Don’t blame yourself, blame your homebirth midwife

who is to blame question

Dear Katie,

You may have seen that I wrote about you and your daughter Natalie recently. I wrote about you and Natalie because she died due to the indefensible decisions of a homebirth midwife.

I see that have now entered the emotionally wrenching stage of determining why your daughter died when she easily could have been saved. You are now blaming yourself for Natalie’s death, reasoning that if you had shared certain information, she would still be alive today.

Then I think back to 2009 when I fell on the stairs and had the worst pain of my life. I never got it checked out because falls happen. It was pretty painful for a few months. So I look up vaginal birth with broken tailbone and read what others say. Some say their doctors recommend c-sections, others say they tried vaginal and it felt like it was being broken again…

But then I think, what if this IS the answer? I grew a perfectly wonderful person inside of me, researched about home birth and took baby classes and got prepared, but I failed to mention my broken tailbone. How could I be so irresponsible? I didn’t know that was going to be an issue, but I should have known. Why wasn’t that question asked to me? Would it have been asked or found out if I did a hospital birth?

The guilt is crushing:

Other mothers on here have reasons for their stillborns like it was an infection or something they couldn’t control with their placenta or the cord. Their problems were out of their control. My problem was in my control. I would have my daughter right now if I just thought of it…

I always thought that maybe finding out the reason would give me an understanding and some peace. But if this is the reason, I only feel more guilt and sadness because it could have been prevented.

But, Katie, a previously broken tailbone is NOT why Natalie died. She died because the evidence that she was experiencing significant distress was ignored. It was ignored by the very person whom you paid to pay attention, your homebirth midwife. You are right about one thing, though. Natalie did not have to die.

Why did she die? Let’s count the many reasons, direct and indirect:

You wrote in your original post on BabyCenter:

After 6 hours of pushing, not only was I in pain and tired but she hadn’t moved and there was meconium running down my leg which indicated that she was in stress…

1. You should NEVER, EVER, under any circumstances have pushed for 6 hours anywhere, but especially outside the hospital where there was no access to emergency care. Your homebirth midwife should have transferred you to the hospital after 2-3 hours of pushing, at the most.

2. Meconium running down your leg indicated the high likelihood that Natalie was severed stressed. Your homebirth midwife ignored that very obvious sign.

3. Your homebirth midwife was either stupid or a liar. You wrote back in March:

My midwife said that these “complications” can be foreseen way in advance and can be fixed as long as the signs are noticed.

That is a lie. If a healthcare provider doesn’t tell the truth, either because she is so uneducated that she doesn’t know it, or because she deliberately wants to keep the truth from you, you should run as fast as possible in another direction.

4. Homebirth midwives are grossly undereducated and undertrained. They aren’t real midwives; they are lay people pretending to be midwives and would not be eligible for licensure in any other first world country.

So the proximate reasons why Natalie died are because you hired an unqualified provider, who either didn’t know or didn’t tell you the truth about complications, and ignored the two major complications that you experienced (vastly prolonged pushing phase, and meconium).

There are indirect reasons, too.

5. The organization that represents homebirth midwives, the Midwives Alliance of North America, is hiding their own death rates. They KNOW that homebirth kills babies, but they are doing everything in their power to make sure that American women don’t find out. But the truth is coming out anyway. On the very thread where you are blaming yourself, two other women reveal that their babies died of preventable causes at homebirth.

6. Homebirth midwives and homebirth advocates LIE about what the scientific research actually shows. There has only been ONE scientific paper in the past two decades that look specifically at the death rates at the hands of homebirth midwives (Johnson and Daviss, 2005). Although the authors claimed that it showed that homebirth with a homebirth midwife is safe, it only looks that way because of a trick. The paper actually showed that homebirth with a homebirth midwife had a nearly 3X higher rate of death.

7. You weren’t told that the CDC statistics show that homebirth with a non-nurse midwife has a death rate anywhere from 3-7X higher than comparable risk hospital birth.

8. You weren’t told that in the states that have kept the best statistics, Colorado and Oregon, homebirth had a dramatically higher death rate. In the case of Oregon, homebirth with a homebirth midwife has a death rate 800% higher than comparable risk hospital birth.

9. You spent a lot of time on BabyCenter surrounded by ignorant homebirth advocates who didn’t know these things either. For the life of me, I can’t understand why women crowd-source a life or death decision like homebirth. The women on BabyCenter are just laypeople who have limited or no knowledge of what science actually shows about homebirth. Yes, I realize that they believe that they are knowledgeable, but they know so little that they have no idea that they are basically ignorant on the topic.

Ultimately, of course, it was your decision that led to Natalie’s death, but it had nothing to do with whether you remembered the possibility that you may have had a broken tailbone in the past. It was your decision to hire an incompetent provider, a lay person pretending to be a midwife, who ignored the signs that your daughter was dying before her eyes. But, in your defense, you probably had no idea that your provider was just a lay person pretending to be a midwife, that all the existing research shows that homebirth leads to preventable deaths, or that the organization that represents providers like yours is desperately hiding what they know about the increased death rate at homebirth.

Tragically, nothing can bring Natalie back. However, there may come a time when you find that keeping someone else from enduring the preventable death of their baby may give you some comfort. In that case, there are several things that you can do.

1. For support you may wish to join the private Facebook group of homebirth loss mothers. If so, you can email me or friend me on Facebook and I will connect you with the group.

2. You can speak out every chance you get about what happened to Natalie, and how homebirth leads to preventable deaths like Natalie’s.

3. You can lobby your state legislator to restrict the practice of homebirth midwives.

4. You (and your family and friends) can sign the petition to force MANA to release the death rates of the 27,000+ homebirths in their database. I suspect that you would have thought twice about homebirth if you had known just how high the death rate at homebirth really is.

I am so sorry about what happened to Natalie and to you. The fact that it didn’t have to happen just compounds the tragedy.