Obstetricians are inherently humble.
You can’t attend thousands of births and fail to be impressed with the unpredictability of life threatening complications. They can come out of nowhere. Within minutes a perfectly healthy baby can die from a cord prolapse, a shoulder dystocia or a ruptured uterus. Within minutes a perfectly healthy mother can die from a postpartum hemorrhage, an amniotic fluid embolus or a ruptured uterus.
As proud as obstetricians are of their hard won knowledge and skills, all of us respect the life and death power of childbirth. We are not foolish enough to believe that we can accurately predict the future, so we plan for all possibilities. After all, the lives of our patients and their babies depend on us being prepared.
Homebirth midwives, on the other hand, are rather prideful. They actually think that they can predict unexpected complications is advance. They show precious little respect for the awesome life and death power of childbirth, reassuring women (falsely) that there will be plenty of time to transfer to a hospital in case of an emergency, even though there is no transfer fast enough to save the life of a baby in the case of cord prolapse, shoulder dystocia, or the need for an expert resuscitation with intubation.
Obstetricians are humble enough to recognize that “normal childbirth” is a retrospective diagnosis. Homebirth midwives, on the other hand, presume to make that diagnosis in advance. Indeed, they presume to make that diagnosis even when a pregnancy is known in advance to be high risk. In their ignorance and hubris, they simply reclassify high risk situations, like breech, twins and VBAC, as “variations of normal.”
Moreover, they impute bizarre, impossible skills to themselves such as preventing and curing pre-eclampsia with diet, turning breech babies by shining lights at the vagina, or stopping postpartum hemorrhage by shoving a piece of placenta under the mother’s tongue.
Is it really surprising, then, that homebirth midwives have hideous perinatal death rates, so hideous that the Midwives Alliance of North America has spent nearly 5 years trying to hide their own death rates? Hardly.
Any woman contemplating homebirth needs to understand that when homebirth midwives say “trust birth,” what they really mean is “trust me; I can predict unpredictable complications in advance, and assure you before the fact that nothing will go wrong.” What they really mean is “don’t show respect to birth; show respect to me and my awesome ability to see the future.”
There’s an old saying, “pride goeth before the fall.” The extraordinarily high rate of preventable death at homebirth reflects the outsize pride of homebirth midwives.
Unfortunately, it is babies and mothers who take the fall.