Blog flamewar winds up in federal court

A Sharon obstetrician yesterday filed suit against an Illinois blogger with whom she's been engaged in an increasingly nasty flamewar over home births.

In her suit, filed in US District Court in Boston, Dr. Amy Tuteur of the Skeptical OB, charges that Gina Crosley-Corcoran, who writes the Feminist Breeder, is abusing a federal online copyright law to try to shut her down.

Tuteur, a former professor at Harvard Medical School, says she uses her blog in part to wage war on proponents of home birthing:

Having seen thousands of births and the serious risks posed to both mother and baby, especially when such births are deliberately performed at home rather than a hospital, Dr. Amy writes for The Skeptical OB to "tell the truth about and expose the lies of self-proclaimed homebirth ‘midwives’, and to protect babies who don’t have to die."

That's drawn the ire of Crosley-Corcoran, who railed against Tuteur and who last month posted a selfie showing her giving Tuteur the finger.

When Tuteur posted a copy of the photo to slice into Crosley-Corcoran (photo since removed), she charges, Crosley-Corcoran sic'ed her lawyer on her, seeking money for using the photo and then, when that didn't work, began using the Digital Millennium Copyright Act to get Tuteur's Web hosts to take her blog site down for allegedly violating her copyright by using a copy of the finger photo.

In a post in which she calls Tuteur a terrorist and compares her to the Westboro Baptist Church, Crosley-Corcoran writes:

She could owe me statutory damages, but because I'm a fair and reasonable human being, my attorney and I felt it was best to discuss a non-monetary settlement with Amy and her lawyer. I’m not looking to be greedy – I simply wanted a resolution. In exchange for me not pursuing the damages, we wanted Amy to agree to stop personally attacking me. It was that simple.

For any reasonable person, this settlement would have been a no-brainer. I was paying her an undeserved kindness by offering her the chance to simply stop badgering me in exchange for the great deal of money that a judge could make her pay me for trying to profit from my copyrighted work.

Then, Tuteur charges, "posts by Crosley-Corcoran on The Feminist Breeder's Facebook page reveal that Crosley-Corcoran has, upon information and belief, been working on a plan to interfere with Dr. Amy's relationship with her website host," by issuing bogus "takedown" claims under the DMCA.

Tuteur seeks an injunction against any lawsuit related to "the Finger Photograph," plus monetary damages.

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Comments

...and the lawsuit winner is...

...the lawyers. IANAL, but since I do have two cents, here they are...

From the 'finger picture' website: "I don’t want to leave you without something you can take back to your blog and obsess over, so here’s a picture of me, sitting at my dining room table, sucking on a cough drop that I took away from the baby (again! she keeps finding them in the strangest places!) "
Implication to me (as a friggin reasonable and prudent man)is that I can take it back to my blog. Oh, and obsess over it. Since I keep my blog online, well, then I keep it there and obsess over it.

Since I still have a penny left, here's my other cent: I have a son. He's over six feet, owns a home, etc. He was a bit of a preemie and had a small umbilical cord problem. OBGYN at the Brigham handled it like she practiced it on the way in. I shudder to think what the outcome could have been if this happened in my living room. Oh, I'm a first responder, can handle the basics.
Hey, you have the science available, the highly trained people, use that advantage. Why not?

Oh, Will...done in one.

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Not horrible people

No way. Gina made some mistakes in making this whole thing personal. It wasn't personal to her. But nor does that make her a terrible person, rather, just a person, like the rest of us, imperfect and trying to make our way in the world. But not terrible. We all make mistakes.

But Dr. Amy has the high road, here: All she wants is for mothers to be informed of the potential risks in making a decision to home birth. She, herself, has decided, that the myriad risks are not worth the "experience" of a home birth, but hospitals are responding to the demands of home birth advocates, and even as recently as my own experience, more "human friendly," comfortable, yet *SAFE* provisions were being made to accommodate mothers giving birth *AND* their babies. And she doesn't deserve to have her website unfairly and unjustly removed from the Internet just because someone else dislikes the information they find, there.

The bottom line is: Abuse the law, and you might find your erstwhile victim becomes your pro-active opponent. I, for one, support Dr. Amy's decision: This kind of abuse of the legal system for personal, petty purposes is an insult to rational jurisprudence, and more people should be held accountable for it.

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If home birth is so dangerous ...

... then why is it the preferred option in places like The Netherlands, where the birth outcomes are also so much better than in the US?

Maybe it is just possibly more hazardous in the US because people like these two spewing nonsense at high volume in different directions prevent rational public health approaches and best practices from leading to appropriate measures that make home birth much less expensive and safe for most mothers and babies? Hmmm.

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Sorry, you just showed how

Sorry, you just showed how little you know. Please see the recent BMJ article on homebirth in the Netherlands which shows that homebirth with low risk mothers has worse outcomes than high risk mothers giving birth with OBs in the hospital.

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Interesting

Thanks for the tip. I'll look past the abstract when I get a chance. That is indeed recent though. Earlier data showed better maternal outcomes and similar infant outcomes.

However, looking longitudinally across multiple developed nations, the US has high intervention rates, high surgical delivery rates (with all the attendant complications for mothers in particular - like hospital acquired infections - an issue that is too often ignored) yet we still get relatively poor birth outcomes for all of the medical intervention.

That's mainly what I'm pointing out here - there is something very skewed about birth in the US when it comes to intervention versus outcomes - even when maternal age and comorbid conditions are controlled for. The Obstetrics profession in the US is well known for staunchly resisting the gathering of statistics and taking best practice and public health approaches to these issues, however, because of an ingrained culture of not wanting to be questioned in any way about how they practice that goes back decades. So, while the Dutch will gather and analyze the data, have their tough discussions, take their lumps, make needed changes in their practice plans and move on, it will remain a challenge to get US OBs to adapt their practices based on very solid and large research studies that indicate that more people would be better off if they did. Dr. Amy is exhibit A for this sort of reactive attitude - one which I screened for when I picked a birth practice, personally. People like the breeder don't help things much when they ratchet up the animosity but don't look at the problems with any scientific rigor.

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Homebirth for Very-Low risk women is still more dangerous

Even that study from last year that so many pro-homebirth people promoted as saying home birth was safe for extremely low risk women (I.e, women who have had absolutely nothing wrong with the current or any previous pregnancy and delivery, were not obese, were not first time moms, had no health issues whatsoever - it literally excluded about 85% of American moms) still showed that a baby was three times more likely to die at a home birth than a hospital birth. Studies that compare women with more normal pregnancies than the perfect ones included in the study show a death rate 30 times greater. I imagine high-risk pregnancies delivered at home would be even worse.

As for the claims that Americans have worse outcomes despite our interventions, that is completely untrue. America has among the very lowest perinatal death rate (28 weeks through the first 30 days of life, the best measure of obstetric care) in the world. Those lives saved are the direct result of obstetric intervention. Whether it's treatment for gestational diabetes or a c-section to save a baby whose heart rate indicates distress, American OBs work hard to make sure every baby is given the best possible shot at living, unlike in countries where interventions have become taboo and only used after a situation has become so dire it is too little, too late.

Anyone who claims that America has poorer outcomes is probably comparing infant death rates (birth through one year),which in the US reflect our high rates of child abuse and poor access to healthcare for children.

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Some more backstory

The problem is when a dogged journalist like Goldberg elevates Tuteur to expert. Tuteur is not a researcher, she's not currently affiliated with any medical institution, and more importantly, she's never published any of her kitchen-table calculations on the risks of home birth in any peer-reviewed journal. Yet she presents herself with the authority of a CDC epidemiologist when she writes, “Homebirth increases the risk of neonatal death. All the existing scientific evidence says so.”

SOURCE

Tateur let her license lapse in 2003. That isn't a huge deal - many public health researchers who came via medical degrees do eventually stop practicing in order to devote more time to research. However, I was similarly unable to find citations for her in any peer reviewed journal articles regarding home birth safety in the peer reviewed literature - just a single reader comment on a study in CMAJ. In other words, she likes blog and use the popular press as her pulpit, but won't actually submit her statements to peer review scrutiny via scientific publication.

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She didn't stop practicing in

She didn't stop practicing in order to devote more time to research, she stopped practicing in order to raise her children. It is written quite clearly in her blog. I suppose you were similarly unable to find THAT?

And since you are such a big defender of research, try to find out just how Johnson and Daviss who wrote the Homebirth Gospel were unable to find the pubished data for low-risk hospital birth which was available when they were doing their study.

You are not a defender of research. You are a homebirth advocate. There's nothing wrong with being one but it does seem a bit out of place when you are pretending to be objective.

Such Interesting Conclusions, Anon

I read that sidebar. I have no problem with her private choices.

However, I know a couple HMS profs who stopped practicing to raise their families - even home school - but remained in adjunct status and occasionally teach or contribute to publications and research. That collegiality means both collaboration and peer-review, which are critical in scientific statements.

I am actually not a home birth advocate. I am a professional epidemiologist and public health scientist who simply rejects these opinions as unsupported and her blog as advocacy and crusade - just as I reject the LaLecheBorg bullshit my SIL spews without scientific support and reject homeopathy and reject anti-vaccination nonsense too. That's because I like to see actual peer-reviewed research supporting opinions like Dr. Tuteur's or see them subjected to peer review in journal publications, not BECAUSE I'M A DOCTOR AND I SAID SO THAT'S WHY YOU STUPID HIPPIE.

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Please correct me

Because it really sounds as though you're trying to claim that doctors are only allowed to read and analyze data if they themselves were the researcher, and must submit all blog posts and anything else they may say for peer review.

Have you actually read Dr. Amy's blog? She is absolutely meticulous about thoroughly vetting the data she presents as well as the conclusions she draws from there. Every single thing she says, the shows the data in full view and links to the research so no reader can claim that she is making any of it up. Unfortunately, that doesn't stop people from trying to insinuate that she somehow is not qualified to speak on obstetrics.

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Might want to check your

Might want to check your research. Low-risk birth with a midwife in the Netherlands was found to have worse outcomes than high-risk birth with an OB. It created quite the furor.

Homebirth in the US has two things going against it: geography and undertrained homebirth midwives (CPMs). If someone lives very close to a hospital with a NICU and has an evidence-based, university trained nurse midwife (CNM) who has strict rule-out criteria (including ruling out first time mothers, breech, twins, VBAC, diabetic mothers, etc) and who works with a back-up OB, homebirth can be almost as safe as hospital birth. But the current anything-goes attitude in the US homebirth, natural childbirth movement is not evidence based. It's ideology, and it's bad for women and children.

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Yeah, balance

Research is showing that a balance is best. Demedicalizing low-risk births so that the mother is in a comfortable home-like setting where she's free to do pretty much whatever during the birthing process generally leads to better outcomes, but so does having the birth attended by someone who knows when to call for an emergency C-section, life support for mother or child as needed, etc., and who has easy access to these interventions right there if they're needed.

I'm someone who's pretty anti-medical-model (both as a healthcare provider and as a person/parent), but I also think that since we're in a country with pretty amazing medical care at our disposal (I mean in terms of training and technology, not in terms of utilization...), why NOT have the best of both worlds and encourage low-risk mothers to give birth in one of the birthing centers that are really not much different from home birth, except for being attached to a hospital with a NICU? We have the money and the resources to have this safety net available for those families where something suddenly goes seriously wrong during a low-risk birth and those few minutes can really make the difference.

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I'm with you. But the

I'm with you. But the impression I'm left with from the SOB site is that anything a pregnant woman says that even remotely questions what an OB says means she hates her baby and wants it to die, because an OB would never, ever do anything that isn't evidence based and if you disagree, you clearly have no understanding of science.

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Maybe read some more?

Really not sure how you got that impression from actually reading the blog? Dr. Tuteur has criticized incompetent OBs and poor hospital care on her blog, though her primary focus is on the incompetent care from US homebirth midwives (typically CPM/LM/DEM, not CPM). She simply wants women to know the truth - the data and statistics behind homebirth, primarily HB in the US (with other topics occasionally included).

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That's not how I see it at

That's not how I see it at all.

My understanding of Dr. Amy's point is that she fully supports informed consent but considers unqualified, google U graduates, woo-imbued radical HB advocates about as welcome/relevant to the discussion as flat-earthers, climate change deniers and creationists at a geophysics convention.

I do not recall Dr. Amy ever saying that questioning an OB means a mother-to-be hates her baby and wants it to die. What she does say is willful ignorance of facts jeopardizes a mother's and baby's life and sometimes for appallingly selfish reasons.

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Actually, comparing homebirth

Actually, comparing homebirth in the Netherlands (or Canada, or anywhere else for that matter) to homebirth in the US is problematic and disingenuous.

First of all, homebirth is not preferred over hospital birth in the Netherlands, they just happen to have a larger percentage of homebirths than Americans do. And the midwives that attend homebirths there are well trained, medical professionals who are much better at following established protocols for things like risking-out mothers who are not good homebirth candidates. Oh and their outcomes? Not that great compared to hospital births. Look at the actual numbers.

Not to mention, comparing the incredibly heterogeneous American population to a much more homogeneous country like the Netherlands makes analyzing outcomes virtually impossible. In the Netherlands: Universal health care. Fewer women of ethnic origin who are statistically more likely to run into difficulty giving birth. Fewer issues with diabetes and obesity. All of these issues have a huge impact on birth outcomes in the US. You can't just look at a few numbers and conclude that obstetrical care in the US is to blame for poor neonatal outcomes because there are myriad factors to consider. It's a complex problem.

Giving birth at home is an option for women. Nobody denies that and certainly I would never take that right away from another woman (even if I would never do it myself). What is necessary, however, is an honest look at the actual data and a real understanding of the risks inherent to giving birth at home. It is not safe for everybody and the issue is compounded by the poorly trained, don't-know-what-they-don't-know lay midwives that are rampant in the United States.

These concepts are so simple - why do homebirth proponents not get it?

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You missed the point

I was pointing out that our whole system of birth options is messed up, and that perhaps birth at home isn't the kind of absolute risk factor in and of itself - which seems to be entrenched default assumptions leading to this mess - if we are not getting better outcomes with more intervention. (Hence my statement about "rational public health approaches" to birth options ...)

I don't have time to look for the stats for the UK or other first-world countries that have better overall birth outcomes and maternal outcomes but still incorporate home birth. The point is that other countries do a much better job of this with less utilization of interventions even when occuring solely in hospital/clinic settings, and we should be asking why that is.

BTW - I'd be interested in your research experience with Dutch data that leads you to your conclusions about homogeneous populations ... because that's not what I'm seeing in the birth outcome and air pollution work I've been involved in. They have a sizeable and fecund immigrant population for starters.

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Actually, you did make a

Actually, you did make a direct comparison between the Netherlands and the US in your first comment (using out of date information). I was only one of several commenters who set the record straight and none of us missed the point.

Logic here?

What is it here you don't agree with?

That home birth is rare in the US?

That home birth, being rare in the US, can't possibly explain the disparities between outcomes in the US and other developed countries, given the variable (but much more prevalent) reliance on home birth in those countries?

That recent evidence that homebirth is possibly less safe than previously thought simply bolsters statement #2? (i.e. the US is already doing the almost all birth in hospital thing, yet still posts relatively poor outcomes)?

That The Doctor and the Breeder screaming at each other via the internet is a distraction from critical evaluation using validated public health approaches of the kind that the Dutch are using?

What disparity?

What disparity in outcomes? The US actually has does quite well in perinatal mortality overall. You seem to be mostly arguing with yourself. Nobody ever said homebirth is responsible for the "poor outcomes" in the US.

Much of what you have said is demonstrably skewed or false after only a cursory glance.

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What Eastcoaster may have meant is:

I think Eastcoaster referred to this statement:

... then why is it the preferred option in places like The Netherlands, where the birth outcomes are also so much better than in the US?

This is the first statement that Eastercoaster may have referred to.

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You need to look at the data

"I don't have time to look for the stats for the UK or other first-world countries that have better overall birth outcomes and maternal outcomes but still incorporate home birth" Then you need to find the time. The stats don't say what you think they do. Read the UK BirthPlace study (and not just the abstract). Even with extremely strict rule-out criteria, a transfer rate approaching 40%, and each birth attended by 2 University trained midwives, Baby outcomes were not reassuring, especially for first-time mothers. Yes c-section rates were lower. The question is: was the decrease in c-section rate worth the increase in baby death and damage? One other important piece of the puzzle is the difference between perinatal death rate, neonatal death rate and infant death rate. If you don't know what each of these terms represents, people with an agenda easily will be able to pull the wool over your eyes. Perhaps they've done it already?

You need to look at the data

"I don't have time to look for the stats for the UK or other first-world countries that have better overall birth outcomes and maternal outcomes but still incorporate home birth" Then you need to find the time. The stats don't say what you think they do. Read the UK BirthPlace study (and not just the abstract). Even with extremely strict rule-out criteria, a transfer rate approaching 40%, and each birth attended by 2 University trained midwives, Baby outcomes were not reassuring, especially for first-time mothers. Yes c-section rates were lower. The question is: was the decrease in c-section rate worth the increase in baby death and damage? One other important piece of the puzzle is the difference between perinatal death rate, neonatal death rate and infant death rate. If you don't know what each of these terms represents, people with an agenda easily will be able to pull the wool over your eyes. Perhaps they've done it already?

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"I don't have time to look for the stats"

Then please refrain from presenting your uninformed conclusions as fact. Alternately, should you have an interest in the subject, you could come and discuss it with us at the Skeptical Ob. Not something that could happen on Gina's page, which is how this situation came about in the first place.

If home birth was ever the

If home birth was ever the "preferred option" in the Netherlands, it hasn't been so in a long time. Dutch homebirth rates are now under 1 in 3, and part of the motivation is money. For a long time, anesthesiologists and obstetricians mostly went home at 5pm, too.

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Gina (The Feminist Breeder)

Gina (The Feminist Breeder) actually captioned the photo of her giving Dr. Amy the finger something along the lines of "Dr. Amy, you can post this photo on your blog and shove it up your a**!" Dr. Amy did just that, and wrote a blog post criticizing Gina and all the dangerously false information and myths about childbirth she posts on TFB. Dr. Amy's goal is to fight against the false info about pregnancy and birth that is so common on the internet (such as people like Gina encouraging pregnant women to carry their babies to 42 weeks or beyond if natural labor doesn't begin, when in fact doing so will dramatically raise the risk of stillbirth). I stand behind Dr. Amy's mission 100%, and the only reason this has escalated to the point that it has is the fact that Gina is unable to tolerate any criticism of herself or the false information she spreads.

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Well, that's another lie

You know, it's really very stupid to lie about what's on my PUBLIC BLOG. All anyone has to do is go straight to my blog to see what it ACTUALLY says, which is NOTHING like what you said. It's like you can't read. Or just don't want to. It's really so very ridiculous.

This is all getting very, VERY funny. I'm not allowed to say anything about this complaint so I'll just laugh over here to myself until all is revealed. HAA HAA HAA HAA HA.

(But seriously, in the meantime, people need to learn how to read.)

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Public Record

Let me go right on public record: LEARN HOW TO READ. It's absolutely infantile to purport that I've said something on my blog that anyone can see is not true. You guys DO realize my blog is published right there on the internet, right? Where anyone can see it? That's how blogs work.

While you're reading, read the actual rules on Copyright Release. Amy followed NONE of the rules in obtaining my permission, she never had my permission and she knew that AND I can prove that whatever permission she mistakenly thought she had was REVOKED in writing to her attorney.

But again, this requires reading. And you can quote me on all of that.

http://fairuse.stanford.edu/Copyright_and_Fair_Use...

(I'll be over here laughing.)

Your GRASP of the LEGAL system is FASCINATING!

You guys DO realize my blog is published right there on the internet, right? Where anyone can see it?

It's also the place where your opponent's lawyers can take any of these ridiculous statements you're making on THIS site and use them in their LAWSUIT!

One would THINK that having once been in A BIG TIME rock band, you would know to keep your MOUTH shut when you're in LITIGATION with someone!

On a personal note, when you're cackling maniacally at those who DARE to doubt your GENIUS, are you more of a grasp the keyboard and throw your head back laugher or are you the type that rubs their hands together with their shoulders hunched while you look side to side?

Revocation of permission

What ever gave you the impression that you could revoke permission under the sort of permission you granted? And how, exactly, have you convinced yourself it didn't fall under fair use? You should have gone with your original instinct: you're in over your head when it comes to the law.

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You're laughing over being

You're laughing over being sued in federal court? I doubt that Gina. That's a very immature response to something pretty serious.

Instead of using the grade school cut down "learn to read" - why don't you take the opportunity to set the record straight? You did tell Dr. Amy to take that silly photo back to her blog. I'd copy and paste your exact words but you are so unfriendly and lawyer happy, I wouldnt dare do such a thing.

The fact is, you tried to silence Dr. Amy and her readers. You abused the system. It reminds me of what Facebook did to you. Silencing and strong arming people to shut up never goes over we'll in the court of public opinion. You went too far this time.

None of this is a laughing matter.

free to read TFB blog, except when you read other blogs, too

You guys DO realize my blog is published right there on the internet, right? Where anyone can see it? That's how blogs work.

No, that is how blogs SHOULD work. Yours is NOT open to anyone. Many people who try to read your blog see this message instead:

Oh, eeek, sorry. Looks like you’ve been denied permission to see my website. This happens for one of two reasons:

A Either you clicked on a link to my site from a really, seriously effed up place on the internet, in which case, for real? Why are you hanging around such places? Nevermind, ick, I don’t wanna know.

B – (paraphrased) I banned you because I deemed you to be a troll via your comments.

Later in your comment you scold your opposition:

But again, this requires reading.

How can they read when you've blocked their access? You don't just shut down their ability to comment - you completely block access. If you want people to get both sides of the story, it helps to allow them to read the other half.

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Dear Gina, I disagree with

Dear Gina,

I disagree with you most of the time but I still admire your enthusiasm to speak up about the issues that are near to your heart the best way you understand how. I do have to tell you that this lawsuit is not a "ha, ha" matter at all and if not taken seriously you can jeopardize the well being of your family for a very long time. Just one estimate, Dr. Tuteur has so far probably spent anything between $5,000 and $8,000 just to retain the law firm, to have the complaint prepared, and to file. Her legal fees will easily amount to $20,000 plus. Are you prepared to be found responsible for these kinds of gargantuan expenses and more, if found liable? Are you saying that the information that your attorney shared with Dr. Tuteur's legal representative is erroneous in some way when saying that you have no case when it comes to your claim for copyright infringement? These are some serious matters to consider and I hope you do.

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Gina you need to read about FAIR USE

The info you linked to had ample info on Fair Use, none of which you seem to have read. You seem to think your blog is not able to be used by other journalists or bloggers without permission - you are wrong.
"Fair use is a copyright principle based on the belief that the public is entitled to freely use portions of copyrighted materials for purposes of commentary and criticism. For example, if you wish to criticize a novelist, you should have the freedom to quote a portion of the novelist’s work without asking permission. "
Amy's mention of you and the use of your 'finger picture' would easily fit under 'Commentary and Criticism'. Her critique also covers ALL of the requirements to be considered Fair Use. I find it baffling that you claim to have studied law yet can't seem to wrap your head around this.
http://fairuse.stanford.edu/Copyright_and_Fair_Use...

OMIGOD!

You would THINK after all those years in the crazy world of BIG TIME rock and roll, you would have developed a thicker SKIN!

After that comment, I think I'll go with TEAM AMY!

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Gina, I find it ironic that

Gina, I find it ironic that you are all pissy about someone telling "stupid lies" about you, when you tell absurd lies with maximal hyperbole about Dr. Amy and others, and also allow your fans to spread falsehoods on venues that you keep on a very short leash. Considering that you and your admins are able to delete any kind of dissent swiftly from your pages, it'd be simple and easy to remove people spewing falsehoods that you very well know are untrue.

Also who have you retained as a lawyer now? The first lawyer, Kim Bilbrey, was a government-employed public defender who is not legally have any private practice. She wouldn't have been able to file the case that you claimed you were going to file. How embarrassing.

Then you bragged about having the bestest IP lawyer evar, and that person wound up being Jake Marcus, who is quite clearly no IP law expert. Anyone with half a brain realizes that you never had any kind of copyright claim against Dr. Amy, and I don't know why you're pushing your luck now.

Finally, everything you write reads as terse and hysterical. Whoops, I mean, TERSE and HYSTERICAL. Grow up, you're in your mid-thirties, try having a conversation with those that disagree with you in a style that doesn't scream "angry middle schooler".

What makes you think she is

What makes you think she is having a "wonderful time".. Is it because she says she is laughing? First of all - do you believe everything everyone says, all of the time? Do you REALLY think she is laughing? Really? Second of all, even if she is laughing, as a funeral home owner I can assure you people laugh in uncomfortable situations for many reasons other than thinking something is funny. Don't presume on another's reason if they haven't actually opened up their head to you and invited you in.

I don't think this is nervous

I don't think this is nervous laughter caused by distress such as at a funeral. I think it's the prideful boasting of a woman who either doesn't realize the seriousness of what she is facing, or is trying to keep up her bad girl/don't give a crap image in the face of a potentially ruinous lawsuit. Gina, please understand that this lawsuit is serious business. I don't want to see you lose your house or be unable to feed your children over this because it could very easily send your family into bankruptcy. It's not clear from your posts whether you have really faced the reality of what is happening. I sincerely hope that you are just putting on a front.

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her posts

I have read her posts that appear to be glee about how she has this or that suprise ready to show that Dr. Amy. She bragged about laughing. I do have a hard time imagining she would enjoy all this but she posts as if she is. I agree with you that people laugh in uncomfortable situations. I agree about not presuming what's in a person's head. But... If you post on the web that you are suicidal, and someone knows where you are, it's possible that you might have someone so concerned they try to get help. If you post a hostile photo like that, an invitation to "take it back to your blog", you should not be suprised if someone does it. If you work at taking down someone else's website and write as if this was some grand plan don't be suprised if someone sues you. If you comment about how much you are laughing or enjoying the process don't be suprised if those screenshots show up in court when you claim to be traumatized.

Weird message?

I tried to do that but the link is messed up, or they hacked you. I clicked over but got a weird message saying Looks like you've been denied permission to see my website.

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TFB sit being inaccessible

Is probably because GCC has checked you IP and sees you have read the SOB site.
She blocks people directly clicking through to her site from DR Amy's and blocks people who post on her sit who don't support her 100%.

If you've been reading the SOB site recently, GCC has decided you should no longer be able to access hers.
Echo chamber is one way to describe it.

Ensuring her regular posters can't actually see any other perspective on this brouhahah other than the official TFB one is another.

I was paraphrasing from

I was paraphrasing from memory, but you said something along those lines, and things far worse. What you said specifically is hard to prove now since you have edited your post to claim that the part where you told Dr. Amy to take that picture of you giving her the middle finger back to her blog somehow......wasn't actually telling her to take it back to her blog. The part where you told her to writhe around naked on the floor in printed words from your blog apparently still stands, as odd as it is.

As for reading up before making accusations, you may want to take your own advice. Let's see what kind of things you're accused Dr. Amy of:

1. You've accused her of not being a real doctor (hence the constant use of quotes around "Dr." when referencing her). She allowed her license to lapse after retiring from medicine to raise her four children, but she is still a doctor, can legally still call herself one, and can still legally practice medicine if she decided to reactivate her license. You don't lose your education and training when you retire.

2. You've accused her of posting a woman's address so her followers can attack. Not true. She posted a link to a coroner's report about a baby who died at a home birth due to what investigators described as extreme negligence on the part of the midwife (who was also responsible for the death of 5 other babies), and somewhere buried in the report was the address of the woman. Not the same thing.

3. You've accused her of being anti-vaginal birth and anti-breastfeeding. Not at all true. In fact, she has four children who were born vaginally and breastfed. What she is against is women being duped into giving birth while being cared for by incompetent CPMs like the one described above (lay midwives with high school diplomas and a certificate awarded after taking a few classes about what happens during birth. The certificate was created by other lay midwives to give to themselves so they could appear more legitimate and to compete with the similarly named CNMs, who have actual medical training and an a college education in nursing). The reason for her concern is also stated above - babies can die when their birth is handled by people with inadequate training. You've said as much yourself in your post about how after attending 20 births, you now realize how much training you really need to be a safe and competent birth attendant and how much can go wrong at birth. Though, oddly, you've also claimed multiple times that attending those 20 births as a doula gave you more training and insight than Dr. Amy despite her actually having delivered many hundreds of babies.

4. You've accused her of not completing her education beyond residency, which is false. She really was a doctor practising medicine for years.

5. You've accused her of having her blog pulled down a few days ago by her web host in response to your lawsuit. Actually, that instance was due to crashing from high traffic lately, which is why it is currently still up despite a few periods of inaccessibility. Your letters to her servers demanding they take it down due to alleged copyright infringement were illegal and abusive, and are the basis of the current lawsuit against you. They may have worked briefly a few weeks ago, but she was back up quickly and this lawsuit you are so quick to "ha ha" about is the result.

I could easily go on, but I think your own words can speak for themselves. It is disturbing that you would be so quick to laugh at a very serious and likely very expensive lawsuit. It is very sad that it came to this, but you were the first to try and sue her and I can't blame her for fighting back.

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I find it so hypocritical

I find it so hypocritical that Gina criticizes Dr Amy for posting an address in error when she posts personal information of dissenters on her facebook page and encourages her rabid dog soldiers to torment them. Not long ago, a woman dared to disagree with her choice to nurse her toddler, Gina posted her facebook name in a screenshot and an entire thread of followers wrote about how they sent this poor woman horrible messages. I personally disagreed with this woman's stance about nursing, but I certainly didn't harass her on her personal page. And then there is the infamous blog post that someone wrote about Gina, in which the author stated she would like to punch Gina for saying she felt anger towards her son. There was no threat, merely the opinion of a mother reacting to Gina venting about something her child did. Her reaction could easily be explained by the fact that her own baby boy had died in her arms not long ago, and the words Gina wrote about her anger at her son made her angry. A grieving mother feeling anger at someone who complained about her living child. Not rational, I suppose, but certainly understandable. Gina's reaction was to post the link to the poor mother's blog and incite her army of vicious toadies to rain down a hail of torment on this woman. Gina is of course unapologetic and manages to find lies to justify it. But there is no justification, Gina is rotten to the core. She isn't even nice to the people that kiss her behind on a daily basis and if you ever presume to disagree with her, heaven help you. In contrast, I find Amy's blog to be nice and sensible. There is plenty of discussion, no one is ever deleted. It is okay to disagree with Dr Amy or any other member, just be prepared to discuss it in depth. There is passionate disagreement and intelligent debate. I know the natural childbirth world would disagree with me, because anyone who doesn't sing the praises of midwives and homebirths must be truly evil. Amy doesn't aim her intellect at midwives who have done the work of being properly trained, she reserves that for "midwives" with haphazard training rife with quackery and foolish natural remedies. As far as I am concerned, standing with incompetent, negligent, poorly trained midwives is siding with murderers.

YOU are lying now, Gina

Gina, Gina, Gina, now YOU are lying.....anyone cannot just go to your website to see what you did or didn't say. Most of us who aren't sheeple will get some lame message about how we are all assholes and cannot be deemed worthy to see your royal blog since we don't kiss your ass and whatever words are spewing out of it......so Gina, who you crappin?
p.s. You really aren't stopping anybody from getting to your blog, since the people you are blocking really are smart enough to get around it. I've been blocked, and I am still able to view your site, not because I am interested in what you have to say, but just because I can. HAA HAA HAA

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The ego's a funny thing, isn't it?

The Skeptical OB:

As I have said before, The Skeptical OB will be here next week, next month and next year.

Thank God!

Meanwhile, don't try to highlight and copy anything from Crosley's page, it won't let you.

And of course their silly egos keep them from realizing the only winner in all this is the lawyers....

When people do that

other than for reasons like a journal article or assessment tool that can only be distributed in its entirety, it really makes me want to take screencaps of their website and post them all the hell over the place and refer to the content within the limits of fair use. It just screams of the person wanting their content to be read, but not commented on, quoted, questioned, or discussed. It's like, you realize what the internet is for, right?

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Finally, a reason for Internet Explorer

Awhile back, Mozilla "updated" Firefox to remove View Source from the View menu, forcing you to right click on a page. Stupid Mozilla.

But IE still has View Source in the View menu (although being IE, naturally the menu bar doesn't show by default, you have to enable it first), which means if you really want to copy and paste some of her pearls of wisdom, View Source is your friend (you'll have to wade through the raw HTML, but eh, in for a penny, in for a pound).

I found this bit interesting

She left the practice of medicine to raise her four children. Her book, How Your Baby Is Born, an illustrated guide to pregnancy, labor and delivery was published by Ziff-Davis Press in 1994.

She hasn't practiced or published in a while (she doesn't say exactly when she left or if she maintains her certifications). Might explain how she seems to be fighting battles from the past, and referring to home birth midwifes as having far less training and experience and supervision as many are legally required to - an not at all acknowledging the role that midwifes take in many hospital births. Not that Feminist Breeder isn't also arguing from talking points popular in the early 90s ... but the whole thing seems rather strangely dated (considering that my boys were born in the late 90s).

Many states prohibit anyone other than a CNM (certified nurse-midwife ... equivalent of a nurse-practitioner in education and training) from attending home births, and these must be supervised by an OB practice with emergency plans in place, including transport to hospital. MA is one of these states. Also, many hospital-based OB practices include CNMs to spend the needed time with patients, set up plans, do the screenings, and attend low risk births (all in hospital settings under supervision).

As a regular reader of Dr.

As a regular reader of Dr. Amy she spends a lot of time explaining the difference between CNMs and DEMs. She worked with CNMs and respects them very much. As you say, CNMs work mostly in hospitals but some attend homebirths. I know Dr. Amy isn't a fan of homebirth but she does defend the right of women to have the choice. It's my opinion that if US midwives all had a CNM or equivalent ( in Europe there are non nurse midwives that have extensive university education in midwifery ) there wouldn't be such fuel for debate.

In my state, there are many

In my state, there are many CNMs, but almost all of them practice in hospitals. It is hard to find a CNM who will do a homebirth. On the other hand, it is very easy to find a homebirth midwife who is NOT a CNM. My state allows anyone to practice as a midwife. I could be one. You could be one. After some horrible outcomes, a few politicians tried to tighten up the regulations to make things safer; they were accused of trying to deny women choice. To be fair, many states that really try to enforce medical training and accountability for birth attendants end up with underground midwives. Those are the ones who hide or take off before the paramedics show up, and ask their clients to pretend it was an unplanned out of hospital birth.

Wonder why CNMs don't do homebirths

Do you think most CNMs don't do homebirths, just maybe, because they think homebirth is dangerous? Just maybe it was a professional decision made based on actual evidence that being out of reach of lifesaving equipment and specialists puts women and neonates at risk? No. It must be because they just don't understand how much you want it.

Other states take a very

Other states take a very different view -- check out Oregon if you want to see what the wild, wild west of unregulated midwifery looks like.

These issues are STILL current. The Big Push for Midwives campaign is actively working to extend the ability of CPMS to practice in various states. Other pro-midwife groups are working to broaden insurance reimbursement for CPMs and the ability of CPMs to obtain Medicaid payments. Bills are still in front of various state legislatures dealing with the legality of midwifery practice. See, for example, the blog "Safer Midwifery for Michigan".

You do realize

That there are areas of Oregon that are so remote that the nearest hospital is 100 miles away.

When my father had a work accident, we drove 35 miles each way to the nearest hospital to visit him.

Not that many people live these places, but home birth is a possibly more attractive than driving to a motel a week before your due date and staying there until you go into labor.

Not that it is a good thing - but having areas that are 2x the size of MA and contain 15,000 people leads states to regulate some things differently at the edges. Such as with supported home schooling when school bus rides are more than two hours each way.

The flip side is also true

If someone is 100 miles from the hospital and decides to home birth because of it, it also means that the reasoning homebirthers use to claim it is safe ("I'm only x number of minutes from the hospital" "I can transfer if I need to" "I can use the hospital as back up") won't apply. If you have a postpartum hemorage, the baby gets stuck in the birth canal and you need an emergency c-section (happened to me!), you develop postpartum preeclampsia, or experience the countless other things that can go wrong with a birth, you and your baby will have no choice but to sit and die at home, because CPMs can do next to nothing to save you. A few states allow them to carry pitocin to combat a very minor hemorage and most know some basic things like CPR, but you are really up a creek if you decide to home birth in a rural area.

If you are very far from the hospital, you don't have to pretend that's an excuse to home birth. You can leave for the hospital early in labor (you will have time - hospitals will turn you away and tell you to come back later if you show up in the first 3-4 hours, so even faraway women will arrive without having missed anything), or you could call an ambulance to rush you to the hospital if you suspect the baby will come fast. Both are options rural women use every day. There is no home birth/motel room dichotomy where you have to choose one or the other.

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"When my father had a work

"When my father had a work accident, we drove 35 miles each way to the nearest hospital to visit him."

Why didn't you just use a local healer? Slap some herbs on there and tell him to breath through the pain?

Demonstrably not true!

She left practicing medicine in 2003. It's all over the place on her blog and elsewhere. Just because her book was published in the early 1990s, it doesn't mean that's the last time she worked.

And you're dead wrong about home birth in Massachusetts. In most states, including this one, direct-entry midwifery operates completely outside the scope of the law. CNMs-- certified nurse midwives, NOT direct-entry midwives-- in most states are the ones who are prohibited from attending home birth at all, or who are allowed to attend home birth only with a cooperating/supervising OB and a hospital backup plan. Because of this restriction, there are very few CNMs who attend home births. The vast majority of home births in the US are attended by direct-entry midwives, who may or may not carry the CPM-- certified professional midwife-- credential. All you need to do is Google "CPMs Massachusetts" to get a long list of local homebirth midwives, none of whom have a nursing license.

You claim to be a practicing epidemiologist, and maybe you are, but you seem really, really uninformed about even basic terminology with regard to current birth practices.

Actually, no

MA is NOT one of those states. Massachusetts requires all CNMs to work under the supervision/cooperation of an OB, none of whom will agree to work with a homebirth midwife. As a result, CNMs in Massachusetts do not attend home births at all. ALL of them work in hospital settings.

Massachusetts, though, DOES have a large number of non-nurse direct-entry midwives (DEMs/lay midwives/CPMs) who attend nothing but home births. This isn't strictly against the law; rather, these midwives practice completely outside any legal oversight. Their services aren't covered by insurance, and there are no OBs working with them.

I'm a little surprised that someone who claims to be a practicing epidemiologist doesn't know even these basics about the circumstances surrounding birth attendants in MA. Dr. Amy, for example, repeatedly makes clear the differences between the types of midwives attending births at home and in the hospital.

Similarly, it doesn't take a lot of digging to find out that Dr. Amy was practicing until 2003, when she retired and let her license lapse. Just because her book was published in 1994 doesn't mean that's when she stopped practicing.

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I home-birthed a Lincoln-log once

Having casually read into this matter a bit, and having read it from reputable sources (medical professionals), I'm at a loss with regard to understanding the militant home-birth movement.

If you are willing to risk giving a home-birth for shits and giggles without an ambulance standing by in your driveway, you are gambling your child's future. Complications during birth can cause crippling damage to the child in a matter of minutes, and having the midwife call 911 when shit hits the fan still sets you up for a good 15 minute ambulance response time at best, then intake, diagnosis, then intervention lasting another half hour.

How do you explain to your brain-damaged child that they're not what they could have been because you wanted the right kind of scented candle burning during their birth. This is some serious stupid shit.

Okay then

How do you explain, given the rareness of homebirth in the US (<1% of births, excluding the OMG BABY'S HEAD!!!! surprises), the lagging fetal and maternal morbidity and mortality outcomes compared to other developed countries?

How do you explain this in terms of home birth, despite much higher prevalence of midwifery and home birth (and, now, some indication that outcomes might be improved with clinic births) in other developed countries.

Also, are you aware of the rates of hospital acquired infections for women and neonates in US hospital settings? The kind of damage those can cause - including death and brain damage to infants? Infection rates as high as 30% in women who deliver by c-section, which can be as much as 1/3 of births in some areas?

Railing against home birth is a distraction from some seriously larger issues of maternal, fetal, and neonatal treatment in the US.

How do you explain how home

How do you explain how home birth, which has a dramticaly higher maternal and neonatal death rate than hospital birth, could possibly do anything to lower mortality and morbidity rate? Please read my explanation above about how infant mortality and perinatal mortality are two very different things, and how the fact that US has among the lowest perinatal mortality rates in the world means moms and babies are safer delivering here than nearly anywhere else, especially countries like the Netherlands where home birth is common. Did you know that in recent years home birth rates have fallen there in response to reports about how a low-risk woman delivering at home with a midwife is more likely to die or have her baby die than a high-risk woman delivering in a hospital with an MD? They were mistaken about the risks of home birth for many years, and you may be too.

If lowering rates of c-sections and maternal infections is your goal, there are effective ways to do that that don't involve home birth. My obstetrician has a success rate of 96% for women hoping to deliver vaginally. He does it by doing things like allowing moms ample time to deliver (36+ hours if baby is okay), encouraging letting labor start naturally, gently augmenting stalled labor, etc. We don't need home birth to fix the problems with birth in the US.

You stated earlier that you

You stated earlier that you were too busy to read the research...are you just too busy to read research that contradicts what you want to believe?

Regarding infections in hospitals...hospitals haven't been dirty places for a good 100 years now. Not since the germ theory took root and doctors/nurses started washing their hands and disinfecting. There is no way a hospital is dirtier than the average household, especially one with pets or kids. And I've seen more than one homebirth on youtube where they gave birth in the bathroom or on the toilet. That's cleanliness?!

Also, you must not have heard of the woman in North Carolina or somewhere who acquired necrotizing fasciitis in her vagina after her homebirth midwife checked her without gloves on.

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You have reached a nonsensical point

Regarding infections in hospitals...hospitals haven't been dirty places for a good 100 years now.

Please do a google search and try again.

Hospital acquired infections are a serious issue in maternal and neonatal health - and for non obstetric hospital stays as well.

If you believe what you wrote, you need to familiarize yourself with modern information of such bugs as c. diff. and others that are 1)antibiotic resistant and 2) nearly impossible to remove from a hospital environment and 3) cause substantial morbidity and mortality from hospital acquired infections.

Sorry, but I do have a PhD in epidemiology and while I didn't read past a SINGLE specific article abstract (since I'm not at work and hit the paywall) doesn't mean that I'm not familiar with the larger issues here as somebody who has aggregated birth outcome data from an international consortium of scientists and authored papers on birth outcomes research. You are welcome to use the internet yourself - there is much in Pub Med on the subject that is available on the public side of the paywalls. Google "Pub Med" to get to the keyword portal. I shouldn't have to catch you up on such basic research.

Otherwise, if as many as 1 in 9 mothers coming home with a potentially life threatening infection requiring treatment sounds fine to you, by all means carry on your anti-homebirth arguments as though they even mattered in the larger scheme of neonatal and maternal health.

In any case, I haven't once argued that unregulated home birth is a good thing - what I have been arguing here is that this crusade against home birth in the US is a complete distraction from the overall situation of relatively negative morbidity and mortality outcome statistics for the entire system of obstetrical care in the US.

I'm sorry if you can't wrap your dichotomous minds around anything that isn't in one bin or the other, isn't "with us or against us!!!" or isn't some sensational and singular horror story. It is entirley possible to criticize the "Skeptical OB/GYN" for her misplaced fervor and point out that the US has overall lousy outcomes despite high hospitalization rates that could use some critical scrutiny without being a "homebirth advocate" or whatever strange things you choose to project upon me this time. You just make yourself look foolish by engaging in such reactionary projections, however.

Of course hospitals have

Of course hospitals have germs. But here's the thing - despite the germs, a mother delivering her baby in the hospital is still dramatically safer than one delivering at home. I would be so bold as to claim that it's you who is trying to distract from the real issues with talks of germs. The real issue is that there are people out there like Gina who are encouraging women to choose a far deadlier option when a much safer one is easily available to all American women. They try to create a smokescreen and the illusion of a grey area by talking about infections and trying to claim that statistics say what they really don't, or citing out-of-context or irrelevant information. They try to make it seem as if the question of the safety of home birth is still undecided when in fact it is very settled. If you give birth at home, you and your baby are much more likely to die or suffer injury. Period. If they really cared about maternal and neonatal mortality, they would not support home birth.

Try again...

The CDC says that 1 in 20 patients will get a hospital acquired infection (HAI). You're claiming the rate is more than double for pregnant women. Of course, midwives don't really have a requirement to report such things.

Also, if you read TFB loon you'll see she attended a birth with a hacking couch! How awesome that a wack-a-doodle like TFB has NO oversight and can endanger a mother and newborn as she did.

She's not an epidemiolgist

She is also not a doctor anymore.

Neither would be an issue if she bothered to submit her research and findings to peer-reviewed journals.

She doesn't do that.

Neither would be an issue if she remained affiliated with a university as an adjunct researcher and maintained contact with other reseachers and colleagues.

She doesn't appear to do that, either (and, I might add, I know a number of professors and doctors who have chosen that route to stay current while they raise families and homeschool their kids and the like).

She is welcome to blog her opinions. I don't accept them as scientific given the lack of peer review that encourages academic rigor.

And you are not an OB

And you were never an OB to start with.

I'd take a retired OB's opinion on childbirth over the opinion of an epidemiologist any day of the week. Infections aren't the only dangers in childbirth.

Dr Amy might not come off as an overly nice person. But she is certainly more qualified to talk about obstetrics than you or I. And she's more qualified to talk about obstetrics than Gina. I don't see you talking about Gina's opinions on her blog?

Where are you getting all

Where are you getting all these peer reviewed pro home birth articles put out about US midwives? Sorry, your bullshit is showing. You would rather believe what a bunch of people who were never doctors has to say than what someone who actually practiced medicine has to say. The fact that everything she says is reflective of what anyone that knows ANYTHING about the subject should alleviate whatever anxieties you have about her not being a 'practicing' doctor. Add to it the only people claiming all the garbage you've posted here have no kind of relevant education, university affiliation, etc and it becomes crystal clear that 'qualifications' are the last thing you are really worried about. You are such an epic lay person that not only do you confuse original research that requires peer review with commentary on research that is ALREADY peer reviewed, but you can't refute anything she says so you attempt to cast doubt on its validity by attacking her qualifications. Fail.

Excuse me?

Your failure to transcend dichotomous thinking is showing.

I'm not a homebirth advocate. I'm just daring to question this doctor's failure to submit her findings to peer-reviewed journals when she seems happy to disseminate them in the popular press where they won't be questioned ... because they should be questioned if they are to be given the mantle of scientific validity. As should any scientific findings, assertions, etc.

Are you that unable to process a world that isn't us vs. them? That it is possible to call BS on unsupported and unchallenged opinions on both sides of an issue?

Oh, and I'm not an "epic lay person". I get to put Dr. in front of my name, too.

Nothing you have said on this

Nothing you have said on this topic is remotely informed, as has been demonstrated by numerous people. You write as if Dr Amy is the only person that says these things. What planet are you on, and for gods sake what kind of doctor are you? Everything you have posted is trumpeted by home birth supporters, I apologize for assuming you support something you are vigorously defending....What kind of doctor doesn't grasp that commentary on studies doesn't need to be peer reviewed? She isnt conducting studies, so why would you be questioning her for not submitting anything to be peer reviewed?? She writes commentary on peer reviewed studies. Why is that so hard to grasp? Everything Dr Amy posts is accepted as medical fact in the medical community, she isn't going out on some weird limb where the burden of proof is resting on her shoulders. It rests on the shoulders of home birth advocates that claim home birth is safe, despite nearly all studies showing at least 3x the death rate. You say you aren't a lay person...yet you seem not to have even the foggiest grasp of US maternity care stats, the literature you randomly quote, or even what is subject to peer review and what isn't....and you still haven't refuted a single thing she's said. Raise questions about Dr Amy by refuting what she says, not by some faux concern over peer review and her not currently practicing. Arguments based on logical fallacies might fly over on the feminist breeder, but you'll need to come up with something of better substance when addressing people that actually know what they are talking about.

Do you even understand what a

Do you even understand what a research journal is? Do you know what peer reviewed means? Do you know what a blog post is?

I am absolutely stunned that you insist that Dr. Amy must be a currently practicing doctor, a professor, or a full or part-time researcher to be able to read a peer reviewed journal write a blog post about it, and must then submit her writings for peer review before posting on a blog in order to have credibility. I am not joking. I am seriously floored that you continue to say that.

I am going to tell you how all of this works, not to try and be a snarky internet commentor, but because it really and truly sounds like you do not know how this all happens.

First, researchers decide that there is a question they need to answer and put forth a proposal to whatever group they are associated with (university, corperation, government, etc.) Once the proposal is accepted, they gather test subjects and perform their research. Afterwards, they gather all the data, analyze it, and come to a conclusion. They then submit their data to a peer-reviewed journal so other researchers can learn from their findings, as well as critique their methods and conclusions and consider it for publication in the journal. They can also choose to try and replicate the outcome in a study of their own.

This is the part where Dr. Amy and anyone else who is interested in the data can come in. Anyone, and I mean anyone, from a high school student to a doctor to a newspaper reporter to a government policy expert can come, view the data, and talk about them. I myself sorted through many peer-reviewed journals in high school and college and wrote hundreds of pages based on that data just like Dr. Amy does. I did not have to submit my essays for peer review any more than Dr. Amy has to submit her blog posts. The peer review part is already done! If she tried to submit a blog post or a Facebook blurb people would scratch their heads and laugh!

And anyway, does it help that the text of the lawsuit says that Dr. Amy is not only a Harvard-trained doctor when practiced for at least a decade, but was also at some point an instructor there? I honestly can't think of anyone more qualified to speak about topics in obstetrics. If Dr. Amy doesn't make the cut for you, no one will - least of all Gina.

I don't care how many Drs you

I don't care how many Drs you put in front of your name, you seem unable to grasp a simple concept: some people write for peers and other write for lay people. Dr Tuteur never claimed to have any "findings", got it? Researchers write for peers and then journalists present or mispresent their findings. Dr Tuteur continues to do what she did when she was practicing - she explains obstetrics to mothers who are, presumably, lay people. While the peer-reviewed research you are whining for is making its way through the routines, babies are dying and that makes Dr Tuteur mad.

Do you realize how pseudo-elitistic you sound? So what, we lay people are not entitled to having things explained as the one doing the explanation thinks they are? Explanations are reserved for peers alone! And you have the nerve to accuse Dr Tuteur of looking down on non-doctors? Irony, thy name is Dr Epidemiologist.

When worlds collide

We seem to have two groups of people in this discussion: People who are seriously invested in the Dr. Amy/Gina war, who have been following it for weeks, if not months and who have irrevocably chosen a side - and Universal Hub regulars, who likely had never heard of either person until I posted about the lawsuit.

I'm in the latter camp; I'd never heard of these two bloggers until I read the lawsuit complaint. And I admit: I'm going to take the word of an active epidemiologist on issues of disease spread in 2013 over somebody else's, including an obstetrician who has not actively practiced for some time. That doesn't mean I think Tuteur doesn't have valid points about birthing babies, but there is more to medical practice these days in a world with nosocomial infections and bacteria resistant to all available antibiotics.

I follow

I follow Amy's blog, though I'm not a hardcore "follower." I would like to point out that Amy never claimed that infections don't occur in childbirth. The point where I disagree the above commenter who claims to be an epidemiologist (I don't disbelieve her, but, you know, it's the Internet so I don't automatically believe her either) is that Amy is not actually producing research that needs to be peer reviewed... She's just blogging. Generally about OTHER people's research.

Err, we're talking about

Err, we're talking about childbirth, not medicine in general, right? Mind you, the epidemiologist here was telling things like "homebirth is prevalent in Netherlands!" and "Netherlands is faring better in the terms of outcomes". Both statements are, in the best case scenario, really uninformed and in the worst case, outright lies.

Still sure you believe her?

Correction: we are talking

Correction: we are talking about childbirth, not medicine in general. Lots of good it'll do to me to escape a hospital acquired infection and instead have my baby's cord prolapse in my living room. It'll be absolutely worth it!

That means you have made up

That means you have made up your mind and taken a side as well, within minutes of hearing about this, and after reading next to nothing about the subject. You have very unwisely decided to instantly and unquestioningly believe someone claiming to be an epidimeologist even though the posters here have proven how very little this person knows on the subject and is making wildly untrue claims.

You don't know anything about me, or her

I've run this site for, gosh, six or seven years now, and Swirly has been an active participant for most of that time. She really is what she says she is, which obviously you're free to not believe, since you don't know me from, well, me, there's not much I can do about that.

You're right - I don't know much about the home birthing controversy - but I'm not going to automatically discount the word of somebody I've known for quite some time on the sayso of anonymous commenters.

Well, we are not talking

Well, we are not talking about smallpox here, we're talking about PPH that can kill a woman in 8 minutes (almost happened to my mother). It seems you've decided to take the word of someone who is not an expert over the word of someone who went through residency, practiced and has a book on childbirth published, so don't start about anonymous commenters. Any retired OB has forgotten more about obstetrics than any epidemiologist can ever hope to learn and vice versa. I really don't understand that line of reasoning - I'll take Swirly's word on something she's not an expert in and I won't do even a basic Google search to see that her main claims are false.

Correction: the 8 minutes was

Correction: the 8 minutes was hearsay, something I heard from my gyn. I didn't think to ask where he knew it from. Still, the point stands: PPH can kill a woman in minutes. Presumably, the same minutes that are needed to transport her to the hospital after her lovely homebirth turns into a nightmare.

The point is PPH can kill a

The point is PPH can kill a mother faster than she can get into a hospital( and that is even if she lives really close to it) the average transfer time in the US is about 40 min, from initial decision til the mom is seen by an OB. HB is great and a perfect choice in hindsight, since there is no way to know for sure ou won't need life saving intervention HB IS a risky choice,even for low risk moms...

Thanks Adam

Something to think about is this. I would never deny the reality have of hospital acquired infections. However, when it comes to maternal or neonatal infections the VAST majority have nothing to do with acquiring them from the hospital. And one thing Dr. Amy has highlighted is that the most common neonatal infection, Group B strep, is often mistreated or not treated at home. There are midwives out there telling women to use garlic or chlorhexidine douches instead of antibiotics. There are midwives out there discouraging testing for this bacteria or treating for it at all. There are midwives out there denying the role prolonged ruptured membranes has in perinatal infection. The epidimiologist is using a bait and switch. Yes, there are rare instances where a mother or baby might acquired an infection in the hospital they would not have acquired at home. There is never any excuse for that. But the statistics still don't support the premise that a baby is safer being born at home over a hospital. In my view, bringing up hospital acquired infections is an attempt to hide the real issues in the debate.

What Findings?

But she doesn't blog about her "findings." She reviews and explains other people's research, interspersed with scathing opinion pieces. There's nothing she SHOULD submit to peer review, she's just making other people's data more available and understandable, talking about possible flaws (including flaws of anti-homebirth research) and conclusions.

Really Swirygirl???

Swirlygirl, you obviously don't read Dr Amy's blog. You want her opinions or research to get into peer reviewed journals? Dr Amy discusses published articles from peer reviewed journals that she bases her opinions on! Don't you get that. She discusses articles from BMJ, NEJM, OB/GYN green and gray journal. She discusses CDC and state reporting agencies statistics. Articles from New Zealand and elsewhere. Dr Amy doesn't have to get anything published, she is educating you about what is published. I have read your comments on here, you are obviously biased towards homebirth, good luck with that. I am an OB/GYN still practicing and I agree with most of Dr Amy. Just because she is retired doesn't make her forget medicine or statistics or journal review. Her reviews of articles and state homebirth statistics are all contemporary and often even before being officially published. She doesn't quote old articles or compare to old statistics like pro homebirth studies like Johnson & Davies does.
I suggest you go there and read some more before you pass your ignorant opinions. What peer review journals to your opinions appear in?

If you are working in the

If you are working in the public health field, you might know some medical doctors. Ask any of them if they would stop being doctors if they stopped practicing and gave up their license. The answer, of course, is no. You earn the doctorate and the title "Dr." when you graduate medical school - even before your residency, even before your fellowship, even before you pass a licensing exam, even before you practice. You have it whether or not you ever go on to get your license and whether or not you give that license up.

If you have time to actually click the links I posted, you'll be able to see that she is not reporting on her own research. She is reporting, in some detail, on the published and peer reviewed research of others. If you have time to click on those links, you may discover that this is an area of public health that you can learn more about.

she never claimed to do research

I am not sure why you keep talking about her research. She blogs about others research. She recently posted about how important it is to read a paper in it's entirety and not just the conclusion. She always links to the research she is talking about and she would be the first person to criticize someone for just taking someone's opinion about what a study says, including hers, as valid without looking at the study itself.

Ha, ha, ha...really?

Guess what, the great thing about science is that it's NOT dependent on anyone's opinion. Dr. Amy is not claiming to "do research", she's presenting the known research that shows how dangerous homebirth is. I don't know why you think someone with an MD, who practiced as an OB/Gyn isn't "qualified" to read and understand the literature.

Besides, it doesn't take any advanced degrees to understand that the rates of injury and death during homebirth far, far exceeds the rate found in hospitals. Anyone who advocates for homebirth is absolutely advocating for babies to die.

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Not science

You can't pick and choose which evidence agrees with you, and then go on pogroms against the people whose research doesn't agree with you.

That shit got her booted off of science-based medicine:

http://www.sciencebasedmedicine.org/index.php/dr-t...

That, and she's neither a physician nor a scientist. Couldn't even fit in with the crowd that is dedicated to looking at the science of medicine? That doesn't concern you?

Don't expect to see her on an IOM panel anytime soon. She has a poor reputation as being both bullying and yet not the least bit rigorous among her colleagues. But she has minions who lack fundamental understanding of how science is made into policy and practice. Lovely.

Um, okay

Because laboring and delivering mothers never have any of those "sick people" germs themselves. No TB, no HIV, no C.Diff., no strep, no staph ... and they never pass stool while in labor all over the room or bleed or even exhale.

Right.

This is an old article, but demonstrative of how such measures don't "fix" the nosocomal transmission problem because a lot of us are walking around with this stuff on and in our bodies:
http://www.ncbi.nlm.nih.gov/pubmed/7559940

Aside from that study being

Aside from that study being too small to show anything worthwhile, it points out that 42% of the babies that tested positive were born with complications. I wonder how those babies would fare at home birth? What exactly do you think this study shows, and better yet, where is a study that compares home birth babies to hospital babies? What group of doctors, researchers, or other interested parties (march of dimes, American academy of pediatrics, etc) is indicating that the risks of infection in hospital outweigh risks of birthing elsewhere?

How do you explain, given the

How do you explain, given the rareness of homebirth in the US (<1% of births, excluding the OMG BABY'S HEAD!!!! surprises), the lagging fetal and maternal morbidity and mortality outcomes compared to other developed countries?

Off the top of my head.....
-We don't have universal single-payer health care, which affects the other factors listed below
-We have great income disparity in this country; poorer women have less access to good treatment over the course of their pregnancies
-We have higher obesity rates

How do you explain this in terms of home birth, despite much higher prevalence of midwifery and home birth (and, now, some indication that outcomes might be improved with clinic births) in other developed countries.

You're an epidemiologist? Surely you have heard of coufounding factors and the principle that correlation does not imply causation?

You're also not being specific. Which outcomes? Lower cesarean rates, even though the WHO retracted their recommended 10-15% and admitted it wasn't backed by evidence? And which other developed countries? Some have higher rates of home birth, some don't. Most other western industrialized developed nations are located in western Europe, which is far more densely settled, implying that that more women live closer to a hospital. Further midwives in these countries have education and training more on par with what American CNMs have. The midwives that attend home births in the US wouldn't be allowed to practice in France or the Netherlands.

Also, are you aware of the rates of hospital acquired infections for women and neonates in US hospital settings? The kind of damage those can cause - including death and brain damage to infants? Infection rates as high as 30% in women who deliver by c-section, which can be as much as 1/3 of births in some areas?

Of course those are important issues. But you're leaving out a few important numbers. How many deaths and instances of brain damage are cause each year by hospital-acquired infections? Is that number higher or lower than the number of deaths and instances of brain damage among home births. More importantly, is that RATE higher or lower? "Can be as high as....in some places" is not universal, for starters, and an "infection" can encompass everything from a minor rash that resolves on its own to NEC or MRSA. Without specifics, it's just a rhetorical device.

I'm not a cheerleader for Dr. Amy-- I'm pretty earthy-crunchy myself. But from my years associating with other natural-minded moms in LLL and similar groups, my experience has been that while Dr. Amy does cherry-pick when criticizing the excesses of the natural parenting community, the fact is those women exist and are a vocal and not-very-nice presence on and offline, and they DO drown out dissenters, and they DO encourage dangerous practices like home and unassisted VBACs and breech births.

Finally, you're complaining that Dr. Amy isn't focusing on more important issues. But neither are you-- instead, you're spending time on a comments thread criticizing her.

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I don't doubt her qualifications as an OB

I'm sure she's quite good on the sort of "why do I have to have a c-section for placenta previa" sorts of issues.

However, she is passing herself off as a scientific expert to both the domestic and foreign press when she 1) has no affiliations, 2) no collaborators, and 3)hasn't published anything in the peer reviewed literature.

She is trying to advocate for policy in other countries, yet she misrepresents the research that is out there (according to her peers - read the earlier link) and has not subjected her opinions to the rigors of peer review.

That's like a US truck driver giving authoritative interviews on roadway design policies in UK and Europe.

If she is SO SURE of her beliefs, then why doesn't she approach colleagues, set up an HMS or HSPH adjunct appointment, and publish a collaborative, peer-reviewed research synthesis in the medical literature using transparent methodologies? Then I will be willing to listen to what she has to say (beyond her experience as an actual physician) because I could take it apart and reassemble it for myself.

However, that would mean criticism. That would mean compromise. That would mean systematic assessment that might not jibe with what she "just knows". That might actually lead her to change her mind or temper her statements. Also, "because I said so and I'm the doctor" doesn't work when you are with a panel of other doctors looking at all the evidence. Moving the goal posts and saying "well, these statistics don't say what I want so I'm going to say that these statistics aren't the ones that you should look at" isn't acceptable in such settings, either. I've seen people try this in such groups, and they get called out to support what they are saying. That's why peer review is so damn important.

This is the way science is done internationally. Tuteur, however, has decided not to subject her work and opinions to the kind of scrutiny of her peers that good science demands. That's why I think she is a crank - a more educated and informed crank than her fellow mommyblogger, perhaps. But certainly the sort of "lone scientist" or "lone doctor" on a mission who occasionally try to worm their way into review panels or spam our e-mails with threats and get turned away because they are doing advocacy, not science. Until and unless she exhibits proper research discipline and submits her personal findings to critical review, her injection of herself into the public health debate of countries who are actually grappling with issues of utilization and outcomes is, quite frankly, appalling and dangerous.

Hi Swirlygrrl, I've been

Hi Swirlygrrl,

I've been reading your comments (well, all of the comments, actually). You are very stuck on why Dr Amy doesn't publish anything she writes. Have you read her blog? Can you give specific examples of blog entries that would be fit for a peer reviewed journal? I'm just confused as to what you are referring that is not valid b/c it has not been peer reviewed.

It also seems that you won't consider ANYTHING she has to say b/c it has not been peer reviewed. What about posts like this: http://www.skepticalob.com/2011/06/electronic-feta...

It has not been peer reviewed so does that make it irrelevant?

What about this one? http://www.skepticalob.com/2013/01/new-cdc-statist...

This is data from the CDC. Anyone can access the data. What would need to be peer reviewed for this blog entry to be considered relevant?

Or what about the countless home birth deaths she has brought up that are stories from mothers about the loss of their babies at a home birth? What about the stories she has found in the news?

I guess I'm just really confused about what needs to be peer reviewed.

Are you sure you are not a home birth advocate? Do you have any personal ties? Is it just something you enjoy reading about? I can't imagine any of my friends or family that have zero interest in home birth would know about any of the studies you have referenced or points you have made. It truly does seem you have some sort of vested interest.

Professor Jan van Lith of

Professor Jan van Lith of Leiden University's teaching hospital told the paper media reports about the high perinatal death rate in the Netherlands were driving women to chose hospital births. The increase in demand for pain relief is also playing a role, he said.

http://www.dutchnews.nl/news/archives/2011/07/insu...

A Dutch professor in a teaching hospital says that their perinatal mortality is high and that women choose hospital births. Swirly says homebirth is a preferred choice in Netherlands and that their outcomes are vastly better. I know who I'd rather believe.

Again, not Dr Tuteur. A Dutch professor.

And Dr Tuteur's point is that women who think that popping a cinnamon candy and blowing at a woman with PPH (I kid you not, this was in Facebook where midwives were collecting tips for Midwifery Today) are not reliable providers and therefore delivering with them cannot be safe. I agree.

Still, it seems we've moved the debate 'Homebirth vs Hospital" here. The post was originally about Gina and Dr Amy. I can only say that I saw on Gina's page what she claims in not there now.

That publishing, that peer

That publishing, that peer review, that everyone here values, has been done by the authors of the papers that she is commenting on or critiquing. She often reports on them within days of their publication.

Her comment on how other countries are cheating to make their statistics look better (http://www.skepticalob.com/2012/03/international-c...) was based on the analysis published by Canadian scientists in the peer reviewed British Medical Journal (BMJ) the previous month. It is linked right there in the post, for you to see for yourself.

Her comment on how infant mortality is the wrong measure of a country's obstetric care is based on the World Health Organization's opinion of the best measure of obstetric care - it's not just her opinion, and she didn't just pull it out of thin air, as you imply. http://www.skepticalob.com/2011/08/infant-mortalit...

The sad truth about the perinatal mortality rate of Dutch homebirths is, again, from a study performed by Dutch scientists and published in the British Medical Journal. http://www.skepticalob.com/2011/07/dutch-homebirth... It was published in 2010. So while it seems to be news to one commenter here, it is not really all that recent. Tuteur's opinion, again, is not based on thin air, but on peer reviewed, published research.

Ugly bullying

Ms Crosley-Corcoran has at the least violated (a strong word but one which I believe is appropriate) reasonable boundaries of disagreement. To accuse Dr. Tuteur of being a terrorist and to compare her to Westboro Baptist Church adherents is purely ad hominem. It is solely a personal attack.

To complain that Dr. Tuteur's posting the middle finger salute photograph is bizarre. It is hypocritical complaint since Crosley-Corcoran already posted for public viewing. (Obviously a photograph delivering a gross insult has nothing to do with any reasonable discussion). But worse, Ms Crosley-Corcoran implies she can abuse anyone she wants, but when someone objects by proving the abuse happened (by posting the picture in the same medium) suddenly Ms Crosley-Corcoran wrings her hands and cries abuse against her. So she can bully and abuse a person but when the victim defends herself suddenly Ms Crosley-Corcoran is the victim?

This sounds exactly like the behavior of a person who tries get their way in the world by intimidation, bullying and abuse. The individual tears through life trampling on other people, shouting down, abusing and bullying anyone who gets in their way. But when someone stands up to them they suddenly fall down like Gollum crying foul. In their mind they can violate anyone they can get away with. But when that violation is challenged suddenly they become Polly Perfect.

These women are not interesting to me but the argument is

Just for shits and giggles when was the last time an EMT, firefighter or police officer failed to manage a successful delivery on the road or wherever those silly women find themselves (because they weren't planning to have a baby)?

I was born in the UK in a hospital but my brother was born at home, as was standard practice after a successful delivery. (I question all the tripe here about European home birth walk-back).

My children were both born in hospitals via midwife only practices, and I was never attended to by an OB during pregnancy. My second time around an OB friend flirted with the option of a home birth with me (but we decided it was undoable by US standards). We both wished we had been able to work it out.

How and where to give birth is no different from deciding if, or when, to commit to a pregnancy. Our choice for so many reasons. Stupid women, stupid men.

Lady Sybil, RIP.

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