MANA’s shocking indifference to homebirth deaths


After my talk at ACOG’s Maui conference, I was approached by quite a few obstetricians who wanted to share their stories of homebirth transfers that they couldn’t save. It seemed that even years after the fact, many doctors were haunted by what might have been: if only the homebirth midwife had understood that the baby was breech; if only she had recognized fetal distress; if only the patient had transferred to the hospital sooner. And it struck me quite forcibly that these supposedly heartless obstetricians mourn the deaths of homebirth babies far more than the midwives who presided over their deaths.

Nowhere is that more evident than in the shocking indifference of the Midwives Alliance of North America (MANA) to the deaths at the hands of their members. To say they couldn’t care less is an understatement. They don’t even bother to pretend for public relations purposes. Imagine that real medical providers such as hospitals, physician organizations or state medical societies were presented with evidence that a higher proportion of patients than expected died under their care. Whether they truly intended to do anything or not, we would expect expressions of concern, promises to investigate, committees to study the problem, etc.

MANA can’t even muster false concern. Instead, every new report of the dramatically increased death rate at homebirth attended by non-nurse midwives is met by a wall of defiance. MANA lies about what the study shows; MANA lies about previous research, MANA adjusts the comment policy on it’s blog to create a “safe space” (i.e. a truth-free zone) where supporters of homebirth can discuss it without the pesky interference of tiny dead bodies.

MANA doesn’t promise to investigate reports of the increased risk of perinatal death at homebirth. Why would they? They know from their own data that homebirth increases the risk of perinatal death.

MANA doesn’t promise to create committees to study the problem. They have no interest in solving the problem, so why would they study it?

MANA never claims to reassess the scope of practice of homebirth midwives. They are publicly on record as supporting each midwife setting her own (!) standards as if standards were personal opinions and not professional guidelines.

MANA no longer even bothers to deny the increased risk of death at homebirth. Their new approach could be summed up as “Sure more babies die at homebirth, but the absolute risk is low” as if that excuses those preventable deaths.

MANA’s indifference to these dead babies is more than shocking to me. It is downright chilling. I haven’t practiced obstetrics for many years, but I still remember the deaths of babies who we expected to live. In most cases we had already applied every piece of technology at our disposal and every bit of obstetric knowledge we had to save them, so there were no personal recriminations about not doing more. Nonetheless, I and the other physicians were profoundly moved, questioned everything we had done, and publicly presented the case to the other obstetricians and midwives in the department to be sure we had done everything we could.

No doctor or certified nurse midwife ever dared suggest that some babies aren’t meant to live, or tried to console us by pointing out that our absolute death rates were small. Had they done so, I suspect the head of the department would have fired them on the spot. Every baby counted for us and, honestly, I cannot fathom why every baby does not count for the women of MANA.

I suppose I could be grateful for MANA’s chilling indifference to the increased risk of perinatal death at homebirth. It certainly makes my job of pointing out the deficiencies of homebirth midwifery even easier than it already is. Sure, I can tell people that homebirth midwives are just laypeople masquerading as midwives, that they lack the education and training of all other midwives in the first world, that they are ineligible for licensure in any other industrialized country. But, at bottom, the most powerful demonstration that homebirth midwives aren’t healthcare providers is their casual indifference to homebirth deaths.

Actually, their reaction is worse than casual. Instead of calling for an investigation, instead of waiting for peer review of the midwife’s actions, instead of withholding judgment until all the facts are in, homebirth midwives call for a rally, raise money and wail that any attempt to hold homebirth midwives accountable for homebirth deaths is persecution and a violation of human rights.

By their actions and their words, homebirth midwives in general and MANA in particular, demonstrate their shocking indifference to the preventable deaths of babies at homebirth. I suspect that their reaction elicits a more powerful response of distrust and disgust than anything I could ever write about homebirth.

So thank you, MANA, I guess, for making my task easier. While you are cheerfully hiding the deaths of babies at homebirth, the public is recoiling in horror.