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Can you believe there are doctors out there who go through medical school and take an oath to do no harm and then ignore everything they learn in medical school? I guess sometimes I might get wrapped up in a little wishful thinking. Of course in every profession there are ones that just don’t take their work seriously and when it comes to a doctor that has great risks. I really think most doctors out there really believe that it’s their job to do no harm. And even when you do find a doctor who’s not so great it might just be a personality clash. Lets face it, we don’t need our doctors to be our best friend though. We need them to mitigate the risks and advise us of what they think the best course of action is going to be. Is it always right? No, doctors are human and they can only go with the most up to date information they have, but for me anyways, I would rather not have my feelings spared. Talk to me with respect, yes, but don’t spare me information because you fear it might upset me.
And when I see a doctor playing tone police on the internet I get very concerned for everyone involved. Mostly because tone is very hard to express on the internet anyways and is completely open to interpretation, but also because I would think a doctor should have a thick enough skin to handle differing of opinion from people no matter how it’s presented.
Aviva Romm, MD?
There is this Yale graduate doctor named Aviva Romm who seems to be quite popular with people. She has a family practice, but has also written several natural holistic books and maintains a blog and Facebook page. And recently she wrote a blog post about her position on homebirth. Now first of all I would like to point out that Aviva Romm is NOT an OBGYN. She is a family doctor who prior to getting her medical degree was a homebirth midwife. She is not advocating what the current ACOG guidelines say in this matter though. Her blog post isn’t entirely even keel, it really does have a way of making the hospital sound less than ideal and glossing over the problems in homebirth. She blames the hospitals really for why homebirths aren’t more successful. If doctors and hospitals would just accept these transfers with open arms, then everything will be so much better.
Now, I’m not a doctor so I can only go by what I know about how things work in hospitals from my own personal experience. Even when I was preregistered at the hospital for all of my births there was still quite a bit that needed to be done by the hospital’s staff when I arrived to deliver my babies. When I was sent there straight from my doctor’s office with my oldest I recall things being quite hectic to start out with, despite having information about my arrival from my doctor. I can only imagine what an emergent homebirth situation must look like, especially when you see so many stories that say and the midwife was in a separate car to the hospital from mom. Now sure, we could blame doctors and hospitals reactions on why a midwife wouldn’t do what she could to prepare the hospital for the arrival of her patient, but in emergent situations I have never known a doctor to not jump into action and take care of what needs to be taken care of.
And Aviva Romm herself is even unwilling or unable to be that smooth homebirth transfer doctor. Actions speak louder than words here people. You have a doctor who is saying doctors and hospitals need to be more accepting of homebirth transfers, but who she herself will not accept homebirth transfers. And do you know why? Because she’s currently not in a practice that offers birth services. Actually, she also says she is traveling too much as to why she can’t be the doctor that accepts homebirth transfers. And through her medical malpractice insurance she was required to decline hospital obstetrics privileges. And yet she expects other doctors to be the ones to do what she herself is unable to do. Well, quite frankly she seems to think she could do it better because again I’ve never known a hospital to turn away a woman in labor simply because she was a homebirth transfer. Aviva can’t and really she won’t work with local midwives because “the standards amongst hombirth midwives are too variable.” Her words.
So Aviva has a whole list of reasons why she is unable to provide that seamless care to women and even admits that there are too many problems with how homebirth midwives practice and yet she thinks women can make a safe and informed choice to have a homebirth with so many variables that a doctor won’t even jump in there and sort out. Maybe Aviva’s next book can be How to pick your homebirth midwife even when a doctor can’t. But hey ladies, it’s your right to choose homebirth so go for it, but don’t go crying to Aviva Romm, MD when things go south because she’ll be off traveling or turning you away because she was unable to get a practice that offers birth services. So good luck.
But It Gets Better
Do you remember how I mentioned a few weeks ago that the new MANA (Midwife Alliance of North America) homebirth study showed a huge increase in death for a baby? Well, when Aviva was asked about that she had this to say:
There you have it, she hasn’t even looked at the most recent data regarding homebirth and yet she is telling women it’s safe. But I was very interested to see what would happen if Aviva took Amy Tuteur up on her offer to find a 3rd party statistician to go over those numbers with them both. One would think this is a win win situation for someone who is so sure that she is right about the safety of homebirth. She would have numbers which would show people just how safe it is and she could shut up one of homebirth’s biggest detractors once and for all. Seems like a pretty natural reaction someone would have when they know they’re right about something.
But no, not Aviva, she accepted and then less than a week later she backed out of it. After Amy Tuteur found an independent statistician Aviva backed out, not because this statistician wasn’t independent or qualified for the job, but because Aviva has decided that Amy Tuteur is just too mean and she needs to disengage from her. Can someone please tell me how looking at numbers with someone who doesn’t have a stake in the race has anything to do with meanness? Because the only reason I can come up with about why someone who is so sure that homebirth is safe would “disengage” from fact finding is if she already knew the truth and it meant she’d have to eat her own words. What would have happened if Amy continued to be mean after the results proved her stance on homebirth to be wrong? Well, Aviva would have facts on her side and Amy would look far less credible. Guess who’s looking more and more like a quack right about now? I’ll give you a hint, it’s NOT Amy Tuteur.
But It Can’t End There
I thought I would try to appeal to Aviva’s desire to create a safe space for women. But it would appear that her idea of safety for women and my idea of safety for women are completely different. Because you see as a mother I feel safe when I know my kids are safe. I don’t think I know a woman and a mother who doesn’t have that feeling of safety in that moment. So I posted this to Aviva’s wall (please ignore the typo in the first line, I’m aware it’s with all due respect):
Yes, I’m aware that by my calling her on having a moral compass that someone who’s so very sensitive to words would have a problem with what I wrote. And I expected it would get deleted and it most certainly did. Without response from Aviva. But the next day she did post this on her Facebook page:
Words have powerful effects, especially when spoken by authority figures. Doctors are frequently guilty of giving people negative health messages. “Nocebos.”
I’ve received many emails from women who experienced obstetric nocebos. Just today I received one from a momma who had a cesarean for her first baby and was told she’d probably never be able to birth vaginally because of the position of the baby in her pelvis. While, in fact, that may be the case for her, an inadequately sized or misshapen pelvis is a only a rare cause of a true need for a cesarean in most healthy women. The first baby I ever midwifed was to a mom who was was about 5’3” tall and the dad was 6’4”. During her pregnancy an OB told her she’d NEVER birth her baby vaginally. She was just :too small.: She actually pushed her baby out just fine in a beautiful home birth. But about 5 minutes before she did she looked at me with fear in her eyes and said “Am I too small? Will my baby come out?”
Nocebos are powerful negative messages that stick because they are told to us by someone we believe, who carries authority about their words, may have a set of skills, experience, or knowledge we lack so we are relying on them, and because they are about something which we feel vulnerable.
Fear has a tremendous physiologic impact on birth. So does our lack of belief in our ability to birth. So we have to work to overcome nocebos in all forms — negative media portrayal of birth, negative messages from family, friends, and health care providers, negative messages from the medical model about birth. Beliefs have a powerful role in our birth outcomes.
What are some of the beliefs you’ve struggled with? Negative messages you’ve overcome? How have you done this?
She is very focused on the how people say things. So much so that several comments on this thread were deleted. Starting with this one:
Actually, this person got banned for saying this. And I then responded with this:
Which ultimately got me banned from the page. The thread continued on where someone asked her about having an HBAC and she did give her advice, which ultimately was correct. This person was NOT a candidate for a homebirth, but that didn’t stop one of Aviva’s followers from telling the woman she could have a homebirth if she just found herself the right midwife and doula. That ultimately was deleted, rightfully so, but the person had already seen it. But what might have been the most heinous act of deletion on this thread was the deletion of a homebirth loss mom’s comment:
So I think what this boils down to with Dr. Aviva Romm is if you call into question the safety of homebirth, then she will delete that. She will disengage from anyone who doesn’t think her Yale degree makes her the be all and know all of all things medical. However, she will tell you to question your own doctors who are telling you that you can’t do something. Just don’t tell her that she might be wrong to be recommending something that is proven unsafe. I mean seriously, how would she know, she said she can’t be bothered with numbers and she has no desire to have someone interpret them for her?
What a shame that she is using her authority as a medical doctor to advise women to do something that she herself will not in fact do herself though. It might be even worse that this practicing medical doctor is giving out medical advice without any sort of warnings to speak to their own medical professional. Opening her and her medical practice up to possible lawsuits. Not even correcting someone who is telling a woman who should not have a homebirth that she can if she just finds the right provider. This is not a doctor I would want overseeing my care, but then again I prefer my doctors to actually believe what they learned in medical school.
What are your thoughts about this latest attempt at hiding the hideous death rates in homebirth?
