant jack of one trade, master of none.

    1. Windriven says:

      “oppositionally defiant jack of one trade, master of none”

      :-)

    2. Vicki says:

      I suspect that many of those parents don’t read it, just say “where do I sign?” and do so. That’s how people seem to handle most forms; on anything from shipping a UPS package to medical paperwork, people who give me papers to sign are surprised when I tell them to wait while I read it.

      If so, saying “I have to tell you what the risks of refusal are,” doing so out loud, and then saying something like “I’m required to make sure you understand this. What are the risks of not screening your child?” might make a difference. Because it’s probably easier for someone to just skip reading the form and sign it, than to say “it says that if I don’t have my child screened, they’re a lot more likely to die” and then sign the refusal. (Sure, some of them would say “well, you say that if I don’t have him screened, he’s more likely to die, but my pastor says that’s a communist plot” or “but my chiropractor told me better” but not everyone.)

  4. goodnightirene says:

    It may be the “one size fits all” approach that bothers some of the granola-crunchy types more than just a naturalistic fallacy. As you all know by now, I had planned home births and while I declined eye ointment (I had a test–unnecessary–for STD), I did have Vit K and PKU testing. My motivation in all this was an innate offense taken at the (to me) over-medicalization of a usually normal event. Every woman does not need to be treated as a high risk OB “case”. My midwife was a nun, not a flake–well, I did have a flake for the fourth, but I dismissed her late in the game. I will defend my position as one coming from being well-informed, not mis-informed. I will also that I guess that I am nearly alone in that. I never commiserated with other home birthers because I did find them to be flakes, but I will admit to picking up the idea of birth being a life event rather than a medical problem from the LaMaze crowd (and I still see nothing at all wrong with delivering without medication). I don’t see where men should have much to do with it, but that’s just me and there are plenty of female OBs these days, but not when I had mine. You also have to take a look at just how it was all done 45 years ago at the average hospital and you will easily see why many women started looking for ANY alternative. Sadly, that honest yearning has been co-opted by the alties.

    1. Windriven says:

      “My midwife was a nun, not a flake”

      The two are not mutually exclusive. As the product of Catholic primary education I can personally attest to this.

    2. brewandferment says:

      GoodNightIrene,

      Hear, hear! Your reasons and thoughts are pretty much the same as mine although in fairness, my hospital delivery sounds nicer than what you’ve described of yours in previous posts. Maybe because it was about 20 years later (eldest is not quite 21) and women like you were bringing about the changes you describe. I too had planned homebirths and chose all 3 interventions for my kids–the ointment more out of indifference than research. My midwife mentioned the issues that some of the crunchies had but my impression was that she didn’t agree with them and was supportive of science at least with regard to the VitK shot. There was a little bit of woo, but minor enough to ignore. And I had concurrent checkups with my military OB as backup.

      1. Calli Arcale says:

        Goodnightirene —
        “Every woman does not need to be treated as a high risk OB “case”. ”

        I general, I agree with your post, but it seems you’re presenting a bit of a false dichotomy in this sentence. It isn’t a choice between homebirth with a midwife and high risk obstetrics. The vast majority of hospital births are not high risk, nor treated as if they are. High risk brings in a whole ‘nother level of medical intervention way beyond the routine labor & delivery experience, where you’re in and out in a couple of days.

        1. brewandferment says:

          Hi Calli,

          Good point, although in my case it seemed almost like it was only those 2 choices–the military hospital (my only hospital option) was pretty hard over for continuous fetal monitoring (so much for staying mobile unlike kid # 1 in a community hospital) and nothing by mouth, among other things. If an option more like the first kid’s birth was available for the other two, who knows, I might have been more interested in a hospital birth. But I’m not trying to sidetrack this and start down the path of a long thread of pro and con, just mentioning my feelings.

        2. goodnightirene says:

          Calli, you make a point, but in 1969, all women were treated as objects to be freed of a rather dangerous tumor without so much as a how-do-you-do from the very serious OB (old white male) who never even spoke to me. Nurse Ratchet, who refused to let me unwrap my baby wasn’t any better. I acted on my own experience and that of all the other women my age who found this regimen repugnant. By the time of my granddaughter’s birth in 1989, things had indeed improved and I had no quarrel with my own daughter choosing birthing room delivery, although it would not have suited me. The anger (and sheer cruelty of) instilled in me by my first delivery will probably never subside.

          As I have said before, I have never promoted home birth to anyone, although in earlier days I did encourage some who were already interested.

          Windriven, I kinda knew you, or someone, would make that note about nuns and flakes. I’m not Catholic, but I have found that nuns have changed as much as hospital birth in the last 40-some years. The one I had as midwife was always a model of virtue and a very well-trained and sensible midwife.

          BrewandFerment

          Thank you for your support. I agree with you especially about the limitations of routine and continuous fetal monitoring. This is what I mean by treating all cases like high risk. Hospitals probably vary enormously and I realize that some people welcome any and all intervention “just in case”. I simply reserve the right to feel otherwise.

          Crankyepi

          It’s some of what goes on in those couple of days that bothers me. I wouldn’t deliver in a hospital even if I was only there for the 15 minutes it takes me to deliver. As I’ve stated here before, part of my decision was based on a history of rather precipitous birth. I decided I’d rather have this happen at home than in a car or on the sidewalk. It seems a little disingenuous of you to imply that I was not putting safety first.

          1. Calli Arcale says:

            I completely understand, goodnightirene. I just wanted to make clear for the record that there is very definitely a middle ground. Just campaigning for the middle, that’s all. ;-)

        3. WilliamLawrenceUtridge says:

          I’m very happy to see Mrs. Utridge’s potential future births treated as high risk, as the thought of her dying in childbirth, assuming she ever births a child, terrifies me.

          I am extremely risk-averse, it’s part of the reason I exercise and eat the way I do.

          I have to admit, reading your (B&F) discussion gives me the heebee-jeebees and I would never personally agree with it. Not that ultimately it’s my decision what my wife would do in childbirth. But you’ve thought it through and came to a conclusion that is reasonable given your acceptance of the risks.

          Just, y’know, in case you gave a crap about what a stranger on the internet thinks.

          1. brewandferment says:

            why thanks WLU! For sure, if I lived out in the back of the beyond where there was no hospital within minutes, or were 5 foot tall (instead of 6 which I am) with a previous history of cephalopelvic (I can’t think of the rest of term which means baby’s head too big for pelvis) or otherwise had known serious issues I would have sucked it up and made the best of the hospital. Even if I had to be a belligerent patient–what would they have done, tossed me out on my arse? made me an ensign and sent me on deployment??

            And no I don’t shame or otherwise push it on other women. At most I tell them that all the stories of how horribly painful labor and delivery is may not actually be their experience, because it wasn’t for me. Caffeine withdrawal while well along in labor with kid #1 was what made that labor the worst of all 3!

          2. mouse says:

            @WLU If you are risk averse it might be that you just want Mrs. WLU treated at the appropriate risk level. Think in terms of appropriate testing and treatment of a person with a high risk of cancer (say 55 with a family history of colon cancer vs 25 with no history of colon cancer). Treating someone that is low risk as high risk may actually increase the risk of false positives or interventions that don’t have a good risk/benefit profile. More medical care isn’t always better.

            You probably knew that, but I’m waiting for my soup to boil, so I just thought I’d throw it out there.

            1. brewandferment says:

              As in, continous fetal monitoring prevents mom’s mobility, which can lead to a slow down of labor (as can too-early an epidural) and that can lead to a cascade of interventions that might not have been needed if mom was mobile, and may even have caused harm.

              A perhaps silly but for the sake of discussion point: Babies do get born in cars enroute hospitals–recently there were 2 cases in my area about a week apart, one a 4th or 5th child–but the other one a 1st or 2nd child (I think it was a first because it was so unexpected to be such a fast delivery.) That doesn’t mean pregnant women are admitted to hospital at 38 weeks just in case!

              My mom’s induction (elsewhere on this post) probably wouldn’t be acceptable now based on newer guidelines about inducing prior to 39 weeks and NEVER for convenience, but you get the point.

              1. WilliamLawrenceUtridge says:

                A perhaps silly but for the sake of discussion point: Babies do get born in cars enroute hospitals–recently there were 2 cases in my area about a week apart, one a 4th or 5th child–but the other one a 1st or 2nd child (I think it was a first because it was so unexpected to be such a fast delivery.) That doesn’t mean pregnant women are admitted to hospital at 38 weeks just in case!

                Babies and mothers also die en route to hospital, and in hospitals, and in birthing centers, and during home births, etc. etc. You can never make a decision on the basis of examples (which I know you know, of course). These days, most births in the first world are safe – so safe, that while we worry about the mother, we do not have the pants-wetting terror of our ancestors did when their wife, daughter, mother, sister, friend gave birth.

                It’s a complex and emotionally laden math that ultimately comes down to what risks you are comfortable with. But many things are like that – one man’s enjoyable hobby is another man’s horrifying invitation to death.

    3. CrankyEpi says:

      I agree that hospital births have gotten better since I was born in one (52 years ago). On the other hand, saying “birth is a life event and not a medical problem” only works when no problems occur during birth. (Or, perhaps medical problems are a subset of life events.) No pregnancy is free of risk, in fact, higher parity is associated with some pregnancy / delivery complications so a history of uneventful pregnancies is not a guarantee that the next labor & delivery will go smoothly. My personal preference is to put the safety of the baby and mom first and the mom’s “experience” next. You’re only in the hospital for a couple of days give or take.

  5. Mike says:

    Is accepting the vitamin K shot linked to any other requirements?

    When our children were born in the state of Maryland, blood was drawn for a variety of genetic tests. In addition, blood was saved for future testing by the state. We tried to prevent the blood being saved for future testing, but were told that the only way to do that was by not having any of the genetic testing done. I think most of the genetic tests were for enzyme anomalies which would cause severe problems in the newborn. I am still angry with the state for making us have to accept them keeping some of the blood for future testings in order to get the other testing done.

    1. Windriven says:

      “I am still angry with the state for making us have to accept them keeping some of the blood for future testings in order to get the other testing done.”

      Why?

      I’ve no idea why Maryland wants to keep vials of infant blood but I’m having a difficult time figuring out why this so incenses you.

      1. Sean Duggan says:

        I have some queasiness over such things due to the various “gene patents” out there. Odds are, we’re never going to get quite so silly as a company laying claim to a pattern in the blood samples and forbidding someone from distributing unlicensed copies by donating blood, but more ridiculous things happen in the legal system.

        And I’ll admit that there’s also a degree of atavistic fear due to centuries of tales of such-and-such sorcerer cursing people via their blood mixed with sci-fi tales of targeted viruses and bioweapons based on DNA.

        Lastly, well, what reason do they have for keeping it?

      2. mouse says:

        I think most of the concerns I’ve heard have to do with privacy/illegal search. The idea is that the blood might be used in a manner that is not approved by the owner to reveal information about them to another party.

        Say a particular police or government offical wanted to identify someone who’s dna was found at a particular location (crime scene, political meeting, etc) What guarantees would we have that the sample wouldn’t be used inappropriately?

        I find the idea of the government keeping samples of anyone’s blood in an identifiable way outside of a criminal investigation with appropriate legal controls really very creepy. But isn’t that already considered not constitutional? I thought I heard that quite awhile ago.

        Now if samples are kept anonymously for population research, if there is a mechanism for separating identifiable information from the sample. I have no problems with that. But I still don’t think that the genetic testing should be tied to consent for archiving blood, that comes across as applying punitive pressure for consent.

      3. Michael Busch says:

        I don’t think vials are stored. I thought the standard was to store Guthrie dried-blood-spot cards, used to screen for a bunch of different congenital diseases and then often archived for later quality control, epidemiological, and environmental studies. e.g. http://www.nature.com/news/archived-blood-spots-could-be-epigenetic-jackpot-1.11258 .

        If such archiving should be mandatory or opt-out voluntary has been argued, and policies vary from country to country, and in the US from state to state.

  6. e canfield says:

    Do they ever combine the K shot and the Hep shot? I only remember my baby getting one shot, but then, I was pretty fuzzy from the magnesium after my bp (unexpectedly) skyrocketed.

  7. NewcoasterMD says:

    There certainly has been a trend in recent decades to over medicalize birth. It was one of the (many) things that turned me off obstetrics during med school and Family Practice residency. I figured women have been giving birth for hundred of thousands of years without doctors, and at the time there was a preponderance of males as ob-gyns which I found odd. There was a wide variation however. I recall one attending ob-gyne who would glove, gown and mask for routine deliveries, and insisted his students did as well. I felt sorry for the women and their husbands, as I’m sure they must have worried what is wrong (As a side note, he later was the victim of a sniper shooting from an anti-abortion nut job. Didn’t kill him, but ended his career as a surgeon). Another attending at the same teaching hospital would arrive in jeans and a t-shirt. Guess which role model I found preferable?

    As another anecdote, but related to newborn Vitamin K. I did my first ( and last ! ) delivery as a freshly minted FP in a remote northern Manitoba nursing station during my first month in practice. A 16 year old girl, arrived drunk and in full labour about 2 am. She’d had no pre-natal care except one visit early in the first trimester and all she could recall was the baby was backwards. Fortunately, it wasn’t , and I delivered a healthy appearing baby an hour later uneventfully. I then left to write up the case, and arrange transfer down south to the city while the nurses got mom and baby settled and give Vit K, among other things.

    Nursing stations are not supposed to be doing deliveries, but they were stocked with the bare basics for those rare emergencies, including an assortment of drugs like Vitamin K for the baby, and Ergot for mom ( for post partum hemorrhage ). Unfortunately they were both in small brown ( and dusty!) vials. I was relaxing and congratulating myself on a crisis averted when a very pale and shaky nurse came to tell me she’d just injected the newborn with ergot instead of Vitamin K.

    Ergot works in part by constricting blood vessels so it’s effects can be quite variable depending on where it acts. This being before the internet I quickly leafed through the CPS (compendium of pharmaceuticals and specialties aka the big blue book of drugs here in Canada ) which listed all the terrible things that could happen, but not what to do about it. I phoned the on call neonatologist who also then leafed through his own copy since he’d never heard of this before. While I was on the phone with him, the baby started having a seizure so I left him hanging and went to deal with that. Essentially, nobody really knew what to do. Eventually we just bundled the baby up, loaded it with anti-seizure meds and flew them to the nearest hospital that had a neo-natologist.
    I never did find out what happened to the baby, but the nurse who gave the injection was fired.

    So, Im in favour of giving Vit K…..but double check the label first.
    And I haven’t delivered a baby since then.

    1. Windriven says:

      “one attending ob-gyne who would glove, gown and mask for routine deliveries … [a]nother attending at the same teaching hospital would arrive in jeans and a t-shirt.”

      I’ve listened to enough Puscasts to hope for something in between. The full regalia might be a little much but there is likely to be an episiotomy or tearing, a wide open cervix, and a whole lot of what-ifs. Come to think of it, the gown, gloves, mask and whatnot sound OK to me.

      1. Andrey Pavlov says:

        The full regalia might be a little much but there is likely to be an episiotomy or tearing, a wide open cervix, and a whole lot of what-ifs. Come to think of it, the gown, gloves, mask and whatnot sound OK to me.

        I’ve delivered 4 babies (no more, no less because that was the minimum requirement for me to pass the rotation). And even in absolutely straightforward deliveries with no cutting, tearing, or sewing of any kind I can assure you that I wanted a full BSL-4 hazmat suit. I’ve seen less blood, feces, and other body fluids come out of multiple trauma and gunshot victims.

        The full regalia is not to protect the patient so much as it is to protect the clinician. At a minimum it is protection so you can keep your shoes out of the trash and be able to go to the next room without showering and changing attire.

        1. Windriven says:

          Good point. Its been a few years and I’d forgotten the poop storm that accompanied 2 of mine.

          1. goodnightirene says:

            None of that happens in home birth (not mine anyway) because without all the intervention, you go into the bathroom, when you want, and have a good clean out all on your own–and then rip the towel bar off with the next contraction! I think Andrey and Newcoaster pretty much vindicate my view of medicalized birth–luckily, those who choose OB as a practice specialty, feel otherwise. :-)

            1. WilliamLawrenceUtridge says:

              It’s part of the ambiguity of medical care (and most philosophical debates). Ultimately there is no, and can never be, one correct answer to many questions. It’s what you’re comfortable with, given the likelihood and impact of the risks. So much of the fighting is over questions that, given the current state of science and technology, can’t ever be resovled with a single correct answer.

            2. Calli Arcale says:

              Well, my dad went through a lot of shoes when he was doing labor and delivery as a GP, and it wasn’t from the poo. ;-) Poo washes off just fine, as anybody with a large pet dog knows all too well. It’s the amniotic fluid that really ruins stuff, especially leather.

            3. moto_librarian says:

              Having an unmedicated delivery does not guarantee that you will not have a bowel movement while pushing, and I don’t think that it matters if you are at home or in a hospital. Unless you take castor oil or have an enema, you are not guaranteed a good “clean out” either.

              If you haven’t given birth in a hospital in the past five to ten years, you really don’t have any idea of what it’s like now. Many larger hospitals have midwifery practices (both of mine were delivered by CNMs), and have birthing balls, jacuzzis, etc. to facilitate unmedicated birth. I know that I was quite grateful to be in one when my first delivery (described as “textbook” by the midwife) abruptly turned into an emergency immediately after the placenta was delivered and I began to hemorrhage. I wound up going to the operating room to have my cervix stitched back together, and narrowly avoided a transfusion. I would have given my right arm for pain medication during the manual examination of my uterus, and can still remember the blissful release when an I.V. was run and I felt the fentanyl flowing into my system.

              Birth is only low risk in retrospect. In the absence of modern obstetrics, it exacts a huge toll on both mothers and their children. I can understand wanting to get away from the model of birth in the 1950s, but remember that one of the earliest feminist causes was for safe and effective pain relief during labor and delivery.

      2. n brownlee says:

        I for one thank whatever and whoever there is to thank for the medicalization of childbirth. I had the long, fruitless labors of soft tissue dystocia, radical episiotomies, a massive delayed postpartum hemorrhage, and several other complications too icky and personal to describe here- but I’m not dead and neither are the babies. In fact the babies weren’t even damaged, and my single regret about childbirth is that I was a little too early for cesarean-on-demand.

        Anyone who’s really curious about the outcome of non-medicalized childbirth ought to go look at some ladies’ bottoms in sub-Saharan Africa, and at the many, many tiny gravestones in the cemeteries of any century before this one, in THIS country. Yes, it’s a natural process, all right… so what?

        1. goodnightirene says:

          I, too, am grateful for medical intervention of high-risk or complicated childbirth (and yes, I am aware that some complications are unforeseen) and I am certainly aware of the horrors of unassisted (and all that goes with it prenatally, including lack of care) or untrained-assisted birth, but that is not what I chose and I do not live in the third world. I had a well-trained and highly experienced nurse-midwife plus the full complement of prenatal care from an OB.

          1. WilliamLawrenceUtridge says:

            And you went with a nurse-midwife, and you ditched the flaky one. If you’re going to do homebirth, yours is the best, most science-based way to do it as far as I can tell (not being a doctor, expert or woman).

            You’re obviously one of the branch points where reasonable people can disagree.

    2. Kerlyssa says:

      People have been dying/being maimed during birth for as long as humans have been around, too… o.0 what a bizarre justification. Do xrays overmedicalize broken legs? Dental checkups overmedicalize the normal process of eating and speaking? Isn’t the whole point of medicine to IMPROVE the human life? Shit, if there’s a process that needs improving in the human life, birth would be it. NOT humanity’s strong point.

      1. Andrey Pavlov says:

        People have been dying/being maimed during birth for as long as humans have been around, too… o.0 what a bizarre justification. Do xrays overmedicalize broken legs? Dental checkups overmedicalize the normal process of eating and speaking? Isn’t the whole point of medicine to IMPROVE the human life? Shit, if there’s a process that needs improving in the human life, birth would be it. NOT humanity’s strong point.

        Precisely. The point of medical care and science should not be to just keep the status quo but to constantly improve it.

    3. Erin S says:

      There certainly has been a trend in recent decades to over medicalize birth.

      Of course there has. That would be because, prior to modern technology, a woman’s chance of dying from childbirth was about 50%. Medical professionals do not like to see their patients die.

      Technology has in fact lulled us into the belief that childbirth is natural and thus safe. We forget just how much can and does go wrong that no longer ends in death, but still can without inverntions. Midwifery is not regulated in many areas of the US (thus no educational requirements, no tracking of them and so forth). And that should be taken into consideration when making your decisions. Does your state regulate and license midwives, do they track outcomes, are they required to carry malpractice insurance and so forth. Do they agree with philosophies that do not stand up to scientifically backed evidence? What are there procedures for identifying problems and standards for transferring care? How will they handle an emergency situation.

      And yes, if you have an OB you should be asking the same questions.

      If you doubt that natural childbirth is dangerous, you should look at the maternal death rates in third world countries who almost routinely have natural childbirth
      You will see lifetime risks of death in the 1:18-1:50 range (the US is 1:2400, France, in comparison is 1:6400, Ireland 1:8100 – the US has one of the worst MMR in the industrialized world) and what you will see is the lower the ratio, the less percentage of births with skilled care or in hospitals (of those that report that statistic).

      1. Michele S says:

        For further comparison, you could also look at mortality rates in countries that have a midwifery model of care, particularly Scandinavian countries, where planned home birth for low-risk women is the norm. Spoiler alert: their mortality statistics are better than ours, and at minimum indicate that planned home birth for low-risk pregnancies is not inherently less safe for mother and baby than hospital birth. (However, your points regarding the training of the attending care provider are well made.)

        “In a planned home birth assisted by an experienced midwife with collaborative medical back up in case transfer should be necessary these drawbacks are avoided while the benefit of access to medical intervention when needed is maintained. Increasingly better observational studies suggest that planned hospital birth is not any safer than planned home birth assisted by an experienced midwife with collaborative medical back up, but may lead to more interventions and more complications. However, there is no strong evidence from randomised trials to favour either planned hospital birth or planned home birth for low-risk pregnant women.” – See more at: http://summaries.cochrane.org/CD000352/PREG_benefits-and-harms-of-planned-hospital-birth-compared-with-planned-home-birth-for-low-risk-pregnant-women#sthash.trvsJaYY.dpuf

        1. goodnightirene says:

          Thank you Michelle S! I have often cited your example, but forgot to do so here.

          To all of you bringing up the horrors of the third world, this is a bad argument to make to a first world woman–apples and oranges.

          Lastly, I have never tried to convince anyone to have a home birth–even my own daughter. It is not a responsibility I would accept for anyone but myself. My home-birthed children seem to have no regrets. :-)

    4. simba says:

      I think the gown and mask and gloves would reassure me. I’d like to think my doctor was crazy-prepared and absolutely anal about hygiene. Ideally he’d be running back to re-wash his hands because he has to do so every time he sees or thinks of the colour yellow.

      Jeans and t-shirt, in that particular situation, would scare me. Fine for the GP though.

      I think it’s because I read so much about medical history. Doctors and midwives would see case after case of childbed fever… which disappeared once they burned the coat they were wearing to all their cases, or stopped using the same blanket time after time. Childbirth has always been dangerous.

      1. goodnightirene says:

        Childbirth has “always been dangerous”–for a segment of the population. We would not have got to 7 or 8 billion (much of it third world) otherwise.

        Hygiene is certainly important–especially in a hospital full of germs, but not so much in one’s own (presumably reasonably clean) home in the first world.

        1. WilliamLawrenceUtridge says:

          Childbirth has “always been dangerous”–for a segment of the population. We would not have got to 7 or 8 billion (much of it third world) otherwise.

          I very much have to disagree here – part of getting to the 7-8 billion is because of superior prenatal care, but much of it is because most births do not end in death. But that doesn’t make it a rare event. It’s a question that could never be answered, but I wonder what the population would have been if all mother and child deaths could have been prevented. I’m guessing much higher.

          Not to attack B&F’s choice, she made an informed one. Or both of you? I suddenly realize that I’m mixing up you two for reasons unknown (in my defence, my web browser doesn’t display the avatars) and my apologies for that. It means my brain sees both of your names as equally reliable and worth reading, if that pleases you in any way.

          But I very much don’t think child birth was historically a safe activity.

        2. Greg says:

          “Hygiene is certainly important–especially in a hospital full of germs, but not so much in one’s own (presumably reasonably clean) home in the first world.”

          That is absurd. A “reasonably clean” home is filled with microbes that could infect open wounds (like tearing, which happens pretty frequently) very very easily.

          1. WilliamLawrenceUtridge says:

            Hospitals, however, are more likely to contain more deadly or more resistant bacteria. More patients with serous diseases and more patients on antibiotics.

            Post-delivery infection (i.e. “caught” during delivery, developing into an infection after) is one of the few reasons I would consider reasonable for avoiding a hospital birth.

            Of course – that’s purely a personal judgement about what is reasonable, people can differ.

            1. Lacri says:

              The people with serious diseases aren’t usually in the labour ward. I don’t think there’s much evidence for hospital acquired infections during or after delivery.

              1. WilliamLawrenceUtridge says:

                The people who clean the rooms do move between the labour ward and other wards. There are opportunities for transmission, and evidence it occurs:

                http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD007462.pub2/abstract

                http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD004455.pub2/abstract

    5. WilliamLawrenceUtridge says:

      I figured women have been giving birth for hundred of thousands of years without doctors

      Sure, but babies and mothers have also been dying in childbirth for just as long. Humans are not optimized for birth, they’re walking a fine line between functional bipedalism and functional incubators. Evolution doesn’t seek the best solution, only the best solution given current parameters for genes as a whole. If that means some mothers die in childbirth so others can run away from an attacking lion, so be it.

  8. Sullivanthepoop says:

    I do not at all believe that birth is over medicalized or that men are overly involved. That all sounds like woo to me. I have a 24-year-old and had none of the issues that people swear were common to hospital birth then. I never even had an episiotomy with 1 birth in the 1980s and 2 in the 1990s.

    1. Windriven says:

      My only disagreement would be the prevalence of men in the field. My primary is a female. My proctologist in NOLA was a female. I draw the line at my urologist. Call me a sexist but I want my urologist to have the same plumbing as me. I felt that way about OBs. In truth we used both and the male was every bit as competent and caring as the two females. But I can imagine conversations that a woman would be more likely to have without inhibitions with a female physician than with a male one.

      1. Calli Arcale says:

        I understand there has been a demographic shift in recent years, to more female OB/GYNs, as they are understandably in high demand, and because, well, it fits the old social mores about women’s work. What’s more womanly than delivering babies? We like to think we’re progressive and that women can do anything, of course, but even the most rampant feminist will imagine a female doctor delivering a baby more easily than a female doctor performing brain surgery, because those are the mental images we’re primed with by society.

        1. Sean Duggan says:

          I’ve even seen one article where the schools are discouraging men who sign up for the OB/GYN program by telling them that they’re going to be facing massive amounts of discrimination because so many hospitals want to hire women instead. Which seems like institutionalized sexism, but of course, I Am Not A Lawyer, so I’m sure there’s a reason why this could go on other than the business’s general right to refuse to indicate why they chose one candidate over another.

        2. Windriven says:

          Funny how we all have our little prejudices. I generally tend toward female physicians and accountants because in my experience they are more detail oriented and thorough. It isn’t a strong bias but it is demonstrably there.

          1. Egstra says:

            “I generally tend toward female physicians and accountants because in my experience they are more detail oriented and thorough.”

            And 50% of my really bad experiences with MDs have been with women.

            1. Windriven says:

              Look, I said right from jump that this was a personal prejudice not based on objective data. Prejudices are definitionally irrational. I was just making the point that not all prejudices about native competencies are universal.

              1. Calli Arcale says:

                Very true. I prefer female doctors for myself (though I’m okay with guys), but my old office mate insisted on male doctors for her pregnancies; she’s a feminist, but she just couldn’t shake in her head the idea of compentent doctor = male. She knew it was irrational, but also that just because a belief is irrational doesn’t make it any less potent. We live in an area with a bazillion doctors, so it’s not like she was narrowing the field or anything.

              2. WilliamLawrenceUtridge says:

                Ha, if irrational beliefs were easy to shake off, they wouldn’t be irrational! If it were easy to make the empirically correct decision, it wouldn’t have taken 100,000 years to invent science!

      2. mouse says:

        Windriven – I don’t really agree. It really depends upon the individuals. I have met and heard about both female and male OBGYN who came across as very prudish and judgmental* and met/heard about both female and male OBGYNs who are very professional and clearly communicate the message that they had no interest in judging but are there to educate and help. To me, that one of the main concerns, when it comes to asking uncomfortable questions.

        *And I’m not talking about anything outlandish here ;)

        1. Windriven says:

          “It really depends upon the individuals.”

          Of course, mouse. I was speaking in generalities. But if my penis started making farting noises during urination … I’d probably feel more comfortable explaining that to a male urologist :-) I’m just inferring that some women might feel more comfortable discussing potentially embarrassing issues with a female OB/GYN.

          I’m really sorry I stuck my toes in this particular pond. Or is that pond my mouth?

          1. mouse says:

            Oh, well I’m pretty much terribly uncomfortable with ALL people. I’m equal opportunity anxious. Actually that’s not true, I’m more anxious with folks from different cultures, or folks who have accents or some other difference whom I may offend by making an ignorant comment. But it’s not healthy or fair to avoid all those people because I’m anxious, so I just try to avoid mean people, when possible.

            Generally (anecdotally)- meanness seems pretty evenly distributed across different demographics.

            Excluding pyscho-therapists, I slightly prefer a woman there…don’t really know why.

          2. Andrey Pavlov says:

            But if my penis started making farting noises during urination …

            I don’t know if you just randomly came up with something, but that is actually a real condition.

            I am a strong individual and a physician who has worked trauma and ICU and, as they say, seen some $hit. But if air or blood ever comes out of my penis, I can assure you I will run crying to the nearest urologist. And I won’t care if it is a man or woman.

            1. mouse says:

              My son told me the other day that he farts out of his penis. But he didn’t seem distressed, just sharing a surprising occurrence. (Okay, actually it was more pride/delight, like he had just acquired a fabulous new skill.)

              I’m just hoping that goes away without a visit to the doctor.

              1. goodnightirene says:

                For girls, it’s called (according to my kids) “coochie farts”.

              2. mouse says:

                “Coochie farts”? Okay, you learn something new everyday. :)

                I think gas in the urine or from the urethra is not good. Gas from the “coochie” or foreskin is okay.

            2. Windriven says:

              Andrey, I pulled that completely out of my ass. I never knew there was such a thing.

              Many years ago I urinated blood once. The time between the appearance of blood in my urine and the phone call to the urologist was measured in femtoseconds.

              1. WilliamLawrenceUtridge says:

                I thought this was a reference to Larry Niven’s Ringworld series. It’s actually a plot point in one of the books.

      3. goodnightirene says:

        My ex had a female urologist for his vasectomy, and I have had mostly male OB/gyn’s. I would not have a problem with a male midwife if I liked him otherwise.

        My objections to hospital birth had more to do with a cultural system than with the actual sex (or gender) of the attendants.

      4. WilliamLawrenceUtridge says:

        Call me a sexist but I want my urologist to have the same plumbing as me

        I would say this does make you sexist, for the same reason that a good oncologist doesn’t need to have had cancer.

        I calls ‘em like I sees ‘em.

        1. Harriet Hall says:

          That is a sexist attitude, just as preferring a doctor of the same race would be a racist attitude.

          1. Windriven says:

            @WLU and Dr. Hall

            The issue is one of patient willingness to discuss intimate sexual details with a member of the opposite gender. There is no racial equivalent that is not inherently racist. There is no oncological parallel either, though I might be convinced that a young female might be more comfortable discussing vaginal or breast cancer with a female oncologist.

            All that said, I’m comfy with my feminist bona fides which reach back to the early 70s. If preferring to discuss an STD or ED or a green and festering glans with a male urologist marks me a sexist in some eyes, I can live with that.

            1. WilliamLawrenceUtridge says:

              If preferring to discuss an STD or ED or a green and festering glans with a male urologist marks me a sexist in some eyes, I can live with that.

              It’s still sexist :)

              That’s the thing – you admit it’s a matter of personal preference and comfort. I can understand it (you’re better off than Calli Arcale’s friend who simply put an irrational gloss of incompetence over female physicians), it’s personal comfort.

              But it’s still sexist :P

              As I said before – if it were rational, if it were easy to be rational, if it were easy to arrive at empirically correct judgments, science would be 200,000 years old, not 200, and we wouldn’t be dealing with peak oil and overpopulation as a problem.

              1. Windriven says:

                Gee, I didn’t realize that personal preferences constituted sexism. If I prefer playing golf with my friend Joe over playing with my friend Cindy does that make me a sexist? If I prefer discussing literature with my wife more than with my friend Chuck, does that make me a feminist?

                Or shall we just not have preferences? We’ll all just have government issued friends, doctors, political representatives, and auto mechanics?

                This whole conversation pisses me off because it trivializes an issue that isn’t trivial.

              2. Harriet Hall says:

                There is a spectrum where personal preference shades into sexism and racism. The point is that we all have prejudices and we should try to recognize them and not let them influence the way we treat other people. It’s your privilege to choose a male urologist. If your primary doctor ordered a urology consult and it was a female urologist who walked into your hospital room, it would be unfair to refuse to let her consult on your case or to yell at her to get out. It would be unfair to discriminate against female applicants to a urology residency. Prejudicial attitudes are universal; prejudicial actions need not be.

              3. mouse says:

                “This whole conversation pisses me off because it trivializes an issue that isn’t trivial.”

                Well all joking and hopefully, admonitions aside there are various ways to look at the issue that are not trivial but ARE interesting.

                It seems like we’ve reached an agreement that not selecting a specialist based on gender because you have preconceived notions about their competence or ability to do their job is sexist and wrong.

                On the other hand whether one selects a medical person based on your comfort level in speaking to them or being examined by them is under dispute.

                Personally, I think that it’s important that a patient feels they have some control when they are faced with an intimate discussion or exam.

                If for some reason, based on cultural training, a past negative experience or some arbitrary phobic response to a member of the opposite (or same) sex, the patient feels that they will not be able to participate fully in the exam or will experience an unusually high level of anxiety or shame (not the typical embarrassment), Then I think it’s appropriate for them to see a person of the gender they will function better with. Of course acknowledging that it’s not really about the doctor, it’s their issue and politeness go a long way here.

                If the emotional discomfort is mild and in reality they would go ahead and see the non-preferred gender specialist if they had to drive an extra half hour (or similar) to see the preferred gender, then, in the interest of fairness and encouraging a diverse and talented selection of specialists, the right thing to do might be to suck it up and try the non-preferred gender. If they gave it a shot and it just didn’t jib, then try someone else.

                So, to me I think this is just a matter of how extreme the discomfort is. I doubt that anyone would suggest that women going for post rape exam was wrong in preferring a female medical specialist, even though, ‘rationally’ a male medical specialist is capable of handling the situation and isn’t the man who raped her. She “shouldn’t” care. That is on the very extreme end of the spectrum. While a person who is mildly taken aback answering questions about sexual partners from a medical person of the opposite sex might be on the other end of the spectrum.

                In the end, we often don’t know people’s back stories or their level of anxiety. I figure, if a person seems generally fair and level headed, whatever is sparking this individual bias is an exception, which I probably don’t have all the relevant information to judge.

                I do have a slight problem with the personal preference arguments, though. You see some people using that same argument to say they shouldn’t have to accept gays, or blacks, whatever, in their store, restaurant, apartment complex, based on personal preference.

                My opinion is that if you have a strong personal preference against a particular group, you don’t belong in a business that requires that you don’t differentiate by gender, race, sexual preference, etc. Being in the service industry is a choice.

                While as a patient, you are, in a sense hiring someone, but you really don’t have a choice in your need to hire someone.

              4. Windriven says:

                “You see some people using that same argument to say they shouldn’t have to accept gays, or blacks, whatever, in their store, restaurant, apartment complex, based on personal preference.”

                And this, mouse, is the core difference: as a consumer I am making a personal choice. As a business, I am operating under state charter whether as a corporation, an LLC, a partnership or a sole proprietorship and have an obligation to serve all customers.

                But that is a technical and legalistic distinction. This started out as a light-hearted but true observation that I would generally prefer a male urologist for penis problems. That is not to say that I would refuse the services of a female urologist in an emergency, if I were in the military, or in any other setting other than the one where I’m plunking down my own money for a service. I never questioned the competence or differential ability of female urologists. I never argued that urology is not an appropriate specialty for females.

                I don’t condone sexism and have fought it since serving on the Status of Women Committee at Oberlin in the 70s when feminism was still controversial, even in quite liberal circles. It torques my jaw in a time when women are underrepresented in the executive suite, when women earn 75 cents on the dollar earned by men, that a choice equivalent to a yellow shirt over a blue one because it goes better with my cow brown eyes, trivializes sexism.

              5. WilliamLawrenceUtridge says:

                You prefer playing golf with Joe over Cindy because you prefer playing golf with Joe over Cindy – not because Joe is a dude.

                I don’t think you can compare this to the decision about technical competence based on gender (which to be fair you weren’t doing at all; in your specific situation it’s personal preference about genitals which is far more grey).

                I can totally understand why males might prefer male urologists and females female OBGYN. Still an irrational choice, and one that doesn’t matter much as long as it’s just specialties involving gender differences in situations where scarcity doesn’t interfere with services. I’m willing to gently (hopefully) mock and argue about it, I’m not going to say you’re absolutely, categorically wrong about it. How can you, it’s a personal preference?

              6. mouse says:

                windriven “And this, mouse, is the core difference: as a consumer I am making a personal choice.”

                ” It torques my jaw in a time when women are underrepresented in the executive suite, when women earn 75 cents on the dollar earned by men, that a choice equivalent to a yellow shirt over a blue one because it goes better with my cow brown eyes, trivializes sexism.”

                The choice might be trivial, but when it gets to the point where men wanting to specialize in OBGYN are discourage from that by education programs or hospitals aren’t hiring men as OBGYNs (as Sean Duggan suggested upthread) that’s where it becomes less trivial.

                I’m perfectly happy saying ‘ban medical specialty from choosing candidates based on gender and hospitals shouldn’t be able to select doctors based on gender’ and let the chips fall where they may. Of course, you know those programs are just going to point to the consumer’s preferences. I’m not sure what happens then.

                If there is a problem, I’d suggest, as consumers, because we have a shortage of doctors in the country and having a larger talent pool is good, it’d behove us to think about how our personal choices might ultimately negatively effect the quality or availability of the services that we want or need. It’s like the Get Local campaign – if you like having local shops then buy local, because you won’t have those shops if you don’t patronize them enough.

                And by the way, I don’t really think it’s my business if you prefer a male urologist or a woman prefers a female obgyn – or either of you shops on Amazon*. But, one of the best OBGYN’s I had when I was a young college student, was a man. I hate to think that someone like him would be discouraged from the field. So what’s the solution?

                *I love amazon. I don’t care if you hate me.

              7. Windriven says:

                @mouse

                I thought of this also very true example after I wrote earlier. I like barbecue. Pulled pork, ribs, it’s all good. Now if I’m visiting a new town and there are two BBQ joints, one run by a white guy and one run by a black guy, and I’m only in town long enough for one meal, All things being equal, I’m eating at the black guy’s place. Does that make me a racist?

                The choice has nothing to do with skin color in the 21st century but everything to do with skin color in the 18th century when black people were slaves. The white man ate ‘high on the hog’ and the slaves got the trotters, the intestines (chittlins (chitterlings)), the butts, and other undesirable cuts and those became part of their culture. Now of course poor white people ate the same stuff and they smoked pork too. But the cultural expressions of barbeque are slightly different. My preference, slight as it might be, is to try the black guy’s ‘que because his sauce is likely to be less sweet and more spicy. And here I’ll give a special shout out to Rudy’s in San Antonio. Best barbecue in Texas. I buy his sauce by the case and give bottles away at Christmas.

                Anyway, fears and hatreds and the isms that hold people down and frustrate their ability to reach their dreams and their potentials are indefensible and sadly very much real.

                In real life I have not needed the services of a urologist since I had a vasectomy 20-something years ago. If I realistically believed that my choice of a male urologist would frustrate the ambitions of a young woman somewhere, rest assured that I would make it my business to find a female urologist. But if that is the case it is an awfully well-kept secret. And that is why in my opinion this has gone off into the weeds of irrelevance and has trivialized the hurdles faced by women.

                Teachers who discourage females from pursuing excellence in math and science, employers who still see women as secretaries and clerks, Army sergeants who see female recruits as easily intimidated sex toys are infinitely more important than my choice of who cossets my dick. If the day comes that my choice has larger consequences, I’ll happily recalibrate. Until then, pfffpht!

              8. mouse says:

                Windriven “And that is why in my opinion this has gone off into the weeds of irrelevance and has trivialized the hurdles faced by women.”

                Oh well, very irrelevant to vitamin K, I’m not one to stick to a topic when I see a shiny argument skipping around on the ground.

                I hope I haven’t trivialized people’s hurdles. But I do find that tension between how our decisions as individual may or may not effect society and what that implies about our responsibilities really just kinda irresistible. It’s sorta my particular form of scrupulosity (some people just get to be obsessed with taking communion). Anyway, sorry if I stepped on you toes (or any other appendage – groan – sorry, sorry).

              9. Windriven says:

                @mouse

                My toes and other parts can take it. No offense taken or intended. These are, I think, really important conversations; conversations that our society often avoids or conducts only in a kabuki of preassigned roles and preassigned positions.

                We’ve never had that conversation about race in America, at least not in the public square. So 150 years after emancipation we have Furgeson, Mo. And we have barely started the conversation about gender roles.

                But this isn’t really the right forum, is it?

              10. Harriet Hall says:

                I must have missed something. What conversations about race and gender have we never had? I thought we’d had a lot of them, and the conversations yielded results: we now have a black President, 50% of medical students are female, and the Army allows women to go into combat. You must be talking about something else; please explain.

            2. Windriven says:

              You’re right, Harriet. We elected a just barely black man with no qualifications to be president out of a sense of white guilt, women still earn less than men and we have not yet had a female president despite women being a much larger fraction of the population than blacks of both genders. Young black men remain a grossly disproportionate fraction of the prison population. And when horrors like Ferguson happen, people generally slide into their assumed identities and talk past each other. Everything is hunky dory. We have very adult conversations about race and gender and gender identity. It’s the effing age of Aquarius.

              1. Harriet Hall says:

                No, everything is not hunky dory. But we are talking and progress has been made. I’m old enough to remember how bad it used to be, so I am encouraged and cautiously optimistic.

              2. Windriven says:

                So … we’ve been so over the board and now your position is cautious optimism despite the casual sexism of Windriven? Breathtaking.

                Are women who choose female OB/GYNs sexist? What are the valid criteria that the average person is allowed to use in selecting the provider of an intimate professional service? Perhaps we should just let the local medical society assign us a physician.

                Fifty years into a battle that should never had to be fought, women have made modest headway. But ours is still a white male dominated society*. There have been some furtive exchanges but there has never been an extended, coherent, adult discussion; if there had been we’d be a lot farther than cautious optimism.

                Sexism is alive and well and hiding in plain sight. Stamping every gender choice as sexism is a distraction and deflects attention from the elephant in the room.

                I’m done. The last word is yours if you wish to have it.

              3. Harriet Hall says:

                There’s at least a possibility that your attitude might change if you had a woman urologist; you might find it wasn’t actually as embarrassing or as uncomfortable as you imagine; you might find it was actually easier to discuss male issues with a particularly understanding female professional than with the majority of other males. And you could congratulate yourself that you were doing your own small part to overcome the societal problems you lament. Accepting an assigned physician regardless of sex would contribute to changing societal attitudes, but I wouldn’t support mandatory assignment. I don’t support affirmative action, either. I support leveling the playing field, not trying to reverse the slope.

                Here’s my last word. My whole life is a testament to the sexism in our society and my efforts to overcome it. I persevered in the face of considerable difficulties and served as a role model to demonstrate the competence of women in 3 male-dominated fields, medicine, aviation, and the military. And I increased awareness of the issues by writing about my experiences in my book “Women Aren’t Supposed to Fly: The Memoirs of a Female Flight Surgeon” http://www.amazon.com/Women-Arent-Supposed-Fly-Memoirs/dp/0595499589. I have tried to educate people about gender myths by writing and public speaking.The progress that has been made in our society in my lifetime on the issues of sexism, racism, and homophobia has been far greater than I ever could have imagined. I am delighted, but not satisfied. The battle is far from won, but I choose to see the glass as half full rather than half empty.

              4. Greg says:

                “We elected a just barely black man with no qualifications to be president out of a sense of white guilt, women still earn less than men and we have not yet had a female president despite women being a much larger fraction of the population than blacks of both genders. ”

                “just barely black” = 50%?

                “no qualifications” = United States Senator, State Senator from Illinois, Constitutional Law expert? Please tell me the last President with better credentials? Thinking back, other than Clinton (who served multiple terms as a state governor in a state where the governor has actual power) I come to Ford and Nixon, who weren’t exactly keepers. Reagan was an actor who did an objectively terrible job in his only other government position. George HW Bush was an ex-CIA chief (with a short uneventful stint at the UN and an equally short equally uneventful membership in the lower-house) and held the most useless position in the US government for the 8 years before being elected, basically meaning that any experience at anything he had was a decade old. So lets say HW was basically on the same level of useful experience as BHO, fine. He wasn’t exactly a winner either. So there we go, since Johnson we have 4 presidents of equal or greater experience with only one of them being able to be even passably called a “success”. Not a good record. And besides, your point is moot. Our next president is almost certainly a woman. Perhaps you should stop thinking in terms of identity politics though, as it appears many if not most women don’t seem to believe that a man is incapable of representing them. Maybe we elected Barack Obama because he had the right message at the right time and Hillary Clinton had a horrible horrible ground-game in the primaries, not because he’s black and she’s a woman. Just a thought.

              5. Windriven says:

                “just barely black” = 50%?”

                Just barely black = light skinned and lacking pronounced stereotypical features.

                ““no qualifications” = United States Senator, State Senator from Illinois, Constitutional Law expert? ”

                We were not electing a Supreme Court Justice. We don’t do that in this country. We were electing the chief executive of the United States. And while executive experience is in itself insufficient, it is nonetheless very nearly necessary. Mr. Obama had precisely zero executive experience – a lacking that has evidenced itself with disturbing regularity throughout his residency.

                “Perhaps you should stop thinking in terms of identity politics ,,,”
                I don’t. I think in terms of political realities as they exist today. If you think that race and gender are not woven deep into the fabric of American politics, you are delusional.

                “Maybe we elected Barack Obama because he had the right message at the right time”

                Marketing fluff. And my hasn’t that worked it well for us? Barring some remarkable turnaround in the next two years, Mr. Obama will likely be remembered as the worst president since Richard Nixon, a considerable achievement considering both Carter and W Bush. Mr. Obama can claim mediocre health insurance reform, an economic recovery outstanding for Wall Street and humble for nearly everyone else, the collapse of American influence in Europe and the Middle East and uncertainty about American interests and resolve in the Pacific Rim, and most ironic, a degradation of race relations.

                “Just a thought”

                Leaves me singularly unimpressed. This stuff matters. Not the message, not the spin. The policies and the actions.

                Mr. Obama was dealt a tough hand but plenty of presidents have been dealt crappy hands. No one dragged him into a run for the presidency and all presidents have to play the hands they’re dealt. If you think he has played his hand well, I’d like to hear the particulars.

          2. Windriven says:

            “That is a sexist attitude, just as preferring a doctor of the same race would be a racist attitude.”

            With all due respect Dr. Hall, that statement is bullsh!t. Arguing that a male physician is more competent because of his gender is sexist. Arguing that a black doctor is more competent than a white doctor because of his race is racist.

            Choosing a white doctor over a black doctor because I think the black guy is an assh0le is NOT racist. In my life experience I haven’t found assh0lery to be gender or race specific. Choosing a male urologist because it embarrasses me to discuss my tiny, misshapen, diseased and malfunctioning penis with a female may be a personality defect but it does not denote sexism.

            1. Harriet Hall says:

              Both racist and sexist attitudes are based on the preference to deal with people who are more like oneself. Your kind of attitude contributes to prejudice and to limiting occupational choices based on gender. If everyone felt that way, there would be no female urologists and no male obstetricians. I think your problem with women urologists is a personal quirk, and if your same-sex preference is widespread, it should not be. Attitudes like yours made my life as an Air Force doctor far more difficult than it needed to be. I took care of lots of patients who initially objected to a female doctor but had to see me because I was the only doctor available for sick call or emergency. After one visit, they would ask for me the next time instead of making a readily available routine appointment with a male doctor. My husband’s military urologist is a woman; he doesn’t have any problem with that. His masculinity is secure enough not to find it embarrassing to discuss his peepee with a woman.

              1. Calli Arcale says:

                “Both racist and sexist attitudes are based on the preference to deal with people who are more like oneself.”

                But is his reluctance due to a desire to deal only with people like himself, or is it more because he is sexually attracted to females, thus making it considerably more awkward to discuss his genitalia with them, even in a professional context?

                And then there is the question of modesty. Modesty is a culturally defined trait and not particularly rational, but it definitely exists. We are raised from children to generally have no problem with disrobing before people of the same sex in the locker room, but a strong social taboo against doing so in front of the *opposite* sex. That certainly can also lead a person to want a doctor of the same sex, without it being anything about one sex being better at the job.

                Also, I have to argue against your premise that sexism is about wanting to deal with people like oneself. I have known a fair number of women who prefer *male* doctors and *male* teachers and *male* pastors and so forth, because they think they will be more competent than females. This is a preference for the opposite sex that is clearly about prejudice and not merely social awkwardness around an attractive member of the opposite sex.

              2. Harriet Hall says:

                I mis-spoke. I did not mean to say that sexism is all about wanting to deal with people like oneself. I meant that he was sexist in wanting to talk to a man because he would be less embarrassed and thought a man was more capable of understanding him. He was putting an individual in a pigeonhole labelled by sex. There might be some male doctors who might embarrass him more than some female doctors, and some female doctors who might better relate to him and better understand his problem than some male doctors. He is prejudging the individual based on the category, which is the essence of sexism and racism.

                Because he is sexually attracted? Women are sexually attracted to men, but that shouldn’t interfere with an OB appointment. I have had patients who had an erection during their exam, but I ignored it and did my job.
                Modesty? A learned cultural factor, shouldn’t interfere with a rational person’s choice of a doctor.

                Of course there are lots of things that might make a specific patient more or less comfortable with a specific doctor. I understand that. I would just hope that people would become aware of their prejudices and not let them interfere with the way they treat others. I would hope that a competent doctor would not be rejected by a patient just on the basis of gender. I would hope that someone motivated to become a specialist would not be dissuaded by certain people’s prejudices.

              3. Windriven says:

                Calli Arcale has hot my point exactly. As it happens, my internist is a female. I have used a female proctologist, my vet is a female, two-thirds of the management level people in my employ are female.

                Sexism is making assumptions about competence based on gender and acting on them. I do not doubt for a moment that female urologists are every bit as competent as males. The distinction is a social rather than a professional one.

                I guess I’m just not secure in my masculinity. Poor, poor pitiful me.

              4. mouse says:

                “If everyone felt that way, there would be no female urologists and no male obstetricians. ”

                This is just a technicality, but don’t females go to urologists too?

              5. Harriet Hall says:

                Picky picky! OK, I’ll have to revise that to there would be no female urologists treating men.

              6. WilliamLawrenceUtridge says:

                His masculinity is secure enough not to find it embarrassing to discuss his peepee with a woman.

                Ah, but is his peepee “tiny, misshapen, diseased and malfunctioning”?

              7. Greg says:

                Sorry Harriet but no. Your example of a male patient having an erection in front of you is precisely why I wouldn’t want to see a female urologist. You may not have cared, but I am willing to bet anything that many if not most men would find that a fairly embarrassing situation. I mean, wouldn’t you be embarrassed if you started orgasming during a pelvic exam? Regardless of the gender of the doctor? I would be embarrassed by having an erection with my pants down in front of a doctor. Thus, I’d prefer a urologist I am unlikely to get an erection in front of. Therefore, since I am a heterosexual, I’d prefer, all other things being equal, to see a male urologist, because I am less likely to embarrass myself with one. If that limits the job choices for women to some slight degree, I don’t actually care. We shouldn’t expect every single occupation to have an even male-female division. To create that you’d need a totalitarian state, requiring people to ignore any and all personal preferences both in their consumption patterns and their career choices. So fewer women can be successful as urologists and fewer men can be successful as OBGYNs because people have these kinds of attitudes. Why does that matter? Seems to me that women get the better end of this deal as most women I know regularly see OBGYNs throughout a large percentage of their lives whereas most men only see urologists if they have a specific problem. (I’d wager there are more OBGYNs than urologists, though I don’t have the stats handy, I’m sure you medical doctor types do).

                So I guess you could say my question to you is: Ok, you want to call this sexist, fine. Why is that something we should care about? Beyond simply saying anything that can be labeled with this specific six letter word is automatically bad and terrible, explain precisely what horrible real world consequences attach to me not wanting to get a boner while undergoing a medical exam.

              8. Harriet Hall says:

                Let me clarify what I was getting at. I agree that people have the right to choose their doctors based on personal preference. But people often harbor prejudices that were inculcated by the society they grew up in; they are often unaware of that influence. We all have irrational prejudices and we should try to become more aware of them and overcome them to treat others fairly. I am in no way arguing for a 50/50 male/female split in this or any other job; I advocate leveling the playing field so individuals can freely choose the career they prefer.

              9. WilliamLawrenceUtridge says:

                Thus, I’d prefer a urologist I am unlikely to get an erection in front of.

                I strongly doubt that getting an erection in front of a urologist is due to sexual arousal caused by the urologist. It’s pretty common:

                http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3123498/

            2. mouse says:

              Windriven – The health of your penis seems to be dwindling rapidly. Get to a doctor, stat!

              I think the advice “Close your eyes and think of England.” might be relevant.

              1. Windriven says:

                And did I mention premature ejaculation? He’s a mess.

                Luckily, what I spend on health insurance I can take him wherever the hell I want. I took him to a female urologist once. She said, “huh, looks just like a penis … only smaller.”

                I stole that joke from Kathy Bates. Classic!

    2. MTDoc says:

      Regarding “over medicalized ” deliveries, let me suggest a couple of the reasons behind it. A century ago childbirth was a leading cause of death in young women, and although accepted as natural, was not acceptable to evolving medical practice. Hence, as sterile surgical practice developed, the same principles were applied to OB deliveries. This was the prevailing practice when I was trained, and no, that was not a century ago.

      How often do you really need an operating room environment in order to deliver a baby safely for both newborn and mom? Not often, but when you do, you don’t have time to screw around. Once you have managed your first thousand deliveries, one may well take a different view on the subject. I can still recall with all too vivid detail a couple of situations that would have been fatalities at home, and problematic even in a birthing center.

      I’m all for making the birthing experience as comfortable and anxiety free as possible for mom, and was there through much of late labor, negotiated analgesia,etc., but safety had to remain my top priority.

      1. Sean Duggan says:

        I think I can see the point of view in some ways. For one, routine measures for rare occurrences. It makes sense, when you set up a campsite, to put up measures to discourage bears, particularly when you’re in bear country. It makes less sense to discourage zebra attacks even if there are rare documented cases, unless you know that you’re in zebra country. Not only will there be additional monetary cost, but the measures may have additional costs. Maybe protecting against zebra stampedes requires flashing lights that will make it harder to get a good night’s sleep.

        This could become even more of an issue with proper universal healthcare because you start having to ask questions about whether routinely defending your camp against zebras is really a cost-effective measure if, say, it means there’s less money available in the pool to ensure that everyone has good hiking boots to prevent deaths from infected heel blisters.

        Of course, I’ll freely admit that I don’t know how often such zebra cases really happen in childbirth. As has been noted, we see birth as a relatively safe process even though it really is dangerous (reminds me of the general maxim that no surgery is truly routine, so you want to avoid non-essential ones. Similar warnings about medications, etc), so maybe zebra stampedes are common enough that it’s worth a little lost sleep and less resources for proper footwear.

        1. Young CC Prof says:

          Probability of something going wrong in an average first birth is about 1 in 5. Probability of something going seriously wrong in a very low-risk birth is about 1 in 20. Probability of something going very wrong very fast when things looked peachy just a few minutes before, maybe 1 in 1000, higher in special circumstances.

          Most of the complications are rare if you look at them separately, but the chances that at least one will happen to you are not so small after all.

          I think that, even from the point of view of a national healthcare system with limited resources, obstetrics should be a top priority.

          Think about it. How many people do you know who have been attacked by bears? How many people do you know who have personally experience a childbirth emergency?

          1. Chris says:

            “Probability of something going wrong in an average first birth is about 1 in 5″

            Yay! I am a statistic! Well, at least I know I am in the 20% part.

            Also I am not surprised that our family doctor who working towards retirement no longer does obstetrics.

          2. Sean Duggan says:

            I suppose my question is, how many of the conditions are that common? I’m a big fan of hospital births, because there are indeed things that can go wrong. My argument is merely that some interventions are chasing that asymptotic risk curve. It’s complicated by the fact that, of course, every person wants the highest level of care possible, but we are facing the reality that giving everyone the very highest level of care costs more than we’re willing to budget out for overall care. And I do think that sometimes the interventions cause their own problems. Take Fetal Heart Rate monitoring, which essentially require the woman to remain immobile for the entirety of labor so as to not disturb the wires. Is that a net gain or a net loss? We can argue that it should be explored on a case by case basis, but how often is it actually explored and how often is it simply stated as it being how things are with the doctor not stating, or not knowing, that it is not mandatory.

            1. mouse says:

              Sean Duggan ” It’s complicated by the fact that, of course, every person wants the highest level of care possible, but we are facing the reality that giving everyone the very highest level of care costs more than we’re willing to budget out for overall care. ”

              I actually think that everyone wants a good outcome, which is healthy mom and baby. Not everyone is intervention happy (as we can see from the home birth discussion). But, the fact is that aside from infant or mother mortality, the cost of a birth that goes wrong can be very expensive, in terms of a life time of specialized follow-up medical care, multiple surgeries, special in home care or nursing home care, time, money and emotional demands for the family and special education/disability costs to the public.

              But sure, there is a hypothetical point where the cost of a intervention is going to exceed the benefit of using it when the risk is a very rare occurrence. If you search a more common intervention, you are likely to find studies/reviews discussing the NNT, cost, benefit, etc. The medical field does think about that sort of thing and appears to make effort to incorporate it into standard of care. Of course, it can be controversial (as you see in the mammogram debate). But, they are not attempting to avoid every possibly bad outcome with any possible intervention, regardless of cost, as far as I can see.

        2. WilliamLawrenceUtridge says:

          It’s less “zebra protection” than defusing an old WWII bomb – in most cases, the bomb is a dud anyway. In rare cases, everyone standing nearby dies.

          You really have to compare it to a situation where there is a rare, but very real risk of one or both participants in a birth dying.

          For the zebra metaphor, the risk isn’t zebras showing up. That’s delightful (unless they are assholes, like ponies). The risk is being trampled to death by a zebra.

      2. NewcoasterMD says:

        I should have clarified that it seemed to me as a naive medical student in the early 1990′s that there was over medicalization of a “natural” process.

        I’m well aware of the morbidity and mortality associated with childbirth before the era of modern medicine, and that 3rd world countries continue to have problems.

        I also wonder whether the glove and gown ob-gyne was preparing for the worst case scenario, or just protecting himself from the mess. I had a pair of sneakers at the time I used just when on call for L&D, and they were ruined by the end of the rotation.

        I think one loves or hates obstetrics, and I am definitely in the latter.

    3. goodnightirene says:

      I clearly stated that my eldest is 45. Birth at that time was very highly medicalized–meaning that a very authoritarian system was in place, one which treated the woman as a very stupid and ill person and the baby as a thing to be extracted by any means other than the participation of the woman. I was so unnecessarily drugged up (we are not talking epidural in those days, but rather spinal block thing and masses of “shots” that were not even identified at the time) that. I was completely shaved, strung up to the ceiling in stirrups, draped, given an episiotomy before anything was happening and then a couple of interns proceeded to push my baby out by physically pushing on my stomach, because I was barely conscious! After my “recovery”, I didn’t even see my daughter until she was 18 hours old and then I was not allowed to unwrap her. I got to hold her for five minutes every four hours, at which time I had to clean my breast with an alcohol swab before attempting feeding. The bottle of formula was in Nurse Ratchet’s hand because she “knew I would fail”, which of course I did.

      I could go on. It was different by the time you birthed because of women like me who began to refuse to participate in the old system.

      By the time my 28 year old was born, I fully realized that things were improved, but by this time I was simply more comfortable with the home setting.

      I am decidedly not a fan of woo.

      1. goodnightirene says:

        Omigosgh,that was in reply to someone way up there, Sullivanthepoop, I think.

      2. brewandferment says:

        That sounds very much the same as what my mom described for all 5 of us (63 – 69) . With her last child in 69, a casually directed (completely elective suggestion by MD) induction at 37 weeks nearly cost her her life and did cost her uterus (that part didn’t really bother her, at nearly 39 with 5 kids age 6 and under!) My dad describes waking up and finding blood everywhere after mom had been released from the hospital. He bundled all of us into the car, drove to a friend’s house and sent me the eldest to the front door with my siblings in tow, and when the friend opened the door, took off to the hospital with mom and newborn for an emergency hysterectomy and transfusion. Which probably was the source of her Hep C antibodies to boot.

        So it’s no wonder that I was wary of hospital procedures–and terrified by the possibility of induction since kid #1 was running late–even in 94! (It wasn’t necessary. Although I was mildly torqued that despite an otherwise low-key birth, my OB gave me a pudendal block “I always do for first time moms” before I had a chance to protest much. Not that it was such a bad intervention, I just hadn’t wanted it. Overall though he was pretty non-intervention.)

      3. WilliamLawrenceUtridge says:

        I’m certainly on board with the idea that the treatment of women giving birth in the 50s, 60s and 70s was over-medicalized, so comparing it to today’s treatments does skew the discussion somewhat. And good for you for bucking the system.

        The system needs flexibility, new ideas, and above all – research to determine what is truly safe versus unnecessary medicalization. And choices for everyone involved.

        Children and childbirth always bring out such active discussions. And circumcision, can’t forget circumcisions.

        1. brewandferment says:

          no you can’t bring out your favorite quote this time! ;-p

          1. WilliamLawrenceUtridge says:

            But I’ve got so many favorite quotes, which one do you mean?

            Hint – this is a trick.

            1. brewandferment says:

              a trick? as in if I say the word, you then have a chance to bring it up? My kids have tried similar tricks.

              1. WilliamLawrenceUtridge says:

                To be honest, it’s always a trick. Mostly I was hoping you would be foolish enough to type out the quote we are both thinking about. MWHAHAHAHHAHAA! I’m like an evil genius but without the wealth, power, plans and cool hideout.

              2. brewandferment says:

                there’s a button my sister and I both have as do plenty of parents (usually mom, IME) that says “you can’t scare me, I have children” and between us we have 38+ years of military service…you’ll have to do better than that!

  9. Kerlyssa says:

    People have been dying/being maimed during birth for as long as humans have been around, too… o.0 what a bizarre justification. Do xrays overmedicalize broken legs? Dental checkups overmedicalize the normal process of eating and speaking? Isn’t the whole point of medicine to IMPROVE the human life? Shit, if there’s a process that needs improving in the human life, birth would be it. NOT humanity’s strong point.

    1. Chris says:

      So how many of your kids are you willing to have a funeral for before they graduate high school? Come on, give us a number. We want to know if you would actually grieve over a loss of a baby or not.

      Personally I know women who still have a hole in their heart for a lost pregnancy. Do you think that is a sign of weakness, or humanity. Be honest.

  10. Silvia Barber says:

    Just a few months ago there was an article about family in Tennessee (I think) who refused the shot at birth. Baby got brain bleeding, unknown permanent damage at time article was written. The parents blamed the hospital for not stressing enough the possible consequences.

    1. R. Miller says:

      “The parents blamed the hospital for not stressing enough the possible consequences.”

      Sad. I like shared decision making, but it’s frustrating many patients do not comprehend that shared decision = shared responsibility.

    2. EBMOD says:

      $5 says they WERE properly explained what the consequences were, but thought the Dr was some paid shill for big pharma and thus discounted the warning as paranoid propaganda.

      And then of course when reality came in good and hard, rather than realize they dun goofed, blame the evil docs yet again…

    3. mho says:

      Dr. Novella’s article referred you to Clay Jones excellent discussion. There were three babies who had brain bleeding and one who had a GI bleed.

    4. Chris says:

      Fourth attempt. I found the article, and the parents had said they were afraid of some nebulous risk of leukemia. But that had been debunked a while ago.

      Though every time I try to link to the article the comment disappears. I’ll try to post the link in the next one. It is from the May 2nd Tennessean.

      1. Chris says:

        Yep, this blog is not letting me link to the news account. It had two interesting quotes:

        Mark and Melissa Knotowicz declined the shots for their twins, who were born last summer. At the time, the couple were concerned because they had heard that a preservative in the shot could lead to childhood leukemia. An old study did draw a correlation between the preservative and leukemia, but followup studies disproved that theory, according to Vanderbilt doctors.

        and:

        Mark Knotowicz said staff at the Nashville hospital, where the twins were born, did not adequately inform him of the risks from refusing the shots.

        Actually it looks like someone absorbed what he read on Google U., and probably when those at the hospital told them the risks they weren’t really listening.

  11. Jeanne Weiske says:

    Since the world is well on its way to severe overpopulation, cold as it seems, this might serve to lessen the problem. It will also remove the less intelligent from the group.

    1. Chris says:

      Unfortunately it doesn’t work that way. The best way to reduce over population is to educate women and make sure they know their kids will grow up to be adults. The countries with the most population increase are those like Afghanistan.

      Watch a few of these: http://www.gapminder.org/videos/

    2. mouse says:

      Oh, you just gotta love a classic eugenics argument.

      1. WilliamLawrenceUtridge says:

        I think Jeanne has her tongue somewhat in her cheek.

        1. mouse says:

          WLU – Oh – Okay. You gotta love a classic eugenics joke then! My side my side…

  12. kaitch says:

    I’ve read on one of the super-woo/scaremongering websites some complaint about vitamin K2 vs K3 and that one of them is BAD/UNNATURAL therefore parents shouldn’t get the shot. Now I know enough to know that at least 101% of the info is crud, but can anyone enlighten me further on that?

    1. Angora Rabbit says:

      K2 (menadione) is the synthetic form and it actually has a longer half-life in the blood as compared with K1 (phylloquinone, from plant sources). I’m sure this will drive $tan crazy.

      I can’t imagine a parent not wanting to make sure their newborn has adequate vitamin K stores. This is like wanting your child to bleed to death. Horrifyingly stupid.

      To reiterate for parents: babies are born sterile, and because most of our VK comes from our gut microbes, babies won’t “make” their own until about 6mo when their microbiome matures. It crosses the placenta poorly, sorry. And breast milk doesn’t contain much, either. I guess evolution thought that enough would come from microbes in a dirty environment. But in our modern environment, that isn’t going to happen. Get the shot and protect your baby.

      1. Michele S says:

        Actually, there is some recent evidence that babies are perhaps not, in fact, born completely sterile. (see http://www.ncbi.nlm.nih.gov/pubmed/18281199 for starters) The media (and probiotic hawkers) have taken this and other preliminary studies and run amok, however. It’s never a good sign when the first page of a Google search on a topic returns 80% pro-probiotic & natural health websites, along with one NYT article and one or two New Scientist summaries. Feh.

        1. Angora Rabbit says:

          Very cool! Thanks for the link! Reality is cooler and more interesting that we can imagine. A PubMed search on fetal microbiota turns up all sorts of cool articles. I think I’m going to run this past the postdoc and get a piece of the action!

          This reminds me. Back in undergrad microbio lab, my lab partner and I chose as our independent project the characterization of vaginal bacteria. These were in the days of radical fems and Our Bodies, Ourselves, when it was empowering just to have a personal speculum. Bless his heart, our TA was super supportive. It was a blast. Just wish I could remember what we found in those ancient, pre-PCR pre-16S days.

  13. Kiiri says:

    I think the pendulum on birth swings back and forth. with my son I never really considered a home birth. I am not into the crunchy granola crowd of home birth enthusiasts in the area and I wanted it to be safe. I was considered on the edge of high risk (and will definitely be high risk due to my age if I manage to conceive planned baby number two). I was also induced. Not a fan of the inducement part. That really was a painfully prolonged two days in the hospital before the bundle of joy arrived. I also don’t understand the mommy bloggers who are wearing the badge of honor that they went through their labors with no medication for pain. I think the epidural is proof the gods love us and want us to be happy. Believe me after 24 hours of constant pain (and at that point 36 hours of no sleep) I was happy as a clam to have the epidural since it meant enough freedom from pain to take a nap which is the only thing that enabled the pushing. We have swung too far in the C-sections, taking a lot of women for elective C-sections, and all but completely denying VBAC attempts. I really didn’t want a C-section, but at about the 32 hour mark (when my extremely stubborn son was still refusing to drop down and engage in my pelvic girdle despite all the Pitocin they were throwing at him) I was ready to consent just to have it over. Luckily, once he decided to come out he was all for coming out and was delivered about 40 hours after all this hoopla started. Having gone through it once I am more prepared and have given moms-to-be my advice from my time in the hospital. And am now going through fertility treatment once again to have another. I must be crazy.

  14. EBMOD says:

    You bring up a great point in those who resort to ‘pain shaming’ those who elect for epidurals. My wife has always opted for epidurals with our children, after attempting to go without for the first delivery. There are individuals in my family who are quite woo/CAM friendly who unfortunately have implied to my wife that she was ‘wussing out’ or somehow cheated herself out of the experience that choosing an epidural was ‘cheating’.

    Just a few months ago, a close friend of ours gave birth and opted for an epidural, and the CNA who came in while she was in the recovery room, upon seeing that she had had an epidural, actually called her out saying she had also ‘cheated’. Needless to say, this was very hurtful and completely uncalled call, especially from an employee of the hospital.

    I am sure that there are many women who choose to forego pain management because it allows them a more visceral experience, and I have no problem with such decisions, however, I really wish that the issue of ‘pain shaming’ would be dealt with and talked about more as I don’t think that any woman has the right to bash other women over the head for making a perfectly reasonable and valid decision either way.

    This would actually make a pretty great topic to be covered here, IMO…

    1. MTDoc says:

      What I find interesting in the last few comments is that epidurals were not part of our available techniques when I was active in obstetrics. But we found ways to manage anxiety and pain. It began with a six month relationship with the patient. As time pressures limited our time with patients, Lamaze classes took up some of the slack, but nothing totally replaced the primary doctor/ patient relationship. I think that what mattered most was that I was there and could respond to whatever was needed. (No algorithm set in stone). Even in a group practice, we delivered our own patients, whenever we could, even if we were not on call. From a patient’s standpoint, I don’t see anything that has improved on that.

      1. n brownlee says:

        Nothing can improve on that- your own doctor, standing there and saying, “I’m not going to let you hurt too much. I’m not going to let you bleed to death.” And later, when I asked to have my tubes tied, my own doctor saying, “Oh, Thank God!”

        1. Chris says:

          “And later, when I asked to have my tubes tied, my own doctor saying, “Oh, Thank God!””

          :-)

          By the way, our family doctor’s kids were both born the same week as my sons’. His second child was born just after midnight on the day he delivered my younger son.

          So we spent the next couple of decades commiserating over the issues of typical child stuff. It is a real family practice, because he knows my family very well. Daughter has an appointment with him next week, but I will not be told about it since she is in college.

          We have even had everyone gathered into a small exam room trying to figure out why two of our kids kept getting strep infections, so samples were taken from everyone for a long test for strep. It turned out that all three kids had strep, but middle one had no symptoms.

          1. n brownlee says:

            My PCP dismissed my second son’s marathon colic (18 hours a day for months) until his own third son’s birth, six months later. It’s the only time I’ve ever had a doctor’s apology!

            1. mouse says:

              After three pediatric health care providers (an audiologist and two speech pathologists) who seemed young, intelligent, well educated, but kinda clueless on dealing with children or parents, I flirted with a bias against pediatric providers that don’t have kids, but ultimately that theory didn’t pan out.

              I reserve the right to believe that good grades in an advanced degree does not automatically produce an effective pediatric therapist, though.

              (whoops, I might be combining the BTDT bias thread with the pain management thread, apologies)

              1. Chris says:

                Ouch.

                My younger son got speech/language therapy at from graduate students at the local university’s speech/language pathology program. The students needed a certain number of hours dealing actual children (and their parents) to get their Master’s degree and speech/language therapy certification.

                This became a real issue when our house was hit with chicken pox. First the child who was getting the therapy was not able to attend for two weeks, then I had to bring him there while leaving the other two kids who had pox in the car (including a six month old baby) to a student therapist at the street curb.

                By the way child #2 “only” had developmental dysphasia which was spotted by child #1′s speech therapist (a minor speech delay). So with twice a week student therapy and once a week with a school district therapy his language use (vocabulary and grammar) increased from two years behind to low normal just before he turned five years old. Yay! (he ended up being a high school honor student, and next week finishes a college degree in math!… and Saturday we are shopping for an interview suit).

                Though in an alternate universe I would like to skip the month where I had to deal with taking my sons to a total of five speech/language therapy sessions per week while dealing with chicken pox. The worst being the six month old baby who could not scratch an itch nor sleep more than a half an hour at a time.

              2. Chris says:

                Oops I ventured off topic on my own comment. The student therapists at that program were trained with real children. They had to spend a college quarter with at least one child, and do this for a year. So that they had experience with many kinds of kids.

                The bonus was sitting in the observation room with a supervising professor. They are always helpful in getting more information.

                An aside: one of my son’s student therapists only had one hand. In her presence he pointed to where her wrist ended in skin, and asked why her hand was missing. All I could think of on the fly was that it is difficult to make a baby and sometimes things will go wrong. Which is why if he looked closely enough he would see he had two tear ducts instead of just one on each eye (something I noticed when I was breastfeeding him).

                I used that explanation later whenever anyone asked me about my older son’s and other person’s disability. It seemed as good an explanation as anything. As a four year old younger son seemed to absorb that message, or he just reflects his father’s good nature to all, and has been one to accept all kids, and that includes teaching swimming to special populations. He is a personable young man with a big heart.

              3. mouse says:

                What an ordeal with the chicken pox!

                Chris – “Oops I ventured off topic on my own comment. The student therapists at that program were trained with real children. They had to spend a college quarter with at least one child, and do this for a year. So that they had experience with many kinds of kids.”

                Most of the SLP’s we had were specifically trained in pediatric SLP and had extensive clinical hours as well. I guess I’m gun shy, though. We had a struggled finding adequate ST for my son in the first two years, then even after that there were shuffles.

                His speech defects were related to the cleft, which required specific techniques and training that isn’t taught in the standard program (this is what I was told by one of our SLPs).

                Unfortunately our cleft program SLP (who did speech, but also swallowing and feeding) was overbooked, but our ENT was adamant that speech therapy was needed. The Early On (school related) program at first declined service, “because he was internationally adopted and just needed to learn English” (I don’t know how to make an angry face emoticon).

                Ultimately we went through four speech therapist/programs and two years before finding the folks with the right combination of hours of intervention, correct techniques and coaching that engaged my son and my guy started making progress. The winning combination was cleft clinic SLP (once we got on the schedule) and the school district provided hearing impaired preschool. Turns out hearing impaired children not only have a high instance of other cranio-facial anomalies, but also often have similar articulation problems, so the teacher and SLP there really clicked with him. It also helped that his teacher there was one of those teachers who enjoys dealing with boys (she had three boys) and liked my guy’s sense of humor.

                That’s kinda why I mistakenly thought maybe not having kids was a drawback in a pediatric SLP. I would have a young SLP who didn’t have children telling me “well he’s having a hard time paying attention to directions, have you considered attention issues?” When I’d ask his private mainstream preschool or later the HI preschool about attention issues, they say, “no he seems a typical boy and he sits for story time, listens well…etc” Ultimately, I just concluded that these particular SLP didn’t have a good sense of typical development – that they were mistakenly labeling age appropriate inattention as pathology. But I’ve seen parents do that too, so just individual errors.

              4. mouse says:

                @Chris – Congrats of your son’s degree, by the way! I’m told by my BIL that the late college, early professional years are great because after years of your kids ignoring everything you say, they start coming to you with questions and actually considering your answers. ;)

      2. Chris says:

        I believe the hospital where my children were born hired nurse anesthetists who spent the longest time explaining the procedure and risks of an epidural. For both boys I was not dilated enough, and then when it finally came time to get an epi, the explanation was so long that I was too dilated!

        The last baby came too quick, less than ten minutes after I laid on the birthing bed. Our family doctor got there just in time to catch her.

    2. CHotel says:

      Just a few months ago, a close friend of ours gave birth and opted for an epidural, and the CNA who came in while she was in the recovery room, upon seeing that she had had an epidural, actually called her out saying she had also ‘cheated’. Needless to say, this was very hurtful and completely uncalled call, especially from an employee of the hospital.

      I’m pretty sure that in the future if an employee were to say that to my (currently imaginary) wife after childbirth, that person would not be an employee for much longer. Ridiculous, all the pain shaming. If you can go without, more power to you, but if your friend can’t, shut the hell up and leave her alone.

      Hypergeneralizing to a borderline offensive degree, so grains of salt are necessary: why is it that those that choose to go against the norm have to be so damn vocal about it? We get it, you’re better than the rest of us plebians because you had 6 kids in a tub of water and your own feces at home with no pain killers who went unvaccinated and gluten free and have never been within 30 yards of animal protein. I don’t go around bragging about the appointment for my 10-year tetanus booster I’m about to make, or the sirloin and bruschetta I grilled last night (unless Instagram counts. Yeah, I’m one of those assholes. Although I didn’t actually with that meal, should’ve though. Gorgeous).

  15. lilady says:

    I posted this link on on Respectful Insolence, a while back, when the subject was parents who refuse to have their newborns receive Vitamin K shots. It’s the Brisbane Coroner’s report which describes the multiple brain bleeds suffered by a 33-day-old infant whose parents refused the IM shot for their baby.

    http://www.courts.qld.gov.au/__data/assets/pdf_file/0009/169659/cif-baby-20121203.pdf

    1. EBMOD says:

      Ugh, that was brutal to read. I have a 5, 3, and 1 year old, I can’t imagine watching that happen to one of my children. So frustrating that people can deny such an obviously helpful procedure…

      1. lilady says:

        I’ve posted that same link on other sites, when the anti-vaccine trolls come on board.

        Here’s the link to “Olive’s Story”…which seems to have a much better outcome.

        http://cestsibonblog.wordpress.com/2014/03/07/why-it-happened-the-truth-about-vitamin-k-deficiency-bleeding/

  16. Stephen H says:

    So much depressing news about stupid parents. Look on the bright side – parents who fail to do what is best for their child are more likely to result in dead children therefore the survivors are more likely to believe in science over time. Maybe there’s a gradual winnowing from the genetic pool of the most gullible, and in 20,000 years or so people will generally accept the precepts of the scientific method?

    1. EBMOD says:

      Problem is the relative birth rate I think is a bit skewed. Reference Idiocracy for a funny yet depressing example…

    2. lilady says:

      Why would you even post such a comment? It reminds me of posters on the internet, who claim to be pro-vaccine and pro-science, yet they post vile comments expressing a desire to have the children of anti-vaxxers die from V-P-Ds.

      1. G Vazquez MD says:

        I think he was making a joke.

      2. EBMOD says:

        I too interpreted it as a joke, thus my response, but I can see how the lack of context and inflection inherent to posting on the internet could make it look much worse than it is. I apologize if our comments were in bad taste, I had no serious intent with the response…

    3. WilliamLawrenceUtridge says:

      So much depressing news about stupid parents. Look on the bright side – parents who fail to do what is best for their child are more likely to result in dead children therefore the survivors are more likely to believe in science over time. Maybe there’s a gradual winnowing from the genetic pool of the most gullible, and in 20,000 years or so people will generally accept the precepts of the scientific method?

      Two points:

      1) It’s only newsworthy because it’s rare – so be heartened. News agencies don’t report “27,642th child from 1998 now able to drive, grew up without dying.”

      2) I’d love to see numbers on this, but my inkling is the kind of people who do this also tend to have more children. Which means in evolutionary terms, they’re winning.

      OK, third point:

      3) People born in 1998 can now drive. Blech.

      1. mouse says:

        Okay folks I was trying to stay out – but how is it a foregone conclusion that someone who makes unscientific decisions will have children who continue a trend of anti-science views?

        Thirty years ago public sentiments were very anti-gay/lesbian. Now, apparently due to young people’s attitudes, gay and lesbian rights are viewed much more positively. How could that happen if children reliably follow their parents belief? I doubt that people with pro gay/lesbians beliefs just out reproduced the anti gay/lesbian crowd.

        I think you should not be writing off these kids of the anti-vaxer, anti-science crowd. And yeah, like lilady pointed out, making joke about children’s deaths based on their parent’s “sins” – not cool. But I appreciate EBMOD’s apology.

  17. G Vazquez MD says:

    As a Pediatrician in private practice I have vaccine exhaustion. At this point our group hands the anti-vaxxers a form that waves our liability for that visit. We then inform them that they will be receiving a polite letter from our group asking them to find practitioners in our area who share their beliefs. They may call us until the time that it takes to find another group. We suggest that they begin their search quickly and wrap it up in two months.
    We don’t want pertussis or measles in our waiting room. It’s happened in the past and wreaked havoc as we contacted every other family who visited us and explained the situation.

  18. Windriven says:

    @Dr. Hall

    You’ve twice used the word embarrassed. That is your word, not mine. If you are only able to imagine my preference for a male urologist as embarrassment you have less considerably less imagination than I gave you credit for.

    “Massa say that if it so important to me and I can find somebody to teach me, he gonna let me learn to read” is slave talk. The fact that gender relations and, to a lesser extent race relations, are not quite as fraught as they were 50 years ago strikes me as rather less than a glass half full.

  19. simba says:

    I dunno, I understand that when it comes to who’s handling your genitals during a medical exam, you might have some irrational prejudices about that without necessarily being racist or sexist.

    I would prefer women, the same sex as me, because of the aforementioned cultural connotations of disrobing or discussing ‘personal issues’ in front of the same sex vs the opposite.

    I know it can be very important for issues of previous sexual assault, too (I know people who’ve suffered serious emotional pain because someone conducted a gynecological exam without adequately reassuring and informing them, and asking for permission before touching them, for example, and who had a strong preference for same-sex examination).

    These kind of examinations can make people feel very vulnerable and you need someone you can trust. If you have an irrational reason not to trust that person, it doesn’t matter that you know it’s irrational any more than someone with a fear of spiders will be cured by being told that one’s harmless. Whatever you need to get through the exam. Work through your issues, yes, but I don’t see that having someone who’s competent and of the ‘wrong’ sex would necessarily be enough to fix that.

  20. Jopari says:

    Christ, can we just bury the hatchet and let bygones be bygones.

    When selecting a doctor whose sex can only be one of two (rare cases both or none, not dicussing those), both choices are taken to be as sexist, therefore, stop harping over it.

    For our individuality, we have various shades of personal preference, so long as they are not excessive, they should be tolerated. Harriet Hall, my apologies, but you really shouldn’t have made mountains out of molehills.

    1. Jopari says:

      As to the idea about being familiar with a person of a similar type.

      This is an assumption, based on the assumption that MOST people who are not the same as I will not understand my problems arising from that difference that separates us as much as the other who is. Sure, there will be people who can understand me as well as the other but as a general rule they don’t.

      Simply because you know a few examples of the other doesn’t invalidate this assumption, and continuously bombarding a person with guilt-tripping, accidental or not, by pointing out that it is sexist is overplaying something that is trivial and should be understandable.

      1. Jopari says:

        Now, can everyone interested just put their last comments and stop?

        1. Windriven says:

          Ummm, three serial comments and a plea to stop? Made me smile a little.

          But yeah. This is probably not the forum and little more will be accomplished than people choosing up sides – exactly what needs NOT to happen.

          1. Jopari says:

            Two and a plea, because I suck at making myself clear the first time. *sigh*

    2. Harriet Hall says:

      “For our individuality, we have various shades of personal preference, so long as they are not excessive, they should be tolerated. ”

      OK, but where do we draw the line? What about personal preferences that have been unconsciously influenced by societal attitudes that tend to treat whole groups of people unfairly? What about someone who says “I have nothing against blacks, I just have a personal preference for white friends, and I prefer that black families not move into my neighborhood”? What if he said “It’s just my personal preference not to drink out of the same water fountain or sit next to them in the movies?” Prejudice is most dangerous when it is subtle and unrecognized. People who are convinced they are only acting out of personal preference might do well to examine their consciences.

  21. Pechepommepoire says:

    When my oldest was born we asked our hospital-based CNM about vitamin K. Specifically, I asked if we decided to refuse the shot and there was a problem would there be warning signs that there was extensive bleeding going on before it was catastrophic. She said yes, there would be. Now I know better and I can’t believe that I was given such inaccurate and dangerous advice!

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