Australian homebirth death shows it’s time to reform midwifery

Time For Change

Joseph Thurgood didn’t have to die.

Tate-Spencer Koch didn’t have to die.

Jahli Jean Hobbs didn’t have to die.

Charlotte Rodman didn’t have to die.

All four died preventable deaths at homebirth.

Joshua Titcombe didn’t have to die.

Nittaya Hendrickson and her unborn son Chester didn’t have to die.

Sareena Ali and her daughter Zainab didn’t have to die.

All 5 died preventable deaths in the hospital.

These 9 deaths, and dozens of similar deaths that I have written about over the years are distinguished by one common factor: all involved arrogant midwives; midwives who thought that they knew more about childbirth safety than doctors; midwives who were utterly, tragically, negligently wrong.

Let Joseph Thurgood’s death be a clarion call for an all out effort to reform midwifery. First world midwives, regardless of educational background, regardless of international location, regardless of the location at which care is provided, are desperately in need of better education about childbirth, greater understanding of their own limitations, and above all, administrators and thought leaders who understand that midwifery is about saving babies and mothers and not about extending the employment opportunities of midwives.

What happened to Joseph Thurgood? According to The Age:

A coroner has found a baby’s death after a home birth went wrong could have been prevented if the labour and delivery had been carried out in a hospital…

[The Coroner] said midwife Fiona Hallinan had indirectly contributed to the baby’s death by failing to tell the mother of the risks of home birth which had “sustained the misguided views of the mother, contributed to her disregarding the advice provided by obstetric medical clinicians and facilitated in her a level of confidence that she may safely proceed to home birth”.

The Coroner correctly identified that Joseph’s mother naively and erroneously thought that she was educated about homebirth because she had done “research” on the internet:

…Ms Thurgood’s use of the internet to research home birth was “sadly an example of the danger of untrained users utilising raw data or statistical information to support a premise as to risk, without knowledge and understanding of the complex myriad of factors relevant to the risk”.

“To disregard the obstetrician’s advice on the basis of a mantra founded in … data obtained from the internet is a dangerous course to follow,” the coroner said.

The coroner recommended the Health Minister consider regulating the practice of providing home birth services and develop a source of information to help prospective parents be fully informed of the issues associated with various birthing options.

That’s good as far as it goes; homebirth advocates pride themselves on what they know, but most of what they know is factually false.

But that only protects women who choose to deliver at home. How about women who choose to deliver at the hospital and then lose their babies or their lives because midwives deny them access to obstetricians and pediatricians? It doesn’t do anything for them. These same midwives are desperately in need of comprehensive education reform.

Unfortunately, obstetricians in first world countries have left midwives to their own devices, reasoning that they ought to be able to handle uncomplicated childbirth and call for help when complications occur. I suspect that most obstetricians have no idea that contemporary midwifery has been highjacked by a bunch of post modernists who appear to think that midwifery autonomy is ever so much more important than whether babies and mothers live or die.

I’m not talking about the clowns of the Midwives Alliance of North America (MANA) who aren’t really midwives at all, just lay people with a pretend “credential” that they awarded to themselves. I’m talking about supposedly adequately trained midwives who spew nonsense, like:

Australian midwifery professors Jenny Parratt and Kathleen Fahy, responsible for the criminally inane “paper,” Including the nonrational is sensible midwifery.

British midwifery professor Soo Downe who invokes quantum mechanics, which she does not understand, to explain why midwives can ignore scientific evidence.

Cathy Warwick, head of the Royal College of Midwives, who thinks the solution to every problem, including the problem of preventable deaths at the hands of midwives, is to give midwives more autonomy.

Hannah Dahlen, spokesperson for the Australian College of Midwives, who has callously asserted that perinatal mortality is a “kindergarten” view of birth.

Dutch midwifery leaders who have yet to take any responsibility for the appalling fact (which they acknowledge to be true) that Dutch midwives attending low risk births, home or hospital, have higher death rates than Dutch obstetricians attending high risk births.

These women, and many of those that they teach and represent, have become infected by a toxic mix of ignorance, arrogance and obsession with autonomy at the expense of the lives of mothers and babies.

The Coroner is correct that women can benefit from greater and more accurate information about the risks of childbirth and homebirth, but even more women will benefit by overhauling midwifery education to reflect scientific evidence, as opposed to the midwifery fantasies that are currently killing women and babies.

Homebirth is just the tip of the iceberg. International midwifery has become infected by the rot of midwifery arrogance and self-interest. It’s time to start improving the education and accountability of midwives. Mothers and babies deserve no less.

  • Well Informed Mommy

    My daughter died in the hospital due to doctors error. I never expected that to happen! I always thought that if I was in the hospital with all the “life saving equipment” then everything would turn out ok. Obviously not – that was a sad education on my part. After that I went on to have 3 boys at home. They are happy, healthy and alive. If I felt that I needed medical assistance I would still go to the hospital. But that would be an EMERGENCY. Regular childbirth in and of itself is not an emergency. Constant medical intervention is not as safe as most of us assume it is. These medical interventions can cost our children’s lives as much as doing nothing when we should. If you started investigating unnecessary hospital deaths and writing articles about that, you’d be in for a rude awakening. There are many hospital deaths that occur that if the parent had chosen another birth alternative their babies would be alive today. I personally know of several and I’m just one person. Start asking others… Your articles are ALWAYS very one sided. It would give you a lot more credibility if you really did your homework and reported both sides. It shows me that you have some kind of agenda and are unconcerned with actually reporting childbirth abuses and deaths on the “medical” side of the fence. That doesn’t help parents with all the facts. It seems the articles you write are done to promote fear, anger, and your agenda.

    • Elizabeth A

      Dr. Tuteur has actually written about – and condemned – deaths due to medical error, several times.

      I’m so sorry about your daughter.

      • Well Informed Mommy

        I’m sorry. I have never seen these. Perhaps you could share them with me.

        • AmyP

          Stick around. There will be one eventually.

          Dr. Tuteur has written a bunch against being too strict about the 39-week induction rule, which is a medical error issue.

  • Jenni

    What do you have to say about maternal death rates in the US (ranked 50th globally), which are rising and almost exclusively under the control of obstetricians?

    • Dr Kitty

      No, Jenni they aren’t “under the control of obstetricians”.
      The leading cause of death in pregnant women in the USA is still murder.

      The leading medical cause of maternal death in the US is now cardiac disease.

      Barriers to accessing antenatal care, obesity, poverty, drug and alcohol misuse and pre-existing illnesses contribute to maternal deaths.

      Obstetricians can’t fix everything.

    • Amy Tuteur, MD
  • Sue

    It’s Mothers’Day in Oz – Happy Mothers’ Day to all my lovely SOB friends!

  • Hannah

    With regard to Joshua Titcombe and the Hendricksons, a toxic midwifery culture was certainly a factor, but that hospital had other systemic problems beyond broader midwifery culture. The families have set up a campaign for an inquiry into what went wrong:

    http://www.morecambebayinquiry.co.uk/

    On a separate but not entirely unrelated note here’s a court case arising out of a homebirth/independent midwife related disaster:

    http://www.bailii.org/cgi-bin/markup.cgi?doc=/ew/cases/EWHC/Admin/2012/3021.html

    It was a breech, vbac in a mother who had an underlying bicornate uterus. The midwife was struck off but went to the High Court to appeal adverse findings of fact that contributed to that.

    Completely off-topic but I came across this, that I thought people here might find interesting/fun:

    http://storify.com/GuerrillaMedEd/my-midwife-said-i-should-bring-him-to-hospital

  • Sue

    I’m still waiting for the Australian College of Midwives – for whom Dahlen is spokesperson – to call out the rogues. Tip: it’s not just that “guidelines weren’t followed”‘ – it’s that these people think they are above guidelines.

  • This is a bit of a problem for everyone – for mothers and their babies as well as those wanting to ensure all women get access to quality maternity care.

  • CanDoc

    Love. This. Post.
    Every. Word.
    Thank you, Dr. Amy, keep the light shining on this issue with such clear logic.

  • OT:
    https://lucina.worldsecuresystems.com/model-faq.html

    I haven’t been able to read through the deliberately obscure language to find out what exactly they want to do. Anyone?

  • I don’t have a creative name

    “Hannah Dahlen, spokesperson for the Australian College of Midwives, who
    has callously asserted that perinatal mortality is a “kindergarten” view
    of birth.”
    As opposed to what? The junior high “My experience is ALL that matters!” view that she has?

  • Amy Tuteur, MD
    • Rabbit

      You know, it seems to me that filing an opposition to the submission of an amicus brief — especially when the proposed brief was attached to the motion — is nothing more than a good way to inflate your billable hours. The judge and law clerk likely read the proposed brief about two minutes after reading the motion seeking permission to submit it; they aren’t going to erase the information from their brains even if the judge does ultimately deny the motion to file. District courts aren’t limited to the grounds or arguments asserted by the parties when making their rulings either, so rejection of the amicus brief does not suddenly wall off any of its arguments from consideration by the judge.
      So the judge now reads the opposition to the amicus, probably re-reads the proposed amicus brief before making his decision, and this gets Gina where? Best I can see, it gets her another 10+ hours on her bill at the end of the month.

    • Lisa from NY

      Dr. Amy,

      Most of Gina Crosley-Corcoran’s fans are illiterate and will believe what she says, true or not.

      In the end, you will win and she will say that you paid her $50k as an apology.

      • suchende

        I am not so sure. I don’t think even Gina can claim to have won if a decision said she lost.

        • attitude devant

          Gina’s readers never look anything up for themselves. They take whatever Gina says as pure gospel. Some of them are still under the impression that it’s Gina who filed the suit.

          • suchende

            She admitted she never filed in the comments of one of her notes. I’ve found her to be a spinner, but not a liar, w/r/t this case.

    • Veronica

      Gina’s fangirls still don’t get it. Posted on her FB page: “Tracy Cassels I just discovered she wrote about me and my site today Kick her ass!”

    • KarenJJ

      Interesting – it reads to me that the latest defence is that you were too proactive in trying to protect your blog by switching servers?

    • theNormalDistribution

      Woah, even Gina is commenting on this article:

      This is Gina Crosley-Corcoran. Since there are two facts here that people are getting wrong, let me help you…

      My lawyer did NOT say that I didn’t have a copyright case. My lawyer said that I DID have a, quote, “slamdunk” copyright case. Her affidavit saying so was already filed with the court, but apparently everyone would prefer to believe the plaintiff’s flat out fabricated lie on that point. The court has evidence proving I filed my DMCA in good faith on advise of legal counsel.

      Second point: I did not “brag” about my DMCA taking down her site. In fact, the court has the evidence (submitted by her side, ironically) showing me saying that I, quote, “wish I could take credit, but this was more than me.” I knew then that the host did not take action to remove her site because of my DMCA, and she knew it too.

      Thanks for letting me clear that up (if you have any interest in the actual publicly available facts anyway.) I can’t wait for you to see what’s being filed next. 🙂

      http://www.techdirt.com/articles/20130509/01272923016/key-legal-fight-shaping-up-over-legality-dmca-abuses.shtml#c357

    • LukesCook

      This needs a wider audience:

      “Re:

      I’ve tried being politely insulting… it didn’t work.

      Now to use an old fashioned method that might get through that really thick skull of yours…

      YOU SIMPERING MORON, THE PEOPLE ON TECHDIRT DON’T GIVE A FLYING FUCK ABOUT YOU OR YOUR PETTY BITCHFEST.
      WE DON’T CARE IF YOU DID OR DIDN’T FILE THIS OR THAT.
      WE DON’T CARE THAT YOUR TRYING TO REWRITE YOUR OWN HISTORY TO MAKE YOUR POSITION LOOK BETTER.
      WE CARE BECAUSE THIS ASININE LAWSUIT OPENS THE DOOR FOR THE COURTS TO ACTUALLY TRY AND FIX THE FLAWED DMCA PROCESS.
      IF YOU COULD PULL YOUR HEAD OUT OF YOUR OWN BIRTH CANAL FOR A MOMENT YOU MIGHT UNDERSTAND THERE ARE OTHER PEOPLE IN THE WORLD WHO DON’T GIVE A FLYING FUCK ABOUT YOU.
      IT IS NOT ALL ABOUT YOU.
      THIS IS NOT THE RIGHT FORUM FOR YOU TO ATTEMPT TO WIN POINTS, YOU IGNORANT PETTY LITTLE PERSON.
      YOU ARE A LEGEND IN YOUR OWN MIND WHO WILL BE LONG FORGOTTEN ONCE THIS CASE IS DECIDED, AND THE REST OF THE WORLD CELEBRATES OR MOURNS THE COURTS RULING ON THE ISSUES ABOUT THE DMCA.

      In closing, here is the advice from your lawyer your ignoring. SHUT THE HELL UP. Everything you say can be traced as coming from you, and your attempts to spin the narrative will be exposed and the Judge will be able to see these things… Judges dislike people who lie.

      I don’t care who is right or wrong in your great moral catfight, but I’m starting to think the Dr. on the other side must be a hell of alot smarter than you because she is keeping her mouth shut and not chasing every little blog mention trying to score points in the court of public opinion to keep herself looking important.

      Grow the hell up and try to think there is a world outside of your little bubble who doesn’t give a crap about you.”

      • Those people who think we are mean are in for a bit of a shock if they stray into that battle, aren’t they? Lawsuits, with their terrifying costs and weird way are about as funny as toothache, but this one is fascinating. It annoys me greatly that it can be treated as a “bitchfest” as if it were nothing more than a petty squabble over something of no importance, a mere slanging match. What Gina did was outrageous on quite a few levels, and it is important that she should learn that. Much as I dislike her, I hope there is a way for her to avoid the worst consequences of her very foolish actions while learning something from it all.

  • Lisa from NY

    The hero of this story is the coroner, Coroner Kim Parkinson, who is speaking his mind.

    • Aunti Po Dean

      clears throat…that would be HER mind

  • I’m an American who lives in a Western European country (for my husband’s work) and is expecting my first baby in a few weeks. I have had all my prenatal care with my obstetrician, but, as is typical here, the baby will be delivered by the staff at the delivery hospital that my husband and I picked. After a diagnostic ultrasound with an OB at the delivery hospital, I was placed in the group that is low risk enough to be cared for primarily by midwives during delivery. However, all deliveries are overseen by the three delivery OBs on staff at any time, and one of them comes in for the last part of labor to be the one to catch the baby. After going home from the hospital a few days later, a different home visit midwife (who already has already met with the mother at least once before) comes to her home ten to fifteen times, as needed, to check on the mother’s stitches if she has any, help her with breastfeeding if she wants, answer any questions about baby care, takes the baby’s weight, etc.
    My baby isn’t here yet, but the system has worked really well for me so far. My midwife didn’t hesitate to tell me to ask my prenatal care OB when I asked her about vitamins, and my prenatal care OB didn’t hesitate to tell me to ask my midwife when I asked about what exactly I should bring to the hospital. I’m sure there is stress, at times, between midwives and doctors, but I haven’t personally seen any instances of conflict or lack of professionalism. I would love to hear anybody’s opinion on this system. Of course, I just want me and my baby to be safe, and we are scheduled to be cared for in a large, well regarded, international hospital with a NICU.

    • Dr Kitty

      Sounds like a good system.

      Are you going to make us play guess the country?

    • I’m thinking Germany.

      • LukesCook

        The key point that seems to distinguish Germany is that the initial assessment of “low risk” – midwife – vs “high risk” – OB – is made by an OB and not a midwife.

        • yes, and it is the only system where you don’t have to choose between OB and midwife, you can have both- and I thought this was Germany because it seemed so similar to my birth there

    • MJ

      That was my experience in hospital in Australia with my last baby – although my little boy was delivered by two midwives and not an OB (he had examined me when i came in for the induction and been consulted on a couple things throughout the labour). It worked very well. My midwife was highly professional and very aware of and comfortable with the limits to her expertise (for example, referring dodgy thyroid results during pregnancy to an endocrinologist etc).

  • Melly

    Let’s see…advanced maternal age, 3 previous cesarians, post dates, breech baby. That’s a whole lot of “variations of normal”.

    • attitude devant

      And a bleed. Good God, just how arrogantly blind to impending disaster can you be? And the description of the baby, born ‘floppy, not breathing, and without a heartbeat.’ In other words, dead.

      I’m reminded of Dickens: “Dead, your Majesty. Dead, my lords and gentleman. Dead, Right Reverends and wrong Reverends of every Order. Dead, men and women, born with heavenly compassion in your hearts. Dead and dying thus around us every day.”

  • Hannah

    Let me get this straight- this midwife was attempting home VBACX3 on an advanced maternal age mom? Oh, and the baby was BREECH? Seriously?? Who would be so flippant about the lives of a woman and her child to actually attempt that?

    • attitude devant

      And a bleed. Don’t forget the bleed. Oh, and this mom saying she didn’t understand there was risk? Oh puh-leeze!!! How could you not? I am damn certain that she was informed of the risk when she was in the hospital for her bleed. It’s like a folie a trois: the mom and the two midwives. Were they just deactivating the parts of their brains that think critically?

  • Dr Kitty

    My DH knows that in the event I ever get pregnant wit #2 and go into labour before my scheduled CS, his job is solely to ensure I see an obstetrician and get my repeat CS as soon as possible, and an epidural placed in the meantime.

    I don’t want to be in a position where a MW decides that I should have a “healing” VBAC against my wishes, and tries to delay or obstruct access to a CS if labour appears to be progressing unproblematically.

    I have also told him that “Asking for an NMC number is a statement of intent”.

    So the strategy is to say:
    “No, we’re very definite that we don’t want a TOL, we’d like a CS ASAP. Oh, you think that might be a few hours? Your NMC number is? Why? Oh, just in case it comes in useful later on, say if we end up with a VBAC, contrary to the plan we agreed with our OB.”

    Nothing impolite, just being very, very definite about the plan, and appearing fully aware of how to complain/sue.

    I hope the strategy is never necessary, but we have it.

    I have personal experience of nurses and Midwives who are great, but also some who overstep the boundaries of their clinical competence.

    • Lisa from NY

      I have a friend who is using a CNM for her baby, if it ever comes. She is 50 years old, in her ninth month, attempting a home vbac. Baby due in two weeks, no braxton-hicks yet.

      This CNM has a full ten years experience as a labor and delivery nurse. You would think she should know better.

      • attitude devant

        I am speechless. Knowing what I know about obstetrics, if I were she I would be booking an OR date. Why a VBAC? So she doesn’t have to worry about a placenta accreta with her next baby? She’s FIFTY, for heaven’s sake!!!! And at home? WHY???

        • KarenJJ

          I can think of one reason why and it’s not a nice one.

          • Certified Hamster Midwife

            She wants to have more kids?

      • Therese

        Why do you say “if it ever comes”? Just because she’s not having braxton-hicks? It is possible to have braxton-hicks and not feel them. I learned that from having NSTs. The rest of that is all very disturbing though.

    • LukesCook

      I suppose that saying “will you write that down for me and sign it please” would have a similar effect.

    • ratiomom

      Do any of the commenters with legal training have more advice on this?
      I share your concern. My first birth was a cesarean for breech, and after much reading and consideration I decided that I just don`t want a TOLAC. My OB says she will respect that choice, as long as I accept that it will reduce my family size (I do!),
      My concern is what will happen to me if I go into labor in the off-hours before my due date. I`ll be at the midwives` mercy and that is not a good situation to find yourself if you want anything other than `natural without pain relief`.
      Writing down their name and NMC nr would be a good idea. I`m also going to ask them to sign 2 copies of a statement saying they have heard and understood that the plan for my birth as agreed with the OB is a cesarean, and that I explicitly refuse to consent to a TOLAC. One copy goes in my chart, I keep the other just in case.

      • Dr Kitty

        If it is the NHS, there will be a Reg on call in the hospital. You tell your MW you want them bleeped to your room. Barring emergencies they should be there quickly and you have a right to request assessment by a doctor.

  • KarenJJ

    I feel like the midwives leaders attitudes today are like the doctors attitudes of 50 years ago that they deplore.

    • Susan

      I agree. “We must be right because it’s us” hijacks any chance of insight into one’s own flaws.

    • Eddie

      VERY good point.

  • suchende

    Educating healthcare providers only helps improve outcomes when the educated use that information to inform their practice. In an industry so thoroughly infected by ideology, I don’t know that credentials are very informative. How terrifying for patients.

    • Amy Tuteur, MD

      It seems to me that a good first step would be to have the courses about the physiology of childbirth and about the diagnosis and treatment of childbirth complications taught by obstetricians, not midwives. Midwives should start off with a grounding in actual science and apparently many midwifery professors are incapable of providing that.

      • Laura

        As someone who is aiming to go into midwifery in a couple of years to get my CNM I am concerned about the sort of education I will be getting. I do see various sides to the homebirth vs. hospital birth, ob vs. mw debate because of my own experiences and the years I’ve spent reading your blog. I feel like, more than anything, your blog has challenged me to question everything and understand the challenge of understanding “facts” presented with all the gory statistics and research methodology picked to shreds. Really, it has been invaluable. I will keep reading as my formal education draws near and sift through the various midwife attitudes I will no doubt encounter. But I ALWAYS want it said about me that I intelligently, passionately, and uncompromisingly put the safety of women and their babies FIRST.