20 years of presiding over homebirth deaths

Baby shoes

Last night a reader sent me a link to this story of an Indiana midwife arrested in the wake of two perinatal deaths in one week:

Barbara S. Parker, 55, faces three felony counts of practicing midwifery without a license. These charges stem from three August deliveries.

The first was on Aug. 2nd when Parker took a woman to an Auburn hospital when she was having trouble delivering her child. Then on Aug. 3rd Parker helped a woman deliver a baby that wasn’t breathing and had no pulse. That child later died at the hospital. Then a few days later, on Aug. 7th, Parker was helping a mother deliver twins and the second infant was only partially delivered and had to be taken through cesarean section. According to court papers, the second child did not survive.

Parker told police that she had been licensed in Colorado in the early 1990’s, but a little research revealed that didn’t go so well either. She lost her license and lost her court battle to retain it (THE PEOPLE OF THE STATE OF COLORADO, PLAINTIFF-APPELLEE, v. JEAN ROSBURG AND BARBARA PARKER, DEFENDANTS-APPELLANTS):

This case involves an appeal of a trial court’s order permanently enjoining appellants Jean Rosburg and Barbara Parker from practicing midwifery without a license as prohibited by sections 12-36-106(1)(f) and 12-36-106(2), 5 C.R.S. (1985).*fn1 The midwives argued to the trial court that section 12-36-106(1)(f) unconstitutionally infringed the right of privacy of pregnant women to choose their method of childbirth and that the section was unconstitutionally vague. The trial court ruled that the midwives did not have standing to assert the privacy right of pregnant women*fn2 and that section 12-36-106(1)(f) was not unconstitutionally vague. The midwives appealed to this court pursuant to section 13-4-102(1)(b), 6A C.R.S. (1987).

We agree with Rosburg and Parker that they have standing in this case to assert the privacy right of pregnant women. We disagree, however, that the prohibition against practicing midwifery without a license infringes a privacy right of pregnant women. We hold that section 12-36-106(1)(f) does not violate the midwives’ equal protection right because the prohibition of lay midwifery bears a rational relationship to the state’s legitimate interest in protecting the health of the pregnant woman and her child. We also hold that section 12-36-106(1)(f) is not unconstitutionally vague.

After reviewing the arguments, the Court concluded:

The term “practice of midwifery” also is not unconstitutionally vague as applied to Rosburg and Parker. They also were aware of what conduct was prohibited by the statute and their conduct fell within the prohibition. Rosburg testified at trial that her profession was that of a lay midwife and she defined the term in accordance with applicable dictionary and legal definitions.*fn10 The trial court also specifically found that Rosburg and Parker had engaged in the practice of midwifery.

Accordingly, we uphold the constitutionality of section 12-36-106(1)(f) and affirm the trial court’s order permanently enjoining Rosburg and Parker from practicing midwifery without a license.

Unfortunately, I cannot find the original case that led to Parker losing her Colorado license. Although it almost certainly resulted from at least one perinatal death, I cannot confirm that. In any case, Parker has continued to practice despite disciplinary measures and mothers and babies have allegedly continued to pay the price.

  • Bloveberry

    First of all this article isn’t entirely true. Secondly, it is interesting that we come down so hard on an individual who truly cares for the health and safety of mother and child. An individual who makes it possible for a healthy woman to deliver in dignity, make decisions based on her preference, and allow her to welcome her baby into the warmeth and safety of the family home where she is able to quickly bond with her baby while she comfortably and quickly heals and makes a smoother transition returning to her motherly duties while there are doctors out there who are so busy that unfortunately there patients become another number and the care and nurturing are absolutely NOT the same. In closing if you have never experienced a homebirth then you do not understand the benefits of being challenged to learning more then you will ever learn in a standard doctors cares and the understanding of responsibility that you gain for your health, and the babies health. In fact if you do the work you gain an understanding for your whole family and you being to build understanding that the responsibility for raising your family is personalized. Meaning it will be different for every family. You can break away from this mind set that you should rely on some stranger (really) to give you complete advice on how to raise and care for your family. Sorry Girls I started out with the doctors for the first 3 babies, if I can helped it I will never return again Lord willing!!!

    • Amy Tuteur, MD

      She truly cares only about herself. No one with an ounce of morality would dare to continue representing herself as a midwife after losing her license. She’s selfish, self absorbed and dangerous. She is nothing more than a criminal and an example of why homebirth leads to preventable perinatal deaths.

  • Sorin

    This post is hard for me to read right now as my SIL is due any day and planning a homebirth with a CPM. She’s 40, never had a baby before, and has a cyst the size of kiwi growing outside her uterus. She’s the kind of person who, if you say you disapprove of something, will try even harder to make it happen, which is why my MIL and FIL won’t say anything to her, even though they are worried about this whole situation.

    So I just sit here and keep my fingers crossed that everything will be ok. Having had one child already, and ending up having a last-minute planned C-section for breech presentation, I know that unexpected things happen at the last minute. I hope she gets lucky because I really want my nephew to get here safely and without any problems.

    • I don’t have a creative name

      I’m so sorry. 🙁 I hope things go well.

  • Delawaremamma

    This is frightening considering that Indiana lawmakers are working on legislation which would legalize Direct Entry Midwifery in that State. The bill has already passed the State House and is waiting to be taken up in the Senate.

  • Squillo

    Compare this post (at Kevin MD) about what happens after an unexpected death in hospital vs. the kinds of excuses and denial one often sees when a homebirth midwife presides over a death.

  • mollyb

    OT: Did anyone see this article in the Daily Mail today (it IS the Daily Fail to take with a grain of salt). Doctor threatens to call the cops on a 35 year old mother for refusing a c-section as she wants a natural, vaginal delivery. She is (from the photos) obese, has gestational diabetes, has had FOUR previous c-sections, is a week past her due date, fetal monitoring showed distress that caused 2 doctors to call for an immediate transfer to the hospital and delivery and a baby in an unfavorable position for vaginal delivery, She, however, feels these concerns are unwarranted.

    http://www.dailymail.co.uk/news/article-2289646/Doctor-sends-pregnant-woman-email-saying-hell-tell-police-bring-hospital-refuses-C-section-week-date.html

    • Charlotte

      Ugh. If she goes through with it, she’ll either survive and become an inspiration of others hoping to take the same risks, or prove the doctors tragically right. Not good.

      • mollyb

        At the end of the article, she indicates that she agreed to a c-section at the end of the week. Hopefully the baby makes it that long.

        • Isilzha

          If it doesn’t, I wonder if that bit of info will make the news too.

    • Lena

      If it’s true that the ob threatened to call the cops…that’s not ok. Until that baby is out of her body every thing is her own decision. He already told her several times what the dangers were. Let her refuse the c-section, and when/if things for horribly wrong, let her be racked with guilt and be a lesson to others.

      • Squillo

        If she refuses the section, I’d still rather she and the baby come through just fine and have her thank her lucky stars (and decide never to do it again.)

      • mollyb

        I don’t agree that a doctor can or should forcibly compel a woman to have surgery against her will. But my God. How deep in the woo must this idiot be to even consider a VBA4C at that point?

        • I don’t think you can without a court order – and that must be ghastly. But unless she is very fortunate this woman might wish that they had.

          I cannot imagine how foolish you have to be to believe this is worth the risk. I was terrified of leaving my children – or being to ill to care for them.

      • Dr Kitty

        Fine, if you think she has capacity to refuse.
        If, for example, she had delusional beliefs about her body’s ability to birth, she may not have capacity, in which case UK common law would allow Drs to proceed in her best interest in the absence of a court order (but in practice very few would be happy to proceed without one).

        • Isilzha

          She has so many risks that her refusal of a c-section is almost suicidal!

          • LukesCook

            Some people’s choices are so bizarrely foolish and dangerous that they amount to proof of incapacity.

          • Isilzha

            And she has that right, but I can see why the doctor could be motivated to say what he did. Doesn’t make it OK, but I can understand.

    • DiomedesV

      This sort of thing seems to happen a lot in Florida–doctors using the police to compel mothers to accept treatment.

      • AmyP

        A lot of weird stuff happens in Florida.

        • Frequent Guest

          IIRC, Florida has some ridiculous plaintiff-friendly malpractice laws, which might have something to do with it. Doctors in Florida probably feel even more pressure to do everything in their power to achieve a good outcome… or at least cover their tails in case things go badly.

    • Isilzha

      The mother is also 35, has GD, is morbidly obese (on her blog it was 200 lbs overweight in her “about me” section), and then something so alarming was found during her doctor’s visit that she was sent directly to the hospital. For the doctor I bet that was like seeing two trains about to collide on a track and standing next to a switch that would prevent a collision. He may have been seriously out of line to threaten the cops, but I doubt his intent was malicious. It’s hard enough for me to watch from the internet sidelines; I can’t imagine being their doctor.

    • Dr Kitty

      I know of a case in the UK where the woman was wrongly sectioned under the mental health act and a CS done against her wishes. She sued, won and got £1 in damages.
      Yes, you read that correctly, less than $2 in damages.

      The judgement acknowledged that the Drs had wrongly applied the mental health act in that case, but that they had done so with the best of intentions and were doing what they believed was in the patient’s best interest, and that their actions had resulted in the delivery of a healthy baby.

      The woman subsequently had at least one successful VBAC.

    • ratiomom

      However nuts she may seem, every competent adult has the right to refuse surgery. That right is absolute.

      • Dr Kitty

        Competence may be impaired by mental illness so that capacity to refuse treatment no longer holds. So being nuts may mean incompetence.

        Capacity to refuse treatment requires the ability to understand, retain, believe, weigh up information and then express your opinion.

        If mental illness impairs your ability to believe, understand or weigh information the information in question you may not have capacity and then may no longer be competent.

        • ratiomom

          I agree. But, to play the devil’s advocate here: holding erroneous beliefs (trust birth, unnecesarean, yadda-yadda,…) does not equal mental ilness.

          If this patient is examined by a psychiatrist and found to be coherent and not suffering from psychosis, depression etc, there will be no ground to force the surgery on her. Sad, but it’s her right to refuse.Take that right away and you wind up on a slippery slope that ends with Savita Halappanavar.

          • Dr Kitty

            Not quite sure where Mrs Halappanavar fits in.
            Yes, I agree with you entirely, although if the patient has delusional beliefs about childbirth and didn’t believe or understand the information her doctors provided she would not have capacity to refuse consent.

            If someone believes that their doctors think their baby will die, understands the risks of refusing treatment and still refuses- fine.

            If someone thinks that their doctors are lying, the baby is fine and that the surgery isn’t at all necessary it could be argued that they do not fully understand the consequences of their refusal and cannot therefore be considered to have made an informed decision- therefore lacking capacity.

            Please note, a diagnosis of depression and psychosis do not remove capacity either. The test of capacity is about whether you can believe, understand, retain, balance information and express an opinion. Your team doesn’t have to agree with your reasoning, but you have to be able to show that you have some understanding of the risks involved in your chosen course of action.

          • Becky05

            “If someone thinks that their doctors are lying, the baby is fine and that the surgery isn’t at all necessary it could be argued that they do not fully understand the consequences of their refusal and cannot therefore be considered to have made an informed decision- therefore lacking capacity.”

            But so many natural childbirth devotees I know believe that doctors really are lying, not do to a paranoid delusion, but because that’s what they’ve been taught by the NCB groups.

          • Isilzha

            But wouldn’t getting the police involved likely be the first step toward someone being evaluated?

        • DiomedesV

          That can become dangerously tautological. People can comprehend the risks and still be willing to take them. One cannot then infer that they don’t comprehend the risks, simply because it is “unthinkable” that they could not take steps to avoid them.

          • Dr Kitty

            Not in practice.
            People decline lifesaving treatments because of lots of reasons (JW declining blood etc). I don’t have to agree with your reasoning, and, in fact you don’t even have to TELL me your reasons, as long as I can be happy that you understand the risks and believe me when I tell you that they are real.

            There is a lot of interesting case law about consent.
            Including a patient with psychosis who refused amputation of his gangrenous leg…the judge agreed with him that he capacity to do so, and he survived the life-threatening gangrene against the odds.

            “I understand that there is a greater than 50% chance that I or my baby may die and I still refuse treatment” demonstrates understanding and belief and suggests capacity to refuse treatment.

            “My baby can’t die because the universe will protect her, and you’re lying to me when you tell me she could because you’re just trying to make money from me” does not suggest that the person really understands the risks involved.

      • Dr Kitty

        Or, more succintly- yes competent adults can refuse treatment, however competence is not necessarily a given, and may require assessment. Refusal of treatment may be a sign a patient is no longer competent.

      • Something From Nothing

        She does have the right to refuse treatment, but its a little over the top to call her treatment abusive and bullying, no?

    • I don’t have a creative name

      What a stupid, selfish idiot. Baby is in distress and she doesn’t even care. Looks like she’s scheduled a section for tomorrow. But waiting this long with baby in trouble for this many days is likely to have dire consequences.

      Look, I get the hope of going into labor when you want a vbac. Been there. But when my doctor made it clear that she was quite worried about letting me go any longer, with my labs as bad as they were, I couldn’t IMAGINE saying, “Oh, so what if my baby is at risk of dying. Let’s wait another 4 days and see what happens!”

      I hope I’m wrong and that for the baby’s sake, this twit dodges a bullet. Sadly I don’t see that happening, though.

      • I don’t have a creative name

        The more I read about this absolute moron, the more I want to SCREAM. “Besides, she couldn’t leave her 2-year-old son with strangers. She was
        driving the family’s only car, so her husband, a team leader at a call
        center, couldn’t get to her.”

        What would most NORMAL people do in that situation??? GO THERE AND PICK HIM UP!!!!!!! An emergency section done an hour or two later than the doctor wanted is certainly better than one done FOUR DAYS LATER.

        I’m going to go out on a limb here and guess that she is “educated” on birth, and has done her “research”. You know, by reading those lovely birthing-worship sites on FB, and maybe Penny Simkin’s book. Her surgery is tomorrow… wonder if there will be any articles following up on whether or not the child is dead or damaged. I hope so much her gamble pays off…. but the baby showed signs of distress on TUESDAY. Why doesn’t she care???? 🙁

    • Amy Tuteur, MD

      It is illegal and unethical to force a woman of sound mind to have a C-section that she doesn’t want or doesn’t want until later, but … merely sending a letter claiming that the situation is so dire that they think they should get the police to bring her to the hospital for an immediate C-section makes a hell of a defense at a malpractice trial if the baby dies. There is no possible way that this woman didn’t understand that her baby could die if she didn’t have an immediate C-section.

      The baby is probably not going to die, but then if you strapped your child to your car roof and drove for a 100 miles your child isn’t likely to be dead at the end, but that doesn’t make it a remotely responsible thing to do.

      • DiomedesV

        Yes, my thought was that involving the police was CYA for a malpractice suit.

        • Becky05

          I don’t think the Dr. was going to call the police at all. I think it was simply a threat, to get the mother to come in immediately for the surgery. I understand the doctor’s frustration, but I also think that this threat was wholly inappropriate. Women have the right to make health care decisions over their own bodies.

  • yentavegan

    I keep thinking about the death of Vylette Moon. Her mother was a client of a birth center in Brooklyn ,NY The midwives on call were so devoted to the concept that babies know how to get born that this otherwise healthy infant died. Babies do not know how to get born and these professional midwives did not recognize that this mother and infant labored in excruciating pain for hours all the while losing precious moments to save Vylette Moon’s life.
    This mother did everything right, and in a hospital her protracted labor would not be so callously labled as a variation of normal. A hospital and ob/gyn would have saved this infant’s life.

    • Jackie

      I follow Vylette’smom on Facebook. I cry whenever I read her story. It’s horrifying what this mother and little angel went through.

  • Karen in SC

    I wonder if Barbara Parker is one of the midwives featured in the ebook “From Calling to Courtroom.” Or if she failed to read it and that is why she got caught.

    • Bombshellrisa

      It looks like Jean Rosburg is mentioned in the appendix, under summary of cases, basically what Dr Amy has posted here.

  • By the strict standard you insist on applying to dietary issues (including formula feeding), you cannot blame this midwife for the baby’s death unless you can prove beyond a shadow of a doubt that the baby would have lived if the mother had done an unassisted homebirth instead.

    On a more positive note, I wonder if anyone else heard this lovely NPR story about a Ft. Collins midwife:

    http://www.npr.org/2013/03/06/173156161/for-elderly-midwife-delivering-babies-never-gets-old

    Maybe this could be an opportunity to say something positive about a midwife?

    • moto_librarian

      Alan, many of us have had our children delivered by midwives (both of mine were delivered by fantastic CNMs in a hospital), so give us a break.

      Having just read about your shenanigans over on FFF, this will be my last response to you. You are clearly a troll (given your obsession with breastfeeding), and I will treat you as such from here on out.

      • Sullivan ThePoop

        Can you link to the shenanigans over at FFF, I couldn’t find it.

        • theNormalDistribution
          • This should be required reading for everyone! DON’T FEED THE TROLL! (also, the best predictor of future behavior is past behavior and all that).

          • KarenJJ

            There’s something very off with this guy. I hope he and his family are OK.

          • Sullivan ThePoop

            Well, after reading the nonsense on FFF, his wife seems reasonable.

          • Sarcasm???

          • Sullivan ThePoop

            Wow! That is really a mess. It is sad that a person who claims to be the primary caregiver for children would act in such a childish way and have so much time on their hands. It reminds me of a court case I heard once where a boy was habitually destroying property in his neighborhood. The problem was that his parents, all 4 of them, were less mature than he was. Even the judge noticed and said he wasn’t surprised that a child raised in that environment would turn to crime for attention.

          • Now you insinuate that my children are likely to be, or become, criminals! Wow, great example you are setting for how to treat people.

            FYI, my school aged kids are in the gifted programme at school and not only get good conduct marks, but regularly get what the elementary school calls “caught being good” slips, and the middle school simply terms “positive office referrals”. So much for that theory…I guess though you can still hope the younger two turn bad. @@

          • Mac Sherbert

            Wow, oh wow. Just wow…

      • theadequatemother

        I think it might be a breastfeeding paraphilia…:)

        • That’s as sick as my in-laws, who shamed my wife for her what they saw as her immodesty and nudity by feeding our baby in front of them. Really sick, sad, lame.

          • theNormalDistribution

            Way to go, Alan! Admitting you have a problem is the first step towards recovery.

          • Ha ha. You know, it occurs to me that I should perhaps not be so surprised to hear people claiming I am obsessed with breast-feeding or childbirth issues or whatever, if they think that every time I go to shoot the shit online, it is those subjects I gravitate towards.

            So to disabuse you all of that notion, here is a sampling of some of my output to other blogs and message boards, on none of which do I ever mention breast-feeding or childbirth or babies or even usually parenting in general. Most of these are under the same moniker I pretty consistently use, “SlackerInc”.

            Debating the pros and cons of bike helmet use (I’m “pro”):

            ——–

            Your cite shows only that serious injuries can still occur despite wearing a helmet, something I did not dispute. The case I made holds up if a severe head injury of one million severeness units is reduced by the wearing of a helmet to 999,999 severeness units. IOW I was only saying ‘they have got to reduce the severity at least a *little *bit.’ Heck, even a paper sailor hat should accomplish that! LOL”
            ——–

            Discussing being “car free”:

            ——–

            I’m impressed by those who show such fortitude in riding in the rain. In our family, we could be accused of acting like we are ‘made of sugar’: we generally avoid riding anywhere if there’s more than a 20% chance of rain forecast. Being able to shrug off rain would make being ‘carfree’ a lot easier, for sure!
            ——–

            Poker theory:

            ——–
            Snyder essentially believes that doubling your chips in a tournament puts you in a position that is more than twice as good as where you started, rather than the conventional wisdom of diminishing returns. This obviously doesn’t hold up in ICM bubble situations, or in single table tournaments; but he’s talking about MTTs and his logic can’t be entirely dismissed.

            ——–

            Movies (this is probably my biggest “obsession” as I used to own my own independent/foreign video store). In this sample, the film is “Take This Waltz”:

            ——–
            I agree for the most part, except that I do think the intentions were strongly hinted at earlier, most notably in the shower scene when the younger women were talking about craving the excitement of a new relationship, and one of the older women cautioned them that “new gets old”. That was like a Chekhov’s gun moment there.

            —-
            See a list of my favourite films here: http://www.flickchart.com/slackerinc

            ——–

            TV shows, in this case last night’s episode of “The Americans”:

            ——–
            I thought Stan should have qualms about what he did because he got rid of a conduit for intelligence. I actually think what he did may have been coloured by his jealousy and guilt regarding Nina’s sexual activity with the Rezident. Otherwise, why not set someone else up in the office? You accomplish the same thing in taking the heat off Nina, while allowing her to still continue to receive intelligence from the Rezident.

            ——–

            Tennis, another of my great passions:

            ——–
            Monica Seles in the ’90s, Serena Williams, Kim Clijsters, Justine Henin, and Maria Sharapova over the past decade, all showed this back-against-the-wall, do-or-die ability, which is amazing to watch. In tennis, there is no clock and thus no deficit that cannot be made up if you just go into “refuse to lose” mode. So these women all seem to have had periods in their careers where they would get lulled into getting into holes no ordinary player could reasonably hope to get out of, and then at the last possible moment sort of waking up and digging their way out by blasting winner after winner like a Terminator cyborg or something, LOL.

            ——–

            Politics. Oh, politics. I take it back about movies–this is the subject about which I am most voluble. Here’s a recent observation about the dilemma facing the GOP:

            ——–
            I do think the dynamic they have set up for themselves as a party, where they are the last guardians of a fading way of life, makes it harder for them to regress to the mean. Makes me think of the dilemma that print newspapers face: their old order is ultimately is a dead end, but if they pull the plug on it too soon, they give up an old but not yet dead customer base that still provides them considerable revenue, while getting no guarantee they will replace that customer base with a sizable younger one.

            It’s almost enough to make me believe we could even have three parties substantially represented in Congress for a generation or more.
            ——–

            NFL football theory:

            ——–
            In a related vein, should Pete Carroll have called an intentional non-TD (not a kneeldown but a running play in which the RB is instructed to stop at the half yard line if necessary) on first and goal with 40 or so seconds left?

            ——–

            Futurism (in this case, discussing the transition to a non-dystopian “rise of the robots” scenario):

            ——–
            So when the janitorial robots become cheaper than hiring people, janitors and hotel housekeepers will be thrown out of work. Same thing for taxi drivers when automated cars are perfected. And so on and so forth. At what point then, and in what way, does it cross a rubicon from creating mass unemployment (which is bad) to obviating the need for employment at drudgery (which is good)? Will the robot-making companies find themselves increasingly with fewer and fewer customers because no one will have a job? Will governments just take over, Tea Partiers be damned? Or will it somehow happen organically without great turmoil? I can see the end result, but that transition is a muddle.

            ——–

            And on and on and on. I’m not “obsessed” with anything in particular, just interested in a LOT of different things and discussing/debating them with others.

          • theNormalDistribution

            HEH. I think it’s pretty clear what you’re obsessed with.

          • Okay, so enlighten me because I genuinely have no idea what you are insinuating.

          • LukesCook

            Damn right you don’t.

          • Well, at least it’s clear what (which is to say, whom) *you* are obsessed with. Don’t you have an NRC to join?

          • Jesus Alan! If we agree you are just too, too, impressive, could you go and be impressive somewhere else?

          • I’m already being impressive somewhere (manywheres) else! 😉

            Can you not even handle my new regimen of starting just one thread per SOB blog post? (And it only even becomes a thread if people participate in it; otherwise it’s just going to be a single post among the hundreds.)

          • I can handle it fairly easily by the simple expedient of skipping over them. But their is a car crash awfulness to your prose that has a bit of a tendency to suck us in – just to see how cringe making you are this time. Alan, the internet is very diverse and I am sure their are like minded fellows who will enjoy pointless arguments as much as you do. You’ve got little to add to this one.

          • “But their[sic] is a car crash awfulness to your prose”

            LOL!

          • I meant its droning or self vaunting inconsequence – can manager the odd typo. If you could occasionally let the odd “Gotcha” moment go or manage a teensy bit of self doubt…

          • I never attacked your prose. You fired the first shot there, and I couldn’t help noting the irony, is all. Cease fire? ::proffering hand::

            “Teensy bit of self doubt”? Is there some kind of magic spell that prevents everyone from perceiving that I have changed my mind about the wisdom of homebirths and about the need to lower the C-section rate since coming to this blog? Or are those concessions insignificant?

          • alan, you can attack away and I will remain unmoved, so I do not perceive the irony. I haven’t perceived any of your ironies.

            I am not everyone; and I do not regard changing your mind when presented with new facts as particularly remarkable, and certainly not as a sign of self doubt. I admit some people cannot own an error or ever let go of an idee fixe, so I might concede a small brownie point but I still find your manner obnoxious. Why on earth are you bothering, Alan?

          • Answer:

            (1) As I have said before, for the mental exercise of debating intelligent people (not everyone here, but more than in most places where it’s boring, like playing tennis or poker against kindergarteners).

            (2) In the process I do learn important, edifying things that genuinely matter.

            (3) There are, despite my partial change of heart, still some disingenuous, sophistic, propagandistic narratives being pushed here that I think need to be challenged by someone neither intellectually out of their depth nor intimidated by the pack mentality here.

            Thanks for the small brownie point.

          • LukesCook

            “Is there some kind of magic spell that prevents everyone from perceiving that I have changed my mind”

            Alan, this blog is not about you. Nobody cares whether you’ve changed your mind or made concessions. Nobody cares what you think or about satisfying or convincing you. Nobody cares about your beliefs, philosophies or opinions, and certainly nobody is impressed by your arguments.

            How are you unable to perceive this? Here you squat, relentlessly appropriating every possible thread of discussion to talk about Alan, Alan, Alan, a topic interesting only to you.

            You’re a bore. Your life is boring, your SATs are boring, your beliefs, opinions, vacillation and ruminations are boring. You’re possessed of neither wit, insight nor expertise.

            Shut up about yourself already.

          • You are too transparent. Why are you talking to me, exactly?

          • Susan

            We would stink at being Amish

          • If Alan thinks he has a problem, he is making a very good job of hiding that. Probably just like the idea of a captive audience for his wonderfulness. His therapist is just BOUND to find him the most interesting patient he has ever had! Or at least, that will be Alan’s conclusion.

            I did used to wonder about the MEN who were gung ho for all things natural. Alan has conclusively demonstrated that they are quite as awful as I had suspected.

    • The Bofa on the Sofa

      By the strict standard you insist on applying to dietary issues (including formula feeding), you cannot blame this midwife for the baby’s death unless you can prove beyond a shadow of a doubt that the baby would have lived if the mother had done an unassisted homebirth instead.

      Whether you can specifically say the babies would have died, no you can’t, however can absolutely blame the midwife for malpractice. Her actions are well outside the realm of anything that even approaches standard practice, and if midwives want to be responsible professionals, they will do things like have malpractice insurance to allow themselves to be subject to civil sanction should they screw up. Of course, most don’t, which makes them more or less immune from civil action, which is fortunate for them, because they know they would never come close to surviving a malpractice trial.

      You don’t need a baby to die to illustrate gross malpractice. Unfortunately, the way the midwifery system is set up, you ultimate do need multiple babies to die to get any action at all.

      • Let me be clear: I am arguing only for consistency. I accept the research findings on the risks of HB, and would not now advocate HB after seeing them (birth center with a CNM, like the NPR story, sounds good though). I also accept the research findings on the risks of formula feeding, and of eating the SAD. Dr. Amy OTOH is wildly inconsistent on the stringency of her criteria, depending on whose ox is being gored.

        • Amy Tuteur, MD

          No, you arguing because you are pathetically desperate for attention, any attention, even negative.

          • I thought you were on the Aunt Bea bandwagon? Don’t respond to my comments if you don’t want to give me attention.

          • Allie P

            Yeah, it’s like no one on this site knows the rules of trolling. Are you as surprised as I am, Allan, that’s they’ve put up with your shit for as long as they have?

          • Please: call me “Alan” with one L, and I will call you “Allie” with two.

          • anonymous

            I’ll call you troll with two L’s.

          • Anonymous, as a fellow member of the NRC (The Non Response Collective) I feel it is my duty to inform you that you have come dangerously close to receiving a sanction for this reply. Since it was short, and also witty, I’m going to let it slide but, just so you know, I’m watching you……. 🙂

          • anonymous

            Ah, Clarissa. You caught me. I could not resist. I will be stronger from now on. 🙂

          • Ha–touche! I did not see that one coming, good one.

        • theNormalDistribution

          What the research says and what the researchers conclude from it are not always the same. You only accept what the “research findings” are because they fit with your beliefs. Dr. Amy, on the other hand, consistently questions everything without bias and can draw her own conclusions without someone in authority to tell her what to think.

          • It’s just the opposite!

            For years, until just a few days ago, I believed that homebirths were just as safe as hospital births for low-risk women. Now I have seen the retrospective/associational/correlational research showing a significantly higher statistical risk, and I believe it and would not seek HB if I had it to do over again.

            For years, until a few days ago, I believed that C-section rates were much too high, both for reasons of risk to mother and baby and for financial reasons, and now I am convinced (again by retrospective/associational/correlational research, which Dr. Amy said was inherently “crap”) that the difference is much smaller than I would have ever guessed. Dr. Amy is the one who accepts the findings she likes, and rejects those she does not.

            To turn it around and accuse *me* of being the one with confirmation bias is positively Orwellian. Oceania has always been at war with East Asia!

          • theNormalDistribution

            Okay, that is just too stupid.

          • What is?

        • Charlotte

          I thought we were supposed to just ignore Alan.

          • LOL at “supposed to”.

    • Mrs. W

      Alan, why do you insist that the alternative be limited to a UC?

      • Because by the overly strict standard she and many here apply to formula feeding, we must show that the midwife actively killed the baby, not that there is some statistical likelihood that she failed to save its life when hospital staff would have been able to do so.

    • Aunti Po Dean

      Alan, that is about a sensible as saying, “you can’t blame the car wreck for the persons death unless if you can’t prove beyond a shadow of a doubt that the person would have lived if the person chose to walk to work instead”

      • But they could have died of a heart attack instead of the accident! Or an embolism! Or a stroke! Or choked on a pretzel!

      • Aunti Po Dean

        oops that would be “can prove”

      • Agreed–exactly my point. Tell that to Dr. Amy!

      • LibrarianSarah

        Don’t feed the troll

        • Aunti Po Dean

          Sorry LS seeing that ridiculous response joining the NRC now

    • Siri

      Alan, I am a midwife. Why don’t you parachute out of here and find another blog to pester, preferably one where you actually grasp what it’s about. I am embarrassed for you.

    • JenniferG

      Alan, that makes no sense. The biological cause of death in my daughter’s case was pretty clearly that she did not get enough oxygen because the cord was around her neck. The reason she actually died is that a nurse did not monitor correctly and did not page the OB; there were not enough OBs (or oversight of less experienced nurses) for the unusual day, and at the critical last minutes, the OB was in a different surgery that had come through emerg.

      Although we chose to drop our case, there was plenty of reason to be able to say that the care was substandard and resulted in her death (IMO — among other things, the tracings were lost and the charting was pathetic). In almost any other hospital on any other day, my daughter would have lived. Formula is nothing like that: You cannot take a child who gets RSV and dies and say that child would not have had RSV if s/he had been breastfed. At best, breastfeeding marginally helps _lower the risk_ of certain things. That is very different from _stopping_ a biological process like asphyxiation.

      Doctors, nurses, and yes, midwives, are there to INTERVENE if there is a problem. I know the homebirth/NCB community does not like that word, but that is because their baseline assumption is that interventions are unnecessary. The fact that some people *think* so, however, does not mean that a midwife failing to intervene is not a cause of a baby’s death who could have been saved, nor does it mean that the midwife does not have a responsibility to do so, or risk people out, etc.

      You can see how ridiculous this is if you take, say, a heart attack. If someone has a heart attack and a doctor performs CPR/defibrilation/whatever and the patient dies, that’s one thing. But if a doctor fails to do tests that are clearly indicated or stands around and doesn’t do CPR that’s malpractice. Funny how when it’s men, it’s obvious. But when it’s women and babies, hey, it has nothing to do with it.

      • Jennifer, I am terribly sorry to hear about the tragic loss of your daughter. It must be all the more agonising to know that it probably could have been prevented. As far as the other points you make, I don’t feel good about debating them out of a desire not to be insensitive to your pain. At the same time, I worry that refusing to debate them is patronising to you. So I apologise if that is the case, but I just don’t feel comfortable with it.

        • kumquatwriter

          “I can’t debate any of your points, and people refuse to praise me when i threadjack to change the subject, so I’ll pretend to.take a moral high ground.”
          fixed that for you.

          • Pretend…because in fact my soul is black as midnight. That it? I actually take delight in the misfortunes of others.

            Jesus, listen to yourselves. *I’m* the one told to get help?

        • JenniferG

          Thanks Alan. It’s fine if you don’t want to debate around and I can get that. For me it’s been enough time that I’m comfortable bringing her into a conversation (or else I don’t.) That said, one reason I do is because she was a real person who really died because people really didn’t intervene. So often I find natural childbirth advocates are willing to overlook that reality.

          I don’t know (I have not looked into it) whether there are people who know as clearly as I do that their children died due to lack of breastmilk, but the presence of formula. My impression is no.

    • Renee Martin

      When a MW is in charge it is HER FAULT, unless the baby has anomalies, because it is her job to keep moms safe. If an OB was losing healthy full term babies, guess what? it would be their fault too! In this case, the MWs were breaking the law too!

      Besides, I know of many HBs that were the MWs fault- one physically stopped a mom from transferring (took her phone, kicked her friends out, isolated her and denied her requests for help), another who told the mom to stay home all was well (she was having an abruption) until it was too late, another who convinced mom she could attend a breech but couldn’t unstick the babys head when it got trapped. and on and on. These 3 would have been fine if the MW was not there because they would have transferred hours or days sooner! The last one wouldn’t even have had an OOH breech if the MWs hadn’t assured her it was totally safe and promised experience they didn’t have.

      I think Im done replying to you, as you are just causing trouble.

      • Sullivan ThePoop

        Yes, I have told the story before of my daughter’s friend where the midwife kicked everyone out and took the girls phone. My daughter had called 911 but they wouldn’t go in because the MW was the only adult there. Luckily mom and baby were fine, but what kind of professional acts like that?

        • Amazed

          I remember reading this post and then bending down to collect my jaw from the floor. An adult woman keeps a bunch of girls and an unborn child basically hostages? Was she, by chance, Darby Parker’s mom? Crazy has progressed to what happened to Margarita Sheikh and her lovely baby.

          Madness.

      • Sigh. Does no one at all get the point I am trying to make? Yes, the deaths are statistically attributable to attempting a HB and I NO LONGER BELIEVE IT IS SOMETHING I WOULD DO AGAIN OR RECOMMEND TO OTHERS, although the risk is within the range of things (like living farther from school) that we allow parents to do, so I don’t think it should be outlawed.

        But this is a big change of position on my part, based on information I learned while reading and debating on this blog. Yet it’s like no one even notices that, and just continues to insist I’m a stubborn troll who doesn’t listen to anything. WTF?

        I am not arguing that the significantly higher death rate in HBs is a fluke, or a coincidence, or the result of some kind of compounding cofactor. I’m simply pointing out the inconsistency of Dr. Amy’s rejecting nearly all research on nutrition (including infant nutrition) as “crap” because it is “associational”, when THE SAME IS TRUE OF THE HB MORTALITY STUDIES. I am not asking her to reject the HB mortality research, but to accept the nutrition research!

        • Isilzha

          Alan, just give it up and take your boob and breastfeeding fetish somewhere more appropriate (ie, a porn site).

          • I’m not sure which would be more despicable: for you to actually believe this, or to know it’s bullshit and say it anyway, to try to smear me. I suppose the latter is worse, and also sadly more likely. I mean just, wow. Take a deep breath and think about this: do you really want to be this kind of gutter dweller?

          • Isilzha

            Yeah, well, this isn’t the only site your trolling with your little obsession.

          • Assuming you mean the first “your” to read “you’re”, a contraction of “you are”, present tense, what other sites do you refer to?

        • S

          =( =( Hasn’t Alan adequately demonstrated his open-mindedness? WHY WON’T YOU TAKE HIM SERIOUSLY????

          I propose we all give him a round of applause and a cookie. Then we shall debate a random topic of his choosing.

          • Suits me, sans cookie of course. 😉

    • Amazed

      Alan, can’t you make the distinction between having some additional, correlational or whatever link and actually killing someone with inaction when they are in acute distress?

      Let’s give you an example: about 12 years ago my mother was visiting me. My father was at sea. My brother got a flare of acute pancreatitis and the fucking hospital staff would not admit him because “there isn’t an adult family member to sign the documents”. My cousin couldn’t believe her ears. She argued, she begged. No and no, they couldn’t admit him. Finally, a doctor poked his head to hear what this uproar was about. He saw my brother, listened to what the people who brought him there had to say and said that they were admitting him. “You can’t!” the others cried. “What about the documents!” And he said, “I am not letting this child die just because his mother isn’t around.” They admitted him. When the tests came back, they showed that his results were 50 times over the limit. He would have died thanks to the hospital staff inaction in the face of an acute problem. That’s the baby in distress – midwife sitting on her hands scenario.

      Fast-forward ten years and here I am, having a migraine. The pain was beyond description. I stumbled for the bathroom for another pill. I couldn’t see where I was walking, I was in so much pain. I fell. I broke my leg. Surely that wouldn’t have happened if I hadn’t have a migraine to start with. I joke that migraine breaks feet but I know it doesn’t. That’s the deaths of formula-fed infants scenario.

      Surely you can see the difference?

      • I don’t see it as midwives sitting on their hands, refusing to help save babies; rather, that they do their best, and usually are more effective than a completely untrained person would be in that situation, but that they do not have the tools to save as many babies as the doctors and nurses in the hospital would be able to. And that does seem like formula: certainly better than trying to feed the baby straight cows milk, or a bowl of clam chowder; but not as good as the species-specific nourishment (and auxiliary immune system) evolution has designed for him or her.

        • Amazed

          The problem is, their best is not good enough in too many cases. Because they lack a main tool: knowledge to properly assess the situation and make a good judgment call. I wonder what you call delaying transfer, assuring moms that they are hearing a good heart tones (actually, the moms’ own tones) and then treating a hemorrage by chewing cinnamon and blowing at mom’s face? I kid you not, that was one of the “tips” they recommended to each other on facebook.

          Why do you compare giving birth with a midwife only with UC? Why won’t you compare it to giving birth in a setting where people are trained to see when normal becomes abnormal? Normal doesn’t have variations, it has boundaries and many midwives do not see them and refuse to admit that they exist. How is this not refusing to help save babies?

          • I will respond more fully later as I only have a sec; but the short answer for now is that this was intended not to be my direct argument, but part of an ongoing meta-argument we have been having over what qualifies as causation of harm vs. simply correlation. Dr. Amy et al have had a double standard in this regard, radically varying the stringency of the standard based on the subject of the research (“whose ox is being gored”) rather than on the methods as they claim, and which the integrity of the scientific method demands.

          • DirtyOldTown

            Here’s a pro-tip Alan: frightening your audience with a few big words strung together in an impressive looking approximation of an argument is not going to work here. But this is the finest example of bafflegab I have seen in a long time. (Meta-argument? Really? Your talents are wasted here.)

          • No, it’s a solid and actually very straightforward argument, which has nothing to do with “frightening” anyone (wha??). But as the saying goes, there are none so blind as those who will not see.

          • Amazed

            Again, Alan: the Wax paper. The recent post. Tear the shutters from your eyes and not be blind. Search function is your friend.

          • Wax paper, heh.

            So why does Dr. Amy get credit for acknowledging a counterpoint but I don’t?

            Anyway, my fundamental complaint still stands and does not rest on any specific study or studies. Dr. Amy dismissed all “associational” studies “(what I call “retrospective” studies) as inherently invalid (“crap” was her word of choice). ALL of them, categorically, as a class. But that category inherently includes all research on homebirth, unless North Korea has done some where they divided pregnant women into randomised groups and ordered one group to birth at home and the other in a hospital.

            No one here has thus far been able to come up with an explanation for this contradiction, so instead they try to shout me down and hiss insults. Pay no attention to the man behind the curtain!

          • Box of Salt

            Alan, let me pose a theoretical question to you.

            Do you think there is a difference between retrospectively studying the outcomes of a single event which occurs once in a lifetime, versus retrospectively studying the outcomes of many, many events repeated several times daily over many years?

            If so, please apply that distinction to the difference between studying birth and studying nutrition. There’s your explanation: there is no contradiction. The studies don’t compare.

          • Sure, there is a difference. But that difference does not help your argument–just the opposite. One of the most important ways researchers help account for the inherent limitations of retrospective research is to study whether an apparent effect is dose-dependent. That is not possible to study with birth (where the “dose” is always “one”);, so the research on diet should be more, not less, robust.

          • Box of Salt

            Wrong, Alan: “That is not possible to study with birth (where the “dose” is always “one”);, so the research on diet should be more, not less, robust.”

            The fact that birth is not dose dependent is one of the reasons you cannot compare studies on birth with studies on nutrition.

            The fact that you are still insisting on trying just shows how little you understand about the scientific process.

          • No-one is attempting to shout you down. Though several futile attempts have been made to deflect you from your not too interesting point. The insults aren’t exactly being hissed, either. Stated openly in plain and specific terms, it seems to me, which is not very nice but you will lay yourself wide open to them. Still the Heroic pose of the Man Who Would Not Be Silenced is flattering, I suppose. The rest of us only see the guy who will not shut up.

          • “Why don’t you go away” and variations of same (including insinuations that my posting here indicates that I am neglecting my children, sending them spiraling down into a life of crime) have been said many times, and you know that.

          • Amazed

            Oh, you wanted credit? I’m sorry, I didn’t realize. This blog not only doesn’t open properly for me, but it causes my PC to run slow, so I never get to read all the comments together. THAT’s the problem with this blog and not the sweeping generalizations you like to envision.

            OK. All you hateful bitches, bravo for Alan! Bravo for the man who acknowledges a counter point. Three cheers for Alan!

            Is that enough?

          • That will suffice for now. 😉

            I too have trouble with technical aspects of reading this blog. Are you using an iPad?

          • Amazed

            Good to know it will suffice.

            No, usually I am with a very ordinary Windows 7 on a very ordinary PC. The one I work from, in fact. For some reason, it’s easier from my laptop, also with Windows 7 but is’s far from perfect. And don’t even get me started about posting. That’s even harder.

            Neither PC nor laptop have trouble connecting to other sites. I think it’s something between them and this particular site. It became worse after Dr Amy switched to Discus.

            Do you experience something like that? I don’t know what my problem is.

          • This is what I experience:

            The comments seem to disappear and reappear, and display in a quixotic order that seems to shift from one visit to the next. If my comment is at all long, it gets kind of “freeze-y” especially if I try to edit it. And when a post gets much more than a couple hundred comments, it just gets really hard to load.

          • Amazed

            Dr Amy was the first to criticize the Wax study, Alan. Not long ago, we had a post titled, You heard it here first: the new homebirth study has serious flaws. The study was showing significant difference in the terms of outcomes and it would have furthered her cause.

            What was it again, subject against methods? Not here.

            And by the way, my main problem is not even the fact that there are midwives who are downright dangerous (although you can be sure my father would not have appreciated having the cinnamon gal at my mother/s second birth, the lovely natural birth of a 10-pounder when she almost bled to death). My problem is that their governing body actually refuses to govern and discipline them. In the aftermath of my brother’s case, you can be sure that the hospital didn’t look the other way around and said, “Well, some 15 year olds are simply just not meant to live”. They tried to work out a better strategy for non-adults in acute distress when the parents could not be present, Something like that for midwives? Is there such a thing?

          • I believe there is, and my friend Lynn is involved in that. Should it be more rigourous and more formalised? I would definitely support that. But this blog does not seem to consider such nuanced approaches, instead making sweeping generalisations that throw the baby out with the birthing tub water, if you will.

          • Amazed

            And I believe the earth is flat. I believe. I believe. I believe. My friend Fred Flintstone will support this. What? You mean you don’t give a f…k about my belief and my friend Fred? Why is this? Maybe because I can’t support it with, err, facts?

            I don’t give a f…k about your belief. I don’t give a f…k about your friend Lynn, either. Not while MANA and NARM, and Ina May, let’s not forget about Ina May, still insist on doing nothing and call babies who were healthy, full-term and very preventably dead “unfortunate birth outcomes”. They are the one leading the dance and not your friend Lynn, whoever Lynn is. When you have something more than your “belief”, like a working process for holding midwives responsible, we’ll be happy to accept it. But your belief when it contradicts facts? No, thanks but no, thanks.

          • theNormalDistribution

            There has been no ongoing “meta-argument” between you and anyone. You must be referring to your repeatedly taunting Amy with your lack of understanding of what, and what does not, constitute good research, and her ignoring you.

          • She was replying to me more than anyone here, until I started doggedly presenting her with this question, which she cannot answer.

          • theNormalDistribution

            “How did the moon get there? Look. You pinheads who attack me for this, you’re just desperate. How’d the moon get there? How’d the sun get there? How’d it get there? Can you explain it to me? How come we have that, and Mars doesn’t have it? Venus doesn’t have it. How come? Why not? How’d it get here? How did that little amoeba get here? Crawl out there? How’d it do it? C’mon.”

          • Wow, this is just…odd.. I’m trying really hard to comprehend how you could think this is either (a) funny or (b) a good illustration of any possible argument…but no. Just not good.

          • theNormalDistribution

            No, it’s a solid and actually very straightforward argument. But as the saying goes, there are none so blind as those who will not see.

          • From my experience with midwives, you are disproportionately representing the bottom of the barrel. But that bottom does exist, for sure (though that’s also true in OB/GYN), and someone I know locally (who posted one comment on here the day I first posted) is very dedicated *within* the midwifery community to ferreting out the lay midwives that witness a couple births, throw up a shingle, and proceed to take clients in blatant disregard for the health and safety of mothers and their babies.

            That was far from our experience with our CPM, who really embodied professionalism and after transport to hospital, impressed the experienced L&D nurse with her skills and knowledge. Unfortunately for her (the CPM), her prudence and caution were appearing to cause her reputation some harm within the local NCB community. She had a streak at one point of something like four or five straight hospital transports. None of them were the kind of desperate, too-late (or close to it) type situations that are focussed on here; rather, they just involved situations where she felt it appropriate to calmly transport before it *did* become a dicey situation.

            But this was getting her a reputation of therefore not helping women *succeed* at birthing at home, making other pregnant women reluctant to hire her; and I can see where this tension can contribute to bad outcomes if there are not strict guidelines for transfer criteria as I understood is done in some countries.

            In any event, at this point I would lean toward advising someone against homebirth even with the best of midwives, as the hospital environment and policies have gotten better, and the decreased risk of perinatal mortality at the hospital is, in my opinion, worth the tradeoffs. But I don’t consider the magntitude of risk reduction so great as to consider parents who choose differently grossly negligent. As I’ve said many times, a similar reduction in mortality risk can be achieved for one’s children by moving a few miles closer to their school or daycare and staying close as they grow up; but we don’t portray parents as monsters if they don’t do this.

          • Captain Obvious

            Practice within your capabilities, and don’t perform activities if you cannot handle majority of the complications that can happen. Why do CPM continue to tell women to trust birth, then like your CPM transfer 4-5 clients in a row. It does make you understand they can’t handle proper care, thus putting women at risk.

          • Most of the complaints around here are about midwives who are too reluctant to transfer and thus put the babies in jeopardy. And IIRC Dr. Amy has said HB is much safer in some countries mainly because they use strict risk criteria for transfer. But you twist around her levelheaded caution into a negative, even though as I said the LD nurse was impressed with her knowledge.

  • multimom

    At what point do these maniacs pick up on the fact that they are incompetent? I get that they’re dedicated to their cause, but lady, you failed at your job. Babies are dead. You did it wrong.

    How many babies would she deliver in a month? I’m guessing about three. So she harmed every baby she delivered that month. Maybe it’s time to quit you freak! How can you be human and still carry on like that? Who would accept a mechanic how ruined three cars in a month? No one. And these are people, little helpless people. What the hell?

    In all seriousness, at what point does it become manslaughter?

    • Bombshellrisa

      They don’t get it because this is their attitude

      “. Great except for the big swooping heart rate decelerations while she was pushing. Just on the edge of calling for an ambulance about a half dozen times. When I’d had enough, the heart rate would go into the normal range. I finally asked my assistant to go get a midwife in the clinic (we were in the birth center) and blessedly, one of them was free. She came down, sat on the bed with the heart rate monitor and listened while the momma pushed. With another few pushes, the babe was born. Screaming. With a big ole loop of cord by his head, which was probably causing all the excitement. What a relief to have a sister midwife by my side.” This from Beth Coyote, Rainy City Midwifery. Dr Amy wrote a blog post about the loss mother Beth attended http://www.skepticalob.com/2012/09/yes-it-is-your-fault-that-your-baby-died-at-homebirth.html

      And this “Surely the work we do is somehow angelic. We agreed that every baby whose birth we have attended is a special baby to us but especially the ones we’ve resuscitated. There is a strong cord running between us when a baby has had to be encouraged to take a breath, when there’s been some drama” http://becoy.blogspot.com/search?updated-max=2013-02-22T13:57:00-08:00

      • I don’t have a creative name

        That second paragraph has evil in it and truly gave me the shivers. This is a woman who has a sick and unhealthy need for drama.

        • Bombshellrisa

          http://www.skepticalob.com/2012/09/yes-it-is-your-fault-that-your-baby-died-at-homebirth.html Same midwife-the one where they were all singing to the baby, hoping that she would take a breath

        • fiftyfifty1

          I got the shivers too. Reminds me way too much of a description I read by a murderer about the “bond” he felt to his victims. Chilling.
          I have resuscitated individuals before and have never felt any special bond to them. Yes, the next time I see them it does give me a little happy thrill and I might say something like “It makes my day to see you sitting up in bed looking so good”. But a special lasting bond? Um no.

      • Anaesthetist

        I am thinking Genene Jones

        • Spamamander

          That is EXACTLY what that sounds like, living a thrill by bringing babies back from the brink. Genene Jones may have actively pushed children into crisis, but these midwives are damn close to it.

      • JenniferG

        This absolutely horrifies me because that was the pattern with my daughter — but on monitoring you can see how it recovers (or not) as well as that it did eventually get back up there.

    • Captain Obvious

      I have seen graduated residents (or anyone with a new job) “fake it til you make it”. They have a patient come back after they could research the problem a little or ask a colleague for advice. Nothing wrong with that as long as you don’t delay a diagnosis. Then after years of experience and wisdom, it should be automatic. How does this twit not get it after 20 years? Another unlicensed midwife example on a YouTube video. Only 4 deaths of her 750 deliveries.

      Check out this video on YouTube:

      http://youtu.be/1cQkyroZ8DY

  • I don’t have a creative name

    Quick, someone check the Sisters in Chains site – surely this poor, persecuted midwife must have a front and center place by now.

    • Bombshellrisa

      Oddly enough she doesn’t but I noticed Katie McCall put herself down, as well as the midwife from the link below. And notice the blurb for Darby Partner
      “Darby Partner (midwife) 2011

      Persecuted by a client after a stillbirth at home via the media’s untruths and lack of community support.”

      • HURRAH for “lack of community support”!

      • multimom

        Persecuted by a client after a stillbirth at home via the media’s untruths and lack of community support.”

        **********************************************************
        So mom a mother upset with the failure to provide proper care is now persecuting? Interesting.

        Do that mean that the people who complain on “My OB said WHAT?” are persecuting Obs? Are people who sue OBs persecuting OBs?

        • Bombshellrisa

          I can’t believe how much that word is thrown around by midwives. They need a dictionary and sense of perspective.

        • Missy Miss

          Maybe they mean prosecuting? That would certainly be appropriate!

    • Captain Obvious
      • Bombshellrisa

        From her letter addressing California “despite my best intentions you say I broke one of your many rules. Well, how was I even to know? You never told me the rules. You were constantly terrorizing me, telling me rules I had broken only after I had done so! There was no way to know how to please you!”

        If you want to practice medicine or nursing or midwifery, it’s up to YOU to know your scope of practice. She is seriously disturbed and much too emotional. I, for one, am GLAD she won’t be practicing midwifery. Her friends, the Henderson Clan, are now asking people to contribute to furnishing the house they are renting as they believe if the court sees they have a place to live that is ready for the kids that they will put the kids back in their custody. Katie McCall was suggesting people also give things like seeds and garden tools and possibly a goat or chicken so they can be self sustaining.

        • Dr Sarah

          Re. the Katie McCall story: Maybe something hasn’t been reported here, but… from the version of the story that that blog linked to, it seems that what happened was that as a student she ended up (through sheer bad luck) stuck alone caring for a mother who *refused* to go to hospital for her birth despite McCall warning her that she wasn’t medically qualified. McCall thus saw herself as being stuck with a choice between doing the best she could in the circumstances with the knowledge she did have, or walking away and leaving the woman *completely* unattended, and chose the former as the lesser of two evils.

          If that is what actually happened (and I’m open to the possibility that this version has been somehow distorted, if anyone knows of any other info), then I think that’s a rather different matter from someone deliberately setting up as an unlicenced midwife and encouraging patients to come to her despite her lack of qualifications. From this story, McCall seems to have done the best she could in a situation where no-one else was available and where the mother was refusing to go to anywhere where anyone else would be available. That strikes me as much more the equivalent of giving what medical help you can to someone who collapses at the roadside (a thorny issue, but one in which it is generally advised – in the country I practice in, at any rate – that if you do the best you can within the limits of your competence rather than walking away then the law will prove supportive).

          • I’ve always heard that in an emergency situation the first thing you should do is call for help before rendering aid (within reason of course). If you see someone on the side of the road and could call 911 but, instead you attempt to provide all care yourself although you know you aren’t capable I don’t know if you can be held legally accountable but, I certainly think it is ethically wrong. At the very least the midwife could have covered her own bases by calling 911 and then she truly could claim she did everything she could to help. I don’t think you can get in trouble with the law for calling 911 in a true emergency–even if it against somebody’s will. Let the mother turn the EMTs away herself if she wants and then the outcome will truly no longer be her responsibility.

          • Bombshellrisa

            The version on the blog is from Katie McCall herself. Ms McCall had arranged to be a doula for the family, saying she would give them a deal because she was a student midwife. There was never any mention of who the primary midwife was, which makes me wonder if this was a sort of UC attempt.
            http://articles.latimes.com/2011/aug/19/local/la-me-midwife-convicted-20110819

            McCall also runs the Facebook page “Sisters In Chains”. It’s an enlightening read. Every “persecuted” midwife is listed there. McCall also lists herself. If you read the blurb about midwife Darby Partner and then read about her on Hurt by Homebirth, you will see there is a world of difference in the versions.

          • Siri

            The piece you link to certainly reads as if she wanted that birth for herself; promising to call a midwife when labour started, and then, whoops! Sorry, no one available, guess the little red hen will have to conduct the delivery herself…

          • Dr Sarah

            Bombshellrisa and attitude devant: Thanks for info. Wow, that certainly does raise some very worrying questions. When I originally read the story, I’d assumed this was some sort of official arrangement as part of her training (which, of course, would be normal for training a health care professional) but I should have thought to question that – if she had been officially under the supervision of a presiding midwife, why would she the one being called to the birth and having to contact the midwife rather than the other way round?

            From this account, it seems that she’d been out looking for business on her own account, without even setting up proper arrangements for supervision. According to what I’ve also now read on her blog, it seems she hadn’t even checked properly that the midwives supervising her were licenced, and, guess what, they weren’t! What exactly was her training consisting of, anyway? Doesn’t sound as though she was enrolled in any kind of official college course, if she was off touting for deliveries herself as part of her training…

            Clarissa: I agree with what you’re saying, but it would be enough of a legal and ethical dilemma that I wouldn’t blame a student for making the wrong choice in that situation if it really was a ‘wow, just got dropped into this mess by total bad luck’. But, of course, that’s a moot point since the above info very strongly suggests that that was not the case.

          • Bombshellrisa

            I think her training was apprentice style CPM stuff, where you shadow a midwife and observe 10 births (which she could do as a doula, and get paid for it), assist in 10 births and be the primary midwife for 10 more births. I am wondering now, given her friendship with the Henderson Clan if this incident was at the births of one of their children. http://supportclanhenderson.blogspot.com/
            http://supportclanhenderson.blogspot.com/2011_08_01_archive.html “Six of their seven children were born without a doctors presence. Five of them were born at home without any medical assistance at all. ” Erica is/was Katie McCall’s roommate when her last child was taken by CPS.

          • Dr Sarah

            So… does the CPM training involve any theoretical stuff?? Is this taking place through any kind of accredited educational institution?

          • Bombshellrisa

            I am not sure how it works in California, but in WA you can train through Bastyr University (http://www.bastyr.edu/academics/areas-study/midwifery-degree-programs) but it’s not a formal learning experience, as you have to get the clinical hours but you also have to find them yourself. From the website:

            Where to Get Clinical Experience

            Students may obtain their clinical experience in gynecology/family planning clinics, prenatal/postpartum clinics, homebirth settings, birth centers, and hospitals in North America as well as overseas. Students may work with licensed midwives, certified professional midwives, certified nurse-midwives, nurse practitioners, foreign midwives, naturopathic doctors, physician assistants or physicians during these rotations.

            Clinical faculty must be practicing legally and have sufficient obstetrical/gynecological volume to adequately instruct, supervise, and evaluate the student’s clinical training. The Department of Midwifery screens and approves all potential clinical faculty.” So if you are going through formal training, you are still learning as an apprentice. Most of the students will be apprenticing multiple midwives, but it will still take 3-5 years to get in all the hours. And there is no requirement that you have formal training for the CPM, some states let you call yourself that without having done anything.

          • Squillo

            More than 50% of CPMs never attend any kind of formal midwifery school at all. They are accredited through NARM’s “PEP” (Portfolio Evaluation Program) which allows them to work with a single preceptor and sit the NARM exam. If the preceptor signs off on the births and the apprentice passes the exam, voilà! She’s a certified professional midwife.

            The ACNM, while it is fairly cagey on the issue of non-CNM/CM midwives in general, has vigorously opposed attempts to get government and third-party reimbursement for PEP-trained CPMs, and they’ve made it clear that they don’t consider it an adequate education.

          • attitude devant

            That is NOT what happened!!! That is what Katie claims but the court record shows that reality is quite different. She was a student and took on a client. She did NOT arrange backup/proctoring for the delivery. When the mom was in labor she simply didn’t take her any where and claimed that she was basically a Good Samaritan. Total BS!!!

          • Bombshellrisa

            That is what I got from the story. What it seemed like to me was NOT that a midwife “refused to show up”. Who was the pregnant woman’s HCP through the pregnancy? If it was an OB, why would she suddenly refuse to the to the hospital? If she was in the care of a midwife for who Katie McCall was an apprentice, surely they have some kind of backup plan for having more than one woman in labor at a time.

        • deafgimp

          Wait, the Henderson kids were taken away or were Katie McCall’s kids taken away? For what reason? How does this all play in with McCall’s situation?

          • Bombshellrisa

            The Henderson kids have been taken away from their parents twice. Once in 2005 and they were returned (Katie McCall was living with the family at the time) and then this past time in 2011. This is a brief from the 2005 story, Erica Henderson was on “Good Morning America” after the rescue was shown on tv, it was during flooding in Southern California.

            http://articles.latimes.com/2005/jan/12/local/me-rescue12

            The children are still in foster care. Katie McCall was lamenting the fact that a social worker had warned the Hendersons not to be socializing with McCall while her trial was going on and after that, when she was found guilty. Katie McCall wrote this version of the Henderson family story and posted it. In the comments, you can see that the Hendersons didn’t register the birth of their child. It made me wonder if Katie McCall was the midwife for the Hendersons at one of their children’s births and her case was an outcome of that. http://www.copblock.org/20885/still-writing-non-abused-healthy-infant-kidnapped-by-leos/

      • Bombshellrisa

        This is the program she is working with http://freestateproject.org/intro “The Free State Project is an agreement among 20,000 pro-liberty activists to move to New Hampshire, where they will exert the fullest practical effort toward the creation of a society in which the maximum role of government is the protection of life, liberty, and property. The success of the Project would likely entail reductions in taxation and regulation, reforms at all levels of government, to expand individual rights and free markets, and a restoration of constitutional federalism, demonstrating the benefits of liberty to the rest of the nation and the world.”

        • Renee Martin

          They think they want a world where markets rule, and there are few to no taxes, and no regulation. They think this would be like America, just better, the way it was “meant to be”!

          I think they love the idea of a “the strong and smart rule”, and have no concept of what its like to live somewhere like this. No man is an island, no matter what these types think.

          • Guest

            I hear Somalia is a lovely place to live, right? 🙂

        • Victoria

          She doesn’t understand that her actions are incompatible with this statment, “the maximum role of government is the protection of life”?

          • Bombshellrisa

            She probably is thinking only in terms of what the concept means for HER. She is probably going there so she can start catching babies again without all the rules and regulations that protect people from her.

          • Playing Possum

            Ah, but see, a stillborn isn’t “life”. Even agonal neonates in PEA are not “life”. At least not for the people who don’t want their malpractice to be investigated by the coroner.

      • Renee Martin

        She will probably come to Oregon, where no license is needed to kill, I mean, deliver, babies!

  • Aunti Po Dean

    Stories like this one make we worry that moves such as the one occurring in South Australia to try to protect the “practice of midwifery” will also have no impact at all on stopping midwives such as Lisa Barrett

  • Mrs. W

    A new way to spell incompetent – CPM.

  • Bombshellrisa

    http://jennifermargulis.net/blog/2012/04/arrested-midwife-says-she-won%E2%80%99t-deliver-babies-in-indiana-anymore/

    This article talks about another Indiana midwife, along with commentary from Debbie Pulley of NARM about how much training a CPM has. This is also a good example for those people who insist their midwife was an L&D nurse before she became a midwife “Keeslar, a trained nurse, worked in obstetrics for almost ten years at two different hospitals and two freestanding birth centers.”

    • The Computer Ate My Nym

      My step mother is an obstetric nurse. Here’s what she has to say about home birth (direct quote): “Do you want a live baby or a dead baby? If you want a live baby, get in here RIGHT NOW!” (Said to a woman planning, suicidally, for an HBAC after classical c-section, with a doula presiding. She did, indeed, rupture, but she and babies survived thanks to being in the OR already at the time…though it might have gone better if she’d told someone that labor had started when she came in for the c-section…)

      • Lena

        Stories like that really test my ability to feel compassion.

    • The Computer Ate My Nym

      Also, someone claiming to be an RN made the ridiculous old comment about “birth is a natural process” in the comments. I attempted to leave a comment explaining that I would have died perfectly naturally without medical care, but somehow doubt that it will be approved.

      • Bombshellrisa

        Two “gems” from the comments: ” many midwives have views that would conflict with the training required to become a nurse in the traditional system of so-called “health-care” and this is what makes them excellent, true providers of CARE to women and have a sensitivity and desire to do what is in the best interest of the patient, mother and child” Guess that is admitting that instead of using science, they are using woo. Great.

        And this, by a lay midwife “If you do research on the safety of CPM births you will find that our safety record is quite impressive.The training may not be formal, college classroom education, but it is complete and extensive.
        I would much rather place my trust in a woman’s ability to labor and birth where she is the most comfortable – both physically and emotionally – than to rob her of all her instincts, place her in a position that is not conducive to good birthing, surround her with strangers who have a long list of rules and machines and who expect her to have problems that will make them feel needed!”

        • Kalacirya

          Even if their training was adequate, which I don’t believe for a second that it is, there’s no systematic review of their work. A CPM that presides over a death and injury doesn’t have to sit with a group of her peers or superiors, and review what happened. There’s no analysis to see what, if anything, could have been done differently to inform future behavior. They’re lone wolves, and sure, some of them are loosely banded under the CPM credential, but it’s not like MANA is calling them up for conferences when they accidentally maim a baby.

          • Bombshellrisa

            In WA, the review board is a group of 1 doctor and a bunch of CPMs and a nurse. The CPMs stick together, out of the group only one is willing to hold anyone accountable. Her comments can be seen on the Tamra Roloff documents.

          • Kalacirya

            Which ones are we talking about. I’m looking at this one right now. http://www.midwiveswashington.com/wp-content/uploads/2012/04/Tamra-Roloff-Final-Order-Nov-2012.pdf

          • Bombshellrisa

            I don’t know where the other documents went for that case, but I know that Erin Curtiss was scathing in her review. Good for her. I know that some people don’t like her because she doesn’t hesitate to transfer care to an OB.

          • Kalacirya

            Wow, so I couldn’t find the statements about Roloff other than the order for her probation, but the legal docs posted for other WA midwives are really something, which I’m sure you’ve seen before. This Leslie Gesner one was appalling.

          • Bombshellrisa

            There is another for a midwife (still practicing) that was slapping a laboring mother for crying out in pain

          • Kalacirya

            Yeah, I remember the Coyote one. Ugh.

          • Durango

            Oh my god, that document is horrifying.

          • guestmama

            I think this is such an important point – accountability. Peer review. The proverbial good, long, hard look in the mirror, studying the mistake to see what went wrong and how to learn from it and improve practices. Having others critique it as well. Human nature being what it is, it’s all too common for people to hide (or at least not draw attention to) their mistakes. Knowing that you’re accountable to your peers/supervisors is huge.

            CPM’s are lone wolves for sure – that was very well put.

        • fiftyfifty1

          “who expect her to have problems that will make them feel needed!”
          Nothing pleases me more than patients who DON’T need me. A patient with cholesterol problems who changes her diet and now has healthy numbers, a man with back pain who is able to improve with exercise, a teen with asthma who quits smoking and is able to join the dance team, a 90 year old whose only “med” is a vitamin. I haven’t deliverd a baby since residency, but I was always super happy for the moms who had nice uncomplicated births. When it was over, everyone in the room, including the attending OB, would be wearing a huge smile.

          • theadequatemother

            agree 100%. I’m happy when my anesthetics are boring!

          • Bombshellrisa

            It is a good night when my patients’ pain in under control, everyone on telemetry is in sinus rhythm and the only calls I get are for a sleeping pill or something like that. Seriously, I am not standing outside someone’s room rubbing my hands together saying “Goody, I hope someone starts crashing so I can do some chest compressions”.

          • Victoria

            They don’t understand that being able to do something in a situation that calls for it is not the same as wanting to do that procedure.

          • MaineJen

            See, this was my experience when I had my kids too. Everyone LOVES you when you’re uncomplicated, and you don’t need much intervention. (I had a nurse say that exact thing to me: “I want you!! You’re nice and boring!!”) It’s a feel-good experience, I’m happy to hear for the docs as well as for the patient 🙂 A far cry from the so-called ‘push’ for interventions…

        • Squillo

          many midwives have views that would conflict with the training required
          to become a nurse in the traditional system of so-called “health-care

          Translation: many would-be midwives couldn’t make it through nursing school and/or can’t be bothered.

          And how exactly do they know that if they haven’t actually been to nursing school?

          • Bombshellrisa

            The same way they know that women are all given C-sections so the doctors can get to their golf games!

          • Dr Kitty

            I read it as “many midwives are flat out wrong headed in how they approach birth and are absolutely resistant to admitting this or learning facts that challenge their beliefs”.

          • Box of Salt

            the fact that many of them use homeopathy and/or herbal remedies came to mind.

        • ersmom

          I tell patients all of the time – “Boring is good.”

          As a resident, I loved the scary cases. Nowadays, give me a reassuring FHT strip and progress during pushing, ending with a squawking baby. I’m too old for that shit.

          • Elizabeth Abraham

            So with you there.

            We were very excited about our first pregnancy, because it was our baby and our family and a big moment for us. The doctors were pretty ho-hum. The pregnancy was a walk in the park.

            Our last pregnancy occurred the first cycle after a miscarriage and involved placenta previa – boy were the doctors excited! But it we really did not enjoy that pregnancy at all, and every thrilled resident was like a nail in the coffin of our remaining joie de vivre.

            That baby is three now, and she’s delightfully exciting, what with how she’s our baby and part of our family and beautifully healthy. Our pediatrician admits to liking our visits because the kids are darling, but not having any reason to be professionally enthralled. This is win.

    • Staceyjw

      I always wonder about these “former health care workers” or “worked on obstetrics floor” or “former/trained nurse”.

      We have a LDEM in Oregon (Eugene to the coast) that tells moms she had a decade experience in OB. sounds great, right? What she doesn’t tell them is that she was the JANITOR. Yeah. Oh, her name is Patty Couch.

      How many are no longer nurses because they did a bad job, or trained gy never succeeded, etc?

      • Lori

        I don’t know if it is just a nursing thing, but I feel like we have a patient or family member proudly declare they are nurses, (usually conveniently thrown in while arguing with the staff about the treatment plan), like once a month that we can never find in the license database once we look them up.

        • Jennifer A

          or all of the “nurses” who are actually CNAs or Medical Assistants or worked in a nursing home one summer 30 years ago….. ahem

      • I don’t have a creative name

        http://oregonmidwifeinfo.com/patricia-couch/

        Looks like she should’ve stuck with scrubbing toilets.

  • felicitasz

    I am not an OB (obviously), and have a question as my imagination fails me. I can’t even picture this: “the second infant was only partially delivered and had to be taken through cesarean section.”

    How on the earth is this possible? What do they mean, partially delivered and then through c/s? A foot sticking out, and they push the baby back (?) and do a c/s? Or what to think of?
    (Good Lord, do I really want to know?)

    • anonymous

      Breech comes to mind.

      • Breech is the first possibility that I thought of. The second is shoulder dystocia. Neither has a good chance of survival due to hypoxia from cord compression.

        • Dr Kitty

          Zavanelli manoeuvre or head entrapment of a breech would be my guess. Desperate measures, but if a baby is truly stuck CS is the only alternative to dismemberment of a dead foetus to allow vaginal extraction.

      • felicitasz

        Thank you for the answer. I thank everyone else here below, too.

    • LovleAnjel

      They had to reach in through the C-section cut and pull the baby backwards through the birth canal, back into the uterus and then out. I suspect it is even more awful than it sounds.

      • multimom

        wonder if we can get everyone to agree that this was definitely a necessary c-section. Probably not.

    • Aunti Po Dean

      yes it is completely possible to do a section to rescue a partially delivered breech
      It is also technically possible to push the head back in of a stuck shoulder dystocia and quickly go to section although I agree with anonymous it was probably a partially delivered breech in this instance

    • Captain Obvious

      Head can deliver with shoulder dystocia and the physician can flex the neck and push the head back in and perform a CS. Zavanelli Maneuver.

      • Lori

        See I’ve always been curious about this. My husband was a forceps delivery and my MIL said she begged for a section as she was terrified of the forceps (can’t blame her, honestly) but they told her the baby was, “too far down”. Is it just super high risk and only done after all other options have been exhausted or something?

        • fiftyfifty1

          Yes, it’s that it is high risk. Last resort to push a baby back up.

        • CanDoc

          @ Lori. Depends on the situation. I can only think of two cases where women absolutely refused an operative (forceps) vaginal delivery when the baby’s head was so low I could see the hair at the vaginal opening. Had to have a nurse attempt to disimpact the head from below while anesthetist gave IV medication to relax the uterus and I brought the baby back up and out through a cesarean incision. Babies were fine, but the uterus is so swollen and bloody after that much labour that it took me twice as long as usual to sew it back up, and was a bloody mess.
          My guess for the “partly delivered” would include hand/shoulder presentation. A second twin shoulder dystocia would be unlikely and a breech the MW would likely just pull and yell and work exceptionally hard to get out (even dead) at home, likely with success after the first babe was out.
          The story of this midwife makes me nauseous.

          • Lori

            Thanks for the reply, that is interesting, I never even considered the effects on the uterus and yes, the midwife in the main post is definitely nauseatingly unethical.

      • Guestll

        In my husband’s case (second twin, footling, prolapsed cord) he was “partially delivered and taken via cesarean” as well. You can’t do a Zavanelli with a footling breech, right?

    • Charlotte

      It happened to my baby, and they had to shove her back in and do a c-section. Screw every last person in my life who pressured me to vbac. I had horrible complications from the attempt and ended up spending 10 days in the hospital. I should have stood up for myself. It always irks me to hear people say they felt pressured into a c-section because most have no problem telling you how horrible you are for even considering a RCS.

  • Lisa

    Horrifying. Imagine if three mothers lost full term, healthy babies under the same OB’s care in a 2 week period. They’d have his head. Yet this baby killer wants to be allowed to continue practicing under the banner of a woman’s right to choose? WTF?

    • attitude devant

      The fact that these deaths tend to cluster more around certain midwives highlights the fact that they are not random. Look at Oregonmidwifeinfo.com and look for the midwives who’ve had more than one death. These deaths reflect reckless patterns of practice, an adherence to ideology before safety, and/or a desire to live up to unrealistic expectations regarding transport rates. The welfare of babies is rather low on the priority list.

    • BlogLurkMom

      It is actually two deaths in two weeks. The first was a transfer and did not say that the child died. Then there were two deaths.

  • ratiomom

    3 dead babies in less than a week?! That’s got to be some kind of record. Which kind of midwife was this?
    It’s incredibly sad that babies in the US aren’t protected against these incompetent ‘birth addicts’

    • Amy Tuteur, MD

      I think it was 3 births in a week, one resulting in hospital transfer and the other 2 resulting in deaths.

      • KarenJJ

        And yet they continue practising? I don’t understand that mindset. I’d be beside myself if that happened to me. If I get something wrong at work I’m upset and try to rectify it and learn from it.

    • I will tell you as a Ped that even a single unexpected newborn death in a hospital will lead to M&M conferences (morbidity and mortality) and an exhaustive investigation to figure out where the system failed– with immediate steps for correction.

      (Though actually most hospital newborn deaths are tiny preemies and kids with severe congenital anomalies. Those count in the death statistics but are of a very different sort than these mentioned in the OP)