A history of homebirth in North Carolina, minus the dead babies, of course

Got ethics?

A big shout out to Kirsti Kreutzer, Anna Van Wagoner and Maria Radonicich of “Where’s My Midwife? “a grassroots organization seeking to increase access to midwives in hospitals, free-standing birth centers and at home through education and advocacy.”

It is people like them who make my job of exposing the ignorance, stupidity and heartlessness of homebirth advocates so much easier. They have helpfully written a history of homebirth in North Carolina that leaves out the many dead babies. Supposedly Van Wagoner “loves using creativity to explore birth issues.” You can’t get much more creative than pretending that homebirth in North Carolina is safe.

To illustrate what I mean, I offer an example from their “history, ” but with the dead babies (in bold) added back. This excerpt covers a period of less than 2 years:

February 2011

A Certified Professional Midwife is arrested and charged with practicing midwifery without a license, and with providing prenatal care in a second case.

A baby was left with major brain damage after a homebirth presided over by Amy Medwin, CPM, who subsequently pleaded guilty to the charges. This isn’t the first time Medwin was arrested. According to the Charlotte News and Observer, she was arrested in the wake of another poor homebirth outcome in 1998.

March 2011

The largest rally regarding midwifery issues that has ever taken place in the United States is at the North Carolina General Assembly, when 650 people come to demonstrate their support of licensing Certified Professional Midwives. At that time, NCFOM has two bills in limbo—both of which end up languishing in Health Committee in both chambers.

You might think that this would be an opportunity for soul searching in the North Carolina homebirth community, but you’d be wrong. The North Carolina Friends of Midwives viewed this as an opportunity to promote the interests of CPMs. No one knew whether the baby would live or die, but homebirth advocates “moved on” to the really important issue, the fate of the midwife.

To my knowledge, there was never any investigation of Medwin by any midwifery organization.

May 2011

Prior to the homebirth VBA2C (vaginal birth after 2 C-sections), the mother wrote:

… I told DH that we’d be having no more babies unless I was able to plan a homebirth for the next one. I’m full-term with baby #3 and hoping to have an awesome HBA2C story in the next month! No matter how the birth turns out, I appreciate having a care provider who understands that each pregnant mother is an individual who is capable of researching and making her own decisions about “HER” body and child…

The mother got “HER” homebirth, with al midwife:

The mother began labor spontaneously at 41 1/2 weeks, labored for 24 hours and apparently delivered vaginally the day before yesterday.. The baby was born not breathing. Subsequent evaluation revealed meconium aspiration and catastrophic brain damage due to lack of oxygen. The decision was made to take the baby off life support.

August 2011

The mother is a diabetic (not gestational) who labored at home and ultimately transferred to the hospital after pushing for many hours. The baby was born by C-section, asphyxiated and brain dead, as well as suffering from overwhelming group B strep sepsis. The baby was taken off life support the next day.

December 2011

Two deaths!

First:

The mother is a doula and had a waterbirth. The baby was a breech with a trapped head. The mother transferred to the hospital with the breech suspended from her vagina. By the time doctors could extricate the baby, she was dead.

Second:

According to the Charlotte Observer:

Just before 8 p.m. Dec. 16, police and paramedics were called to a home on Seamill Road, in a neighborhood near the Catawba River. They discovered the newborn unresponsive.

Charlotte-Mecklenburg police said it appeared complications had occurred after the baby’s mother participated in a water birth – a method of giving birth in a tub of warm water.

Paramedics performed CPR and then took the baby to Carolinas Medical Center, but the infant soon died.

Homicide detectives, who respond to all infant deaths, said they began investigating and determined that two women were in the home at the time of the birth. Police said they were practicing midwifery but did not have the proper license required by state law. Police arrested Mary Stewart Barhite, 43, of Charlotte, and Jacqueline Lynn Proffit, 45, of Indian Trail, on Friday. They are charged with practicing midwifery without a license – a misdemeanor.

This brings the confirmed homebirth death rate in North Carolina in 2011 to an extraordinary 12X times the expected death rate for comparable risk hospital birth.

February 2012

A direct-entry midwife and her doula are arrested and charged with practicing midwifery without a license. Charges are eventually dropped.

May 2012

I’m a police officer and just went to a call involving a family doing a home birth. There were complications so the family called 911. I was the first on scene and started doing compressions on the baby. EMS arrived a few minutes after and took over. I sat and watched, feeling helpless. I have a 9 month old at home and all I could think of was my little girl.

June 2012

A homebirth death occurred in Wilmington in late May/early June. It was the result of a shoulder dystocia at an attempted HBAC (homebirth after cearean).

July 2012

The baby boy died on July 23, 2012. The attendant was Rowan Bailey- a follower of The Matrona and Whapio Diane Bartlett, in Asheville NC. Bailey claims a holistic, non-interference approach, and she lived up to that reputation. She became annoyed at phone calls and doubts from family and the father.

After 4 days of labor, she finally admitted she did not know how to “get the baby out” at home. At the hospital they could not find the baby’s heartbeat. The stillborn baby was born that afternoon.

Summer 2012

A series of bad outcomes (dead babies) comes to the attention of the Midwifery Joint Committee (involving direct-entry midwife Rowan Bailey in July (mentioned above), and a Certified Professional Midwife and two Certified Nurse Midwives around the same time [additional deaths, not mentioned above]). A cease and desist order is filed against both Rowan and the Certified Professional Midwife.

During testimony by one of the Certified Nurse Midwives, she mentions that the obstetrician who signed her permit to practice is also providing supervision for approximately eleven other Certified Nurse Midwives serving families across the state. This obstetrician is called into a closed-door session before the Board of Medicine, immediately after which he notifies each of the eleven midwives that he will no longer serve as their supervising physician. [In the wake of finding himself responsible for the death at the hands of the midwife.]

This leaves hundreds of families planning legal, professionally assisted home births with no care and very few options. There are not enough practicing Certified Professional Midwives, whose numbers have been thinned by fear of arrest, to attend all of these births.

The MJC issues a temporary 75-day license to the Certified Nurse Midwives to cover the gap in physician supervision, but most are unable to find a doctor willing to buck the establishment [and take responsibility for the appalling number of deaths at the hand of homebirth midwives] and allow them legal status. Today, only four Certified Nurse Midwife home birth practices are left in the state.

During the time period in question, at least 8 babies died at the hands of North Carolina midwives and possibly 10 or more for a death rate than is more than 10 X higher than term hospital birth. To my knowledge, not a single one of the midwives involved in these deaths was ever investigated by any homebirth midwifery organization, either in North Carolina or nationally.

When I read alternative “histories” like this I am put in mind of a declaration by Professor Higgins in My Fair Lady:

What a heartless, wicked, brainless thing to do.

That’s why I’m grateful to to folks of “Where’s My Midwife?” I am constantly trying to highlight the lack of education, lack of training, hideous outcomes and the utter contempt for any concept of accountability on the part of homebirth midwives. They’re doing my job for me.

Now I have a question for them:

How can you be so heartless, wicked and brainless as to whitewash the unending procession of preventable deaths that occur at homebirth?

Inquiring minds want to know.

  • kassedi

    what about the babies that die under the care of an OB or do you only slander midwifery here?

  • Joy

    It is sad that anyone in the state of NC who wants a VBA2C only has the choice of having a home birth or flying out of state. No woman should ever have to make that choice!

  • Mr.G
  • Sarah

    I write this comment in the hopes that it will be read as a differing opinion and not an opportunity to attack;

    (Most) Supporters of midwifery and homebirth support homebirth for low risk pregnancies attended by licensed and trained Certified Professional Midwives or Certified Nurse Midwives. Homebirth is a valid option for birth but only if it has been determined (by a medical professional) that the pregnancy presents a low risk of possible complications and the mother is in overall good health.

    Many of the cases you cite in this article include either untrained or undertrained midwives (due to no licensing of CPMs) or mothers who clearly presented risk factors such as diabetes and VBAC. These are not the type of cases that would be referred for home birth in a licensed and regulated state.

    The argument that the death and complication rates for homebirth when there is little to no legal route (Yes, CNMs are able to perform homebirth in NC but they are required to be overseen by an Obstetrician and therefore most work in birthing centers and hospitals) are proof of why it should not be considered for legalization and regulation is the same one seen when abortion is prohibited. With no legal route to abortion (regardless of whether or not you agree with it), women turn to untrained and undertrained providers resulting in deaths and complications.

    There are benefits and risks to homebirth just as there are benefits and risks to hospital birth and personally I support the right to have the options available so that each woman can make a safe and educated decision that best fits the needs of her pregnancy and her family.

  • Jessica

    Hey Dr Amy, Are you prolife? Just curious.

  • Disgusted

    “This leaves hundreds of families planning legal, professionally assisted
    home births with no care and very few options. There are not enough
    practicing Certified Professional Midwives, whose numbers have been
    thinned by fear of arrest, to attend all of these births.”

    It boggles me that after the litany of deaths at the hands of midwives, they think the problem is “not enough midwives”.

  • auntbea

    OT: This looks professional and thorough! Who needs an OB when you can just by this? http://inhishands.com/Emergency-Guide-to-Obstetric-Complications.269

    • Sue

      Wow – that book would take five minutes to write:

      Eclamptic seizures – refer to real medical professional
      SHock – refer to real medical professional
      etc.

      Why spend the $28?

      • auntbea

        Yeah, I’m not sure why it takes 15 pages to type “Call 911.”

  • theNormalDistribution

    Unrelated. A birth doula AMA on reddit:

    “I’ve seen all natural births, necessary and IMO unnecessary C Sections, overuse of drugs, fantastic drs, awful ones (same with midwives) and some inspiring stories. I’ve also assisted birth in. Uganda. Want to know what it’s really like in a birthing room and in America’s birth culture right now? Ask away.”

    http://www.reddit.com/r/IAmA/comments/1d9twt/i_am_a_birth_doula_with_experience_at_over_30/

    • Aunti Po dean

      Gosh she seems to be overstepping her role by a significant margin doesn’t she?

    • auntbea

      I mean, if a woman has *really* investigated her options, I mean really, all of them, especially not having c-section, and still, somehow, wants a c-section, I will support her. And her entitled self.

      • theNormalDistribution

        “A c section is major abdominal surgery and not how a baby is supposed to be born IF you are able to give birth vaginally.”

        I don’t understand this “supposed to” business. How do you know how something is supposed to be done? Who determines it? It makes my brain hurt when people say things like that.

        • Michael AndAmanda Trihey

          Its obviously not “Supposed” to be that way because humans do not have a trap door on our abdomens. Its not the natural way.

          • Amy Tuteur, MD

            So why are you on the internet? As far as I know, humans do not have wifi so the internet is not “the natural way.”

          • theNormalDistribution

            Oh, obviously. Because how things are is how they should be, duuuuhhh. How come I didn’t think of that?!

          • elizabeth a

            Why are we so excited about keeping things natural when it comes to birth, while we remain dedicated to rejecting nature when it comes to, say, climate control or the ability to buy to buy out of season at the grocery store all winter long?

            Naturally, I am an extremely dead woman. I have been very pleased with the results of my unnatural obstetrical surgery. It beats the hell out of January peaches from Whole Foods.

      • Charlotte

        I used to be terribly afraid of c-sections, but after have two, I really feel like I lucked out getting them (both were unexpected). I’m looking forward to having a planned c-section next time around so I can continue to avoid the bladder prolapse, urine leakage, chronic pain, and sexual problems my friends constantly complain about. Tell me again how vaginal birth is supposed to be better?

        • Dr Kitty

          If you are able to…

          Ok…
          What does that even mean?

          If you can do it, but only by having a symphisiotomy, should you still choose it in preference to CS?

          Is she basically saying, that short of actually dying in the process, every complication possible from vaginal birth is acceptable if you can avoid a CS?

          Really?
          Because that sucks, and is much, much less respectful of maternal human rights that the alternative position (whether or not to choose CS should be up to you).

      • Joy

        But in NC a woman does not have a choice! What if she wants a VBAC, she should still be able to have a TOL but many women are not even given that!

    • fiftyfifty1

      It’s pretty funny how she says “I’ve seen it all” after 30 births. Reminds me of Gina, the Feminist Breeder. Strong members of the Dunning Kruger Club.

  • Bystander

    I saw this yesterday and it seemed to sum up so much of what is wrong with the notion of homebirth (and anti-vaxx and other risky things):

    http://terriermandotcom.blogspot.co.uk/2013/04/do-not-put-love-on-edge.html

    If you value it, hold it somewhere safe, not balanced on a precarious edge.

  • guest
    • Aunti Po Dean

      This article is a really good example of ” I did my research and this is what I found and now believe because it suits me.”
      I’d also like to see a Dr Amy commentary on this

      • fiftyfifty1

        I agree. I’m always up for another post debunking the “babies are not library books” argument.

      • Mac Sherbert

        “As you can see, the stillbirth rate actually begins to rise at 36 weeks. At that point, the risks associated with early delivery outweigh the risk of stillbirth.”

        If this is true, why the big push for 39 weeks? I know two women who recently gave birth and were induced at 40weeks exactly Their families gave them tons of grief about it. I wish I could have sent them a link to this article. (BTW both inductions ended in VB w/healthy mom & baby.)

        • Susan

          One hopes it’s not because dead babies are cheaper than preterm babies….

          • Susan

            Or rather, that stillborns don’t have NICU stays.

        • Becky05

          The neonatal mortality rate is decreasing until 39 weeks, as is the neonatal morbidity rate. 39 weeks is the point where the risk of expectant management first outweighs the risk of delivery.

    • Amy Tuteur, MD

      The author was channelling Ina May Gaskin. I debunked her misinformation on Naegle’s rule here:

      http://www.skepticalob.com/2010/10/ina-mays-acolytes-spew-misinformation.html

  • Aunti Po Dean

    Meanwhile, our hospitals—where 94% of women give birth—are delivering us care that has placed our state 47th in the nation for mothers dying in childbirth

    How exactly is this a bad thing? surely this is a list you want to be near the bottom of …you wouldn’t want to be the number one state!

    • Eddie

      It’s the basic right of a woman to decide where she wants to give birth, and with whom. That includes birth outside of the medical monopoly. It’s time we addressed the fact that the corporations making money off the business of birth in North Carolina are the ones dictating our policy and law, and doing their best to eliminate the competition

      What a bogus argument. The irony is that it’s the people who want to earn money taking care of laboring women who are complaining about the other people for making money taking care of laboring women. The tragedy is that so many cannot see that. And “medical monopoly”? Puh-lease. This is anti-evidence-based-medicine drivel. If a women wants to give birth at home, that is her choice. The government is not going to track women to ensure they deliver in a hospital. But untrained and insufficiently trained people have no business (pun intended) providing medical care.

      Meanwhile, our hospitals—where 94% of women give birth—are delivering us care that has placed our state 47th in the nation for mothers dying in childbirth.

      Is it’s true that only 94% of women give birth in a hospital in North Carolina, as the article says?

      If this article is trying to assert that North Carolina is third from the worst, then I cannot find those numbers. One source http://hrc.nwlc.org/status-indicators/maternal-mortality-rate-100000 aggregating data from 2001 to 2006 puts North Carolina 29th (where 1 is the lowest rate). I couldn’t find current state-rankings in MMR.

      Figure 1 of http://www.hrsa.gov/ourstories/mchb75th/mchb75maternalmortality.pdf shows the stark drop in MMR over the 20th century. Thank you, modern obstetrics. To quote the report, “The rate declined from 607.9 maternal deaths per 100,000 live births in 1915 to 12.7 in 2007.” Yes, American can do and should do much better than 13 / 100,000. But let’s keep this in perspective. Let’s fix the problems in the US medical system rather than abandoning it!

  • Captain Obvious

    “Where’s my midwife”? Well after reviewing the NC midwives timeline, I hope your midwife is going back for further education and maintenance CME to become a CNM. She is looking into getting licensed and insured with a decent $3 million/$1 million malpractice policy. I hope she is establishing a collaborative agreement with an OB/GYN to ensure a safe transfer plan with a hospital backup. I hope your midwife will step up to the plate and rally all the appropriately practicing midwives to denounce all the birth junkie high risk outcome midwives instead of defending them.

    • Aunti Po Dean

      Like like like like like…..

    • Lisa from NY

      They won’t get sued if they don’t have malpractice, will they?

    • Sarah

      A homebirth practicing CNM is truly the most highly trained person you could have and would be great if we had enough in North Carolina. Unfortunately, they do not have the option of simply having a collaborative agreement with an OB/GYN but must be legally overseen by one. Yes, there is a shortage of appropriately practicing midwives in North Carolina but it is also at least partially due to the difficulty in establishing a legal homebirth practice.

  • Dallas

    I’m all for natural, intervention-free (or limited intervention) childbirth– I’ve had two children that way, in fact… But I was NOT dumb enough to play God with my children’s lives and try to have a home birth. I went to the hospital when my labor began, and both times, the staff graciously hung on the fringes until it was time to push. The only thing they insisted upon (and with good reason, I felt) was for me to wear the belly monitor, which I agreed to, with no complaint. Their job is to make sure I’m safe while giving birth, but also to ensure that my baby is safe as well. Had there been a complication (thank God there wasn’t) during either of my deliveries, I would’ve agreed to medical intervention in a heartbeat. Why? Because I’m not a goddamned doctor, and I don’t want a dead baby.

    Women need to realize that even though yes, numerous babies have been born at home safely– there are numerous others that died. I would much rather have a trained medical staff right there in the event something goes wrong while I’m in labor, instead of some hippie-granola lay midwife waving sage and crystals at my hoo-ha for four days.

    • The Bofa on the Sofa

      You would think it would go without saying, but thanks for saying it.

      • Dallas

        You would be surprised at how scandalous my choice to give birth in a hospital was to the mothers in my toddler’s playgroup. “Oh, well. That’s not true natural childbirth, if you gave birth in a hospital.”

        Really? Pretty sure that natural childbirth entails pushing a human being out of your body with no medication. I did it. Twice. Does it really matter what bed my ass was in?

        • The Bofa on the Sofa

          “Oh, well. That’s not true natural childbirth, if you gave birth in a hospital.”

          Sadly, I doubt the response “So what?” would sink in properly.

        • Poogles

          ” “Oh, well. That’s not true natural childbirth, if you gave birth in a hospital.””

          And THIS is where we get a lot of the “OBs have NEVER seen a natural birth!”

          • The Bofa on the Sofa

            Exactly!

  • DaisyGrrl

    Thanks for this. From now on, any time I read “bad outcome” from a CPM advocate, I will mentally replace it with “dead baby”. And anytime I read about charges or harassment, I’ll think “preventable permanent disability”.

    The minimization and rationalization that these nuts go through is so disgusting. Thanks Dr. Amy for calling them on it.

    • “tragedy” or “tragic event” should also be translated to “dead baby”.

  • Sue

    While we’re looking at the history of childbirth, what about the history of “natural”? Here’s an interesting paper from the Journal of the Royal Society of Medicine Nov 2006: “British maternal mortality in the 19th and early 20th centuries” G Chamberlain

    An extract:

    ” ‘Death borders upon our birth And our cradle stands in the grave’

    Joseph Hall, Bishop of Exeter (1564-1656)

    In the 19th and first half of the 20th century, everybody knew about death in childbirth, particularly those women who were about to go through the process. Although death rates from many other conditions were high, they at least were among people who had been ill beforehand. Death in relation to childbirth was mostly in fit young women who had been quite well before becoming pregnant. They died, often leaving the baby, and other children in the family from previous births, with a widowed husband.

    It is only recently that the Church of England prayer book removed the service for the ‘churching of women who had recently given birth’ which starts by giving thanks to God for:

    ‘The safe deliverance and preservation from the great dangers of childbirth.’

    • Dr Kitty

      The traditional Jewish prayers after childbirth include
      “Ruler of Mercy, that the same way you have saved me from this great pain and from the dangers of giving birth, so too may Your mercies pour forth to recuse all the daughters of Abraham, Isaac and Jacob, the descendants of those who truly loved You, from this danger.”

      Uh huh. Safe as life gets.

      • Elle

        That’s beautiful… it speaks of humility and thankfulness rather than narcissism and “taking control.”

      • fiftyfifty1

        Saved from this great pain??! How negative that is! Don’t they know it’s not pain, it’s “rushes”, and women don’t need to be saved by God anymore than they need to be “saved” by OBs!

        • The Bofa on the Sofa

          I’ve said it before; 3000 years ago, childbirth was recognized as being so painful that it was considered to be punishment from God for the sin of Eve. I’d also suggest that it shows that they knew that praying to God to make it better is pretty much ineffective (“Why won’t God make it stop hurting?” “He’s punishing you”)

          The suggestion that pain in childbirth is a construct of some sort is completely idiotic.

  • attitude devant

    The terrible thing is that I know of more deaths in NC than are listed here and I suspect Dr. Amy does too.

    • fiftyfifty1

      I’ve wondered about that. It seems to me that Dr. Amy has a policy of only publishing stories that are already published, is that correct? e.g. linking to stories that mothers themselves have already published online or linking to stories already in the newspaper. I have never seen an example of her telling a story that hasn’t already been made public.

      • attitude devant

        That’s my understanding too, fiftyfifty1. Sometimes people share info privately and aren’t ready to go public. I know several moms, in NC and elsewhere, who lost babies in cases of egregious malpractice by CPMs but they prefer to maintain silence. Having seen the abuse heaped on Liz and Bambi and Sara, I can hardly blame them. Bad enough that you lost your baby—but to have to put up with the blaming and the character assassination from NCFOM and the like?

  • Aunti Po Dean

    911 for assistance transporting the woman to a hospital for an emergency procedure. Police arrive before the ambulance. This leads us to believe that the North Carolina district attorneys have been instructed to send police to any call to EMS regarding birth at home.”

    Either 911 works completely differently in the US from 000 in Australia or this is one enormous case of paranoia. In OZ 000 send all three first responders to a call out, so for example a house fire gets sent not only the fire department, (put the fire out) but also the ambulance (care for possible smoke inhalation and burns) police (investigate cause) A car crash, same thing ambulance to care for victims, fire to mop up any leaking fuel, police to investigate cause.

    • KarenJJ

      It’s what happened to an Aussie friend living in California. He came off his bicycle and ended up with an ambulance, police and fire truck arriving which must have been called by a bystander via 911. He felt horribly embarrassed and wondered whether it had been a slow day to get so much attention from the emergency services.

      • KarenJJ

        Although come to think of it. maybe he should have considered whether it was a conspiracy against cyclists from the poilce being in the pay of ‘big motor’. I’m sure the police only showed up to intimidate and harrass a cyclist. Apparently the policeman was very nice and my friend very apologetic for feeling like he was wasting their time, but I can definitely now see a darker side to this interaction.

    • Starling

      I was a 9-1-1 operator for years. In a case of a person not conscious, not breathing, it was standard procedure to send the closest police unit, as the officers were trained in CPR and could assist until the paramedics arrived. Same story for out-of-hospital childbirth when the baby isn’t stable.

      • Sue

        This is the main difference between emergency services in the US vs Oz – our police and firies are not first responders for medical emergencies.

      • fiftyfifty1

        Yes, when I am in clinic and call 911 for ambulance transport to the hospital (for chest pain, respiratory distress etc) they always send both the police and the ambulance. 95% of the time the police arrive first because they happen to be patroling in the neighborhood anyway.

  • Thanks for answering the question I asked on Fed Up..

    The gist was: “So what exactly are these unfortunate events that caused midwives to be investigated?”.

  • Aunti Po Dean

    Inquiring minds want to know.
    yep indeed we do!

  • This is disgusting and reprehensible.

  • Elle

    “I’m full-term with baby #3 and hoping to have an awesome HBA2C story in the next month!”

    Wow. Words tell you a lot. The whole point of childbirth is to safely deliver a healthy baby, not to have an “awesome ______ story”! (fill in the blank with whatever special birthy labels you like.)

    It reminds me of some teens I knew who started dating, and it wasn’t many weeks later that I heard talk of the girl sharing “their love story” with people, and how beautiful it was. Guess how long their relationship lasted? When you place the “story” above the actual process, it probably means you don’t have much of a love OR a love story. When you place the birth story ahead of the baby, you may still get a lovely story and a lovely baby if you’re lucky, or you may be left with just the story, which won’t be quite so lovely if your priorities are out of whack.

    • Sue

      Do these people imagine – for one minute – what they are subjecting their babies to? Long, slow, painful, stuck.

      • Eddie

        I think 1) many of these people are incapable of putting themselves very thoroughly into the position of someone who is so helpless, and 2) they reject with prejudice the concept that these risks are as real as we say.

  • As an aside, I see the blog roll is back – YAY!

    • Box of Salt

      And the archives! Double Yay!

  • Accountability. If midwives want to provide services to women at a medically vulnerable time, there must be standards and accountability. Any professional who wants the privledge of providing care to pregnant women must be willing (and even desirous) of being held accountable for the care provided. If midwives aren’t willing to accept accountability then they should not be allowed to practice.

    Thank you Dr. Amy for demonstrating the appalling lack of accountability among Homebirth midwives and their supporters….

  • anonymous

    What I find so appalling here is that there’s this rally around these people as if somehow all the sane people are going to realize that they were right all along and that it’s not about ensuring the safety of the mother and the baby, but making sure that the mother gets to have what she considers a proper “birth experience.” When you are measuring your achievements by whether or not you can pump out a kid normally, something is very wrong with you.

    I try to imagine this mess with other medical issues:

    “I wanted to have a proper bullet wound experience of treating it with garlic and potash. Those butchers in the ER were only interested in cutting me open and removing the slug as fast as they could”

    “We planned my broken bone setting and the shaman had laid out the crystals and began his ritual. Sure I was screaming and the bone pierced my skin, but I wanted a traditional bone setting procedure, not one full of drugs and interventions”

    I think back to my sister-in-law’s birth with her tag-team granola midwife and doula. No clue how to handle a nuchal cord. Spent hours convincing hubby to not call an ambulance but when he finally broke away to do it the doula came out and started yelling at him about how they “had a plan” and that he would ruin it. For the first two weeks all my wife’s sister could say was “It wasn’t their fault” when they could have called an ambulance the whole time. When I asked as to whether or not either had ever apologized she asked “why would they do that?” It’s just as much the enablers as it is these nutters.

    • No mother, regardless of the experience she desires, wants a dead baby. Failing to inform women of the increased risk of a dead baby if Homebirth is chosen is heinous.

      • Eddie

        Tragically and irresponsibly, I believe that many of these bad midwives reject the very kind of analytic thinking that is required for understanding how bad these outcomes are. Thus, the stupefying, “but babies die in the hospital too” that appears here with startling regularity.

        • I will now translate “but babies die in hospitals too”
          as
          “So I effed up. People eff up in hospitals too!”.

          This ignores the fact that apparently HB midwives eff up (deliver dead and injured babies) at a much higher rate than hospital HCPs.

      • In my limited experience with trying to talk sense into a group of people who were strong believers in out-of-hospital birth, I learned that even if you do inform them, they reject it. No matter how many statistics you point them to. They start with a unshakeable belief that homebirth is as safe or safer than hospital birth, and that lay midwives with only a highschool education are adequately trained. If anyone disagrees with them, they are met with “how dare you question another mother’s decision? Do you really think any of us would ever do anything that would risk our baby’s lives??”.

        • CSM

          Exactly. Many people do not make decisions based on logic, or objective reality. it’s just the way they are. See, it doesn’t seem to bother them but it does seem to bother us. Sometimes I wonder why I should really care if a person is unwilling to take in or trust the concept of risk, or to face objective reality, or to make the cause-effect connection. It is their pregnancy and their baby, after all. Perhaps jadedness is setting in…

          • attitude devant

            I do think, CSM, that we as a society have a legitimate interest in the welfare of babies. If we remove infants from unsafe homes (and we do) why should we not insist on safe care for pregnant women?

          • CSM

            Because pregnant women have autonomy to do as they please as far as medical ethics is concerned. If pregnant women deliberately seek out unsafe care, that’s their choosing. Is it morally right? No, I don’t think so, but she isn’t breaking any laws to do so. All we can do is eliminate unsafe providers but there will always be the fringe that’ll go against the rational majority. The reality is that these women need to be dealt with in a way that a. Doesn’t undermine their autonomy. b. Is safe for both parties concerned. I’m dealing with this specific population and it’s a challenge, and it’s draining at times. Mind you, I’m talking about a different midwifery model (Canada-based) so perhaps it’s a smoother sailing here but still.

          • I completely agree that pregnant women have the right to make stupid decisions. I just wish we, as society, weren’t then on the hook for caring for the damaged infants who grow into brain-damaged children and adults. The only ethical thing to do is care for them, of course, but it’s still very expensive. It’s extremely selfish of the women to risk not only death but permanent brain injury for their children, then ask all of us to pay for their stupidity.

            In other words, I am irritated that the right thing to do (protect pregnant women’s autonomy) also means stupid people get to cause harm to innocents and make the rest of us pay for it.

          • Should we care if people drive drunk, or too fast? If the risk was only to themselves, no – but they do tend to cause damage to the innocent.

            NCB isn’t concerned with validating personal choices – it is an ideology that functions to construct a dominant version of childbirth and womanliness, and consequently affects all women to some degree. Its central text is the Birth Story and its foundation is in lies. If it were a matter of personal choices and personal tests of worthiness, like running a marathon, then no, none of us should care or interfere.

            Like most religions or pseudo religions, it needs its hagiography. My personal hate figure – though disgust is a better word than hate

        • The Bofa on the Sofa

          “You cannot rationalize someone out of a position they did not rationalize themselves into”

          • Oh, I like that quote, Bofa….can I borrow it?

          • The Bofa on the Sofa

            Since I borrowed it myself, sure!

            If you look, you might be able to find an original source for it (or something similar; maybe “reason” instead of “rationalize”)

          • Eddie

            According to some Googling, the original is from Jonathan Swift http://en.wikiquote.org/wiki/Jonathan_Swift

            It is useless to attempt to reason a man out of a thing he was never reasoned into.

          • Bofa modernized it.

  • Neonpantsuit

    This made me want to throw up. I can’t even begin to imagine the pain these families are experiencing, and it only adds insult to injury when people take steps to support and protect those responsible. How do they sleep at night? I just can’t fathom it.