Sara Snyder, Bambi Chapman and I discuss the tragedy of preventable homebirth deaths on HuffPo live.
Author:Amy Tuteur, MD
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Amy Tuteur, MD
Dr. Amy Tuteur is an obstetrician gynecologist. She received her undergraduate degree from Harvard College in 1979 and her medical degree from Boston University School of Medicine in 1984. Dr. Tuteur is a former clinical instructor at Harvard Medical School. She left the practice of medicine to raise her four children. Her book, Push Back: Guilt in the Age of Natural Parenting (HarperCollins) was published in 2016. She can be reached at DrAmy5 at aol dot com... More
what happened to these women and their children in absolutely inexcusable.
that is sooo so sad, this needs to stop!!
If states cared to regulate and increase education and access to this, deaths wouldn’t happen as often. i’d like to see as many articles on moms or babies who caught cre,mrsa or any other nasty and potentially deadly infection after giving birth in the hospital
Which part of “licensed Oregon homebirth midwives at planned homebirths had death rates 9X higher than term hospital birth” are you having trouble understanding?
Here’s the thing: When babies die in the hospital of things that should be preventable, the parent has avenues open to them to seek justice. Also, doctors don’t band together to defend those who did wrong. As a result, doctors and hospitals change their behavior to avoid these outcomes. Evidence so far suggests that for many midwives this is just not the case, and that midwives routinely band together to support even those in their ranks who should not be supported.
Also, the likelihood of death in the hospital is much, MUCH lower than it is in an at-home birth.
Many home births are attended by certified nurse-midwives. I would like to shout that from the rooftops.
My heart goes out to any family that has a lost a child.
I am saddened to see the bashing of midwives by Dr. Amy Tuteur. Home birth is a wonderful option from a knowledgeable midwife. I think the answer is more information for parents. Expecting parents don’t know what questions to ask. Who will attend your birth is a very important decision that needs to be done with knowledge and care. You want to find the right fit for you, whether it be an OBGYN or midwife.
I had 2 amazing home births by excellent midwives. They were there for me and did everything appropriate. They pre-screened me to make sure I was a good candidate for home birth, made sure I was close to a hospital should the need arise, took heart tones continuously and most importantly kept me informed. They gave me all the information I needed to make decisions. I felt empowered and cared for.
The problem is not midwives it is lack of information and lack of state wide or national certification for midwives. If we had a excellent certification and licensure for midwives parents would know what qualifications their midwife had and know they were in knowledgeable hands.It is the same for OB/GYn’s you are not going to go to an OB that says she knows what she is doing, you are going to check her credentials. And even after that more work needs to be done. You need to know her philosophy, when will she intervene, when will she induce, when will a c-section be called for. You have to choose the birth assistant that is right for you and women need to have choices so they can have the birth they want.
Tragedies happen in the hospital as well. Home births are not all sad stories.
Good for you. Does that invalidate others’ stories? Either you had well-trained midwives, or you got lucky, or both. Even 100 years ago, when 25% of women dying in childbearing years died in childbirth and one in fifteen births resulted in a dead baby, *most* births resulted in a live baby and mother.
So in other words, the problem isn’t midwives, but instead it is that the states or federal government don’t force midwives to be properly trained? That is, it is, in fact, the midwives? I agree. Requiring American midwives to train to European standards before they could practice would be a vast improvement. So you’re admitting that today’s American midwives — as a group and not as each and every individual — do not have sufficient training.
Saying that just makes you look ignorant. Do you understand the vast difference in the *rate* of tragedies in the two situations, and that hospital tragedies are largely caused by much riskier births than occur in homebirths (and also by homebirth transfers, which are counted against the hospital statistics in most cases).
Replying again, I see on your facebook page that you want NC Bills S106 and S107 to be passed, saying it will make home birth safer. S107 http://www.ncleg.net/gascripts/BillLookUp/BillLookUp.pl?Session=2013&BillID=s107 decriminalizes DEM. S106 http://www.ncleg.net/gascripts/billlookup/billlookup.pl?Session=2011&BillID=S106 is a “defense of marriage” law, so I don’t see how it relates. Anyway, DEMs simply do not have the medical training to safely perform home birth. They would not be allowed to practice in any other western country. Did you even watch the video, or did you stick your fingers in your ears at every point where facts were discussed? The United States is the only industrialized country that allows such untrained people to practice medicine at a home birth, and it shows with higher rates of fetal death in every single state where statistics have been released.
http://www.ncleg.net/gascripts/billlookup/billlookup.pl?Session=2013&BillID=S106
Here is the bill I am speaking of. It would require midwives to be licensed in order to practice. I did watch the video and have read Dr. Tuteur’s blog. I am saying not all midwives are unskilled and ignorant. By licensing them women will know they have had the correct amount of schooling and practice to be prepared for a home birth if that is what the women want. Perhaps the higher rates is because there is no licensure and women are hiring far too many midwives that have no skills at all, that are in fact not midwives.
I do not want to see the choice of home birth be taken away. I do not want to see midwives lost as an option.
Good midwives exist as CNMs. Why do we also need CPMs or DEMs? No-one is saying *all* midwives are unskilled or ignorant. But current licensed midwives (excepting CNMs) do NOT have the correct amount of schooling. Not even close. Again, not a single other first world country would allow them to practice.
And again, the higher rates of homebirth death ARE IN THOSE STATES WHERE MIDWIVES ARE LICENSED. In every single state where the statistics have been made available, a MUCH higher fraction of children are born dead or injured when attended by a CPM or DEM, when compared to a hospital birth.
It turns out that licensure means nothing for the CPM standard. No actual medical training is required.
No-one I have ever seen post to this blog wants home birth to be unavailable to those who want it. The people posting here want people attending home birth to be properly qualified, responsible (risking out), and insured.
..and mandatory reporting of outcomes, as well.
Right, we need mandatory reporting of outcomes for every birth and stillbirth and death that occurs, which includes the intended location of birth (home vs hospital vs birthing center). Ideally, we also get mandatory reporting of injuries, not just fatalities.
Again, not a single other first world country would allow them to practice.
Hey, not a first world country here. A far cry from it. And CPMs, DEMs and the likes will NOT be allowed to practice here. Isn’t it scary?
Ah, again the bragging how someone had two amazing homebirths with excellent midwives. You know what? Some of the mothers here also had an amazing homebirth with excellent midwives who practically killed their subsequent babies. You were lucky, Kristin. Lucky. You had the luck of having uncomplicated births or you had the luck of actually coming across well-trained midwives in this jungle of midwives who are hiding their lack of education, their lack of regulation and their own outcomes. Either way, you got lucky.
The problem is not the miwives but the lack of information about the certification for MIDWIVES? You know what you’re saying? You’re basically saying, well, this lady had left the door unlocked, so why should we blame the robber that he entered and committed a robbery? That’s your theory in a nutshell. Really, what’s wrong with uneducated babykillers being unleashed on the unsuspecting public? It isn’t the uneducated babykillers’ fault!
Yout last statement, about hospital tragedies, speaks of such ignorance that I won’t even comment on it. I’ll only say that when a tragedy happens in hospital A, you won’t find the head of hospital A say, “But tragedies happen in hosptal B, too!” That’s called professionalism. A hard word to apply to homebirth midwifery, I know.
I am not bragging, i am stating a fact as a way to make a point. I in no way mean to diminish the loss of a child. I do not want to see skilled midwives lost as an option.
Skilled midwives are not lost. CNMs still have the right to practice.
Go CNMs!
Again, not a first world country here. Now, things aren’t this bad but when 26 years ago my mother wanted to see her baby via ultrasound and know what she was having, there was one – 1! – ultrasound in the entire big city hospital and this one was broken. A friend of hers called her aunt – a retired midwife, a sweet old lady who came downstairs with an wooden stethoscope and under the very skeptical looks of the two ladies put this in action. It’s a boy, she said and went off her merry way to gossiping with some other old ladies.
My brother was born a few months later.
Huzza for the skilled midwives. These exist in hospitals, too. Amazing, isn’t it?
There’s no shortage of skilled midwives out there. They’re called certified nurse midwives and they have advanced nursing degrees and the appropriate level of education and supervised practice to deliver babies. Anyone else is a hobbyist. And they don’t deliver babies at home because that’s a terrible, dangerous and foolish idea.
But how do we know which midwives are skilled? Each woman thinks she has one of those skilled ones – you yourself said you did. Homebirth midwives don’t want to improve their education – they want to be licensed the way they are now. And that will make them more dangerous. Women will have licensed morons attending them instead of unlicensed morons. Morons, either way.
I think the CPM credential is bad enough by itself. When I hear “professional”, I tend to think of professional organization which MANA isn’t. I am absolutely against lending them further credubility by licensing and certifying them as if each of them has minimal training when this is not true.
Your analogy with OB/Gyn doesn’t hold water. When I chose my gyn, I chose him by criteria that had nothing to do with his training – BECAUSE I knew he had at least the minimal training he needed to practice safely, so I could indulge my perks and preferences. With a non-CPM midwife, you never know whether you’d receive anything BUT the perks.
No one is against skilled midwives being an option. We are, though, absolutely against so-called midwives being sold as a viable option.
I understand your points. I had a CNM and a CPM at my birth and could not have done it without the CPM. She was there for me the entire time and I would hate to see her lost as an option for women.
Kristin, that’s what women say about Faith Beltz and Brenda Scarpino, too. Didn’t stop them from killing Aquila and Mary Beth with their negligence or lack of education about their specific situation. Are you surprised that Liz and Bambi now fervently wish they had gone without these hailed midwives? That’s why standards should be met – so your CPM could meet not only your needs, but, say, Bambi’s, too. I do believe Faith Beltz was an experienced midwife that some mothers birthing with her don;t want to see lost as an option for women. I also believe her horrifying ignorance about abruption was the direct cause of Aquila Paparella’s death.
Face it: your CPM might have been amazing in your specific circumstances but nothing in her education guarantees that she’ll be remotely adequate in another type of complication.
The bill is meant to lull consumers into a false sense of security. And to help CPMs line their pockets. Safety and education have nothing to do with it.
OK, I will reply one more time. Yes, tragedies happen in hospitals. And what happens when they occur there? Doctors lose their license and can no longer practice medicine ANYWHERE. They get sued out of their practice. Hospitals change their procedures to prevent bad things from happening again.
What happens when a home birth tragedy occurs? It was all the mother’s fault. She should have known better than the midwife. Anyway, not all babies are meant to live. Tragedies occur elsewhere anyway, so it’s not like it matters. And is there any consequence for an incompetent midwife? No, she can continue to kill future babies. She can simply declare bankrupcy and not have to pay a penny in damages. She can move and practice in another state, and kill babies there. She carries no malpractice insurance, so the family of a severly injured child is totally without recourse. And the NCB community will band together to defend the incompetent midwife, to raise money for her defence. But the family? It was their fault anyway.
So again, that statement reveals profound ignorance as well as a horrifying lack of concern about the effects of the bad midwives.
Eddie, no where in my statement did I say if a death occurs when a midwife is present she should hold no responsibility or recourse. No where did I state it was the parents’ fault.
I am saying that because these tragedies occur we should not get rid of home birth as an option for women. We need to make it safer for women and make sure they are making informed decisions when it comes to their pregnancy care.
Tragedies happen in the hospital as well and we are not calling for them to be shut down and taken out as an option for our health care.
I in no way stated I support midwives that had a death occur while they were attending a birth, it is a case by case issue. The same as doctors. When a patient dies in the doctors care, it gets looked at and reviewed by peers, other licensed doctors. If there was certification of midwives it would provide a level of safety for the families involved, before and after the birth.
I appreciate your response. The reason I responded in the way that I did is that allowing DEM in other states has NOT lead to the outcome you suggest. It lead to the outcomes I listed. A DEM does not have to carry malpractice insurance, and there is a history of DEMs moving to other states after tragedies on the rare case where their license is revoked in one state. When DEMs are sued, they just declare bankrupcy. So given the law you are supporting, and the outcomes we see in other states where that is the law of the land, what responsibility would you suggest exists for DEMs?
Anyway, we do have a nationally recognized midwife: The certified nurse midwife (CNM). Why do we need an additional kind of legal midwife who would not be recognized in any other first world country?
Therefore, the law you are hoping will pass will not provide one bit of recourse for families. Not one bit. This is just a fact, as evidenced by what goes on in states where DEMs are legal. Unassisted home births are arguably safer than homebirths with a DEM, because the parents will be more likely to transfer to a hospital if something starts to go wrong.
A different law might make a difference, but the specific law you are stumping for would not achieve any of the goals you state.
And, “because these tragedies occur we should not get rid of home birth as an option for women”? So the tragedies that happen in hospitals — where all possible medical interventions are possible — would be better off at home, where few of them are? I cannot follow that logic.
If it were up to me, unattended home births would be absolutely legal (as of course they have to be), and attended home births would be legal only if the attendant was a CNM or an OB. If it was up to me, I would eliminate all categories of midwives that would not be recognized in any other first world country. THAT would make a real difference in safety.
From what i understand of the bill it is so a CPM cannot be charged for merely practicing. That is a fear to some CPM’s.
So how will that make homebirth safer for women and babies? You have just told us the aim is to protect CPMs.
The licensure bill will make it safer for women and babies. This will provide women with a way to know their midwife is qualified.
You are not listening. The facts show that in every state where that model is allowed, women and children are in fact less safe, and the midwives are in fact NOT qualfied. And there is essentially no recourse whatsoever to punish an incompetent midwife.
All this bill does is make it safe for a CPM. It does nothing at all to make things safer for mothers or babies.
Kristin,
If CPMs are not eligible for licensure in any other first world coutnry, why should they be licensed here? As far as I can tell, the only benefit to licensing CPMs accrues to CPMs. It allows them to apply for insurance reimbursement. It does not thing to protect babies and women.
MANA specifically says that they have NO standards for CPMs; every CPM is allowed to make up her own “standards.” MANA has refused to release the death rates of its members. They are literally hiding the very information that women MUST have to make an informed decision.
Homebirth midwives are licensed in Colorado and they have hideous mortality rates for PLANNED homebirth. They are licensed in Oregon and their death rates for PLANNED homebirth are 8 times HIGHER than hospital birth at term.
There’s simply no evidence that licensing the incompetent makes them competent.
In other words, the licensing body for midwives in the United States — except for CNMs — quite literally has no standards. Thus, CPMs can say they are licensed, but practically speaking, it does not mean anything and it is misleading to the families who want a home birth. This does not mean that all midwives or all CPMs are unskilled. It means that knowing someone is a CPM gives you absolutely no knowledge as to whether or not they are skilled. To the families who would hire them, it gives the illusion that sufficient training occurred, but without anything to back it up.
As far as I can see, the entire text of the bill is:
“11 Notwithstanding any other provision of law to the contrary, any person who holds a current
12 ministerial or tocological certification from an organization accredited by the Institute for
13 Credentialing Excellence (ICE) may provide services as described in 42 U.S.C. §”
Even if one accepts the notion that the CPM credential is indicative of competence (despite the fact that all the existing evidence is to the contrary), where are the consumer protections in the bill? Oversight provisions?
Kristin, how will this make homebirth safer for women and babies? You keep telling us it will protect CPMs, but that in itself will only serve to increase the risks to women and babies. Want to try again, AFTER engaging your thinking gear?
“I am saddened to see the bashing of midwives by Dr. Amy Tuteur”
Please read a few more pieces here-Dr Amy believes that there are already excellent health care providers that provide the midwifery model of care-Certified Nurse Midwives. She has never spoken out against midwives who provide the option of homebirth when it’s part of the healthcare system (where there is physician back up, the midwives have privileges at hospitals, the midwives risk women out of homebirths and there are clear transfer plans written and followed).
I will read more by Dr. Amy. What I have read so far leads me to believe she is against having home birth be an option. Perhaps I am wrong.
From what Dr Amy has written, she is absolutely not against home birth being an option in the United States. But she does want it to be significantly safer than it is today, for example, by guaranteeing that any medical provider presiding at a birth has the depth of training that is present in the rest of the industrialized world.
I do understand how you would think Dr Amy is against home birth. You have to read more than one blog entry to understand the nuanced point she is trying to make. She argues strongly and forcefully, and it can seem like she is throwing out the baby with the bathwater. (Pun intentional. Sorry, couldn’t help myself. I’ll go sit in the corner for ten minutes.) I’m certain from her point of view, she finds it irritating when people accuse her of being against all home birth. But because she does argue so forcefully and passionately, I do understand how you could come to the conclusion you did.
If you stick around and read more, I trust that you will see that her goal is *not* to eliminate home birth, but to make birth — everywhere — safer. She also argues against inappropriate medical practices that ultimately cause harm to mother or child. She obviously writes much more often about harm caused by midwives, but she does not give the medical system a free ride. See, for example, http://www.skepticalob.com/2012/11/you-heard-it-here-first-new-position-paper-opposing-homebirth-is-poorly-researched-relies-on-bad-studies-and-is-woefully-paternalistic.html and http://www.skepticalob.com/2012/12/baby-jacob-a-victim-of-the-39-week-rule.html and http://www.skepticalob.com/2013/01/send-in-the-clowns-to-defend-dr-biter.html and http://www.skepticalob.com/2013/02/two-new-papers-raise-serious-questions-about-banning-elective-deliveries-before-39-weeks.html
NO, she clearly stated in the video that she believes women have the right to birth at home. What she is against is undertrained birth attendants that do not clearly understand (and therefore can’t articulate to the client) the risks of birthing at home as it’s currently done in the US.
You are not wrong.
This mother was not featured in the video but I think she says it better than many of us here could…http://creativlei.com/mirandas-life-and-loss/homebirth/I was a low-risk mom whose child died. In fact, I had NO
risk factors and had chosen a Certified Nurse Midwife with 26 years of
experience. After what I have seen and experienced I could not recommend
birth at home. Even though three of my living children were born at
home with no complication, I would not choose it again if given another
opportunity. The small chance of risk is too high a price for me, having
paid it once I would not do it again.
Three happy homebirths, Kristin. Three. Alas, the fourth time her luck ran out. And she’s against licencing you’re defending because…
recognize that there will always be women who seek to birth at home. I
do not wish to make it illegal, but I do not support legislation that
seeks to increase licensing before setting real standards of safety and
education. I do not support the licensing of lay-midwives (direct-entry
midwives and Certified Professional Midwives). I believe that a woman
choosing to birth at home should expect the practitioner she chooses to
be qualified and well-experienced in properly handling emergencies and
be responsible for their actions or lack thereof. I want to be sure that
women who do choose to birth at home have a full understanding that
choosing to birth at home leaves you at very real risk to losing a child
that may survive if born in the hospital with sufficient back up
services readily available. There my be no indicators of this risk
prenatally.
And the picture of her daughter brings me to tears. She looks so vibrant, so alive, her eyes full of curiosity.
Damn everyone who claims that speaking against uneducated babykillers is midwife bashing.
Rest in peace, gorgeous Miranda.
No, when I look at the picture again, it’s a very sick baby there. But she’s still gorgeous. She deserved better than the “care” she was offered by her very skilled midwives.
“Damn everyone who claims…..”
From what I have read and heard from doctor Amy she seems to think all midwives are uneducated. Perhaps I have not read enough. I was really taken aback by you damning me when you really do not know me.
Not all-she does believe that Certified Nurse Midwives are excellent care providers because of their education and training. She does mention that in the video. She also mentioned the midwives in the UK, Australia and Canada (where low risk women often have the option of homebirth).
I read an article where a five year old child delivered her baby brother in a car on the side of the road (aided by a 911 operator). The mother and baby were fine! Hooray! What an exciting experience!
However, I don’t think based on that, anyone would argue children delivering babies in cars is safe.
The video never opened for me but having read both Sara and Bambi, I can imagine how much more powerful it must have been in person. I am so sorry for what you went through and I think it’s very brave of you to face the truth instead of hiding behind the convenient “it would have happened anyway!” which would have been so much easier on yourselves. I really appreciate the fight you do for your babies and for all those other mothers who you could sway from the hypnothic charm of “our foremothers… bonding… empowering… and of course, safer than hospital!”
Sara and Bambi, I was moved almost to tears by your stories. (I can’t cry. Long story, not worth going into. This was as close as I’ve come in years.) I wanted to say something intelligent and could never think of anything, so instead I finally decided to at least post to say I honor your strength in speaking out, in standing up for what is right and wrong, and your efforts to prevent future tragedies. I respect the stand you are both taking, especially knowing the backlash you would get from the NCB crowd.
Dr Amy, great performance. Not only did you say all the important things, but you put them in a way that makes it especially difficult for the extremists of the NCB crowd to try to poke holes. I mean, we know their fingers are in their ears anyway, but *others* who are not blinded by dogma will hear the truth. I think that is so important. You were very effective in communicating the truth in a way in which it will make a difference.
Sara and Bambi, I applaud your bravery in putting your stories out there. Magnus and Mary Beth have amazing moms! Dr. Tuteur, beautifully professional job as always.
The take away message from this video was clear although left unstated….these infants would have survived if they had been born in a hospital and had these mothers been under the care of ob/gyn’s and hospital based CNM’s.
I don’t mean this to sound harsh because I completely sympathise with Bambi and Sara. I too was unduly influenced by the NCB community but because my husband pulled a power play and insisted on hospital only births I dodged bullets.
I didn’t get to see it live, but I did watch the video. You guys were fantastic. Bambi and Sara, thank you SO MUCH for sharing your stories. You are really making a difference.
Powerful!
Dr. Amy, I thought you were fantastic! I used to be a feminist breeder follower, but as you know, her information regarding anything like homebirth has always been one-sided and I think it’s great that you want to inform mothers of these risks. That is the best way to make any kind of decision. You have to be informed about all the possibilities.
Thank you! Who knows how many lives you saved.
Thanks!
I also found Dr. Amy after TFB. I could never go back!
Totally agree. I really appreciated the clarification that you (and me and many of the people on this page) aren’t advocating to take away the right to homebirth, but rather wanting women to be truly informed of the risk they are taking.
Sara and Bambi, thank you for your bravery in sharing your stories. Your speaking out may save lives. Wonderful piece- way to go HuffPo!!! Kudos to Dr Amy for continuing to spread the news on homebirth outcomes.
Sara and Bambi, I’m so sorry for the tragedies you both experienced. Having lost a son at 14 months I know that losing a child changes you forever.
All three of you did an excellent job with the interview. I hope it makes other mothers consider the real risks rather than being lulled into a false sense of security.
To those of you visiting this website for the first time I hope you will take the time read all the posts specifically about the home birth deaths and the death rate in Oregon.
Noooo Dr A that’s not how you say “Oregon”!
Sorry!
You should not be sorry. Its just a variation of naterel.
hahaha, so true, and I totally noticed it, too. That’s the way anyone living outside Oregon says it. I was born here, but lived in the Midwest for many years, and it always drove me crazy.
I lived in the Midwest for about 10 years and the East Coast for going on 3. When I was in Iowa, everyone said or-gone, in Chicago sizable minority of people pronounced it the way we do, and on the east coast it’s even more common for people to know. But anyone who meets me walks away knowing how to say it correctly! 😀
How do you say it? My flat Aussie accent mutilates most attempts at pronunciation but I’m now curious.
It is pronounced “Or-” (like the first sylable in the word orange) “e-” (like the “e” in the word “open”) “gun” (like you describe a firearm, the “gon” at the end is frequently mispronounced like the word “gone”).
An Aussie might not say “Orange” the way you’d expect… 😉
I say it correctly because my father was a Western-American.
It’s like the word “organ” with an “a” in between the syllables.