The stunning mixture of ignorance and illogic that fuels homebirth midwifery

I've written extensively about the ignorance of American homebirth midwives (certified professional midwives or CPMs). It's not surprising when you consider the pathetic nature of CPM training. Most CPMs have NO midwifery education of any kind. You can receive a "certification" after a program of unmonitored self-study.

It's hardly surprising therefore that death rates at the hands of homebirth midwives are appalling. The latest data from the CDC (available on the CDC) Wonder website shows that homebirth with a non-nurse midwife has a neonatal mortality rate more than 7 times HIGHER than low risk hospital birth.

Licensed homebirth midwives in Colorado have a perinatal mortality rate that is appallingly high and has risen in every year since 2006 when licensing was enacted. The midwives have actually refused to release their death rate for 2010.

In Oregon, there have been at least 19 newborn deaths reported to the state over the past decade for a death rate more than 4 times higher than low risk hospital birth.

The Midwives Alliance of North America (MANA), the organization that represents homebirth midwives, has a database of 24,000 planned homebirths. They refuse to release the death rate. Even MANA knows that homebirth kills babies. They just don't want American women to find out.

But evidently that's not enough. In addition to presiding over the preventable deaths of low risk mothers, they'd like to try their hands at increasing the rate of preventable deaths of high risk mothers.

Consider this idiotic press release published by the Big Push for Midwives, the professional lobbying group trying to obtain state recognition (and therefore insurance reimbursement) for CPMs:

A report released by the CDC today found a 29 percent increase in home births from 2004 to 2009. The rate of home births among non-Hispanic white women underwent a dramatic increase, while the rate for women of color decreased or remained stagnant, a trend that reflects racial and ethnic disparities in other areas of maternity care throughout the U.S.

“Unfortunately, the women who could most benefit from out-of-hospital midwifery care are those who are least likely to have access to Certified Professional Midwives with the specialized training needed to provide it,” said Susan Jenkins, Legal Counsel for The Big Push for Midwives Campaign. “The CDC report and other research shows that babies born to women cared for by Certified Professional Midwives are far less likely to be preterm or low birth weight, two of the primary contributing factors not only to infant mortality, but to racial and ethnic disparities in birth outcomes.”

Just two short paragraphs, but a mountain of ignorance and illogic.

Jenkins boasts that babies born to women cared for by CPMs "are far less likely" to be premature or growth retarded. As my children would say: "Duh!"

CPMs, the so called "experts in normal birth" don't take care of high risk women and both prematurity and growth retardation are high risk. No doubt the women cared for by CPMs are "far less likely" to have congenital heart disease, kidney failure or cancer, so perhaps CPMs would like to take credit for preventing those conditions, too. After all, if you are not constrained by logic or common sense, the sky's the limit.

The concept that high risk women are "most likely to benefit" from CPM care is really breathtaking in its stupidity. Even the most cursory examination of neonatal and maternal death rates shows that these deaths are due to a LACK of technological interventions, nor a surfeit.

Let's take a look at the leading causes of neonatal death. The following chart is 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:



Do CPMs know how to lower the incidence of congenital anomalies? No. Perhaps they know how to prevent pre-eclampsia, gestational diabetes or HELLP syndrome. No, they have no specialized knowledge in that area. Can they prevent abruption, vasa previa, or true knots in the umbilical cord? No, no and no. How about bacterial sepsis of the newborn? Hardly. The leading cause of infectious neonatal death is group B strep and many CPMs don't treat it or employ bizarre "remedies" like garlic cloves in the vagina.

I can't find a single thing on this list that CPMs, those self-proclaimed "experts in normal birth," are educated or trained to prevent, manage or cure.

What about maternal mortality? Last week we looked at the leading causes of maternal ICU admissions.:

... The leading admission diagnosis for pregnant and postpartum women was maternal cardiac disease (36%). Maternal hemorrhage (both obstetric and nonobstetric) was the second leading reason for admission (29%). Hypertensive disease accounted for 9% of ICU admissions...

The majority of cardiac conditions prompting ICU admission resulted from cardiomyopathy. Acute complications associated with peripartum cardiomyopathy
comprised the majority of this group. Congenital heart disease is the underlying etiology for many of these valvular lesions and cardiomyopathies. Congenitally
acquired conditions were the second leading cause of maternal cardiac ICU admissions...

CPMs can't prevent or treat peripartum cardiomyopathy, massive maternal hemorrhage or hypertensive disease. In fact, care by a CPM at home is more likely to increase death from these causes, not decrease it.

I can't decide whether Jenkin's inane boast is the result of ignorance or mendacity. Can she and the homebirth advocates of the Big Push for Midwives truly be so ignorant as to think they can take credit for preventing complications simply by caring for only uncomplicated patients? Or is this yet another bold faced lie told in attempt to increase CPM reimbursement, neonatal and maternal well-being be damned?

I guess the real reason doesn't matter. In either case, CPMs have demonstrated once again that they lack the basic education (and reasoning ability) to be entrusted with the lives of pregnant women and their babies.