Oregon midwives acknowledge hideous homebirth death rates

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Back in March, testifying before the Oregon legislature, Judith Rooks, CNM presented data that demonstrated that planned homebirth with a licensed midwife in 2012 had a death rate 800% higher than comparable risk hospital birth.

Oregon midwives have remained publicly silent on the issue, but now the Oregon Midwifery Council (OMC) has advised its members that things must change.

 

In a letter sent to members, President Silke Akerson wrote:

I am writing on behalf of the Oregon Midwifery Council to suggest specific rule changes to address the apparent increase in perinatal mortality with Licensed Direct-Entry Midwives in Oregon in recent years. While we know that Oregon Midwives generally provide excellent care, we also have been receiving reports of more deaths than usual in 2012 and 2013 and were deeply troubled by the vital records data for 2012 which showed a perinatal mortality rate significantly higher than what we would expect.

Higher than what she would expect? How would she know what to expect when she never bothered to check the perinatal mortality of Oregon DEMs at all, and when Melissa Cheyney, the Head of the Board of Direct Entry Midwifery, categorically refused to released the death rates Oregon homebirth collected by the Midwives Alliance of North America?

In response, the OMC recommends common sense measures that they have hitherto opposed, including:

1. Require LDMs to participate in peer review per Oregon Midwifery Council guidelines …

2. Require continuing education in risk assessment…

3. In recognition of their greater risk and the need for deeper informed choice, we recommend that you separate breech and twin births from the non-absolute risk criteria and put them in their own category with their own rules for consult and informed choice…. We recommend that the LDM be required to recommend that the client consult with a hospital based physician or CNM in order to hear risk and benefit information from a hospital based provider as well as from her midwife as part of the informed choice process. We also recommend that the LDM be required to give the client detailed and specific information about her hospital birthing options related to breech or twin births, including any options for vaginal breech or twin delivery in hospital.

Oops, it turns out breech and twins aren’t variations of normal, something that everyone else has known all along. Indeed, the legislature insisted on separate consent as of June 2011, but Melissa Cheyney and the Board repeatedly applied for extensions, at least up to July of 2012. It is not clear to me whether they ever produced a consent form in compliance with the requirements.

It appears that these common sense provisions, that should have been instituted years ago, are merely “recommendations,” not requirements. It remains to be seen whether Oregon DEMs will comply and whether the Oregon legislature will turn these recommendations into mandates.

I’m glad for the recommendations (woefully late and woefully inadequate as they are), but I find it particularly ominous that Akerson reveals that the hideous death rate of 2012 has apparently continued in 2013.

In all other circumstances, when we find that a product is particularly dangerous, we recall it and ban its use temporarily until the problems can be fixed. It is truly amazing to me that knowing what she does about the ongoing high death rate, Akerson does not recommend physician consultation for all homebirth patients until proper regulations are in place.

I never doubted for a moment that the hideous death rate of homebirth would catch up with CPMs and DEMs, and slowly but surely it is beginning to do so. What I cannot fathom is the extreme coldbloodedness that allows midwives like Akerson and Cheyney to ignore the babies that are inevitably going to die in between now and the time that rigorous standards are instituted.

I learned yesterday of yet another Oregon homebirth death, although I don’t yet have all the details. We cannot bring back the babies who have already died at the hands of Oregon homebirth midwives, but shouldn’t everyone be doing everything in their power to make sure that no additional babies die preventable deaths at homebirth?

I’d be happy to give Silke Akerson a chance to respond in a guest post if she so desires, as long as she is willing to address the fundamental question: why are homebirth midwives still practicing if they are so very dangerous?

 

MANA knows the death rate for Oregon and for every other state in previous years. Please sign the petition to force them to release their own death rates, which they have been hiding for years.

  • Deborah

    I also find it quite incredible as an Australian midwife (hospital setting) that these changes are being referred to as recommendations rather than mandates! It is astonishing. Also, no obstetrician or health care provider I know, including those who provide homebirths, would be positive about attempting a twin or breech birth at home. Not one. Referring to a hospital based care provider would probably only serve to reinforce the belief that “hospitals only want to scare me and take away my birth experience” to someone submerged in natural birth ideology but it may sway someone who is undecided or not indoctrinated. We are very fortunate here (in my hospital) as our obstetricians regularly facilitate vaginal deliveries of breech and twins in favourable circumstances. I cannot even begin to fathom a system of midwifery for which a document such as this has to be drawn up.

  • Deena Chamlee

    With horrendous death rates in: california, oregon, missouri, colorado, north carolina and mana knowing and Ina knowing time for ethics review. They must be barred from future practice in the US.

  • Mr.G

    I wonder if anyone knows of a licensed health profession without liability insurance. Your Ob has one, your lawyer, and also your hairdresser has one, your plumber and the deli at the corner. If midwives would be required to have a liability insurance they will be out of a job in a second because rates would be astronomical.

    • DaisyGrrl

      It boggles my mind that many (all?) of these women don’t have liability insurance in such a litigious society. What about birth centres? Surely they’re required to have liability insurance for the property. What if there’s a slip-and-fall in the parking lot or reception room?

      • Young CC Prof

        As far as I know, birthing centers need liability insurance. That’s why we don’t have any near me, they were driven out of business by the cost of insurance.

    • The Bofa on the Sofa

      My wife, a veterinarian, has liability insurance. In case there is a problem with a PET.

      If midwives would be required to have a liability insurance they will be out of a job in a second because rates would be astronomical.

      Interestingly, midwives use this argument (“it would cost too much”) as an argument as to why they won’t get it. Apparently, they don’t think about WHY the cost would be so astronomical.

    • Jessica

      I hope you realize that only one state requires lawyers to have liability insurance.

      Oregon.

  • Happy Sheep

    “Higher than expected number of deaths”
    They “expected” a rate similar to the hospital death rate or lower, because home birth is as safe or safer than the hospital dontcha know.

    • DaisyGrrl

      Note that the last couple of years have “more deaths than usual”. I wonder if she’d care to release the “usual” number of deaths?

      • Anj Fabian

        I always wondered about the partial release of data.

        If the data is verified and reliable, then release it. Unless there are some ‘bad years’ that will attract attention, in which case just release the ‘good years’ and hope people are satisfied.

  • thankfulmom

    She stated in her letter that they strongly support twin and breech births at home. Then stated to encourage the mother to see an OB or midwife to completely understand the risks involved. Right..they’ll say it is just something they have to do and that doctors will play the dead baby card. They will undermine anything a professional tells them.

    She is aware the death rates are higher in a home birth, but I don’t think she truly cares because her solutions fall way short of preventing more deaths.

    • Sue

      At least that is a step towards proper informed consent for parents.

      OTOH, it is virtually unheard of for an organisation of health care professionals to continue to support a practice that clearly leads to significant harm, when there are readily-available alternatives.

      • Young CC Prof

        You know what we call “medical professionals” who cling to a practice long after the evidence against it is clear? Quacks.

        • AnonymousGuest

          AGREED.

        • Happy Sheep

          I call them CPMs.

  • SkepticalGuest

    OT, but…As many of you know, I’ve posted a bit about combo feeding here. Sometimes my user name shows up as SkepticalGuest, others as OlderMom. I’m the same person.

    Anyway, suffice it to say I’m about as phobic of the breast-feeding brigade as they come.

    Nonetheless, I found this essay in the NYT interesting: http://parenting.blogs.nytimes.com/2013/10/09/a-breast-feeding-latina-mother-looking-for-support/

    For every woman who feels badgered into breastfeeding and shamed for using a bottle–and believe me, I’m one of those women!–it does seem that there are legitimate gripes of breastfeeding moms, especially in ethinic communities.

    • Not out of touch, I hope

      I’m a Puerto Rican woman (or more accurately, a Nuyorican woman) and that essay annoyed the hell out of me. She came across as an out-of-touch yuppie (and I’m saying this as someone who is a college educated yuppie myself). Just one of the many things she got wrong: saying Puerto Ricans in Park Slope are as scarce as gluten-free pasteles (a traditional Puerto Rican dish). First of all, Puerto Ricans have been living in Park Slope for at least 40 years if not longer. Secondly, pasteles ARE gluten-free. Also, she reads a study showing Hispanics have high BF rates yet doesn’t bother drilling down to see that it’s Mexicans and Central Americans that have very high BF rates. Puerto Rican BF rates are lower than the national average, more comparable to rates among black women.

      It does suck to be yelled at or shamed for breastfeeding in public, no doubt about it. And I’m sure ethnic communities could use more breastfeeding support. But this woman just seemed clueless.

      • fiftyfifty1

        No, she says that Puerto Ricans are NOT scarce (i.e. “Lest you think that PRs are as scarce…”). And while traditional Puerto Rican pasteles are gluten free (corn-based tamales), most other pasteles are wheat flour based, so maybe that’s what she meant. I took her point about breastfeeding rates to mean basically what you yourself said: Don’t look at overall “hispanic” rates and take from that that breastfeeding will be supported by the “hispanic” community. It totally depends. As you mention there are huge pockets of non-acceptance based on location, ethnicity and subculture. I don’t think that her not realizing ahead of time that Nuyoricans are one of those non-accepting pockets is due to her being a clueless person. If she herself is Puerto Rican, Puerto Rican rather than Nuyorican she might just have not realized there would be a difference. Just like how sometimes Mexicans will express some mild surprise about how differently Mexican-Americans do some thing or another, you know?

  • Renee Martin

    What I want to know is this: is any media outlet covering this? Can Oregon moms see this statement prior to choosing a HB? Is this the sole place this info is available? How can we ensure moms know the stats, and see this statement?

    This needs to be a press release, and several other blogs must cover this, so it comes up in Google search. You can pay to out a PR out on PR Newswire, and I think its a good idea to do this because all the stats and deceptions are irrelevant if moms have no chance of seeing them.

    Anyone up to making this happen?

    • Karen in SC

      Send this blog post to any reporter in Oregon who has written about Abel Andrews or Marcene Rebeck or any other homebirth tragedy. Also use points from this post to write letters to the editor, and get other people to do it too. If there is are smaller publications, contact any reporter that covers women and/or health.

      • Jessica

        KVAL and the Eugene Register-Guard have had stories over the years on homebirths and midwives. The R-G covered the death of Shazhad in 2011 and the death of Kelsie Koberstein’s son in 2007 (he was footling breech and delivered by the on-call OBs in the back of the ambulance). The Koberstein case is interesting because the Lane County DA’s office investigated the midwife for criminal negligence in his death, but because he was stillborn they could not bring charges against her.

        • Squillo

          The Oregonian’s online version has also run stories about midwifery regulation and scope of practice.

      • Certified Hamster Midwife

        The local public radio station would be a good place to send information and reach potential homebirthers, because yuppies.

        http://www.opb.org/radio/staff/

    • C. Smith

      I found this blog by google searching home birth death rates a few months ago. Someone suggested I should do a home birth and after meeting with a wacky midwife that my friend suggested, I decided to research it, and this blog was the top of the list. So it does show up if the moms are searching the right information. I think the issue is they don’t search the death rate, they don’t want to think about the negative.

      • Susan

        I think that is true and midwives who think informed consent is someone else’s job and then will accuse that person (ob) of playing the “dead baby” card or scare tactics when the mother is justifiably frightened play on that.

    • guest

      Not sure what coverage you could get in the state’s largest newspaper. Last month, the Oregonian went to a four-day-a-week home delivery schedule with a fraction of its former staff, following sister papers in places like New Orleans and Ann Arbor.

  • MaineJen

    I’m sorry but…3 whole hours of training in risk assessment every 2 years? Consultation with a CNM/MD over twins/breach as a *recommendation* now that oops, it seems to be high risk after all? Is anyone else’s jaw on the floor, or is it just me?

    • MaineJen

      Oh, and the chart reviewers have to “listen with empathy” as the midwife narrates? In what other professional organization would this be tolerated??

      • The Bofa on the Sofa

        I don’t even know what that means.

        • Anj Fabian

          As in “Don’t challenge the midwife’s version of events or question any data on the chart.”.

          IOW – Don’t point out obvious gaps in monitoring, actions that make no sense in the context provided, or compare the chart and narrative to standards and scope.

          TL;DR: Don’t make the midwife or midwifery look bad.

  • Renee Martin

    I think we have been getting to Silke, at least a little. She came to talk to us at the statehouse protest, and listened, even though she was defending HB MWs. I am sure she is actually shocked at the bad numbers, but who knows if anything will be done about it.
    Love the use of “apparent”, it’s such a wiggle word…….

  • kari

    “shouldn’t everyone be doing everything in their power to make sure that additional babies die preventable deaths at homebirth?” Might want to edit that sentence.

    • Amy Tuteur, MD

      Thanks!

  • Kelly P

    So has Jennifer Margulis retracted her statements on how safe Oregon birth is or is she still using Portland as her excuse.

    • Amy Tuteur, MD

      Her husband in a member of the Oregon Board of Direct Entry Midwifery. He’s part of the problem and so is she.

    • AmyP

      Boston isn’t a big college town.

  • Horrified onlooker

    I am deeply distrustful of Silke Akerson. Melissa Cheyney’s public stance has always been that she could not release the Oregon MANAstats (even though the state of Oregon was paying to have them collected) because they legally belonged to Silke’s group, the Oregon Midwifery Council, and that only Silke could release them. In other words, Silke has known the death rates at the hands of Oregon homebirth midwives for YEARS. So why is she saying this now? Why is she still keeping the actual data under wraps? Why such minimal steps so feebly made?

    • Amy Tuteur, MD

      I would guess that Akerson recognizes that changes are coming and she is trying to pre-empt them by insisting that new regulations are not necessary because the midwives have voluntarily made changes already.

      These people are morally reprehensible.

      • Horrified onlooker

        Yes…BUT!!! For heaven’s sake, we have NO indication that these deaths are restricted to twins and breeches in the care of LDEMs. What we see over and over are long obstructed labors, often in post-dates moms or moms with other risk factors. If Silke and Missy REALLY want to make things better they are going to have to let us look at the data so we can identify ALL the causes of increased death at homebirths.

      • Certified Hamster Midwife

        And more healthy babies will die while they scramble for cover.

  • Deena Chamlee

    They don’t need continuing education credits IF their individual educational histories do not meet the ICM standards for midwifery practice globally.
    Which is a minimum three years post secondary education that is structured with didactic and clinical based experience. There are currently two states that require this type of educational standards for licensure in order to practice.
    1. Washington State
    2. The state of Florida
    All over states do not regulate for education, except by what MANA calls for. The problem is Ina’s May involvement in the home birth movement and creator of MANA. As you know she has no formal education in midwifery. She is an English Major who thought birth at home was awesome and wanted to become a midwife.
    So other women birthed at home with her and they called her a midwife.
    Hence the national hideous mortality and morbidity rates.

    • Susan

      Yesterday I watched a videoconference with three Doctors Without Borders/Medicine San Frontiers providers. Two were OBs and one was a RN who was also a CPM. It was fascinating and they do work that is beyond heroic. I noticed the requirements for midwives in the US were either CM or CNM. I have a friend who was a CPM who specifically became a CNM so she could go overseas and do work like this. During the blog chat there were some CPMs asking about working with them and they said they do take non nurse CPMs. I was a little confused and I didn’t find it appropriate to ask about the what’s the minimum criteria for a midwife when the issues the organization faces are so huge. But I am wondering if anyone here knows if they indeed do confront US CPMs with the fact that they have so much less education than CNM or European midwives?

      • Karen in SC

        Kelly, did you mean to say they do *not* take non nurse midwives?

        • Susan

          The requirements on their website say CM or CNM… but the moderator said they do take CPMs. There was a CPM ( and she was impressive ) on the panel but she was also an RN. So I am curious. I have a very favorable impression of this organization and if anything from perusing the website it looks like people need more qualifications than the minimum to work at the same job in the US. That makes sense because the work is obviously incredibly hard and it would take a unique person to cope with it. I am really hoping they have picked up on the CPM is not a midwife in anyone else in the first worlds book but I there is reason to wonder if they are taking CPMs who are not also nurses from the discussion.

          • Renee Martin

            I am sure they know what a COM is, even though they may not know the depth of the deception of true standards. They probably use the CPMs as physician assistants. This is a good use for them, when directly supervised.

          • Certified Hamster Midwife

            A CPM/RN would be a great L&D nurse.

          • Certified Hamster Midwife

            Maybe the moderator didn’t know what a CPM is.

        • Antigonos CNM

          In the UK at least, there ARE direct entry midwifery courses, which take three years to complete and are quite rigorous. This is a change from my time [mid 70s], when ALL midwives were registered nurses [but back then UK nurses were diploma, not degree graduates]. Also, it has to be noted that, throughout Europe, what a midwife, DEM or CNM equivalent, can do is strictly regulated.

          CPMs in the US are not really restricted in any meaningful way any more than their education is standardized.

      • Susan

        Also the discussion I believe is available on their website. It’s pretty interesting and they do amazing work.

      • fiftyfifty1

        Doctors Without Borders (MSF) is really competative. It’s not like other programs where you just volunteer and get accepted automatically. They are especially picky when it comes to Americans (they prefer to hire from France). I have a friend who is a somewhat senior MSF doctor and she met a woman who had done Peace Corps and asked her opinion about becoming a CPM and applying to MSF. She told her not to bother. Basically said “Communities already have lay midwives. We need people who can fix the problems that they can’t”. They need real medical skills including surgical skills.

    • Susan

      Deena, so are you saying that keeping Ina May within the minimal criteria for the term CPM has had so much power that it has influenced midwifery to have such minimal standards in the US? Also, I didn’t know that Washington State and Florida had those standards. I am from Florida and that’s where my interest in this subject began. I actually had a homebirth there myself with two CNMs. It isn’t a decision I would make again but I credit my young self with at least a little sense for recognizing that the DEMs I met were not on par with the CNMs. I changed my mind from planning a hospital birth to a homebirth during the pregnancy when my OB actually mentioned the CNM homebirth practice was opening. They did all of two births, mine and one that ended up “risking out” to the hospital antepartum. Still, it was a good experience and part of why I follow the issue. As I said, I would not and did not choose homebirth again, I would no longer have one even if I could have an OB and a neonatologist at the birth, now that I really understand the logistics of handling an OB emergency.

      • Deena Chamlee

        Yes I feel this is a a huge co factor that has prevented MANA from changing the recommendations for entry level practice. s ACNM has faught at many angles since inception of this crazy so called organization.
        When the inability to change “them” continued we created the graduate prepared CM direct entry.
        They now have the US MERA meetings between all 7 organization that educate and regulate midwifery but that has gotten nowhere either.
        I feel we must stop trying to change “them” and begin to take action on “HOW” to stop this type of practice from occurring by anyone “titled” midwife.
        I am going to work on some things.

        • Susan

          Thanks. I am always so interesting in what you have to say you obviously have so much knowledge on these issues. I hope that the tide is turning and you will have success in creating more appropriate standards!

          • kumquatwriter

            This!!!

  • AlexisRT

    Is Oregon still optional licensure? None of this means very much if they can forgo it (as long as they’re also willing to forgo Medicaid billing and pitocin, though I’m not sure the latter is much of a concern for some of these “midwives”.)

    Also, what information? How will they control presentation? It all seems pretty meaningless.

    • areawomanpdx

      Oregon recently passed a “mandatory” licensure bill, but it allows exceptions for religious and philosophical objections, so it is basically still voluntary. Ridiculous. If you’re not licensed, you can’t advertise as a midwife and you have to give your clients an informed consent sheet. No penalties if you don’t, though, because it’s not like they can take your license away if you don’t follow the law. I can’t believe literate adults came up with this bullshit.

      • Renee Martin

        We need to add a law that allows punishment of unlicensed/ voluntarily practitioners that kill through negligence.

        I think the philosophical exemption is ridiculous. Keeping them from getting OHP is the most important thing, as so many moms here use it for their maternity care.

        My concern is that the license requirement still allows total know nothing to practice, and now gives them the legitimacy of the state.

  • NCBer No More

    “Consult” and “informed choice” are Orwellian ways of saying informed consent. So they don’t intend to obtain informed consent as we know it. Rather they will treat breech and twin birth as “separate… from non-absolute risk.” So they are actually to be treated as high risk, but using those words might give people the idea they belong in a hospital, and we can’t have that.

    • Young CC Prof

      Don’t tell people not to do it, just give them a wimpy warning no one will listen to. Then, when things go wrong, hey, you warned them!

      • Susan

        and make sure there is an OB on the hook to blame by sending them to the OB for informed consent instead of requiring the midwife to refuse to care for high risk patients.

        • KarenJJ

          Exactly. The midwife gets the obgyn to do all the dirty work with informed consent while she is “supportive”.

    • Antigonos CNM

      Yes, it’s a weasel way with words. Breech and multiples are “separate …from non-absolute risk”, is it? First of all, I have no idea what “non-absolute risk” is. There is always an element of risk in every birth; even the lowest of low risk patients has the potential to become very nasty. Further, what is this “separate” category? It’s like being a little bit pregnant — either one is, or one isn’t. Either one fits the criteria for low risk or one is automatically, by default, a high risk patient.

  • Durango

    All I can think about is the who-knows-how-many families who had babies that died at the hands of Oregon midwives this year. Who presumably trusted birth, trusted their bodies and lost their babies anyway. Sacrificed their babies at the altar of Lay Midwifery.

    And, of course, to the midwives, it’s just collateral damage.

  • Mel

    DEM’s don’t currently need continuing education credits?!? WTF.

    I’m a teacher. To keep teaching in most states, you need to go to a bunch of unpaid, rather dull, classes on teaching methods or the newest, best way to teach. If you’re lucky, you might find one that is not a massive waste of time. But my job has a very, very, very low mortality rate connected to the students. And we spend lots of time covering the few situations where a fatality could occur – abuse, neglect and mental illness.

    I am horrified that you can charge people for a medical service without having to prove that you are up-to-date on basic medical procedures.

    • Amy Tuteur, MD

      “DEM’s don’t currently need continuing education credits?!? WTF.”

      It makes sense when you realize that Melissa Cheyney and her Oregon cohorts set up homebirth midwifery in Oregon to allow any birth junkie to represent herself as a midwife and worked tirelessly to defeat any attempt at safety regulations. Cheyney has known FOR YEARS that homebirth kills babies and she has known FOR YEARS that Oregon has a hideous homebirth death rate. She literally REFUSED to hand over the MANA data for Oregon because SHE KNEW that babies were dying in record numbers.

      I don’t know where things are at in the Anderson lawsuit in Oregon, but this information could prove to be a goldmine for them. Everyone in a position to know about the increased risk of homebirth in Oregon knew about it, but chose not only to conceal it, but to push for increased scope of practice and no regulation of any kind.

      • Jessica

        I just checked OJIN – the State has filed a motion for summary judgment and the hearing is scheduled for tomorrow. Trial is scheduled for April.

        • Amy Tuteur, MD

          The State will almost certainly win on the basis of sovereign immunity.

          • Jessica

            Oregon’s Tort Claims Act is a limited waiver of sovereign immunity. I am not a trial attorney, but if Oregon had sovereign immunity I would assume the state would have filed a Rule 21 motion (say, for failure to state a claim upon which relief can be granted). I suspect, though I could be totally wrong, that the state’s motion is based on tort law and foreseeability – that even if the facts are exactly as the Andrewses assert, the specific harm that befell Abel was not reasonably foreseeable and therefore as a matter of law the State is not liable.

          • Amy Tuteur, MD

            I defer to your professional expertise. I have no direct knowledge of the law in Oregon.

          • Jessica

            I do agree that the plaintiffs are unlikely to prevail against the state. I dare to dream that it might wake up some of our legislators to the risks of CPMs and inadequate regulation of midwives.

          • An Actual Attorney

            Jessica, do you have a link to any of the pleadings?

          • Jessica

            Unfortunately no. Oregon is slowly implementing electronic filing and case information, but so far access to eCourt and OJIN is limited to paid subscribers or those using public terminals in each courthouse.

    • Certified Hamster Midwife

      To be up-to-date on basic medical procedures presumes that you know basic medical procedures in the first place.

      • Mel

        Yeah, me and my crazy assumptions…..

  • theadequatemother

    It would be “nice” if such a press release or letter or update appeared on the OMC website so….oh I dunno women making decisions on midwifery care could actually have a hope of being informed as to what they are choosing.

    Instead it’s all Johnson and Davis and that damn BC study that doesn’t apply.

  • stenvenywrites

    we recommend that you separate breech and twin births from the non-absolute risk criteria and put them in their own category with their own rules for consult and informed choice….

    Does this mean that twin and breech are currently considered low-risk? Great googly moogly. The recommendation is that women with breech or twins be required to consult with an OB or a hospital CNM, not that the DEMs are required to risk them out of homebirth. It looks to me like women who are set on NCB with twins or breech will just know for sure that they have to go to a DEM homebirth junkie for it, because the responsible practitioners we make them go talk to will be all judgey and scary and disempowering, with their dead baby cards and their facts and numbers and stuff.

    • theadequatemother

      Breech and twins should be absolute contraindications to homebirth. None of the studies purported to show homebirth safety included these categories. The mortality data that is available shows a high proportion of the fatalities occur in breech and twin home deliveries. No ethics board would ever approve a study looking at breech and twin deliveries at home. The only justification the OMC could possibly have for supporting this, as they say they do, is “choice.” Which is bs. Not all choices have to be supported. What is really needed is a specialty program in Portland or another major ctr that can offer women vag breech delivery safely…and for all I know this already exists. Harm reduction and then a swift and brutal yanking of the ability of any dem CPM CNM rm that attempts a vag breech or twin home delivery’s ability to legally continue practicing.

      • Durango

        “Not all choices have to be supported”… AMEN!!!!

        • thepragmatist

          I wanted to do my own c-section but no one would lend me any scalpels. Something about not being able to see the incision. I feel so oppressed. Doesn’t anyone believe in my agency as a patient?

      • Renee Martin

        We already have a VB breech program at the best hospital here, and it was instituted because of the HB fatalities.

        Guess what? A baby was killed during a breech delivery there, and they are now being sued for millions. I will find a link for you.

        • EllenL
        • thepragmatist

          We also have a Breech Birth program here in BC, at Vancouver Women and Children’s hospital. I am sure it will not be long until there are deaths there too. Twin deliveries seem to be occurring regularly even in hospitals that cannot do premature birth. I don’t get that at all. Our local understaffed hospital without NICU can do twins but not a 35 week preemie? One day, one of those babies are going to die too.

    • Antigonos CNM

      Currently, AFAIK, a midwife of whatever kind can make her own definitions regarding low or high risk. There ISN”T any governing body which determines criteria or anything else, really.

  • Elizabeth A

    We also recommend that the LDM be required to give the client detailed
    and specific information about her hospital birthing options related to
    breech or twin births, including any options for vaginal breech or twin
    delivery in hospital.

    Does this sound to anyone else like “Remind your patient that she can’t have a vaginal breech or twin delivery in hospital, and scare her good about c-sections”?

    • Young CC Prof

      Yeah, that recommendation sounded pretty wimpy. First, explain to your client how breech/twin is really not very dangerous, but doctors refuse to see it that way. Then send client to doctor. Unless doctor reads client perfectly and is a genius in communication, client promptly returns to midwife. Nothing changes.

      Proper risking-out for home birth should be NO twins, NO breech, NO VBAC, all basic prenatal tests, no negotiation. For heaven’s sake, when my brother was born in a birthing center 30 years ago, the midwives were all about the prenatal tests, to make sure that everything was normal, and they’d transfer any mothers who showed problems.

      • KarenJJ

        The midwives in Oregon should look at how the midwives in other countries risk women out. Maybe look at the midwifery model of care in The Netherlands? It’s not the midwife-free-for-all there that they have been trying to cling to in Oregon.

        • The Bofa on the Sofa

          Why would the midwives in Oregon do that? If they did that, they would basically be losing all their selling points that make the CPM have any meaning at all.

          I mean, if you are actually going to start imposing standards, what good is the CPM? CNMs can operate with standards.. The whole point of CPMs is that they do things that CNMs won’t do.

          You think the CPMs are going to give up their ability to work as hobbyists and adopt professional standards? Nah.

          • KarenJJ

            ” If they did that, they would basically be losing all their selling points that make the CPM have any meaning at all.”

            e-zackly.

          • Tim

            I don’t know that that is necessarily true. There are still a lot of women who would choose that model of care , even if it was sensibly regulated. (as per my example above of NH, where there is obviously non-CNM midwives doing business)
            And the bonus to them of sensible regulation, is that they also get nice things like laws for insurance providers to reimburse them for care.

          • kumquatwriter

            But Tim, you’re forgetting it isn’t about the “clients,” only about the birth-attendant-womnyn bravely holding the space. And knitting.

          • Tim

            I was just pointing out that it doesn’t have to be that way – they can do this in a much more responsible fashion, while still attracting business. They don’t have to rely on stunt births and other lunacy to keep a client base.

          • kumquatwriter

            Agreed here. I just get so mad I have to snark. My family has worked in the Oregon hospital system (both healthcare and administration) almost 20 years. Also, I live in Eugene.

            These baby-slaughtering ignorant see-you-next-Tuesdays need to be stopped. Not hb – I don’t care what people choose for their own selves and children (vax excluded, obv.). But, as I will always say, I fight lying liars who lie.

            so, didn’t mean to be rude to you Tim 😉

          • Tim

            No worries, and no offense taken. It’s beyond me how there are so many states with no or little real regulations wrt this. I was quite frankly, shocked to see the stuff that gets posted here showing just how little regulation there is when I initially found this site, since our only experience had been with the NH system which was quite strict and sane, and ended up with us back in hospital care where we needed to be.

          • PrecipMom

            Tim, former home birth mom here, and I was shocked at the negligence on this blog because I thought my midwife was awesome. She is a CNM, and the hospital community here was actually referring to her. Then I had a birth that went sideways and my midwife failed us both. It is a miracle that my daughter is fine, and another baby two years later in this small practice was not fine.

            I’m so glad that you’ve stuck around to see what really has been happening in other parts of the country, but I would be cautious about overly relying on the idea that the home birth system in your area is as safe as you experienced it to be. We’ve supposedly got decent regulations in place in my state in terms of who can be a midwife, and they all say the right things, but I’ve seen some truly alarming situations in the last several years and it seems to be getting worse. So, thanks for sticking around to read, but just please make sure to keep your eyes open in your area for practice slide. Where I live now, the only legal practice was doing no VBAC, no twins, no breech four years ago. Now everyone here is legal (change in the law), and everyone is attending those births.

          • Tim

            Oh, I fully understand that it’s still a lot more dangerous than a hospital – regardless of careful risking out, things always can and always will sometimes go horribly wrong, and when the s hits the fan, there is no substitute for someone trained in giving cesareans in a proper OR with all the attendant support staff needed. I have no misconceptions about that, and due to other circumstances, any future children we have must be born in a hospital regardless of whether we felt we could trust the practice we were seeing or not. But I do think they did right by us, that’s all.
            I just think that for better or worse, it’s unlikely that this movement is going to just up and disappear in the US, but it could be made dramatically safer with proper rules and regulations, even if not “ideal” , with ideal being in a hospital.

          • Amy Tuteur, MD

            I don’t think they could attract business if women realized that they are lay birth junkies and their death rates are horrible. They shouldn’t be attracting business in any case; they shouldn’t be practicing at all.

          • KarenJJ

            I don’t know, Lisa Barrett is still rumoured to be attending births and was on the list to present at the recent Trust Birth conference in Sydney,

        • Amy Tuteur, MD

          The fundamental problem is that these women are not midwives; they are lay people pretending to be midwives and their terrible death rates reflect their indefensible lack of education and training. They should not be allowed to practice at all.

          • KarenJJ

            I keep hoping the penny drops once they start looking at how other midwives practise in other countries like “Europe”…. Where homebirth is as safe as hospital and all…

      • Tim

        This just shows the need for federal regulation to be honest. Some states (as we see here) are so wishy washy in their requirements/regulations for CPMs, and some have none at all. I had this discussion with some on another topic a while back about the other side of the coin, where NH has very (to me eyes) well thought out and comprehensive requirements and regulations for homebirth midwives, and midwives who break them actually get their licenses to practice taken away instead of a finger wag and a stern talking to.
        GBS tests, blood sugar, RH , etc are NOT optional, but are mandatory. They aren’t allowed to be the caregiver for anyone with diabetes, epilepsy, hepatitis, hiv, pulmonary disease, hypertension, heart disease, age 40, abnormal pap, prior problems like premature birth, placental abruption, uterine abnormalities, etc.
        They aren’t allowed to deliver IUGR or SGA babies, multiples, premature before 37 weeks, anemia, previa, breech that is not resolved before onset of labor. Strict rules about things that are immediate transfers during labor. Have to have a pre-existing arrangement with hospital & OB or CNM for transfer of care.
        VBAC can only be with a midwife if the mother has only had one previous cesarean, it had to be low transverse, has been at least 18 months since then, no low lying placenta, and has to be signed off and approved by an OB.
        If “live free or die” NH has comprehensive laws guiding the scope of practice, why can’t every state?

    • Happy Sheep

      That is exactly how I read it. It will be said to the client as “you have to go and talk to a doctor, but don’t listen because twins/breech are variations of normal, trust birth, they’re just playing the dead baby card to scare you so they can cut you”.

  • Dr Kitty

    It’s not a great start, but it’s something…