Oregon releases official homebirth death rates, and they are hideous

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Moments ago, the State of Oregon released the official homebirth death statistics for 2012 and they are worse than my worst prediction.

You may recall that back in August 2010, Melissa Cheyney, the Director of Research for the Midwives Alliance of North America (MANA) and also the head of the Board of Direct Entry Midwifery, rejected a call by the State of Oregon for access to the MANA homebirth death rates for Oregon. As a result, the State decided to collect the statistics themselves. They turned to Judith Rooks, a certified nurse midwife and midwifery researcher who is known to be a supporter of direct entry midwifery, to analyze the Oregon homebirth statistics for 2012.

Rooks testified this afternoon at a legislative hearing on HB 2997, a bill addressing the licensing requirements direct entry (homebirth) midwives.

She began by introducing herself:

I’m a certified nurse-midwife, a past-president of the American College of Nurse-Midwives, and a CDC-trained epidemiologist who has published three major studies of out-of-hospital births in this country.

In 2011 the Oregon House Health Care Committee amended the direct-entry midwifery—“DEM”—law to require collection of information on planned place of birth and planned birth attendant on fetal-death and live-birth certificates starting in 2012.

Oregon now has the most complete, accurate data of any US state on outcomes of births planned to occur in the mother’s home or an out-of-hospital birth center.

She then presented and explained the following table:

Oregon homebirth death rates 2012

The death rate is horrific, even AFTER Rooks inappropriately eliminated the death of a baby at homebirth who had congenital anomalies. Since the hospital group contains congenital anomalies, it is not appropriate to remove them the homebirth group.

The total mortality rate associated with those births [planned OOH births with direct-entry midwives as the planned birth attendants] – excluding the one involving congenital abnormalities – is 4.8 per 1000.

For comparison, data on births planned to occur in hospitals is provided in the bottom row of the table.

The real death rate for planned homebirth with a direct-entry midwife in 2012 was actually 5.6/1000.

As Rooks regretfully acknowledges:

Note that the total mortality rate for births planned to be attended by direct-entry midwives is 6-8 times higher than the rate for births planned to be attended in hospitals. The data for hospitals does not exclude deaths caused by congenital abnormalities.

Many women have been told that OOH births are as safe or safer than births in hospitals…

But out-of-hospital births are not as safe as births in hospitals in Oregon, where many of them are attended by birth attendants who have not completed an educational curriculum designed to provide all the knowledge, skills and judgment needed by midwives who practice in any setting.

After reaffirming her support of direct entry midwives, Rooks pleads for more stringent standards:

The legislature won’t have another opportunity to make the law stronger on behalf of safety until 2015. Please keep the six women who lost their babies last year in mind as you legislate this year.

We can only hope that the legislators heed Rooks’ plea. The first two basic steps that they should take are these:

1. Mandate that Oregon homebirth midwives advise women, as part of obtaining informed consent, that homebirth has a death rate 8x higher than hospital birth.

2. Refuse to expand homebirth midwives’ scope of practice and limit them to attending ONLY the lowest risk births.

It’s the least they can do for the women and babies of Oregon.

  • Kethrin Lases

    My neighbor is about to do her second OOH birth at home. The first one a couple of years ago was successful, but this time the baby is past his due date and I’m a little worried. I’m not a religious person but I’m praying the outcome is good and that they go to a hospital if necessary. For the record, I live in Portland, OR and although I’m not a provider I work in a hospital as an interpreter/translator and have seen first hand how things can go wrong. My parents too are perinatologists, and although I have a healthy dose of skepticism and tend to question authority, I decided I would not take any chances when my baby was born last november. Whe I was in my first trimester, out of curiosity I went to a water birth center and left horrified by their brain washing videos. Contrary to popular hipster believe, I really had a beautiful delivery in a hospital, assisted by two wonderful CNM and nurse, plus my husband. It was all I could have asked for, but I arrived with an open mind and educated, knowing what kind of interventions might be needed. Alas, nothing went wrong thankfully. Thanks for letting me share my story and opinion.

    • Young CC Prof

      Yikes! I really hope your neighbor’s baby comes soon and safely. I hate it when someone is bound and determined to do something dumb and you basically have to stand by and hope.

  • athousandthousandtears

    At the hospital I was pressured to accept interventions I didn’t want and told I had a lazy uterus by the asshole who “attended” the birth of my child right after giving birth. I finally let him give me Pitocin to get him off my back. Why was my epidural pushed on me and then I had to wait for the doctor’s permission to get the medicine stopped???
    The way I was treated after was worse; they didn’t want to discharge us when we were ready to leave. I said I had planned a homebirth and wanted to go home where there was no antibiotic resistant germs. They called children’s aid on me and apprehended my son at the hospital. My lawyer was so shocked at the paperwork they served me; they didn’t have a reason to take my son. They just speculated (based only on how I acted AFTER they snatched my son) that I was mentally ill.
    I got my son back three days later but I will never. recover.
    They stole my baby because I wanted to take him home.
    Do NOT go to the hospital. Children’s Aid looked through the nurses logbook and twisted everything so much.

    • attitude devant

      I am so sorry for your troubles. I am not sure what you mean by being ‘pressured to accept interventions’ at the hospital. Surely you went to the hospital after trying to birth at home because you actually needed some interventions?

      • athousandthousandtears

        I went to the hospital because my midwife was unable to attend. I had zero complications. I wish I had stayed home.

        • attitude devant

          So your midwife let you down, and you’re mad at the place that took you in when you needed them.

          • JRD

            Oh, come on. The hospital is *supposed* to be there as back up when needed. It’s part of every home birth plan. They also tend to give transferring women a difficult time. I’ve heard it many many times. And, hospitals pressure people all the freaking time. Nurses act like bossy little mini gods and women are tired of being disrespected, bullied and treated like criminals. If the hospitals and nurses get their acts together, perhaps more women would feel safe and comfortable trusting the environment, People need to quit blaming women and start asking why.

          • attitude devant

            JRD, how many transports have YOU participated in? Until you’ve been there as many times as I have I’m gonna say you have NO idea what you’re talking about.

          • LibrarianSarah

            So they are *supposed* to be there just in case the midwife can’t be arsed to show up and they are *supposed* to be as sweet as pie despite the fact that a patient that they have no history with, have no records on file, and may be an expensive disaster in the making just dropped in their laps because of someone elses incompetence. Hospitals are supposed to take it up the ain’t I great with a smile on their face while midwives who don’t even show up to do their jobs get off scott free?

            Nurses may not always be sweet as pie (though most nurses I have encountered have been incredibly nice and caring people) but at least they show up and do their god damn jobs when it counts.

  • Maggie

    Cesarian section carries risks too and a hospital birth resulting in an unnecessary C-section is very very common.

    • attitude devant

      You do understand we are talking about death here, right?

      • maggie

        Ummm YEAH. Like the risk of death associated with an unnecessary C-section?

        • The Bofa on the Sofa

          Can you provide an example of a c-section that was unnecessary, and how you determined it to be so?

        • Dr Kitty

          Which is, pay attention, MUCH, MUCH LOWER than the risk of a baby dying at Homebirth.

        • Young CC Prof

          Let’s try numbers.

          The risk of a mother dying after a c-section is about 1 in 5,000. Most of those mothers who died were very sick before the surgery, with things like heart disease, pre-eclampsia, etc.

          The risk of a totally healthy baby dying from home birth is one in 500.

          • maggie

            But all babies need to be born. C-sections are a risk that is wholly warranted if the C-section is necessary. So many unnecessary C-sections are performed. THAT is what I’m talking about. Some women undergo major surgery for no reason.

          • Box of Salt

            Maggie “But all babies need to be born.”
            But without c-sections, “all babies” will not be born – some will die in the process, and may take their mothers with them to the grave. Read some history before the past century to gain some perspective on that.

            “Some women undergo major surgery for no reason.”

            Wrong. The women who deliver by c-section undergo surgery in order to reduce the risk of death for their baby, or for themselves. In my book, that is not only not “no reason” but a very good reason.

          • maggie

            Why do you think I don’t believe C-sections are necessary ever?
            Why do you think that I have not read about history?

          • Box of Salt

            maggie, “Why do you think I don’t believe C-sections are necessary ever?”

            That’s not what I suggested. Your first post states that “an unnecessary C-section is very very common.” I have been responding to that claim, because I believe that modern medicine disagrees with you.

            I also believe that no person, and particularly someone as obsessed with the birth process as you seem to be, can make an absolute judgment on whether or not a c-section was necessary when both mother and child are alive and healthy afterwards.

            “Why do you think that I have not read about history?”
            Because your posts suggest you do not have much perspective beyond your own “indescribably good” experience you feel the need to boast about in the comments section of a blogpost about the high deathrate of homebirths.

          • Amy Tuteur, MD

            How do you know?

            Wait, let me guess, you read it in a natural childbirth book written by laypeople for laypeople.

          • maggie

            So you don’t want the answer or you do?

        • attitude devant

          But that’s just my point, maggie. A much higher percentage of babies died at HOME, where, last I checked, there are no c-sections. You think it’s better to have a dead baby than a c/s?

    • Dr Kitty

      Unnecessary doesn’t mean unsafe.
      In fact, unnecessary often doesn’t actually mean unnecessary!

      My OB gave me a 10% of vaginal delivery…10% that included the very high risk of forceps or vacuum delivery.
      He knew my absolute worst case scenario was a failed instrumental delivery and a crash section. He was honest that that was quite a definite possibility if I proceeded with SOL.

      So I didn’t .
      I had a beautiful, calm, painless planned prelabour CS, with a straightforward recovery.

      To me that was my best case scenario. No painful, exhausting labour, no stress worrying about how my baby was tolerating labour….going to hospital at 8am, reading a book until 10:30am and having my daughter in my arms and feeding before 11:30h.
      Best birth ever.

      • maggie

        I really hope your doctor gave you honest advice. I read a very interesting article written by a doctor who admitted that doctors do have a personal interest in scheduling C-sections since they get paid the same or more for less work. If your C-section was necessary then I am so sincerely happy for you that you had access to one.

        Something happens when you give birth naturally that you never experienced if this was your first child.
        I am happy that your C-section was the best of all your births.

        • Dr Kitty

          One and only birth.
          My own clinical experience makes me able to judge whether his advice was sound (it was, but nice of you to imply he’d lie for his own convenience and profit).

          I’m a Dr, been at plenty of births, natural, medicated, complicated, surgical, the full gamut.
          Meeting your baby is the special bit, how they get there is irrelevant.
          A vaginal birth ISN’T super special, no matter what you want to believe.

          My OB saw me as a private patient FOR FREE because he’s a family friend, and if I had opted for a natural labour which had gone swimmingly he wouldn’t even have needed to attend because the midwives would have looked after me.

          • maggie

            I wasn’t trying to imply your doctor would lie. How would I have any way of knowing that?? Nice of you to put words in my mouth. I’m still happy for you and your C-section if it was necessary.

          • The Bofa on the Sofa

            I wasn’t trying to imply your doctor would lie.

            Then why did you suggest he might be?

            These are your words:

            I really hope your doctor gave you honest advice.

            Straight from your mouth

          • maggie

            I really really hope all people’s doctors are giving them honest advice.

          • Dr Kitty

            “I really hope your doctor gave you honest advice”
            Implies that you believe he might have given dishonest advice. Implying he might have lied.

            Your next sentences suggest that Drs may schedule CS to get “paid more for less work”.
            Which implies that if his ad vice WAS dishonest it was for profit or convenience.

            This is simple reading comprehension Maggie, not putting words in your mouth.

          • maggie

            The only implication behind, “I really hope your doctor gave you honest advice”, is that there is a chance that this is not the case. I wasn’t speculating that he lied. On what basis would I draw that conclusion??? That you had a C-section??

            It was a doctor who SUGGESTED to me that some doctors are recommending a C-section for financial/quality of life reasons for themselves which is clearly unethical. How would I know if your doctor was one of them?

            If that is “reading comprehension” as you know it, I’m going to recommend you read everything over twice from now on, Dr. Kitty.

          • Dr Kitty

            “There is a chance this was not the case” ( that he gave honest advice) IS speculating that he lied.

            I give up.

            Maggie, you are not worth responding to.
            You’re passive aggressive, you can’t frame a coherent argument ( “I read somewhere” isn’t evidence) and you don’t appear to understand simple statistics.

            I feel sad for you that your IQ score doesn’t seem to have translated into any meaningful intelligence.

          • maggie

            I feel bad for myself that I’m still talking to you (about nothing). I could evaluate your character based on what I know of you but I’m not mean and I also don’t have any fucks to give. This is not intellectually stimulating me. I’m glad you’re getting something out of this.

            I didn’t speculate that her doctor lied to her. I stated that I hoped he hadn’t. I didn’t speculate at all.
            http://www.merriam-webster.com/dictionary/speculate

          • Dr Kitty

            Would you be happy for me if it was unnecessary?
            If you had psychic powers, could look into the future and see that I could have had vaginal birth if I had just tried?
            Would you be sad for me?

            If so, you’re an idiot.

          • maggie

            If you had an unnecessary C-section then I would feel bad for you.
            If you weren’t a jackass.

            You need this:
            http://www.merriam-webster.com/dictionary/idiot

            Because the one who’d be an idiot would be the one judging someone else’s intelligence based on the fact that they disagree.

            I don’t know whether your IQ is 90 or 130 but you have a one in one thousandth a chance of having a higher IQ than mine.

            Read a book. I highly recommend the whole dictionary.
            -”Idiot”

          • Dr Kitty

            Really?
            What was your SAT score?
            (Joke for the long time readers).

            Show me you are smart by what you write.
            So far…the evidence is not convincing.

          • Guestll

            (if you speak its name it will come!!!!)

          • maggie

            I really don’t want to rub it in about the bits you missed out on. And I myself have never had a C-section. But from women who have had both, “I had a csec with my first, VBAC with my second. My cesarean was a breeze, as far as cesareans go. My natural VBAC was amazing. Sure, I felt ”different” down there and things hurt more than I’d have liked them to but it was by far a better experience. And you’re leaving out one important factor, cesareans are MAJOR SUGERY!! If you want to have major surgery, and risk every complication that goes along with it, to avoid feeling ”different down there” then you’re off your rocker” and also, “Yupp..i went through vaginal birth with my eldest but had to go through c section with my other two.. For me i would definitely say vaginal delivery i a winner! The recovery was faster..although toiletting would be worst the first week compared to csection. Otherwise it was pretty much easier with the vaginal delivery…
            The aftermath feeling? I miss those feeling i felt after vaginal delivery.. The relieve was undescribable. You dont get those feeling with the csection..trust me… Anyway, which one is preferred is actually individual.. Good luck to all mom to be!”

            I have read a lot about the feeling you get right after pushing a person out your vagina but it is so indescribably good. The rush is partly a physical response to the process of labouring successfully. I’m so sorry you don’t know what I’m talking about.

          • Dr Kitty

            Wow.
            Stand by my opinion.
            You’re an idiot.

            I hear you get an amazing rush from pushing hooks through your skin and suspending yourself from them.
            No interest in doing that either.

          • The Bofa on the Sofa

            “Pain…is such a rush”
            -that Stoner guy on Bachelor Party who tried to drown himself in the bathtub, but slammed his head against it because Tom Hanks had drained all the water

          • Box of Salt

            Maggie “I really don’t want to rub it in about the bits you missed out on. ”

            Then why did you conclude your post with this comment? “The rush is partly a physical response to the process of labouring successfully. I’m so sorry you don’t know what I’m talking about.”

            Dr Kitty replied while I was typing. I disagree with her assessment of maggie; maggie is a simply a bully. Passive-agressive, yes, but the bottom line: a bully.

            Maggie, you may feel sorry for those of us who delivered all our children by c-section, but I feel sorry for you because you seemed obsessive — and about something I personally consider relatively unimportant in a life well lived — and you are extremely rude. But you know that don’t you? You started posting here with the intention of being rude to c-section mothers.

          • maggie

            I was commenting my own opinion and I was attacked for things I did not say. The only idiots I’m mean to are the ones who call me an idiot. How do I owe politesse to her at that point????????
            I’m happy you feel sorry for me. It’s a valuable exercise in compassion. My sympathy for Ms. Kitty was genuine. If you read my words and see a nasty tone, I’d just like to point out that my voice is coming from inside your head atm; you are projecting when you ascribe emotions incorrectly to my words. I’m going to stop telling you you’re wrong because I’m worried I’ve genuinely upset you. You can call me a bully if you want to. :) And if you are happier thinking that my intentions were to “be rude to C-section mothers” (like, is that really a “thing to do”?) rather than to entertain for a moment the notion that I might have commented on the article after reading it to contribute my opinion (like everyone else on the message board[?]) than I am happy for you that you think that.
            adieu

          • Dr Kitty

            Dear lord, amazing how someone with an IQ of 145 can write incoherent drivel.

          • maggie

            http://www.merriam-webster.com/dictionary/incoherent
            I’m surprised that you can’t understand me. Are you having a stroke or just willfully ignorant? I’d say stupid except you figured out my IQ.

          • Dr Kitty

            Or remembered mine is supposed to be higher than the top 0.1%…

            No, seriously, never had a formal IQ test.
            Because everyone knows once you hit 120 the number is meaningless in terms of actual real life achievement.

            Google is good though. Helpful for us non geniuses.

          • Box of Salt

            maggie, I will respond to just one part of your incoherent rant: “the notion that I might have commented on the article after reading it to contribute my opinion”

            Had you made a comment which is relevant to the subject of the post (the rate of homebirth deaths), that might be plausible. However, you launched into an argument that very very many c-sections are unnecessary, then diverted into being argumentative and rude to women who had them.

          • Karen in SC

            I had that twice and still prefer orgasms as a great indescribably good feeling. And how great I can have lots and lots. Also, hot fudge sundaes are indescribably good.

          • Guestll

            I’m about to resort to ad homs here, but get a life. Get your head out of your navel, look around, maybe get a job, a hobby, something that has nothing to do with biological essentialism and sending women back to the stone age. Women like you do a huge disservice to women in general.

          • maggie

            Your debating skills are IMPECCABLE. I doff my hat to you. You win.

          • Guestll

            There is no debate here, Maggie, only consensus — you’re an idiot.

          • antigone23

            I’ve had both. Vaginal birth for my first, elective c-section with my second. My vaginal birth caused lasting, painful damage to my sensitive areas. The recovery was awful. It took YEARS for me to have full sexual function, and I regret that it will never be the same down there. My c-section was awesome. The recovery was quick. No damage to the most sensitive areas of my body. There was nothing special about vaginal birth. Sure, for most people, the risks are lower and the recovery easier. But putting it on a pedestal and feeling sorry for people who haven’t experienced is positively ridiculous.

          • Guestll

            Also I’ve pushed a person out of my vagina and it was not indescribably good. It SUCKED. It was painful and torturous, it was the worst pain I have ever experienced, worse than broken bones, ruptured appendix, tooth abscess, THE WORST. I have no idea what the fuck you’re talking about, because although I wept with gratitude when my daughter was born, I wept in large part because a. it was over and b. she was here and well. It wasn’t a rush, it was relief, and freedom from pain.

          • jrd

            I’m so sorry that your experience was so scary and painful. Labor is painful.. but women are also sorely under-prepared for what labor actually is, even by many midwives. Women are not helped to do the exercises that help, they are not helped to practice relaxation techniques, they are not given alternative pain relief options that they deserve. Natural birth can be very painful and scary and frustrating.. but it can also be extremely empowering. There are things that make it much worse, like tight muscles, posterior positions, and stress… and there are things that help, like counter pressure, massage, soaking in warm water, being upright or forward facing.

          • Captain Obvious

            You go girl, mommie superiority at its finest. You are probably pretty big about big weddings compared to great marriages too.

        • Box of Salt

          Maggie “Something happens when you give birth naturally.”

          Guess what? Something happens when you give birth, no matter how it’s accomplished. You become a parent, and you get to raise a child. That process is a lot more transformative for most people that the time spent on the delivery.

          Why are you so concerned about other people’s c-sections?

        • Guestll

          “Something happens when you give birth naturally that you never experienced if this was your first child.” — I’m sure Dr. Kitty spends a lot of time wondering what that is and mourning its loss.

          • maggie

            I hope not.
            Why would you say that?

          • Guestll

            That whooshing sound you just heard…never mind.

          • maggie

            It was beneath me, not over my head.

          • Dr Kitty

            OMG totally…
            In between the parenting and the practising medicine and what not…

          • Guestll

            Look, you might be a successful physician, wife, and mother, and you may have had a perfectly blissful and safe delivery, but I think you should spend more time wondering about exactly what you missed by not pushing your sprog out of your vag. When you’ve figured it out, you need to feel bad about it, okay? And then please be sure to share it with other women. God knows what I felt was akin to the feeling you get after a massive puke, “I feel soooo much better now!” coupled with gratitude for my child’s well-being. I’m sure you’ll discover that you missed something TOTALLY AWESOME, however.

          • Dr Kitty

            You’re so right.
            I shall go and prepare some sackcloth and ashes.

        • S

          How exactly is it less work to perform surgery, versus standing there watching something happen?

    • Box of Salt

      “unnecessary C-section”

      How do you it’s unnecessary? Only in retrospect. Don’t do one – wait until someone dies. Then you know doing one had been necessary.

      • The Bofa on the Sofa

        Only in retrospect.

        And not even then. If a c-section baby is born happy and healthy, how do you know it would have been that way without the c-section?

        • maggie

          Then we should all have C-sections! #logicfail

          • Box of Salt

            Maggie “#logicfail”

            Yes, and it’s yours. On pretty much everything you’ve posted on this site just now.

          • The Bofa on the Sofa

            Why?

            You don’t understand the concept of risk, I’m not surprised.

  • AryaDharma

    You are a fear mongerer…hired moron. It is so unfortunate to see that you preach the status quo… Birth is, but, the most natural of processes and your stupid inquiry and crappy professional opinion is at odds with the “eternal natural way.” I extend myself to this topic that people like you may be sifted out of a “best practice” mentality. Poison..You are!

    • S

      I’m not going to vote up, but this comment just made my day about 75% better.

      • S

        I assume this commenter is ESL and i’m not trying to be a dick about that, but i’m just so unreasonably happy right now about the stupid inquiry at odds with the eternal natural way.

        • Dr Kitty,

          I like the idea that someone is sending out positive intentions to the universe to make OBs turn away from best practice and back to letting nature run its course (because that always ends spectacularly well).

      • Dr Kitty

        Ooh the evils of best practice!
        Let’s extend ourselves to making it go away!

  • Rogue Mama

    So if you’re all experts riddle me this: why are the majority of births in other countries attended by midwives? And why, with a properly educated and experienced midwife attending a low risk birth, is birthing at home ‘too risky’? I am not a midwife, nor a doctor…I am a woman who gave birth to a beautiful, healthy baby girl at home, whose birth experience was life changing rather than scarring. As another poster stated, homebirths are going to happen whether you like it or not, because home births are comfortable, intimate and cheaper for those without insurance.

    • Young CC Prof

      Thanks for asking!

      I’m glad you had a good experience. About 90% of births turn out OK without medical intervention. (The other 10% end very badly unless you get help in time.)

      If you had prenatal care, and are definitely low-risk, and have a skilled and experienced midwife watching you, home birth is still more dangerous than hospital birth, but not by so much. If women understand that the risk exists and are willing to do it anyway, so be it. (I do have issues with people who claim that home birth is safer, because it simply isn’t true.)

      The issue with USA versus other countries is this. In other countries, all midwives have several years of training. In some US states, there’s a license called the Certified Professional Midwife, or CPM, which involves very little training or experience. These women should not be attending births alone outside a hospital!

    • KarenJJ

      “why are the majority of births in other countries attended by midwives?”
      The government provides free homebirth to low risk women that live within 30 minutes of the main maternity hospital. American CPMs and lay midwives would not be allowed to practice. Midwives also cannot provide homebirths for twin, breech, VBACs and must refer on to obgyns. This is not how American midwives practise.

      “And why, with a properly educated and experienced midwife attending a low risk birth, is birthing at home ‘too risky’? ”
      This is an individual choice, and even amongst those that post here, even Dr Amy, has said that the absolute risk is still low and it is up to individual women to decide whether the small risk is worth it to them. It’s not for me, but whatever rocks your boat.

      Problem is the midwives that are practising in Oregon are neither properly educated, experienced nor are they restricting themselves to “low risk” births. In fact some are even lying about the risk or minimising it or even telling women not to get things checked out in case it turns out that they are not ‘low risk’ after all.

      Congratulations on your healthy baby daughter.

  • Bianca Alexander

    I am an RN and apprenticing midwife (with a CPM). There will always be women who choose to have home births. CNMs face many obsticles in attending home births, and many do not want to. Rather than abolishing the CPM credentials, we need to find a way to make it safer for babies.

    I do wonder how the maternal mortality rates compare. These outcomes need to be easily attainable.

    • Knows better

      Only way to make it all safer is to insist on better training, rigid adherence to protocols, transparency regarding outcomes, and accountability. All things that NARM and MANA steadfastly resist.

    • The Bofa on the Sofa

      Why, if you are an RN, are you wasting time getting a CPM?

      There is a good reason why CNMs don’t want to do home births, and why there are “obstacles” for them to do so: it’s reckless, and unsafe.

      • Bianca Alexander

        I want to attend home births, is why. This study is representative or Oregon, not all US CPMs. Don’t forget about the 2005 study that compared outcomes of CPM attended births and hospital births, where the results showed similar IP and neonatal death rates for both, but CPM attended births fared better in other categories. Either way, these statistics need to be very seriously in the home birthing community and hopefully there will be some change in the legislation addressing this issue.

        • attitude devant

          (Like shooting fish in a barrel, isn’t it? They NEVER understand the research they cite!)

          Honey, stick around; you have a lot to learn. The Johnson & Daviss study of 2005 used a neat little trick: they compared CURRENT CPM data with hospital data that was several DECADES old. When compared with CURRENT hospital data, the CPM data showed a 3x increase in stillbirth. This (the 3X increase) is a remarkably robust finding, seen in study after study. You can find the same 3X increase by looking at the CDC Wonder database.

          As for the home birthing community taking this issue seriously, don’t hold your breath. They’re too busy with their coverup.

        • The Bofa on the Sofa

          Yes, take the statistics “seriously.” In particular, read them appropriately, as the comment below describes.

          BTW, there are CNMs who do homebirths. Most, as you indicate, do not. Why do you think that is?

          Think about that. Why don’t OBs and CNMs do homebirths? Oh, I know, they WANT to, but the system won’t let them. But why won’t the system let them? Oh, I know, the liability is too high. But why is the liability so high? Because it is TOO RISKY!!!!!!!!!!!!!!!!!!!

          Think about that. CNMs and OBs either choose not to do homebirths, or the system won’t let them BECAUSE IT IS TOO RISKY. So your solution, apparently, is to take this process that is apparently too risky for OBs and CNMs, and put it in the hands of LESS QUALIFIED providers?

          That’s extremely reckless. People’s lives are at stake, Bianca. And you want a system to throw them to unqualified people.

          It really does disgust me.

          • Emily

            Your logic is so flawed, it’s unbelievable. You’re taking some facts and leaving others. You’re ignoring the place of the insurance companies that want money. You’re ignoring the fact that many CNM can’t afford to do homebirths because they must work in the system to pay off their student loans. It’s not always their choice. Your arguments here are such a mess. You need to do yourself and every mother you know more research. You are wrong in so many ways.

          • AlisonCummins

            Can you clarify? I don’t understand most of your criticisms.

            What is the place of insurance companies? Yes, they want money. So do midwives. What’s your point?

            “many CNM can’t afford to do homebirths because they must work in the system to pay off their student loans”

            I don’t think I follow this argument. They wouldn’t be attending home births for free.

          • Emily

            “I don’t think I follow this argument. They wouldn’t be attending home births for free.”

            Compared to what they would make in a hospital, yes, homebirth provides a significantly lower income.

          • AlisonCummins

            So are you saying that attending home births is more of a hobby than a profession and that it’s unreasonable to expect anyone to take on the costs of professional training for a hobby?

            Or are you saying that people who treat it as a hobby are pricing professionals, who would charge more to cover the costs of training and insurance, out of the market?

            In either case, the hobbyists should not be practicing. It’s not fair to pregnant women who deserve experienced, professional, insured care; and it’s not fair to professionals who have invested in training when market prices are set by hobbyists with low costs.

            What are you doing to eliminate hobbyists from home birth?

          • Emily

            Mothers can educate themselves and make the appropriate choice in regards to who they believe is experienced and professional enough to attend their birth.

            “it’s not fair to professionals who have invested in training when market prices are set by hobbyists with low costs.” Oh, please, we know these two have nothing to do with each other. Do you live in a world without the consequences of healthcare insurance? Your argument is invalid.

          • AlisonCummins

            Q: How many legs does a sheep have, if you call a tail a leg?
            A: Four. Calling a tail a leg doesn’t make it one.
            Believing someone to be experienced and professional doesn’t make them so. If someone has adequate training, is licenced and insurable and is concerned enough about their clients to be insured, they probably are professional.
            I don’t understand the invalidity of my argument. Which argument? What part is invalid? Why is it invalid?

          • Guesteleh

            But they can’t educate themselves. They have no way of knowing whether a homebirth attendant is competent or not. There are too many stories out there of midwives who’ve overseen multiple deaths with no consequences, no professional sanctioning, no monetary outlay since they don’t carry malpractice insurance. And mothers who speak out are shunned by the HB and have their comments deleted from message boards. So how are women supposed to make appropriate choices regarding their birth attendant at home?

          • Karen in SC

            Some OBs here have said payment for births is around 2-3 thousands. Out of that they pay taxes and OBs have overhead with staff, office rent etc.

            A midwife can take 4-5 births a month, times 12. Pricing has been reported 3500 or more. Cash. Do they report to IRS? Do the math, it’s a tidy sum.

          • auntbea

            Those poor homebirth midwives. Such victims of the system.

          • Amazed

            It always amuses me when people who are quite ignorant themselves advise “researching”, You can use some research yourself, Emily. Research, I said, not reading MANA and NCB’s lies. Research, like scientific literature. Preferably not filtered through homebirth midwives’ view.

          • Emily

            I’ve done my research for the last four years. I’ve consulted with CPMs, CNMs, my OB/GYN, as well as two others, and five separate pediatricians. I’ve had my two horrible hospital births at two different hospitals in two different states. I just watched my sister birth in a horrible situation. I’ve watched at least a dozen friends walk out of the L&D floor with a c-section or an epidural they didn’t want. I’m done with this system, about which you all seem so gung-ho. Continue to troll other people’s choices, but I hope each mother does their own research before believing the lies of site called “skepticalob”. Ha!

          • AlisonCummins

            What lies?
            Why did your friends consent to epidurals or c-sections?

          • KarenJJ

            So what are the specific lies? I’m not just going to take your word for it.

          • Amazed

            Anything specific besides moaning about poor little you?

            Any news of how your sister’s lawsuit is going? I mean, doing a c-section on a woman who is screaming “No!” is definitely a reason for suing.

            On the other hand, if I were your sister, you bet I’d whine that I didn’t want the c-section too. It’s more peaceful this way than having to bear with you and your ilk judging me.

          • Young CC Prof

            All these people parachuting on to old posts to say, “This is all wrong and biased” without naming one specific mistake. And of course, the “do your research,” which inevitably means throw away the actual research and read my badly spelled and illogical sources.

            What is this, the tenth one this week?

          • The Bofa on the Sofa

            You’re ignoring the place of the insurance companies that want money.

            Yes, because the the lawsuits that result when things go bad in a homebirth would be very costly.

            That’s because they are an open-and-shut malpractice suit. Don’t even bother fighting it, because you have no case. A homebirth is pretty much the definition of outside the standard of care.

            That the insurance costs for HB providers are too high does not contradict my point, it proves it.

            This is why, of course, most HB midwives run around WITHOUT insurance, to protect themselves.
            And as for CNMs needing money to “pay off student loans.” that accounts for those who are newly out of school, but does not explain why someone more than, say, 10 years out can’t do it. Why don’t the older, more experienced midwives, the ones who have their bills paid off, do homebirths?

            Actually, maybe it’s not a coincidence – new CNMs are most likely to want to do homebirths, but are “unable” because of their student loans. Meanwhile, the older, experienced CNMs don’t have to worry about the money, but choose not to.

            Sorry, you aren’t providing a very compelling argument against my statement. Is that the result of your “research”?

        • Karen in SC

          Why? for the money? You could even now be an L&D nurse and “be the change” you want to see in modern obstetrics. And you would definitely attend more births, bringing joy to many families. Safely.

    • Susan

      It also seems that while it is legal, there will always be people who choose to invest the least amount of time and education to deliver babies at home.

    • Amy Tuteur, MD

      CPMs aren’t midwives. They are lay people pretending to be midwives. They are dangerous because they are poorly educated and poorly trained. A college degree is the MINIMUM for midwives in every other first world country. It sould be the minimum here as well. Why should American women accept substandard care from substandard providers?

      • Bianca Alexander

        That is a generalization. There are plenty of highly educated CPMs with college degrees who go above and beyond their requirements. It wasn’t all too long ago when physicians were deniably spreading puerperal fever, extracting every baby with forceps and cutting every woman’s perineum, killing many baby’s and mothers iatrogentically. I know plenty who still do practice like it is the 1950s. There was and still is plenty of room for improvement in obstetric care, and there is room for improvement in CPM care.

        • Karen in SC

          if a CPM is proper credential, why do other countries that have more integrated midwifery care still require the graduate study?

          Since you seem to know about obstetric history, why don’t you know that CPM was designed to be a short-term transitional credential for experienced midwives – not for new midwives.

        • attitude devant

          Logic fail, Bianca. Do ALL of you just endlessly repeat the same arguments? My barista has a PhD but that says nothing about the education of the average barista. If the CPM credential does not require education (it was only recently that MANA required a high school diploma, BTW) then you cannot make claims about the average education of CPMs.

        • PJ

          Why do NCB advocates so love to bring up what obstetricians did before modern medicine had even been invented? It’s like beating up on physicists because Aristotle thought everything was composed of earth, fire, water and air!

          • The Bofa on the Sofa

            And it’s not like it was homebirth midwives that figured out how to solve the problems that were happening.

        • Amy Tuteur, MD

          So let me see if I understand you, Bianca. You think it’s okay for homebirth midwives to let babies die because at some time in the past obstetricians did not practice medicine as safely as they do today. Is that what you are trying to say?

      • The Bofa on the Sofa

        Moreover, credentials are about MINIMUM competency to practice. If you have a bunch of poorly prepared people practicing, who cares what your average is? The bad ones are the ones who are doing the most damage.

        Once again, I don’t get the attitude. You would think that the supposedly GOOD midwives would being very anxious to cull out the crap in their profession. Instead, they all sit around and deny any responsibility.

        Jebus moses, Bianca. You should have the skills to qualify for a CNM. Even if you want to do a CPM so that you can run around playing on your own without the oversight that occurs with OBs and CNMs, why would you want to accept unqualified people run around doing it, too?

        This just doesn’t make sense. OK you want to be one of the “good” CPMs. So why don’t you insist that everyone is a good one, and hold everyone to the same standards that you intend to have?

  • http://shameonbetterbirth.wordpress.com/ Shameon Betterbirth

    MAN I wish this study had been out when I was pregnant. ugh! Would have saved me a lot of trouble. That answered so many questions that I had.

  • Nurse Jim

    Hi Dr. Tuteur,
    I appreciate the information you have provided.
    As a neonatal nurse in a busy level 3 NICU, I have seen countless babies transported to my unit is severe distress after home births.
    I have seen many of these babies die from preventable complications that occured during labor at home – things like fetal distress, mec aspiration, hypoxia.
    You have noted statistics of home birth deaths, but do these include the babies who were ultimately transported to a NICU and later died there?
    My guess is the statistics do not include these babies.
    This is unfortunate.
    I have seen such tragic cases of beautiful babies placed on life suppporting devices like ventilators, heart/lung bypass (ECMO), and total body cooling. I have participated in countless painful procedures done in the desperate hope of saving a baby. I have bathed and swaddled countless babies in preperation for the morturary.
    I wish there was some way to honor their short lives.
    Thank you for the information you have provided.
    Best wishes,
    Jim

    • NICU RN in Oregon

      I couldn’t agree more! There is nothing more heartbreaking than seeing a mother of a failed homebirth infant that is severly damaged or dying and having her ask you if it could have been prevented. One baby lost is one too many…

  • Ilya

    Amendment: in-hospital planned mortality is 2.1, not 0.6, while OOH 4.0, not 5.6 according to HB 2380 (https://public.health.oregon.gov/BirthDeathCertificates/VitalStatistics/birth/Documents/HB2380-preliminary-birth-outcomes.pdf)

    So 2-times, not 8-times difference.

    Anyway its hard to understand such a low in-hospital mortality rate in Oregon. USA average is 6.15 per 1000.

    • Eddie

      You’re quoting misleading statistics. You’re comparing death rates of out-of-hospital births that are primarily low risk to death rates of hospital births that include all risk levels. When you only compare comparable risk levels, the risk out-of-hospital is much more than twice the risk in hospital. Also, in this document, they exclude the home birth death from severe congenital anomalies, but they don’t exclude such hospital deaths. How is that reasonable for purposes of comparison? Unless you word it as, “Home births in Oregon, which are primarily to low risk mothers, have more than twice the rate of fetal death as all hospital births, which include all risk levels, including preemies, multiples, and so on.”

      Did you actually read the entire post above? By the way, state-by-state statistics vary quite widely, probably due to demographic differences as well as medical care differences. See, for example, http://www.cdc.gov/nchs/data/nvsr/nvsr60/nvsr60_08.pdf page 10.

      For anyone who tried to follow the link and got an error, here it is again without the trailing parentheses: https://public.health.oregon.gov/BirthDeathCertificates/VitalStatistics/birth/Documents/HB2380-preliminary-birth-outcomes.pdf

      • Ilya

        Please address your low-risk considerations to the author of the post, there is no claim of comparing low-risk only, it clearly claims to compare ALL hospital-planned births to ALL OOH-planned births. So I do the same — compare all to all whether it is correct or not.

        All the figures quoted by the author are correct except the one cell which is filled with ***. This cell is for Term Fetal Deaths for in-hospital planned births.

        So they assumed it is zero.

        In fact this cell should contain 59 deaths. Which is clear from HB 2380 https://public.health.oregon.gov/BirthDeathCertificates/VitalStatistics/birth/Documents/HB2380-preliminary-birth-outcomes.pdf

        That gives 2.1 mortality rate vs 4.5 for OOH planned births (both including deaths from congenital anomalies).

        So let me conclude that its not me who distributes misleading statistics.

        I also am not sure that home births have necessarily lower risk. For example according to the same HB2380 homebirthing women were older and more likely to have no prenatal care compared to hospital-birthing.

        It might also be interesting for our readers to know that an extensive Dutch research of 530,000 low-risk only births showed that planned home births’ mortality is even lower than planned in-hostipal births’ one in Netherlands.

        • LukesCook

          It isn’t clear from the document you attached that any of those 59 term fetal deaths were intrapartum, which is why they were excluded.

          • Ilya

            I see no logic for such exclusion. It is equally not clear for those 4 OOH fetal deaths.

            I still cannot understand why these 59 were excluded and such astonishing 8-times difference was loudly and wrongly proclaimed.

            Real difference is 2.14-times (4.5 vs 2.1)

          • LukesCook

            Because it was intrapartum deaths that were being looked at. The document you linked makes it abundantly clear that the OOH deaths were IP.

          • Ilya

            1. I have just reread the document and have not found any confirmation that these 4 fetal death were all IP.

            2. Anyway, part of the 59 deaths quite probably were IP, and exclude them all just because the IP share is unknown is not correct.

          • Amazed

            Ilya, Judith Rooks is a proponent of homebirth midwifery. She did what she could to spin the data to look better for homebirths. If part of those 59 deaths were IP, she would have excluded IP deaths from homebirth group. Look what she did with the baby with congenital anomalies.

            More likely is that there were nonefull-term IP deaths in hospital group but it is an one-time thing that is not likely to repeat in the following years.

          • LukesCook

            The report states that a case analysis was done for each of the deaths. Rooks had the benefit if the raw data, including the case analysis, so if she says the 4 deaths were all IP then there is no reason to disbelieve her. In addition, the report you linked mentioned that 7of the 9 deaths (including neonatal) transferred “during labour”. On what basis do you claim that any of the 59 planned hospital deaths were IP?

          • Amazed

            Because 2.14-times difference is “safe or safer than hospital birth’, eh?

            Low-risk hospital birth is the right group for comparison because midwives scream all over the world that they take only low-risk women. So, we’re left with two choices here since they very clearly don’t do what they claim and take high-risk women: they are either liers and knowingly take high-risk clients, so they cannot be trusted, or they are so incompenent that they cannot recognize high-risk clients when they see them, so they are incompetent and they cannot be trusted.

            Which one do you choose?

          • Ilya

            Hi

            1. Whether home birth is ‘safe or safer’ was not a subject of my comments. I only want to point that the calculation is incorrect and after correction the difference appears to be 2x, not 8x. period.

            2. Let me reject your invitation to judge midwives as a whole — they are too many different people.

          • Amazed

            I cannot open the document you linked to but if the other posters’ comments are anything to bo by, it doesn’t discuss IP deaths which Rooks does. You say you don’t know whether any of the 59 hospital deaths were IP, but you can authoritatively say ‘period’? Doesn’t wash with me.

            You are free to evaluate each lay midwife as a different person, of course. I, for myself, am not inclined to evaluate all of them separately. I’ll take the easy road: I just won’t leave my baby’s life or my own life in the hands of any representative of this profession. Even if they were super-duper extra professional, I’d still want the peace of mind that comes from having the equipment and the people who are able not only to recognize an emergency but deal with it in timely manner – doctors.

          • Eddie

            On #2, you’re right, to an extent. There are too many different kinds of midwives in the United States and they cannot be judged as a whole. CNM’s actually have medical training and a college degree and are actually nurses, so it would not be fair to lump them in with CPMs and DEMs and lay midwives, where the consumer has no effective way to gauge whether or not they have the necessary skills.

            Once you make that division, the statistics available speak for themselves.

          • Jocelyn

            Those 59 were excluded because they were not intrapartum deaths. They were deaths that occurred before labor. When calculating the perinatal death rate, Judith Rooks is adding IP deaths and neonatal deaths, then dividing by the total number of births. This, then, covers all the babies that die (OOH and in-hospital) during labor and birth. If you add those 59 deaths, you mess up the numbers and can no longer compare the two rates. They are no longer comparing the same thing.

        • Eddie

          You’re right, the data was not risk-adjusted. I confused two different blog posts. My error. Taking the data from the document you linked to, I come up with these numbers (using term fetal deaths, from the table, and not intrapartum deaths):

          MD+DO 71/33026 2.1
          CNM IH 11/6816 1.6
          CNM OOH 1/500 2.0
          DEM (licensed) 5/1040 4.8
          DEM (unlicensed) 2/195 10.3
          naturopath 1/216 4.6
          Other IH 2/142 14.1

          Total IH 84/39984 2.1
          Total OOH 9/1995 4.5

          Non-CNM midwifes don’t look very good in that comparison. To compare some of these numbers, you may need several years worth of data to say which differences are significant or not.

          Note: Any study in the Netherlands is pretty irrelevant to anything that goes on in the US. Dutch midwives have a college degree and medical (nursing) training. American non-CNM midwives don’t have to have either one. In any case, see http://www.skepticalob.com/2013/04/dutch-midwives-struggle-to-avoid-accountability-for-high-perinatal-death-rate.html for newer data than the study you are referring to.

        • Jocelyn

          It should NOT contain 59 deaths. I quote from the response I just posted above:

          “In regards to intrapartum deaths, Rooks’ team said that “There are extremely few term IP (intrapartum) deaths in hospitals. Most fetuses in prolonged distress are delivered by cesarean section. Estimated rate of IP fetal deaths is 0.1 – 0.3 from the authoritative medical literature, based on studies in Canada and Europe.”

          What they mean by this that for every thousand births, 0.1 to 0.3 births resulted in intrapartum deaths. What that means in real, manageable numbers is that 1 to 3 babies die during labor for every 10,000 hospital births. Since this data set is for 39,984 births, we can estimate the number of intrapartum deaths to be 4 – 12 intrapartum deaths (if, in fact, it was not 0. Their asterisk “IP death” column could very well have meant that).

          If instead of using 0 (which, again, very may well have been the number of IP deaths), we use our estimate of 4-12 intrapartum deaths for the 39,984 hospital births, we would get:

          4 (intrapartum deaths) + 25 (neonatal deaths) divided by 39,984 births = 0.0007 (0.7 deaths per thousand) or

          12 (intrapartum deaths) + 25 (neonatal deaths) divided by 39,984 births = 0.0009 (0.9 deaths per thousand)

          So, in any case, the in-hospital mortality would still not even be CLOSE to 2.1. It would either be 0.6 (as calculated by Rooks, and the most accurate number), or somewhere between 0.7 or 0.9, based on estimations of usual in-hospital IP death rates.”

          Nowhere close to 59.

    • Jocelyn

      The following numbers are from Judith Rook’s statement: https://olis.leg.state.or.us/liz/2013R1/Downloads/CommitteeMeetingDocument/8585 and the Oregon Preliminary Data: https://public.health.oregon.gov/BirthDeathCertificates/VitalStatistics/birth/Documents/HB2380-preliminary-birth-outcomes.pdf.

      When figuring out the rate of perinatal death for in-hospital births or out-of-hospital births, there are four main numbers we’re looking at: total number of births, total number of term deaths (past 37 weeks), intrapartum deaths (during labor), and neonatal deaths (first 6 days of life).

      Excluding the baby with congenital abnormalities, the out-of-hospital birth data breaks down like this: 1,995 total births, 8 total term deaths, 4 intrapartum deaths, and 4 neonatal deaths. [Side note: there is no logical reason to exclude the baby with congenital abnormalities, other than to try to improve home births' number. Babies with congenital abnormalities were NOT excluded from the hospital data.] INCLUDING the baby with genetic abnormalities, the OOH data is 1,995 total births, 9 total term deaths, 4 IP deaths, and 5 neonatal deaths.

      The in-hospital data breaks down like this: 39,984 total births, 84 total term deaths, ___ intrapartum deaths (This number is not specified in either the preliminary data or Rooks’ data; we’ll come back to this), and 25 neonatal deaths.

      Determining the rate of perinatal death for OOH births is pretty straightforward for this data: we add the IP + neonatal deaths and divide by the total number of births. So, we just divide 9 by 1995. This give us 0.0045, which means that the rate is 4.5 deaths per thousand. [Again, there is no logical reason to exclude the baby with congenital abnormalities. Babies with congenital abnormalities were not excluded from the hospital data.]

      Now we’ve reached the big difference between how Rooks’ team interpreted the data and how the Oregon Health Division interpreted the data: the rate of deaths for in-hospital births.

      The Oregon Health Division divided the total number of term deaths (84) by the total number of births (39984). 84 divided by 39984 gives us 0.0021, which means that the rate is 2.1 deaths per thousand.

      Rooks’ team, however, explains that you can’t do that for this data. The total number of deaths includes babies who die before labor, babies who die during labor, and babies who die after labor. Since the discussion is focused on the mortality statistics of home and hospital labor and birth, babies who die before labor are a subject for another discussion.

      So, Rooks’ team did not use the total number of hospital deaths. They used the number of neonatal deaths, which was 25. So, their calculation looked like this: 25 divided by 39984 = 0.0006, which means 0.6 deaths per thousand.

      In regards to intrapartum deaths, Rooks’ team said that “There are extremely few term IP (intrapartum) deaths in hospitals. Most fetuses in prolonged distress are delivered by cesarean section. Estimated rate of IP fetal deaths is 0.1 – 0.3 from the authoritative medical literature, based on studies in Canada and Europe.” What they mean by this that for every thousand births, 0.1 to 0.3 births resulted in intrapartum deaths. What that means in real, manageable numbers is that 1 to 3 babies die during labor for every 10,000 hospital births. Since this data set is for 39,984 births, we can estimate the number of intrapartum deaths to be 4 – 12 intrapartum deaths (if, in fact, it was not 0. They had an asterisk in the “IP death” column with the above explanation. You can either interpret that to mean 0 IP deaths for Oregon that year, or our estimate of 4-12).

      If instead of using 0 (which very may well have been the number of IP deaths), we use our estimate of 4-12 intrapartum deaths for the 39,984 hospital births, we would get:

      4 (intrapartum deaths) + 25 (neonatal deaths) divided by 39,984 births = 0.0007 (0.7 deaths per thousand) or

      12 (intrapartum deaths) + 25 (neonatal deaths) divided by 39,984 births = 0.0009 (0.9 deaths per thousand)

      So, in any case, the in-hospital mortality would still not even be CLOSE to 2.1. It would either be 0.6 (as calculated by Rooks, and the most accurate number), or somewhere between 0.7 or 0.9, based on estimations of usual in-hospital IP death rates. And the OOH rate is 4.5, not 4.0. We’re not excluding the baby with congenital abnormalities, because those babies were not excluded from the hospital data.

      • Ilya

        Thank you for the explanation.

        1. So for the number of IP deaths in hospitals Rooks use not statistics but some unknown “authoritative medical literature” (even without reference). I think you can’t call it ‘statistics’ in this case.

        2. So one still have to admit that there was a logical error in Rooks’ statement. We have 0.6 + (0.1 to 0.3) which is 0.7 to 0.9 mortality rate in hospitals vs 4.5 OOH which makes 5-6.4 times difference, not 8 times.

        3. What is the reason to count all 4 OOH term fetal deaths as IP?

        4. Let’s take Rooks’ position:
        * assume all OOH term fetal deaths were IP
        * assume “Authoritative literature” is reliable and relevant and IP mortality in hospital is only 0.1-0.3. Let’s assume 0.2 for convenience.

        We now conclude that 8 (0.2 per 1000) out of 59 term fetal deaths were IP, then the rest 51 were AP (86%).

        How can it be? Why there is no AP OOH deaths at all while in-hospital they constitute 86% of all term fetal deaths?

        My guess is that these 4 OOH fetal deaths might not all be IP, if so AP-part also should be excluded from mortality rate.

        • Eddie

          Ilya, do you really assume that the breakdown of term fetal deaths (antepartum vs intrapartum) is even approximately the same for home birth and hospital birth?

          • Dr Kitty

            The alternative explanation is to assume that HB MWs are so incompetent they can’t diagnose AP IUFD or tell the difference between a fresh and macerated stillbirth, so they assume ALL their stillbirths were IP, when some are actually AP.

        • Dr Kitty

          Ilya, AP IUFD is easy to diagnose.
          No kicks, no foetal heart tones on doppler, no foetal heart activity on Ultrasound. Most women, as soon as they know the baby has died want to deliver as quickly and painlessly as possible afterwards.There is no reason to forego pain relief and an immediate induction of labour if there isn’t a live baby.

          If a MW couldn’t hear foetal heart tones at a TERM antenatal appointment and IUFD was diagnosed, few women would still opt for HB. Almost certainly doctors would have been involved at some point in confirming the foetal demise and most doctors would strongly advise against HB after IUFD.

          AP IUFD should have delivered in hospital.

  • Alicia

    I can’t believe how bad it is. Ugh. All those babies. All those heart-broken parents. And if it’s this bad in Oregon, how bad is it in the other 49 states?

  • http://twitter.com/leemccainmd lee mccain

    What I find rather interesting is in Alabama most of the political support for certified professional midwives is Republican, the same party that professes to be pro-life.

    • Bomb

      Egh, where I’ve lived it has been a staunchly liberal pursuit. Where you have large religious republican populations you’ll have conservatives supporting homebirth. Where you have large hippy new age populations you’ll have liberals supporting it, typically for totally different, yet totally the same reasons. “God designed women to birth” “Nature designed women to give birth” “God won’t give you a baby too big to be born” “nature won’t grow a baby too large” etc etc. Throw in libertarians and you get the whole “if I want to pay someone that took a meditation course and calls themself a shaman OB, that is my right!” 100% of my homebirther friends have been lefties of varying degrees of faith (from very religious to very atheist, from pro life to pro abortion -not just pro choice, pro the gov should decide if you are fit and abort your baby if they deem you unsuitable- seriously) but I have seen the righties online various places.

      Pro life and homebirth don’t really have anything to do with each other. A very religious person would see a baby ‘naturally’ dying as part of God’s plan. Home birthers don’t set out with the intention of having a bad outcome. They believe they are making a safe choice and are bringing their wanted baby into the world as peacefully and gently as they believe possible.

  • guest

    And even more from Oregon. A handy article to keep when people pop up to complain that hospitals are so unfriendly. This major hospital in Oregon’s biggest city has bent over backward to deal with home birth transfers. Anecdotally, in the story, they say this means they don’t have to deal with train wreck transfers anymore. But then why are the newly released stats so very very very bad? http://portlandmonthlymag.com/health-and-fitness/articles/home-birth-in-oregon-january-2013/3

    • http://www.facebook.com/profile.php?id=100002171364303 Anj Fabian

      They don’t actually cite numbers in that story. There’s plenty of blithe assertions, but little evidence.

      If it convinces more women that hospitals aren’t evil, and convinces more midwives to transfer in a timely manner, then there is some benefit.

    • Becky05

      “Anecdotally, in the story, they say this means they don’t have to deal with train wreck transfers anymore. But then why are the newly released stats so very very very bad?”

      Well, one hospital may not make a large difference in the state as a whole, and perhaps the numbers really would have been even worse without this?

      • Suzanna Kruger

        Over two million people live in the greater Portland Metropolitan area out of a total state population of not quite four million. I live two hours outside of Portland in a rural county, and people in my county give birth at that hospital. Portland has a disproportionate affect on the rest of the state for many measures, not just births. It’s really a small state in terms of population. OHSU, the research university hospital, also in Portland, where my first daughter was born, also takes homebirth and transfers from birth centers with direct entry midwives.

  • guest

    http://www.thelundreport.org/resource/oregon_midwives_face_new_regulation
    This report from January details what regulators are contemplating in Oregon; the comment at the bottom of the piece is excellent.

    • Eddie

      From that piece, here’s a journalistic standard bad use of statistics: “found that 15 percent give birth early – but only 5 percent deliver preterm when working with a midwife.”

      Of course, it can’t be possible that those likely to deliver preterm are less likely to work with a midwife. Nope. No chance. Not possible. It must be that the midwife magically makes the baby decide to come at the right time.

      • Dr Kitty

        Do not start me on Journalists and bad medical and science reporting!

        Publishing articles based on the press releases of studies, without actually reading or understanding the study itself, for example.

        Never mind simple factual errors in terminology that render articles incomprehensible. The Daily Mail being a particular offender.

  • Hannah

    Is there a limit to the number of links you can post? I keep posting the same comment but it keeps disappearing when I reload the page.

    • Box of Salt

      I think more than two go into automatic moderation: they appear to post, then disappear until Dr Amy approves them (been there, done that).

      • Hannah

        Whoops, she’s not going to be happy when she sees her moderation queue, then. :-S. Sorry.

  • Amazed

    Ah we already have reactions. Go to MDC and see the ridiculous “arguments” these women resort to just to keep pretending that homebirth is safe or safer than hospital birth. We actually have a rocket scientist decrying the fact that twin pregnancies are generally not full-term and they must have been excluded from the hospital group but included in homebirth group, thus making the results of the neglectful OOH providers who took them worse. Clearly, the fact that Rooks clearly specified in her table that it was only for full-term births was too much for the poster’s understanding. Reading is hard, you know.

    Another lady wails that the source of Judith Rooks’ data was not there for her to see. When Rooks was supporting them, they were not so meticulous!

    Homebirthers, unite and stick the wax in your ears!

    • Aunti Po Dean

      the moderator has removed some troll comments and has this to say “And this is not to say that I don’t agree with her assessment (not that I am qualified to weigh in, necessarily). I acknowledge some of the concerns of licensing DEMs but my somewhat uninformed instinct tells me that the benefits outweigh the negatives. ”
      Says it all really!

      • Amazed

        And there is that senior member, the midwife who doesn’t know that mono and di twins are not the same thing. Lovely. And the countries with the best statistics for the last, say, 100 years are all countries with DEM-alike.

        I was wondering when the Netherlands would drop out of their arguments. The day has come.

        • Amy Tuteur, MD

          mwherbs, the senior member, is an ignorant clown, all too typical of homebirth midwives

          • Bombshellrisa

            Indeed, she is. Her advice to someone that was discouraged about how much schooling cost to become a CPM and the pros and cons of distance learning versus apprenticeship only: ” I just did self study, still do self-study, and go to different relevant classes- like NNR or CPR or sometimes march of dimes has seminars on pregnancy or birth related things”.

          • Squillo

            Except that clowns aren’t usually in a position to kill babies.

          • Captain Obvious

            Mwherbs is an idiot, stateing doctors deliver twins electively at 34 weeks? Even when presented with evidence that twins are delivered between 37-38 weeks, she states that in her area the docs were delivering twins at 34 weeks.

    • Jessica

      Oh, those comments are so irritating. The people picking apart Ms. Rooks’s testimony don’t understand that her source material are the birth and fetal death certificates filed with DHS in 2012. They don’t seem to get that, starting last year, when one fills out a birth certificate for a baby born in Oregon, planned place of birth is one of the questions that must be answered: http://public.health.oregon.gov/birthdeathcertificates/registervitalrecords/documents/birth/orebrsinstrbcnew.pdf

    • Aunti Po Dean

      It appears that some are paying attention and are at least a little curious as to why their pet theory hasn’t been supported “I am certainly willing to be open-minded, but when all of a sudden one study/review seems to show results that are radically different from what we’ve seen before, I think it’s prudent to ask why. And when *any* studies are concerned, we have to make sure we’re comparing apples to apples (as much as possible). Even if that doesn’t change the results, it may change the practical ways those results are applied. Hence my desire for clarification. :)” So maybe there is hope for some to start to see that this actually isn’t “all of a sudden” at all and change their minds like many , including myself, reading Dr Amy’s blog have done.

  • Hannah

    Does anyone else have an issue with the background of the page going black when you scroll down to older comments? I find it makes it much more difficult to read and reply to further down comments.

    • Box of Salt

      Short answer:Yes.
      Fix for intermediate-length comment threads: switch the sorting. I read by “oldest” first then “newsest” later to see things on the white background (too many comments will leave the middle ones on black).

      • An Actual Attorney

        There’s also the little negative sign on the top right of each post. Click that and it shrinks the post and its replies, so that the comments move up above the black.

        • Box of Salt

          Thanks – and I’ll point out that you may need to send your cursor into the corner of the post to make those signs appear.

    • Eddie

      Yes, on Firefox. Maybe it is browser dependent; I haven’t tried IE or Chrome or anything else.

      • Hannah

        I’m on Safari.

        • Guestll

          I get it in IE or Firefox. It’s annoying.

          • thepragmatist

            This blog and commenting system is a real pain in the ass. I like it because it keeps out the truly uninterested, haha… disqus has been driving me nuts lately with misappropriating comments to others. And I get the black screen, yes. Glitchy.

          • Hannah

            Yes that’s weird, also it reposts blocks of comments as “new,” often under different names.

      • mollyb

        I get it in Chrome.

      • BeatlesFan

        I use Opera and I get it too.

    • Laura

      I hate it!

  • Eddie

    OK, I have kind of a dumb question. What, precisely, is a Direct Entry Midwife? I found the definition at http://mana.org/definitions.html and according to that definition, it seems like a person with a high school degree plus some self-study can call themselves a DEM. What am I missing? Is a CPM a step up from a DEM, since at least that person has passed some licensing exam?

    And while I’m asking dumb questions, are there male midwives? I’m guessing not, at least, the US.

    How can anyone look at the intrapartum death rate, above, and then decide a DEM is the way to go? That is the most stark, to me, comparing 0/40000 (high risk included) and 4/2000 (low risk only). I know the answer to this question; it’s a rhetorical question. This is a religion to its proponents. They “just know” that they are right. Any dissent must be part of The Conspiracy. I’ve talked to anti-vax people at some length, in other arenas, plus other anti-science types.

    • Bomb

      Many places require no education at all. No high school, no training, no study.

      “Is midwifery & homebirth legal in Nevada?
      There are not any procedures outlined in the law for registration, certification or licensure of midwives. Therefore, midwives are not licensed or regulated by the State of Nevada.”

      So I can just declare myself a midwife with zero training, insurance, or oversight and start taking patients. Super! Someone make me a website! /sarcasm

      • Aunti Po Dean

        a DEM or CPM is basically the same thing
        In Australia a DEM is someone that completes their midwifery education in a 3 year university degree level direct from high school rather than completing nurse education first. so they are not a nurse first they go direct to midwifery education. perhaps she is suggesting this might be a way to educate midwives in the US too?

        • Bomb

          CPMs have a minimal amount of training/births they have to attend etc to be certified. Some states have licensing rules and require a minimal amount of training like CPM, but here in Nevada you can just say you are a midwife and you are one.

          • Bombshellrisa

            Like Oregon!

    • Gene

      Those aren’t dumb questions. Most people don’t know the difference between a CNM (or certified nurse midwife) and “everyone else”. Since there is no standard, a DEM or CPM is basically the same thing: someone calling themselves a midwife who has NO standardized training. A CPM doesn’t have a recognized licensing exam (or, at least, not recognized by anyone with authority). I’m in the field and had no idea that non-CNMs even existed and thought it was something that died out after the sixties.

      There are male midwives. They are uncommon.

      Rhetorical question or not: the problem with homebirth is that the information is hidden, glossed over, made out to be false or biased, or otherwise ignored. People who question the data are made out to be negative nellies or shills for “big medicine”. Having an MD makes someone (like me) automatically suspect. Paul Offit (the anti-Christ to most anti-vaxxers) said it best (apologies as I’m paraphrasing him): cold hard data is never as powerful as a single anecdote.

  • Minerva

    The way the NCBers justify this is disgusting. How they manipulate and cherry pick facts from actual studies to fit their needs is shameful. Twisting medicine and science to support your voodoo pseudo science proves YOU are the charlatans, selling snakeskin oil or “the experience” .

    In the past few days I have seen mothers ask for advice on HBing only to turn away anything that doesn’t fit in with the way “the farm” wants it done.

    If someone gives a fact about how dangerous it is to risk a baby’s life just to say “you did it” then they are wrong, and brainwashed by the medical establishment.

    Complications? No way. “MY midwife has NEVER had anything go wrong in 19 years!” Really? “She’s an expert in baby resescitation, I’m not worried.” Again, really? “Doctors want you to think throwing oxygen on a baby saved them when they didn’t need any intervention.” Yes, it’s a huge conspiracy to make mothers think they need doctors when what they really need is a midwife who has no training other then a certification. You know who else gets a certificate? A dental assistant and medical assistant. Would you trust them to take the place of your regular doctor or dentist? No.

    This is an example of how to argue like a NCBer, anti vax, etc.
    FACT: 100% of serial killers, murderers, and rapists admitted to drinking water.
    FACT: 100% of people who drink water will eventually die.
    FACT: Water is the leading cause of drowning.
    FACT: Overconsumption can lead to excessive sweating, urination, even death.
    FACT: Water is the primary ingredient in pesticides and herbicides.
    FACT: Water can be chemically synthesized by burning jet fuel.

    What the doctors and scientists don’t want you to know! The are poisoning us and our children by recommending we drink water! Protect your children, don’t let them near water. It is SCIENTIFICALLY proven that it will turn your child into a murdering rapist who will sweat and urinate excessively until eventually they die after eating a pesticide covered apple and drown in a pool of jet fuel! It’s science people, science!

  • Liz

    And I keep reading “the midwives here aren’t as good as the ones in the UK,” but no one is advocating reforming our education system to produce better trained, UK-style midwives.

    • Amazed

      You’re soooo right. No one is advocation better education for midwives, especially midwives themselves, er, Liz? They are very content to stay in the mud where they belong.

      I am currenty following the thread on MDC. I suppose you parachuted from there? Very timely, I must say, and this is no sarcasm. We were just starting to feel lonely here without a midife/homebirther dropping by to educate us.

      • Liz

        I’m all for better education for midwives. A system like the UK or parts of Canada (along with the single payer healthcare, so women’s healthcare choices weren’t financially based) would provide US women with better options than we have now.

        • Bombshellrisa

          Certified Nurse-Midwives already are recognized as excellent providers in the US

    • Bomb

      We already have quality midwives and midwifery education. They are called CNMs. If uneducated birth junkies want to be midwives and deliver babies, they can become a CNM. We don’t need to specially reform education for people that invent a certifications and are then sad no one thinks they are qualified or educated.

      • Eddie

        This. Why would we need a new category of people with LESS education for handling the single most risky day of a person’s life, their birth?

        • The Bofa on the Sofa

          This is the question I ask all the time:

          OBs and CNMs are (for the most part) unwilling to do homebirths, because they consider them far too risky. Therefore, the obvious solution is to have someone LESS QUALIFIED do them instead. It makes perfect sense. In some universe.

          Of course, that is not the reality of it. The reality is that OBs and CNMs won’t do homebirths because, even if they were personally willing to do it, the liability of doing such things is far too high, and they would be subject to malpractice suits if they did it. Therefore, the solution is to let people do it who are not worth the lawyers’ time to sue when they screw up.

          They have no professional responsibility at all. It’s a horrid shame.

          • suchende

            Whatever fault we may find with our current medical malpractice scheme, it’s hard to deny that insurance companies are fairly good at weeding out what is high risk. Of course insurance companies have no reason to discriminate against high quality healthcare providers. If midwives were getting good outcomes with a low risk population, their policies would be fairly inexpensive. Perhaps if med malpractice insurance were required, we’d see better quality midwife care as a consequence.

          • The Bofa on the Sofa

            If medical malpractice were required for midwives, it would pretty much be the end of homebirths, because homebirths are more or less way outside the scope of standard medical practice, so every time it goes bad, all the plaintiff has to do is to put any doctor on the stand and say, “Doctor, can you indicate whether the homebirth was warranted?” and the doctor would say, “Of course not. The ACOG indicates that births should be done in appropriately equipped settings.” End of case.

            Add on top of it the stories of incompetence that we have heard about for midwives doing homebirths, and these things would be an actuarial disaster.

          • Squillo

            I don’t know if it’s necessarily true that most CNMs don’t want to do homebirths. The several that I’ve talked to personally (all in CA, so the situation is likely different in other states) complain that they can’t find affordable med-mal to cover it and they can’t find OB backup. Moreover, it just doesn’t pay as well as office gyn and a regular gig at the hospital, so they go where they can make decent money. One of them had a busy homebirth practice and closed it when they lost backup (due to insurance on the doc’s end, IIRC.)

            Of course,they may not be representative of CNMs as a whole, but given the ACNM’s advocacy on behalf homebirth, I suspect a significant portion of their membership have some interest in it.

          • The Bofa on the Sofa

            I don’t know if it’s necessarily true that most CNMs don’t want to do homebirths.

            I never said they didn’t want to, but that they were unwilling to for liability reasons. IOW, exactly what you said.

      • Becky05

        I actually do think that there is a place for a bachelor’s level midwifery degree and certification, which is the common standard internationally. We could have this AND the CNM. But then the adequate training would result in “medwives” rather than “midwives,” according to too many in the homebirth movement.

        • Bombshellrisa

          But the nursing training behind those type of midwives is more extensive than the US system. Canadian RNs have four years of clinicals and do their other course work in between (so the actual nursing school is four years long), where as US RNs do their course work like biology and anatomy FIRST, then do two years of nursing school with clinicals.

          • Becky05

            Then we can make sure to get in plenty of clinicals, yes? International standards call for an at-least-three year educational program for midwives, and I do think it would be good to have a three or four year credential in the US, maybe continuing with the CNM as a step up. Such a program would required some significant differences to the current CNM program.

          • Bombshellrisa

            Also changes to nursing schools, not sure how that would work with RNs from two year associate degrees programs.

        • Squillo

          We have a version of this in the masters entry programs in nursing that prepares those with bachelor’s degrees (but no nursing degree) for advanced nursing practice in three years rather than the nursing-plus-two of the regular masters programs.

          Anecdotally, I’ve heard a number of nursing professors voice concerns that these candidates are often not as well prepared as one might hope.

    • ratiomom

      The system of trained midwives doing homebirths in the UK and The Netherlands isn’t all that good either. I know the system in the Netherlands.

      These midwives have a good education and training, and oversight with strict risk-out criteria for homebirth. But at the same time, they are self-employed providers who only get their pay in full when the client delivers at home. There IS a financial incentive for them to buy heavily into the ‘birth is normal and not a disease’ paradigm. The consequence is that they often don’t recognise a high-risk pregnancy for what it is. As a consequence, the perinatal death rate in the Netherlands is among the worst in Western Europe.

      Since this information became widespread, Dutch women have been voting with their feet. They are opting for hospital deliveries en masse, even those who would be homebirth candidates, in spite of a 300 euro co-pay for a hospital birth where a homebirth would be free.

      The midwives’ professional organisations are bemoaning this, saying that the Dutch government should take measures to promote homebirth. They claim that home birth will become ‘a lost art’ if less than 10% of Dutch women will choose it. There is a big debate going on whether it is ethical for the government to promote homebirth when the outcomes are clearly inferior.

      • http://www.facebook.com/lizzie.dee.71 Lizzie Dee

        There are two arguments in favour of homebirth: the first is “It isn’t an illness you know” – birth generally goes reasonably well, so why tolerate the inconveniences of hospital? The second is the pseudo feminist one: women have a right…..etc. etc. Both make superficial sense, but both come up against the inconvenient fact that the idea that birth is without hazard is false.

        I am not all that well informed about homebirth in the UK. Of course it is properly regulated, and various governments seem to favour it as a cheap alternative to sorting out the escalating problems in hospitals. (One hospital is currently being sued by 32 different families – two maternal deaths, several dead infants and several brain damaged.) I have heard several midwives and midwives organisations speak enthusiastically in favour. But what troubles me is this:

        “The consequence is that they often don’t recognise a high-risk pregnancy for what it is.”

        (Seems like midwife led care in hospitals may be responsible for the appalling outcomes in hospitals too – much on the same basis.)

        At least in the UK system, compensation for negligence is covered – though as I have said before, dead babies are cheap as their is no “pain and suffering” provision for a lost child, so very few people sue. It is those who survive by the skin of their teeth who are expensive – and, let’s face it, that is a lot less likely in a homebirth than in the hospital.

        It seems to me that if legislators want to support homebirth for whatever reason, setting up a system where they pick up the bill for disasters would either reduce one of the hazards or perhaps temper their enthusiasm when the actual costs started to hit home.

        • ratiomom

          From what I read in the media, the British maternity system has first and foremost a lack of staff and budget. Midwife-led maternity units are unable to uphold a reasonable standard of care, with devastating consequences. But the stories one reads are often of the ‘too many patients, too little staff’ variety. It’s difficult to separate the effect of lack of funds from the ‘midwife-effect’.

          In The Netherlands, the in-hospital ‘midwife-effect’ is definitely there. Women who are labelled as high-risk and whose births are managed by OB’s have better outcomes than the low-risk women who give birth in the midwife-led part of the delivery ward.
          Many Dutch women cross the border to give birth in Belgium where OB’s manage every birth, and are accessible without a referral from a midwife.

          • Hannah

            The NHS is probably best described by the ditty “when it was good it was very, very good but when it was bad it was horrid.” It suffers from pockets of terrible practice. The big drivers of poor care are successive governments’ obsession with the twin imperatives of maximal efficiency and introducing the “dynamism of the free market” (these two goals ate mutually contradictory as marketisation inherently introduces inefficiency, but they don’t realise this). This has leads to a pressure to be working at full capacity at all times, and it doesn’t take much for the wheels to come off, and perpetual re-organisation for the sake of it, in the name of “reform,” that attack structures of accountability.

            The result is that you occasionally see departments, hospitals or groups of hospitals with a massive breakdown in clinical governance. This is what appears to have happened at Furness General Hospital Maternity Department. Poor practice amongst low and mid level staff is allowed to run rampant, caused by perverse targets or ideologies (over attachment to “natural” childbirth), nastier things (I don’t know about this larger group, but the original group of patients harmed at FGH were disproportionately non-white, in a very white part of the country), or simply laziness and incompetence; there’s a breakdown in communication and team working between junior and senior staff; senior staff “follow their own agendas” and managers seal themselves off from it all, are driven by, and propagate, perverse incentives, and make it clear they only want to hear good news.

            http://www.bbc.co.uk/news/health-21809368
            http://www.bbc.co.uk/news/health-21798726

            There has recently been a big scandal over very poor care at hospitals in one particular area, unrelated to maternity care, that had many of the similar features of the FGH disaster, including the implication of the, then, Government’s latest vanity project, the “Foundation Trust” scheme:

            http://drphilhammond.com/blog/wp-content/uploads/2013/03/Private-Eye-mid-staffs-final.pdf

          • ratiomom

            This makes for some chilling reading. Is there a private system with better care, or are the wives and babies of these politicians exposed to this along with the common people?

          • The Computer Ate My Nym

            the British maternity system has first and foremost a lack of staff and budget.

            This is an easily soluble problem. All it requires is that people in Britain vote for politicians willing to raise taxes-especially on the very wealthy-and that the increased income be used to increase funding to the NHS. Doing anything else is saying that you’re ok with babies-and adults-dying. (Yes, the US system of not even having an NHS is saying it even louder, but that doesn’t excuse the lack of funding in the British system.)

          • Mrs. W

            You don’t even have to raise taxes, you just have to make different choices as to how much funding is given to other areas – perhaps there are categories that have an over spending relative to healthcare that could do with some frugalness.

          • The Computer Ate My Nym

            perhaps there are categories that have an over spending relative to healthcare

            Like…what? Police protection? The fire department? Perhaps the notoriously over funded schools? Face it, you get what you pay for and if you don’t pay taxes, you won’t get services.
            Ok, maybe the UK could do with joining the US in a few fewer adventures in “peacekeeping”, but other than that, what are you going to cut?

          • thepragmatist

            Not pursuing that wasteful war with Iraq and avoiding the profiteers would’ve been great. Regulating the investment sector would’ve been even better. Neoliberalism failed spectacularly. Here are the consequences. And rather than taking the money back from the thieves, the government does nothing…

          • Hannah

            There’s really not that much more to cut that they aren’t already cutting, or about to cut. The NHS budget has actually been ring fenced (don’t give them too much credit for this, it’s a cynical way of seeming to “protect” more popular or “sexy” areas of spending while providing political cover for the overall austerity programme). Needless to say the results haven’t been stellar:

            http://krugman.blogs.nytimes.com/2013/03/09/the-english-prisoner/

            (For those of you who don’t follow British politics, there was a change of government in May 2010 and a Spending Review in October 2010

            http://www.bbc.co.uk/news/uk-politics-11569160 )

          • Hannah

            “This is an easily soluble problem.”

            So you would have thought.

            “All it requires is that people in Britain vote for politicians willing to raise taxes-especially on the very wealthy-and that the increased income be used to increase funding to the NHS.”

            Unfortunately two out of three of the major parties are currently in government and pursuing misguided reorganisation rather than investment. The other party was also enamoured with “reform” whilst in government, albeit with somewhat more investment, but not enough.

          • Dr Kitty

            The NHS is struggling to cope with an explosion in the birth rate over the last 15 years, partly fuelled by a rise in immigration by working age people.
            It takes a while to reconfigure services to cope, and the political will at present is about pushing left shift to community care and introducing free market economies. No one really wants to build and fund more maternity units.

          • Eddie

            This is a problem with government-provided health care; you are absolutely beholden to politicians to respond to any changes in demographics. Don’t assume this means I support the polar opposite, mind you. With health care in general, there are no easy solutions simply due to the cost. When all market pressures are removed, however, you get health care that doesn’t response to this kind of change.

          • The Computer Ate My Nym

            With health care in general, there are no easy solutions simply due to the cost.

            I disagree somewhat. I don’t think health care costs are the problem. I think they’re the solution. What else do we need the money for, after all? Food is (pardon the expression) dirt cheap. Stuff…well, with electronic media and 3D printers, stuff is pretty cheap too. Health care now…health care is expensive. But embracing that expense and expanding the amount of the GDP that goes to health care could be good for the economy.

            What drives health care costs? More than anything else, labor costs. What is a problem in virtually every wealthy (and most non-wealthy) countries? Unemployment! Problem, meet solution. And health care produces something highly valuable-additional years of healthy life. Health care research provides further improvements in life expectancy and quality of life as well as the occasional fun spin off (insert PDEI joke here.)

            In short, let’s just admit that we need to spend a lot of money keeping each other alive and working out how the human body works and go for it. We’ll live longer, happier lives and still have plenty of food, cell phones, and spare income. Where’s the downside?

          • Eddie

            It depends on what country you’re talking about. The United States spends close to twice, per capita, that any other industrialized country spends on health care without better outcomes. There are many reasons for this; it’s not a one-dimensional problem. Part of this is that with the particular combination of free market and regulation that we have here, the incentives work to increase price, not decrease it. Look at anything not covered by insurance — spiral beam tomography for heart disease, LASIK, and so on. In those areas, prices have come down after being initially high, due to competition.

            More than one friend of mine asked their Ob/Gyn what the prenatal care and delivery cost, and the office absolutely refused to answer since the people in question had insurance. For me, that would be cause to walk to another doctor’s office.

            I had a bill for over $20k from a medical facility for a one hour procedure when usual and customary was $1.5k. They actually told me that since they are out of my network, they charge through the roof to increase their income, and then waive what the insurance does not pay. (To me, that is a fraudulent practice.)

            Other countries probably differ, but in American, the system is out of control. More money, in isolation, is not the answer. Medical care is already 1/7th of the US economy. If we were as efficient as other Western economies, it would be above half that for the same outcome.

            With our youngest, I kept careful track of costs. Before insurance (if we didn’t have any), our billing was over $30k, including prenatal care. Just because we were lucky enough to have insurance, that got cut to about $14k. We paid about 10 – 20% of that out of pocket.

          • http://www.facebook.com/lizzie.dee.71 Lizzie Dee

            Certainly, staff and funding are a problem – but it is beginning to look as if there is rather more wrong with management, aims and political interference.

            The story I was reading about Furness – the latest notorious hospital – a baby died at 9 days old from sepsis. The father said that when they raised concerns about grunting and feeding problems, they were repeatedly told it was not a problem (variation of normal, one assumes) and they could not get to talk to a doctor. I think this is the same hospital where a mother died from a similar lack of concern on behalf of midwives.

            Personally I would want anyone belonging to me to take any “unnecessary” intervention over this kind of laid back attitude.

          • Dr Kitty

            Dr Amy did a post about Joshua Titcombe with his father’s co-operation.

            http://www.skepticalob.com/2011/11/joshuas-easily-preventable-tragic.html

            Desperately sad, and what would appear to be an example negligent care.

        • fiftyfifty1

          “”The consequence is that they often don’t recognise a high-risk pregnancy for what it is.””
          When you don’t have a hammer, nothing looks like a nail.

      • Mrs. W

        meanwhile in Canada (BC) we have a minister of health who is promoting Homebirth….

        • ratiomom

          What this health minister conveniently forgets is that The Netherlands are a small and densely populated country. In case of emergency at home, transport distances are short.

          There are islands without permanent connection to the mainland, and places in the rural north that are >30 min drive from a hospital. Women there are risked out of homebirth by default.

          Following these guidelines would probably risk out all of Canada except the cities.

          • Mrs. W

            I can’t say I agree with the honorable minister….what’s worse is she is a former doctor and as such her ‘encouragement’ of Homebirth carries considerable weight.

          • ratiomom

            Your minister is a frugal woman. Homebirth is definitely the cheapest option in a rural environment where distances are such that a struggling mom and baby won’t make it to a hospital alive. They only cost the system money if they survive and need long term care.
            It’s extremely cynical, but it’s cheap.

          • thepragmatist

            I can vouch for this government (Mrs. W and I share the displeasure of the same “governance”) to say that they care little for human life. Seen it again and again. It’s an election year, so really they will say and do anything they think may pull more of the center-left vote. Because the alternative is a labour party. I’ll take the alternative, soon, please: at least they will restore fundamental social services, or at the least, I can assume such based on their history here. Anyway, they will woo homebirthers, too, though, because again, most don’t understand and will say, Well, it’s feminist…

      • LukesCook

        “The consequence is that they often don’t recognise a high-risk pregnancy for what it is.”

        Where strict risk-out criteria are applied together with strict transfer criteria, I imagine that a midwife who specialises in homebirth will usually treat only the lowest of low-risk women and (hopefully) see very few genuinely life threatening emergencies. The downside is that after a few years (or even a few months) of this kind of practice, the midwife will surely start losing her “high-end” skills, no matter how comprehensive her training originally was, until she really is a specialist in “normal” birth only.

      • Dr Kitty

        See this is the crux of the anti-feminism in NCB.
        Women are supposed to want HB, to avoid interventions and to opt out of epidurals.
        BUT, when given accurate, impartial information about the risks and benefits, those are not the choices that many women actually want.

        So, instead of accepting that these women are making the right choices for themselves, there is pressure to conform to the NCB ideal, which is cheaper and uses fewer resources, without appreciably better outcomes.

        As far as I can see, the whole NCB thing is just sugar coating for “suck it up ladies, the pain won’t kill you and most of the time you and the baby will survive, so you don’t need to worry about it, stop being so entitled and just have your baby in your living room already”.

  • Liz

    I was glad that at least one person at the hearing pointed out that hospitals are driving women away with their inflexible, unfriendly “care.” Maybe if hospital staff gave women what they were looking for out of their birth, they wouldn’t feel like they had to birth somewhere else. Maybe VBACs should happen in a hospital, but if hospitals refuse to do them, where does that leave a woman who doesn’t want a repeat Cesarean?

    • Jessica

      I don’t know what it’s like at other hospitals around the state, but here in the Eugene-Springfield area the hospitals bend over backward to offer NCB-friendly care: private labor rooms with jacuzzi tubs, birthing balls, grab bars for birthing in any position, telemetry monitoring, no requirement for CEFM unless medically necessary, etc. etc. Skin to skin right after birth (at RiverBend, even after a C-section), no nursery, no formula. In areas with lots of NCB/Homebirthers, like Portland and Eugene, the hospitals are fairly accommodating, and it’s still not enough.

      • fiftyfifty1

        It’s still not enough because it can’t be enough. You can’t earn the Unicorn Scout Homebirth badge unless it is an actual home birth you see. Giving birth in an accomodating hospital is actually WORSE than giving birth is a regular hospital. Because at least in the regular hospital you can earn your Unicorn Scout Survivor of Birth-Rape by a Hep-Lock IV badge.

    • Amazed

      Maybe if SOME birthing women didn’t envision themselves as birthing goddesses, entitled to everything they want to gorge on without realizing what it really means, they would have sucked their fucking egos and suffered a hospital for how long? Five days? A week? Funny how 99% of women go to the hospital and don’t complain because doctors wanted to go a VE to know what the baby’s position was, yet there is this small number of ladies who kick and scream because they were deprived of a procedure that has the potential of becoming lethal in minutes because hospitals don’t have anaestesia 24 hours a day. They value their babies so much that they cannnot possibly suffer a few days in the hospital. I am so moved. I am weeping now for their sad plea.

      I am fed up with the VBAC whining, hereby I suggest the following informed consent, “I, Ms Somebody, am aware that Hospital Somewhere can’t offer me a safe VBAC because it doesn’t have an anaestaegiologist all around the clock but I insist on having a VBAC anyway and I take full responsibility for the possible uterine rupture and my baby’s possible death.”

      When a hospital doesn’t offer a repeat C-section, she’ll do the same thing I did when a hospital didn’t offer me the better cast for my broken foot: she’ll go to another hospital. Travel there, if she must.

      By the way, I recently talked to an “informed” woman whining that she just wanted to give VBAC a try but evil doctors wouldn’t let her. Considering the fact that she believed footling breeches were perfectly safe, I doubt her “information” went far beyond “I don’t want a repeat C-section. I want a VBAC. I want a VBAC. Kick and scream. I wanna VBAC, ebil doctors!

      • Karen in SC

        The things I hear about the hospitals here (as justification): “They don’t let you walk if your water breaks – because of liability”, “They don’t let you move around after you get an epidural”, “They don’t let you leave the bed once you are admitted” – all supposedly because of hospital liability….and the kicker “They don’t listen to me!, My birth would have been perfect if they had only listened.”

        It makes me want to sign up for a tour and ask questions!

        • Amazed

          Oh my, justifications! Even if those things were all true, how much they matter in the long run? As I wrote yesterday, no one is making women move to the hospital forever or marry their OB. What would they say to their damaged child – the ones who played the odds and lost? “I am sorry, DD/DS. I am so sorry you’ve got CP but at least Mommy did not have to stay in bed in that nasty hospital.”

          I cannot imagine that such considerations could probably justify the risk. As small as it is, it is a risk with their baby’s health and very life.

        • suchende

          The NCBers told me I would have to birth on my back in hospital, so I was pretty surprised when I was encouraged to birth semi-reclined, which was super comfortable with a supportive hospital bed (and epidural). Of course, most of the home birthing videos I have seen include mom on her back for the pushing, so I don’t know what’s so convincing about that argument to start.

      • AmyP

        “They value their babies so much that they cannnot possibly suffer a few days in the hospital. I am so moved. I am weeping now for their sad plea.”

        Yeah.

        For my last baby (this October), there was a new hospital procedure that squicked me out. They had a urine-collecting cap on the toilet for me to collect pee into for the entirety of my postpartum stay. I had this big container of cold, bloody pee sitting on the toilet the whole time (I was group B strep positive, so it felt like ages before we could be discharged). The nurses would periodically come in and note down the quantities and empty the cap out. I knew there was a good reason for the procedure (which I had never seen with previous babies), but I wanted to get back to my bathroom so much! It was so disgusting!

        I didn’t like the pee cap, I don’t like hospital gowns, I hate IVs and blood pressure cuffs, but I’m an adult and I need to make reasonable decisions for my health and the baby’s health, not react to the hospital like a dog at the vet.

        • Amazed

          I think you found the perfect analogy. A dog at the vet. That.

      • Mrs. W

        In British Columbia there are 2 hospitals with dedicated obstetric anaesthesiology, most hospitals will do VBACS, and further the province and the midwives here have decided that under some circumstances a HBACS is acceptable. I’m not entirely sure why this is, given the horrendous potential should something go pear shaped. I suspect the water supply has been spiked with granola.

        • Amazed

          I imagine those circumstances include midwives keen on playing God and mothers keen on playing Teh Empowered Woman of Women. The problem is, not all babies read the script and when it’s yours that comes out ignorant, you wish you had never heard of this theatre.

          What you say only reaffirms my conviction that there will always be those who value the very excitement of playing the Russian Roulette of birth and winning over safety.

        • Haelmoon

          The numbers in BC are slowing improving. There are more hospitals now with in house anesthesia for OB. These are our tertiary care units, also with in house OB and paeds/NICU.

          In terms of the HBAC in BC, they mostly fall into two categories that I have seen. The first is the patient who flat out refuses to come to the hospital in labour. The midwives are legally not allowed to abandon a patient. They can call 911, but if the patient refuses to leave home, the midwives are stuck attending the delivery at home. Those few cases I have seen generate a lot of anxiety and paperwork. We are always aware of on going home births attempts (they are call into Labour and Delivery), and if there is a HBAC, we make sure that we can move quickly if necessary. However, these are the same midwives I work with in hospital, I know them well and trust their judgement. If they come in quickly, I will learn what is happening on the way, because they will phone in as the ambulance brings the patient. VBAC also requires a MD consult, so we have records of these patients and have discussed their medical risks in advanced, not a stranger being dropped of at our door.

          The second group are higher order multips, with previous c-section for breech, or some non-recurring indications, with a history of precipitous labours. Some of these women barely make it to the hospital, and most have already had one successful VBAC. It does not exclude the potential for complications, and they are transferred in if there is any prolongation of labour. There is no perfect system, but at least in the BC system, the care providers are all working on the same time, and that has to be a bonus for improving patient safety.

          I personally am anxious with HBAC, I have seen the disaster situation, with a complete rupture at home, dead baby and barely saved mom. Lots of medical care providers have seen the disasters, thats why is not just a theoretic risk to us, we know what it looks like. Just deliver in house, and if all goes well, ask for an early discharge. Seriously, how long would you actually be in hospital, but no mess to clean up at home.

    • Amy Tuteur, MD

      Hospitals are not driving women away and it is disingenuous to pretend that they are. Homebirth with a CPM is a fringe practice chosen by a tiny minority of women. They choose homebirth affirmatively because they imagine that they are “educated” and that they will be “empowered.” They and they alone are responsible for the inane and irresponsible choice to give birth at home attended by a pretend “midwife” who is nothing more than an ignorant birth junkie.

    • T.

      If a hospital refuses a VBAC, there are probably reasons, don’t you think?

      Consider this situation: mother wants VBAC, doctor says it is dangerous, mother insists and firm the form, doctor does VBAC and something goes horrendously wrong.
      The mother sues. The hospital pays. Something like that had already happen.

      Big surprise hospitals are adamant on some thing…

      • Becky05

        “If a hospital refuses a VBAC, there are probably reasons, don’t you think?”

        Sometimes there are good reasons, but sometimes the reasons are related to insurance rates, or demands on doctors’ time (some hospitals require an OB attending a VBAC to be in house the entire time the VBAC is laboring, and few doctors want to do this) rather than the most medically appropriate choice or patient safety. I do think that if hospitals strive to fully embrace evidence based practice and fully follow ACOG guidelines, then that would help with the number of women seeking homebirths in unsafe circumstances, but it wouldn’t solve the problem. Many hospitals are indeed seeking not only to offer good, evidence based care but also are striving to provide comfort type amenities to appeal to women wanting a more home like setting. The homebirth movement seems to be gaining ground, not losing it.

        • An Actual Attorney

          Not having an OB in the building the whole time seems like a good reason not to allow a VBAC trial. It’s hard to do a stat CS without an OB. How is that not safety-based.

          • Becky05

            A stat CS could be required with ANY delivery, and not just with a VBAC. I understand that a uterine rupture is an emergency that is very time sensitive, but it isn’t the only one. Any hospital providing maternity care needs to be able to perform an emergency cesarean quickly. Moreover, there are ways to structure maternity care, such as in house OB hospitalists/laborists, that would relieve some of the burden on individual doctors and make labor safer for every laboring woman, not just women attempting VBACs.

          • The Bofa on the Sofa

            But you have to weight the likelyhood of the event happening.

            Are ruptures just as likely in ANY delivery?

          • Becky05

            No, ruptures are not as likely in any delivery, they are significantly more likely in a VBAC. However, in a typical VBAC after one cesarean candidate, they are no more likely than other serious risks, like the risks of cord prolapse, shoulder dystocia or serious fetal distress. The risk of perinatal mortality in a VBAC is about the same as the risk of perinatal mortality in a first time mom. And if a woman has already had a successful vaginal delivery, her risks as a VBAC mother are quite a lot lower. Yet, in many places she will not be allowed the option to VBAC, no matter how many previous VBACs she has had, and regardless of what her own actual risks are.

        • The Bofa on the Sofa

          Sometimes there are good reasons, but sometimes the reasons are related to insurance rates

          How is that not a good reason?

          The reason insurance rates are high is because the risk of a bad outcome leading to a large payout is high. Why shouldn’t hospitals be averse to high risks of a bad outcome?

          or demands on doctors’ time (some hospitals require an OB attending a VBAC to be in house the entire time the VBAC is laboring, and few doctors want to do this

          Again, how is this not a good reason? Who’s going to pay for that doctor’s time while they are sitting with the patient instead of helping others?

          • Becky05

            “How is that not a good reason?

            The reason insurance rates are high is because the risk of a bad outcome leading to a large payout is high. Why shouldn’t hospitals be averse to high risks of a bad outcome?”

            The problem is that the risks of a VBAC are not in fact that much higher than the risks of other kinds of deliveries that do occur regularly in hospitals. As I said below, the risk of perinatal mortality in a VBAC after one cesarean isn’t significantly different from the perinatal mortality in a first time mother. Risks are not constant across the spectrum of VBAC patients. They vary by reason for cesarean, the mother’s personal health characteristics, whether she’s successfully delivered vaginally or not, etc. Across the board VBAC bans don’t respect that.

            I guess that VBACs are treated as different because they’re viewed as entirely optional, but that is dependent on acting as if there is no cost to ERCS. Since ERCSs have significantly higher rates of maternal morbidity and mortality, this essentially treats the mother and her health as unimportant.

    • The Bofa on the Sofa

      Our doctor did not offer us a VBACS because the hospital was not equipped to guarantee anesthesia within 10 minutes, as would be required to safely do a VBACS.

      If we wanted a VBACS, we could have gone to a hospital an hour away that was equipped to do them.

      What do you think should be different? Should the doctor have offered a VBACS under unsafe conditions? Or should the hospital be spending extra money on anesthesia, and who should pay for that?

    • The Computer Ate My Nym

      Maybe if hospital staff gave women what they were looking for out of
      their birth, they wouldn’t feel like they had to birth somewhere else.

      Like, what? You mention VBACs later on, but are there other specific issues that you think hospitals aren’t addressing well?

      Maybe VBACs should happen in a hospital, but if hospitals refuse to do
      them, where does that leave a woman who doesn’t want a repeat Cesarean?

      VBACs are performed in hospitals that have 24 hour OR/anesthesia, OBs who are qualified to attend VBACs and adequate neonatal care. Allowing VBACs in hospitals that didn’t have those qualifications makes no more sense than encouraging home or birth center VBACs: A place that doesn’t have the resources to deal with it if things go wrong is a dangerous place, no matter whether it is a hospital or not.

      Nor is every woman who has had a c-section a good candidate for a VBAC. Some should have sections for any subsequent pregnancies because the risk of VBAC is too high for them. Should doctors simply go along with the patient’s wishes even when they know it to be unsafe?

    • The Computer Ate My Nym

      Another thought: Some OBs will be unreasonable. Some hospitals will have unreasonable restrictions. If you think your OB/hospital is one of those, get a second opinion. But if you’ve been to several OBs and they all say that you’re not a good candidate you should probably start to revise your plans.

    • Aunti Po Dean

      “Maybe if hospital staff gave women what they were looking for out of their birth, they wouldn’t feel like they had to birth somewhere else. ”
      Dr Amy this should be added to the homebirth bingo card!

      • Bombshellrisa

        We need to have the homebirth/CPM birth center and hospital birth L&D checklist side by side. Home/CPM birth center=candles, big tub, pretty room, 2 self styled women’s care providers and their apprentices. Hospital L&D=jacuzzi tub, low lighting, unlimited Chux pads, trained medical professionals, medicine, crash cart, OR, nurses and doctors whose entire focus is YOU if something goes wrong, nurses and doctors whose entire focus is on your baby is something goes wrong. Hmmm

    • suchende

      Of course, obstetric care in hospital has room for improvement, and we can certainly benefit from advocacy on behalf of women in hospitals. I know hospitals themselves are thinking about these things and making improvements, including the Peace Health system in Oregon. For their part, mothers push for more accommodations like birthing balls, bars, tubs, the presence of doulas, etc.

      But, as I have said before, getting a homebirth because you’re unhappy with American obstetrics care is like trading in a BMW with a faulty air conditioning system for a Ford Fiesta with an iffy brake system. That’s not pro-woman advocacy.

  • Natalie

    I attended this hearing. HB 2997 is a great start, but not stringent enough in my opinion. Oregon is a state where a lot of health care providers have a lot of freedoms they wouldn’t in other states (nurse practitioners, chiropractors, naturopaths etc.)

    A local OB/Gyn I know has taken matters into her own hands and reached out to the local direct entry midwives, offering to meet with them and discuss their practices, when they would like to see mothers transferred, and mothers that should be excluded from homebirth. Unfortunately the local DEMs have rejected every attempt and cooperation.
    At least they’re trying to reform this.. moving a mountain one pebble at a time.

    • KarenJJ

      “Unfortunately the local DEMs have rejected every attempt and cooperation. ”

      That seems to be how they operate, isn’t it? They are not feminists, they are not pro-women and they are not interested in becoming better practitioners and for all their their talk about wanting to be better respected by the medical community they only want that repesct to go one way.

      It makes me see red and lose patience and I am very very far from the situation, geographically and professionally. I don’t know how those closer to the coalface put up with it.

    • Liz

      What area are you in, where the midwives aren’t meeting with the OB you mentioned? In our area, the midwives have good relationships with both the local OBs and hospital nursing staff.

      • Bomb

        ORLY? Name names. Which OBs are collaborating with midwives? If they are collaborating then they should have absolutely no problem with their names being shared. The places I have lived recently, eastern and western WA, ID, and NV I have located 0 midwives that collaborate with OBs (and I email lots of them pretending to be a potential client) and if they give a name as backup? The OB is unaware of this and no kind of agreed to be backup. But what an interesting dynamic you have! In another comment you say that OBs won’t do VBAC or support water birth, but they get along just peachy with uneducated wannabe healthcare workers that do that stuff at home, with no insurance, oversight, etc and are TOTALLY cool with cleaning up after their horrible mistakes and risking lawsuit etc. Makes sense to me.

      • Dr Kitty

        Well, it’s easy enough to have a good working relationship with someone if your contact consists of “here are my notes, mama decided to transfer, foetal heart tones were strong right up until they weren’t, see ya!” and you can’t hear what the medical staff say about you in the break room.

        Look CNM is hard work and expensive. Some DEMs would find it too much financially, intellectually or as a time commitment to complete a CNM. I get that. But that is not a reason to accept DEMs.

        It seems to me that the medical profession saw unlicensed quacks and healers as a threat to patients and an unacceptable infringement on the medical profession. So they fought long and hard to protect the title”dr” so that it actually meant something, and made sure that their self regulation was rigorous. Midwifery took a different route, trying to accept DEMs as sisters and fellow travellers who deserve recognition and respect. It does not seem to be working out well for clients and their babies.

      • Natalie

        Corvallis area. As Dr Kitty says, they may think they have a good relationship but they don’t hear what’s said about them once they leave. I was actually impressed at how polite and forgiving the OBs were when they talked about the DEMs (they sounded exhausted and defeated more than anything).

        As previous posters have mentioned: Oregon is a place that really caters to the “natural” crowd. They have tubs to labor in, warmly decorated birthing suites and a lot of super awesome certified nurse midwives. The certified nurse midwives have a great relationship with the OBs- because they are co-workers.

        As Dr. Kitty also mentioned, physicians have worked long and hard to protect their profession. Oregon blurs that line more than anywhere I’ve ever been- it’s likely that a new law will be passed soon mandating insurance reimburses NPs and PAs at the same rate as physicians. Naturopaths have unlimited prescription rights. Naturopaths and chiropractors are introducing legislation to be included as primary care providers in the CCOs… oh Oregon. I will escape this place eventually…

  • Anon_anon

    I think there should be a “you can’t handle the truth” moment for MANA where they admit that they are aware of the increased risk and that they accept it for the “benefits” the other 990+ women get. The 4-6/1000 who would not have lost their baby in the hospital at collateral damage they accept. I want them to admit the truth they are promoting.

  • http://www.facebook.com/dchamlee Deena Chamlee

    Little bit at a time. Keep on facing the truth!

  • Amazed

    What again was the matter with eyes? I am asking because I don;t want to get kicked out of here if I say what I really think about the last post on Homebirth section on MDC. The lady – and I am using the term quite liberally – is amazed by the 0.6 hospital death rate and is suggesting that it might be due to ebil technology which saves babies past their 28th day of life just to have them die later and thus skews statistics against poor midwives. Tsk, tsk, so evil! So unfair!

    I suggest creating Alenishka a Lady of the Order of Patience for managing to keep herself from getting kicked out of there and being always so… patient with those nutwits.

    • thepragmatist

      She is so patient, it amazes me really… and LOL!

  • Bomb

    I have to rant. here is a text block from a local midwife website:

    CPM (Certified Professional Midwife) – a board certified independent care provider with advanced training and education to deliver babies and care for pregnant women. CPM’s may also provide well-woman care, well-baby care, counseling and other services throughout life. They have additional training and certification in nutrition, naturopathy, and emergency care. The governing organization, which certifies and registers these midwives, is NARM (North America Registry of Midwives). Because CPM’s are not required to work under the direction, license, and/or supervision of a physician they do not ordinarily (in Southern Nevada) deliver babies in the hospital. Many CPM’s in other areas of the USA are also CNM’s.

    board certified…uh which board? The board they invented that is completely unregulated by anyone? Advanced training and education? You mean a mail order course and a GED? Additional training in nutrition? From where? Emergency care? They have no advanced training in emergency care. They don’t even have BASIC training in emergency care!! Unless you consider the level of education of a 12 year old Girl Scout to be advanced (which they do). CPMs not required to work under supervision of doctors? They are not ALLOWED to work with doctors! They have no training! No insurance! No real accredation of any kind. They don’t ordinarily deliver in hospitals in southern Nevada?!? They are not allowed to, in any US hospital, ever! They would never be allowed to under any circumstance. Many CPMs are also CNMs? Actually it is less than 1% of CPMs.

    And women read this garbage and think they’ve done “research”.

    • Bombshellrisa

      “additional training in nutrition and naturopathy and emergency care”. So let me guess, that means they believe kale smoothies are better than prenatal vitamins, they use the cohoshes instead of real medicine and they took a CPR class? Big whoop. As for the insurance they don’t have, did you see the client contract that Lorri Carr, the Highland midwife makes her clients sign? Besides making them promise to eat healthy and understand that she may not go to the hospital with them if they require a transfer, she also states that she doesn’t have malpractice insurance, as the cost of it would be transferred onto her patients (because it only costs $3600 pre paid for her to tell you to trust birth for 9 months and then come over and knit in the corner when you go to labor. Wouldn’t want it to cost more and actually get something out of it)

      • Bomb

        The same website basically tells you that if something bad happens it isn’t her fault and you need to take responsibility.

        “I believe that every person is the owner of his/her own health and accepts the responsibility for that ownership. Your choice of a birth attendant should always mean that you trust that person. Your trust also means that you are confident in utilizing the birth attendant’s competence, judgment and advice. You should consider all of these aspects in making your own decisions about your pregnancy and your child’s birth. I should not be held ultimately responsible for your well being. As your midwife/birth attendant, I should be viewed as a resource and friend who will share your experience of pregnancy and birth with you. The word “midwife” literally means “with woman” and her role is to provide you with support and information so that you can make choices about your own health. ”

        And then elsewhere:
        “I believe that couples must maintain the full responsibility for their own health care and for the outcome of the birth. I will assist with information on nutrition, exercises and childbirth education but you must assume the responsibility of maintaining your own excellent health care. Home birth couples must take extra responsibility in this area since technological help is not immediately available as it is for those birthing in the hospital.”

        You are responsible for the OUTCOME of the birth? That must be why so many of these people think their healthy baby is an ‘achievement’. I just wanted my baby to die, that is why homebirth went horribly wrong for us. The midwife being an uneducated moron played no part.

        • Elaine

          That kind of garbage is one reason why we decided against a home birth. The midwives we interviewed said essentially the same thing in their literature. I found the “we’re not health care providers” and “we don’t take responsibility for anything” vibe to be offputting.

          • Bombshellrisa

            Especially if you are having to pay for it!

          • AmyP

            I like the honesty, though. Too bad it’s not more widespread.

        • http://www.facebook.com/profile.php?id=682572949 Natasha Dothnay Seymour

          Disgraceful!

        • Captain Obvious

          Could you imagine if every occupation had this disclaimer? Contractors, pharmceuticals, vacation excursions, etc. no more lawsuits needed ever.

    • Liz

      “Emergency care? They have no advanced training in emergency care”

      CPMs are required to maintain both CPR and NRP (neonatal resuscitation).

      • Bomb

        That is not advanced education in emergency care by any stretch of the imagination. I had to take more courses to be a life guard as a Girl Scout.

        • Bomb

          I took a semester of choir in 8th grade. I totally have an advanced music education. I would play Carnegie hall, but that is like, so mainstream.

          • Dr Kitty

            NRP is useless if you can’t intubate, ventilate or doo all of the steps on the protocol..
            Intubating a doll a year previously is NOT good enough practice for intubating a real neonate.

            If you don’t carry appropriately sized ET tubes, laryngoscope, oxygen, BVM, resuscitation drugs, IV cannulas, a stethoscope and a defibrillator then your special training is useless.

            If you can’t resuscitate a baby the way they can in the hospital then your skills are no more useful than the basic CPR courses they teach new parents, because all you can do is chest compressions and mouth to mouth, and the 911 operator can talk you through that anyway.

            I’ve done various CPR courses. The one for GPs focuses on basic life support and using the automated mode of a defib(if you have one)

          • Dr Kitty

            IPad being weird.
            … While the hospital resuscitation course focuses much more on intubation, drugs and the more intensive stuff. GPs are unlucky if they have to do CPR in a surgery twice in their career, hospital doctors do it every week.

            No doubt I’d rather have a cardiac arrest in hospital than in my GP’s surgery, although both GPs and hospital doctors have had CPr training.

          • Aunti Po Dean

            one of my relatives had a heart attack and died right in front of an anesthetist , if this had happened in a hospital the outcome might have been different but OOH he had no chance even though the anesthetist clearly was well trained and well practiced in resus. Venue is everything!

          • Dr Kitty

            Although, that being said, I know a local man who jumped off a motorway overpass attempting to kill himself, and landed on a consultant neurosurgeon’s car, which is the only reason he survived.
            I think that is called the universe trying to send you a message.
            I’m waiting for the scriptwriters of Grey’s Anatomy to hear about that story and work it into an episode.

          • Natalie

            wow.

          • beth

            my dad had a friend who went into cardiac arrest while driving and crashed into another vehicle. He survived. Because the other vehicle was an ambulance.

        • Liz

          The neonatal resuscitation course is the same for OBs, nurses and midwives. It is not less education that a life guard gets and that perspective is clearly coming from someone who has not taken the course.

          • Bomb

            The problem is not that the course is inadequate or lacking, it is that CPR and neonatal resus are the entirety of their “advanced emergency training”. Maybe I’m a snob, but I don’t consider any course held at a community college to be “advanced”. Yeah, it is more technical than the classes Hobby Lobby has on weekends, but advanced education in emergency care? Really?

          • Bomb

            Actually I will amend that, some community colleges offer paramedic training. If NARM required full completion and certification of a paramedic course, then yes I would concede that being “adequate” education in emergency care for someone attending low risk births OOH that are strictly transferring the moment things don’t look perfect. I still would not call that “advanced”. That would be why paramedics rush your ass to the hospital if you are in labor vs. saying “don’t worry, I got this.” They are part of a system, not mavericks that figure a CPR and Nrp cert make them emergency medicine experts.

          • Bombshellrisa

            Some CPMs train as EMTs to count toward their cobbled together training, but not all. It’s just your usual CPR class otherwise (yes, I took the class).

          • Bomb

            I’m CPR, First Aid, NRP, AER, lifeguard management, and a few other random community college weekend certificates in a variety of health/safety/quality control/etc- if you can pay a small fee and get a dumb certificate, I’ve probably taken the course for fun). SO WHY WON’T THE ER HIRE ME?? I have advanced training! ADVANCED!

          • Bomb

            Lol, I meant AED not AER.

          • Bombshellrisa

            Yeah, I thought you were getting a little Ina May on me there and inventing letters to go after your name!

          • Bombshellrisa

            I was using this line of reasoning, joking with a friend who works for a wine distributor-hey, I have tasted lots and lots of wines and visited different regions in the US as well as tried wines from places like Argentina, Chile, Australia, Italy and France. I have read books, I have wine apps on my phone and I know the names and characteristics of the grapes used in different regions. Wanna know why I am not qualified to work at a distributor? They call what I do dabbling, and while I may know a lot of the terms and can even identify what the wine is without looking at the label, they want someone with experience. Yeah, I have to have the classes and experience to go with my passion. Just knowing how to get a cork out and knowing what a corked wine smells like are not enough. And I thought I could be a direct entry wine distributor.

          • Captain Obvious

            A course doesn’t make someone proficient, performing neonatal resuscitation in real life situations does. Keeping up your skills makes you an expert. You can read a recipe of how to make a complex meal, but them making that meal months later without the recipe in front of you is how good you really are. If you make that meal once a week, you don’t need that recipe in front of you. Some of these home birth midwifes list a NRP course on their website 3-5 years ago, did you know it has to be repeated every 2 years to maintain certification.

          • theadequatemother

            This 1000x. I have commonly seen NPR run in the hospital where junior staff are being trained (eg pediatric residents on their NICU rotation) where it goes something like this:

            NICU doc: are you ventilating the baby
            Res (doing bag mask ventilation): yes…see?
            NICU doc: no you aren’t. The airway is obstructed you are ventilating the stomach.
            Res: what?
            NICU doc: here…see, sniffing position, reapply the mask, now look at the lungs.
            Res: oh.
            NICU doc: okay take over
            Res: wow, that feels different.

            Would I trust a CPM that’s taken a NRP course and ventilated a plastic dummy even if she had done so every year?

            No. Not with the life of my child.

      • Amy Tuteur, MD

        Virtually no obstetric emergencies require CPR so that is useless. Some emergencies require NPR, but CPMs are obviously deficient at it since so many of their babies die. Most obstetric emergencies require a C-section, which CPMs cannot provide.

        The horrific rate of intrapartum death indicate that these clowns can’t even manage basic monitoring of the fetal heart rate. They are killers and the women who choose them are irresponsible fools.

  • Bystander

    So the question to Jane Q. Random should really be: Do you want a 1 in 400 (I’m re-including the wrongly excluded baby) chance of burying your baby or a better than 1 in 40,000 chance of the same?

    • thepragmatist

      Wow. When you put it that way, it’s staggering, isn’t it?

    • Therese

      Am I missing something? The chart shows 25 deaths occuring out of nearly 40,000 hospital births, so where do you get 1 in 40,000?

      • Bystander

        That would be for the intrapartum deaths only. Things don’t improve if you look at intrapartum + neonatal deaths at all: it then becomes do you want a 1:200 chance or a 1:1600 chance?

  • Aunti Po Dean

    Finally some data which shows that babies die at home in a different way than babies in hospital. IP deaths are so rare in hospital there wasn’t even one in nearly 40 thousand.
    IP death is a death from asphyxia not something anyone would want their loved and wanted baby to suffer!

  • Aunti Po Dean

    “Please keep the six women who lost their babies last year in mind as you legislate this year.”
    But there were 9 babies, why dont the others count in thee safety argument?

    • Amazed

      Probably because 1. they weren’t a DEM attended births and 2. because there was one baby with congenital anomalies. Probably would have died in hospital, too, or would have been aborted much earelier (not my words, Johnson and Daviss used them in the amendment of their study).

      • Aunti Po Dean

        But her table shows any OOH birth is unsafe and she is making an argument for safety “The legislature won’t have another opportunity to make the law stronger on behalf of safety until 2015. ” so ALL should be included

        • Amazed

          Well, she is a homebirth proponent. I suppose “six women who lost their babies” sounds better than “nine women who lost their babies”. To me, they both sound hideous considering that neither of them should have lost their full term babies.

  • The Computer Ate My Nym

    To be fair, with numbers this low, a single really bad practitioner could be badly skewing the numbers. Consider Lisa Barrett’s five (or is it 6 now) deaths. OTOH, if there’s no mechanism for getting bad practitioners out, that’s at least on some level the fault of the profession, so maybe it’s not so unfair after all.

    • Aunti Po Dean

      But this is only one year, Lisa’s deaths have been over several years so even someone like her would only be contributing 1 maybe 2 of the 9

    • Amazed

      Yes, but it goes both ways. Take five woo doctors out of all those who attended those 40 000 births, and you have the deaths in the table.

  • Mrs. W

    This is such important information for women to know – if only it had to be included as part of informed consent along with a blurb explaining what it means (Homebirth with a DEM has a risk of death that is x times more than, a, b, and c. Further, Homebirth care providers do not generally carry malpractice insurance and as a result if they do commit malpractice accountability and restitution are unlikely to be attainable.)

  • Amy Tuteur, MD

    Rooks did everything she possibly could to make the DEM stats look less horrible than they really are.

    For example, she compared the death rate at DEM attended homebirth with the death rate at all planned homebirths. Are more appropriate comparison would have been to compare the DEMs to all other attendants.

    If you use the numbers in the chart, you can calculate that there were 760 planned homebirths with non-DEM attendants (CNMs, MDs, unassisted births) and there were 2 deaths for a rate of 2.6 per thousands.

    In other words, the risk of death at planned homebirth is 8 times higher than at hospital birth and 2 times higher than at homebirth attended by anyone besides a DEM (even no one).

    • DaisyGrrl

      The more you look at the chart, the more horrifying it is. Even to a lay person, it’s obvious that the risk of intrapartum death is unacceptably high for OOH births. She notes that these deaths just generally don’t happen in hospital.

      But for the hospital deaths, how many of them would involve congenital abnormalities? The way I look at the chart, she’s saying that the OOH deaths are primarily deaths that would not have happened in a hospital. If she had give the rates in the same way for all categories (total death rate/ death rate excluding congenital abnormalities), how much worse would it have looked?

    • The Computer Ate My Nym

      I ran a p-value on the comparison and it’s not statistically different (p=0.27 for one tailed test). Fortunately, the numbers are too small to make a statistically valid comparison between the DEM home births versus non-DEM home births. The general point stands, though. At best, one can say that a DEM attended home birth appears to be no worse than a home birth without DEM attendant. Hiring a DEM is, at best, worthless.

  • Aurora Borealis

    I’m a bit confused about the table. Are the OOH with DEM numbers included in the OOH numbers? Meaning 760 freebirths and 1,235 assisted births? If so freebirthing lowers midwife-assisted birth death rates? Holy cow!

    And as someone else mentionned, these stats don’t include injuries. Another figure that would’ve been interesting is the mortality rate of planned OOHs that transfered. Might’ve blown the false sense of security of being “only 5 minutes away from a hospital” right out of the water as well.

    I’m (almost) speechless.

    • Becky05

      Those other births aren’t freebirths, they are OOH births attended by CNMs.

      • The Computer Ate My Nym

        Since it doesn’t say, I had assumed that it was a composite category and included freebirths, CNM attended births, even OB attended home births (which, unfortunately, do happen.)

        • Becky05

          Yeah, that’s true, it does. I would assume that the majority of those are CNM attended births, though.

  • manabanana

    MANA, ACNM, I’d like you to weigh in on this testimony from Ms Rooks. I believe she’s a member of both organizations. At least in the past, she’s been very diplomatic and cordial in regard to DE midwifery and CPMs. It’s time for some real leadership to emerge on the issue of safety in home birth.

    • The Bofa on the Sofa

      Ha. MANA show leadership on the issue of safety of homebirth? They are leading the charge to CAUSE the fucking problem. Getting them to start working against it would mean they have to completely reverse their course.

      The ACNM is sadly silent, and indeed they should be stepping up here, but MANA is so far gone, that they are merely going to circle the wagons to protect themselves.

      This goes against everything MANA is built upon (at least the current version). Too many people have their lives staked upon this. They won’t give that up.

    • thepragmatist

      MANA is preparing to reframe this, politically. They will switch focus fully to maternal deaths now, I imagine, as this data emerges. Pitting baby against mother is nothing new for them. If homebirth isn’t safe for babies, then they will focus on maternal deaths alone.

      • Aunti Po Dean

        Only they will probably find more mothers die at homebirth too!
        Dr Amy reported a couple here last year I particularly remember the one where the midwife said ” at least she had a lovely birth” before she died!

  • Dr. Chas

    Are you guys all morons in the pockets of big hospa (a cousin of big pharma)? Both 5.6 and 0.6 have “6″ in them-one could argue these numbers are thus essentially the same………

    • KarenJJ

      They definitely give off the same chakras and that’s what really matters in these issues.

    • thepragmatist

      I do believe the correct term is “sheeple”, Sue. Sheeple.

    • Aunti Po Dean

      and 25 is lots more than 9 so this proves babies die in hospital too

  • Meagan

    Someone may have already asked this… But isn’t the overall neonatal mortality rate for the US 4 per thousand? The in hospital number quoted here is the more shocking one to me (in a good way). Am I missing something here? 5.8 per thousand doesn’t compare quite so badly to 4 per thousand… But personally if these numbers are right, maybe I’ll take a long vacation to an Oregon hospital when I’m very pregnant with my next kid…

    I feel like I’m misunderstanding something pretty important here.

    • areawomanpdx

      It’s because all the numbers quoted here are for full term deaths, both the midwives and hospital. The 4 per thousand number includes premature babies.

      • Meagan

        Thank you!

      • AmyP

        Also, Oregon should have really strong demographics compared to the national average.

  • Eddie

    With numbers like these, it reminds me that just 100 years ago in America, about one in four women who died young died in childbirth. Now this is almost unheard of. Those darn evil doctors who just want to line their pockets.

    • Renee Martin

      1 in 11 women in Afghanistan still die due to pregnancy/childbirth (lifetime risk), and this is a big improvement over just 10 years ago.

      • Eddie

        It’s just stunning that in a world as rich as this one, there are still countries with 100 times the maternal death rate of Western countries. The US has approx 10 maternal deaths per 100,000 live births — which is itself too high — but there are countries where the rate is over 1000 per 100,000 live births. (And there are countries where the rate is well below 5.) I guess in the countries with the highest rates, it is as much a political problem (severe violence within the country making it unsafe for outsiders to try to help) as a money problem.

        So yes, what you said.

        I was also just partly trying to make the point for those who say childbirth is natural, that historically in America, it is also natural for one woman to die for every 100 deliveries, as that was the rate not even 100 years ago. Thus, the US maternal death rate dropped from 1000 in 100,000 to 10 in 100,000 deliveries in less than 90 years. Due to those evil, bad doctors who don’t care about mothers or their babies. If all women in the US had access to high quality health care, the maternal death rate in the US would probably be 2/3 or half of what it is today.

        • fiftyfifty1

          Yes, I recently saw a pregnant woman nearly die of asthma. She had uncontrolled asthma before getting pregnant, and it only got worse when she got pregnant. She did not have insurance. She WAS getting prenatal care because she had filled out the Medicaid application and she knew that Medicaid would pay for her visits retroactively once she was approved. But in the meantime, she didn’t have enough cash to pay for the expensive asthma meds she was prescribed (and there were no longer samples to give her because our health system has forbidden them so we won’t be beholden to Big Pharma). So she just used albuterol again and again and again. She also smoked.
          She went in at 29 weeks for a routine pre-natal and mentioned she was using the albuterol inhaler every hour when awake and a few times during the night. And also the baby wasn’t moving much. Baby got monitored and it looked BAD. She went to immediate C-section, and baby got airlifted to the NICU in the city. Baby not only preemie, but growth restricted. By some miracle, baby has done remarkably well! Extubated after less than 48 hours. Growing well. No NICU complications.Such a close close call for both of them. Such a screwed up insurance system we have here.

          • Hannah

            That exemplifies why the US medical system delivers less for more than most, if not all, high income countries. The intensive care costs for that baby will dwarf whatever would have been paid to provide the mother with appropriate medication.

            It may also help explain why the US does comparatively well for perinatal outcomes but very badly in terms of infant mortality, if massive, high tech, emergency, intervention, which is readily available, has kicked the can down the road, past the neonatal period, but the baby dies at some later date (and it will be higher risk for the rest of infancy, at least, due to prematurity).

          • Becky05

            This also exemplifies why we can’t simply blame the relative high US maternal mortality rate on the cesarean rate, or the rate of obstetric interventions. Most maternal deaths are relating to exacerbated preexisting conditions, in my understanding, and if women can’t get help for those preconception, their pregnancies are going to be far more risky, even with the best care.

          • http://www.facebook.com/lizzie.dee.71 Lizzie Dee

            Most maternal deaths are relating to exacerbated preexisting conditions

            Don’t think so. As far as I know, pre-eclampsia, hemorrhage and infection are still the leading causes – precisely the things those who trust birth don’t bother worrying about. Part of the comforting myth that says all “normal” women are low risk and only those who shouldn’t be having children anyway should pay attention to risk, babies who die weren’t meant to live and so on and so forth.

          • theadequatemother

            Those are the leading causes worldwide. In NA maternal eart disease is in the top three and is poised to become the number one cause of maternal death. Just give it 5-10 years.

          • http://www.facebook.com/lizzie.dee.71 Lizzie Dee

            OK, I got that wrong. I hadn’t realised that the indirect deaths – those not solely related to pregnancy in a healthy women, had edged above the direct deaths. The figures I could find for the UK, from 2004, are 103 directly related to pregnancy and 136 indirect. Nevertheless, I do think the idea that birth is now safe still needs to be clarified. It is a lot safer than it used to be – because of obstetrics, and the minute you reject the idea of a hospital birth, you are choosing to run much the same risks as women who cannot access hospitals. The risk at the individual level belongs to birth – is arbitrary and unpredictable, and no amount of being informed is going to do much to reduce it.

            Maybe one question it would be useful (if difficult) to have an answer to is how many mothers and babies DON’T die in hospital who would have stood a very poor chance at home.

          • Hannah

            The last CMACE report has a breakdown of all maternal deaths, in the UK, since 1985, by cause:

            http://onlinelibrary.wiley.com/store/10.1111/j.1471-0528.2010.02847.x/asset/j.1471-0528.2010.02847.x.pdf?v=1&t=hed4hln9&s=c2b012cafda80479c998d94cd388c91dcb46b0ea (p.36)

            The top 5 categories from 2006-2008- the last measured period- (excluding late and coincidental deaths) were:

            1) Cardiac disease (2.31/100,000)

            2) Other indirect (2.14/100,000)

            3) Indirect neurological (1.57/100,000)

            4) Sepsis (1.13/100,000)

            5) Pre-eclampsia/eclampsia (0.83/100,000)

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

            I love this blog. I continue to learn so much from reading here, the blog posts and the comments. Said it before, I’m sure I’ll say it again….

            BTW… Happy St. Patty’s weekend, all. Hope everyone has a fun and safe time celebrating!

          • Dr Kitty

            One of the chimpanzees at the local zoo turns 1 tomorrow. The zoo is having a party. I shall be spending Paddy’s day half way up a small mountain , no doubt in driving rain and temperatures only slightly above freezing, with a small child who loves monkeys.

            I plan to have a small drink of something Irish after she goes to bed.

            So, basically, not doing it right here in the old country (I live less than 25miles from where St Patrick is buried).

            I hope some of you have babysitters arranged and something more exciting planned.

          • theadequatemother

            birth isn’t safe at all! That’s why you need people ready to catch when things go pear shaped.

          • theadequatemother

            Amending my comment. Just looked up the causes of maternal death in Canada 2003-2010. Number one cause maternal cardiac disease. Number two cause, other indirect )ie not due to pregnancy). Pre-e and hemorrhage ties for third spot. So beck05 was very correct in her statement

            In developing countries infection hemorrhage and eclampsia are the top three. In subsaharan Africa the forth most common ause appears to be HIV related.

          • Becky05

            Well, I wasn’t quite correct. *Most* maternal deaths aren’t due to preexisting medical conditions, but these conditions do form the leading categories of maternal death, in my understanding. Not an expert, though.

            Some info for the US: http://www.seminperinat.com/article/S0146-0005(11)00150-9/fulltext
            http://www.cdph.ca.gov/data/statistics/Documents/MO-CAPAMR-PregnancyRelatedMortality-Berg2010-1998-2005.pdf

          • Guest

            ThisThis

    • Natalie

      I honestly feel like the NCB/anti-vax/lactivst movement is a group of bored women wanting to play “Oregon Trail” in live version.

      “You have dysentery.”

      • The Bofa on the Sofa

        Natalie, as someone who killed a lot of travellers on the Oregon Trail on the old Apple 2e in high school, I just want to say, this is the funniest comment I have ever seen.

  • DaisyGrrl

    This post makes me so sad and makes me feel physically ill. I can’t imagine a mother choosing homebirth if this information is available to her.

    Also wondering how the morbidity rates compare.

    • Renee Martin

      No one tracks morbidity, even severe morbidity like CP.

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

    Don’t you guys see what Dr. Amy did here? She is twisting around the data to make home birth look riskier than it actually is. I don’t know how she’s doing it. But she is.

    I can’t believe anything written here b/c it has gone through a peer review process.

    And what about all the deaths in hospitals?! Babies die in hospitals, too.

    And what about the risks in hospitals with INTERVENTIONS?? Women are strapped to the beds and are forced to have epidurals, which have risks. I educated myself. I know about the REAL risks.

    “Dr.” Amy isn’t even a real doctor!! She hasn’t practiced in years! What can she possibly know about birth and anatomy! No thank you, I put my trust in birth and in my direct-entry midwife.

    (This comment is satire)

    On a serious note, this is horribly sad.

    • Renee Martin

      Actually, TWO of the HB MWs said the middle three in testimony to the legislature. It would be comical if it wasn’t so tragic “why not informed consent for OBs?”, “Babies die in hospitals every day but that doesn’t make the news”, and my favorite- “Half of OR hospitals have benned vaginal birth” (from an unlicensed MW who ran for a city office with a UFO preparedness plan as part of her platform.)

      • The Computer Ate My Nym

        from an unlicensed MW who ran for a city office with a UFO preparedness plan as part of her platform

        So we should probably try to keep her from finding out that OBs are really all Teal Green aliens in disguise then?

    • Aunti Po Dean

      Home birth proponents often claim that Dr Amy twists data because she compares “comparable risk” hospital birth rather than all risk hospital birth. Here we have an epidemiologist doing the same thing…perhaps there’s an epidemic!

      • indigo_sky

        Well to be fair, a big problem with homebirth in the US is that they don’t always fit the “comparable risk” factors she uses. Can’t find a hospital that will let you have a vbac waterbirth for your triplets? Just post on MDC and someone will direct you to a midwife who will be more than happy to handle your variation of normal at home.

        Of course this does not account for anywhere near the entire difference in death rate, but I suspect that the rates would be a lot closer if all cases that clearly should be risked out actually were risked out. I believe that homebirth will always have risks over hospital because there are just some sudden complications that can’t be handled well at home. However, statistics like these don’t so much show the risk between homebirth and hospital so much as they show the risk between horribly incompetent providers vs. ones who know what they are doing, and unfortunately homebirth nearly always seems to come with the former sort. It would be interesting to see more comparison of just homebirth with competent providers to both hospital birth and homebirth with CPM/DEM/LM, but I don’t think there is anyway to actually separate that data.

        • Amazed

          t would be interesting to see more comparison of just homebirth with
          competent providers to both hospital birth and homebirth with
          CPM/DEM/LM, but I don’t think there is anyway to actually separate that
          data.

          It would be interesting to you and me, and tons of other women who are just interested in the subject without intending to have a homebirth themselves. I suspect these good results will be used to push mothers toward imcompetent providers freeriding on the reputation of the meticulous ones which takes us right back where we were. And we’ll have more Margarita Sheikhs and Darby-fucking-Partners. And more criminals crowing, You need to own the outcome of your birth!

          Frankly, my supply of sympathy and understanding for the idiots who go to midwives promoting themselves as being “with woman” btut basically clear themselves off responsibility in advance is running short. I know this won’t make me exactly popular with this blog, but women who homebirth are generally old enough to drive, have sex, get married and have children. So, in my book that means they are old enough to reason that they should give such “providers” a wide berth. It doesn’t take a rocket scientist to gather that it isn’t all sunshine and roses, with disclaimers like those…

          • Therese

            Comparing home and hospital birth with CNMs in the CDC wonder database is interesting. From what I remember, the CNM homebirth is something like .8/1000 compared to .4/1000 for hospital CNM birth. Of course, this is still imperfect since there are CNMs that do VBACs and probably into woo in other ways as well.

          • Amazed

            Yes, but they can’t have it both ways. They either practice woo and get bad rates or are rigorous but underqualified and get bad rates. Everything else is an utopia, it is interesting from purely academical POV.

            They can’t have it both ways.

    • brs

      “I don’t know how she’s doing it. But she is.”

      Perfect example of the inability to be rational.

      • brs

        I’m and idiot – didn’t see last sentence!

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

          ;)

  • The Computer Ate My Nym

    Another thought: What if the congential malformations were removed from the hospital group? If we assume that the rate for fatal CM in home births and hospital births are about the same (1 in 2000 or so) then there would be about 19-20 cases of CM in the hospital group. Leaving about 5-6 deaths in the hospital group. Which puts the mortality rate at between 0.1 and 0.2 per 1000. Sorry about the lazy math and wild estimates.

    • Squillo

      I ran the CDC numbers for 2007-2008 excluding CM and external causes of death, using the following parameters:

      Mom between ages 20 and 44;
      Birth weight > 2500g;
      Gestation >37 weeks;
      Singleton;
      Prenatal care began between 1 and 10 mos. gestation;
      Known birthplace (hospital or out-of-hospital)
      Known attendant (MD, DO, CNM, other midwife.)

      Here’s what I got for mortality rates:

      DO: 31/138,414 (0.22)
      MD: 339/2,292,338 (0.15)
      CNM: 23/202,327 (0.11)
      Other midwife: 14/18,598 (0.75)

      • areawomanpdx

        Wow, it’s nearly as bad as just in Oregon. Looks like it’s going up from the ol’ 3 times as high stat…wonder why?

        • Becky05

          “Looks like it’s going up from the ol’ 3 times as high stat…wonder why?”

          My guess is that homebirth midwives are getting cockier. 10 years ago, when I was pregnant with my first, I still regularly heard “home birth is safe for low risk women.” Now I see much more commonly, “Home birth is as safe or safer than hospital birth,” AND I see many more birth stories about home births with women who should very obviously have been risked out of home birth.

        • Amy Tuteur, MD

          The 3X figure was always a dramatic underestimate because it typically did not include intrapartum deaths and hospital transfers. In Oregon, for example, the number of intrapartum deaths was equal to the number of neonatal deaths. If they had been excluded, the rate would have been only 4x higher.

          Additionally, the numbers usually quoted for in hospital mortality rates typically include high risk births.

          I suspect that the reality is that homebirth increases the risk of death by 10X or more.

        • Amy Tuteur, MD

          The combined CDC stats for 2007-2008 are higher than average because the 2007 death rate was much higher than average.

    • Aunti Po Dean

      Congenital death at term would be more rare thinking maybe only 1 or 2 surely not 19-20!

      • The Computer Ate My Nym

        I came up with the number by assuming that the approximately one in 2000 seen in the home birth group was typical. This could be completely wrong, of course, making the numbers wildly off. Interpret with quite a lot of caution…and if there is a known expected rate for congenital anomalies at term, I’d definitely go with that, not my wild guess. (Though, of course, there’s also the issue of congenital malformations that are fatal at home but quite survivable in the hospital with immediate treatment, i.e. some of the cardiac malformations.)

        • Aunti Po Dean

          Fair enough but I am thinking we aren’t talking hair lips and cleft palates here but lethal abnormality at term so again more rare than one in 2000

  • Eddie

    As horrible as these stats are, Hurray for Oregon for *forcing* these stats to be collected. Now we KNOW. And how horrible for MANA, who clearly knew it was this bad long ago, for deliberately suppressing this information.

    • Renee Martin

      It wasn’t forced, it was a totally different group collecting info, and only a small part of it was on OOH birth. This is the ONLY reason there are stats AT ALL.
      MANA is legally mandated to provide their data, but of course they never have, they have gotten away with murder for too long.

      • Eddie

        When I said forced, I meant this: “In 2011 the Oregon House Health Care Committee amended the direct-entry
        midwifery—“DEM”—law to require collection of information on planned
        place of birth and planned birth attendant on fetal-death and live-birth
        certificates starting in 2012.” Thus, they changed the law to make it actually possible to know these stats. That should be nationwide. Once you require this information on all birth and death certificates, you don’t need to rely on other organization with the motivation to bury the information.

        Of course, I don’t know what percentage of fetal death in childbirth — in OR or elsewhere — is reported on a fetal death certificate. This could still be an underreporting of at-home fetal deaths.

        • Renee Martin

          I think you’re right :-)
          This had to be done because MANA kept refusing to provide the necessary data.

          • Amy Tuteur, MD

            At this point, the only relevant thing about the MANA data is that it is proof that Melissa Cheyney has known all along that the death rates at CPM attended homebirth are horrific and that she has knowingly and deliberately hidden them. She has blood on her hands.

          • The Bofa on the Sofa

            And this is why it is foolhardy to expect MANA to “show some leadership” in furthering the safety of HB, as I described above. They have been actively covering up the problem, and consequently are exacerbating it, much less trying to solve it.

          • Amazed

            Who is willing to lay a bet that MANA will wash their hands of Oregon and say “But it’s just Oregon! There are about 50 other states and they all have excellent homebirth outcomes!” For reference, go to Navelgazing Midwife’s blog and read the post about California homebirth midwives. When asked to show the data, they’ll twist and wriggle until said states follow Oregon’s lead and demand to know the death rates. And even then, it will be ebil doctos’ fault for making poor wee midwives so scared that they don’t dare transfer, poor hearts. My own heart is bleeding for them.

            Just my two cents.

          • Amy Tuteur, MD

            I suspect that they are going to say what some of their partisans said in the hearing yesterday: “most homebirths” are safe.

          • fiftyfifty1

            You bettcha! Also most suicide attempts are safe!

          • The Bofa on the Sofa

            Also, most heart attacks are safe. I looked this up the other day, heart attack only leads to death 16% of the time. IOW, 84% of heart attacks are not fatal.

          • Eddie

            Also, most unprotected sex is safe by these standards. Why use birth control of any sort, since *most* of the time it does not lead to pregnancy? Funny, isn’t it, how “It’s safe most of the time” is appropriate in some areas, but not others. Although I really prefer your comparison to NASCAR racing. :)

          • The Bofa on the Sofa

            But in reality, “It’s safe most of the time” is generally never appropriate. That’s why it’s so disingenuous for them to use that argument.

          • Eddie

            Agreed. That’s why I like the comparisons you bring up.

          • Amazed

            I won’t be surprised at all. Only, I interpret “most” as “more than half of something”. So, no more than 50 per cent of homebirths are lethal. We still don’t know how many of them result in CP and other forms of morbidity but we know this. How very reassuring!

            I really can’t see how any mother, any parent can rely on “most”. It isn’t as if a mother is expected to, say, marry her OB or move to the hospital till the end of her sad days. “Most”? Are these guys for real?

          • The Bofa on the Sofa

            And everyone here can guess my response:

            Yeah, and most drunk driving incidences are safe, too. Heck, they are far safer than even the safest childbirth.

            Will Oregon be repealing its drunk driving laws then?

          • thepixiechick

            ALL home births are safe*
            *except the ones where mothers or babies are killed or injured o_O

          • fiftyfifty1

            I can’t stop wondering when Melissa Cheyney knew. Has she always suspected it was riskier, or did she start out thinking it was safe? How was she able to continue her support once she had the data? What is her excuse? Not the excuses she gives to the outside world (we know those already), but the excuses she tells herself. It’s clear she’s had the proof for quite some time now…

          • theadequatemother

            I bet the excuse goes somthing like this….”the increased risk is going to be temporary as the profession gets on its feet. The profession is new and vulnerable and we’ll never gain acceptance, medicare payments and insurance coverage if this information was known. But once we are well established, those numbers should come down.”

            its all BS of course. The risk is coming from a lack of skills, training and common sense, not from some organizational or systems issue that will resolve over time.

            *not the “midwifery” is new…but the CPM credential is new along with the amount of inexperience and uneducation that is required to obtain one.

          • Amy Tuteur, MD

            Wendy Gordon gave us some indication of the way that MANA will respond:

            http://www.skepticalob.com/2013/03/mana-prepares-to-acknowledge-the-hideous-death-rate-at-homebirth.html

          • Amazed

            I imagine she’s looking at the absolute numbers. A few deaths? But this is so little. Some of them must have been an accident. Hell, all of them must have been an accident. Hospitals lose much more. We are providing good service. Most women are pleased with us. They love us. This is just a few out of 1000. Some people just aren’t lucky. Ad anyway, they are the ones who made the choice to birth at home. It is not our fault. Not our fault. Not our fault.

          • Renee Martin

            Actually, that is EXACTLY what they say.

  • Squillo

    I just sent a heads-up to the Oregonian reporter who did the story on midwifery licensing last year.

  • JenniferG

    Today is the anniversary of the day, 9 years ago, that the staff walked us through all my daughter’s test results, and we decided to take her off the ventilator, and we baptized her. I am really sad for the parents who received similar catastrophic news in Oregon, particularly those who had it at such a high rate. These are not numbers, they are babies who would be children.

    • http://www.facebook.com/profile.php?id=682572949 Natasha Dothnay Seymour

      I am so sorry for your loss, Jennifer. You’re so right, these are not just numbers. They represent children lost and families left devastated. Sometimes these HB/NCB-at-all-cost advocates seem to have completely detached from that reality. It’s easy to emotionally remove yourself from a number on a piece of paper.

      “Some babies just aren’t meant to live”? Disgusting.

      • http://www.facebook.com/people/Amy-Robinson/516281934 Amy Robinson

        It makes me livid when people say that about babies. My baby did live, because when I had an unexpected emergency cord prolapse, we were already IN the hospital. Even then it was touch and go, and for weeks we wondered if she would be severely brain damaged (she is perfectly fine). Its easy to say you are informed and you “know” the risks, and nasty things like “some babies aren’t just meant to live”…but man, when you are living that statistic, or that emergency, you know that all that garbage about “how” natural out of hospital birth is so much better…is just that, garbage. When you are living it, the only thing that matters is that baby and their life and health. When people act like those babies don’t matter, to me its MY baby they are talking about. If she had been born at home she would have died.

        • http://www.facebook.com/rachael.grappo Rachael Murray Grappo

          My baby too. She would have died if born at home, as I was considering. I am so thankful we were in the hospital for immediate life saving treatment. I hear you, and echo your sentiment. So I wonder, if it’s wrong to deny children a doctor when they are ill, why is it okay to deny babies doctors when they are being born? Doesn’t make ethical sense to me. Seems like a selfish decision to have an out-of-hospital birth.

    • Ardent

      I am so sorry.

    • NewName Jones

      “Health statistics represent people with the tears wiped off.” –Sir Austin Bradford Hill, pioneer of the randomized clinical trial.

      I am so sorry, Jennifer. Stories like yours are what keep us all in this.

    • WhatPaleBlueDot

      I am so sorry.

    • Mrs. W

      So sorry for your loss – these children deserve to matter, doing something about the numbers will mean they do matter.

    • Dr Kitty

      Jennifer, I’m sorry, I know today will be hard.
      Thank you for coming here and sharing and for using your experiebce, not just to keep your daughter’s memory alive, but to help other families avoid something similar.

    • Amazed

      I am so sorry, Jennifer. I absolutely can’t understand the babies just not meant to live mentality. I can’t understand it applied to healthy, full-term babies, in particular. It’s terrible that some babies who were absolutely meant to live didn’t because of someone’s mistake. You’re right, they are not just numbers. They deserve to be remembered and taken in account by families, health professionals and legislators making decisions.

    • anonymous

      So, so sorry for your terrible loss. Jennifer, you have done so much to help other moms and babies. Thank you from the bottom of my heart for helping others through your story.

    • Christina Maxwell

      Dear Jennifer, thank you for your timely reminder. Words cannot adequately convey my sorrow at your loss or my respect for your courage in continuing to fight for the lost ones and their families. I just hope that some vestiges of the warmth, love and care in these posts washes over to you and grants a little peace to you and your family. And now I’m crying. Most unusual for me.

    • Frequent Guest

      As always, your comment about your daughter brought tears to my eyes. I am so sorry your family went through everything you did. Thinking of you, your family, and especially your sweet little girl today.

    • Amy Tuteur, MD
    • jessiebird

      I am so sorry for your loss, Jennifer. I cried when I read this story last year, and again when I read it now. There are no words to convey my sympathy, but as a mother, too, I ache that you had to suffer the tremendous loss of your child.

    • Natalie

      I am so sorry for your loss, Jennifer. You and your husband are so brave and made such a tough, but loving decision. Don’t ever let anyone tell you anything different.

      I was a NICU mom and spent years in the NICU after my daughter was healthy doing research. I saw the moms like you, and I cried with you. I cried harder when I saw them holding on so tightly, unable to let go, their babies having their first birthdays in the NICU, unable to swallow, hold their head, eat or smile. It was heartbreaking. I think the strength you exhibited in the face of tragedy trumps the strength it takes to have a “natural” birth 10x over.

      Congratulations on your two healthy children, and thank you so much for sharing your story.

    • http://www.facebook.com/people/Amy-Robinson/516281934 Amy Robinson

      I am so so sorry for your loss JenniferG…one baby, just one baby like yours is one too many.

    • JenniferG

      Thanks everyone. I am so grateful for this community, and Dr. Amy, for all your work.

  • Jessica

    I am assuming this isn’t just a comparison of actual homebirths to hospitals, but rather ALL out of hospital births, including those taking place in birth centers (only one of which is accredited in this state), compared to hospitals.

    In other words, going to Billy Bob’s DEM Birth Center isn’t any safer than delivering in your freaking living room. I hope that point isn’t lost on our legislators or the general public.

    • areawomanpdx

      yes, all out of hospital births attended by midwives.

      • Renee Martin

        BUT- there is ONE OOH BC owned by the local hospital chain, run by CNMs, and accredited (the ONLY accredited center in all the PNW). They had 170 births (or so) last year, IIRC. I wonder what those stats look like with those births removed?

  • Bomb

    Where oh where are the parachuters on this post?

    • Bombshellrisa

      I am sure there will be a troll who doesn’t understand the numbers to come on in and pound the table for us. And get your bingo cards out, watch for the words “spew”, “poison”, “vitriol” and anecdotes about how their child/niece/nephew/best friend’s child was born at home/in the water/unassisted and everything was peaceful and turned out fine.

    • thepragmatist

      They’ve been told not to listen to us because we trying to destroy women’s rights and agency. And that Dr. Amy fabricates data. And that she deletes posts. You know what they say: you accuse others of what you are. Just sayin’.

      • http://twitter.com/SlackerInc Alan

        Oh right: the “she deletes posts” lie. Despicable! ;-)

        • thepragmatist

          Alan, in all the time I’ve been here I’ve only seen her delete your posts. I don’t know whether I would be flattered or not? You are insufferably obnoxious. If this was my blog it is very possible I would have just banned you outright. And that says a lot. So you’ve manage to get to a place here where you are still able to post, with the request that you stay on top and stop derailing conversations, now you are just taunting the blog owner, right? Serving what purpose? Isn’t there another site you could go troll? I wish you’d go do this to TFB, it would be poetic.

          • http://www.facebook.com/people/Clarissa-Darling/100002189584639 Clarissa Darling

            I think Alan said once that TFB had deleted one of his posts and so he got insulted never went back. He also hinted that he wouldn’t be back if Dr. Amy did the same. Such a shame he’s not keeping to his word. It’s clear to me he’s just here to antagonize. So glad Dr. Amy isn’t enabling him anymore.

          • Haelmoon

            He is now posting about his “mistreatment” by Dr. Amy over on mothering.com.

            http://www.mothering.com/community/t/1375250/thoughts-on-planned-home-births-are-associated-with-double-to-triple-the-risk-of-infant-death-than-are-planned-hospital-births/90

            A bit amusing to watch, but painful too. The issue of maternal and child safety is a serious problem, but Alan would much rather discuss his problems.

          • Sullivan ThePoop

            He is too funny. Maybe he can find the encouragement he so obviously needs over there.

          • Bombshellrisa

            Oh boy, well looks another village got their idiot today.

          • http://www.facebook.com/people/Clarissa-Darling/100002189584639 Clarissa Darling

            He has some serious misunderstandings about the words heartbreak, oppression, and now, mistreatment.

          • Lena

            And MDC just deleted his posts.

            It takes an extraordinary personality to get posts deleted by Dr. Amy, Gina, AND MDC.

            I’m in awe.

          • Eddie

            The sad thing is I get the impression that he is earnest and well intentioned, and honestly unaware of what it is about his communication style that is so abrasive, honestly unaware of when he is being insensitive. Maybe thinking that it’s not him, it’s that other people are overreacting.

            Alan, if you’re reading, I have to wonder what is your *goal* in posting here. If your goal was to hijack conversation threads and pull the whole conversation to being about you, then you succeeded in your goal. However, I really doubt that was your conscious intention, much as it’s human to enjoy attention, positive or negative. And in that case, people kept telling you that you were doing this, and I saw no attempt on your part to tune your conversation style to avoid doing so. Additionally, you were prolific, perhaps one of the most prolific posters here, compounding the level of annoyance to others here.

            I reccomend you think about what your goals are. If your goal is communciation, you will have to adjust your style to suit each different forum. If your goal is to troll (hey, that rhymed) then don’t change a thing. I think you can make valuable contributions to discussion, and you have brought up some good points. But that will only happen if you are willing to adjust how you communicate to fit into the culture of the individual blog you are posting in. Note I said “fit into the culture” and not “agree with the host and everyone else present.” Fitting into the culture of a blog *rarely* requires agreement with the host.

          • stenvenywrites

            Yeah, there’s a saying in Texas: If one person says you’re a horse’s ass, that’s one person’s opinion. If two people tell you that you’re a horse’s ass, that’s an argument. If three or more people call you a horse’s ass, buy a saddle. Alan, if you’re reading (and you SO are): buy the saddle.

          • Dr Kitty

            He got to stick around a LOT longer here and on FFF than MDC and TFB though.

            I can’t go to MDC anymore, even to hate read. It just makes me too, too angry and sad. Especially with how many of the women seem…not very well, mentally, and how many of their children…I’m going to be extremely diplomatic…appear that they are not getting parental help to reach their full potential.

            On a completely unrelated note, there are supportive online communities and then there are echo chambers of lunacy, where members appear unable to spot actual neglect and child abuse, but get all het up about safe, accepted and necessary standard medical care.

          • theadequatemother

            Thw most interesting thing about that thread is the number of posters who are quick to discredit the numbers without bothering to look at them and understand them:

            - must include preciptious unplanned OOH births of crack babies!
            - it must be because preterm births were included
            - it must be a fluke year….

            sheesh.

            You can lead a horse to water…

          • Lisa the Raptor

            He has already been banned fro fearless formula feeder. A first for her too. This guy must be fancy terrible.

          • Jo

            What about eyes? I miss eyes :(

          • thepragmatist

            Yeah, that was a banning though, and I don’t think many of us know why… I don’t really know why! I remember someone said something about too much profanity, at the time.

          • Jo

            Eyes was banned for laying into other commenters. It was highly entertaining but wholly inappropriate. Like the opposite of Alan. She had Aspergers tho so I guess she didn’t realise when enough was enough?

          • thepragmatist

            Yes, she was great for that. I do miss that. It was entertaining and she was quite funny. I missed the part where she went too far. This blog does retain quite a high level of respect, in general, even when we are being snarky, so I see how it wasn’t appropriate. I did enjoy her though. In other news, I wandered over to MDC and Alan was deleted there too. When is he going to get the drift? Snark and criticism, sure. Detailed debate, sure. Derailing conversation after conversation did get tiresome. Is Alan banned here now?

          • anonymous

            My understanding is that he is not banned from here but that he has been publicly advised that any off-topic or personal attention garnering posts of his will be deleted.

        • http://www.facebook.com/lizzie.dee.71 Lizzie Dee

          Alan, I don’t agree with posts being deleted. If this really did turn into the echo chamber of I agree/you are so right/ etc it would not be the interesting and addictive place it is. But can we get this one straight? You were not banned for being right/controversial/oppositional but, as far as I can see, for being boring and annoying and highjacking every topic for your own not too interesting agenda. I read all your posts, and more often than not wished I hadn’t. You may IRL be nearly as wonderful as you think you are, but coming here and telling us how smart and informed and superior you consider yourself to be and droning on about the bees in your bonnet detracted from what is normally an interesting give and take of different perspectives.

          You say you like to argue, and I have no problem with that. But it seemed more like you want to WIN arguments of your own creation rather than respond to others. Stop sneering, stop patting yourself on the back and stop trying so hard to force others to accept your view and your posts might become readable.

        • suchende

          In this thread about infant death, you are making it about your personal moderation beef. Gosh, I wonder why you’re being moderated!! I guess Dr A is just a big old jerk, picking on little you.

          • anonymous

            Agreed. Another post that I would delete, if I were Dr. Amy. His post on thepragmatist’s guest post (previous post) is also a thinly-veiled complaint. Honestly, I can’t see how Dr. Amy is not going to have to end up banning him outright. But she has greater patience than I do, so perhaps she will be able to stay the course where another wouldn’t.

          • AllieFoyle

            I think it’s actually more painful for him to have that post up but no replies than it would be to delete it. Deleting it is giving him a lot of attention, and for some people any attention, including negative, is better than no attention at all.

          • http://www.facebook.com/people/Clarissa-Darling/100002189584639 Clarissa Darling

            In theory I agree with you but, people (including myself) couldn’t seem to help but reply and voice their extreme annoyance, indignation etc at his increasingly ridiculous comments and it was just adding fuel to the fire. Desperate times call for desperate measures and all that….. He hung on for months pestering people over at the FFF and I’m glad it didn’t come to that here. Just my 2 cents. I do hope Dr. Amy won’t have to resort to banning/deleting anyone else and I doubt she will. For my part I’m going to try to refrain from commenting on the hipster winbag troll who shall not be named at all from now on b/c no doubt he is still reading and will be relishing any continued discussion of himself.

          • anonymous

            Agreed. I tried to comply with the letter (though not the spirit) of this unwritten law by replying to suchende and not the original post. I am both a person who has suggested to others not to reply to Alan and a person who has had to be reminded not to. :)

          • Bombshellrisa

            Something I did when I would reply was simply copy whatever post of mine he would start tearing apart and paste all the strange “so you are saying x, y, z” comments and simply answer him with posting my comment again. I will not be accused of cherry picking examples, you can’t say you know something to be true without providing your source of info, which I was always happy to provide. I got ripped apart for that.

          • The Computer Ate My Nym

            IIRC, Dr. Tuteur said that she would delete posts by Alan IF they were an attempt to direct attention away from the point of the post and towards him. It is my understanding that he is free to contribute if he has something to say about the post itself.

  • PrecipMom

    And this says nothing about morbidity. This is only death, not brain damage.

    • Lena

      Exactly. I really want to know those numbers.

  • AllieFoyle

    So much for that “birth is as safe as life gets” motto.

    • Eddie

      But it’s NATURAL! Everything natural is 100% good. Because it’s natural. Right? (sarcasm, not serious) It amazes me the simplistic beilef that “natural is the right way.” In other words, yeah, what you said.

  • mimieliza

    I don’t even know what to say about this. The death rate is absolutely horrifying. How blind can the homebirth zealots be?!?

    • Renee Martin

      They weren’t blind, this is the very first time anyone has seen ANY data for Oregon. I think everyone knew it was bad, but they still had deniability, especially since the other moms that loved their HB were the only ones out there until this time last year.

      Now, how anyone thought OR would be better than CO, CA, MI, thats what I don’t get.

    • anonymous

      None so blind as those who will not see.

  • Dr Kitty

    Ok…anyone still think the MANA stats show 3x the rate?

    Oh, wait, maybe they do, and MANA is planning to release them now to say “hey, it isn’t really 8x the rate, like the Oregon stats show, they are an awful anomaly, it is *only* 3x, and three is almost the same as one, so, ipso facto, as safe or safer than hospital birth.”

    Also, was that a comparison with ALL hospital births? Or just low risk singletons at term? If it is ALL births, including the micro preemies and abnormalities incompatible with life, high order multiples and severe maternal illness etc, the results are even more horrifying.

    • Therese

      I think it must exclude premature births. 0.6/1000 would be an unprecedented amazing rate if it was for all births.

      • areawomanpdx

        Yes, I’m fairly certain all numbers on the chart are for full term births. But as Judith also noted in her verbal testimony, the hospital rate contains both low and high-risk births, so the DEM rate is actually even worse in comparison (since homebirth midwives are attending -supposedly – low risk births only).

        • Dr Kitty

          Oh dear.
          That is not good.

        • suchende

          I would be surprised if OR midwives are good about excluding high risk patients.

    • Renee Martin

      It is all full term births, ALL risk levels, INCLUDING congenital anomalies and sick moms/babies.
      Makes those numbers EVEN WORSE.

      • fiftyfifty1

        Yes the home group will contain some higher risk moms (some VBAC, some breech, some GDM) but it won’t contain the full spectrum of high risk that the hospital gets: Women with clotting disorders on heparin, maternal heart disease, moms addicted to crack, moms with HIV, 12 and 13 year olds, women who walk in off the streets in labor with no prenatal care, women with sickle cell and cystic fibrosis and type 1 diabetes, babies with severe anomalies. All these and more are in the hospital group but not in the home group.

        • Eddie

          I used to have a very good friend with sickle cell, she and all of her sisters had it (plus some other related blood disorders). Her older sister died giving birth in her 20s, but the baby survived. It was tragic, and a reality that so many people are not aware of.

        • The Computer Ate My Nym

          I reviewed two cases of sickle cell patients who died during pregnancy. One was totally unexpected and maybe, MAYBE with extremely aggressive care, could have been saved. Only an abortion could have saved the other woman. These cases are atypical-most women with sickle can give birth without undo problems, but it’s extremely dangerous. I still wonder whether patient #2 really wanted a baby or if she simply wasn’t ever offered the option of an abortion. I never met her, only saw the chart, so don’t know, but the idea that she might have died for a pregnancy she didn’t want bothers me immensely.

        • Renee Martin

          I always see the “moms on crack/drugs” when people talk about the danger of births, and how a hospital sees the worst cases.

          Makes me wonder how many babies actually die, or are permanently maimed by moms that have used street drugs. While a daily diet of meth cannot be healthy, I do wonder exactly how risky drug use is, and how much abuse it takes to be ultra high risk. I’m wondering if it’s more dangerous than HB with a DEM or not.

          Anyone know?

          • Bomb

            I don’t know what the numbers are. One branch of my family had a number of heavy drug users that had kids constantly. Preemies, long term neurological damage, spina bifida (poor nutrition?) fetal deaths in labor. Between the 3 sisters in this one white trash branch of the tree, they’ve contributed a lot of bad stats to a few hospitals with no uncomplicated births between 13 pregnancies.

          • katy benson

            But it’s difficult to isolate drug use as the cause of those problems because drug use tends to be associated with other factors like poverty, poor nutrition, poor maternal health, low socio-economic status, continuing to smoke/drink during pregnancy – and all of these are associated with poor outcomes.

          • Bomb

            I totally get that. What the exact effects are of drugs on babies I don’t know. Based on my very limited experience though, characterizing heavy drug users as a higher risk that hospitals must take on, whether it is solely because of the drug use, or from combined factors, doesn’t seem terribly off mark.

          • katy benson

            Oh absolutely – drug use is associated with a range of risks and poor outcomes – smoking, alcohol, poly drug use, poverty, poor general health, lack of support.
            As uncomfortable as I was with being categorised as ‘high risk’ and monitored by substance misuse specialist midwives/social workers, I absolutely understood the need to monitor me and my baby. It was hard, thinking that people were making assumptions about my parenting abilities based on what I felt was my past but it was really satisfying to be able to prove people wrong. I built up really good relationships with all my care givers and challenged some of their preconceptions too which was great.

          • Bomb

            I would have been thrilled if any of my relatives had been on methadone and properly monitored, and would have been crazy supportive and non judgemental. One of them finally got on methadone eventually, but was still selling out of her gov funded apt, and had an entire bedroom devoted to growing weed (so her kids got to sleep in the dining room). Thankfully CPS took care of all that, though she is still making spectacularly bad choices.

          • The Computer Ate My Nym

            I know babies exposed to opiates in utero are born addicted and have to undergo withdrawal. This is best done by giving slowly decreasing doses of opiates so that their dependence decreases gradually. If they don’t have a good taper, they are agitated and don’t grow well in the first few days of life, which can have nasty consequences.

          • katy benson

            Not necessarily. Some babies do not experience withdrawal symptoms. At my local hospital, 40% of babies born to opiate addicted mothers have to be treated for withdrawal. And as you say, management is key. With good management, there is no reason that babies should suffer; opiate dependence is clinically pretty easy to manage.
            Let’s also remember that opiates get prescribed to pregnant women pretty widely – opiates are seen as a pretty safe painkiller to use during pregnancy. The babies of mothers prescribed morphine or codeine are as ‘at risk’ as babies born to mothers who are stable on methadone.

          • katy benson

            I was on methadone when I had my child. I might get slated for admitting that here, but I want to answer your question truthfully. Getting pregnant was a changing point for me, and I stopped using street drugs the day I found out. I was already on methadone – and I was advised by my consultant to continue on methadone rather than risk doing a detox.
            The whole ‘smack addicted babies screaming in pain’ is a horrible misrepresentation of what actually happens. When mothers are on medications that are habit-causing (like methadone), the babies are monitored for signs of withdrawal after birth and if necessary, they are given treatment. There’s no reason any baby should suffer with proper medical management.
            I stuck to my prescribed dose of methadone, stopped using street drugs, ate a healthy diet, stopped smoking, lived a healthy lifestyle and fortunately, my son was absolutely fine – no signs of withdrawal. I took him home after 3 days and he’s been a been happy and healthy ever since.
            My midwife gave me a selection of peer-reviewed articles about mothers on opiate medication and as she explained to me, there’s no evidence that opiate use during pregnancy causes birth defects etc or long term adverse outcomes (learning disabilities etc).
            The main risk of opiate use during pregnancy is dependence and that’s actually not as hideous as it sounds. Even if a baby is born ‘dependent’ on opiates, that does not make the baby an addict. Addiction is about a lot more than physical dependence – it’s about the associated mindset and lifestyle.
            I am of course, talking about opiates here. Stimulant use during pregnancy is a different ballgame. Crack cocaine and crystal meth do not cause addiction but they are associated with a range of risks – possibly because they cut off oxygen supply to the baby.
            I couldn’t tell you about long term risks – why don’t you look it up?
            Please don’t judge us ex-addict mothers, and please don’t fall for the media ‘crack baby’ stereotype. Most of us love our babies, and are doing the best we can in a bad situation. At the time I fell pregnant, I was 19 years old, I’d been living on the streets and in hostels, and I’d just had to flee my physically and mentally abusive partner.

          • anonomom_LLLL_IBCLC

            No judgment here. Everyone makes mistakes, and it sounds like you did the best you could to take care of your unborn child. You should be very proud of yourself for turning your life around and giving your baby such a healthy and loving start!

          • katy benson

            Thank you anonomom – I seriously considered whether it was wise to talk about this here, but I wanted to give ‘the other side’ – thank you :-)

          • anonomom_LLLL_IBCLC

            Well thank you for being brave enough to share your story. I have only seen people be judged around here for continuing to hold onto opinions that are not supported by facts, or for judging others as bad parents for dumb reasons, or taking risks like homebirth for frivolous reasons. Many of us have also made dumb choices before we knew the risks, but that’s life, right?

          • theadequatemother

            I judge you as brave and strong.

          • katy benson

            Thank you both :-)

          • Amy Tuteur, MD

            Thank you, Katy, for the information, and for being brave enough to share your story.

          • http://www.facebook.com/lizzie.dee.71 Lizzie Dee

            I hope no-one judges you, Kate. It takes a lot of courage to try to turn your life around like that, and I hope you continue to get the support you need.

          • Laura

            Thank you for sharing your encouraging and hopeful story. I am so glad things have gone so well for you and your baby. You have a lot to add to this blog.

          • Eddie

            According to what I read in lay literature like Scientific American (but I don’t remember which magazine for sure), it is very difficult to untangle the effects of the drugs from the effects of poor nutrician and a lack of prenatal care in that population. In the past, people conflated the effects of both, blaming only the drug use. The article I read (years ago) was about narcotics so this may not apply to other classes of drugs.

      • Eddie

        Their number is 0.6/1000. According to http://www.cdc.gov/nchs/data/databriefs/db16.htm the US rate is about 6 deaths per thousand. Are these not comparable measurements (other than exclusing pre-term deaths for the OR measurements)? I don’t see above, are the numbers above only for singleton births?

        Is the risk for premature birth so incredibly high that it moves the whole population risk figure by such a factor — or is it that there are that many premature births? Or is it that Oregon has a significantly lower fetal death rate than the US average?

  • Durango

    Color me surprised that Rooks was so unsparing in her conclusion given that she is a supporter of direct-entry midwifery. Hopefully Oregon will act on these stats…

    • Amy Tuteur, MD

      I listened to her testimony (she was reading from her statement), and a legislator who is a proponent of homebirth actually cut her off. No one paid any attention to what she said.

      • Certified Hamster Midwife

        “….Yo, imma let you finish, but BIRTH IS AS SAFE AS LIFE GETS.”

        Hey, Kanye’s an expectant father! I’m sure his child will be born in a hospital.

      • Lena

        That’s horrible. Why demand the stats then?

      • Renee Martin

        Judith did well, people listened to her, she just went way, way, over her allotted time. You would have to understand the politics of OR HB MWery to fully appreciate her. That she got the data out there is actually pretty amazing, considering how much data has been fully hidden here.

      • Natalie

        I bet it was Rep. Greenlick.
        I was testifying a couple weeks ago in opposition of HB 2902 (would mandate insurance reimburse NPs and PAs equal to primary care physicians). He interrupted me, and everyone who testified in opposition within about 30 seconds.
        He is notoriously supportive of the “off the beaten path” healthcare in Oregon. And he’s just plain rude.

    • manabanana

      Could she be positioning herself to rally for the AMCB-trained CM as the only qualified direct-entry midwife. crossing fingers.

  • CNM

    Also, make them get a license? At least with a license there are SOME standards one must abide by.

  • The Computer Ate My Nym

    I note that there’s no information at all on intrauterine fetal demise. IFD is likely to be higher in the planned home birth cohort because DEMs are likely to allow women to go for >41 weeks without induction on the “babies know when to be born” theory. But can’t prove that this is true given available information.

    • Renee Martin

      I wonder how the stillbirths are counted, as babies that die in labor, and the babies that die pre birth due to poor care, like 42+w stillbirths, aren’t born alive and don’t get birth certificates.

  • http://breastfeedingwithoutbs.blogspot.com/ Breastfeeding Without BS

    What the actual fuck!?!

  • The Computer Ate My Nym

    Hey. Just in case anyone’s wondering, the difference between the hospital and home birth groups does appear to be statistically significant (Fisher’s exact test 2 tail p-value of <0.0001). The difference between OOH with and without DEM does not appear to be though.

    • auntbea

      So sad for the midwives. Their contribution cannot be distinguished from zero!

      • Certified Hamster Midwife

        Shhh, you’re vindicating the freebirthers.

      • The Computer Ate My Nym

        Actually, the trend is in the opposite direction, suggesting that DEMs may be actively harmful. But that appears to be a coincidence, statistically.

        • Squillo

          That would make a great motto for DEMs: “Maybe Better Than Nothing”

        • Mariana Baca

          I assumed the numbers in the first row were not DEM or no midwife but DEM or CNM, which would explain the slightly better numbers

          • areawomanpdx

            I believe Judith is using DEM to signify licensed midwives (not CNMs) and OOH births to signify all midwives, regardless of licensure status, which would include CNMs and unlicensed midwives.

          • Mariana Baca

            Yes, that is what i thought. The comments above me seemed to imply OOH was DEM or planned unnassisted, thus the comment that a DEM was worse than nothing at all.

        • Are you nuts

          If a woman is “freebirthing” at least there is a chance that she and/or her partner will freak out and go to the hospital if something seems really wrong. A DEM serves as a cheerleader from hell in these situations, ensuring mom that this is a variation of normal and they shouldn’t seek actual medical help.

          • Sue

            I’ve wondered whether free birth is actually safer than lay MWs – I imagine families might bail out sooner if left to make their own decisions.

          • areawomanpdx

            I believe this to be true. In so many cases, these women are told things that are decidedly abnormal are, in fact, normal. If no one was there whispering bullshit into their ears and worried about getting paid, I think that women, along with their frightened partner, would be far more apt to transfer.

    • Meagan

      I thought the first row included the second row. So 1235 of the total 1995 out of hospital births were attended by DEMs. The remainder is 2 deaths of 760 births (I think) but I’m 32 years old and don’t remember how to math that into a per 1000 rate. Wouldn’t the leftovers include CNMs as well as Unassisted Childbirths? Seems like it could be difficult to make much sense out of a number like that… I could just be misreading it though.

      • The Computer Ate My Nym

        As far as I know, you did the math right and the non-DEM deliveries include all comers, i.e. free births, CNM attended, OB attended, attended by a doula, dolphin midwife, whatever else people can think up.

  • Bombshellrisa

    I am glad that she mentioned only the ones that were happy with the outcome would be the ones lobbying. Who will stand up for those six mothers who were left heartbroken?
    The only part of her testimony I take issues with is that she says Oregon needs MORE direct entry midwives. This is the wrong way to go about making home birth safer.

    • anonomom_LLLL_IBCLC

      “The only part of her testimony I take issues with is that she says Oregon needs MORE direct entry midwives.”

      Yes; wtf? How can she say this, given the results of OOH births? Now that women are starting to get the real info, I bet not so many will be wanting OOH births. And if they do anyway, that does not mean the state is obligated to condone it!

      • Bombshellrisa

        There seems to be an over saturation of the DEM/CPM midwives in Oregon (also in WA state, as some of the midwives on the border practice in both states). I would have liked a little more info on the birth center births, as a lot of women seem to think that they are as safe as a hospital to deliver at .

      • The Bofa on the Sofa

        es; wtf? How can she say this, given the results of OOH births?

        The cynic in me says this:
        Instead of seeing this as an indication that DEMs are not acceptable providers, they will spin it as evidence that DEMs need hospital privilege. See, if they were just allowed to practice in hospitals, then this problem will go away.

        Hence, we need to license DEMs and let them work in hospitals.

        • anonomom_LLLL_IBCLC

          LOL! The hospital’s risk management people might have a slight issue with that idea.

          • The Bofa on the Sofa

            Of course. That’s why they need a law to make it happen.

            Obviously, no health care provider in their right mind would be in favor of it.

  • Josephine

    Having grown up in Oregon (and planning to move back soon) and what with having lots of my nearest and dearest still living in that state, this makes me absolutely heartsick. It would make me heartsick no matter what state I was in, but it’s worse this way. Ugh. Those poor babies and mothers.

    • Bombshellrisa

      It’s especially sad because there are some very good options for women’s healthcare in Oregon. We have a place in La Grande and while the hospital there is small, they still have a really beautiful L&D, with tubs and rooms that are cozy and a nice area for families. There is no reason to be relying on midwives like Darby Partner and Patty Couch and Sherry Dress when there are nurse midwives and doctors who can really help you and your baby if something goes wrong.

      • areawomanpdx

        Yes! OHSU will even let you do a vaginal breech (no tub, because you have to do it in the OR, but REALLY?).

        • Bombshellrisa

          I heard OHSU does waterbirth and has free doulas. Plus you don’t have to buy your own birth kit!

          • Renee Martin

            They do^. There is really NO excuse to use poorly trained MWs here, unless you are without transportation and up in the mountains (I would say you should go into town for birth, but anyway…).

            Most of the population lives in the Willamette Valley, which includes Portland, Salem and Eugene/Springfield. Some of the nicest, most progressive, NCB friendly, highly skilled, hospitals cover this area. Its not 1970 here, everything the nCB crew asks for they get here, but its never enough.

          • Bombshellrisa

            That is the part I am having the hardest time with. If there are so many places that offer the same amenities a free standing birth center would offer (and still be a modern, well staffed hospital) why are women choosing to birth at home? Will the numbers be enough of a wake up call, or are they still going to insist that “babies die in hospitals too”?

          • Renee Martin

            Some choose home because they simply do not know what the hospitals offer, or they don’t believe it. I talked to a few moms choosing HB about my VBAC at OHSU and not one knew about the water birth, MWs, free doulas, or breech VB.

            The rest sincerely believe that even with all is stuff, home is better because there can’t be “cascade of interventions”. They really believe it.

            Personally, I find all the catering to NCB/HBers annoying, as it often comes with an ideological shift in attitude. Adding choices is great, but it seems like when a hospital tries hard to turn into NCB land, the 90% of moms that want NO part of NCB suffer. From nurses that delay your epidural, to being made to walk/use birth ball when you do not want it, to pushing VBAC regardless of history and demonizing ECRS and formula, and adding the “baby friendly” (mom unfriendly) nonsense, too much NCB is bad news. Hospitals need to remember who their base customer is, and not run them off to attract a group that hates them no matter what they do

          • Liz

            It’s great that they’re offering better options at OHSU, but those of us south of Portland don’t have those same options in hospital. Lebanon and Albany hospitals don’t offer waterbirth. Corvallis has just started, but they risk out many healthy low risk moms and the OBs don’t support it. There aren’t hospital doulas and Lebanon and Albany don’t “allow” VBAC.

          • http://www.facebook.com/lizzie.dee.71 Lizzie Dee

            “they risk out many healthy low risk moms”

            Could you expand on this a bit? Are you talking about VBAC, or more generally?

            I believe the much better organised UK system risks out about 40%.

            It seems to me that the biggest hazard in homebirth is the failure to spot the baby who is becoming distressed and transfer before you find yourself trying to resuscitate. Given that reading an EFM trace can be quite difficult, the idea that intermittent is much use seems weird to me.

          • Josephine

            No super special bragging rights for birthing in a hospital, silly.

          • fiftyfifty1

            No kidding. It would be like if a gang let you go in and BUY the stuff rather than shoplift it as part of their initiation! How uncool would that be? Hospital birth, what a cop-out!

        • suchende

          You know what? I think that is great. And I am sincerely grateful to the crunchies for moving hospitals toward being more indulgent towards laboring moms. A lot about medicalized obstetrics care has been historically shitty and I fully support hospitals making changes that give women more choices as long as the risks are low.

      • Josephine

        Yes, exactly, they really do cater to the crunchy crowd. At the Oregon hospital where I gave birth, water births for low risk moms were an option, there was a whirlpool tub for just hanging out in while laboring, birth balls, squat bars, ability to play music, etc etc. The birth suites had just been redone withing the last, I dunno, probably five years, and were huge to allow for free movement during labor. Not to mention a huge midwifery practice (though most of them were decidedly not woo). I mean what more could the BOBB lovers want? Oh, I forgot, their gold medal from the stunt birthlympics.

  • AlexisRT

    So how are Oregon midwives spinning these stats? Are they going to go the Colorado route of claiming they would have happened anyway?

    • Oregoner

      That remains to be seen. Haven’t heard much from Melissa Cheney recently. Colleen Forbes was just named to the Board of Direct Entry Midwifery, so I called her this week to say, “Let’s chat.” Maybe we can talk about transports and risk assessment. It is a huge help to have these numbers. The differences are so large that they can’t be blithely waved away. This is for real.