Third 2012 homebirth death in North Carolina

North Carolina is on track to meet or exceed the horrifying toll of 5 known deaths last year.

The first occurred in May. The second occurred in Wilmington in late May/early June. It was the result of a shoulder dystocia at an attempted HBAC (homebirth after cearean). Now comes word of a third death.

The baby boy* died on July 23, 2012. His death was reported to me by a grieving family member:

[My daughter’s] water broke in the early morning hours of Thursday July 19th…

Her doula was Rowan Bailey- a student and follower of The Matrona and Whapio Diane Bartlett, in Asheville NC

Rowan Bailey claims a holistic, non-interference approach, and she lived up to that reputation. She became annoyed at phone calls and doubts from family and the father.

After 4 days of labor, she finally admitted she did not know how to “get the baby out” at home.

At the hospital they could not find the baby’s heartbeat. The stillborn baby was born that afternoon.

Who is Rowan Bailey? According to her website:

MY PHILOSOPHY~ I believe you are inherently and intuitively aware of your requirements for yourself and your baby. You are your own creator of your dreams fulfilled. I also believe that pregnancy and birth are amazingly transformative experiences to be enjoyed with love and enthusiasm. I honor your journey as sacred and fully yours. As your consultant it is my responsibility to remind you of your power and knowledge to make your own informed choices with clarity of intellect and spirit. We will work together to co-create a nurturing environment for the entire family.

My Work: I am doing global work for peace and non-violence through my commitment to education in conscious birth choices. I co-create with families the space for powerful and transformative experiences in the child bearing year.

Her “training”?

I completed the Holistic Doula Training at The Matrona with teacher and mentor Whapio Diane Bartlett in 2003. I continued to study birth with Whapio and many others through workshops and conferences learning numerous methods and healing modalities such as Homeopathy, Herbs, Conflict Resolution, Reiki, Water Birth and Acupressure to mention but a few. I then went on to graduate from the Midwifery Immersion program at The Matrona in April of 2006. I carefully choose conferences and workshops each year to fulfill my commitment to myself and my community for continuing education. I am currently (2011 & 2012) attending Midwifery SkillsLabs and the Trust Birth Conference 2012 with Ancient Art Midwifery Institute.

Training: I was blessed to assist Claudie Cameron, DEM, for four years. During my extensive training with Claudie, I have attended the home birth of twins, breech presentation, VictoriousBAC, women who birthed premature and post-dates babies, as well as many other variations of normal. I also witnessed shoulder dystocia, hemorrhage and families experiencing grief and loss…

No doubt, she’s witnessed grief and loss. That happens all too often at homebirth in North Carolina.

And her mentor, Whapio Diane Bartlett? Apparently, she is an advocate of quantum midwifery, undisturbed birth, and placenta medicine. Her philosophy?

We feel that trusting women, nurturing women, and meeting women and their families where they at are the tools that allow us to create soul-level connections with each other. When mother and care-give experience deep soul-level connections it is not necessary to disturb the birthing process.

We believe that the study of biology without mysticism is flat. We understand childbirth to be an altered state of reality and we prepare midwives to engage those realms and to facilitate families in receiving gifts that those worlds have to offer.

Who thinks up this idiocy?

Who believes it?

Why would anyone hire such obviously ignorant clowns to preside over a life and death event like the birth of a baby?

When are we going to fine these women out of existence and jail the ones who preside over preventable neonatal deaths?

*I have removed the baby’s name as per the request of the family member who reported the death to me.
  • Rochelle Alberti

    Oh…and as this very well put article puts it:

    “First off, how should we interpret a “tripling of death rates”? This is what statisticians call a relative risk, and it is widely known to be problematic for decision-making. As a simple example,[4]
    would you buy a pair of slippers if I told you that they were 90% off?
    Well, no, you would want to know how much they cost. It is the same with
    risk; it is the absolute amount that matters. The classic example is
    the contraceptive pill and breast cancer. One estimate is that the pill
    raises the risk for early breast cancer by 50%. This sounds pretty scary
    until you realize that most women’s risk is so low that this translates
    to about 1 woman with breast cancer for every 10,000 on the pill. Most
    women would feel that is a risk worth taking, given the benefits of the
    pill and the possible harms of the alternative: pregnancy, which after
    all, has dangers of its own….”

    “On the basis of the results tables, it is possible to calculate that
    this turns out to be 1 neonatal death per 1000 women who choose home
    birth.”

    And of course…

    “However, the results tables show that those women would also experience
    some benefits, including 40 fewer premature labors, 45 fewer cesarean
    sections, 140 fewer vaginal lacerations, and 140 fewer epidurals. This
    type of cost-benefit analysis — trading off neonatal mortality against
    maternal morbidity — can seem sort of cold-blooded.”

    So, if, as Dr. Amy states, “homebirth kills babies…” then we can, actually assume “hospital births kills mothers….” but that would be equally untrue…because, while the maternal death rate in the US for hospital births is approximately 12 per 100,000…it really only relates to less than 600 women per year dying (usually because of c-section infection).

    And I know…because I dare to think differently and not just bow down to the “OH MY GOSH…we’re all going to die” mentality when it comes to having babies, etc…I am a flake.

    You all are welcome to think so….I actually really don’t care.

    • Karen in SC

      Just as many predicted, the NCB crowd was going to switch from “homebirth is safer” to “relative risk is low”. Please note that the increase from .5 to 1.5 deaths per thousand is for low risk births. Other homebirth situations have higher risk, for example, I think the risk of rupture with a HBAC is 1%.

      Who wants to be the one? One of Lisa Barrett’s loss mothers testified at the inquest that she didn’t think her baby would be the “one.” Tragically, she was wrong, and these three mothers back in 2012 surely thought the same.

      • Rochelle Alberti

        Well…there is that..and the fact that if you birth in the hospital you are much more likely to die yourself..there is a higher risk to the mother to die in hospital than there is to a baby to die at home….

        I am sure the family in TX that had their baby’s head crushed by their OB during birth feel the same way.

        • Guestll

          Rochelle. Do you understand the concepts of high risk pregnancy and pre-existing conditions? If homebirth as it it practiced in my country (Canada) is restricted (as it is theoretically supposed to be) to LOW RISK WOMEN then of course the rate at which women die in hospitals is going to be higher.
          No one here is saying that hospitals are perfect or that OBs don’t make mistakes.
          Seriously, critical thinking! Look into it.

          • Rochelle Alberti

            I suggest you do the same.

        • Captain Obvious

          And that doctor will have a root cause analysis performed of the sentinel event and he probably will have to at least have a consult with another physician before he performs another forceps attempt. And at worst lose his license. Check out “Sisters in Chains” Facebook page and read about all the Homebirth midwives who had bad outcomes, and because of no accountibility or malpractice coverage, the families received no money and the midwife is still practicing.

          • Squillo

            Yes. This.

            There is a great deal of oversight and review of medical practice, starting with peer review and M & M conferences (not to mention med-mal carriers), to professional orgs that issue practice guidelines, up to enormous government organizations dedicated to improving safety in medicine.

            And STILL there are egregious errors and lapses in among individual providers and in hospitals–because some people are bad and negligent, and all are human and prone to errors of judgement.

            What do folks think happens when there is almost no peer oversight, when professional organizations have no apparent interest in improving practice or safety, and there is little to no governmental oversight?

        • moto_librarian

          Really? I’d like you to prove that to me, because had I not delivered in a hospital, I would have died. And before you start yammering about interventions, let me tell you this: I had NO interventions aside from intermittent EFM. I arrived at the hospital dilated to 9 cm., pushed in every position imaginable, was allowed to drink during labor, etc. My son was born after 1.5 hours of pushing, and as soon as the placenta was delivered (spontaneously), I began to hemorrhage. Turns out that my son had managed to tear my cervix on the way out. The only thing that would stop the bleeding was prompt surgical repair, which I received, along with pitocin, cytotec, manual examination of my uterus, and vigorous uterine massage. Oh, and all of that without the benefit of pain medication, since I didn’t even have a heplock. Tell me how I would have survived this complication at home? And for the love of all that is holy, don’t you dare suggest that eating a chunk of my placenta would have sufficed.

          BTW, if you really want to engage with people on this blog, why don’t you try commenting on a post that isn’t more than a year old.

        • The Computer Ate My Nym

          f you birth in the hospital you are much more likely to die yourself

          What’s your data for this claim?

        • Squillo

          What are the rates of maternal death at homebirth? What are the causes?

        • Squillo

          …there is a higher risk to the mother to die in hospital than there is to a baby to die at home

          Try doing the math using the numbers you supplied in your comment above. I think you’ll find that you’re wrong.

    • Guestll

      Please list all of the benefits that accrue to a baby by virtue of being born at home.
      Please explain to me how not receiving an epidural or a necessary/desired section is a benefit.

    • Captain Obvious

      Uh, I do not remember any research that the birth control pill increases your risk for breast cancer. It does however decrease your risk for ovarian and uterine cancer by 50%!
      The risk for getting breast cancer is 1/8. So 1250 women of 10,000 will get breast cancer. By YOUR example, if something increased the risk of breast cancer by 50%, then that would not be 1/10,000 more but 625/10,000 more. Even the WHI study on Prempro and Premarin only showed Prempro to raise the risk of breast cancer by 8/10,000 (so 1258/10,000). Interestingly, Premarin actually showed a decrease in risk for breast cancer by 6/10,000 (so 1244/10,000). But you don’t see anyone going around claiming you should go on Premarin to decrease your breast cancer risk.

      Please show me a link to your statement that maternal mortality is usually related to CS infection!

      • attitude devant

        The pill actually has a modest protective effect against breast cancer. It’s a small effect but reproducible in many studies.

    • Trixie

      How on earth would home birth prevent premature labor? That makes no sense.

      • Squillo

        Homebirth prevents prematurity in the same sense that fatal car accidents prevent death from cancer.

      • The Computer Ate My Nym

        No, but home birth being associated with lower rates of premature labor because most women go to the hospital if they’re in premature labor does. In short, it demonstrates that some of the “benefits” of home birth are not causally related.

    • Ainsley Nicholson

      You didn’t include a link to the article, but I think I found it anyway:
      http://www.medscape.com/viewarticle/729137

      • Captain Obvious

        2010 article by a PhD. So much has gone on since 2010. MANA is still hiding it mortality statistics, Judith Rooks CNM made her revelation of how bad Homebirth is, etc etc

        • Ainsley Nicholson

          People with PhDs are fully capable of writing good and relevant articles; the difficulty is that you don’t know anything about their training and background based soley on the letters after their name. An MD, on the other hand, you can be quite confident that person has medical training. In the case of this article’s author, he appears to be a statistician focused primarily on risks in prostate cancer diagnosis and treatments.

        • Trixie

          I don’t have a PhD in anything, but even I can tell that claiming that home birth leads to less premature labor is contrary to basic logic. Home birth leads to fewer epidurals? Uh, yeah…duh. You can also avoid an epidural in the hospital if you want to.

    • Ainsley Nicholson

      Rochelle, you state that you are pro-life…that means that you believe the fetus should have every opportunity to be born alive and healthy no matter what stage the pregnancy is, right? So if some procedure were to result in the death of one full-term baby per thousand, you would be against it, right? Even if the procedure had some benefit to the mother?

      Pro-choice people would also agree that a full-term infant has an absolute right to be born alive and as healthy after birth as they were before labor started.

    • The Computer Ate My Nym

      while the maternal death rate in the US for hospital births is
      approximately 12 per 100,000…it really only relates to less than 600
      women per year dying (usually because of c-section infection).

      I can’t make the least bit of sense out of this claim. First off, the most common cause of maternal mortality (in the US) is cardiovascular disease, not sepsis, c-section related or otherwise.

      Second, spontaneous vaginal delivery has a lower risk of infection, but by no means zero risk. Remember the midwife who infected her client with flesh eating bacteria?

      Finally, where are you getting these numbers? I don’t understand where the 600 came from at all. Only about 600-700 women die in pregnancy in the US in total so unless you’re claiming that all of them died from sepsis related to c-sections (obviously untrue), then this number makes no sense at all.

      • Squillo

        Actually, she’s only claiming that “most of them” died from c-section-related sepsis. Which is still spectacularly wrong. According to CDC data from 2006-2009 (the most recent for which I could quickly find data), causes of maternal mortality (overall–not just in-hospital) were:

        Cardiovascular disease 14.6%
        Sepis/Infection 14.0%
        Noncardiovascular diseases, (e.g. infectious, respiratory, gastrointestinal, endocrine, hematologic), 11.9% [spike in 2009 due to H1N1 flu]
        Cardiomyopathy, 11.8%
        Hemorrhage, 11.0%
        Hypertensive disorders of pregnancy, 9.9%
        Thrombotic pulmonary embolism, 9.4%
        Cerebrovascular accidents, 6.1%
        Amniotic fluid embolism, 5.4%
        Anesthesia complications, 0.6%

        Unknown cause 5.3%

        So if we actually do the math rather than pulling numbers out of our arse, that means that 86% of maternal deaths were due to something other than sepsis or infection. Moreover, I could find no breakdown for causes of sepsis or infection, so the 14% likely includes post-op infections, other hospital-acquired infections, and infections unrelated to care (community-acquired infections, secondary infections, etc.)

        • The Computer Ate My Nym

          I agree. If there were about 650 maternal deaths in the US in 2012 and 14% of them were due to infection and we assume that ALL the infections were in otherwise healthy, low risk women who had c-sections AND that they would not have had an infection except for the c-section then we get at most maybe 90-100 maternal deaths due to c-section infection. But since the two conditions are obviously false (there is a higher relative risk of infection with c-section but by no means all peripartum infections are related to c-section and it’s not clear that the correlation between c-section and infection is causal) so the real numbers must be considerably lower.

          Chorioamnionitis can develop during delivery, especially after prolonged rupture of the membranes. I’d say that quite a few of the deaths due to infection were due to chorio due to PROM. And that is more likely to occur during a home birth.

    • Squillo

      So calculate the rate of maternal deaths (assuming for a moment that they’re all from hospital births) and compare it to the excess neonatal mortality rate for homebirth.

      Now try applying those rates across the population: I’ll give you the relevant numbers: In 2009 (the latest for which I could find homebirth rates), there were 4,130,665 births in the U.S. [per NCHS], 0.72% of which were homebirths.

  • Rochelle Alberti

    Just one of many…..

    and, unlike “Dr.” Amy…his license is active and he actually works in the field of delivering babies.

    http://supportdrfischbein.blogspot.com/2011/01/response-to-acog-committee-opinion-476.html

    and yes…I am pro-life, I do home school my children, and the Hazel E. Metcalf Academy of Excellence is a registered, legal home school in the state where I live.

    I have 6 children, 5 of who were born in hospital. Four were delivered and cared for by Family Practitioners. The fifth was delivered by an OB, who basically caught her and handed her off to the nurses and never actually had anything to do with her again.

    I do support homebirth, but more I support midwives and family practioners being allowed to deliver low risk pregnancies.

    • Amy Tuteur, MD

      You really are a gullible fool, aren’t you?

      His license is currently subject to a disciplinary sentence of 7 years strict probation for being convicted of sexual exploitation of a patient.

      http://www.skepticalob.com/2009/08/can-you-still-be-dr-wonderful-after.html

      • Rochelle Alberti

        Hmm…I guess I did about as much checking into his current standings as all your followers have done of yours, Ms. Tuteur.

        Seems that both of you do not have a license.

        I do know that in the area in which I live, most of the OBs are wiling to be back ups for even CPMs and are very pro-homebirth for low risk pregnancies.

        I really wonder why you feel the need to be so belligerent…what exactly are you hiding?

        • Guestll

          How do you know what the posters on Dr. Amy’s blog have researched or not? All we know for a fact is that you had no clue that Fischbein is in hot water and invoked him as a disturbing example of doctors who are pro-homebirth.
          Why should we trust your statement on what what OBs in your area are willing to do when you reference not only Fischbein but Lisa Barrett, regurgitate standard pro-CPM drivel, fail to display the ability to think critically, and can’t demonstrate basic math skills?

        • Trixie

          She doesn’t have a license because she CHOSE to retire. That’s a lot different than losing your license for committing a despicable crime.

        • Mom2Many

          My goodness, you could not even own your ignorance without also slashing out at Dr. Amy? Slander much?
          ….and SHE is accused of being belligerent? Good grief, look in the mirror, would you?

        • PrimaryCareDoc

          Haven’t you slunk off in shame yet? So far, you’ve demonstrated that you don’t understand statistics, you can’t do simple math, and you can’t assess the reliability of sources.

          By the way, it’s Dr. Tuteur, not Ms. Tuteur.

        • Squillo

          I do know that in the area in which I live, most of the OBs are wiling to be back ups for even CPMs

          How do you know this?

          And if Amy is trying to hide something, she certainly has an odd way of going about it.

    • Guestll

      Fischbein? Rochelle, Rochelle, Rochelle…
      Not all of us here are ardently anti-homebirth. Though the vast majority understand the serious problems with American homebirth as it is currently practiced.
      Your math is disturbingly bad. I was inclined to see Bofa’s point (below) — perhaps it was a calculator error. Evidently, this is not the case. And you homeschool.

      • The Bofa on the Sofa

        I agree. I gave her the benefit of the doubt that it was just a fat finger. No, it’s pretty clear, she doesn’t know what she is doing.

    • Captain Obvious

      Fischbein. (Shudder). Sexual predator.

    • Captain Obvious

      And you’re a Home Management Engineer. Me myself, I am a father and a husband. I shoveled for 2 1/2 hours yesterday, so I am also Mr Snowplow man, er, Snow Removal Engineer.

      • The Bofa on the Sofa

        I shoveled for 2 hrs yesterday, and about 1/2 hr this morning. And am preparing to get back out there. I see it’s warmed up a bit…Only -13F now. Twas -15 this morning when I was out there. Wind still blowing, though, but shifted to the W. That’s good – not filling up the driveway anymore.

        This is some serious engineering…

    • The Bofa on the Sofa

      Fischbein? Seriously? You bring up that sleazeball?

      Wow, you have just no clue what you are talking about, do you?

    • moto_librarian

      Oh yes, let’s support a doctor who had inappropriate sexual conduct with a patient! If you think this guy is doing pregnant women and their babies any favors, you are an even bigger idiot than I thought. Or do you support the patriarchy?

  • Rochelle Alberti

    Wow….three homebirth deaths in North Carolina for the year 2012? and you are worked up over that? What about the 588 OTHER birth deaths in North Carolina for that year…that all occurred IN HOSPITAL?

    • Box of Salt

      Yet another commenter who does not understand the concept of rate.

      • Rochelle Alberti

        Seriously? You are aware that the RATES of death of hospital births vs homebirth North Carolina’s death rate is 4.9% for hospital births and 2.62% for homebirth?
        AND North Carolina itself has seen a 20% DECREASE in infant mortality rates as the homebirth rate has increased by the same amount.

        Sorry if the CDC rates totally defeat the purpose of “Dr.” Amy.

        I am sorry. I just cannot put my trust in someone who has not actively practiced medicine of any kind for 20 years, and considering the number of OB’s who actually support homebirth (and that number is GROWING as opposed to shrinking)…I think it is prudent for everyone to actually CHECK into the actual rates…not just the ones that support their opinions.

        • Box of Salt

          Please post links to the source for your numbers.

        • Trixie

          I’d love to see the numbers showing a growing number of OBs supporting homebirth with any attendant, especially CPMs.

        • Box of Salt

          Rochelle Alberti, “I think it is prudent for everyone to actually CHECK into the actual rates…not just the ones that support their opinions.”

          We took your advice. You overestimated the hospital death rate by an order of magnitude (that means 10x). Would you care to comment?

          • The Bofa on the Sofa

            Because it’s Friday afternoon, and I’m ready to quit working, I did a web search for Rochelle Alberti. I usually don’t do this, but given how she has been so thoroughly humiliated in this thread, I wondered.

            I found two possibilities. One Rochelle Alberti is a hairdresser in the twin cities. I don’t think that’s her.

            The other is in Richmond, VA. She went to college at christian schools in KS. She lists as her current jobs
            1) Video transcriber at Video Jump. No idea what that is.
            2) Teacher/Asst Principal at Hazel E. Metcalf Academy of Excellence. I tried looking up the Hazel E. Metcalf Academy of Excellence, but the only things that come up are a facebook page (with nothing on it that I can see) and links to Rochelle Alberti’s linkedin pages. So I have learned nothing.
            3) Home management engineer, which she’s being doing for 24 years, which, as far as I can tell, simply means that she has been managing living at home.

            If Rochelle Alberti is her real name, then this is likely her.

            I wonder what the “Hazel E Metcalf Academy of Excellence” is?

          • Trixie

            Well, we know they don’t teach math there.

          • Made my day.

            I think I’ll stick with “domestic goddess” myself.

          • Guestll

            Rochelle Alberti is a pro-lifer who posts comments on pro-NCB and midwifery pages.

            Comment #11 here: http://blogs.babycenter.com/mom_stories/09172013home-birthed-babies-10-times-more-likely-to-be-stillborn/

            Rochelle, if you’re still reading here, and genuinely wondering why the US homebirth stillbirth rate is so high, stick around and do some reading on this blog. The answer lies in the crappy education and laughable standards for American homebirth midwives. Other developed countries have superior standards, better educated midwives, and integration into the health care system.

            Pro-tip — if reading this pisses you off, don’t use your real name on the internet.

          • The Bofa on the Sofa

            That’s consistent with her mennonite college background (Tabor in KS).

            I’m going to go out on a limb and suggest that the “Teacher/Asst Principal” position means that she is homeschooling her kid(s). The husband is the Principal, of course. That’s a little speculative, but that’s what I suspect.

            I get the impression she is a pretty big flake.

          • Captain Obvious

            I am all for being proud of staying home and raising the kids, but really, teacher/assistant principle of The Hazel E. Metcalf Academy of Excellence and Home Management Engineer? Either you’re proud of raising your kids or you are embarrassed that you didn’t accomplish more. There is no reason to be embarrassed of this, but the fact that she posted this is truly sad.

    • Guestll

      Math is hard, isn’t it.

      • Rochelle Alberti

        Especially for those who don’t like what the math points out..that the death rate in NC for hospital births is 4.9% and only 2.6% for homebirths.

        • Guestll

          Citations needed.

        • Dr Kitty

          Rochelle how many of the hospital birth were term neonates without congenital abnormalities?

        • Expat

          Think about the number 4.9% for a sec. That is 1 in 20. Out of 100 women that you know personally, did at least 5 have her baby die during hospital birth? I didn’t think so. The answer you are looking for is about 10 times lower than 5% for hospital births irl (0.5%). The homebirth rate is typically 3 times higher unless you are in an area with badly trained midwives where it can be up to 20 times higher.

          • Guestll

            No no, math is hard. She already has all of the answers (minus citations) why spell it out for her?

          • Box of Salt

            If Rochelle’s 2.6% number is right, and we correct her order of magnitude error (0.49% hospital deaths), than the risk at home is 5x higher.
            This is assuming the 2.6% is correct, and I’m not sure that’s a good assumption.

          • The Bofa on the Sofa

            beat ya!

          • Box of Salt

            It seems Rochelle Alberti made the same order of magnitude errors on both sets of numbers. If I use 3 homebirth deaths from Jan – Aug 2012 as the numerator and 1159 from “Live Births with other attendant” as denominator I get 0.00258 (which is a smaller number than the 0.0049 for the whole state of NC).

            But since the state of NC is not breaking the deaths down by location, intended location, or attendant, the whole exercise is rather pointless.

            In addition, Rochelle Alberti has failed to understand that the neonatal deaths almost certainly do not include the death reported in the very blog post where she’s commenting, which ended as a stillbirth in a hospital – a fetal death, not neonatal.

            Rochelle complains: “And again it comes down to how one dices the statistics….”

            Who’s doing the dicing, Rochelle?

        • Expat

          More math: if 600 babies died in hospital in 1 year and your 5% value is correct, then only 12 thousand babies were born in NC that year. In fact, 120 thousand were born in 2012. Say you made a factor of 10 errer and it might be true that nc has a high perinatal mortality rate but you have to compare comparable risk populations. If homebirth moms are low risk then you cant compare them to high risk moms with pre eclampsia in the hospital.

          • Box of Salt

            Oooh, look what I found:
            http://www.schs.state.nc.us/schs/vitalstats/volume1/2012/nc.html

            Rochelle Alberti, do you think maybe you dropped a 0 when you did your math?

          • The Bofa on the Sofa

            So the question is, did she calculate her 2.6% number correctly? At this point, we can’t assume she did.

            But if she did, then suddenly her comment about “Especially for those who don’t like what the math points out” becomes very poignant.

            Let’s see how she responds…Will she
            1) revise her homebirth death rate, meaning she messed that one up, too? or, if the HB death rate is correct,
            2) admit that the HB death rate is 5x worse than hospital (and that even includes the fact that HBs should be low risk and hospital deaths include all of them), or
            3) flounce, thereby illustrating her point about how math is hard for those who don’t like what it says?

            Being hoisted by one’s own petard is never fun.

          • Guestll

            I have a beer that says she’s not coming back. How do you recover from this? I mean, you could say, “what’s an order of magnitude between friends” but we’re not really friends, are we?

          • The Bofa on the Sofa

          • Guestll

            there’s always

          • The Bofa on the Sofa

            Oh, I think we need to be fair. It could be an honest mistake. Hitting the wrong button on a calculator is not really an inability to do math, it’s just a typo. I don’t care about the fact that she messed that up so much as her boasting with it. I mean, she could come back with a, “whoops, my bad” which could be a great learning moment. She won’t, of course, and it won’t be.

            Her problem was she went all in with her rates, and consequently, there is no way to recover.

            Actually, the ironic part is that she absolutely illustrated her point, except in reverse. The reason she unquestionably accepted her math error is because it told her what she wanted to here. We looked at it and said, that doesn’t seem right, and therefore went and checked the math. She was so willing to believe it that she didn’t stop to check her math.

          • Guestll

            Fine and well, but then you need to believe that 1 in 20 neonates die in a friggin’ North Carolina hospital.

          • Guestll

            “Hey online due date group, I’m in early labour and heading off to NC Women’s Hospital to deliver!” “OMG, you’re in NC? 5 women in my graduating class of 100 girls lost their babies there! Good luck and keep us posted!!”

          • The Bofa on the Sofa

            Probably not. Remember, her rate stat was pulled out of the seat of her pants after being called out on her “588 died in hospitals” comment. When pointed out that it was meaningless, she quick tried to calculate the rate and botched it.

          • Box of Salt

            And then she posted it twice, in reply to both GuestI and me in that longer reply where she told us to check for ourselves.

            I don’t think she understood she was posting in a community that does actually check for themselves.

          • The Bofa on the Sofa

            Yeah, but you’d have to actually think about it for a second. She got the result she wanted.

            The unexamined life…

          • Captain Obvious

            So that’s how homebirthers do their research. And referencing the baby killer Lisa Barrett to boot.

          • The Bofa on the Sofa

            Well, well, well…she has not returned. I knew that it was not wise to take you up on that beer.

            It’s actually sad. This was a great learning moment. Unfortunately, I suspect she is going to just put it behind her and pretend it never happen so to protect her delusion.

          • Rochelle Alberti

            I am sorry to refute your opinion and suspicions. I was actually taking care of my family and finding the citations that people requested (and yet were not wiling themselves to provide).

            Basic math…according to NC Department of Health & Human Services State Center for Health Statistics, 06AUG2013, there were in 2012, 591 neonatal deaths (those deaths that occur from birth to 28 days of life). According to the NC Department of Health and this article…3 of those were due to homebirth (or at least the child that died was born at home)…that leaves (oh my gosh..do the math 591-3) 588 other deaths…and even it you go ahead and assume that the 22 undefined deaths occurred due to homebirth…..that still leaves 566 deaths that belong to hospital birthed babies. (http://www.schs.state.nc.us/SCHS/deaths/ims/2012/table8.html)

            As for rates….the statewide rate for infant deaths was 7.4 percent. Hospital neonatal deaths (which they tend to only report those babies who die while in hospital) is 4.9 percent based on the NC Dept. of Heath…and for CNM’s that rate (in hospital) is 1.2 percent and 2.9 percent for out of hospital births.

            HOWEVER…according to the NC Dept of health…in the past 10 years…the neonatal death rate has dropped 20%…which, interestingly enough correlates with the same estimated increase in homebirth and/or use of midwives over OB’s.

            The AAP and the ACOG recognize that the risk of homebirth to the infant is literally ONE more death per thousand than hospital birth.. Olsen O.; Jewell D. “Home versus hospital birth”.

            Of course…this source will be dissed simply because it is from a midwife..even though she does hospital births…but had to share it nonetheless:
            http://www.homebirth.net.au/2008/06/homebirth-vs-hospital-statistics-to-die.html

            And again it comes down to how one dices the statistics….

          • Amy Tuteur, MD

            Now go back and remove the approximately 90% of hospital deaths due to prematurity, severe maternal disease or complications (all of which would never be candidates for homebirth and you get a hospital death rate of 0.79 per thousand compared to a homebirth death rate of 29/1000. That means that the homebirth death rate is more than TRIPLE that of the hoospital death rate.

            Homebirth kills babies. The only people who are ignorant of that fact are homebirth advocates such as yourself.

            Indeed, Lisa Barrett, the midwife you reference is personally responsible for at least 5 homebirth deaths. Most doctors would never have that many term deaths in an entire career, let alone a period of 5 years in which Barrett presided over these deaths.

          • The Bofa on the Sofa

            So after having failed in trying to use rates, you abandon that and go back to absolute numbers?

            Remember you 588 number?

            How does that turn into 7% Oh wait, you switched terms…Why? Because you didn’t get the result you wanted

          • The Bofa on the Sofa

            The AAP and the ACOG recognize that the risk of homebirth to the infant
            is literally ONE more death per thousand than hospital birth.. Olsen
            O.; Jewell D. “Home versus hospital birth”.

            Of course, since the rate of death in a hospital is on the order of .5 in a thousand, and extra 1 in a thousand means that that death is three times more likely. Exactly what Dr Amy has always said.

            Thank you for admitting that she is exactly correct.

          • The Computer Ate My Nym

            You may not have noticed, but this article was written in August. It documents 3 deaths due to home birth that occurred in North Carolina in 2012. It does not claim to have documented all home birth related deaths in 2012, especially since Dr. Tuteur doesn’t claim psychic abilities and therefore could not know whether more deaths would occur in Aug-Dec 2012. Your most basic underlying assumption is in error. As is, as others have pointed out, your math.

          • Box of Salt

            Rochelle Alberti, “this source will be dissed simply because it is from a midwife”

            Are you aware that this midwife whose site you have linked was recently banned from providing birth services by the Australian government?
            http://www.abc.net.au/news/2013-12-06/lisa-barrett-former-midwife-banned-from-birthing-services/5139372

            No, she’s not doing hospital births.

          • Box of Salt

            Rochelle Alberti, “I am sorry to refute your opinion and suspicions. I was actually taking care of my family and finding the citations that people requested (and yet were not wiling themselves to provide).”

            I see you did not notice that I posted two links to the North Carolina Center for Health Statistic yesterday. After you did not reply to my request for links, it took me less than two minutes to find the site and relevant pages for myself. The big difference between my links and the one you posted is that mine work. Yours gives me a 404 error.

            I was going to ask you to show your work calculating the rate of neonatal death based on the numbers posted on the page I linked (where I assume you got the 588 number, since 591 – 3 = 588). Anyone with a calculator can divide the total live births (119,787) by the neonatal deaths (591) and they will get a result of 0.0049. I assume you have access to a calculator, since you are posting from a computer and most computers have a calculator ap.

            Then I realized you pulled 4.9 from the next column over on the table, headed “Rate* 2012.” And I realized where you went wrong. You relate 4.9 as a perCENT (that’s per hundred).

            The asterisk next to rate indicates “*See definitions and formulas section” – this note is at the bottom of the page.

            Here’s a link to the definitions page: http://www.schs.state.nc.us/schs/vitalstats/volume1/2012/section6.pdf

            The death rate is reported as per THOUSAND.

            In any cases, none of these numbers are meaningful in any way. These are not the right numbers (it may be possible to do a more meaningful analysis once NC adds 2012 to the Health Data Query site). For example, an intrapartum death, such as the stillbirth reported in the blogpost above, would not be counted among live births. That’s on the next page of my link – the definitions.

            And, Rochelle, I will ask you again: Would you care to comment?

          • Box of Salt

            Ooops. I described my division wrong. Divide deaths by births to get rate. 591/119,767 (sorry about 8 for 6 typo above) * 1000 = 4.9 per thousand.

            Math is easy. Talking about math is hard.

          • Siri

            But better than being hoist by someone else’s, surely?

          • Guest
          • The Bofa on the Sofa

            This was my first response. “What? There were only 10 000 babies born in NC in 2012?”

        • Ainsley Nicholson

          I would like to know where you got your numbers. I just checked the CDC’s data (http://wonder.cdc.gov/lbd.html), and it says that
          For 2007 to 2009, in North Carolina, there were 14 deaths out of 930 births that occurred outside a hospital (1.5%), and 990 deaths out of 125,915 births that occurred in a hospital (0.79%) . My rough number crunching doesn’t take into account how soon the infants died after birth, or compare similar populations, or even properly manage the number of significant digits in each percentage, but it still shows a death rate for out-of-hospital births that is twice what the death rate is for in-hospital births.

        • Guestll

          Come on, Rochelle, come back. Come tell us how you feel about what the math points out.

          Also, take a math class. Arithmetic 101 would suffice.

        • Captain Obvious

          Nearly 5% death rate? Wow!

    • Mom2Many

      You are mocking and minimizing the loss of THREE unnecessary deaths, all in a sick attempt to be able to say that hospital deaths exist in higher numbers? I’m sure the loved ones of these little ones will appreciate your sensitivity.

  • valerie

    I chose to have a hospital birth with a midwife. It was the best experience! I had 3 other hospital births with doctors, and they went well, but i felt like for me the midwife/hospital combination was perfect! She was with me from the moment i got there til the baby came. Loved her!

    • Young CC Prof

      Hey, Valerie! Glad you had a good birth. Yes, midwives, working together with the rest of the medical system, can help women have safe and comfortable births. It’s a great option. (And of course, hospital midwives are all properly trained, unlike many of the DEMs that are written about here.)

  • stacey

    I sure love the late comers that show up just to spew their vitriol, and usually, share their ignorance as well. I think I will post on every page they do this, so they aren’t the first post anymore.

  • Michelle

    …. Skeptical OB who has too much time on her hands. Stop blogging and focus on helping women or go away. Women deserve choices. If the state of NC wants women to have healthy normal births how about allowing midwives and having them be TRAINED and LICENSED. People would be able to pick a suitable caregiver who has proper training without fear of hospital transfer if something went wrong.

    Get off the blog sphere and go out into the real world and help these women have the birth they want with a skilled attendant!!! An OB like yourself could always start attending home births and really change things up!!

    • Victoria

      “without fear of a hospital transfer if something went wrong”
      So you would rather stay away from the hospital than make use of the life saving measures that can be enacted there? Even if a midwife is trained and licensed there are still situations that cannot be handled at home. I doubt that Dr Amy would want to embrace the risks to her patients by attending homebirths. I don’t think Dr Amy is trying to stop women from having choices – just making sure that those choices are informed ones; there is risk in homebirth and even more so with untrained attendants. Is there a reason that this information should be kept from women?

    • Eddie

      FYI, North Carolina already has trained and licensed midwives. They are called CNMs. Why is there value in certifying an inferior level of training and skill? CNMs are licensed in all 50 states.

  • Life and death. Death is a part of life. You point the finger at the midwife, you point the finger at home birth, but where was the mother in all of this? Was she lying unconscious under a rock while this midwife made her stay home? No. You, are a birth worker, you do not own birth, you can’t tell people with who and where to have their baby. This mom choose to have this woman act as her midwife. Plan and simple. I want to know how many babies or mothers have died in the hospitals that you have worked in. Yes, please, disclose.

    • attitude devan

      What an original comment!

      Not.

      Vanessa, whatever you might like to think people hire healtcare workers because they want support in labor. If Rowan is passing herself off as some kind of trained expert, then the people she hoodwinks are going to listen to what she says. It’s not OK that she’s wrong and they lost their baby as a result.

    • The Bofa on the Sofa

      Wow.

      Pretty amazing, this is the second time in this thread that we’ve heard “caveat emptor.”

    • Eddie

      So cavalier about death, and so ignorant about the importance of RATES of death, not absolute numbers. Do you suggest that since death is part of life, that it doesn’t matter when or where or why it occurs, nor whether it was preventable?

    • ratiomom

      What a marvellous idea, blaming the patient for the avoidable bad outcome! Let`s expand it to other areas of life as well!

      Has your doctor prescribed you the wrong med, causing life-threatening side effects? Can`t blame him! Were you lying unconscious under a rock while you took those pills? You`ve got internet access, right?

      Did a wheel come off your car while doing 90 on the highway? Can`t blame your mechanic, were you under a rock while he serviced your car?

      You`ve got a pretty sick and twisted worldview when you think that sacrificing a healthy full-term baby on the altar of natural birth ideology is an acceptable `choice`.

  • Dr Kitty

    Really?
    http://www.ncbi.nlm.nih.gov/pubmed/22891394

    “Instrumental and caesarean deliveries were not associated with PTSD. Most of the women who developed PTSD symptoms delivered vaginally, but received fewer analgesics with stronger reported pain”.

  • bobtheplumberable

    Dr. Amy, haven’t you realized by now that these people bashing you have “solid internet educations?” They will fight for their ideas (no matter how stupid they are) til the death. They read in a BLOG that it’s BAD to give birth at a hospital, and GOOD to give birth at home! (baa baa baaaaah! .. and they like to call us sheeple)

  • birthLOVE

    isnt it a parents responsibility to choose the careprovider best for them? based on the description Rowan gives of her training, her philosophy and her services, i do not feel these parents were mislead. not saying it is parents fault alone, but think it is extreme and untrue to let it be the birth consultants fault either.

    • Guestll

      Here we go with the “gentle” victim blaming. Passive aggressive much?
      If I’m reading you correctly, the parents weren’t misled, because Rowan is not all that hot as a “birth consultant” (your words — I thought she was a “midwife”, or do you disavow that title for her?) and clearly, the parents should have known better.
      Whenever a baby dies at a homebirth, there are invariably people like you who come here to write what you wrote — to put the onus on the parents — to mitigate the responsibility of the midwife. Much easier to frame the death of a baby as an isolated incident, rather than question the framework that may have led to his death, right? Wouldn’t want to actually have to do anything to fix it, would you now?

      • Should have known what better? If you have spent months reading that birth is normal and that means safe, and only goes wrong if you go to the hospital or Think Bad Thoughts, and that all you need is the “support” of a nice reassuring midwife, how are you supposed to figure out that you are heading for disaster? Everything is just a variation of normal, and midwife magic can fix it. If they can’t, well, it was meant. Isn’t that the general message of “I don’t blame my midwife”

        I had no idea I had pre-eclampsia, a failing placenta and a baby that had stopped growing. Heading blithely for an “unexplained” stillbirth I was. I was low risk, why worry? Thank God for machines that beep.

    • The description Ms. Bailey gives likely omits the cease-and-desist order that would clearly imply that Ms. Bailey was practicing illegally.

      Why was there such an order? I’m sure Ms. Bailey didn’t inform clients of that either.

      But then again maybe ALL midwives lie to their clients and Ms. Bailey was no worse than any other midwife – who doesn’t have a back up, who sleeps through labors, who leaves a laboring woman unattended multiple times.

      With midwives like those, families could do better without. Cheaper too.

  • courtneyann3

    I have had babies in the hospital and at home, both with OBs, a CNM, a DEM, and unattended. A grown woman and her partner are capable of properly interviewing a prospective attendant. There are obvious questions to ask, references to check, etc. The Matrona “school of midwifery” and Whapio have often been in the news in a negative way ever since it started. It is true that sometimes babies die during birth. And yes, many more babies die during a hospital birth, but those statistics include very premature babies and babies with severe birth defects, and the undetermined cause of deaths. OBs handle high risk pregnant women which can result in high risk births and poor outcomes. For a home birth midwife, high risk pregnant women should be referred to high risk providers. Of course, there are times when events can suddenly turn to high risk, and well trained and knowledgeable midwives are ready for such cases. I have met Whapio before, when I was an officer in the state Midwifery organization, NCMA, and I have long known the student population of her school. Given the “hippie environment” of the Asheville area, there are many pregnant women who desire the mysitical birth they advertise. No attendant, whether an OB or a CNM or a LM or a DEM or a CPM can guarantee a safe outcome, a live and healthy baby or a live and healthy mother. When a baby dies, someone is always looking for a person to blame. Most of the time, it is not the fault of the attendant.

    • Guestll

      You do realize that intrapartum death of a healthy neonate at term is extremely rare in the US, right?
      Do you have any citations for your last sentence? I’m interested in how you know that the death of an otherwise healthy baby is most of the time, not the fault of the attendant.

  • A Mexican Mom

    I can’t believe you let this happen in the US. Aren’t you supposed to be first world?

    Here in Mexico we have midwives too, but they are highly trained… unbelieveable, right? They need to be certified and they work with hospitals, from week 40 they start making constant check ups, so if it’s been 42 weeks and the baby is not born yet, they ask a second opinion at the hospital and they decide if home birth is not an option or if everything is ok. If they need to go to the hospital, well, they go and they try to be with the mother all the time, but they will never put in danger the baby.

    We need this because mortality is high in here, not because of hospitals, but because of poverty and illnesses. So the goverment decided to professionalize midwives to work in rural areas to make sure that we lower those rates and mothers get professional assistance. Sadly, even when giving birth is not the problem (since most mothers go to the hospital, and those who decide they don’t want that work with any of this midwives), we do have poverty and lots of illnesses, so kids die because of this.

    Your goverment should make midwifery a legal job and ask for certifications. That way you will avoid this kind of stories. Also you seem to need better education for women, if your midwive doesn’t have a legal document that certifies her as a professional, how the hell do they allow any person like this close to their bodies?

    Ok, many of this women had horrible experiences with hospitals before or they heard histories… too bad, just send them to many mexican hospitals and we will show them what trauma means, not because we have bad doctors (actually they are quite good), but because we are not used to politeness… and yet most women still go to the hospital to get more traumatized and give birth, because we don’t mind to trade our comfort for a healthy baby who can breathe and grow up to be a beautiful nightmare.

    Thankfully we have midwives and hospitals who want to give pregnant woman a different aproach and they are more friendly and try to encourage women to take control of their pregnancy as much as possible, without making it dangerous for both mother and baby. So my son will be born in one of this hospitals, it will be a natural birth without painkillers, in a safe enviroment; and if something goes wrong doctors and nurses will be ready to do whatever needs to be done. I’m scared sick of hospitals, of not having control of the situation, needles and pain but, as I said, I don’t mind to trade my confort for a healthy baby.

    I don’t see anything wrong with c-sections or machines attached to me, if I can avoid them I will, but if needed I will not doubt to make use of technology. I bet my grandmother (who had about 20 kids, half from a first marriage and half from a second, many of which died at birth) and great grandmother (who had lots of kids, many of which died at birth, who also gave birth without any help, at open field and in the middle of a war), would be proud of chosing my baby’s life instead of a traditional birth.

    Yes, millions of women have been giving birth without help and medicines for centuries, but also many of them died and lost their babies in the process. I know I can do it too and I want to do it as natural as possible, but even when I don’t want any painkillers and I’ll try to get as little interference as possible, that doesn’t mean I will not get assistance if needed, that is why I choose the hospital. My baby is more important that anything else.

    And yes, we are animals too and is part of our nature and instinct to give birth. But even animals have trouble on the process and their offspring dies too, so… yeah, if we have the chance to make it better for our species why not use that chance?

    • Siri

      Hear, hear! Very well said, Mexican Mom. I couldn’t agree more, and I wish more US moms would open their eyes to the truth.

  • Renee Martin

    I just love how months after the post, there are a slew of HB advocates who write posts that not only refuse to respond to this actual article, or even the topic, but are full of NCB bingo:
    “babies die in hospitals too!”
    (because that would make preventable death at home a OK, amiright? Besides their complete misunderstanding of statistics, and misunderstanding that HB deaths are usually preventable. If they looked at Hb stats from CO, Ca, OR, they would see how many more babies die at HOME!!!.)
    “MDs never see a NCB and just wanna cut you”
    (this person is wholly ignorant of what OBs do, and does not know they do not make more $ per CS. an uncomplicated VB is exactly what an OB wants! )
    “You hate HB and MWery!”
    (Nope. we hate lying liars that lie! We like CNMs, and CMs, who are the only actual MWs in the USA, and think it’s fine if a mom chooses HB if she is actually informed.)
    “I loved my HBs!”
    (as long as nothing goes wrong, of course you will be happy. You might sing a different tune if your baby had died due to negligence)

    But keep on making yourself feel better! and keep on spreading lies that hit and maim.

    • Box of Salt

      Renee Martin: months after = it’s because the murder charge hit the NC papers on March 28th.

      The thing that bothers me is that amount of homebirth supporters who don’t seem to be interested in the specifics of the story (which I’ll admit is hearsay) and still insist that lady who hired herself out as a midwife against state law should be considered blameless.

  • Renee Martin

    CRUEL?
    Are you kidding me?
    Cruel is repeated preventable deaths.

  • This reads like a hate mail. Midwifes are like mds , in that there are excellent ones and poor ones that gives the rest a bad name. The difference is very few mds have ever seen a natural birth in their rotation verses trained cpms. Dr.Tuteur what do you know of this woman’s record ? How many births as she assisted in as a primary caregiver? Have you contacted her previous clients? An educated well written article would question the facts of her birth record. As patients we have the right to question our care and our caregivers. We make choices on our practioners. The parents involved suffered a tragic loss and you use thier grief to campain your hate. Your comment on grief and loss in the midwifery community of North Carolina show how disconnected you are to it. It is composed of significantly more joy than loss. Of all the places I have lived and traveled the community in NC is stronger than most and the quality of care and birth fairs better than all the hospital births I’ve attended. Ultimately as woman we should have a choice in our care. I would like to see CPMs regulated and legalized verses persecuted and have to god forbid have a woman like Dr.Tuteur attend my birth as she clearly does not trust in my abilities as a birthing mother to do what we have always done. I was born in Germany on a military base by midwifes . Tell me dr t if our standard is so superior why are we USA an industrialized nation rated so high for infant mortality ? When will we accept that midwifes have substantial information on techniques and care? We need to cultivate the wisdom and use it to better our care. We need to educate ourselves on our practitioners and our options. Clearly there is a reason mothers feel they need alternatives. What is lacking in our current care / with our current practitioners that woman are so desperate to seek outside of that?

    • Box of Salt

      Christina Wicks “this reads like hate mail.”

      Really? Perhaps you should double check the defintions of both “hate” and “mail.”

      You say: “Midwifes are like mds , in that there are excellent ones and poor ones that gives the rest a bad name.”

      Well, let me ask you, Christina Wicks, does this story sound like this woman Rowan Bailey is one of the “excellent ones”?

      Would you, Christina Wicks, if you are a midwife (and use your imagination if you aren’t) have allowed this mother whose baby ultimately died in utero, to labor for four days after her water broke? Does that sound like “excellent care” to you?

      You post: “Tell me dr t if our standard is so superior why are we USA an industrialized nation rated so high for infant mortality ?”

      Do you honestly think that this story represents a superior standard of care?

      If not, why are you so vehemently defending it?

      • Let me start with please go to Webster and check the definition of “hate mail ” two words together. Second my whole point is that clearly that midwife wasn’t the superior standard of care. This is why I advocate for regulating licenses of trained CPM midwifes across the nation verses 24 states. I advocate for people making informed consents. Are your docs board certified? How long have they been practicing? Where did they do their fellowship training ( if they did one)? I think you should investigate your dentist, your family doc your surg, your midwife, ect.

        • Dr Kitty

          Really?
          Are they doing certified professional doctors, dentists and surgeons now?

          No?

          CPM is not a real certification. It would not be recognised in any other country. It is useless, and rightly so.

          If someone has my life and my child’s life in her hands I want her to have completed high school, competed for a place at university and taken a rigorous degree course.

          Not a correspondence course and a multiple choice exam after catching a few babies for her extended family.

          • Catching few babies from extended family! Haha! Thank god it’s not that lack. And just FYI nurse midwives with grad degrees are involved with Narm.

          • Poogles

            “And just FYI nurse midwives with grad degrees are involved with Narm. ”

            And? There are MDs who are anti-vaccine and “scientists” who are global warming denialists. It means nothing about the facts concerning those topics.

          • Cnms are also responsible for founding Narm , Ina may didn’t do that on her own

          • but that’s not the real issue

          • Dr Kitty

            So what is?

            Incompetent uninsured practictioners who can’t get government or insurance companies to reimburse them?

          • No recognizing that not all midwives are incompetent . And increasing the standard and guidelines to meet a national scale expectation so that competent qualified midwives can attend to low risk patients. But that’s easier said then done. The point is that not all midwives are incompetent.

          • Poogles

            ” And increasing the standard and guidelines to meet a national scale expectation”

            But CPMs don’t want to do that, they’ve made it very clear. Not to mention, we already have “competent, qualified midwives [who] can attend to low risk patients” – CNMs. Most CNMs are competent, most CPMs are not.

          • Poogles

            “Cnms are also responsible for founding Narm , Ina may didn’t do that on her own”

            If true, still irrelevant.

          • Squillo

            Physicians are responsible for JPANDS, and I don’t know anyone who considers it anything other than a very bad joke.

          • Tit for tat , I made my initial response to another writer who was under the impression that cnms have nothing to go with cpms that’s all. I can see the system is flawed on multiple fronts . Midwives can attend homebirths in Europe because they have a system and standard or care set up for it. I don’t have all the answers but clearly woman in the states have shown a need for a similar system. I don’t argue for incompetent providers , I defend the highly capable midwives that do exist as the forum seems to give the air like its one extreme or the other. Docs good midwives bad… Or visa versa . It’s not that simple.

          • Squillo

            If we had a “similar system” to European midwifery in the U.S., CPMs would not be practicing. There might be expanded recognition of the CM degree, or expanded access to MEPN programs in existing APN programs, but no one would accept the current requirements for CPMs.

            It’s quite simple in that the developed world accepts a minimum standard of education and training as a baseline for being a competent provider. CPMs don’t meet that.

          • Eddie

            I don’t know why someone voted you down, as it is absolutely true that a minority of many groups hold views outside the mainstream. It is therefore meaningless to say, “Some of group X support idea Y.” It is meaningful to say, instead, “The consensus of the group X is that …” That outliers exist is irrelevant, just as you said.

        • Box of Salt

          Christina, I did as you suggested (Merriam Webster on line dictionary) and typed in “hate mail” as two words in one search box.
          http://www.merriam-webster.com/dictionary/hate%20mail
          Here’s the answer it gave me:
          The word you’ve entered isn’t in the dictionary. Click on a spelling suggestion below or try again using the search bar above.

          As their website suggested, Christina – Try again.
          You made up your own definition, and assumed you could source it. Sorry! Some of us do actually check sources.

          • http://www.webster-dictionary.org/definition/hate%20mail

            Follow the link , try again

            Noun 1. hate mail – mail that expresses the writer’s dislike or hatred (usually in offensive language)

          • I hope that makes it easier salty box. I know that these modern terms can prove difficult to follow.My spelling is terrible and I’m certainly not a contributing writer for Oxford or Cambridge dictionaries . With that said the term “hate mail “was not invented by me. ; )

          • Box of Salt

            Christina,
            one of your links reads “unpleasant or cruel letters from someone who dislikes you”

            a blog post, available for all to read on the internet is not mail.

            My ‘nym is NOT “salty box.” You are being rude.

            It’s not just your spelling which is terrible.

            Perhaps you meant “hate speech” – and I still don’t think this blog post qualifies as that.

          • box of salts, I am sorry I upset you.

            The overall tone of the blog “expresses the writer’s dislike or hatred” hence, I stand by my impression that the writer expressed her dislike in this blog.

            She wasnt writing a speech, so no I did not mean “hate speech”.

            We can agree to disagree on this as I do not wish to further split hairs .

          • theNormalDistribution

            Holy crap, your reading comprehension is poor.

            “Hate speech” doesn’t have to be (literally) a speech with hate in it. Hate speech is the act of vilification of a person or group based on discrimination, i.e. a generalization about said person or group. It can take many forms including prose,

          • theNormalDistribution

            I also find it interesting that you still managed not to get “Box of Salt” right the second time. Stupid, or liar, I wonder?

          • Writer above I sincerely apologized to box of salt. Typing on an iPad I fly through the words. I purposely got the name wrong the first time which was rude on my part. Relax please.

        • Eddie

          According to dictionary.com: “letters, telegrams, etc., that express prejudice or disagreement in abusive or threatening terms.” (http://www.merriam-webster.com/ has no such phrase) Dr Amy’s blog post fails to be hate mail because it is not “letters, telegrams, etc” and it is not abusive nor threatening. Criticism and sarcasm are not enough to make hate speech. (“Hate speech” is the correct category for a blog post. A blog post is “speech” in the sense of “free speech.”) To be hate speech, it has to be abusive and/or threatening. This is the commonly understood definition and how it is used in the media, not just the definition at dictionary.com.

    • suchende

      “The difference is very few mds have ever seen a natural birth in their rotation verses trained cpms.”

      Do you have ANY evidence at all to back this up, or do you just parrot back the bullshit you read on pro-NCB message boards?

      • Seeing lots of lovely natural births is worse than useless if you need someone who can act fast (and appropriately) on the rather common occasions when natural isn’t going so well. Deaths are the most extreme and obvious problem – they are not the only one.

      • yes I work in the medical field. This is from their words not mine. An obgyn who practices now flat out told me that she has never seen a natural birth. My boyfriend an md told me about his weeks of rotation in ob, same story. Now granted his specialty is different. So I spoke to other obgyns who also admitted during their training they never saw a natural birth. So I am not parroting back bullshit. I am repeating what I was told by current practicing obgyns.

        • suchende

          So you have an N = 2. Jesus.

          Consider the percentage of unmedicated births that take place in the United States. Then consider the number of births an OBGYN must see to finish her residency. Tell me, do you think it makes any sense that “very few” OBs have NEVER seen a natural birth?

          • How many natural births have cpms attended ? Hundreds that just part of their training. Let me be clear I am not against obgyns they provide a valuable service for those who need it. I am for regulated licensed midwives (CPM midwifes) certified nurse midwifes. They also provide a valuable service for woman who choose to birth their babies with minimal intervention, in a safe environment with a trained professional. A child going through labor goes through what is called the cardinal movements of labors in the birthing process it is not a passive passenger. When you introduce drugs oxytocin, epidural, ect you will require intervention because you have impended the physiological process and the baby is no longer an active participant. But I digress, why are so in such disbelief that there are some obgyns who never attended a natural birth in thier training? They are highly skilled surgeons. My guess is if you worked in the medical field and your colleges/friends were docs you wouldn’t be shocked.

          • Amy Tuteur, MD

            I am an obstetrician and you have no idea what you are talking about. Every obstetrician sees hundreds of natural births during their training alone.

          • I’ve been misinformed I will text the obgyn and ask her to clarify. But sorry obgyns are not experts in natural birth. Trained midwives are and some obs. Are you board certified ? Are you currently practicing? Why do you put all midwives in the same boat ? Do you not think cpms should not attend births ?

          • Dr Kitty

            No I don’t think birth junkies without a college education should attend home births.
            It is *expletive deleted* SHAMEFUL that CPMs even exist.

            I work with midwives. Properly trained, university educated, smart, reflective, midwives.

            Nothing I have seen so far leads me to believe that a CPM deserves to be called a midwife.
            They don’t have the education, they don’t have the accountability and most importantly, they don’t have the common sense that G-d gave a fly.

            I’m a doctor.
            Quick question, I’ve already attended more than 50 births. If I took the NARM exam, would I be an expert in normal birth? Because I’m going to guarantee I’d pass it first time.

          • Bombshellrisa

            I would seriously love to see you and Dr Amy take the NARM exam-you would have the CPM street cred with the real education to back things up along with years of experience and lots of common sense. Bring it on!

          • Dr Kitty

            Oh I’d happily take the exam!

            Actually attend a home birth…hell no.
            Really I wouldn’t be able to live with myself if something went wrong.

            I have patients I go to sleep at night worrying about as it is, home birth is just too big a risk to take on.

            Thankfully I get to do all the bits of obstetrics and gynaecology I enjoy (well woman, antenatal, family planning, menopause care, urogynaecology) without the bits that terrified me!

          • Bombshellrisa

            I don’t want you to catch babies at home! I just want you to be able to say that you have passed their test, and it hasn’t changed your mind!

          • Dr Kitty

            Oh you betcha, I could do that!

            Hey, I have a diploma from the Royal College of Obstetricans and Gynaecologists, how hard could the NARM exam be if 80% of people pass it first time?*

            *The post graduate exams I have taken have pass rates of 50-75%. 80% is easy by comparison

          • Dr Kitty

            oh, just checked the online flash cards for the NARM exam…it might take me a few days to learn the herbal and homeopathic *stuff* you need to know.

            Crazily, I wasn’t aware until today that lemon juice in water was beneficial in pregnancy. My medical school education was sorely lacking.

          • Bombshellrisa

            I was so into the homeopathy and aromatherapy parts and I couldn’t ever get the stuff straight. Which cohosh? Is a warm bath good or bad? Raspberry leaf is good for what and to be avoided when? It depends on which midwife you listen to as well-gets confusing

          • Box of Salt

            Reading the “questions” from auntbea’s post tempts me to try to take the exam myself, and I’m not even any kind of medical professional. I’d love to see how I stack up to the “trained” CPMs based on having common sense and a broad knowledge base in science . . . but if it includes homeopathy, the fact I’m a chemist probably shoots me in the foot.

          • Bombshellrisa

            Here you go, I think you qualify:
            “the current minimum NARM requirements listed below to become a Certified Professional Midwife (CPM). Students who enroll after these dates will have to meet NARM’s new requirements that were announced on April 10, 2012.
            Attending a minimum of 20 births as an active participant.
            Attending an additional 20 births functioning in the role of primary midwife under supervision. A minimum of three of these 20 births must provide a course of care that includes four prenatal visits, birth, one newborn exam, and one postpartum exam.
            Attending a minimum of 75 prenatal exams including 20 initial exams.
            Attending a minimum of 20 newborn exams.
            Attending a minimum of 40 postpartum exams.
            Documentation of NARM skills
            Successful completion of NARM written and practical exam”

          • nurse midwives with grad degrees are involved with NARM.

          • Poogles

            “nurse midwives with grad degrees also are in NARM”

            What do you mean by “in NARM”? Just to be clear, CNMs are certified by AMCB, not NARM.

            http://www.midwife.org/ACNM/files/ccLibraryFiles/Filename/000000001385/CNM%20CM%20CPM%20ComparisonChart%20082511.pdf

          • involved in that cnms have taken the CPM exam and become advocates for it. Clearly they went through a grad program and found it value in it that’s all.

          • LukesCook

            Why would a CNM need to take the CPM exam? Unless she was no longer permitted to practise as a CNM for some reason, of course.

          • So in one of the 24 states she could legally attend a birth in a home as a primary caregiver . She dosnt relinquish her license just builds on it and it’s only to attend to low risk births of course.

          • Bombshellrisa

            That doesn’t make any sense. CPMs are considered primary caregivers in the states that allow them licences. A CNM is already considered a primary caregiver, and also hold the title advanced registered nurse practitioner.
            As for the low risk part, I have seen CPMs tell women it’s fine to fly! Even if you have been on bedrest for preterm labor! It’s fine to go 41w6d and be in labor for 36 hours. Push when you feel like it and for as long as you want-cervical exams are interventions and pushing for six hours is NORMAL.

          • Dr Kitty

            More fool them then.

          • Poogles

            “If I took the NARM exam, would I be an expert in normal birth?”

            Don’t be silly. You are much too educated and trained to be an expert in “normal birth”! All that education brainwashed and ruined you, doncha know?

          • auntbea

            I will take this bet, not because I don’t think you know your stuff, but because knowledge and passing the exam don’t seem to be all that correlated: An amusing read: http://www.mothering.com/community/t/852941/my-reaction-to-the-narm-update-i-passed

          • Box of Salt

            auntbea, I read your link and wish I knew how to shrink urls because I want to post the Picard/Riker double facepalm in response.

            Since I don’t know how, I will this quotation from your MDC poster, because it’s kind of funny. This is her reaction to a diet vs anemia question:

            “WHERE’S THE BEEF? . . . Are we ALL freakin’ vegetarians all of a sudden?”

          • Bombshellrisa

            And here is more about about this same lady “There’s no study guide that I’ve been able to find. There are some NARM-prep flash cards out there which I ordered, but I would not recommend them. I think they mostly wasted my time, to be honest, and I will be returning them for a refund.
            I went to the International School of Midwifery in Miami, a 3-year program. We did not have a NARM prep class or guide or anything. (We did get to hear some really “helpful” rants about what a ridiculous test the NARM is.)

            I think the MOST helpful thing I did (and maybe I flunked, so don’t necessarily listen to me yet) was to basically memorize Heart and Hands. I literally outlined the whole book, memorized the protocols for things like face and breech, etc. But there were definitely things on the test that were not covered in H&H, so it isn’t really enough”

            SO there you go, stop trying to study with flashcards, read Heart and Hands by Elizabeth Davis http://elizabethdavis.com/about/

          • Bombshellrisa

            OBs don’t need to be experts in “natural birth” as a true spontaneous vaginal delivery can proceed without intervention. Seeing thousands of natural births will teach you nothing. Of course, it depends on your mindset. If you believe that most births SHOULD proceed without intervention, then seeing many births where no intervention was needed will back up that idea for you and you will regard it as “proof” that natural is better and to be desired.

          • Amy Tuteur, MD

            Claiming to be an expert is natural birth is like a meteorologist claiming to be an expert in sunny weather: useless.

          • Bombshellrisa

            Or an expert in “normal” plumbing, electrical wiring, carpentry, auto mechanics and home appliances. I am an expert in the normal function of all those things AND traffic lights. I have not sat for the certification test for any of those things, I am a direct entry expert in normal. ((Sorry, just had to say it))

          • Squillo

            Actually, I think it’s more like a jet pilot claiming to be an expert in normal flight. When all goes well, she flips the autopilot on and strolls around the cabin chatting with passengers, or sits in the cockpit doing a crossword puzzle. But when the plane loses its hydraulics mid-flight, everyone’s f&cked if she doesn’t have the skills to manage abnormal flight. Even if they’re only ten minutes from the airport.

          • suchende

            You’re an astounding moron.

          • Captain Obvious

            Bottom line Christina, OB/GYNs are experts in natural birth and complicated birth. Even if CPM were experts in natural birth, they are clueless about to recognize complications let alone treat them. CPM cannot give epidurals if their patients want one. They cannot place internal monitors, perform vacuum or forceps, they cannot repair third or fourth degree tears, they cannot removed retained placenta or replace uterine inversion or perform cesareans. If you work for a reconstructive expert. Would the two of you start a case that he couldn’t handle any of the known complications that might happen during that surgery? I bet he wouldn’t! But CPM take on childbirth risking mothers and babies lives when they know when a complication occurs (and thy do) they have to transfer care to a real expert, because they are not really experts at all, just birth junkies.

          • Epidurals are administered by anesthesiologists , which lead to vacum and forceps when a baby is no longer an active participant in the cardinal movements of labor. a CPMs knowledge is primarily what if ? What if there is placenta previa? Hemorrhage ? Shoulder dyst?how far are you from the hospital She should always know the position of the baby have oxygen and fetal monitors. We preform out patient and in office procedures. The difference… You don’t do an in office surg with a high risk patient, you also have equipment and qualified assistants in place . With that said the standard should be raised and people need to research their caregivers. Homebirth is not for everyone and should not be approached lightly.

          • AmyM

            You think all births in which the mother has an epidural lead to vacuum and forceps? That is simply not true. Anecdotal I know, but I had an epidural and I felt every single excruciating push. (I didn’t feel pain during contractions…very odd) Believe me, I could feel what I was doing.

            I’ll admit my Twin A was vacuum assisted, but he was malpositioned and his brother was preventing him from moving into a better position. That had nothing to do with epidural—once A was out, B didn’t need any extra help, just a few pushes.

          • Absolutely not but the risk is substantially increased. Congrats on your twins and I wish woman spread the word epidurals dosnt always = painless. Nothing wrong with epidurals home birth is not for everyone .

          • Absolutely not but the risk is increased substantially . Congrats on your twins

          • AmyM

            Thanks! (they are 4 now, and WAY more fun now than as newborns!)

          • : ) I responded below wasn’t sure if you’d see it since I accidentally posted to my name . My hats off to you they are mobile now ha! I once took care of newborn twins overnight to give their mom one night of sleep. What a Challange as soon as one napped off the other woke to feed !

          • Squillo

            What should the standards be for homebirth midwives?

          • Eddie

            What is the value of someone who is only an expert in natural birth? When I employ someone for any purpose, I want someone who is an expert in everything that can go wrong, not just the small subset of how things can go right. Can’t you see how meaningless it is to be an “expert in normal birth”? Especially when normal means very roughly 90% of the time, so that somewhere in the range 1 in 10 to 1 in 15, things go wrong to the point of death or severe injury without medical intervention.

          • The Bofa on the Sofa

            What is the value of someone who is only an expert in natural birth?

            I’ve said it before, it’s about as valuable as being “good enough to sit on the bench for an NBA team.” Oh sure, put me in the game and I am a disaster, but I would be a GREAT benchwarmer. And I will do it for a lot cheaper.

          • Squillo

            Can you define what skills one has to have to be an expert in natural birth?

          • Someone who is trained , licensed and primary goal in practice is in attending birth with minimal intervention and has done so for years. CPMs , nurse midwives , established midwives like ina may ,Obs like dr michel odant in my book qualify . But I’m not the expert. it’s just an opinion that I strongly believe in. My whole point is not all midwives are bad. We live in a society that allows us to make informed choices. Daughter in law of a long line of docs? Ha I like the stretch:) I live under the roof with a doc too & believe me when i say i know it dosnt make me one. I respect that you are an l&d nurse. Have you ever seen a csec scheduled for the convinence of a doc rather than the patient? I hope not but it happens. Now that dosnt mean that all do it but it can give others a bad name. I hope with more regulation of cpms we can avoid these debates because woman will have safer options.

          • Poogles

            “I hope with more regulation of cpms we can avoid these debates because woman will have safer options.”

            CPMs will only become a safer option if they agree to more rigorous education/training, stricter oversight, strict risking-out, and med mal insurance, for a start. I’m not holding my breath, considering most CPMs speak out against these things specifically.

          • I think those are all reasonable

          • Bombshellrisa

            I have never seen a section that was “convenient” for a doctor, but plenty of women have enjoyed the convenience of being able to plan for the care of other children while they are in the hospital, planning meals ahead and having everything ready for bringing home their newborn.
            Ina May invented the CPM “credential”. Despite her cult following and the Farm, she would not be welcomed to attend women or catch babies in the UK, Canada, the Netherlands or Australia (where home birth IS an option within the healthcare system and midwives are the usual healthcare provider for low risk women).
            The goal should be the best possible outcome, not minimal intervention.

          • You touched on a very nice point about overseas. I was born in Europe by a midwife and it’s the obviouse choice to me but in the us the laws very from state to state . I wish there was a better system in place because our current ones are not cutting it

          • Dr Kitty

            And in Europe midwives have proper graduate or postgraduate degrees and would spit on CPMs for daring to call themselves midwives.

            Working in the UK, know of what I speak.

          • Spit on cpms come on now , you have no right to speak for my European midwife .

          • Dr Kitty

            Your European midwife had a university degree.
            CPMs are considered inadequately trained, uncertified practictioners in every other developed nation.
            Certainly the NHS midwives I have spoken to about CPMs are HORRIFIED at the very idea.

          • Bombshellrisa

            Every “training” opportunity I was given to attend births as a student CPM was with traditional midwives or in birth centers where they practiced. There were no opportunities to work within systems where the midwives were regulated such as Canada or Australia (where low risk women are attended by midwives). So, sure, I could go to Indonesia, Vanuatu, Manila or Haiti. Costa Rica even. Me and every other CPM wannabe.

          • Bombshellrisa

            I know a CPM here who was born in Germany, she doesn’t qualify to catch babies there but she can do it here. Her degree in Asian studies sounds impressive but it doesn’t help her critical thinking skills at all.

          • That’s cute but I was referring to actual European midwives ( only the ones I know) practicing in Germany. : )

          • Bombshellrisa

            CPMs are not recognized in every state, CNMs are.

          • I commented on that awhile ago I am aware 🙂

          • Squillo

            What training does it take to do minimal intervention? I submit that the point of training is to be able to recognize when intervention is necessary (or potentially necessary) and to be able to do it effectively.

            I agree that not all midwives are bad; in fact, I suspect that most appropriately trained midwives are competent. I simply don’t agreee that the baseline training and education of CPMs is adequate. Increased regulation won’t change the problem unless it addresses that fundamental problem.

          • suchende

            You’re moving the goalposts. You claimed “very few” OBs have seen a natural birth. Now it’s “some” haven’t. If you have a basic grasp of statistics, it will be very clear to you that most OBs must have.

            I am the daughter of a doctor and a L&D nurse and the daughter-in-law of a long line of doctors. So you’re wrong about my personal exposure to MDs too.

          • Bombshellrisa

            “How many natural births have cpms attended ? Hundreds that just part of their training” Did they tell you that? Because CPMs don’t see hundreds of births in their training, it’s not possible with the way CPM “training” is set up in the US. CPMs learn apprentice style. They follow a midwife or practice of midwives. CPMs usually plan for having 3-4 women due each month, meaning a practice of 3 midwives will see 12 births a month. And the rule for CPMs is 10/10/10 for training (attend 10 as an observer/doula, assist with 10 births and be primary midwife for 10 births). Seeing 100 births can easily take 3-5 years for a CPM even in a busy practice.

            “Obgyns are not experts in natural birth, they will be the first to admit it” Watching a trial yesterday, someone was asked about being an expert in something. She replied that usually to be called an expert in something that requires some type of license. Is there a license to practice “normal birth”? There is a license to provide healthcare to pregnant and laboring women (CNM and OB) and a license to specifically provide care to women’s needs (GYN or an ARNP who specializes in GYN).

          • Eddie

            Hundreds of births as part of their training? You’re confusing CNMs and Ob/Gyns — who have probably observed hundreds of births are part of their training — with CPMs, whose training does not involved even close to that many births.

            Saying that ob/gyns are surgeons is just silly, and this is commonly said, I believe, to discredit the rest of what they do.

            Saying that an epidural has any significant physiological effect on the fetus disagrees with the consensus among those who are expert at it, so you’d better have some very compelling evidence of that. (I have not read in either direction about oxytocin, so I cannot speak to that one.) But it is clearly wrong that the use of oxytocin or epidural REQUIRE further intervention.

            If you are for increasing the standard for midwives, why don’t you just say, “Let’s increase the CPM standard to equal that of the CNM, and merge the two standards so we just have the CNM”? That would put the US on par with the rest of the industrialized world. Why is there a need for an additional standard with significantly less training?

          • LukesCook

            “How many natural births have cpms attended ? Hundreds that just part of their training.”

            You are VERY misinformed. The requirement, according to http://narm.org/req-updates/ is about 50 (over a period of not LESS than 2 years, yegods), 10 of which are observation in ANY capacity, so can include being in the same house as your cousin’s home birth 20 years ago before you even thought it might be nice to catch babies for money.

        • Dr Kitty

          Bollocks.
          I saw natural births.

          Of course, if I was in the room it was because the midwives thought there was a chance it would go pear shaped. Really, there is nothing nicer than being woken at 3am for a possible disaster and then leaning against a wall, chatting with the dad, doing nothing and watching a baby being born safely while the midwives do all the work. Especially when you know the alternative is a dystocia or a PPH or a crash CS.

          The fact that those were the minority of births I was at, and I saw more PPH, eclamptic seizures, cord prolapse, shoulder dystocias and nuchal cords than I want to is apparently irrelevant.

          Look, have you ever seen a chip pan fire?
          If you have, it is in the back of you mind every time you make chips

          • Dr Kitty

            Stoopid Disqus….
            I was trying to say that if you’ve seen a chip pan fire you always have a fire blanket handy when you make chips and you take care not to leave chip pans unattended. If you have never seen one, you’ll fry away oblivious to what could happen.

            Dealing with a chip pan fire doesn’t make you less able to fry some chips, but never dealing with one sure as hell makes you less prepared should one break out the next time you decide to make some French fries.

        • CSM

          I’ve been working alongside OBs for a few years now and I don’t understand how OBs don’t see natural births. Many women come in through the doors and have their babies in L&D, many have epidurals, many don’t. Many have pit, many don’t. Some have sections, some deliver precipitously in triage…the OB on the floor sees them all. Maybe med students don’t see many natural births because they don’t see many births period but if you are talking about OB residents or practicing OBs, I’m confused as to why they wouldn’t see natural births.

          • Poogles

            “I’ve been working alongside OBs for a few years now and I don’t understand how OBs don’t see natural births.”

            I’ve begun to believe that for many who make this claim they are refering to a very, very specific type of birth, not just “unmedicated and vaginal”. It seems the meaning of “natural” birth (or worse “normal” birth) has morphed amongst the hardcore HBers to mean a completely hands-off, no “intervention” birth. So a hospital birth where the woman has an IV (or even a heplock), or has any monitoring at all, even if there are absolutely no medications involved is not considered a “natural” birth and thus they can claim that OBs hardly see (or never see) any “natural” or “normal” births.

            And some, obviously, just really believe that OBs don’t even see your run-of-the-mill vaginal births without pain relief.

          • LukesCook

            I’ve begun to believe that for many who make this claim they are refering to a very, very specific type of birth, not just “unmedicated and vaginal”.

            If it doesn’t have sparkles it’s not a natural birth. Obviously.

        • Bombshellrisa

          “I work in the medical field” Do you know how many people say that to try and lend an air of credibility to what they are saying? There is a CPM in Oregon who worked for years in L&D. YEARS. In the hospital. The “medical field”. As part of the cleaning staff! If you are an OB, you would have said that.
          If a “natural birth” means a spontaneous vaginal delivery, there is no training needed and nothing to learn from seeing one (sorry Dr Amy, I know you had two natural births).

          • Wow ! Part of the cleaning staff? Perhaps my dark skin leads you to jump to that as your first conclusion or you were just trying to be witty because I laughed at your I’m the daughter in law comment . i am one of two primary assistants to a reconstructive surgeon who was the president of the national society for her specialty last year and was a department head for cleveland clinic. I went to ut for my undergrad so am just a nurse but hope one day to be a cnm. I also after ut attended a midwifery program CPM geared 2yrs year round and did a 4 month intensive overseas with an obgyn and a cnm midwife. Am not an expert nor did I ever claim to be. But I have met enough midwives to know that there are some incredible qualified practitioners out there and that not all midwives are bad.

          • Susan

            There seems like there has to be some sort of disconnect here. I am a labor and delivery RN and I just can’t see how someone really can avoid seeing some natural births. At the very least there are always going to be patients who deliver too fast to get any medication or intervention. Where I work I have seen tons of planned unmedicated “natural” births. I sometimes think the definition of natural these people who says OBs never see it must be using is that no OB is there as natural. It’s really sort of ridiculous to me. If it helps .you believe me my daughter was born at home with two CNMs attending. All was fine but after all my L+D experience I chose to have my last baby in the hospital. But it was “natural”, not that I feel one ounce better than my friends who choose an epidural . I’ve met good CPMs too but I am not in favor of licensing them. I can’t justify that the most independent practicioners. working without the checks and balances inherent in a hospital system, be the least educated. There’s every reason to think a homebirth midwife should be the most educated type of midwife not the least.

          • Poogles

            “But I have met enough midwives to know that there are some incredible
            qualified practitioners out there and that not all midwives are bad.”

            The vast majority of the good midwives are the CNMs/CMs, with just a few bad apples. On the other hand, the majority of CPMs are not good, qualified midwives simply because the minimum standards and training are so low that the only CPMs that seem to have any scompetency are ones that way above and beyond in their training, of their own initiative – and they are few and far between. Many of the ones I’ve heard of seem to be going on to become CNMs as they realize how inadequate their training/education still is, even with the extra effort. Since almost all homebirths in the US are attended by CPMs or even less qualified “birth attendents”, this is the problem. Saying that “not all midwives are bad” is sort of missing the point.

          • Box of Salt

            “Not all midwives provide poor care”

            ” not all midwives are bad”

            The fact that you had to use those phrases speaks for itself.

          • on this forum I felt it neccesary but the fact is that there are very qualified competant midwives and some that are not. Its the reality we are dealing with and clearly it needs to change on multiple fronts

          • The Bofa on the Sofa

            You keep saying this as if it is a redeeming feature. You could not be farther from the truth. Not only is it not a positive attribute, it is exactly the problem.

            If you have to defend a profession by saying “they aren’t all looneys, and there are some good ones” then that profession has a serious problem.

          • Bombshellrisa

            ” not all midwives are bad.” They are when they believe drivel like this:
            “As we’moon we have the innate ability to handle any situation. We hold a direct connection to the creator. Our wombs are the gate way to a higher dimension, a higher elevation. We are survivors. We carry with us a gift to the universe, the ability to bear the future. What future are we looking for? Everyday we cultivate the future. We give hope for a brighter day. We birth the future. Our powers will be felt for all eternity. Every day we sing in praises of the great mothers who carried our DNA this far through such harsh times but we still work our work is never ending, we work night and day and night we don’t sleep for even in sleeping we still work. But we must continue to work because if the work stops we stop the Human species stops, every animal stops because we are all connected to the great mothers, we are the great mothers because our children will tell the story of our work. We are the great mothers who have survived to work another day in the name of creation. We the chosen to carry and bare our futures. We are the great mothers. We hold the key.” The people in this particular facebook group are Rowan Bailey supporters, instructors at the Matrona and have articles from MDC as “sources”

          • auntbea

            “We’moon”? C’mon, BSR, stop making stuff up.

          • Bombshellrisa
          • copying and pasting from one site dosent reflect the belief of everyone. It also dosnt draw one conclusion to another. There are wolves in sheeps clothing in every profession. Not all catholic priests abuse boys , that why I argue that the poor actions of one midwife dosnt reflect and represent them all.

          • Bombshellrisa

            But this does reflect what you believe, since you are a part of the group. What is more alarming is that you believe this stuff and want to be a midwife.

          • I want to be a cnm dear. That would require getting my masters is that not good enough for you?

          • Susan

            Christina, when you do get your CNM keep an open mind. Try to look at what you are learning for what it shows, not to try to prove what you might already believe to be true. There are CNM’s who support homebirth, I know some of them. Of course you are correct that there are rogue CNMs and MDs out there who are a disgrace to the profession. The problem, as I see it, is among homebirth midwives there is a tendency to reflexively support anyone who does homebirth. There is a great example here of someone who didn’t do that, Judith Rooks CNM, who took an ethical stand in bringing the terrible homebirth statistics in Oregon to the forefront. Hospitals have all sorts of risk management and quality improvement systems in place. Homebirth by definition has practicioners so autonomous that the bar needs to be set very high to ensure ethical behavior and to make it as safe as possible. Hopefully, as you become a midwife, you won’t decide that you want to do homebirths until you have a reasonable amount of experience to know what an emergency willl really be like at home. The odds of a life threatening emergency that a patient faces are very different than the risks a midwife faces. At some point in your career you will face a life and death minutes count emergency. Where will you want to be when that happens? Will you be able to face yourself if a baby dies a preventable death when you were the one ensuring the safety of the birth?

          • Thank you Susan, I will always keep an open mind .

          • Bombshellrisa

            The education is not the issue, although I can see how it could be assumed that it’s the deal breaker. There are plenty of Masters in Midwifery CPMs who went to school at Bastyr and we all know that the credits there don’t transfer and the degree is to give an air of legitimacy to CPMs. There are plenty of CNMs who went through the schooling, the clinicals and attend births within the hospital who buy into the idea that “birth is as safe as life gets” and believe that it’s a sacred dance. They also believe that doing things as “naturally” as possible is best. So the degrees that they have earned merely make them and their woo more available and make it harder for people to question them. I don’t mind someone who is really passionate about the work that they do, but I want that passion and philosophy tempered with logic and solid scientific evidence along with a huge dose of critical thinking skills. I look back at the things that I wrote about when I first decided to be a CPM (I was 16) and I sounded a great deal like the women in that Facebook group.

          • And, of course, you assume that we are all too dim to figure that out for ourselves. But this isn’t about one midwife, is it? It is about one set of pretend midwives being defended by those who should know better in the interests of promoting their view of their profession at the expense of those they are supposed to care for.

            I find it quite possible to believe that there are ill-trained midwives who are more responsible, intelligent and caring than some of the professionals. A normal birth is not rocket-science and if you do not need skill it hardly matters that it is missing. But it is criminally irresponsible to ignore the occasions when skill and RESOURCES make the difference between life and death.

          • I don’t assume that everyone is “too dim” : ) but that earlier reference plays into a stereotype that’s all. Not everyone that went to the Martona stands behind a previous graduate despite their errors. I think you are under the assumption they do.

          • The Bofa on the Sofa

            We are not under the assumption of anything.

            I’ve said it before, “by your fruits, they shall know you.” And the problem is that silence constitutes approval.

            Where is the outcry against it in the midwifery community? Shoot, the ACNM refuses to even take a serious stand. Where is the press release from the professional associations distancing themselves from the whackos?

            It doesn’t happen. And the reason is pretty darn clear, that they are afraid to criticize the sisterhood. I think it’s because they know darn well that if they are too critical, then people will start pointing the lasers at them, and they are afraid they can’t stand up to it, either. I’d like someone to show me I’m wrong, but for now, they haven’t.

          • That comment was for Lizzie d who made a comment in reference to Martona type people in her “we moon”post.

          • Eddie

            There are wolves in sheep’s clothing in every profession. But most professions don’t circle the wagons to protect them, raise bail money, and so on. In most professions, there is not a “conspiracy of silence” among the people who don’t support the bad actors. Most professions don’t routinely bad-talk evidence based medicine, and instead replace it with “special ways of knowing” and wacko anti-science stuff like homeopathy. These are serious problems.

            To use your example, the reason the Catholic church got into so much trouble was precisely because it hid the evidence of abuse, not because of the existence of the abuse. This is, in fact, a good comparison to CPMs, who try to silence the parents experiencing loss so they can protect their careers.

          • suchende

            Well I graduated from a top 10 law school and I have met enough high school debaters to know that this is not your strength. Save your medical opinions for the OR and stay out of policy, dear.

          • Fantastic then you don’t need to be reminded that an Internet comment dosnt mean I’m contributing to policy but the comparison is cute, dear.

          • NCB and those who push it contribute rather too much to policy. It is convenient to some to grab on to the idea that women do not actually want safe, expensive, proper care and would rather have things all nice and natural. Irrational creatures, women, but let us give the poor dears what they are clamouring for. After all, babies die, and no-one seems to be bothered much.

          • Clearly our current system is falling as woman are so desperate to seek outside of it. Id like to see more of more of what one doc mentioned in a comment in which he stood back and lets the midwives catch the babies and intervens for emergancies only. That option is not available everywhere and it should be. In working together you get the best of both worlds

          • Amy Tuteur, MD

            Our current system is not failing; that’s just another lie that homebirth advocates like to tell each other. 99+% are not choosing homebirth. Homebirth is a fringe practice, and is restricted to privileged, Western white women who have read the natural childbirth literature.

          • Box of Salt

            Christina: re “system is falling”
            Please try proofreading before you hit post. It doesn’t always work for me, but I’ll be able to take your posts more seriously when they’re not riddled with spelling and punctuation errors.

            By the way, “Dr Kitty” (who posted the story to which I belive you refer) is a woman.

          • Box of Salt

            Oh, and that’s “believe” not “belive.”
            I also believe in acknowledging and correcting my errors.

          • Clearly our current system is falling as woman are so desperate to seek outside of it.

            Not really. Not hardly. A very small number of women are desperate to believe there is a safer, nicer, way – but there isn’t. A larger number of women are being brainwashed by NCB into believing that hospitals are bad and dangerous places with nothing to offer and that chasing an ideal birth is a reasonable thing to do. Most still have the sense to use hospitals, but end up anxious. If sane people work WITH NCB, you only get the best of both worlds for a few to the detriment of the many. I am all for women working together to make hospital births better – but first there would have to be agreement on “Better for who?” One that would make the Birth Goddesses happy could well be lethal for others.

          • Eddie

            I’d like to see you elaborate on how the current system is failing. And why does it possibly matter who catches the baby? What non-emergency interventions do you think doctors should not be doing, or at least should offer the mother the option of skipping?

            My wife asked for her epidural, it was not pushed on her. She was induced when labor had not really started, hours after the water broke. We had the option of refusing, and they were completely willing to delay the induction for our convenience for a few hours. They used the vacuum to help when my wife was getting too exhausted to push at the very end. We could have said no to this as well. We had three “interventions” as people count them. At each point my wife could have refused.

            This is in the midwest in a hospital with a lot of upper class customers, so I imagine the hospital is used to catering to their customers. I understand that my experience is not representative of the whole US.

          • Bombshellrisa

            I have no idea what there is about this comment that someone would vote down. I remember the story about your wife, Eddie. IIRC, she had given birth before where epidurals aren’t a routine option (Eastern Europe?) and was thrilled to have the option.

          • Eddie

            Yes, Eastern Europe, a poor country where you get free health care, but the government only covers what it decides is absolutely necessary. By its standard, pain treatment in childbirth is not necessary unless you have certain complications or a C-Section. She told me that there was no treatment that would help the pain of childbirth. When she got the epidural, she got a huge smile and said, “This is nice.” While the US system on net is far from perfect, if you have a decent insurance plan, it is very good.

            My wife’s home country does not do well compared to the rest of Europe in perinatal statistics. Doctors and nurses are so underpaid and overworked that many of them seem to have given up. And I cannot imagine the financial restrictions that are put on hospitals by the government that drive poor outcomes. Different regions of this country probably score differently; my wife is from a particularly poor region. (Which is obviously why she came to America.)

            Although I asked very politely, respectfully, and earnestly, I don’t expect Christina Wicks to answer my questions. While I am sarcastic in some of my posts (don’t I get to vent about anti-scientific nonsense?), I’d hope anyone paying attention would see that I go out of my way to engage people I disagree with respectfully. But I honestly didn’t expect her to respond to my questions. I’d like to be pleasantly surprised.

            (Total aside: My temporary absence from commenting was due to the flooding in the US Midwest. I am grateful that unlike so many, I only got a couple inches in the basement. I hope everyone else out there stayed dry and safe.)

          • Bombshellrisa

            Happy to have you back and yikes, I hope that you didn’t have too much damage. Even a few inches of water can be a nightmare!
            I agree that there are things that could be improved in the US system, but what gets my back up are the trolls who parachute in with lots of passion and very little experience and believe that the system is failing simply because doctors want to make use of modern obstetrical interventions and refuse to just stand by and watch. I have been on BOTH sides, at least now I know what I used to sound like.

          • Eddie

            Lost the carpet and a few items, but nothing of significant emotional value and nothing of significant financial value other than the carpet. Basements in much of the midwest are inherently prone to flooding.

            I agree, it’s maddening to see people reject most of 100 years of medical improvements (and the corresponding increases in safety) based on a combination of woo and misunderstandings.

          • Bombshellrisa

            Reconstructive surgery is an intervention.

          • Odd I hadn’t noticed (sorry I couldn’t resist the sarcasm ) was there a point to that remark.

          • Bombshellrisa

            Yes, but I don’t expect that you could grasp it.

          • Awww no need to get snide. But given my sarcasm, it was fair ms bombshell.

          • The point is not that all midwives are bad- no one is claiming that. The problem is that there is no way to tell the difference between good and bad midwives. The whole reason we create licensing is to insure that all practitioners meet certain minimum standards, and if they don’t, they lose their license and right to practice that profession. Lawyers who lose their law licenses for malpractice or any reason at all don’t practice law anymore. When they’re under investigation, often their licenses are temporarily suspended to protect the public from their potential wrongdoing!

            CPMs don’t do that. They rally around the worst practitioners, even when the malpractice causes permanent injury or death. They set the bar so low that I could literally take an easy online exam, forge one signature, and get a CPM license. I would NOT be qualified to do anything with laboring women, but I’d have a license. And it’s not like midwives are the only option! OBs are good at delivering babies. Think of it this way: There are two piles of pills in front of you. One pile has 1 poison pill out of 100. The other has 5 poison pills out of 100. However, the more poisonous pile is tastier. Which pile do you pick from? Without a way to separate good midwives from bad, one should avoid all midwives, because the risk of getting an incompetent midwife is just too high.

          • the standards needs to be raised for CPMs I agree but you could not just go online and take a test to get your licence without meeting the pre-reqs. With that said, I like your style of writing and you prove very good points. I would love to see a system in place that increased the standard for CPMs . There is a reason that families are seeking outside of the current system of care. I loved the example one doc gave of being available for emergencies/edidurals ect. He stood back and let the midwives catch the babies. If this was available on a wider scale woman wouldnt be so desperate to seek alternatives. If the standard isnt increased for CPMs then let the CNMs take the reins. If you read Dr.tuters words (or just glance at her website) she is on a bit on a smear campain for midwives/homebirths clumping them all into one giant bowl of reckless rubbish. In fact you are one of few, who argue without an extremist tone. I appreciate your imput its like a breath of fresh air.

          • Bombshellrisa

            Well, find some MDs that are willing to back up a CPM run homebirth then, and be willing to stand there and watch “just in case”.

          • you don’t have to pass any test to call yourself a midwife

            So again, the naming, the word, is a problem. Is your midwife one who models herself on the medieval version, when there were no interventions, a midwife did the best she could, that wasn’t very much and nobody was too surprised if it went bad, or the modern version who ought to be able to find someone who DOES know what they are doing, and we can hang on to a delusion that safe is normal, predictable and within your control?

            Would anyone want to choose a barber to do kitchen table surgery? We have made some progress since the middle ages! For women, it came quite late, and we still have some way to go to really have choices. Clamouring for progress to be abandoned seems a bit dim to me. Maybe, if women demanded MORE high tech we could get to the stage where low risk could be more reliable identified, and homebirth might become a better bet.

            The idea that this “wise woman” midwife with her secret knowledge has any role in the modern world is just plain daft. You want a risky birth with an appreciative audience to cheer you on, fine. Just forget safe and take your chances. The real implication is that some need it to feel good about themselves, which is just a bit pathetic really; their fear/dislike of hospitals has got out of control; or they have bought into a pernicious ideology with no basis in reality.

            I can have some sympathy for the second+ mother who had an easy time and comes to the conclusion that birth is no big deal, but it is still a myopic approach. Same with those who are phobic after trauma, though some seem to be traumatised by relatively minor upsets. More than any other ideology, NCB feeds off and needs irrationality, fosters and generates it and betrays all women while pretending to support them. It needs to be relentlessly attacked, deconstructed and ridiculed out of existence.

          • No no you’ve missed the point either increase the standard for cpms or have the cnms do it with an obgyn backing them up as is done in some states (but not nearly enough). I’m not looking at it as one extreme or the other.

          • Bombshellrisa

            I still don’t understand. The standards for CPMs can be as high as for any other profession, who would enforce them? There is a conspiracy of silence when it comes to women and their babies harmed by CPMs. When a mother losses her baby to incompetent care, she still may not make a formal complaint. And she may not be able to speak to her friends or family. Even in the case that this post is about, the “midwife” is getting all kinds of supporting including help for her legal fees. People on Facebook are changing their display pics to a pic of Rowan Bailey and starting groups for supporting her. There is a standard that is being enforced (unlicensed midwife should not be attending a woman at birth) and people are bucking up against it.

          • Also my licensing remark was to feminerd who has better articulated her thoughts than anyone on this feed.

          • Babies die in homebirths because midwives stand back.

            Babies die in hospitals too. And I would very much like to see a breakdown of why. I am fairly certain it happens more often when doctors and midwives stand back than because of interventions.

            Why is this a subject of debate and argument? These facts and breakdowns are the information that women need, not this myth making. No-one wants to dwell on disasters when dreaming of bliss and empowerment. Women don’t need to figure out their statistical risks of every obscure complication – but they do need better information than is currently available.

          • Durango

            But why have a second category of midwife at all? We have highly-trained midwives already. Why all this fuss about bringing up the standards of a second-tier of hcp when we already have properly trained ones? That there are some good ones amongst the bad is not a reason to keep the CPM “credential.”

        • Captain Obvious

          I am an OB/GYN. I have seen plenty of natural births in residency and in private practice. Women come in and ambulated with intermittent monitoring or continuous monitoring without pain medicine and push as they see fit in whatever position suits them. It happens. But this is not what most women want! Most want analgesia. What is your definition of natural birth. In the barn on the floor with candles?

    • It is composed of significantly more joy than loss.

      1. I am sure that is a great comfort to the mothers who find themselves victims of the clueless, and having third world births in the comfort of their own home.

      2. The same is true of hospital births.

      3. Ancient wisdom may be very beguiling when things are going well and these idiots cannot do any harm, it is worse than useless when you are in trouble.

      • Not all midwives provide poor care . People should research thier practitioners

        • Poogles

          ” People should research thier practitioners”

          To a degree, I agree. However, there still needs to be a minimum competency and standard of care for all of the practitioners of whatever type, that people can rely on as being the bare minimum in care they can expect to receive. They shouldn’t have to be on the lookout for things like practitioners who hide and lie about past deaths and injuries at their hands, who misrepresent their skills and/or their qualifications. When someone is unfortunate enough to be the recipient of bad care, even with those standards in place, there needs to not only be a strict, unbiased system in place to investigate the care and deal with the incompetent/negligent practitioner as needed, but their also needs to be a means by which the patient can seek damages commensurate with their injuries.This all already applies to OBs and CNMs, but not at all to CPMs or other “midwives”/”birth attendants”. This is the problem.

          • Squillo

            Yes. If you feel you have to ask how instruments are sterilized and if the midwife has a doppler, that says a great deal about basic standards. BASIC.

          • Basics like knowing no one in their right mind should go 4 days with broken waters. Im sorry but it makes no sence. If people go outside of the system then they understand that risks are involved and its also thier responisbility to go above and beyond to ensure thier practioner meets a standard of care that is above and beyond. So yes basics along with all of the emergency I covered at the very least. Just wish cnms where available across the board or raise the standards of CPMs so that they could attend mothers who opt for minimal intervention. That way people wouldnt be so deperate to seek outside the current system.

          • Squillo

            Do you think most laypeople considering going “outside the system” are equipped to judge if their practitioner meets an appropriate standard of care?

            If so, why bother with any licensing at all? Caveat emptor.

          • Again something needs to change I’m not against licensing as you can clearly read in my comment above.

          • Squillo

            Right. But the license itself has to mean something. The CPM, as it stands, only serves to provide a false sense of security to women looking for a particular kind of care–too often, substandard.

          • Susan

            I agree. And when Christina continually points out that there are good CPMs it proves nothing. When I began working there were still a lot of LVNs doing acute care in hospitals. Some of them were excellent. It didn’t mean that hospitals weren’t correct in requiring all RN staffs. It’s not a perfect analogy but a decent one.

          • Eddie

            If people go outside of the system then they understand that risks are involved and its also thier responisbility to go above and beyond to ensure thier practioner meets a standard of care that is above and beyond

            Part of the problem is that when people go outside the system, they are told by the practitioners that they find that homebirth is “safer or as safe as” hospital birth. This is provably not true, but it is what expecting families are routinely told by CPMs. And as others have pointed out, it is not possible to prove or disprove that any given CPM meets any standard of care that is sufficient. So you are saying, “It’s their responsibility to do the impossible.”

          • Squillo

            Moreover, I suspect that those who do the things Ms. Wicks rightly finds crazy (i.e., going 4 days with ruptured membranes) specifically look for providers who will validate their desire to do whatever they want, no matter how crazy. They then tell themselves, “It’s okay, because this expert says so.”

            You might be able to find an OB or hospital-based midwife who’d say “okey-dokey” to 4 days post-ROM and no induction, but it would be tough. And if it resulted in a bad outcome, you can bet your life that doc or midwife would be called to account for it because it violates the clinical standards that exist for those professions. It’s no accident that clinical standards are eschewed by the professional organizations that serve homebirth midwifery.

        • Bombshellrisa

          But how does one research? Not every state has a website where you can verify the license and even in the states like mine that do, just because there haven’t been any formal complaints doesn’t mean there have not been terrible outcomes. The worst case of obstetrical malpractice in my state was by a practice of midwives (CPMs) who are still catching babies in homes and at their birth center. The “lay midwives” who are “working on their CPMs” are still attending births and collecting fees. How would I research these people? Facebook?

          • suchende

            EXACTLY! You can only reasonably rely on free information and markets to weed out bad practitioners when you have an incredibly high level of transparency.

            If there were hundreds of types of baby formula on the market, some of them deadly and some of them safe, would we accept that people should just research their formula?

          • How many births has she attended as the primary caregiver? where did she do her training ?ask to speak to previous clients, ask around the birthing community , if they are cpms then they should have a plan in place. How far are you from a hospital , how do you sterilize your instruments , do you have oxygen, fetal Doppler , is she aware of the position of the baby at all times? What would you do in the event of a breech? Hemorrhage? Shoulder dyst? Placenta previa? Has she encountered emergencies and how has she dealt with them? And be aware if you choose that route educate yourself. A mother that labors for 4 days with broken waters breaks my heart.How was no one aware ? that’s basics if the waters break you start the clock. Home birth is not for everyone and should not be approached lightly. Look I don’t have all the answers and can only speak for my self.

          • Bombshellrisa

            Previous clients will only talk if they loved their care. I have yet to hear any client ask ANY of these questions. Theoretically these should be things that are talked about. But usually the “plan” goes something like this:
            CPM: we have meds and oxygen, we are current with our CPR cards. The hospital is ten minutes away…
            That is the end of the discussion. Who knows to ask about shoulder dystocia or placenta previa? The women think that they are educating themselves being on MDC and talking to doulas.

          • if people are so nieve to Be satisfied with so little information then are not they also part of the problem?

          • Box of Salt

            Christina,
            before you started posting here 3 weeks ago and again in the last couple of days, did you read the background material about the case described in this post?
            Here’s a link to a news article about the midwife’s recent arrest: http://www.citizen-times.com/article/20130328/NEWS/303280028/Police-Asheville-woman-killed-unborn-child

            Dr Amy has a recent post up about it as well (April 8: Rowan Bailey: the single best argument for opposing NC S107 decriminalization of lay midwifery), which I won’t link to avoid moderation.

            The mother whose baby died under the care of this woman who illegally (under NC law) claimed the title of midwife heard nothing but rave reviews about her (Bailey).

            Caveat emptor does not belong in the medical field.

            If you believe it does, YOU are part of the problem.

            P.S. The word you wanted is “naive.” It’s derived from French.

            P.P.S. “caveat emptor” is Latin. It’s also in Merriam Webster On Line – if you don’t know what it means, you can look it up.

          • Susan

            “Caveat emptor does not belong in the medical field”
            That should be the title of an article about the CPM credential!
            Well said!

          • Haha thank you I did know the phrase which is why I was surprised you have not heard of “hate mail “used to describe something.
            http://www.police.uci.edu/safety/hate_crimes.html
            That link will show an example of it being used .I know it’s modern times so it isn’t always easy to keep up these things
            Also
            http://dictionary.cambridge.org/dictionary/british/hate-mail

            http://oxforddictionaries.com/definition/english/hate%

          • Susan

            Yes it’s modern times. It’s quite a modern trend for people to label a criticism as “hate” instead of addressing the criticism itself.

          • Susan ,there are over hundreds of comments which address the criticism. My observation of the writers tone was mentioned. The reason I continued to mention “hate mail” was in direct response to salty box reader. Salty box claimed that I made up the term and assumed people would not be smart enough to check references.

          • Susan

            Fair enough. There is such a thing as hate mail. I don’t think it’s valid to call what Dr. Amy wrote hate mail though. That was my point. I think you sound a little brighter than the average commenter here and since you are at the beginning of your career, and maybe? on the young side, not having looked at these issues from another perspective might be understandable. I just hope you consider the points being made by the other posters. Most of us are thouroughly familiar with the homebirth advocates perspective, many of us, myself included, originally believed much of what you seem to believe. Have you checked out Navelgazing Midwife? She hasn’t gone as far over to the dark side as I have but has come to many simllar conclusions. She is a good writer.Check it out.

          • I appreciate the reference Susan and am always open to other writers. Dr.Northrups book made quite an impression when I was 18. It was a catalyst for my undergrad at UT, thought I wanted to go to med school. Instead, after UT, I attended a 2 yr midwifery program(CPM) geared. Later I went overseas for 4months under the direction of a cnm and obgyn (catching babies) I entered main stream medicine as a nurse for a family doc and managed his practice (5yrs, Naples,fl). Now I’m in the Midwest working for one of the top reconstructive surgeons in the nation (3yrs). So yes, I am still young in my career. While I find what I do challenging Im eager to grow and learn more. So Bsn to cnm makes sense as the next step. It’s bigger than that, never had I felt that feeling more of ,”this is what I’m suppost to be doing” when I caught my first baby. They call it a calling and believe me it was that. I literally had dreams about the midwifery school I attended months before I visited it. Susan I couldn’t make this up and the details would be shocking. With that said I still stand to learn a lot and my time overseas stays with me until this day. I hope one day to bring it all together and get closer to a profession closer to my heart and not just me head.

          • thank you Susan! I will check her out.

          • Box of Salt

            Christina, read my link to the newspaper article. Then answer the questions I posed to you 3 weeks ago (asked again, below)

            I’m not going to look at your links to the dictionaries, because I’m pretty sure that I have a better understanding of language, including spelling and grammar, than you have shown us so far.

            You are waging your argument here in support of those midwives who, to paraphrase own words, “aren’t bad,” on blog post about a case of clear negligence, which resulted in criminal charges. So I’ll ask you again:

            Do you honestly think that this story (related in the post above) represents a superior standard of care?
            If not, why are you so vehemently defending it?

            And a new question: why do you think this post is an appropriate place for you go on and on in support of a craft whose practioners condone negligence?

          • Absolutely it does not represent a standard of care! I find any woman laboring for 4 days with broken waters grossly negligent (I have mentioned this many times in previous comments). No need to click on my links are you seem to believe your grasp of the language superior to Cambridge and Oxford dictionary. I’ve explained I do not defend this one particular midwife but instead have suggested standards be raised for cpms, and cnms attend birth on a wider scale. Also, (gasp) I dare to say not all midwives who practice are negligent. For the record, I’m not alone in that belief. Finally, writers like yourself as well as more eloquent writers like “feminerd”,”dr.kitty”, and numerous others have responded to my comments enclining me to “go on and on”. They did not seem to think opinions different from theirs have no right to be expressed in this forum. In fact, they were gracious in their exchanges.

          • auntbea

            You claim that you only want to point out that not all midwives are negligent. So, fine, not all midwives are negligent. What is it you want to happen as a result of pointing this out? I realize this sounds snarky, but I am honestly interested in what you are trying to accomplish. Do you just want to have an argument? To have Dr. Amy stop posting about midwives? It would really make this whole conversation a lot easier.

          • Eddie

            Your first link to a modern usage of “hate crime” refers to the law. In the law, if a “protected group” is not referenced, it is not a hate crime. Midwifery is not a “protected group.” Quote: “motivated by a victim’s race, ethnicity, gender, national origin, religion, disability, or sexual orientation.” Midwifery does not fall into any of those categories. (The closest would be a religion.) Therefore, it is not technically possible to commit a hate crime against the group of midwives.

            The second and third definitions you reference are very weak and not representative of the real meaning of the phrase. They do represent some vernacular usages though, via hyperbole. Just as it is common to reference as “hateful” speech that is merely critical or sarcastic.

          • Bombshellrisa

            I think that they believe reading the popular books by people like Ina May are an education. If the general idea is that complications are rare, these complications start to present themselves slowly and boldly and a midwife can spot them and treat them, then why would anyone question what is being said? Seriously, how many of the women you saw during your CPM intensive knew to ask about shoulder dystocia? How many said anything about placenta previa? If a midwife tells you to trust birth, but don’t worry she is trained in infant CPR and carries oxygen and the hospital is ten minutes away, for MOST women that is as much as they want to talk about the possibility of something bad happening. My preceptors ran a birth center that is very close to a hospital that has an amazing birth center with CNMs and MDs who are skilled and well known, also one of the best NICUs in the area. The women who birthed at the CPM run birth center believed (because the midwives never corrected the assumption) that if something went wrong that they would be whisked to the hospital that is less than 5 minutes away. Until they found out (usually mid crisis) that the midwives don’t like to transfer patients to that hospital as they perceive the staff there “hostile”. The CPMs prefer the hospital that is farther out, down the freeway, over the toll bridge that is always clogged with traffic.

    • Eddie

      Midwifes are like mds , in that …

      Sorry, I just have to interrupt there. Midwives are nothing at all like MDs, with the exception of CNMs. I do agree with your point, that there are good and bad of any kind of career. But — in America — midwives are nothing whatsoever like MDs. Again, I’ll except CNMs who have actual medical training and college.

      she clearly does not trust in my abilities as a birthing mother to do what we have always done

      Tell me, do you have any clue what the death rate of babies and mothers was before modern medicine? I’m not talking about hundreds of years ago. How about just before World War II? Compare and contrast to now.

      Tell me dr t if our standard is so superior why are we USA an industrialized nation rated so high for infant mortality

      The answer is not simple, but in part has to do with the greater poverty and diversity in America. Also, most other industrialized nations have government-provided health care, meaning ALL mothers have access to first-class prenatal care and don’t have to worry about the cost of medical interventions if any are needed. Also, the infant mortality rate in the US is not as high as you think, even though it is higher than that of some other industrialized nations.

      • Poogles

        “Also, the infant mortality rate in the US is not as high as you think, even though it is higher than that of some other industrialized nations.”

        Not to mention that infant mortality is the WRONG statistic, as it includes all deaths up to 1 year of age. Perinatal mortality tells us about care during birth, and the US does fairly well there, though not as well as some other developed countries for the reasons you’ve mentioned above.

  • Let’s see. Considering that the U.S. is one the most UNSAFE places to give birth, and that technological interference with the birth process is directly responsible for the ridiculously high levels of infant and maternal mortality in this country, I’d say you had better get that uneducated chip off your shoulder and stop harping on 3 homebirth deaths — especially when compared to the thousands of women and babies that are dying every year because of hospital birth. AND, the question about circumcision is a good one, since approximately one baby dies every other day in the U.S. due to this ritual sexual torture and genital mutilation, which OB’s like yourself seem to have no problem “performing.” And if you are one of those who use your “skills” to sadistically mutilate the genitals of an innocent infant, then don’t you dare sit in judgment of those who have a deep spiritual understanding of the birth process and who would never do harm to an infant.

    Should you like to educate yourself, instead of shooting off your mouth about things you do not understand, please check out this link on maternal mortality in the US: http://www.newsregister.com/article?articleTitle=danger+in+delivery%3A+despite+technology%2C+u.s.+trails+entire+western+world+in+saving+mothers–1326911281–2454–home-news

    And this one on infant mortality in the US: http://en.wikipedia.org/wiki/List_of_countries_by_infant_mortality_rate

    Clearly, hospitals are NOT safe places to give birth and, on the contrary, they are the most dangerous.

    • Amy Tuteur, MD

      Yet another homebirth advocates who has no idea what she is talking about. Infant mortality is a measure of pediatric care. The correct measure of obstetric care is perinatal mortality and according to the WHO, the US has one of the lowest perinatal mortality rates in the world.

      But of course you wouldn’t know that since you live in the homebirth echo chamber where ignorant people repeat lies to each other and pretend it is the truth.

      • Betty

        Dr. Tuteur, allow me to say that I’m really put off with arrogant, know-it-all MD attitude! I go on record as making comments in the Asheville Citizen-Times as not being in favor of this Rowan Bailey at all – I think she was incompetent and should be charged. That doesn’t mean that I think all midwives are incompetent any more than I think all MD’s are competent. If I were having a child, I really don’t think I’d want someone with your attitude to attend the birth. I think the truth lies somewhere in the middle on this issue and neither you nor Rowan Bailey represent that middle ground.

        • The Bofa on the Sofa

          Dr. Tuteur, allow me to say that I’m really put off with arrogant, know-it-all MD attitude!

          So explain how she is wrong?

          I think the truth lies somewhere in the middle on this issue

          “The truth” is not decided by popular vote of random people, so what you “think” is not all that relevant, is it?

          (to be fair, neither is what I think – I am also a lay person in this regard)

          • Betty Dishman

            I am NOT a troll – I’m just pointing out that while lay people may not know everything, the medical establishment doesn’t either. This MD is unbelievably arrogant. I wouldn’t go to her with anything!

        • Bombshellrisa

          Another tone troll who wants everyone to meet in the middle.

    • Box of Salt

      Jeanice Barcelo,
      your first link goes to the comments which require subscription, and don’t link back. Could you repost a link to the actual article?

      Your second link shows the US in same dark blue low infant mortality category as Canada, most of Europe and Australia.

      What were you trying to prove?

    • suchende

      lol you’re a moron.

      “Considering that the U.S. is one the most UNSAFE places to give birth, and that technological interference with the birth process is directly responsible for the ridiculously high levels of infant and maternal mortality in this country,”

      Please come share your wisdom with my friends working for UNICEF, WHO and third world hospitals and clinics. With all the death and birth injuries they see, they need a laugh.

    • Bombshellrisa

      “those who have a deep spiritual understanding of the birth process”
      I prefer those who have an education about the birth process and the skills to deal with it when it goes “naturally” (meaning when the sh*t hits the fan, since it’s well proven that nature is a bitch).
      And by the way BINGO-quotation marks, “educate yourself”, “high mortality rate”, “babies die in hospitals too”. I wish I was getting money for this pile of bingo cards the trolls are helping me fill up.

  • Mindy McCormick

    1 out of 160 pregnancies result in stillbirth in this country. I had my baby at home with a traditional midwife and do not consider myself an idiot. I weighed the risks of home and hospital and opted for home, knowing an ambulance could reach my house in ten minutes. My home is free of hospital germs and doctors and surgeons who may have more stock invested in their weekend plans than my birth outcomes, hence the large C-section rate in this country. I think women are not trusted with their own bodies in this country and it terrifies me. There needs to be a merging of western maternal healthcare with midwifery traditions that honor the birthing process. I am not making light of the life or death stakes of birthing, rather it is with compassion and reverence toward life that I wish for a healthcare system that treats women with integrity and grace during their most life changing experience. My heart goes out to the families who have lost their children.

    • Amy Tuteur, MD

      But this was not a stillbirth; it was an intrapartum death. The risk of intrapartum death in US hospitals is 3 in 10,000 and most of those are premature babies, babies with anomalies, and babies whose mothers have severe medical complications.

      The death of a a term baby in labor at a hospital after starting labor alive is vanishingly rare. The death of a term baby in labor at homebirth is appallingly common.

    • suchende

      “knowing an ambulance could reach my house in ten minutes.”

      If your midwife didn’t have privileges at the hospital that was 10 minutes away, this statement is totally meaningless.

    • Bombshellrisa

      ” knowing an ambulance could reach my house in ten minutes”

      That is a very small part of it. A ambulance can reach you but then they have to assess you, get you stabilized and onto a stretcher and then make the journey to the hospital. The process is more like 20-30 minutes plus travel time to the hospital.

      “doctors and surgeons who may have more stock invested in their weekend plans than my birth outcomes” Not more than homebirth midwives, who often leave laboring patients to do things like shop or attend to other laboring women, some times driving hours to get to those other women.

    • bobtheplumberable

      I look at it this way… if you don’t want the hospitals help giving birth, then you don’t NEED their help if something happens and the baby goes in to distress… HARSH I know, but I feel there’s no other way to get it through your thick skulls that home birth IS DANGEROUS. You have this idiotic idea in your head “well if something goes wrong the hospital is close” .. which is what keeps you idiots doing this! MAYBE if hospitals started turning these home birth hippies AWAY when something went wrong, MAYBE then you would stop doing it. It’s not even about what’s best for the baby is it? I see so many videos of home birth online (Yeah if you put it online, it was me bashing you) and so many of the comments are “Such a strong momma!” .. THATS WHAT ITS ABOUT ISNT IT!! It is a selfish move. It’s all about YOU and what YOU want because if you wanted what was best for the baby, you would give birth in a hospital so that the baby would have a fighting chance if something went wrong during birth. YOU CARE NOTHING FOR YOUR CHILDREN if you give birth at home. ITS ALL A SHOW FOR YOU. It’s you, saying “look at me! I can do this with out help!” Maybe, just maybe, you people will quit reading blogs, read real research and smarten up, because you never think it will happen to you, and honestly, I kinda hope it does. ITS TERRIBLE for me to have to say that, but nothing else WORKS. A dead baby is what will smarten you up, and that is the saddest part of all.

      • The problem with that is that a dead baby doesn’t always smarten them up, and that said dead baby is a lost life, a lost person not a teaching aid.

        When one reads of someone taking a suicidal risk to demonstrate how natural and unproblemmatic birth can be, how empowering, how trust is rewarded then it is quite difficult not to feel ambivalent – when things do go well against the odds (or at least can be made to look as if they went well) then it is exasperating to see these dangerous fantasies reinforced, but when they go badly it is just as difficult not to be appalled and saddened at such folly, and the distress that goes with it.

        There really isn’t much that can be done about the women where it really is all about them, and the baby is an abstract notion of seemingly little relevance – but those who are brainwashed into believing the lie that it is about the baby are a different matter.

        • bobtheplumberable

          LIzzie, have you noticed these “mothers” are the first ones to scream “Sheeple” at anybody who disagrees with them on the unassisted home birth bs…. but think about it.. WHO IS REALLY THE SHEEPLE? They are…

    • Captain Obvious

      “Hospital germs”, you do realize that the hospital germs you speak of are germs like MRSA that can be colonized on nearly 15-30% of the general population. So if these carriers come to your house to visit you during or after delivery you could still get exposed to these “hospital germs” that you speak of. The hospital as a building doesn’t carry MRSA or VRE, it is the people that are in the hospital. So your smoker uncle or elderly grandparents might already have exposed your baby with these germs. Did you have everyone wash their hands for three minutes with hospital grade antiseptic soap or sanitizer before you let relatives touch your baby?

  • Marcy

    you are a truly evil doctor. Clearly this midwife was incompetent, but you are evil.

    • Gene

      Evil for pointing out incompetence?

      • Squillo

        Yes, because G-d forbid anyone should actually talk about dead babies and incompetent midwives. Far, far better to just ignore it and let them go on killing babies because it makes people like Marcy feel uncomfortable when you mention it.

      • I don’t have a creative name

        Yes. It’s not evil to raise money for homebirth midwives who kill baby after baby after baby after baby, but it IS evil to criticize them. Haven’t you learned that yet?

  • Amy Tuteur, MD
    • I believed that I would birth with grace and ease. (That unfortunately was not the case for me.)

    • this link does not work.

  • Anonymous Coward

    Three wonderful home births here… the third being unassisted. ; )

    • mom4474

      I guess I’m glad you had “wonderful” experiences, but I don’t understand the point of your random comment. As I’m sure you are already aware, there are a ridiculous number of pages that you can go on and your “accomplishments” will be met with cheers and applause. This page, not so much. Fine, I’ll meet your random comment with one of my own: “Three wonderful c-sections here…and now I’m a mom (which is why I had children in the first place, not to have an experience that I can brag about). When women start looking into homebirth, most of the sites they come across only talk about the positive experiences. This site shows them that there are risks they should be aware of before making a decision. Honestly, I feel like your comment is an attempt to disregard those experiences because your experience was successful. Your good experience has nothing to do with the article. People need to really get over themselves.

    • suchende

      One glorious hospital birth here! I don’t believe in risking my child’s life for a stunt birth, but I am sure that is what worked for your family!

    • Two perfectly acceptable hospital births here, which would have been almost impossible at home – because they were c-sections.

      I paid for the hospital ride and I rather enjoyed it. (Recovery needs to screen movies.)

      • Amazed

        Different colour of nail polish at each finger here! All bright and imbued with spring. Yes, people stare. Yes, it is not a classical approach. Yes, I say “Look at me, look at me, look at me, it’s spring and I am so happy.”

        The difference? If something goes wrong, I can simply remove the polish. No one’s life and health on the line. No woman’s. No babies.

        And yes, sometimes homebirth death is no fault of the midwife. Just the location. I am, sure the many grieving mothers find comfort in thinking that their baby might have lived if they had had the equipment and team at hand.

  • disbelief

    I can not believe the insensitivity from this author, doctor, supposedly healer? I lost a bay in home birth 13 years ago, and do not fault the incredible kind and competent midwives…I would never have allowed you, and such insensitivity into my family’s experience!

    • Poogles

      I am sorry for your loss.

    • suchende

      Question: if it were the homebirth that was responsible for your child’s death, would you ever be able to be rational enough to admit you yourself and others that your child would have survives in a hospital?

    • Box of Salt

      Insensitivity to whom? Did you miss:

      “His death was reported to me by a grieving family member”?

    • bobtheplumberable

      Maybe you should have given birth in a hospital. More likely the child would have survived then.. if you don’t blame the midwives who attended your birth, the only person LEFT to blame is yourself.

  • Rebecca

    Interesting that Amy didn’t answer the question about unnecessary genital cutting of non-consenting minors. (Violation of your oath)

    • Box of Salt

      Perhaps she didn’t answer the question because it’s not relevant to the topic of this blog post. Try the Search box for posts that do cover that topic.

  • How many babies die in hospitals in ND each year? I have a feeling it’s a bit more than 5…I have a feeling it’s a higher percentage than those who die in home births, too.

    This midwife made a horrific mistake and should have gotten help sooner. There are plenty of doctors who make horrific mistakes, too…which is why so many people are turning to home births.

    • Absolutely more babies die in hospitals than in homebirths, because many more babies are born in hospitals than at home. Also, hospitals handle high-risk pregnancies all the time, where deaths and injuries to both baby and/or mother are more likely.

      Your feeling on death rates, however, is wrong. Read this site a bit more. Dr. Amy has a lot of posts comparing the rates of both mortality (death) and morbidity (injury) in only low-risk hospital births, all hospital births, and homebirths (which are supposed to be low-risk only). Mortality in homebirth is at least 3x that of all hospital births, which includes high-risk pregnancies. Some stats, like in Colorado, suggest it might be closer to 8-10x. Either way, homebirth is straight up less safe than hospital birth.

      • The trump card that NCB likes to play is that hospitals can be dangerous, unpleasant places, and that sometimes (but not all that often in obstetrics) people die BECAUSE of hospitals. I think that is an atavistic fear, but an understandable one. (Especially in the UK right now, where people are dying of neglect.) My view is that if there are avoidable disasters with babies, the cause is the general and unfounded belief that because birth is now safer, it is safe.

        One of the things that was better for my daughter was the availability of day clinics, where a worried mother could just turn up and ask for a non-stress test. But, in her case, then get sent home by the midwives with sky high blood pressure on the grounds it was nothing to worry about. (Variation of normal).

        It doesn’t have to be the wonderfulness of hospitals v the wonderfulness of home. What is needed is indeed for women to be informed – properly informed from the standpoint that birth IS safe most of the time, but women may well need to be a lot more aware when it starts to get less safe.

    • Poogles

      “How many babies die in hospitals in ND each year? I have a feeling it’s a
      bit more than 5…I have a feeling it’s a higher percentage than those
      who die in home births, too.”

      Luckily, we don’t have to rely on our “feelings” for this type of information, we can look at the actual numbers. And the numbers do not agree with you that a higher percentage die in the hospital (quite the opposite, a much higher percentage die at home).

      • Dont BS me.

        You just told a lie.

        • I don’t have a creative name

          Oh? Please show us the statistical data that shows that a higher percentage of babies die in the hospital. Go ahead, I’ll wait. Even with all the premature and gravely ill babies born there, the homebirth death percentage is STILL higher. So you can call “lie” all you want. You have no proof because the truth is not on your side.

  • marylanser

    wow! How many births ended badly in any given hospital a year? Unfortunate things happen even in a hospital. But my question is this: How many unnecessary infant genital alteration surgeries do you do in any given week? Tell us why when infants die following a circumcision…..it is always due to “complications” of …. and NOT as a result of unnecessary genital surgery? How ethical is it for doctors to perform non therapeutic genital surgery at the proxy consent of the parents? Foreskin is NOT a birth defect in need of surgical amputation. How many parents are told of the normal functions of the penile foreskin and that it is a normal part of their babies anatomy???

    • itry2brational

      Mary, can you explain how circumcision affects this case? I don’t see it referenced anywhere. The *rate* of births “ending badly” is the statistic you’re looking for. I think Dr. Tuteur has written several articles comparing those rates. You might be surprised by what you find…assuming of course you take the time to look.

    • Poogles

      “But my question is this: How many unnecessary infant genital alteration surgeries do you do in any given week? ”

      See that little blurb at the top right of the page, under the heading “Amy Tuteur, MD”? It says right there that she is retired, meaning she does 0 surgeries, of any variety. Do your “research”, LOL 😉

  • Pingback: Cyprus Photographer()

  • Pingback: discounts()

  • Pingback: yepi 250()

  • Pingback: admin discussion()