Natural childbirth stupid: the pulsing umbilical cord

Natural childbirth and homebirth advocates fabricate claims and then insist that their fabricated claims are "facts." In that way they can ensure that their "facts" always comport with their beliefs, and in that way, they don't have to waste any time actually learning anything about childbirth.

There's one teensy, weensy little problem, though. Their "facts" are not facts at all. They are often stupid and deadly errors.

There are so many stupid and deadly "facts" that it is difficult to choose the one that is most stupid and most deadly, but I nominate the following bit of idiocy taken from Mothering.com:

While the baby is still attached to the pulsing cord, it is still receiving its oxygen supply. This is sort of the same logic which explains why water-born babies don't drown.

Leaving aside for the moment the fact that babies can and DO drown at waterbirth, the claim is a complete fabrication. Why? The baby's heartbeat makes the cord pulsate. But it is perfectly possible that the pulsing umbilical cord is carrying little or no oxygen because the placenta, which absorbs the oxygen, may stop functioning almost immediately after birth.

Simply put, the fact that the cord is pulsating tells us NOTHING about whether the the baby is receiving any oxygen.

The amount of oxygen absorbed by the placenta depends on three things: the functional ability of the placenta, the amount of blood flowing through the uterine blood vessels and the surface area of the placenta that is in contact with the uterus. As I discussed in Trust placentas? the functional ability of the placenta can be compromised by a variety of factors (such as deterioration of the placenta in postdates pregnancy) and the amount of blood flowing through the uterine vessels can be compromised by contractions which squeeze the vessels shut, and the surface area can be decreased by a partial separation of the placenta from the uterine wall.

In the immediate aftermath of birth, placental function is severely compromised as uterine blood vessels close down and as the placenta starts separating from the uterine wall. Both are the direct result of the precipitous change in uterine volume after the baby has been expelled. The following illustration, taken from Williams Obsterics, makes the change clear.



The illustration shows the uterus after the baby has been born superimposed over the uterus before the baby has been born. In the before portion, the entire surface area of the placenta adheres to the wall of the uterus. Once the baby is born, the uterus contracts around the empty space. Some uterine vessels are immediately closed cutting down the available oxygen.

Even more important is the fact that the placenta is incapable of contracting. The illustration demonstrates that as the uterus contracts the placenta is forced off the uterine wall. The space between the contracted uterine wall and the peeled off placenta fills with blood. The pressure of the blood in the enclosed space forces more placental surface off until the entire placenta comes away accompanied by a gush of blood, the blood that filled the space between the uterus and placenta.

Looking at the illustration, it is not difficult to understand that the amount of oxygen absorbed by the placenta in the before view is dramatically reduced in the after view. You could let the cord pulsate forever, and the baby would still suffocate if it did not quickly begin to breathe.

Of course, no doctor or scientist ever claimed that delayed cord clamping improves oxygenation. Delayed cord clamping is supposedly beneficial because it reduces anemia by increasing the red blood cell count. Delayed cord clamping may reduce the need for supplemental oxygen in preterm neonates, but NOT because they have more oxygen in their blood. It's because more red blood cells mean more oxygen carrying capacity. That's it; nothing more. There is no scientific evidence, and no scientific claims that delayed clamping provides oxygen.

The fact is that once the baby is born, the umbilical cord does NOT become a supplemental supply of oxygen because the placenta can no longer absorb very much if any oxygen. Natural childbirth and homebirth advocates have simply made up the claim because it "makes sense" to them. Of course it only makes sense if you are ignorant about placental function and if you are ignorant about placental separation in the third stage of labor. And when it comes to ignorance about childbirth, it's hard to beat NCB and homebirth advocates.

Five bald-faced homebirth lies

One of the things that amazes me about homebirth advocates is that they casually utter bald-faced lies, and persist in doing so even after it has been demonstrated to them that their claims are false.

They are not alone, of course. Anti-vax activists, creationists, and believers in other forms of pseudoscience do the same thing. They boast that they are "educated" but their education consists of what I call pseudo-knowledge, labeled by author Damian Thompson as counter-knowledge:

... [W]e are witnessing a huge surge in the popularity of propositions that fail basic empirical tests. The essence of counterknowledge is that it purports to be knowledge but it is not knowledge. Its claims can be shown to be untrue, either because there are facts that contradict them or because there is no evidence to support them. It misrepresents reality (deliberately or otherwise) by presenting non-facts as facts. (my emphasis)

For example:

Bald-faced homebirth lie #1 Childbirth is inherently safe.

This is without a doubt the greatest bald-faced homebirth lie, and the lie at the heart of all the other lies. Childbirth is inherently dangerous. Childbirth is and has always been, in every time, place and culture, a leading cause of death of young women. For babies, the day of birth is the single most dangerous day of the entire 18 years of childhood.

It is a bald-faced lie that can easily be disproven by even the most cursory examination of the historical record, or by the most basic awareness of the death toll in countries that lack access to the interventions of modern obstetrics.

Bald-faced homebirth lie #2 The countries with the greatest use of midwives have the lowest mortality rates.

Though nothing more than a bald-faced lie, no less an "authority" than Cathy Warwick the general secretary of the Royal College of Midwives has uttered it publicly and then been forced to publicly retract it.

In an interview with a major British newspaper, Warwick railed against those who argue that homebirth is not safe:

Mrs Warwick is determined to prove the critics wrong. She pointed to the Netherlands, which has the lowest perinatal mortality levels for babies in Europe.

It is also a country where a third of women have home births. In the UK the figure is just 3 per cent.

But not only is that untrue, it is the exact opposite of the truth. The Netherlands has the HIGHEST perinatal mortality in Western Europe. The paper was forced to retract the claim from the article.

Bald-faced homebirth lie #3 The US does terribly on measures of obstetric care.

Actually, the US does very well on measures of obstetric care. According to the World Health Organization, the best measure of obstetric care is perinatal mortality (late stillbirths plus deaths in the 28 days of life). In fact, the US has a lower perinatal mortality rate Denmark, the UK, and The Netherlands.

Natural childbirth advocates deliberately misrepresent reality by routinely quoting infant mortality (death from birth to 1 year of age) a measure of pediatric care, not obstetric care.

Bald-faced homebirth lie #4 The World Health Organization recommends an optimal C-section rate of 5-15%.

When homebirth advocate Marsden Wagner headed one of the World Health Organizations divisions of maternal and childbirth health, the organization did make such a recommendation. But now that Wagner is gone, the WHO has withdrawn the recommendation, acknowledging that there was NEVER any evidence to support it.

In last year's edition of its handbook Monitoring Emergency Obstetric Care, the WHO wiithdrew the recommendation and acknowledgd that was not based on solid evidence.

Although the WHO has recommended since 1985 that the rate not exceed 10-15 per cent, there is no empirical evidence for an optimum percentage . . . the optimum rate is unknown ...

Bald-faced homebirth lie #5 The Johnson and Daviss BMJ 2005 study demonstrated that homebirth with a CPM is safe.

This is a bald-faced lie perpetrated by the authors of the study themselves. Johnson, who fails to inform readers that he is the former Director of Research for the Midwives Alliance of North America (MANA) and Daviss, his wife, who fails to acknowledge that she is a homebirth midwife, pulled a deliberate bait and switch.

They compared the death rate of CPM attended birth is 2000 to ... a bunch of out of date papers on hospital birth extending to 1969. They should have compared homebirth in 2000 to low risk hospital birth in 2000, and that data had been published more than 2 years before they submitted their paper. But that would have shown that homebirth with a CPM in 2000 had a mortality rate approximately triple that of comparable risk hospital birth in 2000, so they just left it out.

Far from demonstrating the safety of homebirth, the Johnson and Daviss paper actually demonstrates the opposite.

I often say that homebirth advocacy is based on mistruths, half truths and outright lies. The five bald-faced lies detailed above are at the heart of homebirth advocacy. They have been repeated so many times by homebirth advocates that credulous women have begun to believe them and the mainstream media has begun to repeat them.

Homebirth advocates like to boast that they are "informed," but you can't be informed if you believe in bald-faced lies.

Trust placentas?

Do you trust placentas? Whether you realize it or not, if you "trust birth," that is precisely what you are doing.

Simply put, in order to "trust birth," a woman must trust that her baby will fit, that her baby will survive labor, and that her baby will survive the serious challenges of the transition from life in utero to life outside.

Trusting that the baby will fit may be foolish, but it is usually not dangerous. There are many factors that determine whether a specific baby in a specific position will fit through a specific pelvis (Why won't my baby's head fit?). All the wishing, hoping and "trusting" in the world make no difference, but enduring many hours of fruitless labor is usually not harmful, and eventually it will become crystal clear that the baby does not fit.

Trusting newborns to make the transition is more problematic. Can a newborn be trusted to master breathing difficulties, circulatory problems and infections? As I wrote earlier this month, the signs of serious newborn illness are subtle can often can be diagnosed only by a medical professional. Therefore, "trusting" newborns to let us know when they have been overwhelmed by Group B strep bacteria, for example, is a recipe for disaster.

How about trusting placentas? That is what you are trusting when you "trust" that your baby will survive labor.

The placenta is the interface between the circulation of the mother, which provides oxygen and nutrients, and the circulation of the baby, which distributes oxygen and nutrients throughout the baby's body. While most placentae function well, the placenta can be compromised by a variety of conditions. Moreover, the function of the placenta declines with age and as the due date passes, the placenta may become incapable of keeping up with the baby's needs.

NCB and homebirth advocates who insist that "babies aren't library books; they don't have a due date" are implicitly trusting not merely that placental function will not decline, which is foolhardy since it is well known that placental function declines, but that it will not decline enough to suffocate the baby. Stillbirths rise in late pregnancy as the due date approaches and passes specifically because the placenta was not trustworthy.

"Trusting" birth means, in large part, trusting the placenta to provide the baby will a large enough reserve to tolerate contractions. During contractions, blood flow to the uterus (and therefore the placenta) is cut off. During each contraction, the baby is, in essence, holding its breath. Most babies tolerate this pretty well, because between contractions the placenta is providing so much oxygen that the baby has a reserve to draw upon during the contractions.

But what happens if the placenta is not functioning optimally? In that case, the baby develops fetal distress. Of course otherwise healthy babies can tolerate a fair amount of fetal distress. That's why C-sections done in the early phases of fetal distress produce very healthy, apparently undistressed babies.

It's like drowning. When someone who can't swim falls into the water, they initially bob around for awhile. The sink, resurface and gulp air, and sink again. Eventually they fail to resurface. In the early phases, if you pluck the person out of the water, he or she will be perfectly fine, but that doesn't mean they would have survived if you had refused to pluck them out.

It can take a long time for a baby to die of oxygen deprivation in labor, because the baby is usually getting some oxygen, albeit not enough. The typical pattern on the fetal monitor is known as "late decelerations." The baby's heart rate is completely normal between contractions, but toward the end of a contraction, the heart rate will drop and slowly recover. If that continues, the baby may develop bradycardias, periods of low heart rate that persist between contractions. Ultimately, the baby may develop a sustained bradycardia and the heart rate fails to come up; then the baby dies.

The bottom line is that NCB and homebirth advocates who claim they are trusting "birth" are actually trusting the placenta.

Is the placenta worthy of that trust?

That depends on a variety of factors:

Has the placenta been compromised before labor begins, either by a maternal condition like high blood pressure, or by the natural deterioration that occurs as the due date approaches and is passed?

Does the placenta provide the baby with an adequate oxygen reserve enabling the baby to tolerate "holding its breath" during contractions? That has to evaluated on an ongoing basis. Even when the oxygen reserve is inadequate, the baby can do well for quite some time, just like the drowning person flailing and bobbing for air. Eventually, though, the baby will not be able to tolerate any more and will die.

"Trusting birth" sounds sweetly spiritual. Trusting the placenta, not so much. That's because the placenta is an organ, capable of being damaged, diseased, or failing altogether.

NCB and homebirth advocates need to ask themselves whether they "trust" a specific placenta to support a specific baby through a specific length of labor. And they need to be quite confident that they are right, because the baby's life is literally depending on it.

Mothering.com: more than 20 preventable homebirth deaths in 2 years

Mothering.com has inadvertently become one of the best places to learn about the deadly consequences of homebirth. Babies of MDC mothers routinely die preventable deaths at homebirth, and the moderators routinely remove any discussions about safety in connection with these deaths. In other words, they attempt to sweep the dead babies out of sight.

For a two year period, I kept track of the homebirth deaths to determine just how frequent they are. In the years 2007-2008, there were more than 20 preventable homebirth deaths on Mothering. com, as well as additional cases of anoxic brain damage. Keep in mind that these are the cases that were reported; there may have been more.

Preventable homebirth deaths on MDC 2007:

1. breech, nuchal arms (arms trapped behind head), brain dead, ventilator disconnected

2. shoulder dystocia, profound brain damage

3. unanticipated anoxic brain damage sustained during labor

4. normal labor, baby dead at birth

5. decelerations during attempted home VBAC, transfer to hospital, uterine rupture, baby dead, massive hemorrhage, hysterectomy

6. postdates, severe meconium aspiration

7. normal labor, baby dead at birth

8. post dates, baby dead at birth

9. unanticipated severe birth asphyxia

10. prolonged ruptured membranes, overwhelming infection

Preventable homebirth deaths on MDC in 2008:

11. normal labor, baby dead at birth

12. normal labor, baby dead at birth

13. normal labor, baby dead at birth

14. attempted VBA2C, baby dead at birth

15. unanticipated severe birth asphyxia

16. mother rejected medical care, stillbirth

17. shoulder dystocia

18. transferred for pain relief, severe birth asphyxia

19. cord prolapse

20. normal labor, baby dead at birth

21. abnormal cord vessels, baby hemorrhaged

Sadly, this is what happens when you trust birth.

CPMs include midwives who "damage and ruin lives"

Who said this?

... [T]he [CPM] credential has a huge hand in creating some of the "bad apples" as you call midwives who damage and ruin lives. CNMs and MDs see a zillion more variations of the norm AND abnormal before they ever start practicing on their own. A CPM has seen a *few* typical variations, but if they haven't ever seen the nuances that can lead to tragedy, how are they supposed to recognize it? ...

No, it wasn't me, although I agree with it wholeheartedly. It was actually a midwife, a CPM, in fact. It was Barbara Herrera, also known as Navelgazing Midwife.

Herrera is part of a tiny but growing trend of homebirth advocates willingly to seriously address the deadly shortcomings of the CPM credential. She was writing in response to a post by Imogen-Alternative Mama entitled Home Birth: A Different View.

Imogen emphasizes that she is a passionate supporter of homebirth, but:

... I hate to admit it but I can’t help but worry when I read stories of women giving birth to breech twins at home with a CPM – to me, that is way too risky. That’s not to say that there isn’t a whole load of wonderful CPM’s out there – there are. But there are also plenty who are underqualified, underexperienced and take too many risks.

I cringe when I read stories of CPM’s advising mothers to refuse GBS testing, lest it come back positive and end their chance of a home birth. Why do we think that midwives are somehow immune to greed? We’re all very happy to assume that doctors only care about lining their pockets, but when a midwife advises against testing that could save a baby’s life, coincidentally preventing the mother from having a homebirth and paying the midwife for it, nobody bats an eyelid.

And Imogen is suspicious of the refusal of the Midwives Alliance of North America (MANA) to release the death rates at homebirth:

Ignoring the fact that sometimes things go wrong at birth, even totally natural home births, is irresponsible and ignorant. Furthermore, I am very concerned about the fact that MANA (Midwives Alliance of North America) are hiding their data on homebirth death rates. Surely if the statistics showed that home birth in the US is as safe or safer than hospital birth, they would be shouting it from the rooftops? Instead, they are withholding the data and only allowing access to those who can prove they will use it for “the advancement of midwifery”.

Herrera responds enthusiastically:

Bravo!!! *standing ovation*

Your observations are 100% accurate… right on… exactly what I’ve been saying for a long time and am only just now getting much louder about it.

There are absolutely CPMs that are undereducated and underskilled. If we had a standardized system as you do in GB and in Canada, it’d be a whole lot different around here. But it isn’t. We’ve got a mish-mash of education routes and an endless supply of incestuous apprenticeships that perpetuate (what I call) black holes of knowlege that are only discovered when something goes awry.

I also believe homebirth can be a safe and wondrous option for women and babies. I *do* believe there are limitations to that safety and women need to suck it up that they can’t always have The Experience they want.

When another commenter insists that it isn't the CPM credential itself, but rather the "bad apples," Herrera disagrees as I quoted at the top, and continues:

It’s far, far easier to learn to sit on your hands than it is to recognize and manage the slew of silent-to-deafening complications that can -and do- arise in even the most normal of births. Not often… maybe even not rarely… but they can happen.

Preparation is never a bad thing. Neither is more education and experience.

I have heard privately from a number of CPMs expressing similar sentiments. Most fear going public with their concerns because they believe (probably correctly) that they will be ostracized by their colleagues. It is therefore refreshing to see a midwife who isn't afraid to counsel CPMs to reform themselves as if babies lives depend on it ... because they do.

Did the homebirth rate really rise?

Ahhh, the power of the press release.

Evidently the folks in the PR office of the "journal" Birth: Issues in Perinatal Care have been working overtime. They've sent out thousands of press releases touting the latest study by MacDorman and colleagues purporting to show the the rate of homebirth in the US has risen 20% (from a teeny, tiny number to a bigger teeny, tiny number) during the years 2004-2008.

The public relations campaign that is promoting the paper implies that there has been a meaningful and substantial increase in the rate of planned homebirths in the US as a direct result of women rejecting hospitals and hospital based interventions. Is that what the paper shows? Not exactly, not least because it doesn't even bother to distinguish between planned and unplanned homebirths.

Marian MacDorman et al., authors of the paper, United States Home Births Increase 20 Percent from 2004 to 2008, claim:

In 2008, there were 28,357 home births in the United States. From 2004 to 2008, the percentage of births occurring at home increased by 20 percent from 0.56 percent to 0.67 percent of United States births. This rise was largely driven by a 28 percent increase in the percentage of home births for non-Hispanic white women, for whom more than 1 percent of births occur at home. At the same time, the risk profile for home births has been lowered, with substantial drops in the percentage of home births of infants who are born preterm or at low birthweight, and declines in the percentage of home births that occur to teen and unmarried mothers. Twenty-seven states had statistically significant increases in the percentage of home births from 2004 to 2008; only four states had declines.

But even a brief glimpse at the methods used by the authors to calculate the rate of homebirths reveals that numbers quoted are nothing more than "guesstimates" based on proxies for real data.

In order to accurately determine the number of planned homebirths in the US, we'd need to know the number of women who planned to have a homebirth and successfully did so, the number of women who planned to have a homebirth and ultimately delivered in the hospital, as well as the numbers of babies who were born dead during homebirth. That's not what the authors looked at.

MacDorman and colleagues looked at birth certificates to determine whether a birth occurred inside or outside of a hospital. In fact, the authors used the exact same technique used in part of the Wax study, a technique bitterly criticized by homebirth advocates specifically because it failed to distinguish between planned and unplanned homebirths.

So what did the authors actually find? They discovered that in 2004 there were 23,150 births that took place outside the hospital and in 2008 there were 28,357 births. Then the authors made a leap of faith, or rather several leaps of faith. MacDorman et al. ASSUMED the ratio between planned and unplanned homebirths remained the same from 2004 to 2008. They ASSUMED that the rate of hospital transfer during planned homebirth remained the same from 2004 to 2008. They ASSUMED that the death rates of planned homebirth remained the same from 2004 to 2008.

Those are big assumptions to make about a dataset composed of very small numbers (relative the to overall number of births). It is entirely possible that some portion of the purported "increase" that they observed reflected NOT an increase in the number of planned homebirths, but an increase in the number of unplanned homebirths. It is equally possible that some portion of the purported "increase" that they observed reflected NOT an increase in the number of planned homebirths, but a decrease in the number of hospital transfers. It is equally possible that some portion of the purported "increase" that they observed reflected NOT an increase in the number of planned homebirths, but a decrease in the number of homebirth deaths. And, of course, it is very possible that a substantial proportion of the purported "increase" in planned homebirths actually reflects some combination of the three.

The authors are anything but subtle in their motivation for publishing this study. They announce their motivation in the abstract:

Conclusion:  The 20 percent increase in United States home births from 2004 to 2008 is a notable development that will be of interest to practitioners and policymakers.

In other words, this is an attempt to convince policy makers that the rate of planned homebirth is rising and that, therefore, there is a demand for more homebirth practitioners.

If that wasn't clear enough, the "journal" Birth released the article on-line four months before actual publication. How ironic is that? Homebirth advocates, the very same people who bitterly criticized the early on-line publication of the Wax study and denounced it as an attempt to influence public policy respond by attempting to influence public policy with an article published online even farther in advance.

Of course, the MacDorman paper fails utterly to address the most serious concern about homebirth, the increased risk of perinatal death. The authors enthusiastically boast that the rate of "homebirth" has risen without bothering to find out how many babies died in the process.

That's fairly typical in the world of homebirth advocacy. And increase in homebirth rates is a cause for celebration. Who cares how many babies died as a result?

Complaining that obstetricians "play the dead baby card"

From a recent thread on Mothering.com claiming that doctors play the "dead baby card" with women who are postdates.

I felt exactly as you did around 36 weeks pregnant with my VBAC attempt. I had already switched DRs around 20 weeks to a group of Family Practice doctors that are probably the most VBAC friendly in the area... I watched Business of Being Born and really started feeling like the only way I'd get a VBAC was with a homebirth midwife. Unfortunately, DH was NOT on board with that idea and I felt like it was "too late" to make such a drastic switch. I really should have listened to my instincts... The switch in their attitude around 41 weeks was shocking. When I wouldn't agree to an induction I was told I was risking fetal death and they couldn't be responsible for that - basically the next week was spent scaring me into a bunch of testing where they found a reason to induce me and even with the help of a doula, I wasn't able to avoid ending up with another failure to progress c-section. I later learned that their license and hospital privileges can be called in to question when they "let" a woman go to 42 weeks. Obviously, there utmost concern remained with what was best for them ...

After that experience and the regret of not trusting my instinct, I told DH that we'd be having no more babies unless I was able to plan a homebirth for the next one. I'm full-term with baby #3 and hoping to have an awesome HBA2C story in the next month! No matter how the birth turns out, I appreciate having a care provider who understands that each pregnant mother is an individual who is capable of researching and making her own decisions about "HER" body and child...

The mother began labor spontaneously at 41 1/2 weeks, labored for 24 hours and apparently delivered vaginally the day before yesterday.. The baby was born not breathing. Subsequent evaluation revealed meconium aspiration and catastrophic brain damage due to lack of oxygen. The decision was made to take the baby off life support.

The baby is dead.

Midwife lets baby die, breaks law, pleads guilty to felonies; I think I'll hire her

According to a recent piece in The Washington Post, certified professional midwife Karen Carr boasted in the wake of her guilty plea in connection with the entirely preventable death of a baby in her care, her phone is ringing off the hook with women wanting to hire her.

It can't be because of her safe midwifery practices; it can't be because she abides by the law; and it certainly can't be because the trail of dead babies in her wake demonstrates that homebirth is safe. So why hire her? And why hire her now?

Such seemingly inexplicable behavior is reminiscent of the response of cults when their predictions prove entirely false.

In a fascinating article in Mother Jones (The Science of Why We Don't Believe in Science), the author offers the classic tale of psychologist Leon Festinger's research on a doomsday cult after its prediction for the end of the world proved false:

... [T]he aliens had given the precise date of an Earth-rending cataclysm: December 21, 1954. Some of Martin's followers quit their jobs and sold their property, expecting to be rescued by a flying saucer when the continent split asunder and a new sea swallowed much of the United States. The disciples even went so far as to remove brassieres and rip zippers out of their trousers—the metal, they believed, would pose a danger on the spacecraft.

Festinger and his team were with the cult when the prophecy failed...December 21 arrived without incident. It was the moment Festinger had been waiting for: How would people so emotionally invested in a belief system react, now that it had been soundly refuted?

At first, the group struggled for an explanation. But then rationalization set in. A new message arrived, announcing that they'd all been spared at the last minute. Festinger summarized the extraterrestrials' new pronouncement: "The little group, sitting all night long, had spread so much light that God had saved the world from destruction." Their willingness to believe in the prophecy had saved Earth from the prophecy!

... In the annals of denial, it doesn't get much more extreme than the Seekers. They lost their jobs, the press mocked them, and there were efforts to keep them away from impressionable young minds. But while Martin's space cult might lie at on the far end of the spectrum of human self-delusion, there's plenty to go around...

In other words, in the wake of evidence that their fundamental beliefs were false, cult members responded by ignoring the evidence and attempting to explain how the fact that their beliefs were shown to be false, actually proved them to be true!

Sound familiar? It sounds distressingly like the response of homebirth advocates whenever their fundamental beliefs are shown to be false. If the Karen Carr disaster demonstrates nothing else, it demonstrates that homebirth practitioners are reckless, that intuition (of both mother and midwife) is useless, and that far from being as safe as hospital birth, homebirth increases the risk of neonatal death. How have homebirth advocates responded? Many have responded by insisting that the demonstration of Karen Carr's incompetence proves that she is competent, so competent, in fact, that they want to hire her.

Homebirth involves a cult-like belief in its safety despite any and all evidence to the contrary. Homebirth advocates crown "prophets" like Ricki Lake and Henci Goer, when there is no reason to believe their "prophecies" about anything, let alone homebirth. They repeat outright lies over and over again, even after the evidence demonstrates that they are repeating lies. And the more spectacular the demonstration that they are utterly wrong, the more they insist that being proven wrong actually proves that they have been right all along.

Hiring Karen Carr as your midwife is like insisting that the fact that the world did not end on the predicted day actually indicates that the prophecy was correct. It demonstrates a disturbing willingness to ignore reality in a desperate effort to justify an uneducated and obviously inaccurate system of belief.

No, homebirth advocates, babies don't die in the hospital, too

In the wake of the Karen Carr homebirth debacle, homebirth advocates have trotted out a classic homebirth lie: "Babies die in the hospital, too."

It's time to set the record straight. No, homebirth advocates, otherwise healthy babies DON'T simply drop into the obstetricians hands unexpectedly dead. Otherwise healthy babies DON'T unexpectedly drop dead for lack of appropriate medical equipment and emergency personnel. The babies whose mothers would be eligible for homebirth (full term, no medical complications of pregnancy, no pre-existing medical conditions) hardly ever die during or after a hospital birth.

The following chart, adapted from Infant, neonatal, and postneonatal deaths, percent of total deaths, and mortality rates for the 15 leading causes of infant death by race and sex: United States, 2007 makes that clear. The chart shows neonatal death rates by cause.



As you can see from the chart, more than 50% of all neonatal deaths are due to prematurity and its complications (respiratory distress, necrotizing enterocolitis) and congenital anomalies. These babies, of course, are not otherwise healthy full term babies.

Consider the other major causes:

Maternal complications of pregnancy- not homebirth candidates
Complications of placenta and membranes (i.e. placenta previa, abruption, chorioamnionitis) - not homebirth candidates.

Together, these causes account for 68% of all neonatal deaths.

The fact is that neonatal death in otherwise low risk women in the hospital setting is quite rare. The best estimate that we can make based on CDC data is a neonatal death rate of 0.4/1000 in low risk, white women at term. That figure actually includes congenital anomalies, which account for nearly 50% of term deaths. In other words, the death rate for otherwise healthy babies is in the range of 0.2/1000 or 2 deaths for every 10,000 births.

Considering that there are approximately 10,000 CPM attended homebirths per year in the US, we would expect only two homebirth deaths per year. Yet in 2009 there were 4 neonatal deaths in the state of Colorado alone in 2009!

Otherwise healthy babies do not die in the hospital, too. Yes, "some" babies die, but those are born prematurely or born to women who would never have been candidates for homebirth.

Existing scientific studies and state and national data estimate that homebirth triples the rate of neonatal death, but that considerably under-counts homebirth deaths, which often appear in the hospital statistics, not the homebirth statistics. The real risk of homebirth is larger, possibly much larger.

Is it any wonder that MANA (the Midwives Alliance of North America) is hiding their homebirth death rates? Those death rates, which also under-count homebirth deaths, must be appalling indeed.

Dr. Amy calls in to the Kojo show

Yesterday, Washington DC based radio show hosted by Kojo Nnamdi explored the issue of homebirth:

A midwife in our region recently pled guilty to two felony counts in the death of a baby delivered at home. The case re-ignited a longstanding debate about "natural" versus "medicalized" birth. The American College of Obstetricians and Gynecologists note increased risks for both baby and mother in home deliveries. Natural birth proponents point to complications from hospital interventions that are often avoidable. We'll explore the debate.

The guests included Mairi Breen Rothman, CNM; obstetrician David Downing, Brynne Potter, CPM, on Board of the North American Registry of Midwives (NARM); and Dr. George Macones of the American College of Obstetricians and Gynecologists (ACOG).

The discussion was exquisitely polite, with the participants talking past one another in an effort to get in their own talking points. No one questioned anyone on anything he or she said. Alerted about the show by a faithful reader, I called in. (You can read the complete transcript here.)

Nnamdi

Here is Amy in Boston, Mass. Amy, you're on the air. Go ahead, please.

Amy

Hi. I have a question for Brynne Potter about certified professional midwife. I'm wondering why the Midwives Alliance of North America, which is the sister organization of NARM, is hiding the death rates for the 23,000 certified professional midwife-attended home births that they have collected in their database.

Potter

OK. Well, I can sort of speak -- I can certainly speak to that that the MANA dataset that, I think, Amy is referring to is a private dataset that is not CPM's exclusively. It's not certified nurse midwives exclusively. It is simply a voluntary collection of data that is not specific to death rates, but specific to all information. And that information is available. Researchers can apply for that information. But mandated reporting -- and I'm really speaking back to what Dr. Downing was just saying -- mandated reporting review of outcomes really takes places on a state level under licensure and regulation.

And I completely agree with him that one of the benefits of licensure in all 50 states is having the option to create integrated systems in which perinatal review can happen that includes home birth. And it's not just a review of bad outcomes, it's a review of all outcomes. And an opportunity to really know what's going on and what's happening with birth isn't just going to be a benefit to be able to analyze how we can make birth safer, but to optimize what systems of care are gonna give women the most choices.

Nnamdi

But I have to be more specific here, Brynne, because Amy specifically accuses your alliance of hiding the death rate of home birth. How do you respond to that?

Potter

Well, first of all, it's not -- she's referring to the national midwifery organization, the Midwife she's referring to the national midwifery organization, the Midwives Alliance of North America...

Nnamdi

Oh, I'm sorry

Potter

...that I don't represent. So I can't really speak to a specific about some assumption of hiding. What I would say is that MANA's -- I know MANA stands ready to meet the needs of any reporting mandate. It is a private data set in which isolated cases of death would only be isolated cases similar to this case that we're talking about today. We wouldn't be able to make any extrapolation of a trend to homebirth. The only place we can do that is from the CPM2000, which was a cohort study that mandated all CPMs to report in prospectively all of their data for one year. And that study was published in the British Medical Journal, and it is absolutely in line with outcomes of all other published studies around homebirth, which is...

What can we learn from Potter's attempt to avoid answering the question?

1. Potter was familiar with the existence of the database and the refusal of MANA to release the death rates.

2. She asserted that MANA is not obligated to release the death rates because the database is private. It is not; it's been offered publicly, but that's irrelevant in any case. MANA knows the death rates of CPM attended homebirth and is keeping that information from American women.

3. Potter implies that the fact that participation in the database was voluntary means that the results are unreliable. I agree that the database almost certainly under-counts the number of deaths at CPM attended homebirth. The real number must be appalling if MANA refuses to release its best case scenario death rates.

4. She tries to claim that it doesn't matter because mandated state reporting would be more accurate. That's true; of course, in states like Colorado with mandatory reporting of homebirth deaths, the death rates are extraordinarily high.

5. Potter claims that she cannot address the issue because she is on the board of NARM, the sister organization of MANA, not MANA itself; yet despite that, she is completely familiar with MANA's stance and can't offer any justification.

6. She offers the Johnson and Daviss BMJ 2005 paper which is based on the MANA statistics of 2000. She neglects to mention that the paper is a bait and switch comparing homebirth with hospital birth in years extending back to 1969. She conveniently neglects to mention (perhaps she does not know) that the death rate for CPM attended homebirth in 2000 was triple the death rate for low risk hospital birth in the same year.

Potter deserves credit for deftly refusing to answer the direct question and offering a variety of different obfuscations. She would not have gotten away with it if I had been allowed to respond.

Nonetheless, she (and MANA) would have been better served if she had simply pretended that she didn't know that MANA was hiding the death rates from 23,000 CPM attended homebirths. In essence, she publicly acknowledged the existence of the database, publicly acknowledged MANA's refusal to release the death rates, and publicly acknowledged that the database almost certainly under-counts the number of babies who died at the hands of CPMs

Of note, she didn't offer anything remotely approaching a justification for hiding the death rates of CPM attended homebirths from the public.

How narcissist Gina celebrates her child's birthday

One of the hardest tasks of parenting is recognizing that your child does not exist to validate you.

That means acknowledging that your child is a separate person, with talents, interests and needs that do not have to mirror yours.

It means that your son does not exist to achieve your dream of baseball stardom. It means that your daughter's learning disability should not be ignored for fear that others will label her and thereby you as not perfect. And it means that your child should never, under any circumstances, be identified by whether or not HIS birth was the birth of of YOUR dreams.

Just in case you were still wondering whether Gina Crosley-Corcoran is really a narcissist, even after she lives blogged her homebirth and only allowed her sycophants to comment on it (Feminist Breeder doesn't kill baby; supporters dazzled), Gina helpfully demonstrates that in her mind, it really is all about her.

The title of her current post is Happy 3rd Birthday to my 1st VBAC Baby, a post with all the subtlety of a sledgehammer:

Today is Julesy’s 3rd Birthday. 3 years ago today, my son gave ME one of the greatest gifts he could have, and that was MY first successful vaginal birth. Of course, I had my gorgeous, red-headed, perfectly healthy baby boy, and that was the ultimate prize — but the way he came into the world was a special gift in itself.(my emphasis)

What is wrong with this woman? Her 3 year old did not give her anything. Without ever consulting her child, she chose to risk HIS life by attempting a VBAC. Fortunately, it was successful, but the reality is that she put HIS life at risk in attempting to fulfill HER dream.

My son's VBAC allowed me to have MY recent homebirth with MY choice of providers. If I’d had a second cesarean, it would have been very hard to find a provider willing to attend even a hospital VBA2C, and downright impossible to find any licensed provider in this state willing to attend a home VBA2C. I sincerely doubt I would have even tried to have a VBA2C if I hadn’t been able to vaginally birth the last time. My son’s VBAC very much meant that I’m sitting here with only one cesarean scar right now, instead of three. That’s huge. And for that huge gift, I will forever be grateful to that child for working with me the way he did. (my emphasis)

These paragraphs couldn't have more "I's" and "me's" if it had been about her. Oh, wait, Gina thinks is about her.

No doubt this will come in really handy for her child's therapist when he is an adult. It's one thing to tell your therapist that your mother is a narcissist, that she sees everything through the prism of her own needs. It is another thing altogether to be able to provide permanent documentary evidence that she couldn't even celebrate your birthday without repeatedly referencing herself, her needs, and whether they were or were not met.

Consider this definition of a narcissistic parent:

The narcissistic parent regards his or her child as a multi-faceted [s]ource of [n]arcissistic [s]upply. The child is considered and treated as an extension of the narcissist. It is through the child that the narcissist seeks to settle "open scores" with the world. The child is supposed to realise the unfulfilled dreams, wishes, and fantasies of the narcissistic parent...

As the therapist will be able to explain, Gina considers this child as the one who allowed her to "settle the score" when deprived of a vaginal delivery with her first child. And by "giving her" a hospital VBAC, the child allowed her to have a homebirth and allowed her to take her self-obsession to masses, live blogging what most people consider to be an intimate moment.

I have a personal message for Gina. She may ignore it, but no doubt she will read it:

Gina, take a long, hard look at yourself and the way that you treat your children. It's okay to want attention; it's okay to have needs and try to get them met. However, it is not okay to view your children through the prism of those needs, particularly the desperate needs you seems to have for attention and for validation.

Your son did not "gift you" with a VBAC, and your daughter did not "gift you" with a homebirth. And most importantly, your eldest child did not fail to "gift you" with the validation that you crave. They were born, through no agency of their own and with no intention to meet or not meet your needs.

It is wrong, wrong, wrong to expect your children to serve your needs. Adults should look to other adults for attention. And when it comes to validation, adults should enter therapy if they feel they lack the inner resources to provide their own validation.

Talk to your husband, talk to your friends, talk to a therapist. Don't talk to your children about your needs and absolutely, positively do not create a permanent, written record of whether or not they met your needs (which is not their job, in any case).

Your children are not here to meet your needs. You are here to meet THEIR needs. Their number one emotional need is to be valued for who they are, not what they've done for you lately.

And next year, when your son celebrates his 4th birthday, see if you can celebrate with him, instead of celebrating yourself at his expense. His birthday is about him, not about you. The sooner you learn that, the better for all your children.

Baby's position wasn't the problem; problem was the baby's head became stuck.

Homebirth midwife Karen Carr forgot Mark Twain's famous admonition: "It is better to keep your mouth closed and let people think you are a fool than to open it and remove all doubt."

It wasn't enough to let her actions speak for her after they led to the entirely preventable death of a baby at homebirth. It wasn't enough to let her actions speak after she had plead guilty to felony charges in exchange for avoiding a manslaughter trial. Apparently, she felt she had more to say, so she gave an interview to The Washington Post. You can read the interview here: Midwife Karen Carr, convicted in Alexandria baby’s death, is under investigation in Md.

Ms. Carr's observations on homebirth and the deaths over which she has presided (there have been more than one) have ignited a firestorm of protest. In the nearly 300 comments to data, most readers have expressed their horror at Carr's cavalier attitudes toward neonatal death at homebirth.

Carr's guilty plea to felony charges came in the wake of presiding over the death of a breech baby who's head became stuck for more than 10 minutes before Carr even bothered to call 911.

The baby's position wasn't the problem, Carr said; the problem was that the baby's head became stuck.

That is the obstetric equivalent of insisting that 'it wasn't the fact that I pushed him off a ten story building that killed him; the problem was that he hit the ground."

It's nothing more than a brazen attempt on Carr's part to avoid responsibility for the choices that SHE made and the actions that SHE took. The mother had been counseled by every other medical provider to have a C-section precisely to avoid the "problem" of a trapped head and the neonatal death that is the nearly inevitable result.

According to prosecutors, it was this unwillingness to accept responsibility that led to Carr's indictment. Apparently she still hasn't learned a thing from the baby's death and her acknowledgment of legal responsibility. As Alexandria prosecutor Krista Boucher points out:

The lack of integrity and veracity demonstrated by the defendant's taking advantage of a plea arrangement to her benefit, standing before the court under oath and affirming that she was pleading guilty because she was in fact guilty, and then turning right around and claiming that she did nothing wrong, is extremely disturbing... It evidences the same arrogance that got her into trouble in the first place, and it does not bode well for her future clients.

Don't worry, though. Carr has been "traumatized" by what happened. No, not by the baby's death; don't be ridiculous!

"I was very traumatized by attending that birth," Carr said, hands clasped. "It really shook my faith in the process in a way that nothing ever has done. It was just — a very desperate, heartbreaking situation to be in."

Her faith in the process? Of course. It is axiomatic in the homebirth community that the key to a safe, successful outcome is to simply "trust birth." Carr "trusted birth" and it killed a baby. How traumatic for her.

It apparently never occurs to her that her "trust" was utterly misplaced. Birth is not inherently safe; it is inherently dangerous. Only an uneducated fool would think otherwise.

Anyone familiar with the world of homebirth advocacy will recognize that these are not merely Carr's bizarre personal opinions. Carr is accurately reflecting the views and philosophy of Ina May Gaskin, American homebirth's Fool-In-Chief. Carr is a walking, talking exposition of the "Midwifery Today" school of thought, complete with the trail of dead babies in her wake. She is a perfect example of what happens when we allow high school graduates to give themselves pretend degrees in midwifery and foist themselves on an unsuspecting public.

If we learn anything from this tragic episode, it should be this: American homebirth midwives (CPMs) are grossly under-educated, grossly under-trained and arrogant in their ignorance. They should not be licensed anywhere, because they are unfit to care for pregnant women and their babies.

What else is MANA hiding about homebirth?

I have written repeatedly about the fact that the Midwives Alliance of North America is hiding the death rates for certified professional midwife (CPM) attended homebirths. Not only does this deliberately deprive American women of critical data about the safety or lack thereof of CPMs, but it also deliberately deprives women of critical safety data about the typical claims of homebirth midwives.

When MANA is forced to release these statistics, as they will eventually be required to do, here are some questions that we can expect to have answered.

What are the death rates for breech deliveries attended by CPMs?

Homebirth midwives like to insist that breech "is a variation of normal," that obstetricians are no longer appropriately trained in the delivery of the breech infant, and that homebirth midwives have the education and experience needed to safely deliver breech babies. MANA is in possession of the data that will answer the question, and, I suspect, demonstrate beyond a shadow of a doubt that homebirth breech delivery has appalling death rates.

What are the death rates for postdates deliveries attended by CPMs?

Homebirth midwives like to say that "babies are not library books," due on a certain date. They conveniently elide the mass of scientific evidence that shows that the stillbirth rates begins to rise even before the due date and continues to rise dramatically after 42 weeks gestation. There is a growing body of scientific evidence that even earlier induction for postdates at 41 weeks is effective in preventing stillbirth. MANA is in possession of data that will address the question of expectant management of postdates pregnancy, and, I suspect, demonstrate beyond a shadow of a doubt that postdates homebirth results in an extraordinarily high perinatal death rate.

What are the rates of intrapartum stillbirth for CPMs?

In the hospital setting, intrapartum stillbirth in a term infant is an exceedingly rare event. Is it as rare at homebirth? It is axiomatic in the homebirth community that electronic fetal monitoring is literally worse than useless, failing to improve outcomes but increasing C-section rates. MANA is in possession of data that will address the question of whether intermittent monitoring at homebirth is safe, and I suspect that the MANA data will demonstrate and appalling level of intrapartum stillbirth.

What is the rate of uterine rupture and perinatal death at homebirth VBAC?

It is an article of faith in the homebirth community that VBAC is safe and that virtually any woman, regardless of how many C-sections she has had in the past and regardless of previous obstetric outcomes, is an excellent candidate for VBAC. MANA is in possession of data that will address the issue of uterine rupture at homebirth VBAC, and, I suspect, will show that homebirth VBAC results in disaster and death in an unacceptably high number of cases.

The MANA database is a treasure trove of information, not merely on the safety of homebirth with a CPM, but on the safety of a variety of empirical claims made by homebirth midwives. Of course, if the data shows, as I suspect, that those empirical claims are utter nonsense, it would hardly serve the "advancement of midwifery" to release them.

In fact, I'd be willing to bet a considerable sum that the MANA database represents a major blow to homebirth midwifery. When the data are released, and there is no doubt that eventually they will be released, it will show that MANA is deliberately withholding the death rates because they will establish, once and for all, that homebirth midwives are grossly undereducated, grossly undertrained, and purveyors of preventable perinatal deaths.

Mothering.com: Another day, another dead homebirth baby

I finally read something on Mothering.com with which I agree. Unfortunately, it was written in the wake of yet another one of the dozens of homebirth deaths I've read about on MDC in the past few years.

This is from Loocy:

A beautiful, perfect baby girl is dead. A previously joyful mother and father are grieving.

Read this thread again. If those of you who told the OP that the first midwife was a fearmonger and should be ditched ASAP, that the OP needed to disregard professional assessments and 'trust her body' can read your words now and still hold your sniffy, holier-than-thou, sanctimonious opinions - you are odious. Vile. And dangerous.

What got Loocy so upset? She was upset by the fact that a mother with newly elevated blood pressure (130/100), was encouraged to dismiss her midwife and find another who would ignore the possibility of pre-eclampsia.

On 4/17, the mother wrote:

... After a last minute rescheduling to a much more stressful time of day, I came up with a higher than normal BP reading at my regular visit with my midwife, and she immediately changed gears into "worry mode" - she felt like a totally different person than the woman we hired, and it seemed like a lot of freaking out for a difference of 10 diastolic points.

She ORDERED me to take 3 days off of work and RELAX...

Then she sent an e-mail saying that we needed to take her care much more seriously

The story veers off into personal drama. Evidently the midwife did not feel safe in the presence of the mother's partner and insisted that henceforth the mother must come to her office. Getting back to the medical issues, at a subsequent appointment:

She took my BP again, decided she didn't like the number, and that she needed to refer me to high-risk OB in a hospital - she told me they'd most likely put me on medication and possibly induce me, but that I could always refuse the induction...

I went AMA and didn't go to the hospital

Needless to say, she was encouraged in her defiance by most of the commentors. Interestingly, it was another midwife, Nashville Midwife, who interrupted the rah, rah, you go mama cheering to point out:

... Elevated blood pressure in pregnancy is serious, whether or not the liver is involved. The main risks of PIH are stillbirth, placental abruption, kidney damage, and stroke.

And sure enough, the baby died this past weekend, apparently during a 4 day labor. The mother can't figure out how this happened:

I went through 4.5 days of labor, the last day very intense with painful contractions one on top of the other. Labor was progressing, and we were hoping for a mother's day baby, but we (and our midwives) were starting to get worried that labor was lasting so long. It seemed like the head was presenting in a non-flex position and I still had a cervical lip (but was soft and fully effaced) - those factors were making labor slightly difficult, but other than that, the baby was still positioned well and had a healthy heartbeat around 2pm.

We decided to transfer to the hospital ... the senior-most OB staff were unable to find any indication of fetal heartbeat and informed us that there was no way to resuscitate or otherwise fix the situation.

Defiant, even though her actions led to the preventable death of her baby, the mother boasts:

I gave birth to a beautiful little stillborn girl later that night - pushed her out in about 25 minutes even though the medical staff insisted it would take no less than two hours.

And, inevitably:

I checked myself out of the hospital AMA this morning (they wanted an extra 24 hours of observation beyond any treatment) ...

Because what could those medical people know? No doubt if she had followed her original midwife's advice to see an obstetrician, he would have played the dead baby card ...

... and, tragically, he would have been right.


Here's the original comment thread.

Chiropractic for colic: the stupid goes on and on

As I mentioned yesterday, Gina Crosley-Corcoran, The Feminist Breeder, aggressively demonstrated her astounding willingness to believe nonsense by washing out her vagina with soap in an attempt to prevent her daughter from acquiring Group B strep sepsis.

Unfortunately, as is often the case with homebirth advocates, that willingness to believe nonsense extends to infant care. She has "diagnosed" her daughter's breastfeeding difficulties as "colic" and is dragging the baby off to a chiropracter for "treatment." What's wrong with Jolene?

... She has two modes: asleep, and mad. There's pretty much no in-between. If she's ever awake and NOT mad, it's only a matter of mere minutes before her face screws up and the screaming starts. She pretty much hates side-laying nursing, too...

Here's what I'm seeing: She starts nursing, soon she chokes and pulls away, and by the end of the session, she's angry. She often starts crying in pain (obvious pain) with my boob still in her little mouth. My god – can you imagine how sad that sound is? Sometimes she just wakes up crying, and sometimes, she just fusses for hours on end for no apparent reason...

Hmmm. What could it be? I know, her spine is out of alignment! That makes sense ... Oh, wait, it makes no sense at all. Why on earth does anyone believe such complete and utter nonsense?

It's not like hasn't been investigated. Chiropractic spinal manipulation for infant colic: a systematic review of randomised clinical trials (2009) by Ernst reviewed the world literature:

Collectively these RCTs fail to demonstrate that chiropractic spinal manipulation is an effective therapy for infant colic. The largest and best reported study failed to show effectiveness. Numerous weaknesses of the primary data would prevent firm conclusions, even if the results of all RCTs had been unanimously positive...

This is hardly surprising, since there is no plausible mechanism for spinal manipulation to have any impact on colic. How is it supposed to work? How does it supposedly work? According to Biodynamic Craniosacral Therapy Association of North America:

... [A]ll healthy, living tissues subtly "breathe" with the motion of life - a phenomenon that produces rhythmic impulses which can be palpated by sensitive hands. The presence of these subtle rhythms in the body was discovered by osteopath Dr William Sutherland over 100 years ago, after he had a remarkable insight ... that cranial sutures were, in fact, designed to express small degrees of motion. He ... eventually concluded it is essentially produced by the body's inherent life force, which he referred to as the "Breath of Life." Furthermore, ... the motion of cranial bones he first discovered is closely connected to subtle movements that involve a network of interrelated tissues and fluids at the core of the body; including cerebrospinal fluid (the 'sap in the tree'), the central nervous system, the membranes that surround the central nervous system and the sacrum.

That makes sense ... NOT!

Okay, it's nonsensical, but what's the harm? Plenty, it turns out.

The Dutch Medical Journal reported on a case of infant death at craniosacral therapy.

A brief review of the literature reveals that this is not the first such tragedy. According to Adverse Events Associated With Pediatric Spinal Manipulation: A Systematic Review published in the journal Pediatrics, there have been at least two other infant catastrophic injures, a 3 month old boy who died as a result of a subarachnoid brain hemorrhage, and a 4 month old boy render quadriplegic after treatment for what turned out to be a spinal tumor.

In other words, not only is craniosacral "therapy" absurd; it can kill. So why are lay people like The Feminist Breeder embracing such a ridiculous, ineffective and potentially deadly therapy? It can't be because "nature" was filled with chiropracters bending people's spines to solve their medical problems.

The Feminist Breeder is taking her infant daughter off to the chiropracter for the exact same reason she washed her vagina out with soap to prevent Group B strep neonatal sepsis:

It fulfills the MOST important criteria for a natural childbirth "treatment"; it is a form of defiance of authority. And if that isn't a good enough reason for an NCB advocate to subject her baby to a nonsensical, ineffective and potentially deadly "treatment," what is?

Wash your vagina out with soap!

Sometimes I get discouraged.

This blog rests on the premise that anyone is capable of learning the basics of science, medicine and logic and using that knowledge to see through the quacktivist claims of the purveyors of pseudoscience. But then I read about the pure idiocy spewed forth on a topic like Group B Strep and I wonder if that is an over-optimistic sentiment.

How could anyone be stupid enough to believe that washing your vagina out with soap will prevent neonatal meningitis or pneumonia? (Feminist Breeder, I'm thinking of you, among others.)

Let's step back for a moment and consider what you ought to know before you can make an informed decision to decline antibiotics for Group B Strep (GBS) and to substitute washing the vagina with Hibiclens (chlorhexidine) instead.

1. How does GBS hurt babies?

2. What are the chances of a baby contracting GBS?

3. What is the neonatal death rate of GBS?

4. How does IV antibiotics change the risk of a baby contracting and dying of GBS?

5. Has Hibiclens been shown to be as effective as IV antibiotics?

The latest information on Group B Strep can be found in the Prevention of Early Onset Group B Streptococcal Disease in Newborns published in the April edition of the journal Obstetrics and Gynecology.

1. How does GBS hurt babies?

Group B streptococci ... emerged as an important cause of perinatal morbidity and mortality in the 1970s. Between 10% and 30% of pregnant women are colonized with GBS in the vagina or rectum... Invasive group B streptococcal disease in the newborn is characterized primarily by sepsis and pneumonia, or, less frequently, meningitis.

2. What are the chances of a baby contracting GBS?

For the past 30 years, GBS has been the most common cause of neonatal sepsis. The actual incidence is 1.7/1000 live births (approximately 7200 cases per year).

3. What is the neonatal death rate of GBS?

More than 15% of affected infants will die (approximately 1080 deaths).

4. How does IV antibiotics change the risk of a baby contracting and dying of GBS?

Since the early 1990s, national guidelines have resulted in an 80% decrease in the incidence of early-onset group B streptococcal sepsis, from 1.7 cases to less than 0.4 cases per 1,000 live births.

5. Has any other treatment been shown in large clinical trials to be as effective as IV antibiotics?

No, absolutely not.

In fact, large scale studies done the use of Hibiclens in low resources settings where IV antibiotics are unavailable show that it is in INEFFECTIVE in preventing neonatal group B strep sepsis. For example:

Chlorhexidine Vaginal and Infant Wipes to Reduce Perinatal Mortality and Morbidity: A Randomized Controlled Trial:

... We performed a placebo-controlled, randomized trial of chlorhexidine vaginal and neonatal wipes to reduce neonatal sepsis and mortality in three hospitals in Pakistan....

RESULTS: From 2005 to 2008, 5,008 laboring women and their neonates were randomly assigned to receive either chlorhexidine wipes (n=2,505) or wipes with a saline placebo (n=2,503). The primary outcome was similar in the chlorhexidine and control groups (3.1% compared with 3.4%; relative risk 0.91, 95% confidence interval 0.67–1.24) as was the composite rate of neonatal sepsis or 28-day perinatal mortality (3.8% compared with 3.9%, relative risk 0.96, 95% confidence interval 0.73–1.27)...

CONCLUSION: Using maternal chlorhexidine vaginal wipes during labor and neonatal chlorhexidine wipes does not reduce maternal and perinatal mortality or neonatal sepsis...

What is Hibiclens anyway?

The active ingredient in Hibiclens is chlorhexidine gluconate also known as (1,1'-hexamethylene bis [5-(p-chlorophenyl) biguanide]di-D-gluconate). According to the FDA:

... adequate and well-controlled studies in pregnant women have not been done. Because animal reproduction studies are not always predictive of human response, this drug should be used during pregnancy only if clearly needed.

And:

It is not known whether this drug is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised ...

Why are homebirth and natural childbirth advocates washing the vagina out with Hibiclens instead of using IV antibiotics?

It certainly can't be because it works, since large scale studies show that it doesn't.

It certainly can't be because it doesn't matter since GBS is the leading infectious cause of newborn death.

It certainly can't be because IV antibiotics don't work since they have reduced neonatal GBS deaths by 80%.

It certainly can't be because Hibiclens [chlorhexidine gluconate also known as (1,1'-hexamethylene bis [5-(p-chlorophenyl) biguanide]di-D-gluconate)] is "natural."

So why do women like The Feminist Reader wash their vaginas out with soap to prevent their babies from dying of Group B strep pneumonia or meningitis?

Because it fulfills the MOST important criteria for an NCB "treatment"; it is a form of ignorant, immature, self absorbed defiance of authority. And if that isn't a good enough reason for NCB advocates to risk killing their babies, what is?

Ina May shows how it's done

What a coincidence!

In honor of Mother's Day, Ina May Gaskin, godmother of gobbledly-gook in midwifery has discovered that there is a "crisis" in maternity care, a crisis so enormous, so comprehensive, involving so many well white women that it can only be solved by ... midwives!

Isn't that amazing. Just like Amy Romano, but completely independently, both midwives realized that all solutions to problems in maternity care involve paying more money to more midwives. But while Amy Romano preferred to write a subtle, understated smear that tugs at your heart strings, Ina May shows us how it's really done.

1. Declare that there is a "maternity crisis."

That's where both she and Amy Romano started.

2. Supply an anecdote to "prove" that obstetricians don't know what they are doing.

It is absolutely critical to the natural childbirth project to convince women that doctors don't know what they are doing, and willfully and cheerfully risk the lives of women and babies to promote a secret agenda.

Romano chose a heart tugging anecdote where an non-obstetrician made a mistake. Ina May goes for farce when recounting the story of a North Carolina obstetrician who made the mistake of believing a patient and failed to diagnosis a hysterical pregnancy (pseudocyesis).

According to midwifery "logic," if one obstetrician makes one mistake (or, as in Romano's case, a non-obstetrician fails to diagnose an obstetrics problem) that means that ALL obstetricians, everywhere and at all times, cannot possible be trusted to do anything right.

3. Insist that the dramatic progress of modern obstetrics is an illusion and that obstetricians oppressed midwives because they were afraid of economic competition. As Marketing Professor Craig Thompson has written:

"... [T]he cultural dominance of medicalized childbirth is explained as the historical artifact of a fin de siecle struggle between midwives and physicians, where the latter group held a decided economic and sociocultural advantage. As this critical narrative goes, the medical profession leveraged its emerging economic-political clout and cultural affinities toward ideals of scientific progress and technological control to displace midwives (both socially and legally) as the authoritative source of childbirth knowledge."

4. Lie about the scientific facts.

Ina May claims that the World Health Organization recommended a 10-15% C0-section rate, and "neglects" to mention that the recommendation has been WITHRAWN because, as the WHO acknowledged, it was fabricated without any scientific evidence to support it.

Ms. Gaskin claims that the maternal mortality rate doubled in the past generation, when that is flat out false. The purported "increase" is almost entirely due to two separate revisions in birth certificates that enlarged the classification of maternal death to include deaths that previously would not have been included. In addition, Ms. Gaskin conveniently "forgets" to mention that maternal mortality has actually DROPPED in the past two years for which we have data.

Ina May also neglects to mention the fact that in the 100 years after its advent, modern obstetrics dropped the neonatal mortality rate 90% and the maternal mortality rate 99%.

5. Cynically ignore the real crisis in the care of women around the world who die for lack of access to modern obstetric care, and pretend that the "crisis" is that there aren't more midwives to care for well white women in first world countries. Cynically ignore the fact that the leading causes of maternal mortality in the US are complications of pregnancy and pre-existing medical conditions like heart disease and kidney disease. Midwives can have no impact on these deaths because they don't care for these patients.

6. Insist that obstetricians overuse technology, AND at the very same time, under-use it. The battle cry of midwifery advocates is usually that obstetricians have "ruined" birth with their insistence on using technology, yet both Romano and Gaskin have invoked medical mistakes where the under-use of technology led to the bad outcome.

Which is it? Do obstetricians overuse or under-use technology? Or does it not really matter, when the goal is to use any means at hand to disparage obstetrics and encourage mistrust of obstetricians?

7. Sadly, but firmly insinuate that obstetricians don't want to help women; they want to make money, show off, and get to their golf games as quickly as possible. Regretfully, but firmly imply that obstetricians actually want to HURT women by imposing their fancy technologies to ruin otherwise perfect labors simply so that they can apply even more technology.

And declare (this is the big finish), the only way you can prevent obstetricians from victimizing you, hurting you and profiting from you is .... give more money to midwives.

Homebirth: parody or reality? You decide.

Tina Fey takes on homebirth.



Obviously this is a parody. If it were a real homebirth video there would be an inflatable kiddie pool filled with fecally contaminated water.

Maternity system in crisis?

Amy Romano is at it again.

Romano, like everyone else at her employer the Childbirth Connection, has a vested interest in portraying the maternity system in crisis. This is a classic tactic in "alternative health."

As I wrote in The playbook for challenging conventional medicine:

The first step is to portray the particular discipline as "in crisis". [According to Paul Wolpe in the paper The Holistic Heresy: Strategies of Ideological Challenge in the Medical Profession]:

"... Modern medicine’s conquering of infecious disease set up a quasi-religious belief in its ability to reduce suffering and disease now seems stalled by a of medical economic, organizational, and social problems. [Critics try] to portray the biomedical orthodoxy as responsible for the problems confronting organized medicine .., and suggests that orthodoxy is ill suited to solve the developing challenges to care..."

This is certainly the tactic adopted by homebirth midwifery. The "crisis" is the rising C-section rate, which is portrayed as unjustified, intolerable, unaffordable and injurious. A secondary "crisis" (which is fabricated) is the rate of infant mortality (the wrong statistic) and the rate of maternal mortality (which is falsely portrayed as rising).

And this is the tactic Romano uses in the piece she wrote for The Health Care Blog, A Mother’s Day Manifesto: Blood, Toil, Tears, and Sweat. Romano tells the story of "Near Miss Mom" who suffered a late postpartum hemorrhage (9 days after birth), a rare postpartum complication. Near Miss Mom went to the emergency room, but the doctor who saw her there failed to recognize the seriousness of her condition and therefore failed to refer her immediately to an obstetrician. Indeed, Romano acknowledges the problem was quickly diagnosed by an obstetrician:

When she finally reached Near Miss Mom’s bedside, it didn't take her long to call a Code Red and assemble the team for the emergency hysterectomy.

Romano presents the error of the emergency room doctor as a Mother's Day parable on the "crisis" in maternity care. There just one teensy, weensy problem. This was NOT a near miss maternity event and it is unfortunate that Ms. Romano has chosen to misrepresent it as such.

This is an example of a patient presenting to the emergency room with a rare complication who should have had an immediate specialist consult, but did not. Late postpartum hemorrhage is typically due to sub-involution of the placental bed. Most physicians, like this ED doc, have never seen a case and therefore may fail to recognize it.

This was a mistake on the part of one physician (failure to obtain immediate specialist consultation) and not a systemic failure. If an emergency room doctor failed to recognize a complaint of jaw stiffness and drooling as tetanus, we would not conclude that it was a "neurology near miss" and indict the neurology care "system."

That’s not to say that there isn't room for improvement in maternity care, but it is deeply cynical to use the case of an emergency room doctor failing to diagnose a rare postpartum complication as a failure of maternity care and deeply cynical to use it as a Mother’s Day parable.

Trust newborns?

When I created Hurt by Homebirth, I anticipated stories of homebirth gone wrong. I anticipated stories of life threatening disasters that occurred without warning, like abruption, and babies who succumbed to lack of oxygen during labor and were unexpectedly born without a pulse. I did not anticipate many stories like Angela's story.

Angela was born at home apparently healthy, developed subtle signs of severe illness and died less than 24 hours after birth. It is strikingly similar to Mary Beth's story and Wren's story. If these stories on Hurt by Homebirth are any indication, such tragedies may be far more common than we realize. Moreover, they represented yet another unjustified assumption at the heart of homebirth advocacy.

Homebirth advocates routinely counsel women to "trust birth" or, as in the startlingly stupid formulation of the CIMS' Mother Friendly Childbirth Initiative:

Women and babies have the inherent wisdom necessary for birth.

Let's leave aside for the moment the fact that neither women nor babies have "inherent wisdom" about birth. Let's also leave aside the fact that childbirth is, and has always been, in every time place and culture, a leading cause of death of young women, and the leading cause of death of infants. Even if birth were trustworthy (and it most definitely is not), a newborn can face a host of common, yet deadly threats.

Homebirth advocates explicitly counsel "trust," but can a newborn be trusted to master breathing difficulties, circulatory problems and infections?

Within the first 24 hours, a newborn must:

1. Learn to breathe

Babies are born with non-functioning, collapsed lungs. The baby must generated the force necessary to expand those lungs (think blowing up a balloon), must be able to keep the lungs fully expanded (special substances produced in the lungs make it easier to do so), and must master and be able to sustain the effort of regular breathing.

2. Switch its circulatory system from fetal pathways that transport oxygen from the placenta to new pathways that transport oxygen from the lungs.

The fetal circulation bypasses the non-functioning lungs, whereas after birth all blood must circulate through the lungs to pick up oxygen. Bypass routes exist in both the heart and the lung blood vessels. Those bypass routes must close in order for the baby to survive.

3. Fight off the bacteria and viruses encountered in the vagina.

The primary infectious threat to newborns is not bacteria and viruses in the air, but bacteria and viruses in the vagina. Group B strep and herpes are potentially deadly threats that can begin attacking a baby during birth. Because of their immature immune systems, newborns are uniquely vulnerable to these threats.

Problems with any of these three tasks, particularly early problems, may show only the most subtle signs, signs that may not be recognized by anyone but a medical professional.

1. It is obvious whether or not a baby begins breathing, but it may not be apparent that a baby is having trouble keeping his or her lungs open or maintaining the fast breathing rate that newborns require. Newly expanded lungs have a tendency to collapse and it takes a considerable amount of effort to keep them open.

The baby produces a substance (surfactant) that dramatically lowers the amount of effort needed to keep the lungs open, but even slightly premature babies may not have the amount of surfactant needed. The problem is often not immediately apparent, since the baby does begin breathing and maintains a normal breathing rate. However, the effort required is enormous and within hours, the baby begins to tire, can no longer fully inflate his or her lungs and therefore cannot get enough oxygen. The signs are subtle, and a parent may not realize that there is a problem until the baby stops breathing altogether.

2. If the the fetal circulatory bypass of the lungs fails to close, the baby will breathe, but won't send nearly enough blood through the lungs to pick up adequate oxygen. If the bypass stays wide open, the baby will turn blue (cyanotic heart disease). Even then, a parent may attribute the baby's poor coloring to the unusual coloring of newborns.

If the bypass remains only partially open, the signs will be even more subtle and even harder to recognize. The parent may not realize there is a problem until the baby stops breathing altogether.

3. The infectious threat is particularly insidious. A baby may be born appearing entirely healthy, but the bacteria picked up in the vagina (such as Group B strep) may already be invading and multiplying in the baby's tissues, particularly the baby's lungs.

When an older child develops pneumonia, it's hard to miss. The child is usually coughing, has a fever, and may complain of chest pain. In contrast, a newborn can quickly develop pneumonia without ever coughing and with only a low grade fever if any. Over time, the baby very gradually develops subtle breathing difficulties such as small noises during breathing. The baby continues to struggle, getting ever more ill, but the parent may not realize that there is a problem until the baby stops breathing altogether.

There's a theme here: the signs of serious newborn illness are subtle can often can be diagnosed only by a medical professional. In a hospital, the baby can be examined by a pediatrician. Even more importantly, there are always nurses about, nurses who have been specifically trained to recognize subtle signs of newborn illness. At home, there is only the midwife. Homebirth midwives have very little training in recognizing newborn problems (after all, there aren't supposed to be any problems) and are gone within an hour or so. The parents are on their own, without any counseling about what to look for.

There is one warning sign that every parent of a newborn should be taught to attend to: a baby who refuses to nurse.

Nursing takes effort away from breathing. A baby using every bit of its energy to get enough oxygen has no effort to spare. The baby may latch willingly but quickly become hypoxic and release the latch in order to expend its effort breathing.

Homebirth involves a great deal of misplace trust. It's bad enough that homebirth advocates trust birth, but most don't know enough about childbirth to know any better. But does anyone really "trust" a newborn to master breathing problems or fight off serious infections without help?

Who is supposed to be trusting whom here? Should a homebirth advocate trust her baby to handle serious health problems? Or should a newborn be able to trust his or her mother to give birth in a place where those with the requisite training and experience can diagnose subtle signs of serious illness?

These questions never crossed the minds of mothers and fathers who lost apparently healthy babies in the hours after homebirth. They have generously shared their pain in the hope that it will cross yours.