Look to your right. See the twitter feed? That's midwife Lisa Barrett live tweeting her contempt at the Coroner's inquest into her role in two homebirth deaths.
Her lawyer must be horrified.
I wonder if the judge knows.
Addendum:
Nice touch to include geo-location so you know just where she is.
Addendum 2:
Lisa Barrett is off line now, but here are some of her most recent tweets from the courtroom:
Who was she tweeting with? Here's a sample:
How touching! Both Gloria Lemay and Janet Fraser are supporting her. What could be better than the support of others who have let babies die?
The increasing popularity of homebirth is the quickest road to ending the increasing popularity of homebirth. Why? Because more homebirths means more homebirth deaths. It is difficult to argue for the safety of homebirth when the dead babies pile up all around.
Even homebirth celebrities are not immune. In fact, they appear to have experienced a mini-epidemic of homebirth deaths. Ina May Gaskin, the doyenne of homebirth midwifery, lost a child at homebirth, Laura Shanley, the American exponent of freebirth (homebirth without a midwife) lost a baby at homebirth, and Janet Fraser, the Australian exponent of freebirth, lost a baby at homebirth, too. Don't worry about her, though. She thought the entirely preventable death of her baby at home wasn't particularly traumatic, not nearly as traumatic as the "birth rape" with her first (living) child.
Two months ago Canadian homebirth celebrity Annie Bourgault had a twin homebirth. One of them lived and one of them died.
Bourgault describes herself as:
... a reporter who finds evidence based information about birthing. She interviews health professionals, leading experts in childbirth and parents whose work help women feel empowered and fulfilled during pregnancy, birth and motherhood. Sign up for her free report: 7 Steps To The Perfect Birth Experience.
Bourgault was expecting twins, and her "perfect birth experience" did not involve being "fearful of the birth process."
She was irritated with her obstetrician when he told her:
The babies were not very well positioned. Very unlikely they will move. I will need an epidural for the second twin. Start thinking of a c-section!
Wow! I understand why we are so fearful of the birth process and why we just hand them our lives and the life of our babies. He got me! He induced fear in me very easily...
Later I talked to my Doula & midwife who repeated what I already know: He just wants to paint the worst scenario for you. Don't take that on board. You will be fine...
I love this man for doing his job the best he could. I understand where he comes from. But I would like to suggest to him that fear is not the way to help a woman achieve a happy outcome at birth. Comfort is. Knowledge and fear inducing are two different things.
Knowledge and "comfort" are also different things.
Pushing Max who was breech was amazing. I could even say it was easy-ish. Even if it wasn't that easy. It felt like it. When I held him in my arms I kept thinking: "What was the big deal? Why did the hospital refused to let me birth you the way I wanted? Without drugs? Without a c-section? I knew we could do it."
Then Sam... came out 45 minutes after his little brother. He was in a perfect position: head down. We heard his little heart beating 10 minutes before he came out...everything was fine...seemed fine. While I was pushing him out I heard my midwife say: Oh no! It's the placenta!" She came in front of me and said: "push your baby out right now!"
... I pushed a baby and a double placenta at the same time. They came out at the same time!! I felt like I was opening a bottle of Champagne through my vagina. I scooped my baby out of the water. He was limp. We started CPR and gave him oxygen.
I had my little boy in my arms and I named him. Sam! Sam! I kept saying his name over and over..like a song. I thought if he had a name he couldn't die. " Sam my boy, my beautiful boy. I love you so much...stay with us Sam. We love you. You are not going anywhere. Are you? Stay with me. Stay with us!" I kissed him, massaged him, loved him with all I had. I believed he was going to be OK.
He wasn't. He never took a breath.
Bourgault offer the usual homebirth disbelief:
So what were the chances of me suffering a placenta abruption? I was healthy, had energy, did yoga, ate more broccoli and kale in one day than my whole family in a year and my twins were 39 weeks +. So what happened? Fuck! What the fuck happened????
What the fuck happened happened? An utterly predictable complication of twin birth, placental abruption. In fact the high risk of placental abruption is THE reason that twin birth is considered high risk.
Before birth 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. 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.
In a twin birth, the first baby is born and the uterus contracts down around the empty space. The placenta is incapable of contracting, both the placenta of the baby that has born and the placenta of the baby still in the uterus, still depending on the placenta for all of its oxygen. That's the main reason why twins are considered high risk. The second baby may lose its supply of oxygen long before it can be born vaginally. That's why the second twin needs to be monitored very carefully, typically in an operating room with a team standing nearby to start an immediate C-section if the placenta begins to detach.
What happened to Annie Bourgault's son Sam? First, the midwife utterly failed to recognize what was happening. During the 45 minutes between the birth of the first and second twin, she was almost certainly listening to the heartbeat of the mother, not the baby. The fact that a completely detached double placenta came out before the second baby indicates that the baby had been dead for some time, but the midwife never even noticed. Second, Bourgault was at home, too far away from the personnel and equipment that would have easily saved her baby's life.
Bourgault, of course, is busily pretending that Sam's was unpreventable.
I never thought he wouldn't make it. I never thought he wouldn't survive. Babies often come out flat at birth but they come back...Mine didn't. He never took a breath.
It's not suppose to be like that. Babies come first and the placenta comes out after because if it doesn't the baby is deprived of it's vital oxygen and can die.
Birthing at home is as safe as birthing at the hospital. Isn't? True. But death doesn't spare home birth. It doesn't spare anyone.
Not exactly. Death is ALWAYS a risk at birth. The risk of death does not spare anyone (even those who write books insisting that homebirth is safe). But death itself CAN be prevented. That's what hospitals are for; that's what obstetricians are for; that's what C-sections are for.
Bourgault insists:
When we went to the hospital later that day. I learned that in the case of a placental abruption like this...there is no so called "safer place". Because when it happens the baby has only a few minutes to live. Had I been at the hospital I was told I would have had an emergency c-section...but I would also have a dead baby or a very brain damaged one. A c-section AND a dead baby. Thank you very much. I'd rather be at home.
Not exactly. The obstetrician who had advised Bourgault to have a C-section was not nearly as sanguine as she about the baby's death.
The Ob/gyn who wanted me to have an elective c-section before she went on holidays two weeks prior to the birth came to our room to offer her sympathy and announced that she had called the coroner's office for an investigation in the death of our baby...
Bourgault still doesn't get it:
I came to the conclusion that women are allowed to give birth at home but not allowed to loose (sic) a child at home.
She didn't "lose" a child at home. She let him die. It was more important to her to have the "Perfect Birth Experience" than to take the simple precaution of ensuring that her baby had access to life saving technology. Had Bourgault followed her obstetrician's recommendation for an elective C-section, she'd have two babies at home today, instead of one at home and one in a grave.
In the midst of the discussion that homebirth is not a feminist statement, an interview I did several weeks ago with Teen Skepchick was published. The discussion was wide ranging, but one of the issues we kept coming back to is the need for women to have a strong grounding in basic science and math.
Teen Skepchick is an awesome website run by Rebecca Watson:
... Rebecca is leading a team of skeptical female activists at Skepchick.org and TeenSkepchick.org, co-hosting the weekly podcast The Skeptics’ Guide to the Universe, hosting her public radio show Curiosity ...
The world of skeptics is dominated by men, which is not surprising considering that the world of science was until recently dominated by men. Now, though, women are doctors, chemists and rocket scientists. I love that Teen Skepchick is encouraging the next generation of women to study science, think logically and beware of pseudoscientific claims.
To me, one of the most depressing aspects of health pseudoscience (so called "alternative" health) is that it is dominated by women. Women are far more likely to believe in and use quack "treatments" like homeopathy. They believe in and spearhead nonsense "movements" like anti-vaccination. And, of course, quack practitioners like homebirth midwives (certified professional midwives or CPMs) are exclusively women.
Why might that be? I suspect that it has a lot to do with the fact that many women have no knowledge of basic science and math.
When we were children, my generation was told that science and math were "too hard" for women, and girls were steered away from physics and engineering toward professions like teaching and nursing. Women like me owe a deep debt to feminist pioneers who, often at great personal cost, paved the way for acceptance of women into every subject of study and every possible career.
That's why it's especially depressing to me to find that while women are free to learn science and math, many still avoid it as "too hard." Without a strong foundation of science and math, it is perhaps inevitable that many women are drawn to pseudoscience. What's truly amazing, though, it that they want to pretend that ignoring science is some sort of feminist statement.
I suspect that comes from a fundamental misunderstanding about feminism. True, feminism is about choice; women can make whatever choices they deem best for themselves, regardless of society's view of what is "proper" for women. But that doesn't mean that every choice made by a woman is a feminist choice. It is not a feminist choice to wear a burqa; it is not a feminist choice to remove your daughter's clitoris with a dirty razor blade; and it is not a feminist choice to declare that you are subservient to your husband.
Similarly, it is not a feminist choice to ignore science.
You have to give the feminist anti-rationalists credit for making lemonade out of lemons, though. Rather than confessing to ignorance of science, the feminist anti-rationalists declare that science is male and that women have "different ways of knowing" (i.e. intuition). That's a pretty neat trick: cloaking the sexist belief that science and math are too difficult for women under the intellectual burqa of feminine intuition.
Although women have a right to have a homebirth, a homebirth is not a feminist statement. It is absurd to suggest, in this age when more than half of obstetricians are female, that obstetrics is patriarchal. It is absurd to claim that in this age when women can be nuclear physicists that science is male and women have "different ways of knowing." And now that young women are finally allowed to study as much science and math as they wish, it is downright bizarre to insist that science and math aren't necessary to understand the function of the human body.
Homebirth is not a feminist statement, not merely for the obvious reason that every choice made by a woman is not inherently a feminist choice. It is also not a feminist statement because homebirth advocacy is based primarily on ignorance of science, statistics and basic medical facts. Ignoring science is never a feminist choice.
How's that's "trust birth" thing working out for Lisa Barrett? Not too well, evidently, and even worse for babies, based on what I've heard. Since 2007 she's presided over at least 2 preventable neonatal deaths and one severely injured newborn.
I look up to the birthing woman, her ability, her energy and I trust birth.
That's how Barrett describes her philosophy of midwifery. It's inane on its face. There is nothing trustworthy about birth. It is and has always been, in every time, place and culture, a leading cause of death of young women, and the day of birth is the most dangerous day in the entire 18 years of childhood. Trusting a bodily process to work perfecty in every woman, for every baby, every time, is nothing more than a recipe for disaster ... as Barrett herself has demonstrated repeatedly.
First, Barrett presided over the absolutely horrible and completely preventable death of Tate Spencer-Koch from shoulder dystocia. By Barrett's admission, it took her an unbelievable 20 minutes to extricate Tate after the baby's shoulders got stuck behind her mother's pubic bone. During that time, Tate began to suffocate and she was delivered nearly dead and could not be resuscitated.
Barrett, hoping to avoid an investigation into her conduct argued that she was so grossly incompetent that the baby was completely dead by the time she was born and therefore the coroner did not have jurisdiction to investigate the death. Barrett acknowledged that if she had merely rendered the baby profoundly brain damaged, an investigation would have been in order. But, hey, the baby died; let's just step around the dead body and carry on; too bad, no investigation allowed.
But the ambulance staff begged to differ. Although Tate had no heartbeat at the time they arrived, EMTs were able to detect electrical activity of her heart, known as PEA (pulseless electrical activity), the terminal event before actual death. Therefore, the coroner did have jurisdiction to investigate Tate's death. Lisa Barrett fought the ruling all the way to the Australian Supreme Court. Barrett didn't even bother with the pro forma declaration that of course she would welcome an investigation that she was sure would exonerate her. She did everything in her power to stop the investigation and made no bones about it.
Incredibly, in the wake of Tate's preventable death, Barrett portrayed HERSELF as the victim, arguing that she was merely standing up for legal precedent, that any effort to provide justice for Tate was just a witch hunt against midwives, and, for good measure, Barrett was martyring herself for women's reproductive freedom.
Barrett lost at the Australian Supreme Court.
Now that the investigation has begun, we can see why she was desperate to stop it. First up, the story of ANOTHER homebirth death that Barrett presided over two years later. Barrett apparently learned nothing from Tate's preventable death. This time she was "trusting" breech birth and once again a baby got stuck. Jahli Jean Hobb's body emerged but her arms became wedged behind her head. This is known as nuchal arms and usually can be prevented by properly handling the breech, but that's not what happened here.
Barrett struggled mightily to pull down the baby's arms, but without success. Incredibly, she asked a friend of the mother (who, coincidentally, was a student midwife in the earliest states of her training) to take over for her! The student, thought she very little experience, had read about managing breech birth and remembered what to do. She was able to extract the baby's arm and the rest of the baby was delivered.
Gemma Noone wanted to be part of one of her friend's most exciting moments and witness the miracle of life.
Her elation turned to despair, however, when Ms Noone - a student midwife - was forced to assist in the ill-fated homebirth of Tate Spencer-Koch.
When private midwife Lisa Barrett got hand cramp she told Ms Noone to take over, leaving her to pry the baby's shoulders free from its mother. Yesterday, she told the Coroner's Court she had been traumatised by Tate's tragic death and had been put off her studies as a result.
"(Ms Barrett) asked me to try to get the baby out, it was an emergency," Ms Noone said. "She was sort of saying `you have to help me', she said her hand was seizing up. That was never the plan, I was not to be involved."
Neither Tate's mother, nor Jahli's mother were appropriate candidates for homebirth. Both had had C-sections for their first births. Jahli's mother, and probably Tate's mother were not even candidates for VBAC (vaginal birth after cesarean) in a hospital let alone at home. But Lisa Barrett was too busy trusting birth to pay attention to anything as mundane and restrictive as clinical guidelines and Tate Spencer-Koch and Jahli Jean Hobbs are dead as a result.
And Lisa Barrett is till clueless. Here's what she wrote on the Australian forum Joyous Birth just two months after Tate Spencer -Koch died:
There are actually very few predisposing factors to shoulder dystocia.
There aren't a lot of predisposing factors, but there are some and they should not be ignored. One of the most important is history of a previous shoulder dystocia. But Barrett ignored that risk factor just a year after Tate Spencer-Koch, attending the "accidental" homebirth of a woman whose first baby suffered a severe shoulder dystocia.
Guess what? Another shoulder dystocia. What a coincidence.
Baby comes very quickly to eyes and then each contraction only brings a little more baby,few more and baby's mouth is half in half out, she's on all fours so we are just waiting. chin is barely out just waiting, no contraction for a number of mins so I don't touch but ask her to change position, touching before any sign impacts the shoulder, she changes position baby does a bit of a turtle neck thing but tries to swallow. another 5 mins on peri and I ask them to call an ambulance but all is very calm, I'm well aware of their last experience so we keep chatting. I felt shoulder abdominally and just tried to put them in the AP and I asked her to turn back onto all fours, Still nothing baby is looking a little off colour so with next contraction about 5 mins on, I put in my hand and with some difficulty, (lots actually) I move the posterior shoulder and as it's birthing I hear it snap. FUck, However the arm came through and I was able to pull the baby out. I am so over this!! baby had great cord pulse apgar is 1. I mouth to mouth baby and after 2/3 mins feel a few resps under my mouth ...
Prosecutor Naomi Kerera is conducting the inquest. Fortunately, in addition to investigating Lisa Barrett's judgement and competence, she plans to go further.
It will also look at the wider systemic issue of homebirth, the apparent disparity between public and private midwives (and) the need for closer regulation of homebirths overseen by private-sector midwives.
Lisa Barrett is a poster child for greater regulation of homebirths, but in her case, regulation is not enough. Barrett should lose her license for gross negligence. It's the least that can be done in memory of the babies who have died at Lisa Barrett's hands.
I notice that you are quick to claim credit for a rising number of homebirths in the wake of your film The Business of Being Born:
The impact of the documentary was monumental. The blogosphere blew up (I can handle a few people yelling at me if it means my message is being heard!) Every day women stop me on the street to share stories of their safe, successful, meaningful births. Many say they felt "in the dark" about their options until seeing The Business of Being Born...
I wonder if you're also willing to accept blame ... for the babies and mothers who have died because they believed your nonsense.
What do you say when women stop you to share stories of their dead babies, babies who died because their mothers saw your movie and believe that homebirth was safe and empowering? What do you say when they share their stories of a ruptured uterus, a breech baby with a trapped head, a severe shoulder dystocia? What do you say when they tell you how their "midwife" encouraged them to labor for days and push for hours, all the while unaware that the baby had died from the stress of labor?
In the past several months alone I have written about 10 babies who have died at homebirth in addition to the older stories recounted on the website Hurt by Homebirth. And this week, a mother apparently died as a result of an attempted homebirth. Just this afternoon, in fact just before I sat down to write this, I learned of a baby born this week after an attempted homebirth whose parents are currently trying to process the fact that their baby has suffered significant brain damage.
What do you tell them, Ms. Lake? Oh, and don't bother saying, "babies die in the hospital, too." That may work on uneducated lay people, but that doesn't work on me. I know that CDC data shows that homebirth triples the rate of neonatal death. I know that in the state of Colorado, licensed homebirth midwives attending planned homebirths have a death rate DOUBLE that of the state as a whole (and the state numbers include premature babies, babies whose mothers have pre-existing medical problems, and babies whose mothers suffered complications of pregnancy.
In fact I know, and perhaps you know, too, that the Midwives Alliance of North America, the organization started by your friend Ina May Gaskin, is refusing to release their own death rates because an appalling number of the 23,000 babies in their database died at homebirth.
Do you plan to take responsibility for these deaths, Ms. Lake. Because if you do, I have a great idea for you. I think you ought to set some of your profits from YOUR business (and it is a business) of being born (books, DVDs, etc) into a no-fault compensation fund for those parents who have lost babies at a homebirth. I'm not sure how much money would be available for each family, since, unfortunately, there is a large and growing number of such families, and I don't know if would be enough to cover the millions of taxpayer dollars that are going to be spent caring for the babies who were left brain damaged by homebirth. Nonetheless, it seems to me that it is the least you could do.
But if you don't plan to take responsibility, and I'm not holding my breath because I would turn awfully blue, the very least you could do is amend your film, books and website to reflect the very real dangers of homebirth. I don't doubt that you were unaware of the dangers of homebirth when you started, and as you seem to have no knowledge of science, statistics or obstetrics, you may still be unaware. But it doesn't take any specialized knowledge to count the growing number of dead babies, babies who died preventable deaths because their mother listened to you.
Sincerely (and with a great deal of sadness and anger),
Amy Tuteur
I have received word of an incredible tragedy. A Florida mother of 6 died in the wake of an attempted homebirth.
I have tried to assemble as many details as possible, but several reports on birth related websites were removed over the past day.
The mother posted on homebirth websites and reported that she had already had one successful homebirth after 2 previous C-sections.
In the wake of her death, a friend began soliciting breast milk for her baby:
A beautiful, wonderful, amazing friend of mine passed away on Monday (08/22/11) after giving birth to her sixth child just a day before. She never got to meet her son, as she had lost so much blood by the time he was taken via emergency cesarean section. She tried so hard for this last pregnancy, and continued to nurse her second youngest (nearly 2 now) through it. She was a beautiful, WONDERFUL soul...
Her doula Michelle Fonte had posted a prayer request on August 21:
PLEASE. energy. thoughts. prayers for a very special mama of mine. in the hospital. who needs all of our help. she needs you. really. really.
and an update on August 22:
mama is strong and stable...but has a long way to go. please continue to keep her in your thoughts and prayers. thank you so so so much.
Unfortunately, she died later that day.
In the wake of her death, her former physician who runs a "holistic" practice posted:
I would also like to extend prayers to my former patient who did not make it. We were due at the same time ... a beautiful woman/spirit. So sad how we have to expose ourselves to such risk since we can not rely on the "establishment".
Sad? Sad is not the word I would have used to describe the decision to take such a terrible risk.
Home birth as a way to find a loving supportive environment and fight the enslavement of the patriarchy is absolute, utter nonsense. It's one of the only medical scenarios I can think of where women place health and welfare in jeopardy in order to feel "in control" and avoid intervention.
She examines the data on the safety of homebirth and states:
If you can look at those data and still decide ... to choose home birth, then I say "You go get 'em, Gloria Steinem!" But, you should know that I'm going to judge you. Choosing to deliver at home because it makes you feel empowerful isn't a feminist act. It's a selfish one...
She draws the obvious parallel with vaccine rejectionism:
It's no different from the attitudes of the anti-vaccine mothers who choose delayed vaccination schedules, or no vaccines at all, because it makes them feel safe and in control of their children's well-being. You might feel empowered, but the data tell us that you are hurting your children with your choices...
She concludes:
I can think of no other women's health area – Pap screening, breast cancer treatment, HPV vaccination, in which forgoing a treatment shown to improve health outcomes would be flown on a feminist banner...
If feminists care about empowering women during child birth, they should do so in an evidence-based manner... We should be continuing to ask how can we make women feel empowered in an environment that offers the best chance of survival for their offspring. This home birth talk is shenanigans.
I empathize strongly with those who advocate home birth, and I am not completely against it. And I think that comes from a number of places... But when I see this population of women denigrated, called "homebirthers," essentialized, and conflated with anti-vaxxers, I feel like something needs to be said.
What should follow is an exposition demonstrating that homebirth advocates do not believe in biological essentialism or are not more likely to be vaccine rejectionist, but Clancy offers no evidence to rebut Dr. Isis. That's because there is no evidence. Biological essentialism is a critical component of homebirth belief starting from Grantly Dick-Read (the "father of natural childbirth") right through Ina May Gaskin who is a staunch biological essentialist.
Overall 132,473 Oregon births were included in this study... The 2,200 children who were born in locations other than a hospital or freestanding birthing center were 8.8 times more likely not to be seeking or receiving immunizations than those born in hospitals. Those with a direct-entry or non-certified midwife in attendance were 7.4 and 8.8 times more likely to not be shot seeking as those with an M.D...
When I presented this information in the comments, Clancy blew it off with this non-sequitur:
Amy, please read two of the comments above yours, both by scientists who have had home births, and link to their own birth stories and their own justifications for their home births, before you paint all women who advocate home birth with the same brush.
Then Clancy demonstrates a complete failure in her understanding of mortality statistics. She appears to believe that perinatal mortality (deaths from 28 weeks of gestation to 28 days of life) means deaths of premature babies starting at 28 days of gestation:
... It would be stupid to try and give birth to a baby at home before 38 weeks; it would be taking an unnecessary risk. This is why I take issue with Dr. Tuteur trying to change the metrics for evaluating infant mortality to include those births that it would never, ever make sense to have at home or in a birth center...
All and all, I'd say that Kate Clancy offers an excellent example of what I always warn against, women who think they are "educated" about obstetrics but have no idea what the scientific evidence shows and no idea what the scientific terms even mean*, and what Dr. Isis was highlighting, "women [who] place health and welfare in jeopardy in order to feel "in control" and avoid intervention."
*rather startling that she claims to be studying the anthropology of women's reproductive physiology but doesn't know the definition of the terms used to measure women's reproductive outcomes.
Homebirth advocacy has become so extreme that it is occasionally difficult to tell the difference between a real story and a hoax. This story posted on Mothering.com sounds so extreme as to be a hoax, but readers can decide for themselves.
On 7/20, klamp posted on Mothering.com:
... I had mentioned no prenatal care/self prenatal care and the intention of a UC. Due to this post everyone is flaming my thread, saying that I am neglectful, ignorant, uneducated; there are even posts saying "screw you"... Why should I be bound to diabetes testing, blood testing, urine testing, pressuring, poking and prodding if I do not want to be? Better yet why is society so reliant on medical professionals and to the extent that it is viewed as required? I feel like I am missing what the big deal is.
Here's the birth story, posted on 8/21. It starts of promisingly:
For all of you out there considering or determined to have a UC, congratulations. It is empowering, exhilarating and I am a firm believer of having healthier babies and easier births due to UC.
I was one who didn't receive any prenatal care or use a midwife; I found it pretty useless as I could weight myself, check my blood pressure I felt sense able enough to know if something felt wrong. I tracked his positioning and even knew that he was a boy!
I went into labor at 1 a.m. on July 18th of this year and had Tyson at 9:08 a.m. My partner was there and was supportive ...
So everything turned out great, right? Not exactly.
Rubbing the outside of my vagina, I felt a large bulb and told my partner that the head was coming out, he was just about here! There was a loud bang and my amniotic sac literally exploded and the water covered the bathroom. His foot immediately came after wards. We were shocked, sure he was head first. I didn't panic right away, I knew that breech, vaginal births were totally possible.
But they handled it successfully, right? Not exactly.
The next foot came seconds later and he came out up to an inch above his belly button. This is where I panicked he wasn't coming any further and was stuck, I had my partner call the ambulance. Throughout the course of the call I was told to try different positions with my boyfriend pulling, pushing, prying and the baby had turned a deep shade of purple and was no longer moving when I tickled his foot. We were certain that he was dead by the time the ambulance had gotten there.
What ensued was a virtual horror show. The EMTs were unable to deliver the baby and elected to transport the mother to the hospital.
... They carried me down the stairs sin my comforter, while I held my baby up, still stuck. The man in the ambulance was trying to get his arms down, which was keeping him from coming him out, Tyson had his arms raised up so his shoulders were in the way. They had my push but I was exhausted and ... I had given up, I didn't see the use in it because I knew in my heart he was dead anyways. I give a huge push and feel terrible finally the EMT in the ambulance got his arms down and there was a huge release of pressure and I could feel Tyson Sliding out... [I]t was nice feeling his skin against mine but I could see he was still a very dark purple.
The baby was not dead. The EMTs and hospital personnel manage to resuscitate him and keep him alive.
klamp reports:
There is no feeling like the feeling of having a baby dangle halfway out of your vagina while you are certain that it is dead. There is no way to explain the guilt, terror, depression, anger and other emotions that we have gone through. Tyson might have brain damage but after being stuck for over 10 minutes and all the progress he has made as well as the brain's ability to regenerate and reroute it looks promising that he will lead a healthy and normal life.
klamp suggests that maybe getting prenatal care isn't such a bad idea after all:
... Don't just guess or go on instinct, make sure, this has been so painful and I don't want it to happen to others. I would still have a home birth it was an amazing experience up until the foot came out and I encourage others not to be afraid but to be safe and protect themselves and their babies. Good luck!
Jill Arnold at The Unnecesarean wrote an interesting recap of a discussion that occurred on her blog between Ina May Gaskin and me. What's most interesting about it is Jill's conclusions.
Jill quotes two comments.
Ina May:
... I understand now that one reason that Dr. Tuteur has objected so strenuously to my ideas comes from the helplessness she and other staff members felt during her residency when those three mothers who did need obstetrical intervention refused it, unaware that their babies really could (and did) die for lack of it...
I didn't make up the incident ... in which repeating the traditional wedding vows made it possible for my friend’s cervix to dilate fully after she had been stuck at 7 cm for more than a day. She gave birth about an hour and a half after that impromptu ceremony. I realize, of course, how hard it can be for anyone who prides herself on being "rational" and skeptical to accept this, but I’m stuck with what did happen. There were witnesses...
I don’t find it at all hard to believe that he encountered tribal people whose experience told them that a labor could be prolonged when a mother had a sexual secret that she was keeping. It doesn’t mean that will happen with everyone, but it does happen sometimes. And no randomized controlled trial will ever demonstrate this...
And my response:
You don't have to conjure up any secret motivations. I've explained why I object strenuously to your ideas: I find your philosophy of biological essentialism and anti-rationalism completely unpersuasive, and I have pointed out ad nauseum that most of your empirical claims are factually false. That’s more than enough reason to explain why I disagree with you.
In recounting those anecdotes, I was not describing my "helplessness" since I did not feel helpless. I recounted those anecdotes specifically to illustrate my claim that homebirth and NCB advocates don't understand the risks of their choices because the NCB literature is silent or lies about those risks.
Let me make myself very clear, Ms. Gaskin, so you cannot twist or misinterpret what I mean. I disagree with almost everything you say because I think you are wrong. The scientific evidence does not support your claims, and your invocations of non-rational forces and energies is nothing more than quackery. (my emphasis)
Jill's take on the discussion:
Amy has more or less placed the OB philosophy in the science category and NCB philosophy in the mysticism (or non-rational) category. Scientism holds science as superior and therefore will always trump any non-empirical philosophical explanations for phenomena...
I agree wholeheartedly that NCB philosophy, at its purest and as I understand it, is biological essentialism. It ranks unmedicated, vaginal birth as superior to all other ways to become a mother.
Unfortunately, Jill goes on to confuse the impact of the mind on the body ("psychosomatic aspects") with anti-rationalism:
The source of contention seems to be whether or not there is a psychosomatic aspect to pregnancy and labor ... This is the classic debate between the Cartesian view of the patient (edit: the patient’s body) and what psychosomatic medicine refers to as the “body-mind.” It bleeds through into discussions about alternative medicine ... And if there’s anything on science blog ...that will drive scientists and doctors up the wall, it’s claiming that a treatment works based solely on a personal experience.
But the impact of the mind on the body is a concept firmly embedded in science. Non-rationalism is the idea that there are OTHER forces, like spiritual forces, that come from outside the body to impact the body. It also invokes the idea of special powers such as intuition that give certain people secret knowledge.
Jill concludes:
Within the framework that Amy is working, I'd have to say (as a layperson, so who cares, right?) that most non-biological (i.e. psychological) claims about birth are unscientific, as they are yet unproven. Neuroscience appears like it might someday bridge that gap, but as of yet, it hasn’t.
She goes on to say
As far as correctness and being right is concerned, a cultural relativist (like me) will hold that separate philosophies are equal and can both lay moral claim to rightness, with none being superior to the other.
And that is the quintessential anti-rationalist claim. All ways of looking at things are equal. Empiricism and rationality shouldn't be privileged. Women have other ways of knowing.
As I understand it, Jill is saying that it is her personal belief that vaginal birth is best even though that's not what the scientific evidence shows. She has every right to that personal opinion as do other NCB and homebirth advocates, but they need to realize what Jill has acknowledged: the scientific evidence does NOT support the claims of NCB or homebirth advocates.
You might think that such a doctor would be a pariah among patients, especially after a conviction, and the decision by the California Board of Medicine to place him on probation for 7 years, but you'd be wrong about this doctor. He is currently soliciting donations from patients and supporters for his latest legal woes ... and women are proudly giving money.
Recently, Dr. Fischbein petitioned the California Board of Medicine for early termination of his 7 year probation. You can read the 6 page opinion denying his request here. The board was unimpressed with Dr. Fischbein's request for a variety of reasons detailed in the report. However, most compelling to them was the fact that Dr. Fischbein has attempted to make a movie promoting "his side" of events, and portraying himself as a victim.
12. In the Fall of 2007, after Petitioner was placed on probation by the Board, he began working with a screenwriter friend on a ... a script entitled "Bedside Man." By this time. Petitioner had already completed the PACE Professional Boundaries program. The cover of the script states it is "based on a true story," and credits "Story by Stuart Fischbein." A promotional trailer was later made, in which Petitioner was also involved and credited... Although fictional names are used in the story, the script and trailer are obviously based on Petitioner's version of events. [They] tend to minimize Petitioner's culpability, make him look more like a victim and his victim less of one, and depict Petitioner as being persecuted for his views on some aspects of medicine.
13. In an effort to promote "Bedside Man" for financial investment to make a full length movie, the trailer was made accessible over the internet. One hospital where Petitioner was affiliated found out about it and contacted Petitioner's psychotherapist... From her letter detailing the events, it appears that [she] was readily able to see the impropriety of the project while Petitioner had not. She told him that the project "did not represent him as a man who had made a terrible error in judgment." [The psychotherapist] persuaded Petitioner that the project was an error and for the trailer to be removed from the internet. Petitioner has done so.
The Board did not terminate the probation, writing:
[He] views probation as punishment and an inconvenience... Although he no doubt has encountered difficulties practicing while on probation, he still tends to overstate those difficulties. He has openly chaffed at the requirement that he have a third party chaperone during interactions with female patients. It is clear that once off probation, the chaperone requirement would quickly disappear from his practice as the lessons learned from these events fade and the inconvenience grows...
The report concludes:
More alarming was Petitioner's participation in the movie script and trailer. This activity shows that Petitioner still harbors bad feelings about what happened to him, suggesting that he does not fully believe he engaged in misconduct... Such a state of mind does not bode well for the proposition of removing Petitioner completely from the Board's probationary oversight. In all, these events demonstrate sufficient concern over the course of Petitioner's rehabilitation as to indicate that continuing probation with all terms should continue in order to protect the public...
I don't hesitate to call out natural childbirth bloggers when they disseminate misinformation, so it is only fair that I compliment them when they go out on a limb to make brave pronouncements.
Not often, but occasionally I take a peek at one of those awful anti- natural childbirth websites. You know the ones I am talking about. They mock natural birth, non-vaccinating parents, Chiropractic, herbal remedies and all those who follow those types of lifestyle choices. They have a special place in their hearts for the unassisted birther or the woman who claims that childbirth was painless and wonderful. They particularly disdain midwifery, particularly the home birth variety...
But then comes the unexpected:
... [S]ometimes I find something that is kind of disturbing on their blogs. You are not going to appreciate me saying this, but sometimes they say things that are.....
True.
Mama Birth explains that there are two main claims that we make that ought to be heeded:
1. Homebirth midwives can behave in ways that are dangerous to babies and mothers
There are bad midwives... I mean midwives who trust birth and say all the right things and even think all the right things- but who are simply incompetent, dangerous, or unethical.
I have heard awful stories of midwives who can't start an IV when it is needed, who don't carry drugs for stopping hemorrhage, who can't properly suture and even who are unable to provide infant CPR... I have talked to midwives who ... inflate their abilities in order to get clients.
We must open our eyes to some of the problems within midwifery that make it possible for incompetent and even dangerous midwives to continue to practice. This can only be ignored at our peril. We must carefully choose our own midwives. If we are studying or training to be a midwife, we must do more than just trust birth. We must be able to recognize when it can't be trusted. (my emphasis)
2. Many claims of homebirth and NCB advocates are not supported by the scientific evidence.
... [S]ometimes I notice that some of the things stated, claimed, or quoted among natural types are not true, not substantiated, not based on evidence, or are misinterpreted.
For the natural birth community to be respected we must speak the truth. We must also back up what we say with some real evidence. It is out there, but just because it is on somebodies blog, doesn't mean it is true. (my emphasis)
I admire Mama Birth for having the courage to speak truth to power. The celebrities within the community and their acolytes wield power in that community and they do not hesitate to use it harshly to suppress dissent and to marginalize any midwife or homebirth advocate who does not follow the party line. It takes bravery to speak up for babies and mothers and risk condemnation by one's peers.
What might have precipitated Mama Birth's post? Only she can tell us, but I wonder if the publicity given to the recent homebirth deaths has been a factor. Many babies have died in the past few months, generally when midwives were violating the law, and usually because the midwives themselves were unsafe practitioners. Instead of investigating, though, the NCB and homebirth communities closed ranks behind the midwives without even bothering to determine if they were at fault, and without offering any support to the bereft parents.
I also wonder if this is one of the first glimmers of dawning realization in the NCB and homebirth communities. What might they be realizing? Finally, NCB and homebirth advocates may be recognizing that the public positions they have taken don't benefit mothers and babies. They benefit homebirth midwives AT THE EXPENSE of mothers and babies.
The reality is that no law can take away a mother's right to give birth at home, and no law can take away her right to be attended by whomever she chooses. Laws that regulate homebirth midwifery don't impact these rights, and therefore, they don't threaten the choices of mothers who wish to have a homebirth. However, they do impact the ability of homebirth midwives to get PAID for attending birth.
Even a cursory inspection of current and proposed laws about homebirth midwives reveals that every single legal effort is designed to increase the chance that a homebirth midwife will get paid, and to decrease the education and skills that she must have in order to qualify for payment.
A very simple example is the sad case of Margarita Sheikh and her baby Shazhad. Midwives in Oregon oppose mandatory licensure. But if mandatory licensure had been in place, it wouldn't have prevented Margarita from having a homebirth and it wouldn't have prevented Darby Partner and Laura Tanner, two unlicensed midwives, from attending her. What it would have prevented is Darby Partner and Laura Tanner CHARGING MONEY for attending Margarita's birth. And it certainly would have prevented Darby Partner and Laura Tanner from getting away scot-free after presiding over Shahzad's completely preventable homebirth death.
No doubt Mama Birth is going to take a lot of criticism for speaking out on behalf of mothers and babies. It's only fair that she also gets some praise for bravely doing so.
I'm 32 weeks pregnant and just found out yesterday that the hospital I wanted to birth at, thought that I WAS birthing at has rejected me "because I don't fit their birthing criteria".
This is a BIG deal for me. This is my fourth bub but my first hospital birthing experience. It has taken a long time for me to be "OK" with the idea that this baby won't be born at home, like my other 3 children...
Why is this mother considered high risk?
After an amazingly simple and straight-forward and glorious first birth, my second daughter "got stuck" (our belief as to why this happened differs from "the experts"... so, apparently, we have no clue and are wrong!! We believe it was the distracted (sic) labour, they believe it was my daughter's size) and needed some resusitation (sic) when she was born.
That's not the only problem:
After a very "political" and battle-weary third pregnancy (trying to achieve the kind of birth I knew I needed), something (nobody knows exactly what) went wrong right at the end of the labour and our little boy was born unresponsive and died 2 days later in hospital.
But the birth of the dead baby did have a bright side:
NB. Bub was BIGGER than his sister and DIDN'T get stuck!
Phew! At least she got the birth that SHE needed, even though the baby didn't get the oxygen he needed.
Just because one of her babies died and the other nearly died at homebirths, the mother can't understand why doctors are concerned:
Now I know there will be those of you out there going "well, I'd say they have good cause to be concerned by your birthing history". My point is, WE aren't!! We don't look at what has happened and automatically go "oh no! That is going to happen again! Oh no! Oh no! Oh no!"
... If WE aren't "frightened.... why do THEY need to be?? Why can't we all assume everything is going to go fine and IF something does go pear-shaped, let's deal with it then. WHY DOES THERE HAVE TO BE SO MUCH FEAR AROUND CHILDBIRTH??
Why can't we all assume everything is going to go fine and if something does go wrong, we can deal with it then?
Let's see. I'm wracking my brain and scratching my head at this question.
Not because I don't know the answer. The answer is painfully, glaringly obvious:
YOU DID THAT THE LAST TWO TIMES AND IT DIDN'T WORK OUT TOO WELL, DID IT?
I'm wracking my brain and scratching my head at the question because it is difficult for me to fathom that after burying a baby, a woman could still be more concerned about HER birth experience than preventing the death of her next baby.
Why does there have to be so much fear around childbirth? If this mother can't understand, I can't possibly explain it to her. But I do have one question for her:
How stupid and self absorbed do you have to be to ask these questions after your baby died?
Oh, dear. Homebirth and midwifery advocates appeared to be having great success with their campaign to discredit obstetrics as "not based on scientific evidence." But then it turned out that obstetrics IS evidence based.
Time for a change in tactics: Obstetrics shouldn't be based on something as cold and impersonal as ... scientific evidence!
I've written many times about popular smear strategy of accusing modern obstetrics of ignoring scientific evidence. The celebrity natural childbirth advocate Henci Goer has stake her entire professional life on the smear. As recently as this week, a major homebirth organization distributed a (hypocritical and mendacious) press release accusing obstetricians of having evidence that was less than perfect to support some of their recommendations (no other kind being available currently).
Dr. Kierse is publicly known for his relentless support of breech vaginal delivery. Now he dolefully acknowledges that the existing scientific evidence, of the highest quality, shows that C-sections are safer. And Dr. Kierse makes it clear that breech homebirth is NOT a safe alternative:
Home birth is a well-established recipe for disaster for a baby in breech presentation and contrary to any sensible guidelines that have ever been developed. (my emphasis)
Given that the scientific evidence supports C-section for breech, patients face two choices, C-section or unsafe homebirth. Dr. Kierse is eager to place "blame" for this outcome.
Clearly, the blame must rest fairly and squarely with what was heralded as a new paradigm, "evidence based medicine" ... [which] means a new scientific order in which there is no place anymore for the concepts of old. In the new evidence-based paradigm anything randomized became the gospel and anything else became either low evidence or lack of evidence. (my emphasis)
In fact:
Obstetrics, perhaps even more than any other discipline, fell victim to this new paradigm determined as it was to get rid of the slur that had hounded the specialty before.
And just who was responsible for the slur? Why none other than midwifery and homebirth advocates. Oh, the irony!
Dr. Kierse acknowledges that the recommendation of C-section for breech is based on rigorously, obtained high quality scientific evidence.
A fundamental issue is that probably no study with selection and management criteria such as those applied in the term breech trial would have seen the light of day in a prestigious journal if it had not been randomized.
Kierse then peevishly dismisses the value of rigorously obtained, high quality scientific evidence:
Of course, nothing is wrong with advocating or promoting randomized trials. There is a great deal wrong, though, with the perception that evidence, to be evidence, needs to be randomized evidence. There is also a great deal wrong with the belief that only evidence is an e-word that deserves to be written with a capital "E," whereas other e-words, such as education, experience, expertise, and even excellence, are merely ignominious. (my emphasis)
So after years of insisting that the recommendation for breech delivery by C-section was not based on scientific evidence, Kierse now claims that, oops, scientific evidence isn't really that important anyway.
Just in case you didn't pick up on the claim that scientific evidence isn't really that important after all, Dr. Kierse hammers it home with his clunky title. Those mean, heartless obstetricians are making recommendations based on cold scientific evidence and thereby "freezing" out warm, loving recommendations for a vaginal birth that could kill your baby.
Time to edit the midwifery and homebirth battle cry:
Don't listen to obstetricians, because their recommendations aren't are based on ^cold, impersonalscientific evidence!
Imagine this scenario: A woman, after reviewing the evidence from both sides, after carefully considering the increased risks, and after deciding that she is willing to accept the responsibility for the outcome, decides to ... smoke cigarettes.
This situation happens all the time. Indeed, a substantial portion of the population smokes cigarettes. In 2011, everyone knows that cigarette smoking increases the risk of lung cancer, emphysema and other diseases. However, most smokers will accurately point out that not everyone who smokes gets a smoking related illness, that smoking provides both pleasure and concrete benefits such as relaxation and increased concentration, and that adults are entitled to make their own healthcare choices. In addition, there are scientists who assert, and who have testified under oath, that the harms from smoking have been dramatically exaggerated.
So if a woman claims to have made a knowledgeable decision to smoke cigarettes, and is aware of the potential consequences, does that mean that she is "taking responsibility" for her health?
In one very real sense, it does, since she is the one who will suffer if any harmful effects ultimately occur. She is the one who will gasp for breath with emphysema, she is the one who will endure treatment for cancer and who may die a painful death from it. However, it most other ways, she has no intention of "taking responsibility" for her health.
First, most women who elect to smoke cigarettes have some measure of denial about what is can happen. They tend to grossly underestimate the risks of getting a serious illness; they tend to be unaware of a variety of less common illnesses caused by smoking (bladder cancer, peripheral vascular disease); and they tend to drmatically underestimate the impact that emphysema, lung cancer and other diseases will have on their life as a whole. So while they may be technically "educated" about the risks, they are not acting with a clear eyed assessment of those risks.
Second, smokers have no intention of managing any complications alone. If they get emphysema or cancer, they will expect and demand state of the art treatment for those diseases. They caused their own disease, but they will expect and demand that others do everything possible to cure or at least ameliorate it. Moreover, they have absolutely no intention of paying for their decision. They bought insurance for just this eventuality. As far as they are concerned, other, healthier people can pay for their illness with higher premiums overall.
In a very real sense, they don't plan on taking ANY responsibility for their health. They plan on other people doing all the work, and paying most of the money to rescue them if their choices were wrong. The bottom line is that women who "take responsibility" for smoking are generally in denial, grossly underestimate the risks of serious harm, have no intention of fixing their own medical problems, and have no intention of paying the bulk of the cost from those problems.
Homebirth is very similar. Most homebirth advocates have no clue as to the real risks of homebirth. Second, most homebirth advocates are in denial about the fact that serious complications can occur in low risk women. Third, homebirth advocates expect, demand (and sue) for state of the art medical care to rescue their babies and themselves from their own choices. Fourth, homebirth advocates have absolutely no intention to pay the bulk of the costs that may result for their poor choices, ranging from a long term stay in the NICU to life long special needs assistance for an impaired child.
In other words, all the talk about homebirth advocates "taking responsibility" for birth is just talk. In the ways that count, homebirth advocates expect everyone else to do all the work, take all the responsibility and shoulder the bulk of the expense for their choices. Homebirth advocates intend to take precisely the same responsibility for their health that smokers intend to take, in other words, no responsibility at all.
A version of this piece appeared on Homebirth Debate in March 2008.
One thing you have to say for homebirth midwives. They have chutzpah. They are grossly undereducated, grossly undertrained, and ineligible for licensure in any first world country, but when it comes to hypocrisy and mendacity, they are second to none.
Consider the following press release sent out to news outlets by The Big Push for Midwives, a national campaign to license homebirth midwives so they can collect insurance reimbursement.
Here's the first paragraph:
A study published this month in Obstetrics & Gynecology, the journal of the American College of Obstetricians and Gynecologists, found that barely one-third of the organization’s clinical guidelines for OB/GYN practice meet the Level A standard of "good and consistent scientific evidence." The authors of the study found instead that the majority of ACOG recommendations for patient care rank at Levels B and C, based on research that relies on "limited or inconsistent evidence" and on "expert opinion," both of which are known to be inadequate predictors of safety or efficacy.
That sounds bad (and it is meant to) until you understand that the rating system for clinical guidelines: A (good and consistent evidence), B (limited or inconsistent evidence), or C (consensus and opinion). In other words, there IS scientific evidence for ACOG recommendations, but not all of it is of the same quality.
What's hypocritical and mendacious about the press release from The Big Push for Midwives?
When it comes to the practices exclusive to homebirth midwifery, 0% meet Level A guidelines!
... and 0% meetLevel B guidelines; and even 0% meet the lowest level, Level C guidelines. That's because there is NO evidence of any kind to support the practices exclusive to homebirth midwifery.
Homebirth in the US- no evidence of efficacy or safety
Refusing postdates induction- no evidence of efficacy or safety
The Brewer diet- no evidence of efficacy or safety
Home VBAC- no evidence of efficacy or safety
Herbs - no evidence of efficacy or safety
Chiropractic in pregnancy - no evidence of efficacy or safety
I could go on and on, but you get the idea. It is both hypocritical and mendacious to send out a press release accusing ACOG of having less than perfect evidence when homebirth midwifery has no evidence at all.
The ultimate irony? The Level of Evidence for the actual paper that The Big Push is quoting, Level III, is the lowest possible level!
Two weeks ago I wrote about yet another needless, senseless, utterly predictable, totally preventable homebirth death in Oregon. Now the mother has come forward to tell her story.
According to Margarita Sheihk:
I didn't know that I was in danger...
I didn't go into this thinking, 'Oh, there's going to be a chance that my son's going to die.
But baby Shahzad did die, during labor, with unlicensed midwives Darby Partner and Laura Tanner in attendance and completely unaware of it.
Now Sheikh says she wants to fight for licensing requirements.
I don't want the baby's death to be for nothing ... I'm just looking to have things changed here in Oregon so that it doesn't happen again.
Who's leading the opposition to licensing midwives? You'll never guess ... Melissa Cheyney, the very person responsible for overseeing the licensing of midwives! That's right, the individual who chairs the Oregon Board of Direct Entry Midwives, which oversees licensing homebirth midwives, is publicly on record as opposing licensing homebirth midwives.
Why would anyone oppose the licensing of homebirth midwives?
According to Cheyney:
There are many, many issues involved with mandatory licensure and barriers to training, issues of paying the high cost of a license, and just the general concern that making something that was formerly legal illegal doesn't necessarily make it safer
That incomprehensible response hides the real reason that Melissa Cheyney opposes the licensing of homebirth midwives. The real reason is to avoid the four pillars of responsibility ensured by professional licensing.
Educational requirements
Practice standards
Reporting requirements
Accountability
American homebirth midwives are not really midwives. They do not meet the educational and training standards for American nurse midwives, and they do not meet the educational and training standards for midwives in the United Kingdom, the Netherlands, Canada or Australia. In fact, they do not meet the educational and training standards for midwives in ANY first world country.
American homebirth midwives are women who couldn't be bothered to obtain the college education and training required by midwives in EVERY other industrialized country, but they want to call themselves midwives anyway. So that's what they did and the state of Oregon has obliged them.
Licensing would very quickly put an end to this game of make believe, by mandating that homebirth midwives meet the very standards that have already decided they cannot or will not meet.
Educational requirements
American nurse midwives are required to hold a master's level degree in midwifery. A European, Canadian or Australian midwife is required to hold a university degree in midwifery. A homebirth midwife in Oregon has NO educational requirements at all. You might be a 4th grade drop out, but by the laws of Oregon, you are legally entitled to call yourself a midwife.
Practice standards
ALL healthcare providers in first world countries are held to practice standards. That's how we ensure consumers a minimal level of safe practice. Every practitioner must adhere to these agreed upon standards, based on scientific evidence, and consistent with the education and skill levels of specific types of providers.
Oregon homebirth midwives don't want to adhere to practice standards. That would certainly restrict them from doing whatever they want to do regardless of their skill level and regardless of the risk status of the patient. They don't want to adhere to consumer protections, because that would constrain midwives' actions.
Reporting requirements
Licensed health providers of any kind are subject to a variety of reporting requirements that allow state and national officials to review outcomes and identify unsafe practitioners. In other words, reporting requirements are just another form of consumer protection.
Homebirth midwives have a very serious problem, though. Too many babies die preventable deaths in their care. Instead of discussing, analyzing and taking responsibility for these deaths (like all other healthcare providers), homebirth midwives prefer to bury them ... both figuratively and literally.
Accountability
If you are merely pretending to be a midwife, the last thing you want is to be held accountable in the way that real midwives are held accountable. That's the best part of pretending; there are no consequences. Oh, there are consequences for the patients and their babies: babies die preventable deaths, mothers risk their health and lives. But there are no consequences for homebirth midwives. It's such a drag to take responsibility for your actions, so they don't, and the state of Oregon abets them in their desire to shed any and all responsibility.
Licensing requirements are consumer protections, no more and no less. Of course Oregon homebirth midwives oppose licensing requirements. When you think that all you need to do to be a midwife is to call yourself a midwife, licensing requirements could really harsh your mellow. Education, standards and accountability? That's for everyone else.
Regular readers are aware that I repeatedly point out that most of what natural childbirth and homebirth advocates think they "know" is factually false. Moreover, the claim of being "educated" about childbirth is the surest sign of ignorance since most of the "education" comes from the websites and books of lay people or other NCB advocates who have no idea what they are talking about.
For example, Babble, itself one of the leading sponsors of a pregnancy blog riddled with errors and lies (Being Pregnant), has created its Top 50 Pregnancy Blogs. The list features some of the most egregious purveyors of mistruths, half truths and outright lies in the pregnancy blogosphere, and that's quite an achievement because the pregnancy blogosphere is a virtual carnival of lay people spouting mistruths, half truths and outright lies.
I'd like to point out the 10 worst offenders from the Babble list. It was not an easy decision because it often seems like there is an ongoing competition among pregnancy bloggers to offer the most dangerous misinformation.
The 10 worst blogs vary, but they have some common themes. Most are written by lay people who have no education in science, statistics or obstetrics and have literally no idea what they are talking about. The remainder are maintained by childbirth "educators" most of whom also have no education in science, statistics or obstetrics and, amazingly, also have literally no idea what they are talking about. The blogs include outright lies, dangerous "advice" and, in may cases, sheer stupidity.
Without further ado, my list of the 10 Worst Pregnancy Blogs.
My OB Said What?
The website "My OB said WHAT?" is supposed to highlight "stupid" things said by obstetricians. It is a slick, professionally designed smear campaign, clearly requiring a fair amount of money to create and maintain. Yet the owners feel that they have something to hide --- their own identities.
Apparently they are hiding their identities because they don't want it known that a nationally prominent childbirth educator is behind "My OB Said What?" Teri Shilling, former president of Lamaze International.
At least the site makes no pretense of being scientific, evidence based or remotely true.
Science and Sensibility
Science and Sensibility, the blog of Lamaze International, does make a pretense of being scientific and evidence based, hence the name. Unfortunately, it is filled with the mistruths, half truths and outright lies that are the hallmark of NCB advocates. That's not surprising from an organization that promotes 6 "Healthy Birth Practices," the majority of which are not supported by scientific evidence.
S&S was previously edited by Amy Romano, CNM. She repeatedly presented her opinions as scientific facts, and routinely misrepresented the scientific literature. S&S is also the home of Henci Goer, who has staked her professional life on the bizarre claim that obstetricians ignore the scientific literature that they create and that only NCB advocates assiduously scour the literature and change their recommendations based on research.
Romano left S&S to join another NCB advocacy organization, and Lamaze was evidently forced to scrape the bottom of the barrel to come up with a new editor, Kimmelin Hull who is even more incompetent and less knowledgeable, and also censors physician comments.
Being Pregnant
What more can you say about a blog that includes a vaccine rejectionist blogger who fantasizes about the death of one of her children?
It is long past time for Babble to assign a technical editor (a doctor) to vet bloggers' material for factual accuracy. It is wrong to allow women who are have no medical (or even midwifery) qualifications to make unchecked factual claims about pregnancy and childbirth. Babble must accept responsibility for ensuring that its readers are receiving scientifically accurate information about pregnancy and childbirth.
The Unnecesarean
I like Jill Arnold. She seems like a smart woman whose heart is in the right place. The empirical data she provides on C-section rates is accurate and valuable. The opinion pieces? Not so much.
ICAN
Help! Help! C-section is the work of the devil! Or of doctors who want to get to their golf game! That pretty much sums up ICAN.
Poor them. They had C-sections and all they got were healthy babies.
Scour the site and you'll be hard pressed to find any facts about the dangers of breech or VBAC or the number of babies (and mothers!) saved each year by C-sections.
The Feminist Breeder
It's pathetic narcissism to live blog your homebirth, but it doesn't harm anyone. But advising women with group B strep to wash their vagina out with soap instead of using prophylactic antibiotics kills babies, and chiropractic for colic despite no scientific evidence of benefit and multiple deaths in the wake of pediatric chiropractic is glaring evidence that the Feminist Breeder offers patently ludicrous and inaccurate information.
Giving Birth With Confidence
Another Lamaze International Blog, long on opinion, and very, very, very short on scientific evidence.
Erin Ellis Homebirth Midwife
Hmmm, who is more ignorant, Erin Ellis Homebirth Midwife or Danielle Elwood of Momotics? It's a tough call, but I'm going with Erin Ellis because she represents herself as a midwife, while Danielle spreads her misinformation under the guise of "childbirth educator."
Erin's disquisition on obstetric hemorrhage is a textbook example of what passes for "knowledge" among homebirth midwives and their terrible propensity to make stuff up instead of actually learning something. It would be funny if it weren't so deadly.
Momotics
Danielle Elwood is an example of why childbirth "educators" are dangerous. She is soon to be]Lamaze certified, and trained as a doula with the organization run by Terri Shilling of "My OB Said What." She censors comments on her personal blog, but can't do the same on Babble, where I and others have repeatedly pointed out her egregious factual errors.
I am flattered though to find out that I am a huge figure.
... Danielle's post on the rise of pregnancy-related deaths spurred a heated debate in the comments between Ina May Gaskin and Dr. Amy Tuteur themselves, two huge figures in the birthing community.
Stand and Deliver
What more can you say about a woman proudly who posts a video demonstrating how she nearly killed her own baby at an unassisted homebirth?
The video includes the immediate aftermath of the birth when baby Inga became profoundly blue and lost all muscle tone due to lack of oxygen. Ultimately Rixa was forced to provide mouth to mouth resuscitation and fortunately, the baby responded. When I first watched it, I was so angry I was shaking, but then I realized that Rixa Freeze has done obstetricians a wonderful favor. She has inadvertently produced the ideal teaching video for demonstrating how and why babies die in increased numbers at homebirth.
*****
You've got to admit it's a pretty impressive group of 10, although not for the right reasons. With the exception of a few certified nurse midwives on the Lamaze blogs, not a single one of the authors of these pregnancy blogs has ANY formal training in science, statistics or pregnancy and childbirth. That would be fine if they restricted themselves to presenting their personal experiences, but they are offering completely erroneous "information" unsubstantiated by scientific evidence or even directly contradicted by scientific evidence.
It's also a very incestuous group. Many of them "trained" with each other, or were certified by each others' programs. No wonder it's an echo chamber. There's nothing inherently wrong with an echo chamber, of course, unless what they are echoing is mistuths, half truths and outright lies.
Edited 8/14: Danielle Elwood is not yet Lamaze certified, but describes herself as soon to be Lamaze certified.
The Oregon Midwifery Council (OMC) is the most important midwife organization in the state. It pays for our lobbyist who fights to maintain midwifery the way we hope it will be. This includes things like ensuring we are autonomous practitioners, maintaining our right to attend VBAC, twins, breeches, post-dates and so many other types of births. The OMC is glad to receive donations to help pay for the lobbyist and further the cause of midwifery in this state. --- Alma Midwifery, Portland Oregon
The righteous anger in the wake of the most recent senseless, totally preventable homebirth death in Oregon seems like the only fitting response to the tragedy. That a couple of "birth junkies" exercised their legal right to call themselves "midwives" in the absence of even the most basic education and training and let a baby die is a scandal.
But don't make the mistake of thinking that because Oregon's homebirth [direct entry] midwives are so grossly unqualified, uneducated and unprofessional, they are equally ignorant of politics. Nothing could be further from the truth. And those who ache to protect innocent babies from the lethal incompetence of these women need to become equally politically astute.
Consider what you are up against in Oregon. The current situation is a result of a concerted, ongoing effort by state and national homebirth midwifery organizations to allow any "birth junkie" to call herself a midwife, to make consumer protection laws toothless, and to allow "midwives" to collect insurance reimbursement. Although their informal motto is to enable choice for "women," their real aim is to enable enrichment of uneducated, untrained women who wouldn't qualify for midwifery licensure in ANY other country in the industrialized world.
I recently reviewed the Oregon statutes governing direct entry midwifery. The Oregon Board of Direct Entry Midwifery, charged with licensing and regulating midwives doesn't even require a midwife to be licensed. The statutes governing the regulation of homebirth midwifery are designed to protect midwives from consumers. The qualifications for licensing are minimal, the disciplinary penalties for licensed midwives are vague and limited and there are no provisions for regulating unlicensed midwives.
How did this happen? Part of the problem is that homebirth midwifery is a fringe practice and doesn't draw much attention from lawmakers. To the extent that the Oregon legislature is subject to pressure from consumers on this issue, it is only proponents who call, write letters and attend public hearings. From the point of view of the average Oregon lawmaker, promoting the goals of homebirth advocates is all upside. Homebirth advocates will be happy, and no one else will care.
But the real reason is hidden. State and national homebirth midwifery organizations hire professional lobbyists and, since lobbyists don't come cheap, they raise money to do so.
A Facebook group supporting the Oregon Midwifery Council makes this clear:
Contribute to the OMC. We desperately need money to pay our lobbyist and to cover other expenses. Join OMC, and donate an extra amount. You can mail a check directly ... Or use Paypal from our website ...
The Oregon Midwifery Council is not alone, many state and national homebirth organizations have professional lobbyists. Take, for example, the MAMA Campaign, a collaborative effort by the National Association of Certified Professional Midwives (NACPM), Midwives Alliance of North America (MANA), Citizens for Midwifery (CfM), International Center for Traditional Childbearing (ICTC), North American Registry of Midwives (NARM), and the Midwifery Education Accreditation Council (MEAC). They employ Billy Wynne, former Health Policy Counsel of the Senate Finance Committee. His other clients include major corporations like Abbott Labs.
The services of such a lobbyist do not come cheap, costing tens of thousands or even hundreds of thousands of dollars. What has their money bought?
On Friday, November 13th, MAMA representatives met with a top health aide to Senator Maria Cantwell from Washington State. In direct response to MAMA advocacy, Senator Cantwell has included a provision in the Senate Finance Committee bill that will require Medicaid to reimburse licensed birth attendants (which would include state-licensed CPMs) who provide services in licensed birth centers. We were told that the Senator feels strongly about including CPMs in the health care bill ... The Senator has heard the call from MAMA loud and clear and committed to finding a way to move the ball forward for CPMs...
As a key member of the Senate Finance Committee, Senator Cantwell has a limited number of initiatives that she can champion herself, but she has offered to fully support any other Senator who will file MAMA’s original provision on the floor of the Senate to require that Medicaid reimburse all CPMs in all settings.
The take home message is that toothless homebirth statutes and virtually non-existent consumer protections do not happen magically. They required a coordinated campaign involving letter writing, attendance at public hearings, and, above all, professional lobbyists.
The single most effective thing that those mourning the unnecessary homebirth deaths in Oregon could do is to raise money and hire a lobbyist to take the stories of these innocent, unprotected, and ultimately dead babies directly to the only people who could put an end to these tragedies, the legislature of Oregon. In the meantime, write to your legislators, attend public hearings, contact local media and encourage your friends to do the same.
Don't let these deaths go unnoticed, unchallenged and unpunished.
Dr. Amy Tuteur is an obstetrician gynecologist. She received her undergraduate degree from Harvard College in 1979 and her medical degree from Boston University School of Medicine in 1984. Dr. Tuteur is a former clinical instructor at Harvard Medical School. 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 can be reached at DrAmy5 at aol dot com.
