In her new book, Push Back: Guilt in the Age of Natural Parenting, self-proclaimed “skeptical OB” Dr. Amy Tuteur argues that home births are actually pretty dangerous, that there’s nothing inherently better about “natural” or drug-free childbirth, and that breast-feeding is not always best.
In fact, the book takes many assertions of the natural-childbirth movement and pushes back against them. Hard.
Dr. Tuteur has been an outspoken opponent of home birth since around 2009, when she began to blog about its dangers as she saw them. She’s well-known in certain parenting circles, and by no means universally loved. “I get some death threats,” she admits. But with this book, she’s taking on the entire natural child-rearing industry, aiming to become a spokesperson for parents who are sick of seeing anti-formula screeds on their Facebook walls or getting guilt-tripped about their C-sections on the playground.
A Harvard graduate with a medical degree from Boston University School of Medicine, Dr. Tuteur traded in her medical practice for a career as a writer about a decade ago. She is also the mother of four grown children, and she’s not completely unsympathetic to the crunchy parenting cause: “I’m basically an attachment parent. I just never called it that,” she says. “I breast-fed all of my children, had two of them without pain meds, two with.” In writing this book, she’s entered a war zone. Below, she takes on four of the most controversial topics in modern parenting philosophy.
1. Natural childbirth
You read this a lot in childbirth literature: Your body knows how to have a baby. People have been doing this without the help of doctors for thousands of years. The word natural appears 78 times in Ina May Gaskin’s Guide to Childbirth alone. (Gaskin, one of the most popular leaders of the early natural-childbirth movement, is a frequent Dr. Tuteur target.)
But, says the doctor, “There was a time when everything was natural and it sucked.” The arrival of modern medicine, in particular obstetrics, was a boon to women, she argues: Current maternal mortality rates are between one-fortieth and one-fiftieth of what they were less than 65 years ago.
“Obstetrics is a victim of its own success,” Dr. Tuteur says. Now that having a baby is fairly safe, “Everybody thinks that that’s the way childbirth always was.” She argues that the ubiquity of modern medicine has allowed a certain segment of the population — i.e. upper-middle-class women, often white — to feel good about opting out: “Nothing screams privilege louder than ostentatiously turning down something that a poor woman would trudge five miles to get for her child.”
In nature, women with unexpected medical complications in childbirth — in other words, many of us — would simply die, slowly and unhappily. “Go to any old cemetery,” says Dr. Amy. “They’re filled, just filled, with women and babies.” Obstetric interventions like fetal monitoring, IV antibiotics for Strep B positives, and epidurals are “preventative,” she argues, and what they’re trying to prevent, often, is death.
Using plenty of studies as backup, she argues that there is no real advantage to not using pain medication in labor. Natural-childbirth advocates say that getting an epidural can kick off the dreaded “cascade of interventions,” in which one medical procedure leads to another and another until the woman in labor has lost all agency. But that cascade, Dr. Tuteur says, is simply a process designed to avoid life-threatening complications for mother and child. It’s the ounce of prevention that’s worth the pound of cure.
2. Home birth
In the U.S., where birth outside of a hospital had dropped to less than 1 percent by the middle of the 20th century, home birth numbers have actually begun to rise over the past decade — thanks to the natural-childbirth movement.
Dr. Tuteur is not a great fan of home birth because most of these home births are attended by midwives, and as she argues in Push Back, many midwives are self-trained, rather than credentialed by the medical Establishment. Even the Midwives Alliance of North America, she writes, self-reports that “planned home birth has a death rate 450 times higher than comparable risk hospital birth.”
She argues that this is because midwives lack the training and equipment to deal with complications — the sort that would be manageable in the hospital but could be life-threatening at home.”No one needs an expert in normal birth,” Dr. Tuteur writes. “If the birth is uncomplicated, a taxi driver can do it.” But for the many women who experience complications, she argues, neither a taxi driver nor a midwife can take the place of a hospital full of professionals.
3. C-sections
“Some natural childbirth advocates claim a C-section doesn’t even qualify as a birth. In this way, having a C-section becomes the ultimate failure,” she writes. This is an extreme view, but Dr. Tutuer argues that a more common but just as harmful myth persists: that C-sections are undesirable and very often avoidable.
“A C-section is often a life-saving procedure,” she says. Doctors recommend them for many reasons, the most controversial of which is perceived fetal distress. The trouble, she argues convincingly, is knowing in advance when a C-section is warranted or not: “Many C-sections done for fetal distress are probably unnecessary, but then a lot of biopsies of breast lumps are also unnecessary in retrospect.”
Dr. Tuteur concedes that the U.S. C-section rate of about 31 percent is “maybe too high”; her rate when she practiced obstetrics was 16 percent. But she takes issue with people — whether they’re midwives or judgmental moms on the internet — trying to decided which C-sections were necessary and which were not. She argues in the book that women who have C-sections should not feel guilty, or like their birth experiences were somehow less valid than vaginal delivery.
4. Breast-feeding
“Your baby,” Dr. Tuteur once counseled a mother with a low breast-milk supply, “needs enough milk more than she needs breast milk.” This advice can be a bitter pill to swallow for those who’ve struggled with feeding a newborn who won’t gain weight. It can be devastating for a mother to witness weigh-in after weigh-in, knowing she’s not producing enough milk for her baby to grow.
But like most doctors, Dr.Tuteur argues that while breast-feeding does have real benefits, they don’t last. Most studies demonstrate some modest immediate benefits for breast-fed babies, but none have proven any long-term impact. In areas of the developing world, where the water supply isn’t adequate for mixing up formula, breast-feeding has major advantages. But formula feeding, or combination feeding (using breast milk and formula), she argues, is a perfectly acceptable choice for women in the U.S. to make.
Dr. Tuteur does not argue against breast-feeding. She does, however, argue that there is nothing wrong with not breast-feeding. “Women do or don’t breast-feed for lots of reasons, and you’re not going to do any harm by formula feeding,” she says. “Stressing out about it will probably cause the baby harm, though.”
Dr. Tuteur’s book will make a lot of sense for people who already lean toward her brand of pragmatism. And it is almost certain to incense those who feel that the medical Establishment doesn’t have the best interests of women at heart. To that point, it’s worth mentioning that she does credit the natural-parenting movement for revolutionizing hospital birth in the ‘60s, ‘70s, and ‘80s, and making breast-feeding rates rise. “The natural childbirth movement changed a lot of things for the better,” she says. But that movement, she argues, is now an industry. And like all industries, it can benefit from some pushback.
