Yes, it is your fault that your baby died at homebirth

There are so many homebirth deaths occurring that I am having a hard time keeping up. I originally planned to blog today about the recent homebirth death in New Jersey attended by a CPM who had already had her license revoked. I’ll need to save that one for another day.

I came across the story of this homebirth death because of a post entitled, The MOTHER of all posts: IT’S NOT OUR FAULT.

Her heart rate was monitored closely with consistent reassuring heart tones the entire time. At the point when she was crowning … we were still getting a steady, consistent heartbeat. I pushed for a reasonably short amount of time and delivered her without the need of an episiotomy … and I only tore minimally not requiring stitches. She was born and had already passed, the cause of which we can only conclude was having suffered a cord accident in the last moments of birth. She received immediate emergency care but was unable to be revived.

The stories are sickeningly familiar. The blog detailing the mother’s commitment to unmedicated childbirth as “healthier”; the death that supposedly took place in the moments before birth; the clueless midwives who had no idea that the baby was dead; and the link to site where donations can be made to cover the cost of the funeral.

The mother is livid that someone chose to mention that it was her decision to have a homebirth that led to her daughter’s preventable death.

I received a comment on my blog yesterday. Completely, off the topic of the post it was attached to. Unrelated. Here is what it said:

Knowing that this was a “home birth” and that you have NOT once mentioned home birth in all the blog entries that you have written…I would like to just say one thing, that “women who give birth at home trade the “birth experience” for “safety”. There are “risks” with both home birth and hospital birth, but I can’t understand why anyone would want to sacrifice safety for experience…just saying!

… We are devastated by the tragic loss of our baby girl and this judgmental, hateful “anonymous” has the audacity to tell us it’s our fault…

If this person believes we are responsible that’s one thing, but to point their finger at grieving parents in the midst of our immeasurable pain, something this individual could NEVER understand, and try to shame us and blame us by telling us our child’s death is our own fault is disgusting. What type of human being could sink so low? How revolting can someone really be?

What type of human being? The type that cares that babies are dying unnecessarily.

One of the delicious little lies of the homebirth movement is that women who choose homebirth take responsibility for the outcome. The hell they do.

They blather on about being “educated,” about doing their “research,” about ignoring the advice of obstetricians, family members and friends. They insist they understand the risk that the baby might die … right up until the moment the baby dies.

Then they blame God, the universe, fate, anything else but themselves, the people actually responsible for making the choices that led directly to the death of their babies.

Hey life, universe, god or whomever it concerns,

I’ve got some questions for you.

I’m suppose to be celebrating the birth of my baby girl right now. Snuggling her, holding her and kissing her. Why am I planning a funeral?

She was healthy, strong and perfect, why couldn’t she survive the last moments of childbirth?? Why wasn’t my body perfect for her exit? I TRUSTED it. I trusted you.

No, you didn’t trust life, the universe or god. You trusted YOURSELF to know better than medical experts.

Who made the choice to deliver at home, far from emergency equipment and personnel? The homebirth mother. Who made the choice to hire a substandard practitioner? The homebirth mother. Who chose to ignore the medical advice of obstetricians? The homebirth mother. Therefore, who is responsible for the death of a baby that could have been prevented by obstetrical interventions provided by legitimate obstetrical providers in a hospital? Who else but the homebirth mother?

Saying that the homebirth mother bears responsibility for the death of her baby at homebirth is not incompatible with feeling sorry for her loss. It’s no different than grieving for a child who went through the windshield and died because her mother didn’t buckle her into a carseat. That mother is no doubt devastated, and no feeling person can failed to be moved by that devastation, but that doesn’t change the fact that the mother, through her action or inaction, is ultimately responsible for the death.

It is all so damned repetitive:

• The claim of being “educated”:

We researched for months, we read all the information we could find, we learned from every source out there. Our midwives educated us but never pressured us or even encouraged us to give birth at home.

• The claim that the midwives were not at fault.

Our midwives closely monitored the entire pregnancy… The attention, genuine concern and high quality care we received from these three amazing women (and EVERYONE who worked at the midwifery practice) was incredible…

Incredible? That’s not how I would characterize midwives who didn’t know that the baby was in distress until it dropped into their hands already dead.

• The pathetic assertion that the baby received the same resuscitative measures that would have been available in the hospital.

Could she have been revived if she were in a hospital? The same procedure that would have been made to attempt to resuscitate her in a hospital WAS MADE for Aisley.

No, the same resuscitative measures were not used. There was no expert resuscitation with intubation.

• The insistence that it is no one’s fault.

It was an accident that she died. Accidents occur in hospitals as well. The risk of infant death in a home birth is less than 1%. It was an unforeseeable tragic event. Would anyone blame a mother in a hospital for being responsible for her baby’s death? How dare anyone blame us!

How dare they blame you?

YOU are the one who chose to give birth far from emergency equipment and personnel. YOU are the one who insisted that you were “educated” about the risks of homebirth. YOU are the one who chose midwives who were so clueless that they didn’t even know that the baby died during your labor.

When a baby dies at homebirth, those who warned you are entitled to say “I told you so.” What happened to your daughter is precisely what those who warned you were afraid of. They did tell you so; you chose to ignore them. YOU were the one who made the decisions and therefore, YOU are the one who is responsible.

  • Nova

    Amy,

    You are so harsh and cold, no woman in her right mind would want you in the room while giving birth – be it a hospital room or a room at home.

    • Nova

      Furthermore, your sensational language undermines any validity you may have had.

  • Captain Obvious

    CEFM was originally hoped to decrease CP. it hasn’t. It has led to more interventions and cesareans. BUT, it has significantly decreased intrapartum stillborn and neonatal seizures. Wouldn’t you agree that is important. I would allow a vacuum delivery or cesarean instead of having an intrapartum stillborn or a baby on phenobarbital. But you go ahead and be gullible and believe the woo hype.

  • Nicky Pemberton

    Thank god that people would never dare speak their minds, in public, with so much venom, cruelty and lack of compassion as they have done here on this blog. Safely hidden behind their computers, people let loose the nastiness that they secretly harbour against one another and their intolerance for points of view that differ from their own. The internet has definitely created a platform for people to express themselves freely. Let’s remember though that we are human beings and its cowardly to hide behind usernames and slag eachother anonymously. We need to evolve past primitive emotional reactions and find some integrity in our expression. After reading this entire blog, it’s so obvious that some of these bloggers take a sick pleasure in writing their cruel comments. Crude slags at a woman who just lost her baby disguised as concern for innocent infants? Who are you fooling here? A pretty sad state of affairs is an understatement.

  • Nicky Pemberton

    The risk of AROM (artificially rupturing membranes) isn’t in causing a vasa previa but I understand what you mean. If the AROM is performed before the baby’s head is low in the pelvis, the umbilical cord may become trapped in front of the head, cutting off the oxygen supply to the baby. Impatient OB’s that perform premature AROM’s are negligent and this problem does contribute significantly to hospital morbidity as a STAT C-Section will be required and that carries it’s associated risks, not to mention the potential risk to the baby of asphyxiation due to the cord compression.

    • Captain Obvious

      Nicky, again your ignorance is showing. If a vasa previa is present, performing an AROM may rupture a vessel coursing over the area of membranes in front of the fetal head. Of course AROM doesn’t cause a vasa previa. Read and understand before you comment. And for OB eating mama, if a vasa previa is present, when SROM occurs, what do you think is going to happen? The membranes are going to rupture, en caul is vary rare. Hemorrhage from vasa previa from AROM or SROM is almost a certainty. You picked a bad example. Some vasa previas can be detected by ultrasound visualizing Doppler vessels near the cervix, or by pelvic exam feeling a pulse in the membranes in front of the head. The woo genenerally discourage ultrasounds and pelvic exams so a doctor is more like to find and prevent a catastrophe from a vasa previa than a Homebirth midwife.

      • Nicky Pemberton

        Captain Obvious, “your ignorance is showing again”?
        Can people not have a decent discussion here? Again,
        slagging somebody under an anonymous username is cowardly.

        • Wren

          Perhaps if you hadn’t come in with insults and false assumptions you would have received a warmer welcome?

          • Nicky Pemberton

            Perhaps, but I don’t see a lot of warmth or welcome towards anyone here which why I’m signing off this forum.
            .

          • Susan

            Gosh, someone who posts here often just had a baby and the lines of congratulations warmed MY heart and I have never met her. Once in a while someone with a different opinion on the issue at hand comes in and is intellectually honest and polite; I don’t think those people would say they felt unwelcome or that the regulars lack warmth. It’s a smart group overall and what I most enjoy is if anyone, including myself, says something foolish they are called on it, and I have been from time to time. There are lots of people who post here that disagree with Dr. Amy on some point or another. What’s nice is she’s a grown up and so are we and we can deal with being confronted on issues. It’s healthy.

  • Nicky Pemberton

    It’s quite possible as well that Dr. Amy Tuteur is not who she says she is. I’ve never heard an OB speak so misguidedly or vehemently.

    • Wren

      Many attempts have been made to discredit her, but claiming she isn’t who she says she is, after years of running this blog, speaking in public and being involved in other skeptical blogs is a new one to me. It is quite possible that you made a completely ridiculous suggestion without the tiniest bit of evidence or research behind it.

      • Nicky Pemberton

        Yes, I realize that. After I posted that comment, I did do a short search and from that, she seems to check out. I was just so shocked by her commentary, I thought “how can this be?” but you’re right it wasn’t based on any evidence or research and I admit that fully.

        • Karen in SC

          Because of very vocal midwives and the lies they spout about how homebirth is safer than the hospital. In many cases, they even psychologically groom the parents so any tragedy, those grieving also take on the guilt, or ignore the incompetent care. (see above post)

        • Captain Obvious

          You sure do post a lot of comments, then do your research to find out you were wrong. Why don’t you try it the other way, read a little more then post.

          • Nicky Pemberton

            Thanks Captain OBVIOUS!! Lol!

  • QB

    Excuse me, Miss Amy, without the slightest intent of disrespect, I ask are you aware of the recent study of home-births? According to a new study, babies born from low risk mothers are no more or less likely to die in a home birth than low risk mothers in hospital births. With that being said the grieving mother whom you are condemning was no more inclined to have a living baby in her arms if she had delivered at a hospital. I hope you realize how vile and cruel you are being blogging hate to a mom who lost her baby.

    “Conclusions Planned home birth for low risk women in North America using certified professional midwives was associated with lower rates of medical intervention but similar intrapartum and neonatal mortality to that of low risk hospital births in the United States.”

    http://www.bmj.com/content/330/7505/1416

    In addition, I would also like to point out how TINY the absolute risks are for babies of low-risk mothers dying at all, in your outdated study that has been replaced. The risks in that particular study were ~0.7% for hospital births and ~2.1% (that’s 0.021 or 21/1000, ma’am) for home births. That means in every 979 (nearly a thousand) healthy happy babies only 21 (less than 30) passed away (In that study however). The authors of the study explained that because the risks are so small, it fluctuates between values of 1 to 3%, therefore, direct comparisons between the values are not appropriate.

    Can you please explain what is your bitterness about women teaching their newborns to use the potty so they won’t have to sit in their own stool, having them at home in the intimacy and privacy of family into a warm quiet familiar environment they were aware of as preborns, being healed with the herbs from the earth, or being breastfed extensively and/or with a younger sibling? Why does this disturb you when it does no harm, makes little ones happy, and welcomes a child into the world in love and deep consideration (as you implied, BFing is indeed hard). Why does nature disgust you, so much? It just doesn’t make any sense… Please explain.

    • Amy Tuteur, MD

      It’s not a recent study and it ACTUALLY showed that homebirth with a CPM in 2000 had a death rate 3X higher than comparable risk hospital birth in the same year. The authors have publicly acknowledged that they did not compare homebirth to hospital birth in 2000, but instead to a bunch of out of date papers extending back to 1969.

      Moreover, Ken Johnson failed to disclose a major conflict of interest. He is the former Director of Research for MANA.

      The paper is a piece of junk designed to fool the gullible, and apparently that means you.

    • The Computer Ate My Nym

      That means in every 979 (nearly a thousand) healthy happy babies only 21 (less than 30) passed away

      No, it means that for every 21 babies who died, 979 survived. Not necessarily happily or healthily. A baby with anoxic brain damage due to prolonged second stage which is severe enough to cause learning defects or cerebral palsy or even persistent vegetative state will not be among those 21 who died, but they will certainly be damaged by mismanaged delivery. Mortality is only the tip of the iceberg.

  • QB

    Is it my sister’s fault her baby died in a c-section?

  • Sad Dad

    This just happened to my son Isaac, I was scared but my wife and the midwife reassured me constantly it was safe, got to the hospital too late, RIP Isaac July 2, 2013

    • The Bofa on the Sofa

      Oh how awful :(

    • S

      I am so very sorry.

    • yentavegan

      I am so sorry for your loss.

    • Bombshellrisa

      I am so sorry

    • Jocelyn

      I am so, so sorry.

    • Susan

      I am so sorry about the loss of your son.

    • fiftyfifty1

      Oh Sad Dad, I am so so sorry for the loss of your son.

    • Squillo

      I’m very sorry for your loss.

    • Box of Salt

      I am sorry for your loss.

    • Amy M

      I am so sorry to hear of your loss.

    • I don’t have a creative name

      This just breaks my heart. Yet another casualty of the NCB lie that tells women that birth is “safe”. It isn’t, and how heart rending that so many families have to find out the hard way that they’ve been lied to.

      I am truly sorry for your devastating loss.

    • http://whatifsandfears.blogspot.com/ Doula Dani

      I’m so sorry. So sorry….

    • http://gamesgirlsgods.blogspot.com/ Feminerd

      That’s terrible. I’m sorry for your loss.

  • Megan E Powers Cma

    And what about MATERNAL mortality rate?
    Face it doc: the ONLY reason you down natural and homebirths is because YOU don’t as much MONEY. (NONE at all, since it requires a midwife) and you can’t STAND that! I can’t stand money hungry OBs like YOU, which is why I will ALWAYS use a midwife. What’s your c-section rate doc?? 30%? Higher? You disgust me, ESPECIALLY when you go against current ACOG guidelines

    • Amy Tuteur, MD

      What makes you think I would want an ignorant fool like you as a patient?

      Conspiracy theories are the “explanation” for everything among the those who don’t understand what they are talking about and who feel powerless. Thanks for dropping in and illustrating that point.

      • QB

        “What makes you think I would want an ignorant fool like you as a patient?”

        It doesn’t matter, you were fired decades ago. Jeez, why do you act so vicious and coldhearted , Amy?

        • Amy Tuteur, MD

          Do you always make things up to suit yourself or do you just make things up about me?

          • Nicky Pemberton

            This is a debate about home vs hospital birth. The real debate, however, is about competent birthing practices. Without more details it’s hard to know exactly what happened at this delivery however it sounds like perhaps the midwives were not monitoring the baby appropriately because they were “surprised” when the baby was stillborn. If this was in fact the case, these midwives were negligent. Negligence occurs both at home and in the hospital. People (including the very misinformed Dr. Amy Tuteur) seem to think that all home births involve hippie midwives singing to babies to revive them. This is pretty far from the truth. Here in Canada, home birth with a midwife is legal and covered by MSP. The midwives take the same NRP course as the GP’s, OB’s and paediatricians and they arrive for delivery with all the necessary equipment to fully resuscitate the baby if need be, the same as at the hospital, and are skilled and certified to intubate the baby. You should not be risking “ending up the river without a paddle” as commented here. If this is the case in the US, that’s appalling. Here, midwives are obligated to follow protocol. Transfer to the hospital, if needed, is streamlined in advance. As a perinatal nurse, I would not give birth at the hospital where I work, not because of the high mortality rate, but due to the very high morbidity rate for both mothers and infants. Definitely, OB’s need to address their skyrocketing C-Section rates, overuse of oxytocin and AROM before things will improve. Even though our midwifery program is very safe, the same hospital vs home birth debate goes on here too. It is mostly due to the public’s misguided perception that homebirths are provided by incompetent hippie midwives which is not at all the case. Many perinatal nurses on my unit choose midwifery care for their own births because it’s more thorough. Only very low risk births are attempted at home and some of these end up as hospital transfers, wherein upon admission to the hospital, an OB is waiting. The midwife remains part of the team and still follows the mother postpartum for 3 weeks. If no midwife is involved, the mother is discharged home at 24- 48 hours with only one follow up visit to the GP a week later. As for postpartum follow up by Public Health..what public health? Our Healthy Beginnings program was stripped of almost all it’s funding. The funding went directly to vaccination programs.
            In closing, Dr. Amy Tuteur is the kind of person that is not cut out for a caring profession such as medicine. Also, her ability to reason (or lack thereof) and arrogance are an example of how even medical specialists can fall short. Her argument is tantamount to a doctor blaming a mother for the death of her baby from a hospital acquired infection because she chose to deliver at a hospital with a poor record of infection control.

          • Wren

            Do you understand that a CPM, the type of “midwife” used in this case, does not compare in any way to midwives in the rest of the Western world? They do not have anything close to adequate training and are not working within the rest of the healthcare system at all. Transfers are generally no more than dropping the patient and running off, as they have absolutely no hospital privileges and generally do not hand over their patients at all. They have neither the equipment nor the training to perform their job adequately. Perhaps some understanding of that prior to your criticism would have been good?

          • Nicky Pemberton

            Yes, we used to have the same kind of problem here in British Columbia before midwifery was legalized. Why are these CPM’s still allowed to practice? Why don’t you have a legitimate midwifery care model available there? Where in the U.S. did this happen?

          • rh1985

            Well, there are certified nurse midwives, but I believe most of them deliver in hospitals.

          • Nicky Pemberton

            In Canada, we have Registered Midwives. They have admitting privileges and do practice mainly in the hospital. The still do a significant number of home births though. They have a higher level of education than American Certified Nurse Midwives. Some labours start out at home, however, if things don’t progress smoothly, the patient is transferred to the hospital and the MRP becomes the OB. A perinatal nurse is also assigned. Only low risk pregnancies where the patient lives in close proximity to a hospital are permitted. If a patient is transferred to the hospital, the midwife remains a part of the team and will still care for her patient postpartum. Our midwifery care is modelled after the Norwegian and Swedish ones as they have the best track record and lowest rates of mother/infant mortality and morbidity.

          • Bombshellrisa

            The midwife in question is a Seattle based CPM. She attended a friend’s homebirth and decided she wanted to be a midwife. If she had any proper training, this story would never have happened.
            Dr Amy has said time and again there IS a qualified credential for midwifery-in the US it is the CNM. The reason she speaks out against CPMs is they are the ones who are the most vocal, the most reckless and are by and large the provider women turn to for home births in the US. Most are more like Gloria Lemay and Moreka Jokular than a real healthcare professional. But they have a tremendous amount of support even from Certified Nurse Midwives and they know how to manipulate the political system enough to benefit from it.

          • Nicky Pemberton

            Thanks Bombshellrisa for your reply.

          • rh1985

            While I can’t explain why they are legally allowed to practice, I can explain the “demand” for them – I personally wanted OBGYN care so I don’t have personal experience, but from what I’ve heard from mothers I know online who used CNMs, the ones they saw were affiliated with OBs, delivered at hospitals, risked out patients, sent for detailed high risk ultrasound if needed, wouldn’t deliver vaginally if a c-section was indicated, etc. One mom I know of saw a CNM for the entire pregnancy, but her very flexible baby managed to go breech at full term so the affiliated OB gave her a c-section (she had no problem with this, some crazy people would). And unfortunately there is a radical part of the natural birth community for whom avoiding those things is their hill to die on, basically.

          • DaisyGrrl

            I’m also in Canada (Ontario). On the Ontario midwives association website, there’s a newsletter bragging about a midwife attending a homebirth over an hour’s drive from hospital (so had there been a complication, she could well have been screwed, even with air ambulance). Our midwives also attend VBACs.

          • Nicky Pemberton

            That doesn’t sound very responsible.

          • DaisyGrrl

            I agree it’s not very responsible, but it’s happening amongst educated midwives (similar to BC midwives) and this irresponsible behaviour is encouraged by the governing body. While the midwifery model of care is very attractive, I don’t think that can make up for some downright dangerous practices.

          • Nicky Pemberton

            Sounds like some new protocols are needed. I don’t agree with attempting a home birth unless the mother lives within close proximity to the hospital and the midwife needs to transfer as per protocol without delay.

          • Karen in SC

            New protocols, or just adhering to existing protocols, is what Dr. Amy is fighting for with this blog. Currently there are no penalties or censure or anything for midwives who don’t risk out properly.

          • Captain Obvious

            You do realize this blog is primarily about the undereducated, under licensed, underinsured CPM credential in the USA. You sound so ignorant and foolish when you come on here comparing apples to oranges. Read a little about the blog before you burst into criticism, you probably would agree with a lot of what is posted here.

          • Nicky Pemberton

            Captain OBVIOUS, Wren already explained that to me. I got it and responded. Why are you re-explaining that to me and continuing to call me ignorant (3rd time here)?

          • Karen in SC

            That was an earlier reply (5 hrs ago). The way Disqus nests posts and replies does make it difficult to follow comments in a time organized way. Also noting that many posted must remain anonymous due to work requirements etc.

          • Nicky Pemberton

            Thanks Karen, I appreciate that. What I don’t appreciate is people that sling mud on forums just because they can get away with it. I’m a perinatal nurse and have posted my name because I am not ashamed of anything that I have posted here and am willing to stand behind it with my name. I admitted when I had made a mistake (something that I don’t see anyone else doing here) and am not ashamed of that either. I believe it’s part of a healthy discussion and part of listening and learning from eachother.

    • Squillo

      Actually, natural homebirth doesn’t require a midwife.

      It’s kind of fun when someone parachutes in to tell us how money-grubbing ob/gyns are so afraid of homebirth cutting into their profits. Let’s look at some actual data, shall we?

      A midwife makes close to 100% of her income from her birthing clients. How many clients does your midwife have? Let’s be generous and say four. That comes to 48 births a year. Each patient she loses to hospital birth is a fraction more than 2% of her annual income. If she averages fewer births, that percentage rises quickly.

      How many patients (OB and gyn) does the average OB have in a year? A 2012 Medscape survey suggests between 2500 and 3750 (if we assume a yearly two-week vacation.) A 2003 ACOG-sponsored survey (the most recent I could find) says OB/gyns averaged 186 deliveries per year. So, using the most conservative estimates of OB patient load, each patient lost to homebirth would represent 0.53 percent of the doc’s DELIVERY income. It would not, of course, affect gyn income, so in reality, the total percentage of income lost is orders of magnitude smaller.

      So tell us again which practitioner has the greater incentive to ignore a patient’s/client’s welfare in order to squeeze every penny out of her?

    • Captain Obvious

      Here is One of Dr Amy’s comments about maternal mortality.

      http://www.skepticalob.com/2010/03/hold-handwringing-is-maternal-mortality.html

  • http://www.facebook.com/kathleen.neely Kathleen Elizabeth Neely

    letting your baby die should be child abuse not an accident.

  • http://www.facebook.com/kathleen.neely Kathleen Elizabeth Neely

    Sara, God bless you, Im so sorry for your loss, one of the Midwives who was at your center did my prenatal care in XXXXX, I had a breech and I had had a previous C/S. She kept telling me all was fine you wont need an epidural blah blah blah… I have a family member who is a M.D., who educated me about this stuff. I immediately transferred care to an OB and had and really really wonderful C-section and a healthy living baby. Thank you Jesus!! Please keep on speaking up, what they did to you was beyond wrong!!

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