Homebirth midwives reveal death rate 450% higher than hospital birth, announce that it shows homebirth is safe

Hospital vs MANA

True to form, the Midwives Alliance of North America continues its deceptions about the risk of death at homebirth.

For the past 5 years, I have been relentlessly publicizing the fact that the Midwives Alliance of North America (MANA) has refused to release their own death rates. It doesn’t take a rocket scientist to realize that the death rates must be hideous, AND recognized as hideous by MANA executives.

After 5 years, and mounting pressure, MANA finally decided how to spin their hideous death rate: pretend that the hideous death rates aren’t hideous!

Isn’t that clever?

They are hoping that journalists will print their bogus conclusion, instead of the actual numbers.

The papers themselves are due to be released later today (at which point I will analyze them in depth), but the press releases include some of the numbers so we can take a look at them now.

According to Citizens for Midwifery:

The overall death rate from labor through six weeks was 2.06 per 1000 when higher risk women (i.e., those with breech babies or twins, those attempting VBAC, or those with preeclampsia or gestational diabetes) are included in the sample, and 1.61 per 1000 when only low risk women are included. This rate is consistent with some published reports of both hospital and home birth outcomes, but is slightly higher than others.

No, it isn’t “slightly” higher. It is MASSIVELY higher.

According to the CDC Wonder database, the neonatal death rate for low risk white women at term from the years 2004-2009 is 0.38/1000. As Judith Rooks, CNM MPH noted in her review of Oregon homebirths, intrapartum death among low risk babies is essentially non-existent in the hospital, so the neonatal + intrapartum death rate for the hospital is still 0.38

As the chart above demonstrates, the MANA death rate for the same years was 5.5X HIGHER. In other words, the MANA death rate was 450% higher than the hospital death rate.

On what planet is a death rate 450% higher than expected a safe outcome? Not on this planet.

MANA and homebirth midwives have been lobbying extensively for a scope of practice that includes breech, twins, VBAC, etc. Now they want to exclude those same births from their statistics. Even then, the MANA death rate is 4.2X higher than hospital birth. So even when homebirth midwives stick to low risk patients, homebirth has a death rate 320% higher than comparable risk hospital birth.

That’s hardly a safe outcome, either.

The results for various risk factors are even more appalling.

Of 222 babies presenting in breech position, 5 died either during labor or the neonatal period.

So the homebirth death rate for breech was 20/1000 compared to approximately 0.8/1000 in the hospital. That’s a breech death rate 25X higher (2400%) than the hospital.

To summarize, the MANA statistics show that homebirth as practiced in the US has a death rate 450% higher than hospital birth.

No wonder MANA has been hiding these numbers for years.

 

More on this study:

Why did MANA wait 5 years to publish its statistics?
The many deceptions, large and small, in the new MANA statistics paper.

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  • Jonah Stephen Swersey

    Hi, I had trouble using the database to reproduce your 0.38 figure; do you think you could give us a step-by-step guide on how you got there? I couldn’t find the option for “low risk”. Or if anyone else could help me, that’d be great. I’m just not sure where the 0.38 figure comes from. I keep on coming up with a lot closer to 2.

    • Young CC Prof

      Make sure “age at death” includes only 0-24 hours, 1-6 days, and 7-28 days, not the last row.

      Also make sure gestational age is set to 37-42 weeks, and birth weight is more than 2500 grams.

      Get those three, even if you don’t include any other risk factors, and the results should be less than 1. Also, go down to “cause of death” and exclude congenital abnormalities.

      • Jonah Stephen Swersey

        Ah, fair enough. I get 0.57 in hospital and 1.20 out of hospital. Not quite 4.5x, but still definitely very considerable.

    • Ash
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  • RN101

    I have the feeling this blog is written by a very scared doctor. I’m based in the U.K. that has a world class safe and effective midwifery service where most babies are born under the care of a midwife. They are independent practitioners that work with set of national and local guidlines. The only doctor most women will see anaesthetist unless the midwife detects any problems or the mother is classed as high risk due to medical problems or due to previous problems with births. We have home births and there is no research in the UK that supports your argument that there is an associated risk of death to babies born outside the hospital setting. Oh I have just seen one born every minute USA style, I advise all pregnant women to watch one born every minute uk style then make the decision weather to have a midwife or a doctor you could save mega bucks

    • moto_librarian

      So you’re going to argue that the U.S. needs the UK’s version of midwifery? The model where women have to beg for pain relief? The model where “phsiological” birth is valued above the life of infants?” The model being investigated by RCOG because of the shockingly high rate of stillbirths (17 a day)?

      No thanks.

      P.S., Dr. Amy is RETIRED.

  • GmaGardner

    Where the heck did you get your chart and conclusions??

    They are inaccurate: This is the MANA research study

    http://onlinelibrary.wiley.com/doi/10.1111/jmwh.12172/full

    Per Unicef stats, see pages 35-37 to compare the US with all nations worldwide (or read the whole article):

    http://www.savethechildren.org.uk/sites/default/files/images/State_of_World_Mothers_2013.pdf
    http://onlinelibrary.wiley.com/doi/10.1111/jmwh.12172/full

    If only 1% of US babies are born at home – explain these stats:

    http://www.cbsnews.com/news/us-has-highest-first-day-infant-mortality-out-of-industrialized-world-group-repo

    http://www.dailymail.co.uk/health/article-1383244/America-WORST-maternal-death-rate-industrialised-nation.html

    • Young CC Prof

      You clearly have an interest in the topic, but you might not have a whole lot of background knowledge.

      Do you know the difference between perinatal mortality and infant mortality? Which one is a more appropriate measure of obstetric care, and why? How does the USA’s perinatal mortality compare to that of other developed nations?

      Here are some basic answers to start you off, feel free to explore the questions further. Perinatal mortality is stillbirths + newborn deaths (up to 28 days.) Infant mortality is deaths up to age 1 of babies born alive. Perinatal mortality is a better measure of obstetric care, as deaths of older babies are rarely related to the circumstances of birth, and stillbirths can often be prevented with good care, especially term stillbirths and intrapartum (during birth) stillbirths. The USA’s perinatal death rate is quite good, lower than that of the UK or the Netherlands, and only slightly worse than Sweden.

      And those numbers are drawn directly from MANA’s paper. The authors listed intrapartum stillbirths, early neonatal deaths, and late neonatal deaths separately, presumably to make it less obvious just how terrible the death rates really were.

      • GmaGardner

        I am a Midwife with a huge amount of knowledge. You can interpret the stats any way you want and post your slanted opinions.

        I am also the mother of 4 adult children, all born at home beginning in 1978.
        with my 4th born when I was 40 – at home.

        You are incorrect that “stillbirths can often be prevented with good care….,” since most stillbirths are caused by congenital abnormalities – and most happen in the hospital where 98% of babies in the US are born. Deaths of older babies do have to do with standard of care (or lack thereof), by Pediatricians or MD’s since Midwives do not do care past the 6th week, but are usually available to their clients for life on a referral basis, or as I have done – suturing my kids deep cuts & splinting broken fingers.

        You did not cite any references better or different than MANA’s or UNICEF’s – as I cited-. The standard the medical establishment decided on is to count neonatal mortality to cover pregnancy thru the first year of a baby’s life. Since babies are born with genetic issues such as a heart malformation, they can possibly live to a year, for example. A lot of these genetic issues have nothing to do with quality of care or place of birth.
        Basically all you did was argue with the standard of measurement and state your opinion that studies of infant mortality should be broken down into categories. Again that is your opinion and has nothing to do with my knowledge base, or MANA’s stats. You’re arguing with established standards of collecting data to study infant mortality rates.
        Neither UNICEF nor Save The Children agree with you, they agree with MANA.

        • birthbuddy

          No, you are wrong and missing the point. Read the recent SOB comments on infant mortality from a few days ago.

        • guest

          Can you cite references that support your claim that most stillbirths are caused by congenital abnormalities?

          • The Bofa, Being of the Sofa

            Even if they are, and? To quote a doctor from Dr Radio, “There are more adults now living with congenital heart problems than there are children.”

            IOW, we are getting much better at saving babies with congenital heart problems and they grow up to be healthy adults. So even it were true that most stillbirths are caused by congenital abnormalities, shouldn’t we still be trying to save them? That’s what real medical professionals do.

        • Young CC Prof

          The World Health Organization defines perinatal death to be deaths during the later part of pregnancy or first month of life. Neonatal deaths are babies born alive who die within 1 month. Infant deaths are babies born alive who die before age 1. These are the definitions used by all major health organizations.

          And if you don’t know the basic definitions, and don’t believe people who try to correct you about them, I don’t see how we can have any sort of conversation about statistics! Do some reading on the WHO site.

        • Dr Kitty

          You may have a “huge amount of knowledge” but much of it appears to be incorrect.

          Stillbirth is related to prematurity, APH, diabetes, infection, cord accidents and is often unexplained despite post mortem. The UK, recognising their high stillbirth rate, despite universal access to good antenatal care and high detection rates of congenital anomalies with elective termination as a frequently chosen option after detection, aren’t throwing their hands up and saying that those stillnirth deaths can’t be prevented. There is currently a massive undertaking to identify causes and reduce the rates.

          Are those midwives, obstetricians, paediatricians and public health doctors wasting their time?

        • Trixie

          Pretty sure that having a few babies crawl out of you doesn’t automatically give you training in statistics.

        • DiomedesV

          No, you are an idiot. It is blindingly clear that MANA broke up those deaths into separate categories to hide how terrible their stats are.

          “The standard the medical establishment decided on is to count neonatal mortality to cover pregnancy thru the first year of a baby’s life.”

          Neonatal mortality is death within the first month of life, not year. If you don’t even know that, then you don’t know anything.

        • Stacy48918

          A midwife with a huge amount of knowledge. AND a therapist apparently. What other qualifications do you have? What are your professional certifications?

  • Frederick chao

    I agree with everything said in this article. However, as a parent of a child who was killed during childbirth in a hospital, I must make note that a third group not considered here is also a danger to birthing. That is the extreme branch of the “natural childbirth” movement which sometimes uses hospitals but demonizes parents who want medical procedures that would save their child’s life or prevent brain damage from oxygen deprivation. Their goal is not a healthy birth but rather a birth that has no medical interventions. This is extremely dangerous even in a hospital. Thankfully, most doctors who are not familiar with heart monitors and other modern medical procedures are retired or deceased by now so this group is getting smaller as time goes by. My son was a victim of one such doctor who wasn’t retired and was killed as a result of the doctor ignoring the heart monitor for four hours even though we had our birth in a hospital.

    • Jocelyn

      I’m so sorry for your loss.

    • Amazed

      I am so sorry. Unfortunately, you are far from the only parent who became a victim of the natural childbirth philosophy in a hospital setting. I really cannot remember any case of a baby who died or was injured due to overuse of interventions. I am certain there are some but I cannot think of example. The majority of low-risk hospital deaths are due to the lack of intervention, just like in your case. Comes to prove that even the best equipment is only good as the person wielding it. And this is a problem. Doctors, more than anyone else, should be aware of the latest development in their field.

      Once again, I am so sorry.

  • Miche Strong

    I’d like to join in as a user. I am British but my first baby was born in The Netherlands. I was not eligible for a home birth, too old at 27, a possibility that had never crossed my mind, anyway.
    To get a home birth, you had to attend all your pre natal examinations, expect no complications, have a fully qualified midwife and a helper, usually your mother, and live 20 minutes by ambulance from the hospital. There were a set of times and stages for the birth and if you did not meet those stages, you were immediately removed, sirens blaring to the hospital.
    Birth at home was followed by a huge family party, so the new mothers who arrived on my ward, were usually howling with disappointment.

    • MaineJen

      …too old at 27? That is some strict criteria.

  • MrsWilliams

    Hospitals do not report accurately deaths related to birth. Death certificates are not standardized and do not require reporting of whether or not a woman woman had recently given birth. Cause of death is often “doctored” to reflect something that is laterally true, but perhaps not completely factual.

    • Young CC Prof

      1) This article is about deaths of newborns, not mothers. There is no reason to believe that dead newborns are being incorrectly recorded as dead adults, for example.

      2) As for deaths of mothers, death certificates in the USA WERE changed about 25 years ago to record whether a woman was or had recently been pregnant and whether the coroner considered it a maternal death. After this change, the official maternal death rate DID go up. So, there used to be under-reporting, not so much now.

  • Fawn

    This Lady is nuts. Find something better to do. Maybe you should check out why hospitals and doctors do so may unnecessary C-sections. Or how many complications to mothers and babies are created by inductions. Or better yet how about all the mistakes (that turn into tragedy) that are made by doctors during surgery or delivery that are swept under the rug. No wonder no one trust the doctors or hospitals anymore. Unfortunately the doctors and hospitals are now making decisions based on $ or the fear of being sued, not what is best for the women and babies.

    • Stacy48918

      Well since you know, why don’t you share with us? Please, enlighten us. Link to the journal articles documenting your claims.

      No comment on the actual paper discussed in this post though, since dead babies obviously don’t matter to you. Just C-sections and inductions.

    • KarenJJ

      They’re not so much in Australia and yet we have a similar c-section rate. Maybe if you got some better ideas as to what’s going on you could share with us?

    • guest

      Really?? And what are YOUR qualifications? Doctor? Nurse? Or, maybe just some disgruntled home birth midwife? And just what do you base your claims of so-called unnecessary C/Sections on? Or mistakes that “turn into tragedy”? In over 10 years of working in many hospitals as an L&D RN, I’ve never seen a decision made based on “$”, but I HAVE seen decisions based on the fear of being sued. And, most of them because of people such as yourself, who spew ungratefulness and contempt for people who are trying to HELP others. If you’re going to make claims on this site, you better be able to back them up! Put your money where your mouth is honey.

      • Amy Tuteur, MD

        Her qualifications? She is a CPM so she has no qualifications. The truth about homebirth deaths threatens her income, so she rails against it.

        • guest

          I know… their blatant arrogance and disrespect really gets under my skin sometimes..

        • Amazed

          Dr Amy, I won’t expect of you to reveal anything leading to the identity of any of your commenters. I’d like to know, though, is she indeed a CPM? Because it would be quite disingenuous of her to rant like this without mentioning this little detail.

  • Ash

    The data from the MANA study makes me sick. It demonstrates a disgusting death rate.

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  • mom of many

    so…are we assuming that we get to through out the c-section rate at hospitals? So the average woman walks into a hospital, has a c-section because someone thinks her baby is too big…Is she then thrown out of the study? Do they reconsider her when her baby is born at a whopping 7#s? when many hospitals have a 40% c-section rate…is it fair to compare only the vaginal births?

    If hospitals could only use technology when it scientifically benefitted my baby and me…I’d go.

    • Young CC Prof

      I’m not sure what you mean by “thrown out of the study.” Death rates in the hospital include all babies. So do c-section rates.

      Are you saying that you don’t want to go to the hospital because you might have an unnecessary c-section. I understand your concern, but there’s something you might not be aware of: Most c-sections in hospitals are performed on women with problems that are known in advance, or women with a prior history of c-section.

      Here’s a statistic that shocked me when I learned it. When a woman who has previously had vaginal births and has not previously had a c-section goes to the hospital in labor at term, if she’s carrying one head-down baby, the probability that she will have a c-section is only 3%. Not 30%, 3%.

      • GmaGardner

        LOL. Unless the mom ‘schedules’ a c-section because she does not want to go thru labor! It happens much more often than you might imagine. Doctors also persuade women to schedule a c-section around the doctor’s vacation.
        When I was teaching prepared childbirth classes for people who wanted a natural birth in the hospital, one woman told me her OB had never done a pelvic assessment (the old fashioned way) and she didn’t want to have any ultrasounds. She hired me to be her Doula in the hospital. Her SOB-OB ‘allowed’ her to labor hard & long, had convinced her to have her bag ruptured – which put her on a 24hr time limit. So at hour 22, he checks her pelvis and guess what? her pelvis was Android (male) shaped and would never be able to birth a baby vaginally! She was a true bonafied candidate for a section. It was like he was punishing her for wanting a natural birth & could have prevented her 20+ hrs of extreme painful labor. The baby was also going into distress & passing Mechonium!

        • birthbuddy

          What is ‘mechonium’ and ‘bonafied’?

          • guest

            Now, now, don’t criticize her spelling, she’s a highly edumacated CPM with a “huge amount of knowledge”! *snort!*

          • birthbuddy

            A ‘different way of knowing’ and a different way of spelling.
            Maybe ‘bonafied’ is calcified?

          • Dr Kitty

            I think she means bona fide, as in genuine.
            That doesn’t necessarily make it better, of course.

          • birthbuddy

            I like calcified better.

          • GmaGardner

            If all you can intelligently comment on is my spelling – you are seriously missing the boat and need to get a life! Everyone makes typos, are tired sometimes and forget to spell check. That means nothing in the real world of things that really matter, such as- lowering the US’s horrible rates of infant mortality!

          • birthbuddy

            Read the topic on infant mortality from earlier in October on this site and try again.

          • Bombshellrisa

            It’s because of a social MORAY
            (How can it be that these midwives who claim to be so educated, although the only formal education that MANA requires is a high school diploma, manage to continue to write the exact same idiotic things?)

          • birthbuddy

            Gotta love those morays!

          • Trixie

            LOL!

          • GmaGardner

            **snort, snort** right back at cha, sweetheart! What the hell does “edumacated” mean?? LOL

          • GmaGardner

            If all you can intelligently comment on is my spelling – you are seriously missing the boat and need to get a life! Everyone makes typos, are tired sometimes and forget to spell check, which you so beautifully proved -thank you! Typos mean nothing in the real world of things that really matter, such as- lowering the US’s horrible, shameful rate of infant mortality!

          • Guest

            And how many times does someone need to tell you that infant mortality is not the proper statistiic to measure obstetric care???

          • birthbuddy

            There you go, you have predictably just mentioned the next misunderstanding on the NCB script.
            Next is the 15% C-section rate.
            Come on, you know you want to.

          • Amazed

            Not twice, sweetheart. Not when the typo is pointed out to them in such a comment.

            Look, we both know you don’t know how they are spelled. Why don’t you do yourself a favour and stop demonstrating just how justified the comment was?

          • Trixie

            Repeat after me: infant mortality is not a measure of obstetric care.

          • DaisyGrrl

            Lowering the US’s horrible infant mortality rate has nothing to do with midwifery or natural birth. If you really want to lower infant mortality, here’s what you need to do:

            - easily accessible universal health coverage so that poor people can go to the doctor at the first sign of illness.

            - supportive public health system that can ensure parents have the resources they need to properly care for their children (including vouchers for transportation to routine medical appointments, and clinics located in the neighbourhoods where people live). Where I live, resources include home visits by public health nurses and free drop-in infant feeding clinics.

            - a real maternity leave available to all working women (1 year, funded by government). This will enable women to properly care for their children during the critical first year of life and eliminate barriers to obtaining proper medical care (if you work full time, it’s harder to get baby to his appointments)

            Notice how none of this has anything to do with prenatal or obstetric care? Notice how I’m not mentioning breastfeeding bullying going med-free during birth?

          • GmaGardner

            Mechonium is a baby’s first poop that can be passed when a baby is in distress during labor. It’s dangerous because the baby can aspirate it upon delivery. bonafied was explained to you by another commentr – excuse my mis-spelling, but it does men ‘genuine’. You can Google on-line dictionaries, you kno.

          • birthbuddy

            The point, GMA, is that your spelling is atrocious.
            It’s bona fide and meconium, both terms I am quite familiar with.
            I always have a concern that when people use terms but can’t spell them, they often don’t understand them.
            Why don’t you google on-line dictionaries if you know they exist?

        • Young CC Prof

          I have no idea whether this comment is pro or anti scheduled c-section. You apparently demand that doctors schedule one in advance for all women who will need it, without doing any unnecessary ones. And you condemn women who prefer to schedule one specifically to prevent hours of exhausting labor followed by emergency surgery.

          • Amazed

            Well, yes, of course! She has a Mercedes to buy and 99 percent of low risk women don’t want her. Of course she condemns them.

          • LibrarianSarah

            Because as any librarian will tell you, perfect precision and perfect recall is totally possible.

            …oh wait…

          • GmaGardner

            Sorry, you’re trying to make assumptions about my intent. I never demanded nor did I condemn anyone. I do have little respect for women who schedule a c-section to avoid labor and/ or to maintain a tight vagina. Yes, this does happen. I was not referring to anyone going through “hours of exhausting labor followed by emergency surgery”. Of course a woman should schedule a c-section when there is no doubt they can deliver vaginally. That’s their choice. You might have been picking up on my scarcasm regarding women who schedule one for purely cosmetic reasons. That’s also an individual’s choice, but I don’t have to respect it.

          • theNormalDistribution

            I have little respect for women who are quick to cast judgement on others when they themselves are scientifically illiterate and intellectually lazy. You clearly are both if the only reasons you can come up for having a c-section is fear of labor and wanting a “tight vagina” (by the way, the underlying sentiment in that accusation is disgusting and sexist in the extreme).

            “Scheduling” a c-section to avoid labor is perfectly reasonable choice. Given the evidence we have now, a good argument could be made that a planned c-section is the safest choice for both baby and mother. Your ignorance is showing.

          • GmaGardner

            Hello!!?? When did I ever say that “fear of labor and wanting a “tight vagina” ” are the ONLY reasons “for having a c-section”??!! Dramatize much?

            “Given the evidence we have now, a good argument could be made that a planned c-section is the safest choice for both baby and mother. Your ignorance is showing.”

            Please re read your comments I have quoted and use your critical thinking skills – if you have any – to determine who the ignorant one really is. Or an easier, less brain taxing way would be to look at yourself in a mirror and repeat your own statements over and over till you are hypnotized to believe them – like a robot!
            Better yet – create your own perceptions & thoughts! What a novel idea! >>> I dare you to become a free thinker.

          • Stacy48918

            Well you clearly think that “cosmetic” reasons are not good reasons for having a C-section. What “cosmetic” reasons were you thinking of exactly?

            I *AM* a free thinker. I had a long difficult “empowering” homebirth for my first baby. I had watched the Business of Being Born, I adored Ina May, I was “educated”.

            Then I actually read the scientific literature and understood the real risks of homebirth. And of dangerous CPM homebirth midwives.

            I will never have a homebirth again. How’s that for free thought?

            Have YOU read the studies on the safety of C-sections at term? You skipped right over the possibility of scientific evidence to whine about “freethought”.

          • Theoneandonly

            It’s a good thing I don’t need or want your (or anyone’s for that matter) respect when it comes to my birthing choices. I am scheduling a c-section in December because I am wanting to avoid labour *and* maintain a ‘tight vagina’ among other reasons – none of which are necessarily medically indicated (yet).
            I am not in a situation where there is ‘no doubt I can’t deliver naturally’, but it is my choice, and my obstetrician and her midwife agree with my reasons so who cares what you think? I am more confident in their judgement than yours from what you’ve posted here. Of course them knowing my medical/obstetric history does make their opinion much more valuable as well.

          • Amazed

            It’s really a good thing. On the other hand, cheer up. She would have respected your choice to scream yourself hoarse in agony without any pain relief. Of course, the reason would be that that reinforces the belief lining her pockets through other people’s agony. But she would have respected it.

          • Trixie

            Lol. You’re a caricature. Why do you care what other women want to do with their vaginas?

          • Theoneandonly

            Also, how do you know who’s going to go through hours of exhausting labour before their c-section? If we had that kind of knowledge then we probably wouldn’t be discussing any of this at all.

        • Cobalt

          Lots of women with an android pelvis are able to deliver vaginally and manual estimates of pelvis size and shape are not definitive except at the extremes. Are you really suggesting that the doctor should have scheduled a cesarean before labor because of a suspected android pelvis? Without any ultrasound measurement suggesting the baby is too large or poorly positioned to navigate the pelvis? You would have denied this woman a trial of labor?

          • GmaGardner

            This is true with a lower birth weight baby. When the client refused US, I think the OB should have done a manual pelvic assessment. (Midwives are trained to do manual measurements). This way the client has more information and can prepare for a possible c-section. A mother can still request a ‘trial of labor’, but 20 hrs. is excessive when a woman does not even have a clue she can’t deliver vaginally. During the final weeks of pregnancy the baby’s approximate weight can be assessed so that a client with all the info of possible risk factors, can further prepare. There are several books written by women who ended up with a c-section would have wanted the respect from their OB’s about ALL the possibilities in order to prepare themselves emotionally for major surgery and what that would mean for bonding, breastfeeding, pain & recovery at home while tending a newborn.
            I am saying it was disrespectful of my client’s OB to not assess for ALL risk factors and give her ALL the info necessary so she could make her own informed choices – whatever they might be.

          • Cobalt

            EVERY woman, in EVERY pregnancy, should be prepared for the possibility of needing a cesarean. There is no such thing as zero risk, and any childbirth class should help women understand the process and reasons for this intervention so she could make a truly informed choice without unnecessary fear. Any valuable childbirth class covers the standard technology available during labor and delivery, what this technology actually does, what complications can occur and how this technology can be used to help. A woman may choose to decline any intervention, but it should be a truly informed choice.

            To say that an epidural drugs the baby is not TRULY informative. To say that fundal heights and manual pelvic measurements are anywhere near accurate enough to base surgical decisions on is not TRULY informative.

            And to imply that anyone other than the person experiencing the pain is an adequate judge of the effectiveness any pain relief option is horrific beyond words.

        • Cobalt

          And if your labor is extremely painful, there are extremely effective pain relief options available. You need an anesthesiologist, not a doula, to provide them, but they are very much available.

          • GmaGardner

            Midwives and Doulas give such great support that most women can work through the pain and do not need pain meds which are drugging the baby also.

          • birthbuddy

            How does an epidural drug the baby?
            It shouldn’t be too long before we get through the whole NCB script.
            Keep them coming.

          • Bombshellrisa

            You want to fill that bingo card don’t you?

          • birthbuddy

            It’s just too easy.

          • Bombshellrisa

            Here we go with the “support takes away the pain” argument again. I gave EXCELLENT support as a doula and as an apprenticing midwife, so why the hell did half the women whose births I attended howl, scream and moan in agony while laboring and giving birth? I am only counting the homebirth and birth center births there. Why the hell did the great support of the nurses and my husband not help me work through the pain? No interventions either, just the IV.
            Why do you believe that epidurals drug babies? Did you hear that or did you learn it in nursing or medical school?

          • Trixie

            That’s bullshit.

          • Stacy48918

            I had a homebirth midwife – TWICE. I *HATE* labor. It’s unbelievably excruciatingly painful. If I ever have another baby I want an epidural. But I guess I just wasn’t doing it right.

          • Karen in SC

            Bullshit! You are certainly clueless. I had a doula and horrible mind numbing pain. An epidural is placed in the dura of the spine and does not reach the baby.

    • mythsayer

      Ignore the CS rate at hospitals. Look at the death rate MANA has shown in their study. THAT’s what’s relevant.

    • Mom2Many

      Hey…nice name! For the record…guess there’s two of us!

  • Las

    The CDC Wonder database is amazing for all of the ways you can slice and dice the numbers. But this is what also makes it a confusing and somewhat deceptive tool to quote unless one outlines the exact parameters they are selecting.

    After perusing it for quite some time, I cannot get the Wonder database to come up with the some numbers as you quoted below. Would you be willing to help me dissect it?

    “According to the CDC Wonder database, the neonatal death rate for low risk white women at term from the years 2004-2009 is 0.38/1000.”

    1. Could you outline the selections/parameters you chose? (Just copy and paste the “Query Criteria” on the results page would be easiest I think)
    2. Specifically, how did you select “Risk” (was it the selection of “single” under “Plurality or Multiple Birth”?)
    3. The database doesn’t allow for the years 2004-2009 in one search/chart. Did you calculate the same parameters seperately for those years and then come up with the final number (0.38/1000)?
    4. While you selected “white women”, the MANA stats included all race/origin. While the majority of home birth clients are white (92.3% according to MANA here: http://onlinelibrary.wiley.com/doi/10.1111/jmwh.12172/full) there is still a decent percentage that aren’t. Shouldn’t the CDC Wonder comparison include all?

    Thank you.

    • The Computer Ate My Nym

      One quick note on point 4: Minority women make up significantly more than 7.7% of the overall population. In the US, I think that about 25% of the population consists of racial minorities and if you include ethnic minorities you get something closer to 50%. Therefore, the restriction of white women only makes the input population closer to that of the MANA data, even though it is not exactly the same, i.e. the survival for a group that is 92% low risk is going to look more like the survival for a group that is 100% low risk than for a group that is 50-75% low risk. In other words, you’re right that it’s not a perfect comparison, but it’s the closest one that it is possible to make.

      • Las

        Thank you for the clarification. I *think* I followed your explanation, but not fully. And this is why statistics is a subject and profession-of-sorts all of its own! It is rarely cut and dry.

        • Young CC Prof

          Actually, if you wanted to you could probably BUILD a population that matched the MANA one almost perfectly with stratified sampling techniques.

          That would be complicated, though, and the final number wouldn’t change much. You can play with the WONDER database yourself, and what you’ll see is that basically any hospital sample is going to look much better unless it contains significant numbers of micro-preemies. The MANA group contains very few preemies and basically no severely premature babies since women who go into significantly premature labor tend to go to the hospital instead.

  • Dr McKenzie

    Although it is against my better judgement to post on this topic. I can not help myself. I am a registered OBGYN. I work in a hospital as well as with midwives and i participate in home births regularly. I do not agree with statistics not being released. i firmly believe that all woman and families have the right and responsibility to be well informed. That being said. There is a huge amount of misinformation out there its scary.
    1. Breech birth has taken place for century the problem with natural delivery of beech babies occurred when we stopped being taught how to deliver them. That solely falls on un-education. Doctors fail at it because they do not know what to do with it. It is still common practice in many area’s of the world that babys are delivered vaginally in a breech position as long as baby is handling it well.
    2.. C section does not by any means give promise that mother or baby will not have complications or die. Usually a section is necessary because there is a complication. Not only that C section is NOT the best way for a baby to be born. Coming threw the birth canal prepares the baby for the outside world. it helps to push fluids from there air ways, releases hormones in mother and baby.C sections rob the mother and baby of that. I do not section unless it is an absolute emergency. If you are looking for an elective Section without cause I will refer to another OB I do not believe in Sectioning for no reason. It is and always will be major surgery.
    3. Statistics prove over and over again that in a hospital setting there is much more unnecessary intervention that takes place. because procedure and protocol of the hospital must be followed.

    4. In Ontario Canada a pregnancy deemed high risk would not be delivered at home. also depending on your region vbacs are also not permitted. But we like to have it as close to a home birth as possible just using a hospital room. all midwives in canada under go 4 years of schooling, are registered with the college of midwives as well as work in hospitals, birth centres, home births clinics etc.
    5. These numbers must be taken with a grain of salt. These numbers are not specific, Still birth due to complications during birth?, or had the baby passed prior. miscarriage, are these certified midwives? have these woman had proper prenatal care?

    Unfortunately the medicalization of birth went overboard. it is not known as a natural occurrence any longer it is a medical condition that requires treatment.
    There is an equal amount of statistics that point to hospital birth being unsafe as there is home births. vast amounts saying home birth is save and hospital birth is not. This information is usually released with a very bias personal opinion. without knowing the details it is completely unprofessional and unethical to make a statement saying home birth is unsafe, If YOUR personal opinion is so, that is your right but it needs to be stated as such MY PERSONAL opinion is. I would never make the gross error in making a statement as you have. That is MY personal opinion.

    I believe the answer to the problem is regulation. Midwives should be educated and regulated. Woman should have free or affordable prenatal care and access to proper health care professionals. The Training for an OBGYN is changing thankfully. OBGYN’s are starting to be trained in delivering breech births. And in natural child birth. the call for midwives has never been greater because there are so many woman that medically speaking has no reason to attend a hospital or have an OBGYN, midwives are just as qualified in the aspect of natural child birth if not more so then an OBGYN. Education and INFORMED choice for expectant mother is what needs to become common place.

    Dr. Mckenzie

    • NoLongerCrunching

      How do you explain the fact that am MANA boasted about their C-section rate and their transfer rate, but hid their death rate for five years? What do you mean you don’t agree with that? That is what happened; it’s public record.

    • Young CC Prof

      Um, is English your native language? I really hope not.

    • Jessica S.

      “the call for midwives has never been greater because there are so many woman that medically speaking has no reason to attend a hospital or have an OBGYN”
      Until, of course, they do have a reason. And I guarantee you they will wish they had been in a facility equipped to deal with any eventuality. I’m happy to have my pregnancy “medicalized”. I had a c-section with my son and it certainly wouldn’t have passed your unnecessarily restrictive guidelines for what constitutes medically necessary. (I’m quite grateful I had open-minded OBs caring for me, as opposed to someone like you!) He wasn’t in distress, but it had already been over 24 hours since my water broke and my contractions weren’t budging him. Let me tell you, he has no troubles whatsoever meeting “the outside world”. All the talk of over-medicalization is just another version of naturalistic fallacy.

      • GmaGardner

        You were put on a 24 hr time limit because you let the OB break your waters. This a requirement of mal-practice insurance that the baby has to be born in 24 hrs.
        It is not at all uncommon for a labor to last 36 hrs as long as mom & baby are doing fine!
        If you had a marginal pelvis shape, that’s another story.

        • Dr Kitty

          You ignore the cases which caused the 24 hr protocol though.
          It didn’t come about from nothing, did it?
          It is based on plenty of cases where membranes were ruptured for more than 24 hrs, labour didn’t progress and DESPITE foetal monitoring suggesting all was well there was an adverse outcome-usually chorioamnionitis, foetal sepsis or HIE.

          Here’s the thing, IF foetal monitoring was sufficiently sensitive to detect and prevent those adverse outcomes in prolonged ROM, it would be an adequate defence in malpractice cases, and the protocols setting time limits wouldn’t exist.

          The truth is, the technology isn’t there to properly prevent adverse outcomes with prolonged ROM, so intervening is safer than not.

          • GmaGardner

            I didn’t ignore anything. I was referring to AROM which does invoke a 24 hr time limit to get baby born. Midwives often attend women with SROM, and are trained to prevent infection and complications, to transport if mom develops a fever, baby goes into distress, etc. All the complications you refer to – sepsis, etc are from germs in the hospital which also treats very ill people (people in their own homes develop immunites to their own germs!) and where protocols are sometimes broken. Didn’t a nurse contract Ebola just the other day because of broken protocols????
            And of course, intervention is sometimes necessary with prolonged ROM, but it is not a given and the 24 hour number was set by insurance companies. the ‘technology’ might not be available to prevent adverse outcomes, but good old fashioned common sense is; no baths – only showers, no bareback horse riding, nothing but sterile gloved fingers inserted into the vagina, monitor temp and FHT’s, clean sheets, stay out of hospitals, subway cars, NYC cabs, the back of mini vans with bikers…… ;) etc.

          • birthbuddy

            You have no idea what you are talking about.
            You have not even mentioned garlic for GBS yet.

          • Young CC Prof

            Those are all great ways to keep out new infections. Unfortunately, GBS and the organisms that lead to chorioamnionitis are already on a woman’s body and living inside her vagina. No taxicab needed.

    • Guest

      Well said!

    • DaisyGrrl

      Dr. Mckenzie,
      The majority of midwives that responded to this survey were Certified Professional Midwives. What does that mean? Well, they do not require any post-secondary education in order to become certified. At the time of the survey, they didn’t even need a high school diploma. They simply needed to observe some births, attend a few more under supervision, then pass a test written by other CPMs. The never set foot in a hospital or encountered an actual medical professional.

      Unfortunately, several states see no problem licensing these individuals and allowing them to preside over risky homebirth situations. They don’t have risking-out criteria. So a high school dropout could have conceivably attended VBACs, breech and twin births at home as a licensed and certified midwife practicing legally and within her scope of practice. That scares the everloving bejeezus out of me!

      I am in Ontario. I realize that you think our midwives are well trained, and perhaps they are when compared to CPMs, but I disagree with you about their competence. I have had family and friends give birth under the care of midwives. I have heard first-hand stories of women being denied epidurals, lied to about the effects of epidural analgesia, and not being provided with proper informed consent about the risks of going to 42 weeks at her 41 week appointment (as in, the mother wasn’t told anything that was in the College of Midwives’ sample consent document about increased risk of stillbirth). I’ve heard of them recommending FUCKING HOMEOPATHY! I have also heard friends and family sing their praises, so there is some good in there too.

      I am appalled that the midwife-led birth centres in Ottawa and Toronto are not on hospital grounds. If there is a cord prolapse or other life-threatening emergency at the birth centre, what odds do you give of the baby surviving vs. being already at the hospital? What about lifelong neurological injury? My PERSONAL opinion is that women giving birth out of hospital at these sites are taking unnecessary risk with their babies and that the government should not be encouraging such shenanigans by sinking millions of dollars into cozy rooms with fireplaces and big screen tvs while leaving the hospitals to go begging.

      I very much want to have unimpeded access to a medicalized childbirth. I want the machines, the epidural, and the OB. I want every woman in our province to have meaningful access to choice in childbirth (yes, even homebirth or vbac). I wish the midwives here were a little less nutty and a bit more medical but it could be much worse. I want every woman to have access to all relevant information needed to make an informed choice – and it is increasingly clear that they are not getting it from the natural childbirth advocates.

      • Audrey Yarper

        Excuse me! I am attending a fully accredited midwifery school (which receives federal funding), as part of my path towards becoming a CPM. I will have been to well over 100 (Including required hospital births) births by the time I get my license and my degree (bachelors in midwifery). Only the first 10 are as an observer. I have to do 20 births as a secondary assistant, 20 as a primary under observation, and many more in order to check off every required skill. The test to get a CPM is an 8 hour long test, in addition there is another full day skills test, where I have to physically and verbally demonstrate perfection in every skill. In addition I have to do 20 primary continuity of care prenatals and postnatals as well as newborn exams. The texts that I’m required to practically memorize are the same ones used by Obgyns and Nurse Midwives, such as Myles and Old’s. It normally takes at least 5 years for anyone to get certified as a CPM and that doesn’t include the 2 years of prerequisites I had to do at the university in order to get into the bachelors program.

        • Murrishmo

          100 births isn’t that many. And just because you have 8 hours to test does not mean the test should take 8 hours…as if testing rigor should be judged by linear time to completion anyhow.

          • GmaGardner

            Midwives are trained & educated to work with zero to low risk births. That’s 97.3% of births worldwide. We are trained to perform risk assessments through a thorough 45 minute intake interview. We are trained to refer moderate risk to high risk mothers to OB’s who are trained surgeons and technical equipment users to handle the 3% of births that are truly not normal, natural spontaneous events.
            Midwives are also trained to handle reversable mild to moderate complications such as anemia, high BP, turning Breech babies, narrow pubic arches, etc. utilizing nutrition, episiotomies, slant boards, red clover & hops teas – which usually work well when our clients are taking 100% responsibility towards having a safe & uncomplicated home birth. If the parents are not truely devoted -won’t eat better, or high BP can’t be reversed -as examples – they are referred to OB’s. These are just some of the standards of practice & protocols developed by NARM & MANA.

            As I have already pointed out!

          • Anj Fabian

            Loose the hounds of judgement!

            ” If the parents are not truely devoted”

            I didn’t see this question on my patient intake form for my OB practice
            “Are you truly devoted to your pregnancy and birth?”.

          • MLE

            Why won’t you reverse your high blood pressure? Have you tried standing on your head? You’re too stubborn for midwifery.

          • GmaGardner

            I was referring to having a safe and uncomplicated HOME BIRTH! I think that was clear in what I wrote. Don’t distort my comment and over-dramatize!

          • GmaGardner

            You’d be surprised at the number of women who are more devoted to eating donuts for breakfast than eating toast & eggs AND avoiding diabetes! Or smoking during pregnancy, drinking alcohol, doing drugs, etc, etc, etc. Not everyone has the same values as you.
            I was speaking of RISK FACTORS, and some women do try to avoid an OB’s scrutiny by planning a Home Birth. Midwives are trained to detect these risky behaviors and refer to Ob’s, while refusing to provide care at home.

          • Bombshellrisa

            It’s the placenta that causes the insulin resistance, not the manner in which a woman eats. Anyway, toast will raise your blood sugar too. This does vary from woman to woman, which is why meeting with a diabetes educator and tracking blood sugars is so important.

          • DaisyGrrl

            MANA has standards of practice? That’s the first I’ve heard of them.
            Please, give us the link so that we can all see what a responsible, professional group MANA is!

          • LibrarianSarah

            You keep repeating that number but there seems to be know evidence that it came anywhere but your rectum.

        • Captain Obvious

          If certain complications only occur 1/100 or 1/1000 then you couldn’t possibly be prepared to recognize or handle these complications that will happen. OB/GYN will do 100 deliveries in one month of the OB rotation. 4 years of medical school to understand anatomy, physiology, biochemistry, immunology, statistics, nutrition, pharmacology, etc. Then 4 years of residency. I wouldn’t attempt a project or procedure (medical or other) that I couldn’t handle any of the known complications. We hope for the best but prepare for the worst. But CPMs make affirmations and believe everyone is low risk and nothing can’t go wrong that a lengthy transfer to the hospital cannot remedy.

          • fiftyfifty1

            Exactly! I did 100 births as a family medicine resident and I knew that that was grossly inadequate training to be able to deliver babies independently. That’s why I don’t. I don’t want to get my patient into anything that I can’t get them out of. But these homebirth midwives feel confident delivering babies far from the resources of a hospital after far less training and fewer independent births than I did. What is wrong with these people?

          • GmaGardner

            Midwives are trained & educated to work with zero to low risk births. That’s 97.3% of births worldwide. We are trained to perform risk assessments through a thorough 45 minute intake interview. We are trained to refer moderate risk to high risk mothers to OB’s who are trained surgeons and technical equipment users to handle the 3% of births that are truly not normal, natural spontaneous events.
            Midwives are also trained to handle reversable mild to moderate complications such as anemia, high BP, turning Breech babies, narrow pubic arches, etc. utilizing nutrition, episiotomies, slant boards, red clover & hops teas – which usually work well when our clients are taking 100% responsibility towards having a safe & uncomplicated home birth. If the parents are not truely devoted -won’t eat better, or high BP can’t be reversed -as examples – they are referred to OB’s. These are just some of the standards of practice & protocols developed by NARM & MANA.

          • fiftyfifty1

            There is no such thing as a “zero risk birth”. Your assertion that 97.3% of births worldwide are zero or low risk is laughable.
            Your are not a midwife, you are a dangerous quack. But you know what to do when patients have a bad outcome–throw the blame back at them by saying that they must not have taken “100% responsibility towards having a safe and uncomplicated home birth”.

          • guest

            Trained to turn breech babies??????? fiftyfifty1 is right.. you ARE a dangerous quack! ANY midwife who would attempt to turn a breech baby is worse than a quack.. and as for these so-called “reversible” (learn to spell- it’s not “reversable”) conditions, you really do have a God complex.. I truly feel sorry for any woman unfortunate enough to fall for your quackery. please go do something other than prey on vulnerable women then blame them when your malpractice kills them or their babies.

          • DiomedesV

            3%? Where did you pull that figure out of?

            And if midwives are trained to handle “reversable” mild to moderate complications, then why are their mortality stats for babies so bad?

          • MaineJen

            I call troll. This absolutely, positively has to be a troll. Well played, though.

          • LibrarianSarah

            So you are able to figure out which women will have potentially life threatening complications, many of which come out of nowhere, in about the same amount of time it takes me to do a reference interview? Put me on the list of people who are surprised you haven’t killed somebody yet.

          • GmaGardner

            It certainly sounds like you didn’t learn to TRUST women and their instinctual birthing knowledge! I suggest you study up on Michel Odent, OB’s work. Also Grantly Dick Read, MD.
            CPM’s are trained to and required to assess risk. We refer women to OB’s when necessary based on risk factors present at initial interview and any that should come up during pregnancy, labor, birth or postpartum. We appreciate you OB’s in those 3% of cases (worldwide).
            You need to leave the other 97.3% of normal uncomplicated births to us Women/Midwives. But of course you wouldn’t be able to buy a Mercedes if you did that!

          • birthbuddy

            And NCBers can’t buy a Mercedes on the leftover 2,7%, hence their agenda.

          • GmaGardner

            LOL! I drive a 1990′s Toyota 4Runner I absolutely love and have maintained well. It gets me to births thru rain, sleet & snow.

          • Trixie

            That’s great! Your mechanic has more training in fixing Toyotas than you have in delivering babies!

          • Roadstergal

            If it breaks down, it’s because she didn’t Trust Engines enough. Don’t check the tire pressures – that will set off a cascade of interventions.

          • Amazed

            Dumbie, dumbie, dumb. Captain Obvious is an Ob/GYN, sweetheart. He makes the vast majority of his income by being a gyn – thankfully, a specialty you and your fellow clowns cannot pretend to be experts at.

            And sweetheart? Why are you referring to him? Refer to the 99 percent of women with normal pregnancies who DON’T WANT YOU, and righfully so, with your horrible death and brain damage rates.

            You know what? Study hard, work hard, and you might be able to buy a Mercedes, one day. Of course, I know you won’t. No one this stupid to take pride in being taught to do something everyone else can is able to study in any real field taking actual brains.

          • GmaGardner

            OK. So if captain Obvious did not identify himself as an OBGYN, how could I know that?? What’s your point? Midwives refer clients who risk out to OB’s. what’s your question about that? BTW, the 98% of women who give birth naturally, normally & spontaneously WORLDWIDE do not see OB’s.

            Re: “No one this stupid to take pride in being taught to do something everyone else can is able to study in any real field taking actual brains.”??? Huh? Are you referring to OB’s who are trained specialists & surgeons- attending normal, natural births – as stupid? – because ‘everyone else can…’

            BTW it takes trust in the natural process to birth a baby in 98% of all births (no degree in nuclear science is needed to understand this fact!). Surgeons (OB’s) are rarely needed.

          • Amy Tuteur, MD
          • birthbuddy

            Just because you keep repeating the 98% number does not make it true.
            In fact, it is crap.
            One very simple contradiction is that at least 10% of all births are premature and NCB shouldn’t have anything to do with those.

          • Stacy48918

            If it’s such a “natural process”, why do women need YOU?

          • Amazed

            Because she wants women to suffer the pain of childbirth, so she can get paid.

          • Amazed

            He did identify himself, dumbie. And you even REPLIED to him, begrudging the fact that he, the doctor, can buy a Mercedes while you, the midwife, cannot.

            You already forgot THIS? And I’m supposed to take you as a reasonable human being with actual brains… why?

          • MaineJen

            OMG. Is this a joke?

          • Dr Kitty

            No. I think she’s serious.
            Arithmetic, like risk assessment, epidemiology and statistics, does not appear to be this lady’s forte.

            Complications occur in more than 3% of births worldwide, and are foreseeable but prevented in many more.

            I mean, in countries where half the population is HIV positive and has limited access to HAART, I can think of ONE reason why women might opt out of Homebirth, just as an example.

          • Houston Mom

            I clicked her Disqus profile and read the comments she has left on other websites. She claims vaccines cause autism, believes in chemtrails, and seems open to the idea that our government was behind 9/11 and some school mass shootings. She says several times she is retired. The job stress was too much for her.

          • Amazed

            And here, she claims to be a childbirth educator. I hope that’s the job she’s retired from. I’m afraid it isn’t, though.

          • MaineJen

            Mystery solved.

          • Bombshellrisa

            So she quotes UNICEF and Save the children while totally ignoring their stance on vaccines (both state vaccines save lives)

          • Captain Obvious
          • Stacy48918

            Wow you’re funny. Scary, but funny.

            And Grantly Dick Read is a misogynist bastard.

          • Stacy48918

            Oh, and if women have an “instinctual birthing knowledge” why do they need YOU? Women’s bodies KNOW how to give birth…but pay me $2500-$4000 a birth. The true “Business of Being Born”.

          • birthbuddy

            You do realise that Odent was trained as a surgeon, don’t you and that Dick Reid was as misogynist as they come?
            Good choice of heroes……not.

          • Trixie

            I’m liking this just for the lolz you just gave me.

          • Happy Sheep

            Odent is NOT an OB-GYN by the way….

          • Happy Sheep

            MANA’s own stats show a much higher incidence of issues than 2.7%. For example, 15% of Mothers had a PPH. Shoot, the mortality rate alone from the MANA stats is 1.2%

          • Dr Kitty

            True.
            I COULD remove moles from people’s faces in GP.
            I don’t though, I send them to the dermatologists and plastic surgeons.
            A) because they’ll do a better job than me, having had more practice.
            B) because they are better placed to follow up an abnormal pathology result.
            C) if it goes wrong, and they bleed, they will be in a hospital, not alone in a room with me in a GP surgery.

            If I wasn’t looking out for my patients, of COURSE I could just take the minor surgery fee and forget about all the other stuff.

            As it is, I’d rather not get paid and ensure they get top quality care.
            I’m pretty sure most doctors are the same, actually.

        • The Computer Ate My Nym

          I did well over 20 prenatal and postnatal continuity of care evaluations as a medical student. Not to mention something like 30-40 newborn exams. It doesn’t make me anything close to ready to deliver babies.

          • GmaGardner

            That’s because most of your training was in surgery and analazing high tech equipment printouts. You were not trained to attend normal, natural, low risk, spontaneous births. That would be boring to a highly skilled surgeon. You were not taught to give laboring women massage, to walk the halls with them, to whisper positive, empowering affirmations in their ears, to help them change position, to catch a baby with mom in a squat or on all 4′s!

          • birthbuddy

            GMA, do you realise how predictable you are?
            Every single issue or opinion you have raised is directly from the NCB script and all have been shot down in tatters on this site already.
            Read a few more of the existing topics and stop making a fool of yourself.
            How long before you mention the WHO 15% C section rate?

          • GmaGardner

            I have been stating my experience and training.
            How many births have you attended either at home or in the hospital? How many complications have you successfully handled at home?
            ‘Shot down in tatters’ by whom? Nay-sayers who are projecting their negative experiences onto others? Judgmental people who refuse to open their minds?
            I have repeatedly stated I and all Midwives I know (a few thousand) assess for risk initially and throughout pregnancy & birth. If a woman ‘risks out’ she is referred to seek care with an OB and care is declined by the Midwife.
            What do you not understand about that?
            I do not trust this ‘site’ any more than you trust my experience. Anyone can create a site on the inet. Use your critical thinking skills to determine your own agenda, please.

          • birthbuddy

            I stopped counting in the thousands but that is not the point.
            This is not about your or my thoughts on the topic. It is about what scientific research tells us.
            That is where you arguments start falling apart.
            You do not feature in my agenda because you are no threat to me.

          • GmaGardner
          • Stacy48918

            And you’ve made quite the example here.

          • Amy Tuteur, MD

            No, but you, through your ignorance and arrogance are a threat to babies.

          • Dr Kitty

            GmaGardner, Perhaps you would like to lead by example then, and provide evidence for any of the wildly inaccurate, dangerous or factually wrong things you have posted here.
            Prove, by example, that you know what you are talking about.

            Specifically,
            Show evidence that your definition of neonatal death rates is the correct one, or admit you were wrong.
            Show evidence that only 2.7% of pregnancies and births are high risk, or admit you were wrong.
            Show evidence that red clover and hops are safe and efficacious treatments of pregnancy induced hypertension, or admit you were wrong.

            I am being open minded, I am willing to hear your evidence and arguments.
            The fact is that you have so far not provided anything which could be construed as an argument or any evidence to back up your claims in order to change our minds. This shows me that your “example” so far is to bullshit your way through, hoping no one calls you on it, and then to ignore anyone that does.

            Either own your mistakes or prove that you are correct.

          • Amazed

            You could indeed change the world if you at least learn what neonatal mortality is. Or the other things you supposedly teach. As of now, you’re changing it but not the way I’d want it changed. Dead and compromised babies and mothers are not to my taste, no matter how much the sweet song of bucks is to yours.

          • GmaGardner

            I notice you only answered 1 of my questions.
            Again…. how many complications have you successfully handled at home births?
            What do you not understand about Midwives referring women who risk out to OB’s?
            Who specifically that has any expertise in this matter, has ‘shot me to tatters’?
            Please answer these questions.

          • Stacy48918

            Ah. So when a complication does arrive at home you sit on your hands and let the baby suffocate to death waiting for the ambulance to take you to the OB to save the day?

            You just admitted that you have exactly ZERO experience managing any complications whatsoever at home.

            Why on earth would anyone need you at a birth?

          • KarenJJ

            Actually I’d be really interested in how many complications you have unsuccessfully handled at a home birth? I imagine that someone with vast experience, such as yourself, has had some very scary cases that resulted in poor outcomes for mother and/or baby.

          • birthbuddy

            1) Like many others here, I handle the many homebirth disasters that literally get dumped at the hospital.
            2) What do you not understand about NCB re-labelling risk as ‘variations of normal’?
            3) Pick any example you like.
            Violence against women? I do not appreciate or respect the NCB violence of deliberately perpetuating life threatening lies to pregnant women.

          • GmaGardner

            Also, why is your birthbuddy user id grey’d out, so I cannot see your profile?
            I smell a troll! LOL

          • Stacy48918

            Whoever smelt it dealt it.

          • Anj Fabian

            Neither my OB or CNM whispered empowering affirmations in my ear.

            That’s a good thing because before the epidural, I’d be tempted to reply with some spicy aphorisms and after the epidural, I’d be upset that someone was interrupting my sleep. I didn’t want a massage. I didn’t want to walk the halls. I wanted to get my baby out safely with a minimum of fuss and pain.

            Teal deer version – sorry, GmaGardner, not everyone is buying what you are selling.

          • MaineJen

            If someone had tried to whisper empowering slogans into my ears during labor, they would have lost a few teeth.

          • Amazed

            Thanks for proving what I’ve been thinking for a long time: homebirth midwives are inherently stupid.

            You might be proud of being taught how to walk the halls with labouring women and whisper positive, empowering affirmations in their ears, to catch a baby with mom in a squat or on all 4′s… but you know what? Those are things I don’t NEED to be taught. Nature gave me the vastly superior brains that I need to do those things without being taught. Of course, I don’t really need a vastly superior brain since a ten year old can do those things.

            In other words, only stupid folks take pride in being taught those things. Thanks for proving that it isn’t this hard at all for your average Jane to be smarter than an educated homebirth midwife.

          • GmaGardner

            Well, first of all, I never said YOU need to be taught these things. I said Midwives are taught these supportive things. I have never witnessed a 10 yr old encouraging a laboring woman or giving birth in a squat, but I guess you have.
            I absolutely think a birthing woman is ‘smarter’ than me. She knows her body, baby and needs when I do not. I do know how to be a ‘sister’ – as a mother who has also given birth, a supporter who that ‘average Jane’ wants with her during her pregnancy, labor, birth and postpartum.
            I can’t help but wonder at your defensiveness, accusations and judgment? What’s that all about?

          • Amazed

            Oh, I tend to judge folks who are damaging babies and mothers with their blathering incompetence and wrap it in being taught “sisterhood”. One greedy sister you are! I don’t have a sister but when I support my brother in the hardest periods of his life, I don’t want to get paid. Period.

            Once again, the only ones who need to be taught these “supportive skills” are those with a very tiny headspace. After your laughable incompetence about what constitutes neonatal mortality and that you don’t even know what meconium is (meaning that you haven’t seen it spelled often enough to memorize HOW it’s spelled), I call bull on your “education”.

          • fiftyfifty1

            “You were not trained to attend normal, natural, low risk, spontaneous births…[...]…You were not taught to give laboring women massage, to walk the halls with them, to whisper positive, empowering affirmations in their ears, to help them change position, to catch a baby with mom in a squat or on all 4′s!”

            I, on the other hand, was taught to do all these things. I trained in Family Medicine, so I am no surgeon. All my patients were low risk women planning spontaneous vaginal births, and the hospital I trained at did not offer epidurals (they brought them in only at the very end of my training years). We were required to be with our primary patients during labor from the moment they checked into the hospital, walking with them, encouraging them (I will admit I drew the line at whispering into their ears. I’m their doctor, not their lover), helping them change position, catching babies born with mom squatting or on all 4′s.

            I delivered about 100 babies and assisted with many more. And after all this, I am in no way capable of providing independent Labor and Delivery care. There are a lot of things that can go wrong suddenly with even the lowest risk labor. Each of these problems may happen only in 1/100 or 1/1,000 births. To provide safe care, you needs LOTS of experience. The “standards” for CPMs are inadequate and unsafe. CPMs are charlatans.

        • mythsayer

          Wow! A whole 50 births? How could you possibly miss seeing a bunch of complications?

          • NoLongerCrunching

            Easy! She doesn’t need to see any complications, because she will be an expert in normal birth. Therefore complications will not happen on her watch. /s

          • GmaGardner

            This is true. Midwives are trained & educated to work with zero to low risk births. That’s 97.3% of births worldwide. We are trained to perform risk assessments through a thorough 45 minute intake interview. We are trained to refer moderate risk to high risk mothers to OB’s who are trained surgeons and technical equipment users to handle the 3% of births that are truly not normal, natural spontaneous events.
            Midwives are also trained to handle reversable mild to moderate complications such as anemia, high BP, turning Breech babies, narrow pubic arches, etc. utilizing nutrition, episiotomies, slant boards, red clover & hops teas – which usually work well when our clients are taking 100% responsibility towards having a safe & uncomplicated home birth. If the parents are not truely devoted -won’t eat better, or high BP can’t be reversed -as examples – they are referred to OB’s. These are just some of the standards of practice & protocols developed by NARM & MANA.
            Parents wanting a home birth need to interview all the Midwives in their area and find out if they adhere to these protocols or not.

          • Amazed

            Really? Breech babies usually work out well in homebirth as long as mom doesn’t have a bar of chocolate from time to time?

            In your tiny mind, maybe. Pity that even the joke that passes for MANA study proves otherwise. But I guess they DO work well: you line your greedy incompetent pockets and it’s mom’s fault the baby couldn’t pass through her pelvis because of that bar of chocolate i the sixth month.

            Barf.

          • Young CC Prof

            What are these “zero risk” births? No such thing. And 97.3% of births are low-risk? That’s a rather remarkable claim. Just for example, in the USA, 12% of babies are premature and 8% are low birth weight. That’s hardly low risk.

            And you attempt to reverse high blood pressure in a pregnant woman using herbs and diet rather than immediately referring her? That’s terrifying. I’m amazed you aren’t killing mothers.

            And since when does MANA have practice standards? They’ve explicitly refused to provide any.

          • Amazed

            ” I’m amazed you aren’t killing mothers.”

            She might be. After all, we know how MANA stats are collected and how unfortunate “birth outcomes” are treated in her community.

            She mentioned she’s a childbirth educator. With this level of knowledge, I’ll be amazed if she isn’t indirectly responsible for more than one “unfortunate birth outcome” by teaching the garbage she calls information.

            With her level of expertise, she might have been one of the counselors on Gavin Michael’s case.

          • GmaGardner

            Sadly, you clearly have not given birth at home nor have you attended any home births! Again, Study Michel Odent, OBGYN.
            I have SUCCESSFULY REVERSED high BP with hops &red clover! Whoop! Try it if you care to open your mind just a bit!
            Isn’t it amazing we are all here after our Great Grands gave birth at home??!!

          • Amy Tuteur, MD

            QED!

          • birthbuddy

            Really, Michel Odent, is your go to?
            You are slowly but surely removing any doubt about your credibility.

          • Stacy48918

            I’ve given birth at home and I still think Michel Odent is a blathering idiot. So are you.

            Oh yea, *psst* dead babies don’t post on internet forums.

          • birthbuddy

            Yes it is truly amazing that you survived at all.
            I guess cardiologists are beating down your door for that hops and red clover potion.

          • Young CC Prof

            Another square on the Bingo card: “Open your mind.”

            You have no idea how long a journey I’ve made mentally to get where I am now. You have no idea how shocked and outraged I was when I understood the truth about, for example, labor induction, or epidural pain relief.

            I’ve already opened my mind. I am an avowed Skeptic, and I question my world view every day. Every new piece of information that I encounter may change some of my prior beliefs, if it is compelling enough.

            Why don’t you try opening your own mind?

          • Dr Kitty

            Red clover contains isoflavones, which are plant chemical with oestrogen like effects. It is therefore not recommended in pregnancy.

            Hops also has oestrogen like effects, as well as some evidence suggesting it inhibits inflammatory pathways, and is thought to have sedating effects on the central nervous system.
            It is also not recommended in pregnancy.

            So…you opt for herbal remedies of dubious benefit, unreliable potency and unknown but possibly major side effects to “treat” a medical condition with known potentially serious outcomes.

            Excellent work. Well done you.
            Do you want a cookie?

            Sorry, I don’t give cookies to dangerous quacks.

          • Beth

            Logic fail! Yes, all of us who are here arguing about this are here, despite the fact that our ancestors gave birth at home. And all the people who were never born because the person who WOULD have been their ancestor DIED while giving birth at home, well, they aren’t here to point that out to you!
            It’s sort of like saying “isn’t it amazing that we are all here even though the World Wars supposedly killed millions of people?” Well, yeah….we are here… but plenty of people. and the descendants they would have had, aren’t.

          • Dr Kitty

            Ok, I’m going to list as many risk factors I can think of.
            Ms Gardner, how about you tell me which ones you feel it is safe to ignore, and proceed with Homebirth, because I guarantee you my list will total more than 2.7%.

            Breech
            Twins and higher order multiples
            Previous CS
            Pre-Eclampsia
            Placenta praevia
            Cervical incompetence
            Previous late stillbirth
            Previous premature birth
            Grand multiparty
            Age under 18
            Age over 35
            Smoking
            Drug use
            Severe mental health issue
            Epilepsy
            Type 1 diabetes
            Type 2 diabetes
            Gestational diabetes
            Asthma
            GBS positive
            Abnormal antibodies
            Transplant recipient
            Congenital heart disease
            Known foetal abnormality
            Immunosuppressive medication
            MS
            Physical disability
            Intellectual disability
            Hypothyroidism
            Hyperthyroidism
            Previous shoulder dystocia
            Previous 3rd or 4th degree tear
            Sickle Cell anaemia
            BMI under 18 or over 35 at conception
            Previous massive PPH
            APH in current pregnancy
            HIV/AIDS
            Hepatitis B or C
            Active TB
            IUGR
            Oligohydramnios
            Polyhydramnios
            Child previously removed from custody because of abuse
            Uterine abnormalities such as uterine septum or double uterus
            Previous uterine surgery for fibroids
            Chronic renal problems
            Hypertension
            Auto immune condition
            Previous stroke or blod clot
            Cancer
            Domestic violence or abusive home
            Prisoners
            Homeless women

            It isn’t exhaustive by any means.

          • birthbuddy

            Silly Dr Kitty, you just made a list of variations of normal.
            (sarc)

          • Bombshellrisa

            Nothing that the brewer diet, some kale and aromatherapy can’t cure

          • Jocelyn

            “Breech babies…usually work well when our clients are taking 100% responsibility towards having a safe & uncomplicated home birth.”

            The MANA data recorded a death rate of 22.5/1000 for breech babies. That’s 28 times higher than the death rate of breech babies born in the hospital. TWENTY-EIGHT TIMES HIGHER. Instead of a risk of death of less than 1 in 1000 (as breech babies have in the hospital), breech babies at home have a risk of death of more than 1 in 50.

          • FormerPhysicist

            Well, technically 49/50 does fit under “usually work well”. Not well enough, mind you. But it is “usually”.

            Edited for typos.

          • Amazed

            Jocelyn, you clearly don’t understand. Let me explain: those five breech babies were all born to parents who were not truly devoted to safe and happy homebirth. Lack of devotion, that’s the problem. Not the homebirth midwife.

          • LibrarianSarah

            You see Jocelyn when GmaGardner says “work well” she doesn’t mean work’s well for the BABY. She means it works well for her as the midwife because a client that is willing to take 100% of the responsibility for the birth won’t turn around and blame her when she drops a dead baby in their lap. Being a CPM is so much easier when the victims blame themselves.

          • Bombshellrisa

            And you know that they always blame what the mother eats-since it’s her fault for not being devoted. Cause you only get gestational diabetes or preeclampsia if you eat non organic stuff

          • Life Tip

            Ah, the nice subtle victim blaming for when things go wrong.

            I guess those homebirth disasters were all the fault of the poor mama not committing herself 100% to that hops tea.

          • Bombshellrisa

            I am sorry, but doesn’t the above post remind you have a five year old?”I have FIVE WHOLE dollars! That is TONS of money!” And in this case “I will have been at over 100 births! That makes me, like, totally an expert. And I get to read books like doctors do!”.

          • GmaGardner

            She states 100 total births, which are low to zero risk after applying standardized risk assessments protocols developed by MANA & NARM. That makes it very unlikely she will see a ‘bunch of complications’ in even 1000 births! Get it?
            I did part of my training in a birthing center training clinic in ElPaso, TX. We got a fair amount of mamas in labor crossing the border to give birth at our clinic. Some showed up in the middle of the night which means we had never seen them for prenatal care. I saw plenty of complications but women and birthing is so amazing! We had very few transports for things we couldn’t handle and TX state laws for licensed Midwives were required to transport. Out of the 100 births I attended there, only 3 had to be transported via ambulance. One was a baby boy who was 100% fine by the time we got to the hosp. I know, because I carried him in my arms – but we had to call 911 because the law said we could not ambu a baby for longer than a certain number of minutes. I cuddled & talked to him. His breathing and heart rate (I was using my stethoscope) became normal, the EMT’s could tell he was fine and were asking me what they should do!!!

          • Bombshellrisa

            Texas state midwifery oversight is a joke. Isn’t Texas the state that required a midwife to write an apology letter as her only punishment for a mishandled birth?

          • Trixie

            Great, so if she’s not qualified to see complications as a CPM, then why does MANA advocate for CPM-attended VBAC, breech, and multiples?

        • Trixie

          Wow! A test that’s 8 hours long? Gosh! And a whole other day of demonstrating skills? Who evaluates you — other CPMs? Do you learn actual science? Chemistry? Pharmacology?

          I took an 8 hour long test to obtain a professional certification for my job once. It really was not that big of a deal. The difference is, I didn’t hold anyone’s life in my hands afterward.

        • GmaGardner

          Hey, Audrey have you noticed all the unreasonable ones arguing with us have grey’d out user names – so we cannot see their profiles? I smell trolls. How about you?

          • Stacy48918

            I’ve noticed that Audrey hasn’t been back for 5 months….

          • Amazed

            Now, now, Stacy! Don’t make GmaGardner use her brains. She’s not used to such activities…

          • Dr Kitty

            No, some of us just don’t want to link our comments here to our Facebook and Twitter profiles. Doesn’t make us trolls, just careful about our personal security.

            I’ve been posting here for years, Dr Tuteur knows my real name. I just don’t want to use it to post, like most of the real physicians and nurses who post here.

            I think I’ve been perfectly reasonable with you, by the way.

    • Siri

      I don’t for a moment believe you’re an OBGYN with writing, spelling and grammar skills like that. Stop pretending please.

    • Captain Obvious

      1. When breech birth is attempted, anywhere, first or third world countries, there is always a higher morbidity and mortality. Even doctors experienced in breech birth have worse outcomes then vaginal birth.
      2. According to you CS should only be done in case of emergency. And many times it is. So how do you know any complication isn’t due to the maternal or fetal complication and not the CS itself? Repeat and elective CS have lower rates of morbidity and mortality than emergent CS. Do you then tell your patients that had a CS that their baby is now worse off because they had a CS? They missed out on all that squeezing, release of hormones, and gut flora? Cesarean birth is abdominal surgery and vaginal birth is vaginal surgery. Both have risks and benefits including bleeding, need for transfusion, post procedure fever and infection, need for antibiotics, risk for injury to surrounding organs like bowel, bladder, urethra, vessels, anal sphincter, with need for suturing or need for reoperation.
      3. Statistics prove over and over again that in a homebirth setting there is often necessary interventions that don’t get performed that could have allowed baby and mom to survive, because procedure and protocol of homebirth are non existent. Just ask the family of Caroline Lovell, or Judy Fraser, Annie Bourgault, Ina May Gaskin, Laura Shanley. All Homebirth advocates who would have avoided loss had they been in a hospital.
      4. This blog is about CPM and DEM here in USA. As practiced in the USA, you barely need any training at all. Until a year ago, you didn’t even need a HS diploma.
      5. These numbers are the numbers created by the home birth advocates themselves. They are not biased. These are the numbersand statistics of the American Homebirth midwives published by them. How do you claim not to take them seriously?

    • Cody

      I call BS on “Dr. McKenzie”. None of the OBs practicing in Ontario would use this type of vocabulary. This is the vocabulary of a layperson and not that of a professional working in the medical field.

      • theadequatemother

        There is no obgyn or OB physician of that name registered in ON. See the CPSO has a website where you can look up this kind of thing. Kin of make me cheerful.

  • Jessica Hedgcock

    Your chart is cropped to exaggerate the difference. Here is the same chart without the distortion:

    http://i.imgur.com/pZsXzzZ.jpg

    Also, why does it exclude high risk hospital births?

    Finally, you use the number 450% because of how scary it sounds. With all of your education, this is most certainly purposeful. If I buy five lottery tickets instead of one, my odds of winning increase by 500%. That sounds really good, but in truth my odds just changed to five-in-a-million from one-in-a-million…still highly unlikely.

    Frankly, these stats actually make hospitals look bad. With all their technology, I’d expect a hospital to have a much higher improvement than .003.

    If home births are so dangerous, why the need for deception?

    • Young CC Prof

      “With all their technology, I’d expect a hospital to have a much higher improvement than .003.”

      That’s because bad home births transfer. With no hospitals around, the death rate is about 10% for babies and 1% for mothers. The very same study showed 20% of mothers transferred to hospital care before labor and 10% during.

      And “All risk hospital birth,” excluding only young preemies but INcluding loads of risk factors totally absent for MANA’s pool, still has a death rate half that of MANA’s low-risk group.

      If you’re that worried about absolute death rates, the absolute difference in risk between home birth and hospital birth is about the same as the absolute difference in risk between driving your child with a proper, age-appropriate car seat and driving your child without even a seatbelt. For his or her entire childhood.

      So, if you’d buckle up every day for 16 years to avert a supposedly small risk, wouldn’t you go to the hospital just once?

    • NoLongerCrunching

      Since the differences are per 1000 births, I’d say that’s a fair lot different than the difference between five and one in a million. In any case, don’t moms deserve to know these numbers so they can make an informed choice about whether THEY think it’s worth the (in your opinion) small risk? If so, you must agree it’s unethical of MANA to publish this with NO comparison group in their paper, and to proclaim that their paper shows homebirth is “safe.”

    • MLE

      When you say you won’t section unless it’s an absolute emergency, what do you men by that? I surely hope you won’t sacrifice brain function for a vaginal birth just because the baby won’t be dead?

    • FutureDad

      Exactly. The difference between 0.0004 and 0.0016 is hardly significant. That means that under your stated conditions, there are still 998.4 happy healthy home birth babies out of every 1000, which would be hard to argue is unsafe. Given a healthy mom and baby, it appears there is still less than a 1/5th of 1% chance of mortality.

      That said, MANA refusing to release their statistics for so long does border on negligence. We, the non-medical public, deserve to at least know the reality of the choices we make.

      • The Bofa, Being of the Sofa

        Exactly. The difference between 0.0004 and 0.0016 is hardly significant. That means that under your stated conditions, there are still 998.4 happy healthy home birth babies out of every 1000, which would be hard to argue is unsafe. Given a healthy mom and baby, it appears there is still less than a 1/5th of 1% chance of mortality.

        Did you know…

        The fraction 0.0016 is approximately the rate at which drunk driving results in either an accident OR a DUI (and 2/3 of the time, it’s the DUI). IOW, the chance of a drunk driver getting into an accident is about 1/3 of that number. That means that for every 1000 people who drink and drive, more than 999 will make it to their destination safe and sound, without and accident, and 998.4 will make it without so much as a DUI.

        And that isn’t even talking about the chance of someone (anyone – driver, innocent bystander) dying, which is somewhere on the order of 1000 times less likely (for every 1 million people who drink and drive, 2 people will end up dead (most likely the driver)).

        Do you consider the risks of drinking and driving “hardly significant”?

      • AlisonCummins

        No, “not dead” is not the same as “happy and healthy.” There are on the order of 20 permanently injured babies for every dead one.

        If the death rate for in-hospital births is 0.38 per 1,000, then you would expect something like 7.6 permanently injured babies born in hospital for a total of around 8 per 1,000 dead or permanently injured. Less than 1%.

        Compare with the death rate for low-risk pregnancies for babies born at home: 1.6 per thousand, which suggests around 32 per thousand permanently injured or 33 per thousand dead or permanently injured. That’s 3.3%, or 1 in 30.

        If you look at the death rate when high-risk pregnancies falsely classified as low-risk are included (midwives claim to only attend low-risk births), you’ve gotten up to 2.0 per thousand deaths and about 40 per thousand permanently injured for a total of 42 per thousand dead or permanently injured. That’s 4.2% or 1 in 24.

        Really? That’s a chance you want to take???

      • Stacy48918

        “hard to argue is unsafe”
        Except of course that those extra dead babies are almost always completely preventable.

        Homebirth midwives take on high risk patients routinely (Amos Grunebaum, 2014) and don’t have the education (or mindset) necessary to recognize when things are going poorly. As a result they kill babies, preventably. Sure MOST mothers and babies will go home ok…but the ones that die?

        They didn’t have to.

        So, you readily admit that homebirth is more dangerous and kills more babies than hospital birth, right? You just acknowledged a difference. That difference has been found significant in MULTIPLE peer reviewed published articles, in just the last year.

        Does FutureMom know this and agree that homebirth is more dangerous than hospital birth? She knows and agrees that both she AND her baby are more likely to die at home?

    • Ash

      Pray tell: what is the Y axis of your graph?

  • Sabrina Antoinette Magis Nicho

    Just watch The Business of Being Born, and you’ll realize that things CAN happen @ home, but it is the midwife’s job and responsibility to KNOW when to transfer if necessary, or to transfer care to an OB if there is need at some point in the pregnancy. I had my second at home, and would have had my first at home too if I had been able to. (I was living with my mother who was adamantly against it). My hospital experience experience WAS NOT what I intended for my first meeting of my first child. I never had that amazing high or feeling of “I can’t believe I just did that!”. So I was so glad to be able to labor the way I wanted to with my son. He was in OP presentation, so I was actually blessed to have delivered in the water, it was the reason I didn’t tear! & my 3 days in the hospital post-partum was such a mixed bag and overwhelming with conflicting info. My midwives in their follow up visits that first week were straight forward and encouraging. Being in my own environment was more healing and gave me more of an opportunity to bond and SLEEP with my son. Just amazing and empowering. Also, I live in Canada where we closely follow the European midwifery model. This is so bs, and women need to make the right decision for themselves and partners need to be supportive. If women have the right to “choose” to end her pregnancy, they also have the right to choose how to carry it out and how they want to birth. It is personal and can be made on her own. If she doesn’t have the right support, it doesn’t matter where she births, it won’t be the experience that she wants or needs. This information is BOGUS, and it needs to be kept in mind that in some states, they have made almost IMPOSSIBLE for women to even have a choice as homebirths are illegal. Not because it’s less expensive, or because it’s “harmful”, but because doctors have used their power to limit a woman’s rights. Just thought I’d give another view. Just someone who’s determined to discredit others for their own ends.

    • AlisonCummins

      Which information exactly is BOGUS? How do you know it is BOGUS?

      In Canada, midwives are qualified and work with a hospital.
      In the US, most homebirth midwives have no qualifications and do not work with a hospital. There’s a huge difference. You say “it is the midwife’s job and responsibility to KNOW when to transfer if necessary, or to transfer care to an OB if there is need at some point in the pregnancy,” and that is exactly right. If the midwife cannot do her job because she doesn’t have the training, that’s a major problem.

      Nobody here suggests that women not have the choice of where to give birth. Of course they have a choice.

      What people here are against is allowing women to call themselves midwives when they are no such thing, to say untrue things which make women think that homebirth is much safer than it is, and to charge money for it.

      • Sabrina Antoinette Magis Nicho

        This is a long video, but I found it very informative: http://www.youtube.com/watch?v=_nBPp3eZgR0

        • AlisonCummins

          Sabrina,

          You haven’t answered a single one of our questions. If you can’t answer our questions in your own words, it sounds like you don’t really understand.

          What did this video inform you of?

          > Does the video specify which statements in the blog post are bogus?
          > Does the video explain how you know they are bogus?
          > Does the video reveal whether your midwives obtained your informed consent by telling you about complications that could result in the death of your son or yourself that could be more safely managed in hospital?
          > Does the video provide the relative rates of death and permanent disability in home and hospital birth in Canada?

          • Sabrina Antoinette Magis Nicho

            It explains the lack of communication and working together of midwives, and other healthcare professionals and hospitals in the US. Just because I use a video or article that best explains things, that just means I’d rather let someone else who KNOWS what they’re talking about tell you rather than look like an idiot, just cuz I’m not the most eloquent person on the planet

          • AlisonCummins

            You said that the information in the blog post was bogus.
            Why did you say that? You must have had an idea in mind.

          • Sabrina Antoinette Magis Nicho

            No one who posts extremely skewed results are trying to share truth, but to create fear. Doctors especially perpetuate this to convince you that their way is “safer”, @ least that was my experience. The only results you can truly find is looking at ALL the information presented you, or lack there of, and make the right decision for you and your family. While no biased source should be taken as gospel, that doesn’t mean they can’t have some points to take away with you. And until birthing tubs are standard in all hospital L&D rooms, you won’t see me set foot to birth in one til they do. But on that note, I take full responsibility of my decision to birth at home, I now trust my body to know what to do when even a small complication arises. (during birth, not pregnancy)

          • AlisonCummins

            What statements in the blog post are wrong? I keep going back to this. You were very sure that they were wrong but you haven’t come up with a single example of a mistake.

            Do you have any evidence that obstetricians are wrong about how to give you and your baby the best chance of staying alive? If they are not wrong, then why shouldn’t they tell you what they know even if it’s scary sometimes?

            Why would birthing tubs need to be available in all L&D rooms [in Canada? North America? The entire planet?] before you will accept medical care for you and your baby?

            What are the risks and benefits of birthing tubs?

            You trust your body to know what to do in the case of a small complication (by the way, do you have an example of a small complication?). What about a big complication? Can you give an example of a big complication?

            Did you understand what I said about the difference between trained canadian nurse-midwives and american untrained midwives?

          • Melissa

            Why do birthing tubs need to be in 100% of the rooms if 100% of the people don’t want them? They have birthing tubs available at all the hospitals I’m familiar with, although you may have to request it ahead of time so they can put you into one of the rooms where it is available. But you also have to request a kosher meal because they don’t just bring one along with every meal just in case someone wants it.

    • Karen in SC

      It’s great you had a safe experience but read the statistics above for the US. More babies die at a homebirth that would be born healthy and alive in the hospital?

    • DaisyGrrl

      When your midwives had you provide informed consent to give birth at home, did they inform you that there are complications that can arise spontaneously in low-risk women that could result in the death of your son or yourself that could be more safely managed in hospital? Did they provide you with the relative rates of adverse outcomes in home vs. hospital? And by adverse outcome, I mean morbidity and mortality. Not c-sections and epidurals.

      I live in Canada as well and I cannot find this information anywhere. I don’t care what the epidural rates are. I don’t care about the c-section rate of my hospital. I want to know what the relative risks are regarding the life and long term health to mother and child.

    • Karen in SC
    • sarahh.rosanne@gmail.com

      I would think a majority of women here who believe that homebirth is unsafe, or disagree with the ideology of the NCB movement, would support your right to choose a homebirth in spite of their concern or even contempt. They would likely discourage it. I would not wish anyone be denied that choice. When someone I know chooses to give birth at home, which is not terribly often, but happens often enough to note, I suggest certain reading material and relay my own experience with sudden complications during my first hospital birth, to the extent that they are receptive to listening, and I offer to bring food after the birth. I would say that it is a moral issue of providing accurate information that supports the safest option for all possible scenarios, and providing informed consent of risks and misconceptions. There is also a need to bring light to systemic abuse and unethical behavior within midwifery and natural birth “cults”. There are sometimes unfortunate outcomes in hospital birth and compassion can be in short supply in any environment, but the statistics are representative of an increased risk that is inherent to giving birth outside of a medical facility.

      • Melissa

        Exactly. Homebirth should not be outlawed, but those who choose it should have full and accurate information on the risks of doing so. All we want is for the truth to be out there without the skewing of numbers by MANA. There are real risks to birthing at home in terms of safety and outcomes. The benefits to be found at birthing at home are psychological, but for some women those benefits are worth the increased risk. To each their own.

        But now that most hospitals include birthing pools, yoga balls, showers, birthing chairs, private rooms, full menus, and free on demand movies the stories of women being strapped down and forced to give birth while being yelled at by doctors is not happening most of the time. I’m sure that there are places where these things aren’t available because this is a big country, but both of the hospitals in my town have these types of full service options. Part of the problem is that if you’ve been outside of the hospital system for your whole pregnancy and then show up when something goes south at the homebirth, you aren’t going to have access to these nice things. You’re going to be in an emergency situation with doctors and nurses you don’t know who are not going to have time to let you search google before making a medical decision. The experience that someone has with hospitals when being transferred from a homebirth is nothing like the experience that women have when they plan a hospital birth. Just like my outpatient gall bladder surgery experience was much nicer than someone who has to have an emergency operation when they come into the ER.

    • MaineJen

      BINGO

    • Captain Obvious

      Uh, the BOBB midwife Cara Muhlhahn has several lawsuits against her for malpractice/shifty care. All evidenced on line. I woundn’t be using BOBB to support your belief.

  • ShaunWaugh

    Support for the claim that homebirth has been empirically shown to be a failure.

    International research on safety of homebirths [1]: “In 2014, a comprehensive review in the Journal of Medical Ethics of 12 previously published studies encompassing 500,000 planned home births in low-risk women found that perinatal mortality rates for home births were triple that of hospital births. This finding echoes that of the American College of Obstetricians and Gynecologists.”

    The NZ the rate of homebirth was around 2% nationally (in a 2004 Health Ministry report, the most recent I could find) [2].

    [1] http://en.wikipedia.org/wiki/Home_birth

    [2] http://www.newswire.co.nz/2012/11/new-zealand-homebirth-figures-being-addressed-by-ministry/

  • ShaunWaugh

    Thank you for this post Dr Tuteur, and for your work championing science in women’s health. It is difficult/impossible to get statistics on the impact of the natural birth movement and homebirth in New Zealand over the past 25 years or so since it really took off. My fear is that the situation is as bad or worse than in the US. Although controversy flares up sporadically in the media when a tragic child death occurs during a homebirth that would have been avoided in a hospital OB birth unit the Epidemiological data on homebirth is not even collected here. It is not controversial to say that this is a public health travesty for a developed nation.

    In New Zealand [3] the situation is sadly not as enlightened as you may have assumed, the homebirth movement here is championed by “bachelors of midwifery”, who have not undertaken a degree in medical nursing training. Midwifery regained its status as an autonomous profession in NZ in 1990. The Nurses Amendment Act restored the professional and legal separation of midwifery from nursing, and established midwifery and nursing as separate and distinct professions. Nearly all midwives gaining registration in New Zealand now are direct entry midwives who have not undertaken any nursing training. Midwives are required to undertake a 4 year equivalent undergraduate degree to become registered [4]. A bachelor of midwifery is nowhere near equivalent to a evidence-based medicine nursing degree. By comparison a bachelor of midwifery is a degree that blends science-based medicine with psuedo-science and anti-science (under that weasel-worded banner of anti-enlightenment casuistry”different ways of knowing”), women’s studies, cultural safety and the humanities. The study of actual human physiology is not significant compared to a medical nursing degree here. [6]

    This question was posed to NZ’s children’s commissioner Dr. Russell Wills in 2011:

    Q: What are the outcomes of the changes to maternity care in the 1990s, allowing midwives to act as independent lead carers, for mothers and babies?

    A: We have no idea. We don’t track those outcomes.

    In New Zealand science-based medical degrees in nursing offer midwifery as a post-graduate certificate and masters degree specialisation. I note that Victoria University is discontinuing its Master of Midwifery degree this year [6a]. As in the US, Nurses with post-grad midwifery qualifications have collaborative relationships with other science-based physicians and are an integral part of Obstetrics in New Zealand hospital birthing units.

    The role of non-nursing trained midwives in New Zealand is dogged by controversy such as the feature article in North and South Magazine in August 2011 “A failure to deliver” [9]

    Link to a pdf of the North & South article – “A failure to deliver” http://d3nd7i493f0o21.cloudfront.net/assets/NS0811midwivesopener-1.pdf

    The debate about the merits of natural/homebirth in NZ is derailed by feminist anti-enlightenment casuistry. If you’re male, and question the hegemony non-medically trained midwives assert over childbirth, or suggest that the homebirthing movement is a failed experiment you can expect nasty ad-hominem from the post-rational coterie who will do anything to avoid addressing the substance of the contention that natural birth and homebirthing have been empirically shown to be a failure, and should be abandoned.

    [3] http://en.wikipedia.org/wiki/Midwifery#New_Zealand

    [4] http://www.midwife.org.nz/education/where-to-start-becoming-a-midwife

    [5, 6] http://www.cpit.ac.nz/study-options/qualifications-and-courses/programmes/Bachelor-of-Midwifery.xml

    [6a] http://www.victoria.ac.nz/nmh/prof-programmes/qualifications/midwifery/masterofmidwifery

    “From 2014 there will be no new intake into this degree. Students currently enrolled in this programme of study will be supported by the Graduate School to completion. Some students may consider transferring into our new degree, Master of Health Research – Thesis in Midwifery (MHR) and will be given individual advice on their future options for study.”

    [9] http://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=10738247

    http://publicaddress.net/hardnews/complaint-and-culture/

  • travaggie

    Wow, you completely attack them for “spinning” statistics by making up and completely spinning your own. First, the big one, is that miscarriages are classified as death via home birth. Yes, pretty big oversight considering virtually all miscarriages are away from the hospital. Also, while their research included all women, you specifically compared it to a study of white women only which could throw off the comparison considerably depending on circumstance, affordability of proper healthcare, etc. Then you compare your numbers, which specifically state low risk, to the high risk numbers from the study, and quote 450% as if it’s fact. Talk about completely and utterly misleading. You tried to clarify below, but in no way is 450% accurate or should even be mentioned, it doesn’t exist. As far as the breech death rates, again completely misleading and intentionally so. Most all babies who are breech at the hospital become cesarean births, of which there are still many deaths, but are now classified away from breach. Just terrible skewed and objective positioning of your beliefs that are doing serious, serious harm to the reputation of home births which have been proven over and over again to be significantly safer all the way around versus hospital birth.

    • Amy Tuteur, MD

      No, miscarriages are NOT characterized as deaths at homebirths.

      You don’t have to take my word for the fact that the MANA death rates are hideous. You can just look at MANA’s actions. If they thought that the data showed that homebirth was safe, they would have announced it years ago. Instead they waited 5 years, put it in a crappy paper and hoped that gullible fools like yourself would accept whatever they said. You behaved just as they thought you would. Fortunately, the rest of us aren’t so easily fooled.

      • travaggie

        They are, perhaps in this situation they did take that into account, but in general they are. But thanks for pointing that out and ignoring the remaining points.

    • Young CC Prof

      Nope.

      The only births in this study are women who planned to birth at home and started labor at home. Almost all of them were at full term.

      And it’s extraordinarily rare for a breech baby (with no other problems) to die during or shortly after birth in a hospital. Yup, they are delivered by c-section. And if they are alive and well at the beginning of the operation (as opposed to already dead or very close to it) they come out fine and almost always stay that way.

      Why WOULD a baby die during a c-section? It just doesn’t make sense.

  • plaiddog

    Thanks for this valuable information, doctor. When I was pregnant, many friends were also pregnant. The two friends determined to have home births were, in my humble opinion, control freaks. They were skeptical of science and Western medicine, but completely accepting of holistic alternatives. They also seemed to overestimate their expertise in the area which was based mostly on internet sites that were anti-Western medicine. This is simply illogical. You can find doctors who will work with you, natural birth rooms in hospitals and medical facilities. You can have a natural birth, but also have the advantages of medical science if something goes wrong. In the end, it’s about bringing a healthy child into the world.

    • OK

      plaiddog, if you were friends of these women, you would support them. sometimes, whether control freaks or skeptical of western med, there is some reason for the skepticism. whether illogical or otherwise, if you’re a friend, you’re a friend regardless of their logic. if you’re pregnant along with your friends, you know that this is a very important time for women, a very emotional time. they’d need supportive friends, family, and loved ones standing behind them encouraging them. there is no proof that hospital birth is 100% safer than a home birth, with midwife. Ultimately, safety is important. Midwives are trained in listening to the woman and taking her health as well as infants’ health into consideration and getting mom and babe to hospital if emergency arises which she is unable to perform miracles for in a home setting. It is down to choice. You chose to speak up about your friends in such a way that does not support their choices. Be a friend, not judgmental.

      • MLE

        If I knew that the death rate at home with a midwife was 450% higher than at a hospital and I kept that information to myself for fear of sounding “judgmental” of my friends’ choices, I would certainly be in for some judgement of my own were they to experience the worst. It’s called having a conscience and being a true friend instead of a pandering sycophant.

        • Karen in SC

          I wonder if the 450% higher number is translating to 450 times higher and thus easier to ignore – since it can’t be that high, that number must be wrong….

          Lots of my freshman students don’t understand percentage. I have to explain step by step how to calculate percent error, percent yield, percent composition, etc.

          Maybe stick with 4.5 times….

          • MLE

            Agreed, I copied it directly from the title because it’s ridiculous to make a comment like that dismissing the risk when it is spelled out so clearly only six inches above (depending on your choice of electronic device)

          • The Bofa on the Sofa

            A 450% increase means it’s actually 5.5 times…

            :)

          • Karen in SC

            I was obviously confusing it with percent yield, I think.haha, so if it can confuse a chemist (part time) it can confuse anybody!

      • Captain Obvious

        What if they smoke? Are using drugs? Participate in high risk behavior? Fail to attend their prenatal visits? These are all choices. Should no one say anything, except just give them support?

      • NoLongerCrunching

        No. I would ask who her midwife is, dig up some dirt on her which should be pretty easy, and then tell her the following: this is not easy for me to say. All I ask is that you hear me out, and then I will not bring it up again and I will support whatever choice you make. I think you should know…

        When I was giving birth in a birth center my uncle basically said the same thing to me. He had had three children who had died at birth from a genetic anomaly. I of course dismissed what he had to say, but I certainly didn’t resent him for trying.

      • Durango

        My most cherished friends tell me whAt they really think. It can be painful, but how can you have any hope for truth if you surround yourself with only the opinions you want to hear?

        • plaiddog

          I agree. The women were acquaintances more than friends. Both actresses. Beautiful ladies, but not women I respected intellectually.

      • plaiddog

        I used the term “friends” loosely. One woman was a neighbor, the other a work-colleague’s wife. Neither mom vaccinated her child. Yes, I’m judgmental and have little tolerance for people who are anti-science.

  • Laura Spilde

    I had a still birth at home……

    I planned it that way because I wanted herbal therapy and not pharmacological “poisons” to induce labor.

    Ultrasound in the hospital already showed that the baby had died.

    Now its time to add more #’s to this ridiculously twisted data.

    Yes……..many babies do die at home. You are right 100%. Many of them are miscarriages. Herbs stop pregnancies and are grown in mommas garden and YOU don’t even KNOW about ALLL of those deaths nor will YOU get access to those deaths.

    Next stat that actually has evidence of reality please.

    • Karen in SC

      Sorry for your loss. Were you at term? Do you know that preterm were included in the MANA statistics? Is that what you are trying to point out?

      Otherwise, I’m unclear about your request about evidence of reality. These statistics are in the MANA report.

      • Laura Spilde

        It was a 20 week loss. This was the second, second trimester loss.

        After some experience with pharm. drug and more experience with herbals I used your basic herbal therapy and I’m not ashamed to choose to do that my self. Financial benefit, social benefit and health benefit for both sides of the fence.

        If you are interested in information you may read here:
        http://www.bubblews.com/news/2207064-choose-life-yet-nature-has-its-ways-miscarraige-stillbirth

        I support home birth because of 1. financial benefit to mother and society, 2. God’s original plan 3. freedom of religion benefit 4. determination of overall society health 5. Political retributions and restraints.

        A sign of many pregnancy losses in home-birth or hospital-clinic care is a sign of an overall social problem (nutritional, spiritual, educational or otherwise).

        • The Bofa on the Sofa

          “God’s original plan”?

          How do you know that hospital birth was not part of God’s original plan?

          How are they any less of “God’s original plan” than the computer you used to make this comment?

          • OBPI mama

            While I think God’s original plan was perfection and, obviously, we don’t live in a perfect world anymore. I really think He has given us wonderful, problem solving minds that help us deal with the consequences of living in a fallen world. And by bettering this fallen world (insert: by building hospitals, using modern medicine as well as nature’s medicines if we choose), using the gift of the mind, we are respecting, cherishing, and fully embracing His most miraculous creation (insert: babies here). I like to think of this whenever I hear how “horrible” hospitals are, how they interfere with God’s design, etc. We aren’t in Eden anymore and thinking that we are puts babies in danger. Now that I know the truth about the risks of homebirth, I have chosen to cherish the gifts God has given to me… enough so that I use people He’s gifted with knowledge/training/passion/etc and places He’s blessed so these wanted and wonderful babies can come into this world healthy and whole.

          • OBPI Mama

            Guess that was geared more toward Laura… Sorry Bofa on the Sofa!

        • LynnetteHafkenIBCLC

          No one is trying to take away mothers’ rights to give birth as they see fit. But don’t you agree that mothers deserve accurate information about risks before making decisions about where to give birth?

        • Medwife

          So do home birthers have substandard nutrition? Are they not religious enough? Are they not educated enough (or are their midwives not well educated or religious enough?)

          What do you think?

        • An Actual Attorney

          “Political retributions”??? So, when one party is in power, the babies of the other get left to die? How Pharoh-like of you.

        • OBPI Mama

          I am so sorry for your loss. I have to take some issue with your statements though. 1. When a trauma (brain or otherwise) happens due to having a homebirth, the financial burdens are enormous. What was once a 1,300-5,000 dollar homebirth is now a 100,000+ bill. Surgeries, NICU stays, brain cooling treatments, lifelong nurses and therapies… it adds up and completely cancels the financial benefit. If the family needs help with the bill, we all pay for it. 2. God’s original plan didn’t involve sin. But we messed it up. And sin and brokeness and death and trauma entered the world. And all was no longer perfect. 3. I don’t believe in banning homebirth… I just want women to know the real risks of their decisions and have it be plain knowledge. I did not know the real risks and my son suffers because of my homebirth-gone-wrong. I don’t want that for any woman. 4 and 5… no idea what you are talking about.
          And I hate, hate, hate when lack of faith is brought into the trauma that is in this world. God gives LIFE! God wants to bless us and wants nothing but good. Satan is the one who comes to kill, steal, and destroy. And what does Satan love and use to do the things he does when he can? Lies, deceit, omission of truth…

        • prolifefeminist

          Laura, I think women have the right to give birth wherever they want, with whomever they want. But I have a big, big problem with birth attendants misrepresenting their training and abilities and telling expectant parents that home birth is “as safe or safer” than hospital birth when the data shows the exact opposite. I think it’s totally immoral and unethical for a trade organization like MANA to hide safety statistics from expectant parents, and then “spin” the truth like they have when they do release the numbers.

          If home birth advocates would be honest and just come out and say, “these are the risks, these are the benefits…now you can make an informed decision” I would be thrilled. It’s such a massive responsibility to be entrusted with the care and safekeeping of another human life. How utterly wrong it is to withhold the truth from parents who are the ones responsible for making these important decisions! I know that it took me and my husband a long time to stop being angry that we were lied to by our home birth midwives when we were planning a home birth. There is NO excuse for dishonesty like that.

          • Kathy Tsangaridis

            I agree with you 100% and I’d like doctors from hospitals to
            do the same. I dont think one is safer than the other full stop. I think there
            are times and situations when one may be better than the other. I wouldn’t say
            delivering twins at home an hour away from nearest hospital is safer than being
            in the hospital. but i wouldn’t rule out low risk birth, close to hospital i
            case of emergency with a professional and registered midwife as being worse
            than being in hospital. Best thing i read lately is why not we focus on how to
            make homebirths safer rather than continually trying to make them out as the
            enemy? so that women can choose and know they are going to be well looked
            after! can we improve on hospital transferes can we look at better regulation
            of professional midwifes? we do with our doctors don’t we? is that maybe why
            they are supposedly safer? imagine if anyone could rock up to a hospital and
            claim to be a doctor would we see hospital births being as ‘safe’? can we offer
            different training and equipment for midwives so women get the benifits of
            things proven to help in hospital while the comfort of their own home which
            also has benifits. why do we always talk about how to make hospitals more like
            homebirths having recognised that private midwives have lots to offer but dont
            give them access to stuff that makes hospitals record safety. you know it just
            aint about us pregges women. hello we are here we are your customers cant you
            people just work on giving us choice and best care instead of fighting over statistics?

          • KarenJJ

            “Best thing i read lately is why not we focus on how tomake homebirths safer rather than continually trying to make them out as the enemy?”

            Fantastic. I agree 100%. A few things to get started then:

            The education of midwives to be a university degree minimum standard.
            Strict criteria for risking out (no twins, no VBAC, no more than 30 minutes drive from the hospital).
            Midwives to carry malpractice insurance.
            Completed pre-natal screening (ie GD, PE, GBS testing, ultrasound etc) and anything out of the ordinary to be referred onto an obgyn. You are high risk unless you screen to be low risk.

            Then we should put all that to MANA and see what they say.

            Funnily enough I have a similar type of homebirth community midwife program available for me for free (not in the US), but MANA doesn’t seem to want to emulate it. Why not?

        • Karen in SC

          Two second trimester losses? I’m very sorry but you really need to see an OB to rule out any medical reason for those.

          • theNormalDistribution

            Well it wasn’t the herbals…

    • Trixie

      I’m very sorry for your loss. If your baby had been determined to have passed before the onset of labor, then for statistical purposes, it wouldn’t count in the intrapartum or neonatal death rates that we are comparing here.

    • Captain Obvious

      Sorry for your loss. As the others have stated, MANA clearly stated these babies were alive at the onset of spontaneous labor (or maybe induced with “herbal therapies” at home like black and blue cohosh, EPO, sex, rebozo scarf, sweeping membranes). Are suggesting MANA should have included all the stillborn babies that were delivered at home as well? Please explain these pharmaceutical poisons you speak of.

      • Laura Spilde

        If hospital’s override the rights of the patient the patient gets a dose of “poison” rather than good care. Its hard to balance between herbals (God-made) and pharm. industry (man-made). Pharm. drug prescribed in my first pregnancy was well a bit too much on my body. Herbal care (not allowed in hospital due to legal issues) was not prescribed by doct. in hospital. I had to take on my own care because I wanted gentle care on my body and more financially reasonable choice for a dead baby. It was more gentle and that is NOT A LIE. It was also less expensive. Homebirth may be a significant reason why women WANT homebirth. Medicaid is a drain pipe wading around in waist high medical bills for maternity care. The result socially of high medical costs and time drained on woman and family: Don’t ask, don’t tell.

        I don’t discredit medical care when it is really needed in a hospital. However pointing fingers at homebirthers (certified as midwife or not) is a blame game that gets the fingers pointed right back at the finger pointer.

        • Trixie

          Again, with due respect for your loss and suffering, your risk at a home birth was significantly lower because your baby had already passed prior to the onset of labor. No one here would ban home birth. We just think that women deserve the actual facts before they make the decision.

          Neonatal death includes only babies who were born alive. Intrapartum death includes babies who were alive at the start of labor but died before delivery. Your baby was neither of those and so therefore it wouldn’t be included in anyone’s statistics on the subject.

          • Laura Spilde

            Science (and the stats) without religion is weak.
            Religion without science is blind.

            Obama care and professionalisms of this world will never be able to tell the difference between good and evil. Its all about the business of tweaking things and stats to make a profit……maybe its the midwife and maybe its the hospital.

            Hopefully science leads to truth rather than profit or it isn’t worth the effort of calculations in the long run cause a man can’t survive the eye of a hurricane.

          • Unplanned C-section

            Isn’t it wonderful that we have science to let us know when a hurricane is coming? Thank God we have science monitoring them, and we can forecast and tell humans to evacuate–thus saving and preserving human life in the path of a destructive force!

          • LynnetteHafkenIBCLC

            What does this even mean? Most professionals in health care went into this field to help people. Hospitals and insurance companies may have a profit motive, but the individual doctors, nurses, etc are focused on caring for their patients using the most up-to-date medical science there is.

          • AlisonCummins

            You most certainly can survive in the eye of a hurricane: it’s the calmest part, with light winds and clear skies.
            http://en.wikipedia.org/wiki/Eye_(cyclone)

            (On land anyway. On sea is a different story.)

          • Trixie

            Someone ought to run the numbers on the safety of hurricanes vs. home birth….

          • Unplanned C-section

            That would be a great one. I’d also like the numbers of people who died because they refused to evacuate because anecdotally, they know people who survived the last big storm.

          • AlisonCummins

            Apparently hurricane fatalities have been dropping since 1900 even though the population is rising. Science and technology: advance warning of the hurricane, emergency plans, improved building codes.

          • Young CC Prof

            Look at Hurricane Sandy. For a natural disaster of that severity to strike a population center the size of New York City and produce only about a hundred fatalities… A miracle of science and planning.

            In the spring of 2011, a tornado supersystem tore through the state of Missouri and killed several hundred people. In the spring of 2012, a similar system struck Kansas. This time the death toll was 6. The difference? The second time around, the Weather Service saw it coming 24 hours in advance. The day before, they sent out a very explicit warning, and people listened. They stayed close to shelter and kept their radios on, and when the twisters actually came, just about everyone made it to safety.

          • fiftyfifty1

            But, but, but, the last time the tornado sirens went off I went into the basement but no tornado even struck my house! A tree fell in my backyard and took down the power lines, but not a thing happened to my house itself. Tornados are as safe as life gets! Next time I’ll Trust Tornados.

          • Roadstergal

            You had an unneccesbasement!

          • Squillo

            Wait, you mean expertise and technology can save lives? Say it ain’t so!

          • Trixie

            In other words, when confronted with basic arithmetic and facts….fall back on religion to assert your point.

          • Lizzie Dee

            This makes no sense to me. I thought the general idea was to examine what makes birth safer, and even more how to reduce unnecessary deaths. A CEMACH report I read was very damning about stillbirths, claiming that a fairly high proportion could have been prevented with better care. It may be difficult, but I think stillbirths, especially post dates stillbirths, should at least be mentioned.

          • Young CC Prof

            Stillbirths don’t have birth certificates or death certificates, hence they aren’t in the complete national numbers from the CDC.

            However, some researchers have attempted to count, or at least estimate the prevalence of, stillbirths and look at ways to reduce them. Definitely postdates stillbirths are a low-lying fruit. The “39 weeks or more” campaign should be matched with a “41 weeks or less” campaign, because many people don’t recognize the dangers of going post-dates and believe that longer gestation is better.

          • Amy Tuteur, MD

            Stillbirths are counted. There just not included in the linked birth-infant death data set because the babies weren’t born alive. The CDC published data on stillbirths each and every year.

          • Trixie

            My point was that Spilde was not comparing apples to apples.

          • fiftyfifty1

            You make such an important point. MANA’s data show that babies who are ALIVE at the onset of labor are 5 times more likely to die (almost all from birth-related injuries). You are very rightly saying “Hey, what about all the babies who die PRIOR to labor”. If MANA had kept numbers on these stillbirths, the numbers would look far, far worse.

            Homebirth Midwives say “Babies aren’t library books, they don’t have a due date”. And that’s true. The problem is that placentas DO have a “best by” date. Going over 41 weeks is very, very risky.

          • guest

            They obviously have an ‘expiry’ date.

        • Unplanned C-section

          I am sorry for your loss.

          Although I think homebirth takes on a set of risks a hospital is in many cases equipped to handle in a time frame that provides the best chance for life, I don’t deny a woman’s right to choose either for her family.

          I do, however, refuse to allow her to do so in an environment where she is ill informed of the risks because data is misrepresented.

          You can argue there are interventions and care standards and expenses in a hospital you disagree with. You can argue it is ridiculously expensive to the underinsured and that the government should do more. You can prefer herbal”gentle” treatments to pharmacological treatments and interventions.

          However, a thorough examination of MANA’s provided data with hospitals’ compiled data, with real available data at the present time, show homebirth is a higher risk to babies. Unless you can provide better documented science and bonafide data, your finger pointing at Dr. Tuteur is unfounded as it is entirely anecdotal and based on a hunch and is frankly, more of the same from homebirthers. Use science, logic and evidence in your argument and I may come to agree with you.

        • The Bofa on the Sofa

          Its hard to balance between herbals (God-made) and pharm. industry (man-made).

          I don’t understand this claim. What do you mean “balance”?

          What’s the distinction between them other than how they are made?

        • prolifefeminist

          “Its hard to balance between herbals (God-made) and pharm. industry (man-made). ”

          But…God made EVERYTHING. Including the elements that make up pharmaceutical drugs. That doesn’t mean they’re all bad or all good – just as many herbs can kill you or make you better, so can pharmaceuticals. “It’s man-made not God-made” simply isn’t a good argument if you believe that God made everything. It makes no sense.

          My condolences for the loss of your little one.

        • Soon to be dad

          Hi, I appreciate your comments and I’ve been reading them carefully. I hope you take the time to read mine.

          I get it, you had a rough birth, and the modern medical intervention wasn’t what you expected. It let you down. But sometimes that stuff HAPPENS. and you know what? It did HAPPEN to you, and I hope you still have your baby even after what you’ve been through.

          However, what you’re advocating for; because of your ‘bad’ experience with modern medicine; is a form of birthing in which things WILL ALSO HAPPEN… the only DIFFERENCE here is that you’re not left with a ‘bad experience’, you’re left with a dead child. and more of them too.

          Dont you get that? Can’t you see how you’re ONE experience, in the scheme of things, is trivial compared to the BILLIONS of recorded, documented, medically deduced conclusions from other births?

          Not that I want to trivialize your experience, but this is basically the equivalent of you washing your hands with soap, and getting dry cracked hands… then telling the rest of the word that NEW, MAN MADE SOAP is horrible and we should just wash our hands with water for cleanliness and disease prevention!

          Think about it, you’re letting a personal experience dictate a whole MENTALITY on modern medicine.

          Truth is, soap can disagree with some people, but modern medicine have alternatives that have shown to reduce bacterial spread just as much, but without the drying properties of soap… this is the same with birthing. THERE ARE OTHER OPTION during birth that you can choose from- options that have been tested and legitimately justified.

          The most important thing here, is education and understanding. You need a team that will not only care for you (which i’m sure is what you’re trying to provide) but provide you with help, knowledge and experience if something goes wrong.

          Deviating a complete 180 degrees and spreading the word because of your opinion can genuinely hurt many others. Please think about it.

          • toni

            Great comment, Soon to be dad. I might use this analogy in future! Best wishes for the baby

        • http://shameonbetterbirth.wordpress.com/ Shameon Betterbirth

          There are problems with the medical system. Midwives/home birth aren’t a good answer though. I would also like to point out that the study only had a 30% response rate so it is hard to be positive that any specific event was included in the numbers. Hang in there.

        • http://kumquatwriter.wordpress.com/ Kumquatwriter

          You are a reprehensible human being.

        • birthbuddy

          This poison that you are referring to is ‘prostaglandin’, I presume.
          You do realise that this is produced naturally by the mother, don’t you?

    • Amy Tuteur, MD

      According to your posts on Mothering.com. you deliberately had an unassisted birth as well as no prenatal care. Is that correct?

      • Trixie

        She’s got a little business where she charges $15 per hour to not assist you during your unassisted home birth. If you have a medical emergency, she’ll even include prayer, for free! She will not, however, drive you to the hospital. http://www.joyfilledhomebirth.blogspot.com

        • The Bofa on the Sofa

          Is that serious, or Tau’s law?

        • Trulyunbelievable2020

          Here is one of the things that are specifically NOT included in her services:

          “Listening to screaming. Seriously. I know that when you see me and I
          see you there is distraction going on. So I may need to take the kids
          to the park until all is said and done.”

          Sounds like a very useful service!

        • LibrarianSarah

          My favorite part is where she said ” if you would like an assistant with medical stuff, a husband may be the best help”

          My second favorite part is where she said she won’t “listen to screaming” but she will take your (and hers of course) kids to the park until you’re done!

        • PrimaryCareDoc

          This…has to be a joke. Right? I love how she considers her lack of education to be some sort of positive trait. Also- toddlers are not fun to have around in labor UNLESS THEY ARE TRAINED FOR IT??? Are toddlers supposed to be trained as doulas? CPMS? I like how she’ll only cook if “necessary,” because cooking is supposed to help with labor pain, or something. I feel pain when I cook when I’m NOT in labor, I’m sure as hell not going to cook while laboring! And she will NOT be held responsible for any deaths or injuries, but she will pray for you.

          “If you are reading this blog post, live near Luana, IA area, are interested in having a home-birth and need assistance. I am here to help!! Yay! Someone who will help!! However, I will only help with “so much.” In someways, I would be considered more of an old fashioned midwife, more than a modern day midwife because of my lack of “professional” education.

          This “so much” includes the following:
          -Clean Up of the mess.
          -Babysitting of littles…..Toddlers are not fun to have around during labor unless they are trained to deal with it.
          -Signing off as witness on birth certificate papers. Having a witness makes filling out the vital’s record paper work much easier.
          -Cooking if needed. A woman who cooks during her labor is much less likely to feel the “pain.”
          -Advice is free!! Call me or e-mail me anytime if you want to know more about unassisted childbirth. e-mail lauraspilde@yahoo.com
          -Any other “household” needs.

          This “so much” does not include the following:
          -Invasive cervical checks on the woman
          -Medical assistance….sorry if you would like an assistant with medical stuff, a husband may be the best help or a professional midwife.
          -Driving to the hospital for emergency. Unless specifically stated by the woman in labor and she lacks a spouse or medical “friend”. I am not to be held responsible or placed in a position for any deaths or major injuries. I will pray for you however.
          -Being there “on time” My labor was under one hour so do not expect timely appearances.
          -Leaving additional children home. Yes I may take my children with me while working on the job……
          -Getting the paperwork from the vital’s record’s office for your state. No, I will not go through the battle of explaining your choices to home-birth for you. Yes it is a battle to face those who do not agree with home-birth, but it can be won.
          -Listening to screaming. Seriously. I know that when you see me and I see you there is distraction going on. So I may need to take the kids to the park until all is said and done ;)

          Ok….so what is my going rate??? Well, since I so desperately believe in home-birth and especially in unassisted home-birth I would definitely prefer donation base only. Yes, if you are seriously financially deprived and can only afford 5$, I will be happy with that. However, if you know and depend on government assistance I would not feel comfortable assisting with your home-birth because the source of funding is not of a “higher power.” All financial responsibility is placed in the hands of the birthing family. Preferably, if I have to clean your toilet, make your bed and wash your dishes all while watching the children I would appreciate a 15$/hr rate or more. However…..I’ll continue to leave it at donation base only depending on what happens…..because in home-birth we really do not know.

          • The Bofa on the Sofa

            I’ve said it before, and I’ll say it again: It’s a shame I have ethics.

            What a friggin scam.

            The sad part is that I am very familiar with the area “near Luana, IA.” Used to golf the Luana golf course all the time when we were little.

          • Certified Hamster Midwife

            O_O

          • Maria

            This is astounding! I am quite taken with her preference to not assist those on government assistance since the money doesn’t come from a “higher power”. WTF. And the money from a job does? Is she a “prepper” as well?

          • Young CC Prof

            I really think this is a parody, perhaps intended to discourage HB. Or, it could be real…

          • debra singer

            This article is worse than a parody. It is chock full of lies. Poorly written at that, and please do not be hoodwinked by this propaganda. The writer knows nothing.

          • KarenJJ

            What lies? Want to explain further? Funnily enough I’m not convinced and I’m not jut going to take your word for it.

          • OK

            The ‘doctor’ seems to know nothing either. How could any one of any medical knowledge support such bull unless paid by sources that take profitable interests in such propaganda. Caregivers were once for the commonwealth and common good of others and needed no monetary prompting for wanting the benefit of others. But it comes down to the dollar line.

          • OK

            I agree. I simply read the title and assumed the same. I had to read comments to see where other people were on this, just to determine whether there was all down play for home birth. I live in a state where I don’t even have the option (Iegal) for a midwife to practice her business in home birth. It is a shame, but we let ‘the system’ rule our lives in other ways, so they’ll determine and take away all liberties that should be choice and human right not determined by other people who say they’re in charge for our best interests. Hospitals have always tripped me up. For care and procedure that is not an illness (which is the purpose of a hospital) I shouldn’t have to receive care from perfect strangers, in a strange place, for strange reasons, for such an intimate event. It’s personal and should be used as in respect to emergency and true illness. It should be the back up to care, not primary expected care for delivery of babies and care of their mothers. ALL of my considerations are not taken into account. Yet, I have to abide by ALL of their policies and rules and pay ALL of their bills for services I never wanted to begin with.

      • Trulyunbelievable2020

        Professor Spilde has also accused you of “money laundering” on MDC. I would LOVE to hear her learned explanation of how that even enters into this conversation…

        • An Actual Attorney

          How would that even work? There’s no money in the blog.

          • KarenJJ

            Did Professor Spilde make that accusation without any evidence of reality?

    • OK

      Thank you for being on the other side of the table on this issue. Sorry for your loss. Death can occur at any time. Just because an infant survives infancy doesn’t mean he or she won’t pass away before adulthood. None of us are in control of expiration of life. We experience the time we are alive and grateful for it. Respectful of it. Anyone opposing another’s personal choice is a biased biggot and should be more spiritual and open minded when it comes to others. For oneself, be all that you are and can. Support others.

      • Captain Obvious

        “Anyone opposing another’s personal choice is a biased biggot and should be more spiritual and open minded when it comes to others.” So parents, teachers, and law enforcement are the leaders of biased bigotry.

    • birthbuddy

      Was your baby alive at the start of your herbal induction of labour?

      • Laura

        Ultrasound confirmed child was created “deformed.”

        Epidemiology is more trustworthy in area of gynecology these days. More babies die IN HOSPITAL care these days……via the abortion industry and unwanted disabled children.

        • Dr Kitty

          I’m sorry for your loss Laura.
          MANA stats show horrible rates of intrapartum deaths (baby alive at start of labour, dead during it) and perinatal deaths, babies that die in the hours or days immediately before and after birth.

          If the RATES of stillbirth in home birthing women were the same as for hospital birthing women, there should be no increased rate found.

          The increased rate, sadly, cannot be explained entirely by women such as yourself.

        • birthbuddy

          It is almost unheard of that a normal term pregnancy will die during labour in hospital.
          Out of Hospital, very common.

    • Anj Fabian

      Well…..

      “YOU don’t even KNOW about ALLL of those deaths nor will YOU get access to those deaths.

      Next stat that actually has evidence of reality please.”

      You just stated that we do NOT have all the data and THEN you ask for evidence of reality. You imply that people are creating their own stillbirths and then covering them up.

      You do realize that you aren’t painting a warm rosy picture of herbalists or home births, right?

      • Laura

        Well, how many abortions happen within the hospitals or by “professionals”?? There is the starting point of reality and epidemiological study. How many pregnancy’s fail to complete under hospital care vs. general “unprofessional” care. Then the DIRT SHOWS UP. I know that 1/2 of the patients that go to a doctor for their “maternity” care end up dieing under the care of professional doctors and nurses. And the number could possibly be even higher when we look at birth-control industry……via birth-control pill especially the racist Margaret Sanger stuff.

        When we LOOK at reality……when we REALLY LOOK closely at who’s life is snuffed from EXISTENCE……MORE PATIENTS DIE UNDER HOSPITAL CARE than the non-professional quazie care. Where in the world did all those DOWN SYNDROME CHILDREN GO???? WHY are MOTHER’s NOT GIVING BIRTH in the 5-10 children range? Is the HOSPITAL CARE too expensive?? OR does the birthcontrol industry 400$/abortion appear to be cheaper than a 150$ homebirth????

        OHHHHHHHH When women listen to the epidemiologist FIRST and then LOOK at her pocket book and what her husband/mr man can actually provide for her maternity care……. Is $$$$$$$$$$$ worth saving or is Human life worth saving.

        Turns out the money hungry abortion practices in “hospitals are so everlastingly perfect” realm fails the test of preservation of pregnancy to child-raising rate……

        Now I need to go and study the FREAKY effects of the birthcontrol pill and how many women’s lives are cut short by that “stuff” that is designed by such perfect “professionals.” More like professionals designed to eat your $$$$, take away a woman’s sense of wisdom and give her a nice healthy dose of cancer.

        Have a good day. Talk to the epidemiologist before you talk to your “gynecologist”

        • Laura

          Ohhhhhh did I forget to mention that abortion CAUSES HIGHER break up rate than one would expect…..like 80% of the women who have abortions break up with that man that was there from the start. There goes the increase of dependency on alcohol. There is the increase in dependency on drugs. There is the increase of suicides or other crazy stuff. Of course….I know that MORE abortions happen within hospitals by “professionals” than by the average quazy who hardly knows her herbs.

          Have a good day. Think a litter more to the right and you will finally “get it” right.

          • Dr Kitty

            Correlation does not equal causation.
            Women in unstable relationships are more likely to opt for abortion than women in stable relationships.
            Women who opt not to end a pregnancy may also be more likely to opt to continue an unhealthy relationship “for the sake of the children”.

            Women in abusive relationships who are tied to their abuser by a child are more likely to suffer ongoing abuse at his hands than those who are able to end the pregnancy and leave him.

            You assume that a break down of a relationship is always necessarily bad…if it is an abusive relationship a breakup is a GOOD thing.

            http://www.nccmh.org.uk/reports/ABORTION_REPORT_WEB%20FINAL.pdf
            If you want some food for thought, perhaps you’d like this.
            The major finding:women with UNWANTED pregnancies have similar rates of mental illness regardless of whether they opted for abortion or not.
            The trigger for mental illness is the pregnancy, not the outcome.

        • An Actual Attorney

          Half the women who go to a doctor for prenatal care die? Oh, dear, adjust the tin foil hat.

        • birthbuddy

          You seriously need to cut back on the coffee.

        • Sara M.

          I am fairly certain an epidemiologist would debunk your statistical analysis. You actually concede that there are two kinds of care hospital and nonprofessional care. How you came up with the death rate is beyond me.

          Lastly, I do not equate any of the political movements you described with quality hospital-based maternity care where many mothers and babies go home alive.

    • Bombshellrisa

      Miscarriages aren’t part of these numbers, the babies counted were viable.
      What do you mean “herbs stop pregnancies”? Are you referring to the highly unsuccessful attempts to abort via herbal tinctures?

  • Violette

    As my husband and I plan our first pregnancy (hopefully in the next year we’ll be pregnant) we’ve become very focused on gathering research to determine the best and safest choice for prenatal care and birth. We were obviously tempted by the idea of using a midwife after watching Birth Story, but I adore my current doctor and couldn’t imagine going through pregnancy without her. Obviously, I’ve heard a number of disturbing things about US maternal mortality compared to other countries, but I would rather just find cold hard facts and statistics than biased stories about why homebirth is better/safer.

    The best mortality rates I found were from cia.gov’s World Factbook, where the US maternal mortality rate is listed as 21.0/100,000 live births (as of 2010), placing it below many European countries and the UK. In comparison, their infant mortality rate is 5.9/100,000 live births (it lists est. as of 2013).

    I know that many homebirth advocates proclaim the greater maternal mortality rate to be due to US tendency to value child over mother…which obviously concerned me a little bit because, much as we look forward to a child, if I had to choose I would prefer to stay alive and try again than die and leave my husband with a child.

    However, I’m leaning towards a less paranoid interpretation of the US maternal mortality rate. Namely, comparative health of the population pre-pregnancy. After all, a 2013 study I read in the US National Library of Medicine/National Institutes of Health points out that as of 2009 20.5% of women pre-pregnancy were obese. That is, I believe, a significant risk factor for pregnant women and increases their chance of death in childbirth. I assume the excellent prenatal care helps to lower infant mortality, but the listed rates on the CDC website for maternal death due cardiovascular disease seems to support the idea that it’s our overall lack of health, not quality of medical care, that causes us to be at greater risk of death than our European counterparts.

    Based on this, my husband and I are going to plan on a hospital birth, and employ a pre/post pregnancy doula for added help and support. I feel as though this simply makes the most sense, and what a number of homebirth advocates tend not to mention is that midwifery in European countries and the UK is frequently controlled through hospitals- you can request a midwife, but odds are you’re giving birth in the hospital, with an attending ob on call, and the midwife is sanctioned by the hospital. This isn’t a lay midwife shuffling over to your house when you go into labor.

    Plan: OB/GYN, hospital birth, doula for added help, focus on a maintaining a healthy weight, diet & exercise plan pre, during & post pregnancy.

    Something like this seems rather “duh,” and makes me feel a bit sheepish that I didn’t register that possibility earlier and instead temporarily gave in to the fear mongering of the homebirth advocates…

    • Karen in SC

      That is exactly what I did (twice) and many others here. Hopefully, you will get the timing you like too.

    • Young CC Prof

      Sounds great, and I hope you do become parents soon!

      Yes, a big of the reason for our higher maternal mortality rate is general health of the population, which is associated with some other reasons: poverty and lack of access to care. The New York City department of health recorded all maternal deaths across several years, a key finding was that uninsured women were seven times more likely to die than women with health insurance.

      Another reason might be reporting differences, believe it or not. A couple decades ago, the CDC changed the way information about maternal deaths was collected, and there was an immediate spike in reported maternal deaths which probably did not correspond to any change in actual maternal deaths.

    • Unplanned C-section

      I was for a natural childbirth and had a great pregnancy. I think an open minded person listens to all arguments, and makes a decision based on the facts, and don’t see much of a reason for youto be sheepish.

      In the end, I made a very similar plan to yours, and have been grateful for my choice to give birth in a hospital. It saved my life, and my child’s.

  • Ducky

    That is an interesting database! Thanks. An armchair epidemiologist could get into all sorts of trouble…

    I think you are making the important point, which is that MANA is spinning the data to say something it does not, and sometimes it’s necessary to overemphasize to get a point across clearly.

    It is however a little misleading to promote the relative risks, when the absolute risk of neonatal death is low in both cases. Psychologists of risk know that the human brain has trouble with low probability, high consequence risks though… We are much better adapted to understand relative risk anyway.

    • LynnetteHafkenIBCLC

      >It is however a little misleading to promote the relative risks, when the absolute risk of neonatal death is low in both cases.

      You do realize we are talking about human lives here, right?

      • PrecipMom

        Don’t worry. It will almost always be someone else’s baby “born sleeping.”

        • Certified Hamster Midwife

          We’re all “someone else” to someone else.

    • The Bofa on the Sofa

      See the discussion about how “low” the absolute risk is.

      Short answer: it is almost impossible to find something LESS safe than childbirth that normal people do.

      As has been figured out, a single childbirth is about as dangerous as doing the most dangerous job in America for a whole year.

      Now, you want to take the most dangerous job in America and make it 5 times more dangerous.

      And YOU call that “low risk”? I’d like to know what you think is high risk?

      Remember, drunk driving is much, much safer than childbirth (per event). Would you call drunk driving “low risk”?

  • Jade Mullins

    Can you please explain to me your take on why c-section rates are so ridiculously high in hospital births, far beyond the recommended amount, as opposed to home births?

    • Young CC Prof

      a) There is no recommended amount of c-sections, the WHO withdrew that recommendation and admitted there was no evidence to support it.

      b) There are no c-sections at home because homes do not have operating rooms. No, snark aside, high-risk women who know in advance that they need a c-section are less likely to choose home birth.

      c) It’s harder to detect fetal distress at home, hence no c-sections for fetal distress. Most of those distressed babies are born OK anyway, a few suffer brain damage or die, hence the higher intrapartum and neonatal death rates.

      • Captain Obvious

        d) So many of you who are complaining of the high CS rate are looking on line at the total CS rate which obviously includes repeat CS for previous CS or elective CS for breech or multiples. The 33% national CS rate is at an all time high. But if you break down the CS rate for a laboring patient attempting a vaginal birth, it is generally between 18-23%. It can be as low as 10% for some practitioners who select out especially low risk patients.
        Some hospital with low CS rates are just smaller hospitals who don’t see enough high risk patients and who might transfer such a higher risk patient to a higher risk bigger hospital. Thus this bigger hospital will have a higher total CS rate. Don’t pick your hospital because of its lower CS rate, if you develop a complication, you may be likely need to be transferred to that bigger hospital because they are better equipped to handle complications. That smaller hospital with the better CS rate may actually put you and your baby at risk

        • The Bofa on the Sofa

          But if you break down the CS rate for a laboring patient attempting a vaginal birth, it is generally between 18-23%. It can be as low as 10% for some practitioners who select out especially low risk patients.

          This is an important point. How many people think that the differences in CS rate among doctors/hospitals is due to differences in criteria for deciding to do a CS? Given that the medical community has pretty well-agreed upon guidelines for what should trigger a CS, that’s not going be a huge difference. As CO suggests here, the biggest difference is due to the populations that are served.

          The one thing I think you will see are those hospitals that can do VBACS. If the hospital is not staffed to do a VBACS safely, you will find that the rate of CS after the first is much higher, but then again, as CO notes, look at the primary rate, which, again, will mostly reflect the population.

          Then again, if you want to do a VBACS, the hospital stats aren’t all that relevant, the question is whether they are adequately staffed to do it.

          • LynnetteHafkenIBCLC

            Isn’t it true that the c-section rate is pretty high in countries like Brazil, where maternal request c-sections are high? I think there needs to be more understanding of women who prefer c-sections, especially among people who claim to care about listening to mothers and respecting their choices. I’m looking at you, Childbirth Connection.

          • Captain Obvious

            Yes the total CS rate includes elective repeat CS, maternal request CS (there are women who will choose a CS if their baby is >5000g nondiabetic/>4500g diabetic), TOLAC that leads to CBAC, multiples, PPROM with malpresentation, congenital anomalies like ventriculomehaly or others. There are woman who just want a CS too that are included in that total CS rate.

          • The Bofa on the Sofa

            I was just thinking that as well. Suppose we give the moms the option. The doctor says, you have factor X that makes the vaginal birth risky. We could do it, but there is probably a 1% chance that the baby will die, and a bigger chance that something will turn out otherwise bad. The alternative is a c-section.

            Now, that is the current situation we have, basically, although there are situations where it comes to basically not a choice, for logistics or whatever, and the c-section is the only real option. Let’s propose the scenario where we get rid of that. We will only have c-sections in those cases if the moms want them. Clearly, the number of c-sections would decrease, if that were true.

            However, let’s be fair, and make the offer one really open. All indications are normal, and you are perfectly low risk for a vaginal birth. Or you can have a c-section. What would you prefer?

            Currently, pretty much everyone in the latter group goes through a TOL, because the c-section is not indicated. Therefore, if there are any in that group that would prefer a c-section, that would increase the c-section rates.

            The question is, what is the balance of the two? Since the vaginal delivery group is twice the size of the c-section group, that means that if 10% of those who get c-sections would rather risk the VB, and 5% of those who had VB would opt for a c-sec, then the rate of c-section would not change.

            I don’t know what those percentages are, however, or if 10 and 5 is anywhere close. But we would have the same conclusion if it were 20 and 10, or 50 and 25.

            So do we have a handle on how many women would just rather have a c-section, regardless of their risk status? I know my wife was one (she was delighted to have a breech presentation and thus an excuse for a c-section with our first; she never had any interest in going through labor)

        • Young CC Prof

          At the hospital where I had my son, I think the rate of c-section following attempted vaginal birth for first-time mothers was 10%. For subsequent children it would presumably be even lower. Most non-VBAC moms who are near term and planning a vaginal delivery get one. (And those who don’t, there’s generally a good reason.)

    • The Computer Ate My Nym

      Which c-sections do you think are unnecessary and on what evidence? Simply declaring that too many c-sections are occurring is not enough: we need to know which c-sections are potentially unnecessary in order to reduce the number performed. If that is, in fact, even a reasonable goal.

      • anion

        And not just potentially unnecessary, but unwanted. I love the assumption among these “too many c-sections!” people that every woman in the world had to be dragged kicking and screaming into the OR, and are bitterly disappointed that they didn’t get to give birth vaginally.

        Some of us didn’t care about vaginal delivery, or particularly want one, and were perfectly happy to have c-sections.

        But oh, I forget…we don’t count. There are just “too many” c-sections, period, so women shouldn’t have a choice.

        • The Computer Ate My Nym

          Yeah, my suspicion is that the first c-sections that would be declared unnecessary would be maternal request c-sections.

          BTW, I’m totally fine with maternal request c-sections, as long as the woman involved got proper counseling regarding the risks, benefits, and alternatives. There are risks and they shouldn’t be downplayed, but there are also benefits and to me an empowering birth would be one where you make the call after receiving the best information possible about each method of delivery and have ongoing good information and care as the situation changes.

    • yentavegan

      Herpes?

    • Unplanned C-section

      I am inclined to think that the rate is higher because mother and child are fully monitored. Problems that aren’t apparent in an unmonitored homebirth scenario lead to lifesaving measures in a hospital, which may include a c-section, with both parties surviving childbirth alive and with a fully oxygenated brain.

      Also, there is no longer a recommended amount of c-sections.

    • Medwife

      Mostly because EFM has high sensitivity and low specificity. Lots of false positives, not many false negatives. And in the hospital, we are far more comfortable doing a c/s that IN RETROSPECT wasn’t necessary than not doing it and winding up with a dead baby. Most parents feel the same way.

  • Ash

    Hi y’all, could you link me to analysis of in hospital neonatal death for breech babies (and is this vaginal+section or just vaginal)?

    • Captain Obvious

      I believe somewhere below someone already posted that. Anecdotally, in 21 years all breech births with no neonatal or maternal morbidity or mortality for me.

    • Young CC Prof

      Look up the Term Breech Trial. It’s 25 years old, but it’s probably the best recent analysis of vaginal vs section for breech birth.

      It came down so firmly in favor of section that no more recent data on vaginal breech in high-technology settings is available, because it’s now a violation of the standard of care.

      • Ash

        I thought it was TBT, but I was not sure. Thanks!

  • Chris Hitchcock

    The statistics in this blog differ greatly from the 2002 study of women in British Columbia, where there was no increased risk to women choosing a home birth. http://www.ncbi.nlm.nih.gov/pubmed/11868639

    A friend pointed out that, in the US, some women choose home birth and midwifery because of the cost difference.

    In Canada, where women do not pay for medical care associated with pregnancy and delivery, the difference between home births and hospital births is probably not contaminated by socioeconomic status.

    • LynnetteHafkenIBCLC

      Well that’s great, but since we are talking about American women and MANA’s deception, that’s kind of irrelevant. Also, that study was so small that (as the authors say) the sample size was too small to make a conclusion about some adverse outcomes.

    • Young CC Prof

      862 planned home births? And they excluded high risk women? If they’d found a statistically significant difference in perinatal mortality on such a small sample, THAT would be a horror. This MANA study (without proper risking-out) found a perinatal mortality rate at home birth of 2 per 1,000. You can’t find statistical significance when your expected value is 1 or 2.

    • Trixie

      In Canada, you also no longer have CPMs who are allowed to practice. Your home births are done byy the equivalent of our CNMs, which are not the group in a question in this study.

    • yentavegan

      here in New York, women who can absolutely afford ob/gyn and state of the art hostpitals choose homebirth and free standing birth centers because they’ve been lied to about the safety of homebirth due to confusing Canada’s model of care to the unregulated/uninsured unaccountable lay midwives model of care.

    • Karen in SC

      To be clear, it’s not the statistics “in” this blog. These are MANA statistics, finally published.

    • Squillo

      By and large, women who cannot afford hospitals in the U.S. are not choosing homebirth (If they were, there would be a larger proportion of non-white women in the MANAStats data.) They are choosing to go without prenatal care and–this is a guess– showing up at our hospitals-of-last resort (public hospitals) in labor, leading to worse outcomes.

      Just as an exercise, I ran the CDC numbers for 2007-2009 and got a total of 154,908 births to women with no known prenatal care. The neonatal mortality rate for them was a shameful 20.99.

      Of those, 40,196 (26%) were to black women, whose babies died at the astounding rate of 31.62. The number of births to black mothers in U.S. hospitals overall during the same period was 16%, vs. 2.1% for the homebirth cohort in MANAStats.

      The burden of caring for those who can’t afford healthcare falls overwhelmingly on our public hospitals.

  • Dr Kitty

    This is nice, for a change.
    Arguing about actual numbers and data instead of tone and hurt feelings.

    The mansplaining I could do without (funny how the Menz parachute in…and run away when asked to bring evidence to back up their assertions).

    • Box of Salt

      The mansplaining. . . it makes me wonder if there are NCB advocates who recognize their own debating skills are poor and are sending in their husbands to debate and distract instead.

  • Box of Salt

    Since it’s been buried in the comments, here’s the link to the actual paper (found in Dr Amy’s next post on the subject, also dated Jan 30, 2014, but a few hours later than this post):

    http://onlinelibrary.wiley.com/doi/10.1111/jmwh.12172/full

    Could you folks weighing in please read the whole paper first?

  • Dexter

    Worst
    use of stats I’ve seen in a long time, but perfect example to laugh at in a
    stats class, and good reason to stick to actual scientific reports, not
    personal blogs. All sorts of hilarious errors– using one type of data
    (ICD10 code data from ‘white healthy
    women’ and essentially comparing the best possible data from one set of
    hospital data related to low-risk births to the worst possible single
    set of data related to high-risk at-home births)– if you use the
    writer’s same data source for hospital births but include all comers in
    2007-2010 (not just low-risk healthy white women), the infant death rate
    is actually 6.14 per 1000, which is ’300% higher death rate than
    at-home births!’ And this inflammatory use of a ‘relative percentage
    risk’ rather than relative risk or absolute risk… for example, even if assuming the writer’s awkward data is valid, you can to look at infant living
    rates and see 99.6% vs 98.4%, which means there’s only a 1.2% higher
    risk of bad outcome from at-home birth than hospital. Just lots of ways
    to twist the same data, but in this case the comparisons are not even valid, and this is very embarrassing for a doctor to promote such awful misinformation. I don’t have a strong opinion either way on
    this issue, but I feel I must respond when I see bad data analysis anywhere.

    • Box of Salt

      Dexter, would you care to address this issue with the data from the “actual scientific report” published by MANA:
      “Participation in the project was voluntary, with an estimated 20% to 30% of active CPMs and a substantially lower proportion of CNMs contributing”

      Is that including “all comers” from the homebirth group?

      • Dexter

        Thanks for posting the actual report. No, this report does not include all-comers from the homebirth group (which may mean the actual data are worse or better, no way to know). My reply to Young CC Prof above also briefly addresses this issue as well.

        • Box of Salt

          Dexter, you’re welcome. It’s hard to have a discussion without knowing what you are discussing.

    • Young CC Prof

      Um, Dexter? 6.14 is the INFANT mortality rate. That’s all deaths through age 1. The MANA report includes only neonatal deaths, that is, in the first month of life. Further, a good 2/3s of those deaths are related to prematurity, and very few home birth babies are premature. Hence, the proper comparison group is full-term or nearly full-term hospital-born babies.

      I think you need to research the matter some more before you critique it.

      • Captain Obvious

        Would love to see Dexter’s stats class teacher’s response to his post.

      • Dexter

        Yes, you see my point– the data are not comparable and can be very confusing unless you understand the assumptions and comparisons that are being made. There a numerous issues with this report, and the report itself is good and mentions some of them– but my real problem is with the way this person’s blog reports the data, as mentioned above, and comparing cohort data that was obtained via completely different methods, the completeness of the data, etc., not to mention the problems that arise when you are comparing very skewed events (as the report says only 1% of births are home births, with even fewer CPM respondents, and out of that bad events only happen 1-2% of the time)– unreliable stats are bound to emerge!

        But let me explain with an example– using data that are actually consistent between comparison groups, we know that the U.S. has by far the worst mortality rate on the first day of life for industrialized countries: 11,300 babies in the U.S. die the day they are born (3.7 per 1000 births, not 6.14 as I stated above, which is for the whole first year, thanks for the note). Compare this to Scandinavian countries where the death rate is 0.5 per 1000 births on the first day of life– that means the U.S. has 740% higher death rate!! Somewhat misleading, albeit technically correct.

        • Box of Salt

          Dexter, Day 1 mortality is going to be complicated by some of the same factors which make infant mortality (i.e., through the first year) difficult to compare. Please take a look at p 10 of this report which discusses “Inconsistent Recording of Live Births” internationally:
          https://www.fas.org/sgp/crs/misc/R41378.pdf

          • Dexter

            Just another way of looking at this issue: the infant death rate in the U.S. on the first day of life is 3.7 per 1000 live births (and only 1% of those are home births, meaning that for every 1 that dies at home 80 die in the hospital, but ya this doesn’t take into consideration their condition), whereas in Scandinavian countries like Finland it is 0.5 per 1000 live births. This is a 740% increase in death rate in the U.S., which albeit technically correct, is misleading, and does not mean we should all run to Finland to deliver babies.

          • Box of Salt

            Dexter “does not mean we should all run to Finland to deliver babies”

            No: we should all just become Finnish (genetically, not as immigrants), then deliver in Finland.

          • LynnetteHafkenIBCLC

            Finland is much healthier than the US given less poverty, universal health care, whiter population (African Americans have poorer health for not completely understood reasons), less diabetes etc.

          • C T

            The infant death rate in the USA has been studied. It’s clear that the main reason for the high rate compared to wealthy northern European countries is the relatively high rate of preterm birth here. We do a good job taking care of preemies compared to those other countries, but we just have too many of them. The issue you have raised shows the high quality of neonatal care available in US hospitals compared to Finland. I don’t know why we lose more 37+ weekers than Finland, but I find it hard to believe that it’s because of something US hospitals are doing wrong. http://www.cdc.gov/nchs/data/databriefs/db23.htm

          • Dexter

            Yes, all very relevant, but prematurity only accounts for 1/3 of the deaths (see second link I posted). Also, there is no reporting of medical errors in the U.S., so we really don’t have the data to draw conclusions, but the Institute of Medicine in 2000 reported that “at least 44,000 and perhaps as many as 98,000 Americans die in hospitals each year as a result of medical errors,” meaning that “deaths due to preventable adverse events in hospitalized patients exceed the deaths attributable to motor vehicle accidents (43,458), breast cancer (42,297) or AIDS (16,516).”

          • Young CC Prof

            Only one third? About 2/3 of infant deaths occur in tiny newborn preemies.

          • Dexter
          • Young CC Prof

            That 35% number is worldwide. Look at the graphic below it that calls for cord care kits. Babies in the USA very rarely die of cord stump infections, but they’re common in poor areas due to lack of sterile tools for cord cutting.

          • Dexter

            Do you have data to support the idea that U.S. infant death is so high primarily due to higher prematurity rates than the rest of the world? Also, since prematurity is unpredictable, wouldn’t a lot of premature babies be delivered at home and therefore count as home births?

          • Young CC Prof

            The MANA data set involves only planned home births. And I’m not sure what you mean by “prematurity is unpredictable, most pregnant women know their due dates and are very concerned if they go into labor more than a few weeks early. I suppose precipitous preterm labor exists, but that’s not a planned home birth.

            Source: http://www.cdc.gov/nchs/data/databriefs/db09.pdf

            Read it all, then argue. I’m happy to debate you, but you’re getting a lot of basic facts wrong here.

          • Dexter

            Ya, got it, thanks. Obviously we are getting off on tangents. The main point is that, even if we consider this skewed data, at home birth appears riskier by about 1.2% when considering the ratio of those who live in hospital versus at home, or 450% when considering death rate (the point being that percentage statistics are extremely deceptive for data with very small occurences). I don’t know why people are not understanding this.

          • Young CC Prof

            Yes, most babies survive whether born in hospital or at home. However, MANA claimed that their study found “no increase in adverse outcomes.”

            I would say the death of one’s child is an adverse outcome, and even a small risk of that should be taken very seriously.

          • DaisyGrrl

            Which is the more honest way to present the data to a woman making a decision about health care providers and place of birth? Telling her only her absolute risk or giving her the relative risk? I would argue that it should be made clear to women that, while the risk of a homebirth is small, the risk of perinatal death is several times that of a hospital. Why? Because having a living baby at the end of it is the entire point.

          • Box of Salt

            No, Dexter, it’s home birth appears 1.2% riskier in an absolute sense about 20-30% of the time.

            For the rest of the time, we have no clue.

            Tell me, have you personally ever been on the wrong end of the odds?

          • Karen in SC

            small occurrence but huge consequences. It makes a difference.

          • Trixie

            If you are planning a home birth and suddenly find yourself in labor when you’re 6 months pregnant, do you go to the nearest hospital with a NICU or do you call your home birth midwife to come over and deliver the baby. Unless you’re profoundly stupid and reckless, you go to the hospital, and even a pretty reckless midwife would probably revommend it. There could precipitous labor that the baby could be born at home, but that would be a rare exception.

          • DaisyGrrl

            “Also, since prematurity is unpredictable, wouldn’t a lot of premature babies be delivered at home and therefore count as home births?”

            Short answer: no

            Long answer: the above study is looking at home births attended by midwives. An unexpected premature birth that occurred too quickly to happen in hospital would not be counted in these statistics because they would be considered unattended births and would not have been captured in this study. Additionally, many of these studies look at outcomes based on planned place of birth at the onset of labour. If labour starts weeks early, there is no plan to deliver at home. The plan is to get your ass to a hospital asap. Most women make it in time to deliver in hospital.

            This is why it is appropriate to compare the term death rate in hospital births to home births in general. Premature births are excluded from the comparison because virtually no one deliberately has a premature baby at home.

          • Amy Tuteur, MD

            Save the children is not a scientific citation. Please present data from scientific publications or databases, not fundraising literature from charities.

          • LynnetteHafkenIBCLC

            Why not just admit that you don’t have a handle on this data the way the people who have been studying it for years? Your arguments are frankly embarrassing. But please feel free to stick around with an open mind and learn something.

          • Dexter

            Um, looking at your posts you haven’t contributed one useful insight or analysis of the data. I am just discussing the raw data, not trying to sway opinion one way or the other, but I will be glad to listen if you come up with something useful to say.

          • LynnetteHafkenIBCLC

            Because I am not a statistician and I know better than to bloviate on subjects I don’t have a good grasp on. My lack of useful analysis does not mean that you are correct, however.

          • theNormalDistribution

            Moo point. Neither have you.

          • Anj Fabian

            So what are midwife errors classified as?
            They can’t be called “medical errors” because midwives will immediately jump onto the other side of the fence if you claim they provide medical care and should be regulated. Then what they do is to provide “midwifery care” and “attend births”.

            When they want to be able to carry and administer drugs, then they jump over the fence and say they want to do the same things as advanced practice nurses – CNMs.

          • Box of Salt

            Dexter “Americans die in hospitals”

            Your aim * is * distraction then.

            Let’s carry on.

          • Amy Tuteur, MD

            Dexter, please educate yourself on this topic before instead of spewing nonsense. ALL (100%) of INFANT DEATHS are tallied and matched to birth certificates. There is no lost data.

          • Dr Kitty

            There is another reason for the higher rate of infant mortality in the USA.

            The USA has a higher rate of child abuse and child murder than the majority of the rest of the developed world, and sadly, no, it isn’t due to better detection and reporting.

            http://www.bbc.co.uk/news/world-us-canada-15288865

            That, of course, is completely irrelevant to the data we’re discussing, but still, knowledge is power.

        • Box of Salt

          Dexter, please post a link for your Day 1 stats.

          • Dexter
          • LynnetteHafkenIBCLC

            While very sad, none of those links are relevant to this discussion. We are talking about healthy full term babies who did not have to die, and their families who were tricked by MANA withholding their death rates. You are grieveously wrong.

          • Box of Salt

            Dexter, thanks!
            However, from your links:
            “The nation’s high preterm birth rate plays a role. The U.S. has one of the highest rates of preterm birth in the industrialized world (1 in 8 births) — twice that of Finland, Japan, Norway and Sweden.”

            “Another factor, which contributes to the preterm birth rate, is the country’s high rate of teen birth.”

            Is this really relevant to the matter at hand? Do you think there are a lot of mothers of premature babies and teenaged mothers in that 93% white homebirth population represented in the data for the MANA paper?

          • Dexter

            Ah yes, this is definitely relevant, but due to lack of clear data, hard to decipher the true role, but we can say with certainty that premature babies are far more likely amongst non-white populations and poor socioeconomic status, meaning that the true complication rate is higher than reported.

          • Captain Obvious

            Dexter, make a comment about MANA. MANA has this data, doesn’t report it for over five years. But they do report all the low intervention rates years ago. Women are choosing Homebirth because they are told it is safe or safer than hospital birth. Then MANA finally presents the study, but in their press release say Homebirth is safe. How is that ethical.

          • Dexter

            I’m not a moral judge, but I think it is always sad when data is hidden. Unfortunately hospitals do the same thing– what hospital voluntarily releases its complication and mortality rates for services they provide? Also, the mortality rate in U.S. hospitals is 740% higher than Scandinavian countries, so by your same argument couldn’t you claim birth in the U.S. is unethical? Obviously that is a misapplication of data.

          • Young CC Prof

            What hospital releases its complication and mortality rates? All of them! It’s required.

            For one really easy example, see: http://health.usnews.com/health-news/blogs/second-opinion/2012/10/18/at-new-york-hospitals-heart-patients-death-rates-are-an-open-book

          • Box of Salt

            Dexter “I’m not a moral judge, but I think it is always sad when data is hidden”

            Then why are you not expresssing outrage that MANA is writing a scientific report which misses ~75% of the data?

          • Box of Salt

            Dexter, If the premature babies are far more likely not to be white, how are they relevant to a discussion of the 93% white homebirth population in the MANA paper (which only includes ~25% of the homebirths in the USA from 2004-2009 anyway)?

            Or are you just trying to divert the discussion to another subject?

          • Dexter

            It is relevant because the blog is retrospectively comparing idealized birth outcomes of white women in hospitals to a small cohort of homebirths with unclear race or socioeconomic status. This is not my main argument, but I’m just saying that a good study needs to randomize patients into similar demographics and prospectively analyze outcomes. But to be fair, the original report is just trying to use the data available to them.

          • Young CC Prof

            Fine. Look only at hospital births of full term babies. No other restrictions. (All but the most wildly reckless home birthers go to the hospital for preterm labor.) Look up the neonatal death rate of full term infants across the entire USA.

          • Amy Tuteur, MD

            You cannot randomize patients in a homebirth study, and you don’t need to in order to determine whether homebirth is safe.

            In the first place, MANA’s data isn’t even a study. It is a non-scientific, non-random survey completed voluntarily without any effort made to determine whether midwives were including all their patients.

            You can’t study the safety of homebirth when 70-80% of the midwives refuse to participate in the study.

            So it’s a survey, and a biased survey as well, no one left out their good outcomes, but there is considerable reason to believe that some midwives left out their bad outcomes.

            Nonetheless, even this survey, which is biased toward good outcomes, had an appalling number of bad outcomes. The authors are well aware of this and that’s why they had to be forced to acknowledge the death rates in the first place and why they refused to compare them to the appropriate comparison group, which is white women at term. Instead they compared them to studies from other countries. Even then, they acknowledge that their intrapartum death rate is much higher than reported by anyone else, anywhere else.

            MANA is trying to trick you and the only question is whether you are going to let them. So far you are letting them.

          • Young CC Prof

            This guy seems to believe a lot of memes. “USA has terrible infant mortality rates! Like the third world almost!” (Um, no.)

          • Box of Salt

            Dexter “a good study needs to randomize”

            If you don’t understand how unethical this would be for studying births , you shouldn’t be having this discussion.

          • Box of Salt

            Dexter, can you read? ” a small cohort of homebirths with unclear race”

            Race = NINETY THREE PERCENT WHITE

            Exactly what is unclear about that?

          • Young CC Prof

            Actually, African-American women are three times as likely to deliver prematurely. The reasons are complex and not entirely clear, but most folks who have studies the problem believe that the obvious socioeconomic factors do not adequately explain it, and it may be partly genetic.

          • Amy Tuteur, MD

            No, there is no lack of clear data. The infant mortality data is quite comprehensive and no one has questioned its validity. You seem to be confusing infant data with maternal mortality data.

            Infant mortality data is gathered differently than maternal mortality data and the difference is quite relevant. Maternal mortality is only tracked when the practitioner writes it on the death certificate. Therefore, a woman could die of a pregnancy related cause, a pulmonary embolus for example, and if the practitioner doesn’t mention that she is pregnant or was pregnant within the last year, it is isn’t flagged as a maternal death. The US has revised death certificates in 1999 and 2003 in order to highlight maternal mortality. Now death certificates ask whether a woman was pregnant at the time of death or within a year prior to death.

            Infant mortality is tracked by looking at every baby age 1 and under who dies. Then the CDC goes back and matches the death certificate with the birth certificate (that’s why it’s called linked birth infant death data) to make sure that we know as much about the baby as possible.

            Since almost all babies in the US are born in hospital, the data is quite comprehensive and quite reliable.

          • Sally RNC-NIC

            WRONG. I’m not going to bother finding a peer-reviewed source for this one. Let me tell you something about my experience working in a Level 4 NICU at a large urban birth center (hospital). The majority of the near-termers, premature, and micro-premature infants are white as snow. WHITE. Oh, and as far as socioeconomic….many of these kiddos are multiples from IVF. Which, is kinda pricy.

            Again, no citation. Just from my experience….

        • Young CC Prof

          Short answer (Sorry, you’re like the 5th person I’ve explained this to this week) almost all newborn deaths in the USA involve babies who are premature or have severe congenital defects.

          US stats are worse than other countries for 2 reasons:

          1) We have more preemies, which is partly due to poverty and uneven access to prenatal care and partly due to genetics. We do really well at keeping preemies alive, but there are so many of them.

          2) US health authorities are more generous about issuing birth certificates. Pretty much any baby who draws breath, however briefly, counts as a live birth and a death. In other countries, the really hopeless cases would be counted as stillbirths.

          Homebirth deaths involve full-term, healthy babies who almost certainly would have been fine in a hospital.

          • Dexter

            I would like to see where you got this data. I doubt the reason that the U.S. has higher mortality rates than any other industrialized country has to do solely with prematurity and birth certificate protocol. Also, premature babies are often born unexpectedly out of the hospital, meaning they are not necessarily counted as a hospital birth.

          • Box of Salt

            Dexter “Also, premature babies are often born unexpectedly out of the hospital”

            Citation needed.

          • Young CC Prof

            I gave you a CDC link below. Read it all, please.

          • Amy Tuteur, MD

            Scientific citation please.

          • Jen

            Just because you “somewhat” doubt it, doesn’t make it untrue. The U.S. tends to “count” EVERY birth that is live properly… that is, as a live birth, whether the baby lives 1 minute, 5 minutes or a few hours… live birth. Many countries do NOT. That was the point… our “rates” are higher because EVERYONE gets counted. In many countries, it is common practice to not record the birth or record it as a miscarriage or stillbirth if the baby doesn’t live past a day or so. There is a lot of flexibility in some countries, because of their lack of maternity care to begin with. SINCE we have such advanced care available, many babies who never would have lived at all, or would have lived a very short time (minutes, hours) have a chance here. They may still not make it, they may live for a few weeks or months. Then they are counted in the mortality rate. But we also save many babies that never would have lived had they been born in a country with much less access to advanced maternity/infant care. Does that make more sense now?

          • Sally RNC-NIC

            Fist pump.

    • Captain Obvious

      Try to compare apples to apples. We all know more babies will die in the hospital if you include all comers. Please assess MANAs press release statement with their data, just doesn’t add up. I don’t believe ICD10 is being used here in the USA until 10/1/2014, we are still using ICD9

    • Box of Salt

      Dexter “not just low-risk healthy white women”
      Before commenting, you did check the paper we’re discussing – look at the details of the group to which Dr Amy is comparing – right?

      From Table 2 Demographic Characteristics:
      White 15,614 (92.3)

    • Jade

      Thank YOU!! I am a student at the University of Oregon and had the privilege of listening to Dr. Cheyney lecture on her findings from this study a few days before it came out. The finding of this study are groundbreaking for the home birth movement. This blog was very upsetting to me. It’s a perfect example of misinformation being spread. It only takes a brief moment to look through her past articles to see she is absurdly biased to the point that she would be willing to twist statistics in such a way. Disgraceful! Luckily we are moving ever forward on this issue. Slowly, but surely.

      • LynnetteHafkenIBCLC

        Exactly what part of Dr Amy’s analysis do you object to?

      • Young CC Prof

        Please tell us what the mistakes or distortions in this blog post are. The author’s bias is not in and of itself evidence that the post is wrong.

        • Amazed

          I wonder what the University of Oregon’s problem is. Why do they let an employee of theirs promote herself shamelessly by using THEIR students?

          Please someone explain what the link between antropology and homebirth is. Disclosure of interests: I’ve taken a few courses in antropology at the uni. No one ever thought to use the lectures to promote their own side business. And homebirth definitely wasn’t in the lectures!

          Come to think of it, it took months for us to realize why the homework we were given to translate was always in parts and never had titles… because the books had been published in our own lecturer’s translation. She was not allowed to promote herself in such a way. Not that she needed to impress a bunch of students anyway, she had had her recognition at national and international level. She didn’t need us to shine her own glory back at her.

          • The Bofa on the Sofa

            Please someone explain what the link between antropology and homebirth is.

            Missy’s expertise is in understanding why women choose homebirth. That was her thesis. In that respect, it makes sense as an anthropological topic.

            The epidemiology of homebirth, however, is way outside her field. She’s not a medical practitioner (although a CPM, right?) so is clueless regarding standards of practice.

          • Amazed

            But why would she choose to lecture students on her thesis? Do you know what the thesis of each one of your professors was, Bofa? Yes, I didn’t think so. I certainly don’t.

            It is of interest for a very limited number of people. It isn’t a big enough part of anthropology to merit a lecture of its own. Let alone the fact that she isn’t a medical practitioner, as you pointed out.

            I have no doubt that she has pregnant students. I am aware of just how much influence a professor’s opinion on different matters might have on his/her students. So far, it reeks of self-promotion and brainwashing to me. Using her students, pure and simple.

          • The Bofa on the Sofa

            But why would she choose to lecture students on her thesis?

            Depends on the class.

            In advanced classes, I knew exactly what the research interests of my professors was. Shoot, in the class I teach, which is not even all that advanced, we talk about topics related to my research, and the students know a little bit about what I do.

            It’s easy for me to understand the anthropology of midwifery as being relevant in a lot of different contexts.

      • Amazed

        What does Dr Cheyney teach you? That collecting data from 20-30% of practitioners constitutes a “groundbreaking” study? That licensing her fellow “professionals” is something to be avoided like the plague? Because you know that’s her stance, right? She recommends unleashing her fellow “midwives” on the unsuspecting public.

        I’d strongly recommend a crash course in statistics – one that is NOT taught by Dr Cheyney, as privileged as you feel to be able to listen to her lectures. Followed by a crash course in researching the way how much of hospital outcomes get reported. Hint: it isn’t about 1/3 of them.

      • Karen in SC

        And Dr. Cheyney isn’t biased???? How gullible you are! And she’s not a medical doctor, does she explain that?

        Yes, groundbreaking in exactly the way Dr. Amy explains. More risk of death, and nothing done by MANA to improve this at all.

        Why move slowly when lives are at stake????

      • Amy Tuteur, MD

        This isn’t even a study. It’s a report on a non-representative, self-selecting minority of homebirth midwives. Even so, it a bunch of crap. Ask Missy Cheyney why she released the C-section rate, the intervention rate, the transfer rate and just about any other rate you can imagine for this group of nearly 17,000 women EXCEPT the death rate. Why did she hide the death rate if is shows that homebirth is safe?

        Melissa Cheyney is grossly unethical and has blood on her hands. Dozens of babies died at homebirth while Cheyney and MANA refused to disclose the death rates that they knew about.

      • PrecipMom

        Yep, we sure are moving forward on this issue! We, home birth moms I mean, are realizing exactly how badly we were manipulated, lied to, with our children’s lives on the line by a home birth lobby that does not give a damn about our babies as long as we pay up and sign paeans to the beauty and safety of home birth birth.

        Guess what, Jade? The emperor has no clothes. Not with a 2 per thousand death rate coming out of the top 20-30% which constitute your brightest, most motivated and research minded midwives. That rate is deplorable. It’s an embarrassing, damning indictment of the home birth movement in the United States, one that makes me as a former home birth mother ashamed that I ever encouraged anyone in a plan to birth at home.

        Signed,
        3 babies at home, and now happily back in the hospital where I have been treated with far more kindness, respect and compassion than I and my babies ever received in a home birth setting. Not to mention, far more skill.

      • moto_librarian

        Oh Jade, I was one a young graduate student like you, ready to worship my professors. Then I grew up. “This blog was very upsetting to me,” is hardly a legitimate complaint of Dr. Amy’s analysis. Your beloved Dr. Cheyney is the one who is manipulating data in an attempt to cover her ass. You might consider asking her how she manages to sleep at night, knowing how many babies have been sacrificed to the lie that homebirth is safer than hospital birth.

      • MLE

        So as Cheyney’s student, you failed to read the primary source, AND you failed to read the entire takedown of Dexter’s assumptions and argument below. I give you both an F.

      • Dexter

        Sure, hope it helped. I also forgot to point out how she gives no margin of error or statistical significance of her data. Also, the last doctor to use such poor statistics to prove an agenda was the guy who tried to say vaccines cause autism, and he lost his license for doing so, so this doctor should be very worried (but apparently she doesn’t even practice anymore).

        • Young CC Prof

          Actually, the original authors were the ones who failed to do any statistical analysis. I would think that a supposed research paper with no proper statistics is a much bigger failing than a blog post quoting said paper without statistics.

  • attitude devant

    Here’s a question I haven’t seen asked: Why do they start the stats with labor? One of the things that unhinges me about DEMs is their willingness to go way pas due dates, the way they sit on high blood pressure and so on. Is it possible the ANTEPARTUM death rate is also higher for DEMs?

    • fiftyfifty1

      ” Is it possible the ANTEPARTUM death rate is also higher for DEMs?”

      I can’t imagine that the rate wouldn’t be higher. A number of the stories Dr. Amy has shared have involved women planning homebirths who have gone past their due dates and suffered spontaneous stillbirths while waiting to go in to labor.

      • toni

        This is OT but I saw this a few days ago (linked on MOSW) and have been meaning to ask you specifically. I found it disturbing and it’s been bothering me since I saw it. It’s very graphic btw. http://www.youtube.com/watch?v=F-mcYmFva_Y
        This is bad isn’t it? The doctor did not treat the patient respectfully and looks like he kind of botched the procedure. Would the patient be justified in complaining in your opinion?

        • toni

          I’m surprised no one has commented on this yet. Is it not extraordinary? :/ I really want someone to tell me it is.

          • Stacy21629

            “I really want someone to tell me it is.”
            So you are only looking for validation of what you already believe? Or are you actually interested in a critical assessment of what happened?
            Could this mother have gotten the baby out without an episiotomy? Sure, maybe. She could also have suffered a 3rd-4th degree tear, or maybe none at all. There’s no way at all to speculate on any of those possible outcomes. This is also a very short video – we have no idea how long mom was in labor, what the baby’s tracing was doing or any other context that may have influenced the doctor’s recommending an episiotomy.
            I agree 100% he should have respected her request to wait on an episiotomy. BUT – he did ask/offer before he did it and he did attempt to explain his reasonings. You might not agree with his reasonings, but he did not just do an episiotomy with no notice or explanation at all. I see nothing wrong with how he did the procedure and seeing as a live healthy baby was delivered within minutes I don’t see how you can call that “botched”.
            So yes, not how I would want my own “birth experience” to go…but there is nothing malpractice worthy that happened. If mom is upset she should express that to the patient liaision – I would have appreciated more notice/more discussion/better bedside manner etc – docs need to hear that to improve.
            There are many many doctors out there that are NOT this guy – the negative stuff just makes the rounds easier.
            [ETA: I hope folks have equally as much rage against the (I suppose) grandmother - she pressured the mother as much or more as the doctor.]
            To choose a homebirth that dramatically increases the risk of your baby’s death to avoid an episiotomy is a foolish decision, though one I know many women make.

          • toni

            I want the truth of course. I’m just hoping the truth is that this is untypical and that it should take one snip not half a dozen and that other physicians agree his attitude to his patient was shitty. I didn’t question that an episiotomy was appropriate (baby’s head looked very big to me) so not sure why you are lecturing me. I do think that even after the doctor has explained why a procedure is necessary if the patient says no the doctor should respect their wishes. Also ‘the baby was fine therefore the procedure was not botched’ doesn’t make sense to me. A badly done episiotomy would cause the mother to suffer not the child. But if you’re telling me that it is not unusual for it to take that many attempts to cut through the tissue I guess I will take your word for it. Just makes me even more in favour of elective caeserean.

          • Stacy21629

            I will apologize for my attitude…one gets a little jaded reading all the NCB garbage that gets thrown around. I don’t mean to lecture *you* specifically…it’s just that there are a lot of folks that ask questions here about stuff that OBs do but they aren’t really looking for an answer – just picking a fight. My apologies.
            I agree with consent (to a point) – if patient says no, doc should respect that. The “point” being if there is true imminent life-threatening danger. If there’s meconium laced fluid pouring out of mom and the HR is 60 but she’s declining a C-section…I think that’s a place to override her wishes…but (from what we see in the video) the OB should not have in this video.
            Regarding a botched procedure – what I mean by that is weighing morbidity and mortality. Yes, a “botched” episiotomy causes more morbidity to mom…it’s just that most NCB/homebirthers are 100% focused on “interventions” that cause increased morbidity to mom…so they make choices that cause increased mortality to baby. Of course no one wants a “botched” episiotomy…it’s just that if you hold that position and then choose to homebirth to try and avoid one – THAT’s the bad decision. If you’re small and measuring ahead or previously delivered a macrosomic baby and are at risk of SD – I would totally support an elective C in that case.

          • toni

            Thank you for apologising. I really don’t want to be mistaken for a homebirth enthusiast or anything. Perhaps I should have made my views clear before asking my questions but I do post here a fair amount so assumed most other commenters know I am pro obstetrician. I did want an honest answer but was hoping for reassurance that that sort of treatment is not common in American maternity wards because I found it distressing to watch. The combination of his obvious irritation with his vulnerable patient and what looked like a brutal, sloppy execution of what I thought was supposed to be a delicate procedure. Most posts and comments on MOSW elicit nothing more than an eyeroll from me because so much of the complaints are over such trivial things but even a stopped clock is right twice a day, I couldn’t dismiss this one. I think most people here are willing to acknowledge physician mistakes/mistreatment so I wanted to know if the HCPs here think this qualifies because my gut feeling is that it does.

          • me

            I know episiotomies are often described as a “little cut” or a “little snip” (kinda like circumcision is described), but I’m pretty sure it is usually that brutal – would anyone ever agree to it (unless someone was about to die) if it weren’t couched in such benign terms and they actually saw what it looks like?

            That video was hard to watch, but, yeah, episiotomy is that disgusting. And, no, it’s not just a little snip.

            I was angrier at her mother than the doc, personally. First, who films a straight on crotch shot of your child giving birth, second, what mother tells her daughter to just do what the doctor says when she is adamantly refusing? The doctor was absolutely wrong. Period, full stop. She said no. No means no. But that worthless bitch of a “mother” pissed me off way more than the doctor. He was an ass, sure, and obviously assaulted that woman, but what mother can watch her daughter be assaulted against her frantic protests and actually egg the perpetrator on (telling him to go ahead and just do it, yuck)?

          • toni

            I actually couldn’t make out the full conversation between the patient, patient’s mother and doctor and I didn’t want to watch it twice. I did hear the patient object and the doctor scolding her, that was enough. I could hear the patient’s mother encourage her to go along with her doctor’s advice but didn’t hear her instruct him to just go ahead without her consent. That is disgusting. I wouldn’t speak to my mother for a long time if she’d done that to me.

          • toni

            I have seen videos of episiotomies before, and a couple of forceps deliveries when I was expecting because I wanted to know what I might be getting myself into so I braved it and forced myself to sit through some demonstrations on YouTube. (I was considering asking for a c section) They made me wince but didn’t horrify me like this one. The ones I saw when I was pregnant were all quick and straightforward and just a singular incision and I thought as long as they gave me enough local I wouldn’t mind having one too much so I ultimately went ahead with a natural delivery. If I had seen that one I might have made a different decision. I think I’ve cut lamb chops with more care and precision that he cut that woman’s genitals! If women knew an episiotomy was likely to be carried out like that I think you’re right that more would refuse.

          • me

            He may have been punishing her for arguing with him. Doctors aren’t immune from metal illness…

            And, yeah, her mother said something along the lines of “go ahead and do it, on the next one just do it” to the doctor (paraphrasing, I don’t want to watch it twice either). That woman should be tarred, feathered, burned, and shot several times. Disgusting.

          • toni

            Is wickedness a mental illness? It did cross my mind that it was done punitively. Awful :( I dread to think how he treats his patients when he’s not being filmed! Maybe the mother had an epi when having her daughter and is sort of getting back at her. Bit silly to speculate on these things but I just can’t imagine being so enthusiastic about my child being cut especially in such an intimate place! You’re the poster that was cut without consent weren’t you? I may have mentioned this before but I was in a rail accident about ten years ago in India and a doctor ordered several nurses to hold me down and insert a Foley catheter that I didn’t want or need (in my opinion) I had a broken femur, collarbone and one of those claw like hair clips imbedded in my scalp but being cathed like that is the most painful memory to recall. It just makes it so much worse when its a person doing something painful *to* you and not even being apologetic about it. You may not think that comparable to your experience since there is no lasting damage from a cath but it was traumatic and I was incensed about it for some time afterwards!

          • toni

            Also I think it’s okay for me to say this as I am somewhat of a ‘foreigner’ (Anglo-Indian) myself. I’ve spent almost exactly half of my life in W.Europe and the Anglosphere and half elsewhere (India, Singapore, one eastern bloc country etc) and it’s very noticeable the difference in attitude regarding informed consent. Non western doctors almost always in my experience are authoritarians and don’t think they owe their patients (particularly female patients) explanations or permission for treatments. The ones that take the time to tell you what they are going to do before they do it and answer questions will be known as extremely nice, considerate doctors whereas in America, Britain etc it’s just expected and if they refuse to answer questions their patients think they aren’t good doctors. So it does not surprise me to notice that this doctor does not sound like he was born and raised in the United States.

          • Stacy21629

            And I’m not a physician – I’m a veterinarian. But I can attest that there are some tissues that are harder to cut than others. We can’t really see what he’s looking at there – perhaps he’s taking multiple small cuts to make sure he doesn’t cut too much too fast. I would also wager that there’s a decent amount of hemorrhage obscuring his view – so he may be being cautious and only cutting what he is certain he needs to cut based on what he can see. It’s also entirely possible he just needs sharper scissors too… :)

  • snicoler

    This post has really got a lot of people worked up. Why? Be honest with yourself. What motivates you?

    If you are someone who thinks people should not have homebirths do you think that because you GENUINELY care about the safety of “those people” who want to have homebirths? Or do you care more about being right and getting others to see things your way?

    And yes, I do believe most don’t really care that much about other people but actually care about being RIGHT. It just sickens me to see people hiding, even from themselves, behind faux concern.

    And no, I am not in favor of homebirths.

    • Happy Sheep

      I can’t speak for everyone, but I know that I genuinely care about THOSE people who make this choice, I also care about innocent babies who didn’t have to die. I care a lot.
      I fully support the right of a woman to choose anyone and any where to give birth, but I also am adamant that they should be making these decisions fully informed. When they are misled, misinformed, gaslighted and outright lied to, I care. I care a great deal.
      I care that women will lose their babies or have them seriously injured because of the lies spread by the NCB and homebirth communities.
      I care that the national organization behind CPMs is outright lying to the public, and that due to the echochamber that is homebirth, no one is actually reading the studies or doing the math themselves.
      No matter where you stand in this whole issue, anyone who has a modicum of math ability and critical thinking should be shocked and appalled that MANA had the numbers for 5 years and sat on them, and then when they finally released them, bent and twisted and fibbed to make themselves look good instead of using this as a wake up call for action.

      • LynnetteHafkenIBCLC

        >shocked and appalled that MANA had the numbers for 5 years and sat on them

        I’d like to know, in their own words, how they can justify releasing all the data (c-section rates etc) EXCEPT the death rate. The c-section rate means NOTHING without knowing whether babies died to achieve it.

    • DaisyGrrl

      I think the problem many people have with the homebirth culture (and this paper) is that it minimizes the risk of death or serious morbidity to the baby.

      I would never have a homebirth for myself, but I have far less problems with a woman having a homebirth if she’s been properly informed of the risks. If you go to the Hurt By Homebirth website, none of these women were informed of the risks they were taking when they chose to have their babies at home.

      If every woman planning a homebirth signed a piece of paper saying “I understand that my baby is 3-5x more likely to die in a homebirth than a hospital birth. I understand that there are complications that cannot be predicted that will result in my death or my baby’s death at home that can be safely resolved in a hospital. However, I am satisfied that the absolute risk is low and I am willing to risk my child’s life and well-being in order to give birth at home.” then I would stop getting worked up over homebirth deaths.

      • DaisyGrrl

        Just want to add that the above signed piece of paper should also include provisions that the woman is verified as low-risk and that the midwife is properly trained. Otherwise the consent should also read: “I understand that I am depriving my child of the best chance of surviving the most dangerous day of his life by taking unnecessary risks and trusting in someone with no medical training to recognize an emergency. I accept liability should my baby die and am willing to be prosecuted for criminal negligence as a result of my choice.” Obviously it should be prettied up a bit, but that’s the gist my feelings on the matter.

    • fiftyfifty1

      I have 2 reasons for caring about this paper:

      1. I really hate misinformation. It bugs me when people lie and get away with it, especially when it involves pseudoscience. I don’t “care about being RIGHT” for myself because my real name isn’t “fiftyfifty” any more than yours is “snicoler” so it’s nothing to me personally. But I do hold science to be a higher good. It pisses me off when somebody lies but uses the veneer of “science” to give legitimacy to their lies. So basically I do care that SCIENCE be RIGHT.

      2. The other thing that motivates me is more personal. When I was 14 my youngest sibling came very, very close to dying in a homebirth. It wasn’t pretty. I wouldn’t wish this experience on anyone. It’s not about being RIGHT, it’s about watching your baby sister almost bleed to death.

      • Trixie

        I’m so sorry you had to witness that. It must have been awful.

    • MLE

      If you knew anything about this blog’s audience and community, you would know that a lot of them have been directly impacted by amateur midwives, either through the deaths or injuries of their own children, or those of their family members, or via hospital transfers that they have cleaned up after as medical professionals. What sickens me is your complete lack of “research” before casting a tone-deaf judgement like that.

      • MLE

        *not to mention injury to themselves as birthing mothers

    • Amazed

      This post has really got a lot of people worked up, including some who had never bothered to comment before. Why? Be honest with yourself. What motivates you?

      I’ll daresay that motivates you is that your spirits are low and you need to feel better about yourself by scolding us. Poor snicoler, go and find yourself a kindergarten where the occupants will look at you with admiration.

      I hate to break it to you but we’re all adults here and we don’t need to explain ourselves to every passing troll who needs to feel superior.

    • KarenJJ

      I feel so sad that you think this.

      Best example of faux concern I could think of.

      Now women being fed bullshit information and being lied to – dunno if it’s concern on my behalf but it makes me fucking angry. We deserve better, don’t you think?

    • Stacy21629

      I’m worked up because I had a homebirth to avoid an episiotomy and a C-section. No one told me MY BABY COULD DIE.
      I’d just like to make sure other women aren’t so horribly misinformed. MANA hid this information for years. That’s criminal.

  • Someone

    Amy, please go retake your freshman statistics course.

    • LynnetteHafkenIBCLC

      Exactly what statistics are you objecting to?

      • Happy Sheep

        The ones that show results that Someone doesn’t like.

    • DaisyGrrl

      Someone, please describe in detail what statistical errors Dr. Amy is making and how you would do it better. Show your work.

    • Happy Sheep

      Did you take freshman stats? I did. I learned enough in that class to know what I don’t know. Did you?
      From your freshman stats course knowledge, please outline Dr. Amy’s errors. Show your work, and citations are mandatory so that the folks at home can play along.
      I’m expecting crickets.

  • LynnetteHafkenIBCLC

    Can we just stop feeding the troll? It is cluttering up all the good comments.

    • Stacy21629

      I agree in principle. But sometimes it’s a good exercise to have them state clearly in their own words that they oppose improving the conditions of home birth and feel that experience is better than decreased mortality. Shows the terrible extremes to which folks in the homebirth NCB movement really go.

      • LynnetteHafkenIBCLC

        Yeah…only he’s already done that…for hours.

        • Stacy21629

          Sorry…I work nights – just now getting back to these posts. :)

      • Box of Salt

        Yes, but one’s not going to do that. He is here to argue for argument’s sake. He’s quibbling over the meaning of the word “claim.”

        My guess is he’s here to distract folks from a real discussion of this paper.

        • AlisonCummins

          No, he’s just distracting himself by getting the ladies all worked up. He’s probably got porn on the other screen. And he’s working his way through that six-pack.

  • Mishimoo

    As my husband just said: “This reminds me of the tobacco companies before government regulation. They want people to buy as much of their product as possible, knowing that it is unsafe, because otherwise they’d be out of a job and it’s not like they (DEMs +CPMs) can just go and find a new one in a hospital.”

  • Staceyjw

    I admit, I am losing patience with people that love to dismiss the danger of HB by saying “but x, y, z, is more dangerous, and we still do those things!” or “other things kill more people, this number is nothing.”.

    This misses the point entirely, as the things they reference are indeed regulated, and we do quite a lot to make them safer. Some things kill many more people, some kill many fewer, but we don’t ignore the dangers, and we do what we can to lessen the death toll. We even regulate things that don’t kill!

    Why do we have
    Car seats, seat belts, license/ insurance laws, crash tests, airbags?
    Life guards, life jackets, classes, supervision for kids anytime near water?
    Investigators, amber alerts, offender lists, talk of “stranger danger”?
    Weather stations to broadcast conditions causing lightening in public areas?
    Giant warnings on cigarette packs, banning ads, free help quitting?
    Tight restrictions on sale and consumption of alcohol, bans on DUI?
    Seismic data collection, warning/ evacuation plans for tsunamis/quakes?
    Fire fighters, fire plugs, alarms, sprinkler systems, extinguishers?
    TSA, Homeland security, FBI, watch lists, anti terror conferences, policies?
    Bike helmets, reflective clothing, lights, bike lanes, related rules?
    Kevlar or leather coats and suits, helmets, license laws, speed limits?
    Bans on hollow point/armor piercing ammo, automatic weapons, CCW?
    Bans on other concealed weapons, limits on blade type/how knives open?
    Education/ licensing requirements for hair stylists, interior designers, LMTs?
    Food handler licensing, USDA inspections, regulations on food sales.
    I could do this all day…..
    And
    OBs, hospitals, prenatal care, Medicaid for low income moms, WIC?

    It is because we CARE about health, and we want to avoid preventable DEATH, and disability. We may not always be good at it, but once we see something can be improved, we try and do it. Often, it’s a victim or their family that makes the push for change, and HB is no different.

    • Staceyjw

      I know the jokes about TSA are coming….

      • LynnetteHafkenIBCLC

        Oh I’ve got one! What’s the difference between a TSA agent and Ina May Gaskin? One molests you while doing her job, the other one works at the airport. Reference for those who haven’t seen this gem: http://www.skepticalob.com/2013/06/would-you-hire-this-midwife.html

        • Coraline

          Whaaaat?!?! I think I threw up in my mouth a little, reading those “gems” from Ina May. WOW. Words can’t even describe the shock and disgust!!!

    • The Bofa on the Sofa

      What are they claiming for x, y and z, btw?

      • Young CC Prof

        Good question. Very few things that “average” people ever attempt, even those perceived as dangerous, are actually as dangerous as home birth. (Some extreme sports might be as bad.)

        • Trixie

          The number of babies that died preventably in this study are enough to fill a kindergarten class. Just imagine all those empty chairs, and how much attention that would generate if they all died at once, in the same room, instead of quietly, one at a time.

          • Young CC Prof

            If this were a real controlled study run by a real IRB, it would have been shut down at the first checkpoint.

          • melindasue22

            And one of their arguments about putting it out late was IRB approval.

          • Squillo

            No, that was their argument about why they couldn’t release the dataset publicly, outside of a study.

            Which is… mistaken, to put the most generous interpretation on it.

          • The Computer Ate My Nym

            I’ve gotten IRB approval for retrospective chart review analyses within weeks of submission. What did they say that got them delayed by 4 years?

          • Meerkat

            I pictured it, and got a chest pain.

          • araikwao

            How does being upset or outraged about preventable perinatal deaths earn you a downvote? I don’t get that mentality one bit.

        • The Bofa on the Sofa

          I am serious in my question, of course, because I have have done a lot of comparisons.

          What’s safer? Childbirth? Or driving in NASCAR? If you consider the risk of a single race, the answer is racing NASCAR.

          etc.

          A 1 in a 1000 risk is really, really high compared to what we are used to.

          Climbing Mt Everest is, in fact, riskier than childbirth, probably. Although that only considers those who made it. I need to check the risk for those who attempted it.

          • Trixie

            Being president is riskier than childbirth.

          • The Bofa on the Sofa

            Good one. I think that even holds if you consider the number who attempt it, since that is what people control.

          • Trixie

            I suppose it depends on where you cut off “attempt”.

          • The Bofa on the Sofa

            Always. I’ll look into it, though.

          • The Bofa on the Sofa

            Apparently, 175 people officially filed the papers to “run for president” in 2012. I have found a claim that it was 44 in 2008.

            There have been 56 presidential elections, and 8 presidents have died in office. To get to 1/1000, that would require 140 candidates per election. Doubtful.

            Now, if you restrict it only to those assassinated, you could cut that to 4 deaths, but you’d have to add in Bobby Kennedy and apparently Joseph Smith, candidates who were assassinated. Even if these are the only two, that brings it to 6, which would require more than 100 candidates per election on average. I suspect the actual average is no where near that, so I would conclude that, yes, running for president is more dangerous than childbirth.

          • The Bofa on the Sofa

            OK, through 2006, I have found that the fatality rate in climbing everest is about 2% of the attempts. So there is clearly something riskier than childbirth.

            Interest, you are almost as likely to die on the way down as you are on the way up. The fatality rate of those who didn’t make the summit is 2.1%. The fatality rate of those who DID make the summit is 1.8%.

            IOW, when it comes to Everest, reaching the summit is only half the battle!

          • FormerPhysicist

            Much like childbirth. Lots can happen after the baby is out. PPH, PPPreE, … The PP = “post-partum” gives it away.

          • Young CC Prof

            A study of maternal deaths in NYC found that approximately half of them occurred two or more days after delivery. (33% occurred on the day of delivery or the day after, and only 16% occurred before birth.)

  • Source Checker

    CHECK YOUR SOURCES! I do NOT believe the “statistics” provided in this clearly bias article. I searched the CDC wonder database myself for white women birth death rates, grouped by the Birthplace, then by Medical Attendant….

    According to the CDC, a Doctor of Medicine(MD) and Doctor of Osteopathy(DO) have an infant mortality rate of about 3.5/1,000 births in a hospital when compared to a Certified Nurse Midwife(CNM) and Other Midwife outside of a hosptial with a rate of 1.5/1,000! Where the hell is this article getting the 0.38/1,000 figure?

    Another Fun Fact from the CDC: The infant mortality rate in a hopsital of a Certified Nurse Midwife(CNM) is 257% LESS (0.98 vs 3.5) than a Doctor of Medicine(MD) and Osteopathy(DO) in a hosptial! So based on this, women who chose a hospital should STILL use a Midwife!

    • anion

      Read the comments, like the one just a few down from yours, which explain exactly how those numbers were found.

      (And by the way, “bias” is a noun, not an adjective. The adjectival form is “biased.” You mean to say this article is biased, not bias.)

    • The Computer Ate My Nym

      What years and parameters did you use? For example, did you include all gestational ages at delivery? Because that will give you a much higher number than if you limit to later GA. Also, did you include up to 1 year at time of death? Because that will confuse the issue, adding differences in pediatric care to differences in obstetric care.

      • Source Checker

        I used 2007-2010 and only included infant age 0-27 days (the next category being 28-256 days). I reran the query with gestational age >= 39 weeks and came up with these numbers:

        CNM outside hospital = 0.8/1,000
        MD/OD inside hospital = 0.6/1,000

        This new view of the data shows a very similar infant mortality rate.

        • LynnetteHafkenIBCLC

          Ok…but MANA represents CPMs, who primarily attend home births.

        • The Computer Ate My Nym

          Women who deliver outside the hospital tend to be less likely to be extremes of age (45), more likely to be white, more likely to have a HS diploma or more. In short, to be lower risk. So simply restricting to GA>=39 weeks, while helpful, is not adequate. I repeated your original search and got slightly different results, with MD/OD in hospital at about 0.7, CNM outside of hospital at about 0.9 and other midwife, outside of hospital at 1.48. So, while you could argue that the difference between 0.7 and 0.9 is minimal, the difference between 0.7 and 1.48 certainly isn’t. And that doesn’t account for other variables which make women who deliver at home lower baseline risk.

    • PJ

      Ummm … or maybe doctors take riskier cases than midwives?p

      • Source Checker

        Could be. Or that doctors could be more inclined to introduce risk into an otherwise natural birth.

        • PJ

          Are you being serious?

          • Source Checker

            Yes. Most hospitals are unfortunately in the business of making money (even non-profit does not mean non-revenue). It just reminds me of the documentary “The Business of Being Born”, which while I’m sure is also not 100% true, it does shine a light on how doctors in a hospital tend to over prescribe treatment during labor that causes spiraling complications to what could have been an otherwise safe natural birth.

          • PJ

            There’s no evidence that interventions in the US are causing a higher rate of neonatal deaths. At most, they result in more c-sections.

          • http://shameonbetterbirth.wordpress.com/ Shameon Betterbirth

            Funny how their protocols have much better outcomes. You would think that the outcomes would be the measurement of if treatments are being ‘over prescribed’ or not, rather than the opinions of a bunch of moms on some movie you watched.

          • Melissa

            Doctor- gets paid the same if there is a c-section or vaginal birth.
            Midwife- only gets paid if they convince the mother that homebirth is safe and hospitals are dangerous.

            Who has the profit motive here again? It isn’t the doctors.

          • Source Checker

            Melissa, It is not true the profit margin is the same if a doctor does vaginal or c-section birth. The more births a doctor can do, the more money the hospital makes by freeing up a bed for more patients/births, which is intensive for a doctor to perform a c-section.

          • Box of Salt

            Source Checker – that doesn’t really make sense. You might be freeing up a delivery bed by doing a section a few hours sooner, but since c-sections usually stay in the hospital longer you’re keeping your postpartum beds occupied longer by doing the section. Where will the extra moms and babies go?

          • Melissa

            Since C-sections have longer recovery times they take up those precious beds for longer. So by your logic it makes sense for those evil doctor/hospitals to do fewer c-sections so they have more open beds.

            Of course the open beds thing would only matter if we were in a situation where hospitals regularly have to turn away patients because they are all filled up. That doesn’t seem to be the case (certainly not where I live). The demand of hospital patients doesn’t regularly outnumber the supply of hospital services. So the whole freeing beds thing isn’t the issue.

            A truly profit motivated hospital would refuse to do any c-sections. Those NICU babies mean $$$$$$$! But since in real life hospitals do everything possible to avoid harming babies we might have to accept that they have a motive other than profit.

          • The Bofa on the Sofa

            I know that with our second, the hospital birth center was so busy that they had to use a room that is usually reserved for 1 week checkups for post-partum. I think there was a lot of pressure to get mothers out to make room for more coming in. As noted, that is harder when you have c-sections.

          • Captain Obvious

            If a doctor has 25 patients due this month, he has 25 patients due this month. How does freeing up hospital beds get him more deliveries if all he has is 25 patients due this month?

          • Bombshellrisa

            The profit margin isn’t the same- in WA state, there is an incentive for doctors who are attending patients on Medicaid if they DONT do a c-section.

          • attitude devant

            Logic Fail, Source Checker. If you follow that line of reasoning (freeing up beds) the hospital is better of with vaginal births, since they go home faster.

          • PrimaryCareDoc

            Typically the doctor does not work for the hospital.

          • anion

            If that were true, wouldn’t women–all women, including women with zero complications or indications–be encouraged to avoid labor entirely and just schedule a c-section right from the beginning? Wouldn’t hospitals do away with labor wards almost entirely and just build more ORs?

            Because they’re not. Maternal choice c-section is pretty rare; it’s very hard to find a doc willing to do it, if you can find one at all.

          • Captain Obvious

            That’s your source? BOBB.

          • The Computer Ate My Nym

            Most hospitals are unfortunately in the business of making money

            I must admit that you’re right and I am disturbed at a number of things that hospitals do to make money. But insurance companies are also in the business of making money (and they are NOT nonprofits) and they don’t allow doctors or hospitals to charge more for c-sections than for vaginal deliveries. So there is no profit motive for the hospital in doing unnecessary c-sections. Or any other treatment, for that matter: hospitals get a set fee for delivery, no matter how complicated or simple.

          • Stacy21629

            “Most hospitals are unfortunately in the business of making money”
            And homebirth midwives deliver babies for free out of the goodness of their hearts…..

          • Sally RNC-NIC

            Can you elaborate, with documented cases you can share, on your claim that “doctors in a hospital tend to over prescribe treatment during labor that causes spiraling complications to what could have been an otherwise safe natural birth.”

            Is this based on personal experience, the experience of friends, articles read in the news, are you a researcher? I’m just curious if you’ve gathered actual data on an appropriate number of births that support your claim. Or, are you generalizing? How are you quantifying this claim?

            And I am seriously not trying to be rude or sarcastic. It’s just such a broad statement, I’m genuinely curious of your source.

            I’ve been in hundreds of deliveries…high-risk, low-risk, low-risk and turns into super high-risk.

            I’ve never witnessed a physician cause a spiraling complication to what could have been an otherwise healthy birth. So, I’m asking you to please tell us more. Thanks!

          • The Bofa on the Sofa

            And I am seriously not trying to be rude or sarcastic. It’s just such a broad statement, I’m genuinely curious of your source.

            How do I say this delicately….oh screw that.

            She pulled it out of her ass.

          • Sally RNC-NIC

            Shhhhhhhhh!!! Don’t ruin the fun!!! It’s Saturday night and I need to be entertained! : )

            My attorney grandfather taught me the smartest lesson when I was a wee-girl. Never ask a question I don’t already know the answer to!

          • PJ

            Disqus playing up; I thought I was replying to Anion. But nonetheless, you can’t seriously think doctors have a mortality rate that is two and a half times higher than midwives in hospitals because they do too many interventions?! You need to compare like risk with like risk! Midwives in hospitals supervise LOW RISK BIRTHS. The births that are riskiest, most difficult, and therefore most likely to result in lethal outcomes are supervised by doctors.

          • Source Checker

            And where is the “low risk” box to check while searching the article’s source, the CDC website? Can’t seem to find that…

          • PJ

            Well then, you have a problem, don’t you?

          • Source Checker

            The point of my comment thread was to check the sources. If you don’t want to contribute then it’s not my problem.

          • PJ

            Um, no it wasn’t. The point of your comment was to show how DUMB we all are for being hoodwinked by Dr Amy’s OBVIOUSLY fraudulent numbers!!!

          • AlisonCummins

            This has already been discussed elsewhere on the thread. Select for term, singleton, >2500g, vertex, white, high school+ and so on. Keep going through the comments. It’s been a big subject of discussion.

          • Guesteleh
        • auntbea

          Because why? Because doctors become doctors because they enjoy human suffering? Because they only let sociopaths take the MCATS? Because doctors pay for medical school by making with a deal with the devil to give him souls in exchange for a low-interest loan?

          Do you have a more realistic explanation for why doctors would intentionally create a risk of harm for their patients?

          • Meerkat

            It’s because doctors looooove golf.
            (sarcasm)

    • The Computer Ate My Nym

      Try limiting to women age 20-44, with at least high school education, delivering week 39 or later, with babies weighing at least 2000 grams and vaginal delivery, dying within 28 days after delivery. If you want to be really strict, restrict to white patients, married, and singleton. That will give you MD in hospital 0.37, other midwife out of hospital 1.41.

    • Staceyjw

      CNMs are restricted to low risk patients and transfer moms to OB care anytime an issue arises. Same for GPs and DO’s. If their numbers weren’t better, it would be a serious issue.
      If you like MWs and are low risk, and stay low risk, have a CNM! They aren’t safer than the same mom with an OB, but you may like their approach better. (Or not.)

      Not that this is relevant. We are talking about HB MWs, that report to MANA, which are only CPMs. Not the same at ALL.

      A commentor below already explained how the numbers were reached. You don’t have to make things up to know HB is dangerous. EVERY SINGLE state that keeps records shows the increased risk. Why would this be different, even when the reporting is voluntary, and missing many moms?

      • Guest

        FYI for statistical/fact purposes: There are many DOs (Doctors of Osteopathic Medicine) who practice obstetrics and gynecology as a specialty, and are fully responsible for the care of high risk women, including many who did additional specialty training as MFM (Maternal Fetal Medicine) subspecialists. The distinction between MDs and DOs in this country is now largely obsolete. There are really no longer any “GPs” in practice, (general practitioners who did only one year of internship after medical school), for both MDs and DOs. Almost all physicians in this country now complete a full residency. Those who wish to pursue more of a general practice opt for Family Medicine and are referred to as FPs. Some include obstetrics as part of their services, but typically, they do transfer care of high risk patients to OBs or MFM specialists.

    • Jane Lucas

      As has been said time and time again infant mortality is the wrong figure to use.

    • Dr Kitty

      Orly?
      EVERYONE should choose a midwife?
      Placenta praevias, IUGRs, high order multiples, cervical incompetence, placental insufficiency, cholestasis of pregancy, breech, Pre-eclamptics, eclamptics, women with pre-existing serious medical conditions, grand multiparas, women with BMI over 40, extreme prematurity, foetal abnormalities…

      Yup, you’re right, natural vaginal birth with a midwife would TOTALLY improve their outcome.

      No?

  • Coraline

    I’m a typical “layperson,” so I’m not trained in reading statistics. What is so confusing for people like me is that you have each camp claiming the stats are in their “favor.” What I seem to gather is this: 1) The absolute risk of death from home birth is LOW, which is why homebirth advocates say that this study proves homebirth is “safe”, however: 2) Compared to HOSPITAL births, the rate of death for homebirth is MUCH higher, and 3) The midwives reporting did so on a voluntary basis, so this isn’t a study that is worth very much anyway. Is this a correct observation?

    • The Bofa on the Sofa

      1) The absolute risk of death from home birth is LOW, which is why homebirth advocates say that this study proves homebirth is “safe”

      What does that mean?

      The absolute risk of death from drunk driving is much lower than that in homebirth (per event). Would that make anyone say that drunk driving is safe?

      If I say that, yeah, I drank and drive, but I only did it once, would you say that was “safe”, since the absolute chance that anyone would be hurt was LOW?

      Childbirth (much less homebirth) is pretty much the riskiest single thing that anyone will ever experience in their lives. A NASCAR driver is less likely to die in a race than the baby is to die in childbirth. Skydiving, scuba diving, drunk driving, all things that are considered to be risky are much safer than childbirth.

      If childbirth is safe, I’d like to know what is considered risky? Russian Roulette?

      • Coraline

        I’m not defending homebirth advocates, I’m trying to understand HOW and WHY they’re saying what they’re saying in regard to this study. And what they’re saying is: “Study proves that homebirth is safe.”

        • The Bofa on the Sofa

          I understand that, and what I am suggesting that what they are saying is a steaming pile of nonsense.

          They are trying to sell this “absolute risk is low” crap, hoping that people swallow it, but without mentioning the implications.

          That “the absolute risk is low, therefore it is safe” claim comes with it with serious unspoken baggage, and if you want to know and understand what they are claiming, then you need to know and understand that part. Yes, they claim the risk is low and therefore it is safe. However, the logic they use to get there also leads to the conclusion that drunk driving is safe, or driving your child around without a car seat. That’s what they are saying, even though they won’t admit it.

          • Coraline

            Oh I agree; I think it’s extremely irresponsible for them to sell homebirth as “safe” even if the absolute risk is low. They must have had some serious PR discussions (5 years’ worth!) before they decided to publish these results…every “mainstream” article I’ve read starts with the headline: “Study finds homebirth safe…” which is very unfortunately and misleading. The other question no one seems to address is that these were the VOLUNTARY results … why isn’t anyone questioning about the ones that weren’t reported? Surely, if these results were given on a voluntary basis, they’d present as the “creme de la creme.” What worries me is what would happen if they were REQUIRED to report their outcomes … then the truth would come to light, and I’m sure it wouldn’t present a pretty picture of homebirth. Certainly not one they could even try to repaint as “safe.”

          • Squillo

            The other question no one seems to address is that these were the VOLUNTARY results.

            They note this in the limitations section, sort of. And yes, it is a serious limitation. While midwives who enrolled in the MANAStats project were required to log every patient (unless the patient didn’t consent), only “20-30% of active CPMs and an even lower proportion of CNMs” contributed statistics.

            It is possible, even likely, that midwives who took the most risks with clients–and are most likely to have had the worst outcomes–didn’t participate.

          • The Bofa on the Sofa

            The other question no one seems to address is that these were the VOLUNTARY results … why isn’t anyone questioning about the ones that weren’t reported?

            Oh, people are certainly taking that into account, but the reasons it’s not emphasized are that

            1) It’s pretty obvious that the bias on the sample size is going to skew the results toward fewer problems. It’s biased, yes, and it is unarguably biased toward the midwives, and
            2) The biased numbers are bad enough! I mean, even if we assume that the results are accurately reflecting what’s going on, they are terrible!

            So we don’t need to rely on the fact they are biased to criticize them.

        • Squillo

          The problem with simply saying “hurray, it’s safe!” is context. The study is intended to help women make a choice: give birth in or out of hospital (or, I suppose, not give birth at all.)

          For example, my doc recently recommended a new medication for me. She gave me a list of all the risks, including the very tiny risk of a fatal side-effect so I could compared that to the risks of the medication I had currently been taking, and the risk of taking no medication at all. If she had simply said, “it’s safe,” that wouldn’t have been especially useful in my decision-making because the other two options were “safe” too, in absolute terms.

        • AlisonCummins

          I’d say that’s partly accurate. They are saying it probably won’t happen to you, which is correct. It probably won’t. They could have stopped there but they didn’t.

          They go on to say “Low-risk women in this cohort experienced high rates of physiologic birth and low rates of intervention without an increase in adverse outcomes” which is a lie. Death is an adverse outcome and they had more of it. This isn’t open to interpretation, it’s just not true.

          • The Bofa on the Sofa

            As Steve Novella says, “Unless you call death an “adverse outcomes”

        • Young CC Prof

          Yes, that’s what home birth advocates are claiming, that it’s safe because it turns out OK most of the time. Opponents point out that it’s substantially less safe than hospital birth.

      • AllieFoyle

        Well, it’s safer than russian roulette; most people will have a good outcome, but even small numbers are meaningful when you’re measuring DEATH. The post on the Neurologica blog suggests the differences amounts to about 20 babies based on the size of the study population.

    • Staceyjw

      That is an extremely accurate observation. while “overall risk” may be low for one person, and not another, I can see the Hbers thinking it’s fine. After all, I have seen a HB advocate pushing HBAC because 1 in 200 ruptures meant that 199 would be fine. To ME 1 in 200 is scary enough to want to avoid VBAC altogether, but some others think they will be in the 199 and that is reasonable to them.

      Birth is the most dangerous day in moms life, and the most dangerous in a kids first 18yrs. That this is ignored is beyond me, but some people take big chances. The issue is that they take the risk unknowingly. If all HB moms knew this and though it was fine, I wouldn’t even care, though I would be shocked.

      • Trixie

        If you’re someone whose chance of successful VBAC is high, and risk of complications is low, based on various factors, and you’re in a hospital with access to immediate surgery, then the risks to maternal health are a bit lower with a TOLAC, the rates of neonatal morbidity may even be similar between the two delivery methods.

      • The Bofa on the Sofa

        Birth is the most dangerous day in moms life, and the most dangerous in a kids first 18yrs.

        Below, we have identified attempting to climb Mount Everest and running for President as two activities that are riskier than being born.

        What else might you suggest, that is something that almost everybody does (instead of being a freak activity) is more dangerous in someone’s life after the age of 18? Certainly not giving birth.

        • AlisonCummins

          I looked up the ten most dangerous jobs and on this list snow crab fisher has some numbers:
          http://www.oddee.com/item_97224.aspx

          129 deaths per 100,000 workers per year; snow crab season is about four months long; fishers work every day.
          That means that each fisher has a 0.0011% chance of dying each day on the job.

          • Stacy21629

            Interestingly enough, police and firemen rarely make these top 10 lists. Manual labor, fishermen, farmers…always way up there.

  • Squillo

    OT–Steve Novella has posted on this over at NeuroLogica. But of course, as a neurologist, he has a vested interest in spinning the data… oh, wait…

    • Box of Salt

      Is anyone willing to clear up some of the confusion in the comments over there?

      • Squillo

        I tried to comment, but WordPress hates my login (since I deleted my blog, maybe?) and I can’t be fussed to get a new one.

  • Impute

    I’m trying to fact check this posting and having problems.

    First is that a the CDC (http://wonder.cdc.gov/), I can find data on neonatal death rate for low risk white women 2004-2009. Which table and criteria did you did use to find this? I can’t even find a way to specify low risk.

    What I can find is that (in Compressed Mortality, 1999-2009), 2.7/1000 children <1 day old died. 0.9 age 1-6 days, and 0.9 age 7-27 days, for a total of 4.5/1000. This is greater than the 4/1000 neonatal death rate reported in some places (http://data.worldbank.org/indicator/SH.DYN.NMRT)

    Another table (Linked Birth / Infant Death Records, 2003-2006) lets me look at neonatal deaths by location, attending heath care provider, and race, gestation, weight, etc. This gives an interesting look into risks:

    6.65/1000 deaths on average in hospital
    5.5/1000 deaths of white infants in hospital (all the numbers below are also for white infants)
    2.95/1000 not in hospital and attended by a midwife
    23.7/1000 deaths if not in hospital and attended by an MD
    For an average of 7.17/1000 not in hospital

    2.44/1000 in hospital, attended by midwife
    5.81/1000 in hospital, attended by MD

    I tried defining a low risk birth as: vaginal, 39 weeks gestation, 2.5-4.5kg (roughly 5.5-10lbs), and white. This lead to:
    1.31/1000 in hospital, attended by midwife
    1.53/1000 in hospital, attended by MD
    (The out of hospital numbers are too small for the CDC to show them.)

    Humm, I can't find your 0.38 number anywhere. All the CDC data I can find says that a midwife is always safer. Why did you wait so long before you wait so long before you punished this?

    • anion

      You’re looking at the wrong parameters, I believe. Numerous people have re-crunched the numbers, and shown the parameters to search, in the comments here. (I’m not one of them, and math isn’t my best subject, so I’m not listing them/running any numbers.)

    • Squillo

      I ran the numbers for 2005-2009 (MANAStats included November 2004 – December 2009). Here are the parameters I used to try to match as closely as possible the MANAStats:

      In-hospital
      Attended by MD/DO/CNM
      Gestation 37 weeks and up (it’s hard to make this correspond, as MANAStats didn’t give gestation lengths, but only 2.5% of their mothers “showed clinical signs” of preterm birth)
      Singleton and twins (MANAStats didn’t include any higher order multiples)
      Vaginal and c/s
      Death from <1 hour to 28 days of life

      I got an in-hospital neonatal morality rate of 0.84
      Excluding deaths from congenital anomalies, as MANA did for no particular reason, the rate falls to 0.40
      Excluding deaths from congenital anomalies, "special causes" (terrorism), and external causes (vehicle accidents, poisonings), which I suspect were not part of the MANAStats data either, it falls to 0.37

      I did not exclude non-white women, although the MANAStats data overwhelmingly contained white mothers, so "my" data is probably somewhat skewed against hospital birth.

  • hurricanewarningdc

    I wonder if NCB-leaning parents viewing these stats try to convince themselves that “5 babies” is not very much. Like there are millions born each year… so what? (Followed, of course, by the typical, myopic “more babies die in hospitals anyway.”) It may be helpful to do a post (if you haven’t already) on what a “few” babies mean in context… especially if one of those babies is yours and if your baby didn’t have to become a statistic. One simply can’t ignore the numbers even if they sound small or if it appears to be an unlikely outcome.

    • Tim

      Statistics are just numbers until you become one. It’s easy to dismiss them for a lot of people until they find themselves falling into that “not very many” bucket :(

    • Staceyjw

      I am sure some do, if they admit this is correct at all. Most surely believe MANA.

      Its easy to depersonalize risk, and disassociate from it. We do this with most scary things, like car accidents, dog attacks, drowning, airplane crashes, terrorism, etc. We know these kill, and most of us do common sense things to lessen the risk, but we don’t think about it happening to us.

      Unfortunatly, with HB, there aren’t any regulations, and few ways for the low risk mom, that gets prenatal care, to really lower the risk in the USA. The things they need to know are simply unavailable (their MWs stats, if they are actually trained, etc).

      I sure wish they would consider the horror of a HB loss. The dead baby may be the worst part, but much trauma is causes by the events surrounding the death/disability. All you have to do is talk to a loss mom, or read the stories of moms rushing to the hospital with: a breech baby hanging out, an almost dead baby with a mom bleeding to death from abruption, a baby not breathing, an already dead baby they try to revive. The scene surrounding this, and the wait for EMTs or ride to the hospital, is brutal. all of these are real stories,

      If baby survives there is all the time spent in the NICU on life support or on the cooling cap therapy, then having a brain damaged baby, or taking one off life support. Jackie, Vylette Moon’s mom, has an entire set of pics of Vylette on the hundred machines that make up life support.

      Maybe they would feel the pain of mom that has to get pics taken of her perfect baby, her perfect dead baby. The only pics they will ever have. Shahzad Sheik has some beautiful pics, he looks ready to wake up. His mom has a beautiful collection of art based on those few pics, but it cannot replace her son.

      Maybe listening to Wrens dad speaking at his funereal would help? I have heard the eulogy, and it’s a tear jerker. He also posted video of his sweet baby making telltale signs of respiratory distress, that he couldn’t, as a layman, recognize. All because GBS was treated with garlic by an ignorant HB MW, instead of antibiotics.

      Let’s not forget about the babies with preventable HIE that leads to CP, like our little hero Abel Andrews. I am sure his mom Kristine would love for him to be able to walk unassisted, and do all the other things kids do, without years of intense therapy (if at all). She would also love to have the funds to care for him. Alas, the birth center and MW did not have malpractice, so they are stuck without the funds for his care. Even things like a van with a lift are not possible.

      Last, maybe they could stop and visit a mom after she gets the first part of the full reconstructive surgery she needs after some severely negligent care. Seeing the pain she is in, and hearing all that needed done, and still needs done, to her most delicate parts, is enough to make you never have sex again. Hearing how her relationship was challenged, sex life destroyed, and fertility taken, is pretty sad. Thankfully the baby didn’t die too.

      All that to say- these lives MATTER. These are deaths and disabilities that didn’t have to happen.

  • hurricanewarningdc

    Dr. Amy – A suggestion: You might update your “guide for fathers” to include this information. Maybe highlight this dismal statistic about deaths, even for low-risk birth, and then restructure that with bullets to counter some of the key cliches that moms will parrot from the midwives’ salespitch.

    • Meerkat

      I agree. Too many of the fathers are sidelined in this argument.

      • Dr Kitty

        If they’re fathers like the crazy pastor below, could they continue to be sidelined please?

        • OBPI mama

          He is insane.

          I told my husband about this new news and he said, with tears in his eyes, “I don’t want to talk about all this stuff. I should have done something. I should have stepped in and said we need to go to the hospital. I should have….” It’s one of maybe 3 times he’s ever talked of our son’s birth and he just can’t do it. I reminded him that I was crazy and would have been a brat and all that.

          Anyway, It made me think of Dr. Amy’s letter to fathers…

  • Clint Armstrong

    I want to share this, but I can’t verify your citation. I can’t find the quote from “Citizens for Midwifery” anywhere on their site, nor can I find the 2.06 or 1.61 per 1000 numbers. I keep finding 1.30 per 1000 in the study itself.

    • Busbus

      That’s because they (purposely?) avoided stating the TOTAL death rate anywhere in the article. 1.3/1000 is only the intrapartum death rate. You have to add up intrapartum (1.3), early neonatal (0.41) and late neonatal deaths (0.35) to get the total death rate of 2.06/1000.

  • Bob Rogers

    Whilst these data do show a large relative difference in the mortality rates, the absolute risk of home birth is very low and it is therefore reasonable to call it safe, particularly in the case of ultrasound-confirmed uncomplicated pregnancies. An absolute risk of 0.15% for an event that happens only a few times in one’s lifetime is very low (in other words a woman would only expect to have 1 child die if she had over 650 children). Of course the choice between home and hospital birth is a free one for couples to make, so if one was particularly risk averse, a hospital birth seems eminently reasonable.

    • The Bofa on the Sofa

      Whilst these data do show a large relative difference in the mortality rates, the absolute risk of home birth is very low and it is therefore reasonable to call it safe,

      Bob – the absolute risk of drunk driving is much, much less than that of home birth (if you look at a single event, as opposed to annual or lifetime stats; the problem with drunk driving is not the risk, it is the prevalence).

      Do you think it is reasonable to call drunk driving safe? If I were to stop at the bar before I leave for home today, get drunk, and drive 8 miles to my house, would you call that safe?

      Because I will say it again: in terms of ABSOLUTE risk, it is FAR safer than a home birth.

      • bubbasixpack

        It is far safer than any child birth.

        • The Bofa on the Sofa

          In fact, yes it is.

          So do you agree with the conclusion that drunk driving is safe? Because that is what Bob is suggesting.

          • bubbasixpack

            Bob is suggesting a relative safeness. Also, it depends on your definition of drunk driving or impaired driving.

          • The Bofa on the Sofa

            Bob is suggesting a relative safeness.

            No, he’s not. He is SPECIFICALLY NOT suggesting relative safeness. He is specifically referring to absolute risk.

            Jeez, talk about missing the point.

          • Squillo

            And your definition of safe.

      • Mishimoo

        As someone pointed out upthread, paramedics don’t generally deliver babies. They do deal with the aftermath of drunk drivers fairly regularly, so there is that factor to consider as well.

    • LynnetteHafkenIBCLC

      No one’s arguing with that. What bothers most people here is the lying, deception and atrociously inadequate training and accountability of CPMs.

    • Shang Tsung

      “An absolute risk of 0.15% for an event that happens only a few times in one’s lifetime is very low (in other words a woman would only expect to have 1 child die if she had over 650 children).”

      This is the most dishonest and blatantly misleading statement I believe I’ve ever read, holy damn.

      Except, Bob, the entire population of birth giving is not a single woman, it is a population of millions of women a year. You can’t apply population data to an individual, that’s just bizarre thinking.

    • Karen in SC

      Yes, absolute risk is low, but someone’s baby dies. Or someone’s child has Down Syndrome or another rare genetic syndrome. How do you know it won’t be your child?
      Informed consent, truly informed consent, should be required. This blog presents the information that midwives conveniently leave out. Or just say something like “birth is as safe as life gets.”

    • Guest

      Many homebirth midwives eschew any kind of prenatal testing, particularly sonograms. Do you think they should start requiring sonograms to properly assess risk?

      • bubbasixpack

        Yes, forced medical procedures are the hallmark of a free society.

        • Busbus

          This is not about forced medical procedures, this is about holding midwives to a professional standard of care. Homebirth midwives shouldn’t be taking on high risk patients.

          • bubbasixpack

            The ones that we used did not.

          • AlisonCummins

            So you mean the midwives you used refused to take on patients who had not had sonograms and other prenatal tests to cofirm that they were not high-risk?
            How did they know their patients were not high-risk?
            How did they define high-risk?

          • bubbasixpack

            You don’t need a sonogram to evidence high risk.
            Examination
            Weighing the chance of needing medical intervention during birth

          • Guestll

            You don’t need a sonogram to evidence (sic) high risk?

            Pray tell, how does one diagnose placenta previa, fetal anomalies, confirm multiple gestation, abnormal fetal growth, the list goes on and on…please explain how these things are diagnosed in absence of an ultrasound?

          • AlisonCummins

            How do you know down to the day how far along the pregnancy is without an early sonogram?

            Without that information, how do you know when the baby is premature or post dates?

            Or do your midwives not consider prematurity or post dates to be risk factors?

          • Captain Obvious

            Wouldn’t you at least want to rule out a placenta previa?

        • The Bofa on the Sofa

          A free society and true choice requires honest information.

          Which is not what midwives are providing.

          • bubbasixpack

            My experience is different. We spent many hours discussing the pregnancy, child birth, the benefits and risks of home birth. The doctors we saw provided none of this.

          • The Bofa on the Sofa

            Did your MW mention that your baby was 5x more likely to die?

          • bubbasixpack

            It wasn’t. We were low risk, near a hospital and a doctor on duty associated with the midwife was aware of the home birth.

          • AlisonCummins

            Right, according to MANA stats since you were low risk (as defined by your midwife) your baby was only 3.5x as likely to die.
            Did your midwife also tell you that your baby was 18x as likely to have permanent brain damage?

          • bubbasixpack

            Are there any benefits to home birth?

          • LynnetteHafkenIBCLC

            Assuming healthy baby and healthy mother and no desire for anesthesia, it is more comfortable and peaceful, and there is no need to travel or be separated from older children. However, you can’t assume mother and baby will not develop complications, and you can’t know whether you will change your mind on wanting anesthesia if the pain is worse than you thought it would be.

            Given that the benefits are so small and the risks so great, I would never give birth outside of a hospital again. My main regret given that my daughter and I got through birth unscathed is that I willingly gave up the 2 days of having her monitored by medical professionals in the hospital. We saw a pediatrician the next day, but in hospital postpartum care involves being checked by several doctors and nurses around the clock. Newborns are very vulnerable, and having that observation in the 48 to 72 hours after birth is a wonderful thing.

          • bubbasixpack

            Even with our hospital birth, we went home the same day as the birth. The hospital does not need to continuously monitor a healthy baby according to the pediatrician.

          • LynnetteHafkenIBCLC

            I never said she needed to be monitored. But getting that monitoring from highly skilled and experienced people is a benefit of hospital birth. I loved my birth center birth. It was wonderful. But I was very naive and very lucky. I would never take that risk again. Safety trumps comfort.

          • Squillo

            Sure. You’re less likely to have an unnecessary intervention. You’re also less likely to have a necessary one.

          • AlisonCummins

            As far as I know, in terms of outcomes for mother and child there are not. Both mother and baby are more likely to die or have ongoing disability after a home birth than after a hospital birth.

            In terms of having extremely large families, there may be. For starters, if you go UC and have no birth attendants there are savings that add up. Never having a c-section allows a mother to have more pregnancies and not die. A child may die for lack of a c-section but if the family have religious reasons to allow god to direct their reproduction they may feel that the sacrifice was worth it. This seems to have been Liz Paparella’s reasoning, but when Aquila died they rethought things. They realized that they wanted Aquila to live more than they wanted to avoid a c-section. http://hurtbyhomebirth.blogspot.ca/2011/01/aquilas-story.html

            And some people just prefer the whole DIY thing. If they can do something themselves they just prefer to. I really get that. But many people have expressed that they felt very DIY in the hospital. They were being monitored, everyone could see the baby was doing fine, so the staff let them just get on with things on their own. And they did. So the DIY element isn’t strictly about homebirth.
            What are the advantages to homebirth that you are aware of?

          • bubbasixpack

            We never felt more of a family than on that night and it carries through the rest of our lives.

          • Young CC Prof

            Alone with my husband and newborn in a comfortable postpartum hospital room, watching the snow fall outside, we never felt more of a family either. I watched my husband become a father there.

            Due to various risk factors (which I would never have known about without sonograms) if I had given birth at home, there’s a very high probability my son would have been killed or seriously injured.

          • bubbasixpack

            I am glad it worked out for you.

          • Guestll

            I would say this is pretty universal to a happy and healthy birth in general, regardless of location.

          • bubbasixpack

            Well, I don’t. God’s presence was felt but I won’t convince anyone here so bye y’all. Thanks for letting me relive the experiences of the birth of my children.

            I have that joyous feeling.

          • Guestll

            Awesome. Be sure to stick your flounce.

          • Elizabeth A

            Is God somehow magically excluded from hospitals, such that you would not be able to feel God’s presence if you were in one?

          • AlisonCummins

            I don’t get that statement. God only attends homebirths?

          • bubbasixpack

            I didn’t say that. What do you gain by twisting my words?

          • AlisonCummins

            GuestII:
            I would say this is pretty universal to a happy and healthy birth in general, regardless of location.

            bubbasixpack:
            Well, I don’t. God’s presence was felt but I won’t convince anyone here.

            *** *** ***
            What words am I twisting?

          • bubbasixpack

            I said “God’s presence was felt”

            By this statement, you twisted my words to say that I meant “God only attends homebirths?”

          • anion

            She’s just quoted the exact statement(s) that led her to that conclusion. I’m not sure why you are repeatedly failing to understand it, and repeatedly accusing her of “twisting [your] words” when she just took your “Well, I don’t,” at face value.

          • bubbasixpack

            I can now see how my haste in typing the post created this misunderstanding. Believe me it was not intended. I am trying to back out of this discussion but am finding it difficult as people ask for clarifications.

            I do not believe all experiences are the same.

          • OBPI Mama

            God gave me a peace that passes my understanding the minute my OBGYN said I needed a c-section. So much that I cried from amazement. And that peace was felt so deeply… much more so than I felt at my homebirth. that peace is what I remember the most about the day my 2nd son was born, healthy and whole.

          • bubbasixpack

            I am glad we both had that experience.

          • Mishimoo

            I didn’t know that God was banned from hospitals. How does that work, exactly?

          • Stacy21629

            First thing I said after my homebirth-transfer baby was born safely in the hospital was “Thank you Jesus.” So if you can’t feel God’s presence in the hospital, that’s on you.
            Glad you at least admit though that it’s your feelings and experience that mattered more than making sure your baby lived.

          • bubbasixpack

            Asshole. I never said that in fact I said the opposite.

          • AlisonCummins

            Then it’s not at all clear what you meant, because a bunch of us understood that 1) you contradicted GuestII’s statement that that glowy feeling was not dependent on birthplace and 2) you insisted that yes you did feel god even though nobody believes you, implying that you felt something nobody else did and that they can’t understand.

            No matter how I reread your statement I can’t read it as the opposite of 1) that glowy feeling is dependent on birthplace and 2) you felt god and nobody else understands.

            I don’t really care what you meant, but you obviously weren’t clear so there’s no point in calling people assholes. It would be more to the point to learn to express yourself clearly.

          • bubbasixpack

            Well. Why can’t anyone accept the experience that I describe. Could it be that theirs was different? Is your home more comfortable than a hospital?

          • Stacy21629

            Interestingly enough, despite music and a birth pool, when my baby had decels and I was afraid she’d be born blue and needing expert neonatal resuscitation, my living room was suddenly a rather uncomfortable place to be.

          • Stacy21629

            Wow…way to stand up for your faith!

          • bubbasixpack

            My faith cannot eliminate the assholes.

          • Amazed

            It’s good it worked out for your family.

            Should I mention a few names here, from this blog, of women who spent that night making a mad dash for the hospital and ended up with dead or injured children? It would carry through the rest of their lives, too. They were just as low-risk as your wife was (or at least their midwives assured them they were). They were simply unlucky.

            Don’t you think women deserve to know that there is no guarantee which way that first night would turn out for them and that stats show they are more likely to have it the second way with a homebirth than with a hospital birth?

          • The Computer Ate My Nym

            We never felt more like a family than the moment my partner brought my daughter over so I could see her for the first time while a room full of people closed my abdomen after the c-section. But I felt even happier a few minutes earlier when I heard her cry and knew that we weren’t too late with the c-section, that the baby was alive and had an apgar of at least 2. (9/10, as it turned out.) Yet, I can’t help feeling that we’re even more of a family when we take the 10 year old climbing or eat dinner with her or help her with her homework. Babies are great, but kids are even better!

          • bubbasixpack

            I am glad. A family is an amazing thing with all the changes and experiences that happen.

          • Karen in SC

            And hospital families don’t feel that? I can assure you that they DO.

          • The Bofa on the Sofa

            OK, did your MW tell you that your baby was 3x more likely to die?

          • Guestll

            I’ll counter your anecdote with mine — my midwives spent a lot of time discussing pregnancy, childbirth, benefits and risks of homebirth, too. Benefits? All of them were to me, because no benefit accrues to the baby. Risks? Mitigated by the fact that “you live right around the corner from the paramedics.”

            What the paramedics said, when my husband visited them before our daughter was born? We aren’t experts in delivering babies. If something goes wrong, you should really be in a hospital. Total number of babies delivered by the 3 paramedics my husband spoke to that day: 1

          • AlisonCummins

            Did your midwives spend hours discussing things like the risks and benefits of vitamin K shots, hep b vaccinations and strep b testing, letting you conclude that because of your specialness you probably didn’t need any of them?

            Because you’re right, an OB probably would have said “I strongly recommed strep b testing for you and vitamin k supplementation and a hep b vaccine for your baby because we know these things save lives and I want to help you give your baby the best chance possible.” You would have been free to refuse but there would have been less implication that the facts were open for interpretation.

            Honest information is what is needed.

          • AllieFoyle

            I’m sure you and your wife did spend a lot of time thoughtfully considering what to do. The question is not whether you and your wife wanted the best for your child–I’m sure you did and your choices reflected that–it’s whether or not you had complete and accurate information to make those decisions. Your doctors didn’t have the time or inclination to give it to you (and I agree that’s a shame), but did the midwives give you accurate information or just a biased account that was wrapped up in a good-feeling package? Here we see that they are willing to lie about their own statistics, which show that home birth is in fact riskier than hospital birth. How many people will they deceive in this way? Don’t people deserve accurate information, especially about something so important?

          • bubbasixpack

            We don’t rely on any one source. We made an educated decision. I am not a person to be swayed by “good feeling” package. I would expect that home births like we had (planned, informed, low risk, healthy parents, not poor, near a hospital, doctor supported) are as low a risk as a hospital birth and less intrusive.

          • The Bofa on the Sofa

            Why would you expect that?

          • bubbasixpack

            I don’t rely on emotion, I rely on research. In answer to your next question, do your own.

          • Guestll

            Then you would be wrong, and the data bears that out.

            If you’ve made such an educated decision, did you consider the fact that some emergencies require immediate care that cannot be addressed in a timely manner at home?

            With significant change, homebirth in the US could be much safer. But it will never be as safe as hospital birth, even with full integration into a healthcare system. Unless you have an OR in your dining room, of course.

          • AllieFoyle

            But did you understand that by having a home birth you were substantially increasing the chances of your baby dying or being seriously injured? I’m sure you are loving parents and do everything you can to keep your child safe. You certainly wouldn’t intentionally choose to place your child in danger if you could avoid it.

            I think you probably read the same sources that were available to me when I was pregnant–they emphasized the risks of interventions and idealized the natural process, but had very little information about what could go wrong and how unpredictable and dangerous the process can be. People want to do the best they can for their children, but there aren’t many good, unbiased sources of information. The way this study is being presented to the public is the classic case in point. A substantially increased death rate is spun as evidence that home birth is safe and even preferable.

          • bubbasixpack

            I was in law school taking Torts class at the time. I was more aware than most of the risks.

          • AllieFoyle

            Then I would expect you to be especially concerned about a professional organization making misleading public statements about the safety of its practioners.

          • The Bofa on the Sofa

            So did your midwife have malpractice insurance?

            If she did screw up, how were you going to address it? By suing her for everything she has?

            The vast majority of HB midwives do not carry malpractice insurance. As a torts lawyer, that should scare the crap out of you, because there is no recourse in the case of a foul up.

          • bubbasixpack

            Yes, it did.

          • Busbus

            You know what? I had a nice midwive, too. I honestly believe that she cares about her patients, and I think that she is one of the more skilled, responsible and sane CPM midwives out there. She also cooperated with an OB that I did parallel prenatal care with. I know that she is horrified by some of the unprofessional and dangerous things other homebirth midwives do.
            However, the data she showed me (about c-section rates and the like) didn’t even mention death rates or morbidity rates for the babies. We did not ever discuss the details of our emergency plan (beyond, we’ll call 911). There is no way for me to verify her professional credentials (she “apprenticed” with another midwife) or to see her practice record. She does not carry insurance, so in the event of something horrible happening, there would be no way to even get help with possibly life-long medical bills etc. Because of the fact that there is no meaningful educational minimum standard for CPMs, I don’t even know if she can set an IV. I don’t KNOW what she learned. I don’t KNOW how much I could have trusted her in an emergency. That’s the problen with this system – nobody knows that. And even my generally sane, responsible midwife responded to my question about breech birth in a way that made me think that she would have at least considered attending me (at the time, I immediately made it clear that I would go to the hospital if the baby was breech, so we never got to have that conversation – but in any case, she did not say “no”).
            I like my midwife as a person. I would like her more as a midwife had she been prepared to get the necessary medical background education to be a truly safe provider.

          • Bombshellrisa

            Of course, most midwife prenatal visits last an hour. You get to talk about your feelings, your feelings about other people’s feelings about your pregnancy and what to expect. Since doctor’s visits tend to be brief, people actually think that sitting for an hour with a midwife (no matter how untrained and how woo woo their information and stats) is better care

          • Mishimoo

            My appointments were quicker and full of big words, I guess that’s what I get for going with ‘medwives’: good quality, efficient medical care. ;)

          • Melissa

            Did that discussion of risk include the details about how for every 5 babies that die in homebirth, 4 would have lived if they were in the hospital? An hour of talking about risks and benefits of homebirth are useless if those risks are not accurate.

          • bubbasixpack

            I have found that an hour of posting on the internet is also useless.

          • Stacy21629

            “We spent many hours discussing…risks of home birth.”
            No you didn’t. MANA just now released their death statistics so you did not have adequate information available to you to discuss the risks of home birth.

          • bubbasixpack

            Asshole. Don’t call me a liar.

          • anion

            You know, I curse like a sailor in general, but every time you call someone an asshole like that’s a legit rebuttal or like it’s what they deserve, I lose even more respect for you. You’re like a child sobbing, “I hate you!” at parents who won’t let you play hide-the-fork in a toaster.

          • bubbasixpack

            You are so judgemental. I feel sad for you.

          • The Bofa on the Sofa

            Bless your condescending heart!

          • AlisonCummins

            Nobody’s calling you a liar, just mistaken.

          • bubbasixpack

            Yes, they are calling me a liar. I am neither a liar or mistaken.

          • AlisonCummins

            Whatever, hon. What about drunk?

          • bubbasixpack

            No, hon.

          • Captain Obvious

            I believe they are saying, how can you discuss the risks when MANA was withholding the statistics of what those risks might be? And regardless of what the midwives sat down and discussed with you and what you feel the doctors did not, it appears the doctors have better outcomes. Why does it seem that unscrupulous people tend to have to groom the victims into persuasion, like child molesters, salespeople, and midwives, when people have what it takes to make things work don’t have to.

          • bubbasixpack

            Better outcomes. How do you measure outcome, alive or dead. Child birth is much ore complicated than that.

            It is hilarious that you group salesman, child molesters and midwives. What do you do for a living?

          • Amy Tuteur, MD

            Hint: dead is ALWAYS a bad outcome!

          • Guestll

            The flounce is always difficult to stick, but this is an Olympic year, and I have hope…

          • bubbasixpack

            Practice in front of a mirror, I know you can do it.

          • AlisonCummins

            There might be more to it, but that’s where it starts. First, live, non-disabled baby. Once we get that or as close to it as possible, then we can move on to other things.

            Your midwife is just not as good at the live, non-disabled baby thing as your local obstetrics ward is. If she were then we could move on to other discussions. But she’s not.

          • bubbasixpack

            Do you have the statistics on my midwife versus your doctor?

          • Stacy21629

            Outcome measurement. If I end up with an epidural, pitocin, an episiotomy and a C-section and a healthy baby, that’s marvelously better than candles, eating in labor, a birth pool and a brain-dead baby.
            Of course everyone wants a good “experience” but choosing to give birth in a location that dramatically increases your child’s risk of death or brain damage to get it is a poor trade. Comparing “interventions” to dead or brain damaged babies is foolish.

          • The Bofa on the Sofa

            Duck and dodge.

            Remember, YOU claimed that the MW explained all the benefits and risks.

            Risk of death is a risk. She didn’t tell you the real risks of death because she didn’t KNOW the real risks of death.

            No, that doesn’t have to be the ONLY risks, but you can’t deny that death is certainly an adverse outcome. It certainly can’t be considered a good outcome.

          • bubbasixpack

            I knew that there was a greater risk of deat. We lived near a hospital, we knew people who used the midwife, a doctor was at the hospitap who knew my wife was in labor and would handle any problem. I believe that we reduced the risks much closer to hospital birth .

          • Stacy21629

            How long can you hold your breath?

          • bubbasixpack

            Long enough to avoid your stench, I hope

          • Stacy21629

            Obviously the best way to win an argument – profanity and personal insults.

          • bubbasixpack

            I can certainly stoop to your level.

          • Stacy21629

            And yet, I’ve done none of that. Disliking what I say is not equivalent to my using profanity and personal insults.

          • bubbasixpack

            Are you saying that asking me how long I can hold ky breath is not an attempt to insult me?

          • Guestll

            No. She’s asking how long you can hold your breath, because that’s what a baby’s doing in an emergency. And time is brain.

          • bubbasixpack

            Wouldn’t she be more interested in how long the baby could hold its breath. The only baby I knew to have oxygen issues at birth was born in a hospital.

          • Guestll

            She’s asking you because she wants to know how long can do it. So, for how long can you hold your breath? Surely you understand the question and why it’s being asked?

            Your anecdote doesn’t change the fact that a baby born at home in the US is statistically 18x more likely to require cooling therapy.

          • AlisonCummins

            So you’re working on the assumption that all the other people who use midwives are far from the hospital and have no references for their midwife. That your circumstances make you different from the people whose babies died.

            On what basis do you believe that you were different from other homebirthers? I actually think that for many homebirthers, knowing that they are five minutes from the hospital is reassuring and allows them to feel better about choosing to give birth at home. I don’t think you were that different from the general homebirthing population that you could expect the relevant statistics to be different.

            Was the doctor at the hospital your wife’s ob, in possession of all your wife’s test results and a strip?

            What made you that different from the homebirthing families that this pediatrician sees?
            http://www.skepticalob.com/2012/05/pediatric-er-doc-homebirth-5-minutes.html

          • bubbasixpack

            Many rural communities do not have access to the facilities that we did. I do not assume I am a special case, many people managed the risks as we did. The one bar includes this wide variety of experiences.

          • Karen in SC

            Google from Calling to Courtroom, an ebook for midwives about avoiding prosecution and lawsuits, and what to do if you can’t.

            There is definitely grooming by midwives, it’s detailed in that ebook. Some even put it in consent forms as in “I don’t carry malpractice insurance since I believe our relationship will be better than that” or words to that effect.

          • bubbasixpack

            I will read it. But you have to realize that doctors have lawyers and malpractice carriers that spend a lot of time teaching them to avoid and mitigating malpractice claims

          • Captain Obvious

            Well midwives have to lie a lot to sell themselves off as safe as hospital birth and if you ever read Spiritual Midwifery by Ina May Gaskin, she molests women while they are in labor.

          • bubbasixpack

            People are bad. You can find examples in every profession, even lawyers!

            I have no more information to share on this issue. Love you all.

          • anion

            The thing is, however much you thought you were discussing the risks, you couldn’t have been, because all the necessary information was not provided to you. If nobody ever told me that it was dangerous to drink antifreeze, and there was no label to tell me it was unsafe, I couldn’t make a truly educated decision to drink it, could I? It’s not about you being a liar, it’s about evidence and facts being hidden from you.

            You claim to have gone to law school; is this how you argue in court?

          • bubbasixpack

            I claim?

            If I saw people drink lemonade and enjoy it, I could assume that drinking lemonade is safe, couldn’t I? Many more babies have been born without OBGYNs than without if that is analagous to drinking antifreeze.

          • AlisonCummins

            What about seeing people smoking crack and enjoying it?
            Or getting flown up onto mountaintops and snowboarding down?
            Or heading into the gay village and beating up a faggot? If they enjoy it, it must be safe.
            Right?

          • bubbasixpack

            The hate is strong in this one.

          • Guestll

            Why are you here? You said you were leaving. That was several hours ago. Why do you care? You had a homebirth. It worked out for you, your wife, and your baby. Fantastic. You can’t accept the fact that MANA’s own datasets prove that homebirth in the US is more dangerous to the baby than hospital birth, yet you persist in flinging mostly lame rejoinders and getting your dander up when anyone has the temerity to call you on your ignorance. Pro-tip — we don’t care! If you want to listen and learn, stick around, even if you have a dissenting voice, that’s fine — but really, I wonder, again — what is your purpose here?

          • AlisonCummins

            You’re not answering the question.

          • bubbasixpack

            I know crack is bad. Skiing is less risky for a skilled skier with proper precautions and support team. I don’t have my reading glasses so excuse the typos.

          • The Bofa on the Sofa

            Yeah, that’s easier than answering the question.

            They have seen people smoking crack and enjoying it. Should they assume that it is safe?

            Pay attention: THAT IS WHAT YOU HAVE SAID!

            “If you see people drinking lemonade, you can assume it’s safe.” But by that same logic, I should assume drinking and driving is safe.

            That’s great advice from a lawyer.

          • anion

            And many more babies, percentage-wise, have died without OBs than with.

            Also, you completely missed my point. And yes, you claim to have gone to law school. I have no confirmation of that, so I said “you claim” instead of “you went.” You also did not say whether you graduated and passed the bar, so I can’t just say “You claim to be a lawyer,” or “you say you’re a lawyer.” It’s not an insult, it’s being careful and exact with words. If I’d said, “You say you’re a lawyer,” you could have (correctly) come back with “No, I didn’t, I said I was in class at law school when my wife was in labor.”

            If you want to provide proof of your law school attendance/law degree, I will happily stop saying “you claim.” Either way, my question was whether you actually show up in court and use “Asshole,” as a rebuttal, take insult at every argument, misunderstand everything said to you, and then refuse to address the actual point being made.

          • bubbasixpack

            I claim that I am not a litigator. I claim that I have not been insulted, I claim that I understand most of what is said to me and the points that were actually made to me. I have said that through proper planning risks may be managed.

          • anion

            So “Asshole. Don’t call me a liar,” is meant to convey that you’re not insulted? You’re not insulted when you (incorrectly) think you’ve been called a liar? You just call people assholes to indicate your easygoing nature and lack of insult?

            You claim you understand most of what is said to you and the points actually made to you, but your responses tend not to indicate that, frankly.

            Yes, through proper planning risks may be managed, but they’re not going to be eliminated. I’ve seen more than one mother who lost a baby due to a CPM’s inadequate “care,” who believed they were managing the risks, too, and that hey, if there was a problem, the hospital was just a few minutes away so everything would be fine! Except that “few minutes” isn’t just a few minutes, and seconds count in an emergency. Read some of the stories here, seriously. Look at the data above; I’d bet good money that all of those mothers whose lost babies are reported also thought they had the risks managed just fine, and that the hospital was right there in case a problem occurred.

            You know, I’m sure you’re actually a good guy, and I’m sure you’re not a moron. But that makes me wonder why you’re being so deliberately obtuse, and so very rude, here. It makes me wonder why you refuse to apply whatever analytical skills you have to this particular subject, especially in the face of pretty overwhelming evidence.

            I co-slept with my youngest child; we were nursing exclusively, and I read a bunch of feel-good articles about how if you were nursing it was actually much safer to co-sleep. I fully believed that, and felt really good about what I was doing. Then I saw the real statistics, and was and am filled with retroactive horror at the risk we took. However great it turned out for us, and however much I *want* to believe that it was completely safe, it just wasn’t. I have to admit that, because the evidence proves it to be so. I know how it feels to realize I made a decision without having all of the facts, and that that decision could have resulted in tragedy. We’re all lucky that nothing happened, and that my daughter is now a happy, thriving, smart, beautiful nine-year-old. I can even still be glad that we had all that snuggle-time while wishing I’d known the true risks. Admitting that homebirth isn’t as safe as you thought it was isn’t the same as wishing you hadn’t had the experience you had; it’s just realizing that the risk was greater than you knew, and you didn’t know because you weren’t given the facts. You’re not to blame for that. And I’m honestly surprised that you’re not also angry in retrospect for what could have gone wrong because you were misled.

          • bubbasixpack

            I don”t have my reading glasses and this is too long to struggle through.

            I claim I am not insulted .

          • Karen in SC

            Hit Control + a few times and the text will enlarge :)

          • Siri

            Wrong use of word claim. Try state. Or reiterate. Or confirm.

          • Siri

            No, you don’t claim those things; from your point of view, if you know them to be true, you simply state them, or confirm them. Hey, I’m not a native English speaker, and I get this!

          • The Bofa on the Sofa

            When In was in high school, I had a lot of friends who drank and drove home with no problems, and no one got into an accident.

            Can I assume then that drinking and driving is safe?

          • bubbasixpack

            Without any further evidence, it would not be unreasonable to reach that conclusion.

          • The Bofa on the Sofa

            And it would be completely wrong. So much for that assumption.

            Moreover, you HAVE “more information” about HB with midwives now, dumbass, and you are STILL blowholing about how great your midwife is.

            In the end, you are the equivalent of a drunk driver who made it home safely, and therefore insists that it is safe, even after being shown the stats that show how dangerous it is.

            Non-morons will admit that, yeah, we were the lucky ones. Dumbasses stand by their decision.

          • Stacy21629

            “Many more babies”….ah, but that’s the trick with STATISTICS. It’s not the raw absolute numbers that matter – is the percentage or relative risk.

          • Stacy21629

            I am not calling you a liar. I am stating a fact. MANA purposefully withheld information from women, preventing them from making truly informed consent. It was not possible for you (or me when I had my first homebirth) to truly be educated on the risks of homebirth because MANA would not allow us to be.

        • The Computer Ate My Nym

          Who said anything about force? The conversation about ultrasounds usually goes something like this:
          OB: I recommend an ultrasound to assess the fetus.
          Patient: Cool! Can I have a printout to take home?
          If she asks about risks, the OB will discuss risks (if s/he can think up any…I can’t really right now apart from maybe the probe sitting on your bladder and the jelly feeling cold. Oh, I suppose the risk of false positives leading to anxiety/more invasive procedures.)

          If the patient refuses, the OB might ask why and might argue a bit about risks and benefits, but if she continues to refuse, s/he will drop the discussion and honor the patient’s wishes. Where’s the force?

          In contrast, if the patient isn’t offered the procedure, she has no opportunity to consider risks and benefits or decide what she wants to do. Forcing the decision by ignorance, effectively.

          • The Bofa on the Sofa

            Patient: Cool! Can I have a printout to take home?

            We got a digital version on DVD. I have the movies on my iPod.

          • The Computer Ate My Nym

            Ok, so I’m a little out of date. My pregnancy was 10 years ago now…

        • Stacy21629

          Do you feel the same way about mandatory seatbelt and child safety seat laws? I mean, come on! It’s a “free society” – I should not be forced to have to strap my infant into the car. Never mind that it dramatically increases her risk of survival in an unexpected life-threatening event.

          • bubbasixpack

            I have been promting management of risks. How far should we go to protect each other, ban driving?

          • Stacy21629

            False argument. Not even Dr. Amy advocates banning homebirth.
            Better training. Better licensing. Stricter patient selection and screening. OB back-up. Mandatory reporting. Malpractice coverage. Mandatory independent investigation for negative outcomes.
            Which of those do YOU oppose?

          • bubbasixpack

            In general none.

          • Stacy21629

            Do you oppose organizations that oppose those things? ETA: Because in general NONE of those things are standard practice in American homebirth midwifery and MANA has actively campaigned against such safety measures.

          • bubbasixpack

            No. The capabilities of midwives vary greatly. In some areas midwives are untrained and kerely women who have learned through older untrained midwives. Ths is a crime when a negligent crime occurs. The statistics lump the completely untrained midwife and the trained midwife that is associated with a medical practice. My risk is not represented by the oversimplified bar graph shown in this article.

          • Stacy21629

            And yet, that vast difference in capabilities does not exist among CNMs and OBs because they have standard training and expectations of their skill sets. You really mean to say you find no fault with an organization the opposes eliminating that vast difference in care so that the lives of babies and women are improved?

          • bubbasixpack

            You asked if I oppose. They make some valid points. Not all people have access to quality health care. Would certain regulations remove access to the only help poor rural people have? We are fortunate but people are going to jail for pproviding services to the poor.

          • Stacy21629

            Where in this country is there no hospital available? Poor people do have access to quality health care. Hospitals are bound by law to provide maternity services to any woman that shows up in active labor. As the MANA data shows and you admit yourself there are underqualified midwives “providing services” – the poor deserve better than under-qualified care providers.

          • Elizabeth A

            The image of the granny midwife working for the underserved poor is a compelling one, but so far as I can tell, it has no basis in reality. (Do, please, give me the name of one single midwife who is in jail for providing medical services to the poor. And if I google them and find there is nothing more to the story – that they weren’t arrested for negligent homicide, and no poor people were harmed by their services – I will knit you socks.)

            Fact: Women in rural areas, geographically removed from hospitals, are often also geographically removed from midwives. It turns out to be much easier to make a living as a freelancer of any kind (midwife included) if you live in a major population center, among a geographical cluster of patients.

            Fact: CPMs often either will not or cannot be paid by either state or private insurance in the U.S., so their clients are usually women who can afford to pay them out of their own pockets. In other words, they are far more likely to work with the wealthy.

            Fact: People who live in poverty often suffer health consequences as a result, which sometimes lead to potential obstetric complications. This can make them inappropriate candidates for midwifery care.

            The vast majority of midwifery patients are white, well-educated, and well-off. CPMs in the United States are unqualified to change that, and most of them don’t seem interested.

          • bubbasixpack

            Tina Bailey.

          • AlisonCummins

            Negligent homicide. No socks for you!

          • bubbasixpack

            She was arrested and indicted on a murder charge. Just as you requested.

            I will take grey socks, please.

          • Elizabeth A

            I requested the name of someone who *wasn’t* arrested for negligent homicide.

            If you really want socks here, find your darn reading glasses and up your game.

          • bubbasixpack

            I don’t know why I am responding but she wasn’t arrested for negligent homicide, she was arrested for murder.

            Name me one dr. that was arrested for anything related to a death during child birth.

          • theNormalDistribution

            I’m afraid you’re not really grasping the point here.

          • Elizabeth A

            “Arrested for murder” is not the same as “in jail for providing services to the poor.” I’m serious about the socks, but this is not moving me to ask for your foot measurements.

            One doctor arrested for anything related to a death during childbirth – Kermit Gosnell.

          • bubbasixpack

            Brenda Capps

          • Squillo

            Also unlicensed.

          • bubbasixpack

            It will be difficult for me to find someone that was arrested for unlicensed practice of midwfry if they had a license.

          • Squillo

            The point is that you will have a hard time finding a midwife who is being arrested “for providing services to the poor.” Which was your original implication.

          • Box of Salt

            The state of California requires a licence:
            http://www.bakersfieldnow.com/news/health/Kern-Co-woman-accused-of-midwifery-without-a-licence-179735181.html

            This news report also notes she was given a warning prior to getting arrested.

          • Box of Salt

            Another news report
            http://www.turnto23.com/news/local-news/a-local-woman-is-being-charged-for-delivering-babies-without-a-license
            notes why she is unlicensed:
            “she has failed an exam that would give her the proper licensing twice.”

          • anion

            Milos Kilvana, among others.

            http://www.obgmanagement.com/index.php?id=21013&tx_ttnewstt_news=173650&cHash=4ef0798d675bc418eff2d2310487ce1b

            Now you name one midwife whose malpractice resulted in a million-dollar+ payment to the injured family.

          • anion

            Sorry, I should have clarified that by midwife I meant CPM/direct-entry.

          • Stacy21629

            Bubba, you still haven’t answered the original question. You are concerned about midwives being jailed simply for practicing midwifery and serving the poor. Name ONE midwife that is facing prosecution simply for showing up at the birth where there was NO dead baby, brain damaged baby, near dead PPH mother or other complete mismanagement of the labor and delivery. If a midwife is facing prosecution it’s because she completely bungled the thing. NOT because she was just trying to help the poor (by charging them $4000-5000 for her services…).

          • bubbasixpack

            Brenda Capps?

          • Elizabeth A

            I’m poking at Brenda Capps on Google, to see if she fits the stated criteria (1. a midwife who is 2. in jail because she 3. provided services to poor people and 4. for no other reason). The internet is not giving me a lot here – I am seeing nothing dated after the first few months of 2013, when it seemed that she had pled not guilty to all charges, and the CA Medical Board was considered to be dragging their feet about the case. The Birth Freedom Network of California started her an Indiegogo fundraiser, but this page hasn’t been updated since a few days after her arrest.

            My questions at this juncture are:
            1. Is she incarcerated?

            2. Did she provide services to poor people, or were her clients mostly well-off?
            3. Were there truly no issues with her practice besides her lack of a license?

            Appropriate answers to those questions will get you socks.

            Further to these, I would ask you to consider some additional questions:
            4. Is it appropriate for a person who announces that she has no formal training at all to charge money for sitting in on a delivery? If things did not go well, what would she be able to do to help?
            5. Is Capps correct in her contention that the Religious Exemption Clause allows her to legally practice midwifery without a license?
            6. Is charging people for your services in an area in which you have no knowledge ethical behavior?
            7. If you wanted to help women and families during birth, wouldn’t you, logically, want to be well-trained so that you could prevent as much harm as possible?

          • Box of Salt

            Elizabeth A, did you see the BWF post about the twin delivery in 2011? I won’t post the link to avoid spoilers.

          • Elizabeth A

            I have now.

            It was stupid of me to read it, but not half as stupid as many of the things in that story.

          • Box of Salt

            Not quite Bingo – no homeopathy.

          • Elizabeth A

            I feel like it needs a new bingo card. Does the standard one include consulting a psychic, remote labor support from someone else’s therapist in a foreign country, or midwife leaving patient alone for half an hour between deliveries?

            That last makes me want to scream.

          • bubbasixpack

            1. She was incarcerated.
            3. There were no other issues reported.
            2. She advertised a low cost service.

          • Elizabeth A

            There’s at least one link here that suggest a fraudulent insurance claim. The gaps in the reporting, frankly, suggest that she pled out and didn’t spend time in prison.

          • bubbasixpack

            She was booked in jail whick counts as incarcerated to me. I could research it further on lexis but only to get my socks. The least I have ever been paid for legal research.

          • Elizabeth A

            I don’t get real excited about booked – loads of people are arrested every year, and most of them are in for just about long enough to post bond and that’s it. Your claim was that “people are in jail…” so I’d be spotting you kind of a lot there.

            A pair of men’s socks takes me about 12 hours of knitting time. I don’t know how much you’ve been paid for legal research. I bill out at $50 an hour. Hand knitting is not freaking cheap.

          • Box of Salt

            Bummer! Bubbasixpack ran away. I was hoping he’d share what he learned about the Brenda Capps case.

          • Box of Salt

            Two out of 3 of the news reports I found mention the billing fraud. The ABC news plus this one:
            http://www.kerngoldenempire.com/mostpopular/story/Bakersfield-woman-charged-with-delivering-babies/d/story/qfFlBwnVzkq2BK1PYzhSxQ

            I also didn’t find anything more recent than a year old.

          • anion

            Indicted for murder.

          • Squillo

            Tina Bailey was unlicensed.

            Physicians, CNMs and other medical professionals accept heavy regulation and mandatory licensing in exchange for certain privileges, including immunity from prosecution for murder or manslaughter in connection with executing their professional duties (although some egregious cases where there is serious dereliction of the duty of care are prosecuted). Lay midwives don’t want that kind of regulation.

            If there’s no license to revoke, no malpractice liability, no sanctions to be applied, what kind of protection does the public have against incompetent practitioners?

          • bubbasixpack

            I am not going to enter an endless discussion of the optimal level of regulation that a modern society should enact. I was trying to tell a birth story and got baraged people questioning my and my wife’s characters.

            I am now being tested on my google searching capabilities. Maybe tomorrow.

          • Box of Salt

            bubbasixpack “I am now being tested on my google searching capabilities.”

            Silly me. I assumed you knew something about case who you are using as an example before you posted.

          • Box of Salt

            ^the case.

            I’ll never get a job close-captioning: too many typos and non ability to proofread.

          • KarenJJ

            I watch a lot of closed-captioning services and quite frankly you’d be an improvement on many.

          • Squillo

            Sorry. I thought you were arguing that midwives were being sent to jail for providing services to the poor. I wondered if you had any thoughts about how to protect those poor people they served.

          • Siri

            Lovely Rowan Bailey, baby-killer. A shining example of selfless midwives caring for the poor. NOT!!

          • The Bofa on the Sofa

            No, Stacey, the absolute risk of having an injury in a car accident is LOW, so you don’t have to bother.

    • Guest

      “so if one was particularly risk averse, a hospital birth seems eminently reasonable.” <— This message is spot on, thank you. 'If you are 'particularly risk averse' ie. don't want an increased risk of death or permanent disability, do not home birth."

    • AlisonCummins

      Death is not the only possible bad outcome. There’s also permanent brain damage due to oxygen deprivation and brachial plexus injury, among others.

      A newborn is eighteen times as likely to be a candidate for cooling therapy to prevent or reduce brain injury if born at home than if born in the hospital. Using a mashup of statistics from different sources, I calculated that risk as being about 1 in 15 for babies born at home. Mashups are problematic so let’s say I was off by a factor of ten. The risk would be 1 in 150 for a baby born at home and 1 in 2,700 for a baby born in the hospital.

      Yeah, my baby would probably be born alive and healthy at home, but that’s not a lottery ticket I want to buy.

      • The Computer Ate My Nym

        They claim a low rate of low apgars, implying that their rate of hypoxia is low, but given the poor ability of non-CNM midwives to assess apgars, I don’t think the claim is meaningful. And since there is no comprehensive newborn evaluation for home born babies, the rate of hypoxic encephelpathy that results in less than death is unknown.

        • Guest

          I just saw pictures from a homebirth that happened with CPMs last night. The baby was clearly blue minutes after birth, almost purplish (though appears to be perfectly fine now). Apgars: 10/10.

        • Stacy21629

          And it’s rather hard to assess Apgars by candlelight…

      • anne

        I think women needlessly suffering pain is a bad outcome that it’s not really discussed. For some women labor pain is manageable but I have some friends for whom home birth was agonizing and they did it because they believed that it was better for the baby and them somehow.

        This ideology creates needless suffering on so many different levels.

    • moto_librarian

      I love my children, but I did not enjoy being pregnant with either one of them. Pregnancy is a huge investment for the mother. It takes a long time, it often includes lots of discomfort, and it can exact a huge toll on her health. From that aspect alone, why on earth would I do anything to jeopardize the health and safety of my child at the end of that long journey?

      • Meerkat

        You said it so well. My pregnancy was a huge journey, and it changed my whole life, forever. My body will never be the same, and neither will my waf thinking and feeling. I thought and worried about my baby all the time. Then there was a huge physical toll of 10 months of discomfort and sometimes even pain. I decided to stay home with the baby for a couple of years, so my career has suffered. In the end, pregnancy and childbirth was a huge project for me. It took so much love, pain, effort, suffering and sacrifice, I wouldn’t want to take any risk with with my baby, none at all, no matter how tiny it was.
        Let’s not forget everybody else, like my husband and my parents, whose lives would have been shattered forever if something bad happened to me or the baby.

    • The Computer Ate My Nym

      If you want to take that risk, fine, go ahead. It’s not my role to judge your decision. However, MANA’s claim that their data shows no difference between home and hospital birth is immoral and deceptive. Make the decision knowing the risks? Fine. Lie about the risks? Not acceptable.

    • AllieFoyle

      Perhaps the absolute risk is low. Since we are talking about death though, any appreciable change in the numbers reflects actual tragedies that happen to real people. Numbers are easy to dismiss, but people are not.

      Further, is it not irresponsible of MANA to mislead people into believing that home birth doesn’t carry extra risk? It’s one thing to say that there is some extra risk, but it’s small, and another completely to take evidence showing an increased risk and pass it off to vulnerable people as a safety endorsement. It seems completely unethical to me.

    • Captain Obvious

      Then so is driving drunk and not using seat belts for your children.

    • PJ

      I look forward to homebirth advocates laying off their (badly misinformed) handwringing over American maternal and infant mortality rates then. Since a 450% higher risk of death is no big deal and all.

  • Logic

    Millions of years of evolution vs a building filled with the worst diseases and sick people of an area? Doctors that don’t particularly care about their patients desires when it comes to natural childbirth and would rather preform MAJOR surgery so they can make it home on time? Ill trust nature.

    • Gene

      Logically, I should be supporting homebirth. The more birth damaged babies that are born, the more money I get as a Ped: NICU bills, ED visits, physical/occupational/speech therapy, etc. I’d love to know your thoughts (assuming you don’t post and run) on WHY, if a disaster does happen at home, you run to the hospital to see the evil disease ridden doctor who obviously cares more about golf than patients. If we are so awful, why do you even bother coming in? Just continue the natural remedies (that worked so well in the first place)!

      • Dirtpuddle

        Do you also take that attitude with car crash victims?

        • Anj Fabian

          Cars are an unnatural intervention!

        • Gene

          Believe me, there are plenty of people who choose to do stupid and risky things regardless of safety mechnisms. People who work in emergency care have total job security. And I’d much rather send you home to your family than send you to the morgue.

      • bubbasixpack

        Pregnancy and illness are not the same. This is probably the attitude that makes women prefer home birth.

        • moto_librarian

          Yeah, I used to think that too. Until I actually got pregnant. I was miserably ill for the first five months of my second pregnancy, and could barely walk by the end of it due to SPD. I know some women just glide right through their pregnancies, but many of us don’t.

        • Box of Salt

          bubbasixpack “Pregnancy and illness are not the same.”

          You mention your wife in another comment. Unless you’re a lesbian, you’ve never experienced pregnancy. Had you experienced a typical pregnancy, you probably would not be so fond of that silly claim.

          For many women, the symptoms of pregnancy are in fact symptoms of illness – the only difference is the cause is the fetus.

          • bubbasixpack

            Why don’t they just cut the fetus out to cure the mother if a fetus is the cause of the illness. The body responds to pregnancy is many ways, it is suggested, to protect the baby. My wife was threw up almost daily during the first trimester. It was horrible.

          • Box of Salt

            bubbasixpack, please have some sympathy and respect for your wife who threw up almost daily in order to reproduce with your and just stop staying “it’s not an illness.”

            Your wife knows it does a very good imitation.

            As for your first sentence: why take this to the absurd? It accomplishes nothing.

          • Box of Salt

            oops. Extra “r” in first paragraph. The second “your” should be “you”

          • bubbasixpack

            I have respect from my wife. She says that pregnancy is not an illness.

            Sometimes being blunt is required to make a point.

          • Box of Salt

            OK, bubbasixpack “Sometimes being blunt is required to make a point,” I’ll be blunt. I don’t think you actually have a point to make.

            In one comment you claim you were in law school taking torts class, and in another, your wife gave birth 22 years ago after you had 12-hour shift at the plant.

            I think you’re here arguing for the sake of arguing.

          • bubbasixpack

            I worked as an engineer for a dozen years then went to law school. My daughter was born when I was an engineer and my son was born at home while in law school. I graduated at 40. There is no inconsistency, there is no sake of argument, I had a most beautiful experience.

          • AlisonCummins

            They sometimes do. For instance, the only cure for pre-eclampsia is delivery.

          • Dr Kitty

            Did you know that some women suffer such sevr hyperemesis that they choose to end their pregnancies before it kills them?

            If you’ve got a PICC line for parenteral feeding, are on IV steroids and anti emetics and you’re STILL vomiting to the point of dehydration and oesophageal tears…I bet “pregnancy isn’t an illness” would cause serious rage.

          • bubbasixpack

            Is pregnancy an illness? Or can it possibly lead to an illness? No one in their right mind would say pregnancy is not an illness to an extremely ill pregnant woman.

          • bubbasixpack

            My wife had an IV to manage dehydration in our home, she tested her urine to determine her level of dehydration everyday. Please assume some level of intelligence and not just another snarky internet poster. I am not cavalier about health.

        • AllieFoyle

          Well, it’s certainly a popular meme. LIke most complicated subjects though, the relationship between pregnancy and illness is not adequately captured by catchy one-liners.

          • bubbasixpack

            I don’t know anything about popular memes.

            I agree, but perspective matters on complicated subjects.

          • AllieFoyle

            Perspectives should be informed. If the decision about medical care for a baby’s birth is based solely upon “pregnancy is not an illness” then perhaps it’s time to look further into the relationship between pregnancy, childbirth, and associated medical illnesses and complications.

          • bubbasixpack

            I didn’t say any decision was “based solely” on any one factor.

            I have to flounce now.

          • AllieFoyle

            No, I’m sure was a combination of:

            “pregnancy is not an illness”
            “avoid interventions!”
            “mean doctors, in a hurry”
            “natural, healthy, blah, blah, blah”
            “too many c-sections”
            “major surgery!”
            “gentle, natural vs. cold, sterile”
            “caring midwives”


            and, of course,

            “home birth is safe”

            No one can make a truly informed decision on the basis of half-truths and misinformation.

          • bubbasixpack

            Are you attributing these statements to me?

          • anion

            I think it’s fairly clear that she is not.

          • bubbasixpack

            It seems she is.

          • bubbasixpack

            “your responses seem consistent with those attitudes”

            I consider that attribution, maybe you don’t.

          • AllieFoyle

            I’m suggesting that they’re all of a piece with “pregnancy is not an illness.” There’s a predictable list of catch phrases that people toss out, and your responses seem consistent with those attitudes.

            They’re bandied about endlessly and seem to be pretty effective as propaganda, but they’re all incomplete and can be effectively countered with just a little more depth of information.

          • bubbasixpack

            They are not any piece of pregnancy is not an illness. It is not in illness at home, it is not an illness in the hospital, it is not an illness on a train, in a plane, in a box, with a fox.

            People should have their babies wear they want (if possible) properly considering, among other things, the safety of the baby and their reasons for doing so do not need to be effectively countered.

          • AllieFoyle

            Sure they are. They’re all catchy and intuitive and sound convincing, but they’re meaningless when you start to look and think a little harder.

            People should have the right to have their babies where they prefer, but their choices should be based upon the truth. It’s unethical to tell pregnant women and their families falsehoods about the safety of home birth.

            As far as pregnancy not being an illness, I think you could argue that even a healthy, uneventful pregnancy shares many of the important elements of illness (pain, discomfort, unusual physical demands on the body, impaired or lack of function, danger to continued health and life), and that distinguishing them completely isn’t possible.

            There are textbooks full of documented medical illnesses that are directly related to pregnancy or childbirth. Pregnancy can unfortunately be physically hazardous. It introduces new demands on the body and can exacerbate pre-existing problems. You’d have to be willfully ignorant to ignore the reality of pregnancy-related hypertension, cardiomyopathy, preeclampsia, RH disease, cholestasis, hyperemesis gravidarum, diabetes, ectopic pregnancy, fetal anomaly, hemorrhage, asphyxia, jaundice, birth injury, infection…etc.

          • Mishimoo

            Give me ‘cold, sterile’ over Puerperal fever any day!

        • Meerkat

          My very typical pregnancy felt like an illness very often. Extreme fatigue, nausea, heartburn, sciatica, back and foot pain, shortness of breath in the third trimester, physical discomfort, insomnia, ligament pain, foot swelling.

          • bubbasixpack

            Thank you for saying ‘felt like an illness.’

          • Meerkat

            Honestly, I often wished my doctor would treat it as an illness and somehow make me feel better. I suffer from chronic migraines, and when I get them I just take my meds and relax, knowing that they will go away in a few hours. When I was pregnant I often felt trapped because I couldn’t escape or forget my condition. My body was no longer my own. I don’t care for the
            whole “pregnancy is not an illness” argument. It’s irrelevant. To me it was an illness, because it made my body feel miserable.

          • Meerkat

            You misunderstood me. I felt sick and uncomfortable during most of my pregnancy. I really wish pregnancy would be considered an illness, so women could get some time off work to recuperate. To me pregnancy and illness were the same—I felt crappy during both.

        • The Bofa on the Sofa

          Pregnancy is a medical condition that increases risk of mortality or morbidity.

          • bubbasixpack

            So is digestion, I guess.

      • OBPI Mama

        Thank you for your work! My homebirthed son was injured at birth. At first we saw a “natural” doctor who missed a lot with him as a whole child (we saw Children’s specialists and therapists for his specific OBPI). Then we switched to a wonderful ped. … who realized our son was missing a lot of dev. milestones, was causing injury to himself (sensory issues), not chewing properly… She got us the help he needed and was so quick about it all.. calling lots of places, putting in way more hours than she billed.

        Your work changes lives… thank you.

    • Anj Fabian

      Nature is content to discard as many millions of lives as is necessary to improve any species.

    • Trixie

      My eyesight is so terrible that I’d be dead for sure by now if I were a hunter-gatherer. Should I let nature take its course and avoid optometrists who are only out to make a profit by selling me corrective lenses?

      • bubbasixpack

        Yes, please.

    • Johan Berggren

      Nature. Which before modern medicine killed at least 20% of the children before they reached adulthood. If you don’t like unnatural tools I guess that you give birth without a bed in some meadow somewhere.

    • anion

      Nonsense. The vast majority doctors care very much about the wishes of their patients, and will do everything possible to honor those wishes. The vast majority of doctors would rather avoid performing surgery if possible, and “making it home on time” isn’t something that happens for them, either.

      • bubbasixpack

        It doesn’t matter about the vast majority only the one that is stressing out the mother during labor.

        • Amazed

          Yeah. Funny how we have too many non-stressed mothers who now have all hours, days, weeks, months, years, and decades of their lives to remember the few non-stressing hours of blissful labour paid with their children’s lives. Everything comes at a price..

        • anion

          It does matter when you have someone spouting ridiculous canards about how OBs don’t care what their patients want and just want to “perform MAJOR surgery so they can make it home on time,” and is essentially saying that’s all you’ll find in a hospital.

        • Box of Salt

          bubbasixpack, maybe you should find out more about other people’s experiences with hospital labors under the care of OBs before you continue generalizing your own.

          Or are you just claiming your experience is the most important one?

          • bubbasixpack

            I have.

            I am not claiming anything.

    • Squillo

      Hint: those diseases and sick people are also a result of millions of years of evolution.

    • Young CC Prof

      Ah. The last resort of the naturalist movement. “The statistics don’t support me, so I’ll just use vague philosophical arguments instead.”

      • bubbasixpack

        I see nothing vague about logic’s statement. S/he has weighed the risks and benefits and decided to have her child by a method that s/he thinks is better overall.

    • Julia

      Yawn. If it wasn’t for one of these buildings filled with diseases and sick people and a doctor who may or may not have cared I would have died of appendicitis at age 17. I’ll take modern medicine over letting nature take its course any day.

      • The Bofa on the Sofa

        My great-grandfather, in fact, died from a burst appendix when he was 35 years old.

        • Julia

          It’s shocking how quickly we forget what life without modern medicine was like…

        • DaisyGrrl

          Huh, so did my great-grandmother (age unknown). I had mine removed by laparoscopy and was only in the hospital overnight. How times change!

      • The Computer Ate My Nym

        a doctor who may or may not have cared

        You’re arguably better off with a doctor who doesn’t care all that deeply and sees you as appendectomy #16 for today. If your surgeon looks at you and yawns, she not only knows what to do, she likely knows what to do if you turn out to be the EXCITING case of the day where things go wrong. Just as long as she doesn’t forget to give you the PCA for when you wake up.

        • Young CC Prof

          Indeed. I never want to be the most interesting patient of the day, I want to be routine and simple.

    • http://shameonbetterbirth.wordpress.com/ Shameon Betterbirth

      I don’t think you understand evolution very well if you are citing it as something to put your trust in during birth. Evolution is in essence weeding out less adaptive traits via death (or lack of breeding). Do you want to gamble that you might not have adequately adaptive physiology to have a vaginal birth and survive (or for the baby to survive)? That’s your choice. Nature is cruel and indifferent to your well being. Don’t think that the progress that humanity has made as a species came about without cost- the toll was enormous.

    • The Computer Ate My Nym

      Homo sapiens aren’t millions of years old. H sap evolved a few hundred thousand years ago. Though perhaps you meant millions of years of evolution of placental mammals.

      However, many years evolution has had, it’s not done the best job. Women and babies die in pregnancy and childbirth pretty frequently in the absence of buildings full of diseases. The death rate in pregnancy for rural Afghanistan, which is effectively a natural childbirth only zone, is about 1 in 6. Giving birth in a pretty room with a jacuzzi and soft lights is nice, but it doesn’t mean much when you don’t have a baby at the end of it.

    • Elizabeth A

      Yeah, I actually take the other side of that trade.

      Millions of years of evolution did nothing to prevent my placenta previa, and if I’d had that as little as 70 years ago, it probably would have killed us both. Not to mention what Rh incompatibility would have done to the little girl who bled into my system on and off starting in early pregnancy.

      The building full of the worst diseases and sick people had a team of doctors who had drilled the heck out of a routine that saved our lives. They had no particular interest in us as individuals, but did seem to care passionately about providing high quality patient care.

      The doctors and nurses at my son’s birth (vaginal, prolonged) all stayed past shift change to see me through.

      • The Computer Ate My Nym

        Not to mention what Rh incompatibilit

        I do not understand how Rh negative people (and I’m one of them) survive. RhoGam is, as you said, a very recent innovation, evolutionarily, and without it, women might lose all their children (except the first–and first births are dangerous anyway) to Rh incompatibility. I’m pretty sure that’s why two of my great aunts have no surviving children: they both carried for shorter and shorter periods of time before eventually giving up on trying…

        Anyway, there must be some evolutionary advantage to being Rh neg or maybe to having Rh+/-, but I don’t know what it is…

        Sorry: off topic.

        • Elizabeth A

          There doesn’t actually have to be any advantage to being Rh-. This is one of the few things about evolution and genetics that I understand. Genes for recessive traits are extremely difficult to weed out of a population. Many people with the gene won’t have the trait expressed, so they’ll pass the gene on, and the trait will persist even if it’s disadvantageous.

        • The Bofa on the Sofa

          Anyway, there must be some evolutionary advantage to being Rh neg or maybe to having Rh+/-, but I don’t know what it is…

          I like to think it has something to do with our relationship with rhesus monkeys. Maybe something about flinging poo.

        • Ainsley Nicholson

          There are a few studies suggesting that being Rh+/- may offer some protection against the negative effects of chronic toxoplasmodium infection…(thank you Wikipedia!)

    • auntbea

      You really shouldn’t trust nature. Nature is responsible for killing almost 100% of insects, fish and invertebrates before they even hatch (ever wonder how it is that fish lay so many eggs and yet our oceans are not a solid mass of exponentially expanding fish populations?). Left to her own devices, Nature would also kill up to half of human babies and a quarter of their mothers.

  • Elisabeth Holm

    “According to the CDC Wonder database, the neonatal death rate for low risk white women at term from the years 2004-2009 is 0.38/1000.”
    It seems this article refers to “low risk white women at term” when the notion “hospital birth” is used. Is it possible that other factors than the home birth itself (e.g. socioeconomic factors like income, education, housing facilities, health insurance, etc) affect these numbers?

    If I had understood things correctly, a hospital birth in US isn’t something everyone can afford. Am I wrong?

    • Captain Obvious

      Public aid assures every baby the right to prenatal care and hospital delivery.

    • anion

      Any public hospital in the US cannot turn away a person in need of medical care, and any public hospital will make payment arrangements after the fact, so being able to afford the birth isn’t really such an issue–especially as there are public health policies and organizations which will help with that or provide low-cost care. (I’m not saying it’s absolutely not an issue, just that it’s not out of reach for the vast majority of people in general.)

      And honestly, if they can’t afford a hospital birth, chances are they can’t afford a homebirth midwife–who are generally not cheap, who will not generally make payment arrangements (or rather, will not make the same type hospitals make, payable after the fact and in small monthly increments for years; midwife payment arrangements tend to be along the lines of “Half the fee at the first appointment, and the other half a month or two later”), and who will not deliver a baby without having been paid in full prior to onset of labor (I don’t have a statistic, but it seems most midwives have this particular payment policy, and payment is non-refundable).

      • Random

        @anion
        My wife and I are interviewing midwives who demand none of the financial arrangements you describe. It is incorrect to say “it seems most midwives have this particular payment policy,” when most midwives do not. Their profit motive is much different from that of hospitals. And of the many things the Mindy Project teaches us, midwives just care more :)

        • Trixie

          That’s interesting. Could you share a typical payment arrangement? Are they CPMs?

        • anion

          *shrug* Every midwife whose website I’ve looked at has had a “must be paid in advance” policy; that’s about as scientific a sampling as yours. And there’s nothing incorrect about saying something seems to be the case; I didn’t say it was an absolute truth with every midwife, I said “seems” to be the case with “most.” What part of the country are you in, and what seems to be the typical payment structure there?

          I’d agree, at least in large part, that the profit motives of midwives differ from those of hospitals. Midwives are looking to make income for themselves and that income depends directly on how many babies they deliver (regardless of the health outcomes of those babies and mothers), whereas hospitals, among other numerous other things, must cover the costs of treatment for those who can’t afford it upfront.

        • Karen in SC

          There are some good blog posts on choosing a midwife at “Safer Midwifery for Michigan” and “What Ifs & Fears Welcome.” You can search on those and find information on eduation, what a good midwife should bring, etc.
          PS. You get your birth information from the Mindy Project? Did you see the episodes of Grey’s Anatomy where the mothers’ refusal of interventions cost one baby brain function and another an emergency c-section. (two separate episodes). And of course, the unforgettable Love’s Labors Lost (ER) when the ER doctor Mark Greene tried to deliver a baby and got in over his head since he wasn’t an OB. Come on, dude. If you are going with television research, include all the shows!

          • DaisyGrrl

            I saw that ER episode as a teenager and it was one of those shows that stuck with me for months. It cemented in my mind that birth is not always safe and that just being in a hospital won’t guarantee good outcomes without the knowledge and skill of specialist professionals.

        • Shang Tsung

          Fuck you. “Midwives just care more.” Fuck you. Thank you for shitting on all of my years of experience, the long nights that I’ve stayed up restless and crying over the fact that I’ve lost a patient who was too far gone by the time they got to me. The time I spend with my patients, the ways I get to know them, the blood, sweat, tears, and not to mention mountains of debt that I’ve accrued over the years just to do this calling, this horrible calling that overworks me, underpays me, and leaves me with more stress and a shorter lifespan is all turned into some nebulous evil doctor woo woo that completely disregards me (and not to mention my patients who you seem to view as bleating sheep) as a professional and as a human being.

          I’d love to be kind and polite and let you know that you’re making an ignorant, hateful comment grounded in bullshit in the nicest possible way, but I’m just sick and tired of people like you so fuck off.

          • bubbasixpack

            Your true nature is revealed.

          • The Bofa on the Sofa

            Yeah, it’s easier to whine about that than to point out how she is wrong.

          • bubbasixpack

            Whose whining? Shang Tsung is. over worked (who controls that), under paid, mountains of debt (focus on money). There is not one statement that shows she cares. We had a midwife at the house and midwife in the hospital. Started at a doctor who had Shang’s attitude, then switched to teh beautiful midwife birth. In the hospital, the midwife ran interference with the doctor that wanted to speed things up. What’s your point?

          • The Bofa on the Sofa

            That you cannot address her point about how much she cares for her patients.

            Your MW “ran interference”? Why? Do you have the first friggin clue as to why maybe the doctor “wanted to speed things up”?

            Maybe your doctor cared so much about your wife and baby that he/she didn’t want to take the chance of something bad happening? Meanwhile, your wife doesn’t give a fuck about whether the baby is healthy, and just tries to protect the precious experience.

            Yeah, it’s pretty disgusting. Even more disgusting is that you confuse that shit for “caring”

          • bubbasixpack

            You are a complete and total asshole. Judging my wife, judging her intent (she did it for our baby, not herself), judging a situation that you were not involved in nor have any similar experience.

          • AlisonCummins

            If she did it for the baby then she and the ob were on the same side. No need for anyone to run interference.

          • Amazed

            Emily comes to mind. Remember Emily who was foaming at the mouth at being offered an induction at 37 weeks and prided herself so for not caving in while in all probability she was starving her kid without knowing it?

          • The Bofa on the Sofa

            Who says I don’t have a “similar experience”? Although I admit, I have not watched the “Mindy Project”

            YOU are the one who claimed that midwives obviously care more than OBs. An OB describes what she does, and all you can do is complain about her tone.

            You tell me, genius. Why did the doctor try to speed up your wife’s labor? Come on, show us how smart you are.

          • bubbasixpack

            What the hell? I never said all midwives care more than all OBs. I shared my experience. An OB that started with telling a person Fuck you. I don’t know the Mindy Project either.

            The doctor wanted to speed things up merely because of the time that had lapse between admittance to the hospital and birth. I am a genius but this is not evidence of that.

          • anion

            Your grammar, language usage, and spelling aren’t evidence of that, either.

          • The Bofa on the Sofa

            Do you think we are as incapable of reading as you?

            And of the many things the Mindy Project teaches us, midwives just care more

            BTW, something doesn’t make sense. If your MW was so great, then what were you doing in a hospital with an OB?

            Was it that your wife’s labor/delivery got too risky for a MW to handle and so you needed a doctor? And if that is the case, that it was beyond the scope of a MW and you needed a doctor, why in the blazes would you be ok with the MW interfering with the OB?

            That doesn’t make any sense.

          • bubbasixpack

            You are not quoting my post.

            It is simple, South Carolina laws required it.

            Does that make sense?

          • The Bofa on the Sofa

            South Carolina laws require what?

          • Box of Salt

            bubbasixpack ” I never said all midwives care more than all OBs”

            You weighed in after Random–who at this time has just the one comment–who claimed it.

            What is your point? My reading of your comments is a general “OBs are bad but my wife’s midwife was good.” Please correct me if I’m wrong.

          • The Bofa on the Sofa

            Yes, the doctor wanted to “speed things up” because it was taking too long. That is pretty much tautology. Thanks, genius.

            Now, why do you think the dr thought it was taking too long?

          • bubbasixpack

            Asshole, the birth did not take too long. It was right on time.

            He was bored.

          • The Bofa on the Sofa

            Yeah, and I’m the asshole.

          • bubbasixpack

            I knew we would find common ground.

          • anion

            Really? The doctor was “bored,” so decided to speed up your wife’s labor? How many patients were in this maternity ward?

            If you remember, how long had you been in the hospital at that point? How much time had elapsed since your wife’s water broke?

          • bubbasixpack

            It was twenty two years ago, I worked a twelve hour shift at the plant, came home with my wife starting labor, we began timing contractions, at 10:30 I called the midwife to say that the contractions were four minutes apart. She said stay home. At about 2 AM the contractions were about three minutes apart and she said to meet her at the hospital. We arrived about 3-3:30 and my daughter was born at 10:36 AM. I forget the timing of the water breaking. I don’t know how many patients were in the maternity ward.

            So what is your conclusion?

          • moto_librarian

            Right, she did it for your baby because she truly believed that home birth was safer than hospital birth. IT’S NOT. You fell for a line of propaganda with no factual evidence behind it.

          • Meerkat

            Thank you. Thank you for spending years and years studying, struggling, working night shifts, and dealing with sick people. I don’t know how doctors survive internship. I wouldn’t do it even if I were offered millions. So thank you! I hope you make a ton of money, because you deserve every penny. Respect? You already have it. We, the sheeple, respect you.

          • Houston Mom

            Another sheeple who wants to say thank you.

          • Dr Kitty

            BTDT.
            The lying awake at night worrying about patients, replaying mistakes over and over, calling patients just to see how they are, working hours and hours of unpaid overtime, sleepless nights,100 hours weeks, mountains of university debt, almost no social life for years on end AND ALL OF IT BEING DISMISSED BY THE ALT-MED CRUNCHY WOO PEOPLE.

            Shang Tsung- you keep doing what you’re doing and know that in the end your balance sheet of good done on earth will show a worthwhile life.

            And theirs… probably not so much.

          • Mishimoo

            Thank you! A doctor like you saved my life by insisting my mother had a caeserean. He worried all night, talked my parents into having one, and when he opened her up, he promptly discovered that there had been a placental abruption + my head was so stuck that I had a halo-mark around it for the first 3 months. Once I’d been delivered, he reportedly said “I have never seen a live baby come out of that much blood.”

            Of course, NCBers managed to convince my parents that it was an ‘unnecessary’ intervention. Luckily, VBAC wasn’t a thing when my siblings were born, because android pelvis + large babies is not a good combination.

        • Amazed

          Here we have the typical homebirth mentality again: me and my wife, we’re soooo important that what matters most is everyone to love us (even if we pay them to love us).

          I marvel at this way of thinking. Don’t you folks have people who love and care about you? Why on earth would someone need “caring” the way you describe from their caregiver?

          I don’t need my doctor to be my friend. I already have friends. I want to be case number 1999987 with certain symptoms in his career, so he can see the problem half-asleep instead of having someone crowing over my bravery. Paid caring is no adequate substitute for competence.

          • bubbasixpack

            Is this sarcasm?

          • Box of Salt

            bubbasixpack, I’m going to repeat Amazed’s main point for you so you can figure it out:

            “Paid caring is no adequate substitute for competence.”

          • bubbasixpack

            We paid for child birth, not caring. Amazed’s condescending attitude can be ignored.

          • Amazed

            Actually, since many, many homebirthers crow all over the “caring” they get and midwives actually use it as a selling point, Amazed’s condescending attitude cannot be ignored.

            As to your specific circumstances, your ignorance of what statistics show and how low-risk and high-risk are defined shows that you paid for having your ego stroked, not being adequately informed.

          • bubbasixpack

            No one stroked my ego. We started at a OB and were well informed. Care is a benefit.

            I can ignore your condescending attitude.

          • Amazed

            You started with an OB? Who told you that you didn’t need a sonogram and what else to define that you were actually low-risk? He just handed you off to the midwife?

            Wow.

            If you were not told about the risks and were instead drawn into long discussions about homebirth that left you feeling educated, fulfilled and so special but were not sent to tests and ultrasounds to make sure you were truly low-risk, then yes, the midwife was just stroking your ego, no matter whether you realized it or not.

        • The Bofa on the Sofa

          What in the blazes is the “Mindy Project”?

          • Box of Salt

            Bofa, You’ve just failed pop culture for the current decade. It’s a TV show on Fox:
            http://www.fox.com/the-mindy-project/

          • The Bofa on the Sofa

            You’ve just failed pop culture for the current decade.

            The concept does not compute.

          • Box of Salt

            Bofa, I did find it ironic that you of all people didn’t know (although I will confess I’ve never watched the show; I read about it in a dr’s office waiting room magazine).

          • The Bofa on the Sofa

            There is nothing pop culture about Fox other than Family Guy and old Simpsons.

            I mean, you could just as well be referencing Herman’s Head or Greg the Bunny.

        • Busbus

          I had two homebirths and had paid both midwife’s fees in full, out of pocket, before the babies were born. When I was in the US, my insurance did not cover maternity, and I paid all my prenatal care (I had parallel care from an OB) out of pocket as well. However, with my low income, I was eligible for emergency coverage for pregnant women via medicaid, which would have paid for a hospital delivery in full. Had I been a US citizen, I would have been eligible for full medicaid coverage, which would have paid for prenatal care and delivery at a hospital, or, if I had a little more income, would have given me insurance with a small co-pay. I believe that, thankfully, there are programs like that for low income pregnant women in most US states (the coverage usually ends after the baby is born). Even in my case – without full medicaid coverage – a hospital birth would have cost me about 3000 dollar less than I ended up paying for my midwife, homebirth supplies etc. For us, it wasn’t easy to come up with the money; for someone who is really tight, it would be impossible. Hence the middle class clientele for homebirth midwives.

        • Box of Salt

          Random “Their profit motive is much different from that of hospitals.”

          Particularly since non-profit hospitals in the US outnmuber the for-profit ones: http://www.aha.org/research/rc/stat-studies/fast-facts.shtml

      • EmbraceYourInnerCrone

        Bingo! My Sister in law found out she was pregnant a few weeks after losing her job, her husband had just lost his job. She received Medicaid benefits due to being pregnant and she and her husband ended up not having to pay anything. She had a closely managed, high risk pregnancy, pre-e/HELLP syndrome and gave birth prematurely. Happily her daughter is now a healthy, successful 20 year old. Unhappily my SIL passed away due to stroke at 42, probably due to a familial history of high blood pressure, stroke and heart attack…

        I do realize that for the people in the US that fall in the middle(working but not at a job with any health benifits, make too much to qualify for Medicaid) things may be difficult.

  • anion

    Is anyone else curious about what the rate of reporting was–or if/how it changed–from the beginning of the study to the end?

    In other words, did MANA start discouraging reporting after they saw how bad the numbers were in 2006? And perhaps the reason for the delay in releasing the numbers was to wait for plenty of “good” reports to cancel out the bad? I wonder if private words were said to members, to encourage reporting only of positive numbers.

    I’m not saying it absolutely happened, only that I really wonder.

  • Gene

    FYI, you’ve made the front page of Reddit. Predictibly, the top comments are name calling, calling you “Dr” Amy, and have no idea how to understand statistics. It’s sad. (This is Gene, BTW).

  • Burt Wonderstone

    The Midwives Alliance of North America had better identify those 20/1000
    woman who should be at the hospital, if they want to stay viable for all those
    woman who obviously hate hospital births

    • Elisabeth Holm

      I might sound stupid now, but are there no midwives in the American hospitals?

      Living in Norway, and having an uncomplicated pregnancy, I was able to have what I believe “midwifery birth” at a separate part of the hospital – with the possibility to be moved across the hallway if something should happen that required doctors.

      With my oldest son, I had some camplications during the pregnancy, so the hospital decided I had to deliver my baby at the more “hospitalish” part of the hospital. Even there, I was mainly cared for by midwives, who would call the doctors if needed.

      • Elisabeth Holm

        * Living in Norway, and having an uncomplicated pregnancy, I have beem able to have what I believe resembles your “midwifery birth” (…)

      • Anj Fabian

        There are Certified Nurse Midwives caring for patients in hospitals. I could link you to multiple practices in our metro area.

        MANA represents mostly the lay midwives who have no hospital privileges.

      • Trixie

        The problem is that the CPM credential that we are discussing here is a self-created, alternate “midwife” credential that does not have the education and training that midwives do in all other first-world countries. Our equivalent to your midwives would be a CNM.

      • Karen in SC

        Norway’s system is very different. Prenatal care does not even begin until the second semester. A friend with a history of low progesterone (with 1 miscarriage and 1 progesterone supported birth) become pregnant while living in Norway and could not get to see an OB or even a midwife to get a prescription for the hormone. She miscarried again. Upon her next pregnancy, she immediately flew to the States and saw her US OB. Happily she is now near term and having obtained private insurance will be delivered by an OB there.

      • The Bofa on the Sofa

        I might sound stupid now, but are there no midwives in the American hospitals?

        There are two types of midwives in the US. The Certified Nurse Midwife, who is a nurse with advanced training in midwifery, and is what you would think of from your experience. There are CNMs in the US, and most of them work in hospitals, along side OBs.

        Then there are Certified Professional Midwives (CPMs), who have who knows what for credentials, and, it was not until recently, that they even had to have a high school diploma. Not surprisingly, hlegitimate healthcare providers won’t let these folks anywhere near them or hospitals, since they are whoafully unprepared in much of anything. The only thing they CAN do is homebirths, but then again, that’s pretty much why they invented the stupid thing.

        See, legitimate providers, like OBs and CNMs are generally unwilling to do homebirths, because they recognize that the are extremely risky, and thus a bad idea. Therefore, the obvious solution is to create an inadequate certification to do them instead.

        I’ve likened it before to the situation where a licensed electrician tells you that he can’t do what you want because it violates numerous safety codes, mainly because it creates a dangerous safety hazard, so instead you call your brother-in-law to do it because you know he has a great stereo setup and thus knows something about wiring.

      • http://www.antigonos.blogspot.com/ Antigonos CNM

        America has nothing remotely comparable to the “socialist” countries of Western Europe. It is all private; overwhelmingly OB-led, and there is no control over education, licensure, or permitted protocols for “midwives” [ranging from zero knowledge and capability to holders of Masters' Degrees] on a national basis.

        Having worked in the UK and Israel, I know where you are coming from, and I know how hard it is to believe that an advanced country like the US can be so primitive in this regard.

  • Steve

    Am I missing something? This is far from an object article. It seems to be written by someone with a financial interest in getting rid of home birth. The conclusions seem to be drawn long before any data is discussed. It looks like the data is twisted as well. Why should I take this article seriously?

    • Jane Lucas

      Am I missing something? This comment doesn’t seem to raise any substantial criticisms of the post. Why don’t you set out how the data is twisted? Otherwise why should we take your comment seriously?

    • Anj Fabian

      Did you have a specific question we could answer for you?

    • Trixie

      Dr. Amy is retired. Even if you thought there was a financial benefit for a practicing OB, which there isn’t, she’s not practicing. MANA, on the other hand, has a financial interest in promoting home birth.

    • Stacy21629

      Financial interest? You do realize that Amy is no longer practicing OB/GYN and has not done so for years. On the other hand, we have an organization of midwives assuring us that midwifery care is safe. Who exactly has the financial interest here?

    • Stacy21629

      Also, you should take the article seriously because it concerns the lives of babies. The stakes are high enough to warrant close consideration, even if you think the tone is harsh or otherwise disagree with Dr. Amy. She has never claimed to be “objective” – no more so than MANA has. Both have a view they are promoting. If you want objectivity, hold MANA, midwives and the entire NCB movement to the same standard.

    • Squillo

      Amy personally has no financial interest in getting rid of homebirths, as she no longer delivers babies. Homebirths don’t impact OBs practices in any significant way; the loss of <1 patient per year isn't even going to register.

      Homebirth and related services are the only source of income for a a non-nurse midwife. A very busy homebirth midwife will deliver 4 clients per month.

      Tell us again who has the greater financial incentive to skew the data?

  • Jane Lucas

    In MANA’s “fact sheet” they state that national data is not available for comparing intrapartum death rates. A little disengenuous. http://www.mana.org/pdfs/DOR-Outcomes-Paper-Fact-Sheet-on-Risk.pdf

    • MrG

      MANA’s data show an intrapartum deaths rate of 1.3/1,000 that would be 1 in 769 births! Any hospital with that intrapartum death rate would be immediately shut down

      • Karen in SC

        That fact would make a good meme, with a “source: MANA database” printed prominently at the bottom.

  • LMS1953

    Another question/comment. What percentage of homebirthers get an ultrasound during their pregnancy? A transvaginal USG at 7 to 9 weeks helps immensely to assure the EDC, especially when issues of post maturity or prematurity arise. Do they get fetal anatomical surveys at 20 weeks to check for congenital anomalies and placenta previa? Do DEMs have the “privilege” to order these? Can a woman just walk in to a hospital and ask for a USG or in to a lab to get a prenatal panel, QUAD screen, etc. Will their health insurance cover it without an order from a physician or higher level nurse provider?

    • Anj Fabian

      You forgot BPPs and NSTs starting at 39 weeks or if conditions indicate the need for closer monitoring.

      Those tests can detect problems that could threaten the life or health of the baby. What you don’t know can hurt your baby. Ignorance isn’t bliss, it’s just ignorance.

    • Stacy21629

      I didn’t have an early US, but I pretty much knew to the day when I conceived. My midwife (CNM) pretty much insisted on the 20 week US (held at the local independent birth center). We also did the glucose test and GBS screening. But she’s a CNM and I WANTED all of these things. I even asked for a heplock in labor and her response was “Well I’m certainly not going to talk you out of more interventions.” I definitely do not think that most CPMs require these things, however.

    • OBPI Mama

      My old midwife (and many others I know) tell us that ultrasounds are dangerous. That they can cause tumors and other damage. I did not have one with my first son. Another couple I know didn’t have one and their daughter was born at home with organs outside her body… on route to the hospital via ambulance their daughter died… and still the midwife promotes the evil of ultrasound…

      • Stacy21629

        This view (anti-US) was briefly mentioned/promoted in the Bradley classes I took with baby #1.

      • http://www.antigonos.blogspot.com/ Antigonos CNM

        Well, this old midwife categorically states that there are NO dangers associated with ultrasounds, except possibly that you and your HCP might get some knowledge about the state of the baby and your uterus et al.

        Years ago someone suggested that babies moved more during ultrasounds, and with no evidence whatsoever, assumed it was from “radiation” [there isn't any radiation in ultrasound] from the sensor being moved across the abdomen. Well, try massaging your tummy gently and see whether Jr. responds by increasing fetal movements — it is perfectly natural.

        • Young CC Prof

          I had to have about half a dozen ultrasounds in my 3rd trimester. Baby Prof would kick the wand every time. (Well, if you were asleep in bed, and someone started poking YOU, you’d probably kick back, wouldn’t you.)

        • OBPI Mama

          Maybe I should start saying “ex-midwife”. haha. I had ultrasounds with my other 3 children. With the last, we even used it to find out the gender!!! The horrors!

      • Dr Kitty

        I’m so sorry for that poor baby and couple.
        USS may not have saved her life, but it would have given her parents knowledge and options, including the option of high intervention birth and immediate surgery.

        • Young CC Prof

          Ultrasound did that for my cousin with the heart-defect baby! She delivered in a university hospital with a top pediatric heart surgery program. He was on oxygen in a specialist’s hands the moment he was born and had his first surgery a few days later.

          He’s eleven months old now, and yesterday she posted a video of him on Facebook, sitting in his high chair and laughing and laughing.

          • The Bofa on the Sofa

            Had he been a homebirth, he would have been one of those “congenital defect” deaths that would have not been counted.

      • Amazed

        Sounds terrible. Poor baby, poor parents.

        How can information be a bad thing?

  • LMS1953

    As I understand the MANA numbers, they only include 20% to 30% of all homebirths. Reporting is only mandatory in Vermont and Oregon, IIRC. Those two states have a relatively high acceptance of the woo and unicorn sprinkles – even with the medical community which is on free retainer by EMTALA to provide 24/7 coverage with no a priori input or knowledge of what is going on. The demographics of those two states is about 90% Caucasian. The point is the lack of reporting requirements most likely skew the numbers to make it appear homebirth is “safer” than it actually is. A couple of years ago, Vermont passed a law mandating that state Medicaid and private insurance pay DEMs for homebirth services. Obviously, these stats were NOT available when they passed that law. I doubt they would have the integrity to repeal it now to protect the lives of baby Vermonters.

  • FirstTimeMama

    So, I’ve read through most of these comments and all of these numbers that are being thrown about don’t really mean much to me. Here is what I know. I live in Austin, Tx where there is a very large midwifery community. My husband and I chose to have a home birth after some not so pleasant visits with obstetricians around the city. I am sure there are some nice ones out there and I was even treated for hyperemisis gravidarum by one that my midwife referred me to because she is not able to obtain a license to be able to prescribe medications to her clients. My midwife gave me complete prenatal care and was by my side along with her partnering midwife and her apprentice for the entire 33 hour labor. My water never broke but she let me make the decisions and my daughter was eventually born in the water sack which burst open once her head was out and my daughter has been perfectly healthy and has been now for 10 months. My midwife also gave me 6 weeks of full post partum support including a doula for 2 weeks and a lactation consultant in my home for the first day after my daughter’s birth.

    My family is not “privileged” as someone commented. We are actually considered lower middle class. We paid for midwifery serves out of pocket. We did not use insurance or government programs or whatever else may be available. And we are not the only ones. In fact my midwife has a number of mamas that she suggests get together and share experiences and show support. She has created a community for women and their families that teaches health and wellness as well as communication and early childhood parenting and coping skills. She has been a midwife for about 7 years now and has had births that needed emergency attention. She was very upfront with us about having a plan B available just in case but also respected our wishes for a drug free and private home birth.

    My husband and I also did a lot of research on home birthing including researching Ina May Gaskin’s midwifery career as she is one of the most beloved midwives in the country. Please do look her up. My mother was very concerned when I told her I was giving birth at home. Like a lot of people she thought that home birth is riskier than hospital birth. I believe that not to be true. From personal experience and hearing the stories of many mothers in my city who have done either or in some cases both hospital birth and home birth it seems to me that the majority, if not all, said they preferred the home birth. That they felt safer, calmer and that they were able to be in control under supervision.

    For anyone reading and not sure what to make of the information I say go with your gut. Do the research and make an intelligent decision based on how you feel about what you’ve found. Like birth and parenthood, if you have any doubts then you’re probably not doing what you really want to do.

    • Stacy21629

      Oh we’ve heard of Ina May. She’s the one that let her own premature baby die rather than seek medical care for it, right? Or do I have her confused? She likes to massage laboring women’s “buttons” too, if I recall correctly.
      Oh yea, “go with your gut” and “do the research” are not compatible.

      • FirstTimeMama

        So you’re one of those literal people then? I don’t believe everything I read. I take all of the information and then make a decision based on my thoughts about the research. My gut feeling. Why so hostile?

        • Stacy21629

          Because I’m a scientist. I try to practice evidence based medicine. I’ll go with my guy about Ina though – I wouldn’t let someone that denied their child life-saving care around my baby so she could molest me during labor. How’s THAT for a gut-feeling?
          I’m hostile to a movement that wants to claim that OBs ignore evidence…and then tries to tell women to “trust their gut”. Amy just posted a couple days ago about a woman who was so proud of “trusting her intuition” to find a great midwife to deliver her vba2c. Her baby is dead and buried. How’s THAT for a gut-feeling? Rather than trusting science and data that could have all but predicted that outcome, she went with her feelings and now she has a dead baby. Emotions can and often are wrong.

          • FirstTimeMama

            So, you’ve proven my point. You would go with your gut and not have a midwife take care of your pregnancy. Good for you. To each his own.

          • Anj Fabian

            I did have a ‘midwife’ take care of my pregnancy. A real midwife, CNM, part of a practice of both CNMs and OBs, fully integrated into the hospital care system.

            Not some CPM who has zero OB back up, next to no oversight, no malpractice insurance, no relationship with the hospital and in general, no one to help out if and when she needs it. Or more importantly, when her clients need that help.

            Screw the experience, I want the best outcome there is.

          • Mishimoo

            “Screw the experience, I want the best outcome there is.”
            100% this. I had hospital-based CNM care too and when my blood panels came back, I had 2 CNMs and 2 Ob/Gyns call me at home to make sure that I’d had a proper follow-up about my iron + B12 levels, and that I had received the correct advice. I’d rather be frustrated by repeating conversations in order to stay safe than not hearing back and having a negative outcome.

          • C T

            I was nearly sure that I was having a baby boy this time after four little girls. The morning sickness was so different from the other times, and I found myself oddly drawn to baby boys. I just had the 20-week anatomy ultrasound on Tuesday, and here comes baby girl #5.
            Mamas’ gut feelings can simply be wrong.

          • FirstTimeMama

            Also, I’m sorry that mother lost her child. That is horrible.

          • anion

            There’s another story, from November, where the mother had meconium running down her leg and was begging to go to the hospital; the midwife kept refusing to allow it. The baby girl died. That’s only one of many where midwives refused to listen to laboring mothers and completely ignored serious signs of fetal distress.

            Those mothers trusted those midwives.

        • T.

          It is not hostility. It is called truth or reality. And it is how it is, it doesn’t care much about feeling.
          I may think it is nasty, but alas.
          I am not a scientist. I do however have a background in statistic, and some in confirmation bias. Do not believe in anything you read if only useful if you know how to chose your source. Say, not believing in large, well made studies about how the piramids had been made in favour of “the aliens did it” is not smart.
          Most births go well. But birth is not safe, inherently so. Not for the mother and twice not for the baby. I have known many people who have driven drunk and nobody never got hurt.
          I’ll go with my gut feeling and I’ll drive drunk.

          • FirstTimeMama

            You are comparing apples and oranges. Are you a parent? Have you been pregnant? If so, good for you! All I am saying is I went with my true feelings after doing 2 years of research before getting pregnant and for me everything pointed to home birth as the safest, calmest and most fulfilling way to bring my child into this world. To each his own.

          • Stacy21629

            Your research pointed to homebirth being the safest…because MANA released their results yesterday, rather than in 2006 when they started collecting it. You didn’t have very valuable information available to you because they purposefully withheld it. That is a travesty.

          • FirstTimeMama

            Yes, that is a travesty. Women should know all sides of the story. Having already had a successful home birth I will likely have another when the time comes. I will also plan on going to the hospital in case of emergency as I had planned with my first. I still hope that women researching birthing possibilities will look at all sides objectively and decide for themselves what they feel comfortable doing.

          • Guestll

            How long can your baby hold its breath? 5 minutes? 10? A half hour?

            Just wondering if you understand that some emergencies don’t respect the “I’ll go to the hospital if the shit hits the fan” timeline.

          • Trixie

            Does your midwife have hospital privileges?

          • OBPI Mama

            I hope you realize that even being minutes from the hospital doesn’t mean you would come home with a live baby. Or a baby who’s not severely brain-damaged. Time is of the essence and it’s hard to see those you love realize this from first hand experience, just a little too late for their babies.

          • Amazed

            Why, then, are you here? By all your posts, it looks like you’re here to stop women from taking this post into account… pointing them at Ina May instead.

            Why are you trying to stop mothers from taking those numbers into account?

          • OBPI Mama

            I studied midwifery for 4 years and went to training to be an assistant… did my research (which turned out to be very slanted) and had a homebirth. My son turned out to be a severe shoulder dystocia,(surprise! there are emergencies that midwives don’t predict!!!) almost died, and suffers a severe brachial plexus injury while I ripped end to end and broke my tailbone… Safest, calmest, most fulfilling, my arse. I can’t say “to each his own” when real numbers aren’t being told because I would give my left foot to have this stop happening to other babies!!! I’ve seen other injuries, I seen other deaths from homebirth… and it’s heart-wrenching and life changing… We were lied to.

          • T.

            I am not comparing apple with orange. It is exactly the same thought process you had.
            I also don’t understand how my status as a parent is important in the discussion. We are discussing science and statistic. I don’t have scientific qualification, but I do have an adequate background to evaluate statistic claims. This is a lot more relevant in this discussion.
            I have a news for you: having carried and birthed a child does not make you a doctor or a scientist (as other people who are both in this community will attest). Nor it makes you magically able to make a difference between legitimate and illegitimate sources of information.

          • Amazed

            Then you are not a very good researcher. But I do believe you were a “researcher” instead, reading only materials that supported the “safety” of homebirths.

            You are entitled to claim that for you, homebirth was the calmest and most fulfilling way to bring your child into the world. You are not entitled to say that it was the safest because it was not. Safety is not a product of how one feels. It’s an objective measure.

            Your gut was wrong. Homebirth was and is a more unsafe way to bring one’s child into the world. Now even MANA admits it, although they try to pretend they aren’t.

            Please stop advocating “your gut” as the best judge of anything and trying covertly to diminish the meaning of this new data by innocently pretending that you only want women to have choices and make the best decision for them. What you seem to want is to discourage them from taking the real information into account and instead repeat your choice.

        • Trixie

          Ina May let her own baby die rather than seek medical help for it. That is a fact, it’s not disputed by anyone.

        • OBPI Mama

          I’ve met Ina May, I studied under her once… she is the one that is hostile. And a little crazy.

        • anion

          So when Ina May specifically says that she “massages” the mother’s “button” during labor, and “plays with” the mother’s “tits,” that’s not to be taken literally?

    • Young CC Prof

      90% of babies are born without special problems. The other 10% are why we have obstetricians. The tricky part is, we can measure risk factors, but no one knows for sure who’s going to have problems until it’s all over.

      You got lucky, and I’m glad you and your child are OK. If your friends keep home birthing, soon enough one of them will be unlucky.

      • FirstTimeMama

        Sure, the more home births the more risk…but isn’t it the more births the more risk instead? I have no problem with modern medicine or hospital births. I don’t feel like I got “lucky” with my birthing experience either. The hostility and perhaps “one-sidedness” of this article bothers me. If I was trying to decide whether to have a hospital versus a home birth I would probably just set this article to the side because it doesn’t have enough information in it. From what I’ve researched this just doesn’t make sense. If you think you can make sense of it for me I’m listening. My midwife is a CNM and she is absolutely wonderful at her job. It makes me wonder what areas the midwives who are “not educated/trained properly” are in. Is there a correlation to poor training and region? One of my friends had a birthing center labor and nearly bled out after the birth. She’s older and had preeclampsia so she was being observed very closely. What stopped the bleeding was her midwife gave her a chunk of the placenta and told her the eat it. Would a doctor have done that? I’m legitimately curious.

        • Guestll

          No, a doctor wouldn’t have done that, because it isn’t the standard of care as there is no evidence that it works.

          If your midwife told you at the onset of labour that your baby had a 1 in 769 chance of dying during his/her homebirth, what would your feelings on where to give birth tell you? That is not Dr. Amy slicing and dicing the numbers, that is the data as reported by MANA.

          • FirstTimeMama

            If it were me then I would tell my midwife that I would like plan B. Point taken. However, given the care I received I didn’t have to go to the hospital and my daughter and I are very healthy. I’m not saying the data is wrong. I’m trying to understand everything that went into this outcome. What are all of the variables and why were they chosen versus others and I believe someone pointed out that the majority of women in the data are white. Why is that? How does that effect the outcome? I don’t believe there is enough information here for an objective answer. It’s not just Dr. Amy. It’s MANA too.

          • Trixie

            There are things that happen during labor that can kill your baby very quickly. Most all of them can be avoided by skilled providers trained appropriately (not CPMs), continuous monitoring, and the quick availability of c-sections. All out of hospital birth is always going to result in more dead babies than in hospital birth simply for the lack of immediate access to an operating room, but home birth with a CNM tends to only be about twice as risky, whereas, thanks to these numbers from MANA, we know that using a CPM makes it at least 4.5 times riskier. Because they don’t have the training to recognize problems or deal with them appropriately.

          • Houston Mom

            Over 90%of the homebirth women in MANA’s data were white. White women make up the vast majority of women who homebirth.

          • Squillo

            I believe someone pointed out that the majority of women in the data are white. Why is that? How does that effect the outcome?

            According to MANA, only 2.1% of their dataset was black women.

            For the same period in the hospital, 16% of mothers were black.

            The mortality rate for babies born to black mothers is in the vicinity of double that for all races combined.

            So it skews the data heavily in favor of homebirth.

        • Stacy21629

          Your friend’s midwife could have given her a CC of cat urine SQ and the bleeding would have stopped. That’s about as medically useful as eating your placenta. She got lucky and had enough uterine contraction and good enough clotting cascade to not hemorrhage to death. There is no evidence whatsoever that eating your placenta helps in the face of PPH.

          • FirstTimeMama

            The birthing center was in a hospital with an obstetrician available to step in. I was told that the dr was informed of the situation though I don’t know how involved the dr got. I don’t know what to tell you. I will say that I encapsulated my placenta and took it for post partum depression and it seemed to work for me. Again, I don’t know what to tell you.

          • Guestll

            I ate McDonalds hot fudge sundaes with extra sauce and no nuts, and that seemed to work for me. Don’t know what to tell you.

            Listen, snark aside, why don’t you stick around and read? A lot of us who post here were once homebirthers, and/or deeply in to the natural-childbirth-is-best mindset. Read and learn the facts and draw your own conclusions.

          • Stacy21629

            Tell me you have data in a peer-reviewed publication that eating your placenta has any effect whatsoever. I’ve had 2 babies and no PPD. Placentas in the trash.

          • Macsen Rutledge

            waste of good chile fixins!

          • Trixie

            Out of curiosity, how much did you pay to have this done?

          • OBPI Mama

            I paid $140 to have mine encapsulated because a friend gave me a discount. She no longer encapsulated placenta when I had my 3rd son and I got a quote from someone from Placenta Benefits and she asked for $386!!! No way. And by the way, it did not help me increase my milk supply. It wasn’t magic.

          • The Bofa on the Sofa

            I’m in the wrong business….

          • OBPI Mama

            I just trusted her. There really isn’t a way to tell, other than she told me i had a huge placenta (and it was heart-shaped… insert smiley face again) and that all my capsules would’t fit in the jar she uses, so she gave me a baggie with it that had the overflow. She did take it right after my c-section from a shocked nurse and went straight to her home…

            I think if you are “professional” about it, the encapsulist has to come to your house to dehydrate it and all that. I don’t think they are technically allowed to do it in their home. Maybe for risk of mix up…

            Now I’m a little freaked out I might have ingested someone else’s placenta!

        • Stacy21629

          The article is “hostile” because it is regarding an organization (MANA) that has purposefully withheld its stats on death rates at home birth. This organization has actively campaigned against increasing the education and licensing requirements for homebirth midwives. They claim to care about women but actively take steps to deny them the information they need to have truly informed consent and work to make them less safe by not demanding that homebirth midwives be adequately educated. We should be hostile to an organization like that because it leads to dead and brain damaged babies.
          If you want to do your “research” in an echo chamber of niceties in which no one presents an opinion with which you disagree, fine. But that’s not “research”. It’s self-selected ignorance. Dr. Amy is abrasive because BABIES ARE DYING. That fact tends to get folks a little riled up. The fact that so many people want to parachute in here and ignore that is very troubling.

          • FirstTimeMama

            I’m just trying to have a conversation and not get upset. I want to know what you think but you won’t even consider my side. I would rather not be shot up with pitocin and then have an epideral needled into my spine or have a dr cut out my child because they think that 12 hours of labor is long enough. My research showed that not allowing the child to come out naturally could lead to breathing problems because the lungs are not able to expel the fluid within them if they are cut out of their mother. It showed that though there isn’t much research yet err might be a link to pitocin injection and autism. It showed that having an epideral denies the body the release of oxytocin which makes it harder for the mother and child to bond, the mother to produce milk and the mother to heal faster. It showed that hospitals have a limit on how long a mother is allowed to labor and if the mother goes past that time there is a very great possibility that the mother will be rushed to the OR for a c-section. It showed that mothers are not allowed to eat while laboring just in case they have to be rushed to the OR. It showed that a mother could not give birth in any position that felt comfortable because the doctors need to be able to see everything, even if that position doesn’t work for the mother and causes severe tearing. It showed that mothers have to tell the nurses before hand that they want to keep their child with them after birth so they can try nursing immediately and if they don’t their children would be taken immediately to the nursery without the mother’s say so. It showed that the baby would be completely cleaned after birth instead of letting their skin absorb that white stuff that actually helps protect their skin. Unfortunately I can’t remember the name of it because it’s 3am and the only reason I’m arguing on the internet is because my daughter is teething and is waking up every couple of hours anyway.

          • Macsen Rutledge

            if hospitals didn’t suck at childbirth this wouldn’t even have to be a discussion. it’s all fine to blame midwives, but people are fleeing the hospitals for a reason.

          • Stacy21629

            Define “suck at childbirth”. If you mean, they don’t wave incense, sit and knit, hum, hold your hand, and spoon feed you icecream in your birthpool, then yes – They “suck” in terms of a touchy-feely maternal experience. I guess I just happen to define “suck at childbirth” as “burying my baby rather than bringing it home”. Hospitals do rather well in terms of the live baby thing. So I guess it depends on your definition. People are fleeing hospitals because they want an EXPERIENCE, not because of safety stats. Selecting an under-qualified lay person to deliver your baby because she’ll
            let you light candles and eat during labor is a really poor reason to have a homebirth. But frankly, it does seem to be the most prevalent one.

          • Mishimoo

            My hospital allowed real candles, even scented ones. I wasn’t particularly interested in having them, but the option was there.

          • Trixie

            Who would downvote that lol

          • Mishimoo

            Someone that genuinely believes that hospitals are the most evil places on Earth. (I somehow feel that should be trademarked)

          • SarahSD

            Exactly. Childbirth sucks, it has a great capacity for doling out suck, but this depends on your perspective. Childbirth sucks a lot more as a result of babies dying than as a result of a lack of atmosphere or idealized experience. As has been pointed out so many times here, it takes an immense amount of privilege and whitewashing of human history and biology to get to the place where you think atmosphere or idealized is the main priority. What got us to this place where we so rarely see death in childbirth that we can walk around with the mistaken assumption that childbirth is safe? Modern medicine! Dun dun dun.

          • OBPI Mama

            Hmmm… funny how when I had a homebirth with my midwife, she permanently damaged my son. But when I had 3 babies in a hospital afteward, they were born healthy and whole. Who “sucks at childbirth”?

          • The Bofa on the Sofa

            What is the basis for your claim that “hospitals suck at childbirth”? I know that “patient satisfaction surveys” put the rate of satisfaction for mothers in hospitals at about 90%.

            So far and away, mothers are satisfied with hospital care. It’s only a small number who aren’t. Then again, there are a small number of people who think the moon landings are faked, so it’s hard to say exactly what that means.

            But it doesn’t matter. Hospitals do listen to patient concerns, and are willing to do things that are reasonable in response. As a result, we have seen significant changes in what hospitals offer in terms of childbirth.

            The thing they WON’T do, however, is compromise safety.

          • SarahSD

            I used to believe this. Now I think it’s childbirth that sucks, and is such an intense experience that its perception can be easily distorted. Hear me out.

            NCB leads people to believe that “natural childbirth” is #1. a better, more pleasant, more holistic, spiritual, less medicalized experience, and #2. Better for the mother and the baby. # 2 has been shown to be false if you define “better” objectively, ie, living, healthy babies and mothers. # 1 is still important – it’s important for mothers to not be overly traumatized by birth. The heart of the problem is that NCB rhetoric misleads parents into thinking that somehow, #1 has a causal relationship to #2. That is, that if you have the “right” kind of labor experience, then you won’t have labor complications or bad outcomes. This is not true, and is totally unfair to mothers who have complications or whose babies die to imply that it is somehow their fault for not thinking positively or being calm enough.

            If you come to the hospital believing that every intervention is going to undermine your labor (false), and that medical professional are not looking out for you and your babies’ best interests (also false), you are fairly likely to have a shitty time because the normal, preventative-medicine-based standard of care contradicts the idea that “trusting birth” is enough to produce good outcomes. Add to that a crap-ton of unfathomable pain and fear for yourself and your baby, and it makes sense that women who believe in natural birth are having negative experiences in the hospital. This happened to me with my CNM-led hospital birth – I thought that pitocin was evil and nearly always unnecessary, and so viewed the CNM who ordered it as standing in the way of me getting my natural birth. Now I think it was a combination of being misinformed about what intervention are for, why they are used, and what they can and can’t do, and the immensely intense experience of labor that led me to perceive the hospital and interventions as the enemy (and also to be a kind of jerk patient).

            There are absolutely things that hospitals could do better to honor women’s autonomy and personhood while overseeing the process of labor; and of course, there are crappy doctors and hospitals with not-awesome practices. But I have come to believe that in the vast majority of cases, the reason people are running from the hospital is that NCB has taught them to under false pretenses.

          • Stacy21629

            You see, I HAVE considered your side. I was completely immersed in NCB culture and woo-ism when I had my son at home. Then I did REAL research – outside of the NCB movement. The fact is that NONE of the “connections” you reference have been validated – which you acknowledge by saying “there isn’t much research” and “might be a link” over and over. There is no validated scientific reserach to link C-sections to allergies, asthma, autism or any of the other NCB boogie-men out there. An epidural cannot block the release of oxytocin as oxytocin is required for uterine contractions and you wouldn’t be getting an epidural if you weren’t in labor alreadying having uterine contractions and the delivery of the baby itself results in oxytocin release. The time “limit” (not set in stone FYI) is there as a guideline because negative outcomes (i.e. dead babies, PPH) increase the longer the mother is in labor. Hospitals do not wisk babies away without the mother’s say-so. This isn’t 1970. I had a homebirth transfer with my second child – the OB let my midwife catch the baby, immediate skin-to-skin, delayed cord clamping, baby never left the room, and I even got pit (after they asked my permission!) for some moderate bleeding and still managed to breastfeed and bond with my baby.
            Folks in the NCB movement tout “research” but none of it is actually validated or reproduced in any peer-reviewed publication. Then these myths are repeated over and over and over and over until they seem like “truth”. I know. I used to believe them too. But they simply are not true.

          • anion

            God, I WISH hospitals automatically “whisked” the baby away to a nursery. I believed that nonsense, so didn’t even ask about it at the hospital where my first was born. Turned out they had no nursery; rooming-in was forced upon me despite my tearfully begging the nurses to please just take my baby for an hour or two so I could sleep.

            When it came time for my second, I chose a different hospital. It made all the difference, especially as I had a slightly more difficult recovery from my c-section. (My baby ended up there for about seven hours the day she was born, and the nurses came to ask if they could give her a bottle; I said yes, and it impacted our breastfeeding not one bit. I nursed her for seventeen months.) Thanks to those fantastic nurses I managed to rest when I needed to, and the whole experience was great. With my first I begged to leave the hospital, because if I wasn’t going to get an iota of help from the nurses what was the point of staying there? With my second I wanted to stay an extra day simply because it was so wonderful.

            Nurseries are becoming more and more rare in hospitals, despite what the NCB movement tells you, and I think women should fight to keep nurseries as an option. I ended up with PPD after my first and I put a lot of the blame on that no-nursery policy, which made the whole experience tremendously stressful and difficult for me. I left the hospital having gotten about eight hours of sleep over three nights. It was awful.

          • theadequatemother

            When people who have “done their research” come here to tell us about modern obstetrical care it’s nicely illustrative that the amount and type of information available is, well, absolute crap.

            Almost nothing in your above comment is actually true. I’m sorry you were misled to such a degree by an industry that wishes to profit from your ignorance.

          • moto_librarian

            You are wrong. All that your “research” demonstrate4s is that you have fallen for NCB dogma hook, line, and sinker. No one is going to make you have an epidural in the hospital. Pitocin is a life-saver if you’re bleeding out. And WTF is the big deal about eating during labor? I have never been hungry during active labor, and most of the women that I know have been nauseated and/or vomiting, not hungry.

        • jimmy

          “but isn’t it the more births the more risk instead?”

          No. Risk figures are always given as ratios or percents. In this case, 0.4 out of 1000 (hospital) compared to 2 out of 1000 (home).

          What the figures in the article show is that if 1000 women went to the hospital for delivery, and 1000 had their births at home, there would be 5 times as many deaths involving the home deliveries as compared to the hospital deliveries. FIVE times as many.

          Please read my comment elsewhere about my friend that also had an “amazing” doula and midwife. My friend had to pull the plug on her own baby, and this absolutely would not have happened if she had had standard care.

          • FirstTimeMama

            So very sad. Sorry for her loss. I am done talking to you and Stacey. Goodnight.

        • realityycheque

          “What stopped the bleeding was her midwife gave her a chunk of the placenta and told her the eat it. Would a doctor have done that?”

          No, and for good reason. As far as I understand, the claim is that the (allegedly) high levels of oxytocin in the placenta cause the bleeding to stop, however oxytocin is a peptide hormone – like insulin – and cannot be administered orally, as it is unable to survive the enzymes in the digestive system.

          ETA: Beyond that, even if oxytocin were able to be administered orally, who has time to sit around while the body digests a piece of placenta to extract the required nutrients to stop a PPH?

        • Young CC Prof

          Wait, what? The birthing center let a woman with preeclampsia deliver with them and didn’t send her to the hospital? That’s horrifying. I used to think birthing centers were reliable about testing and risking-out, but not anymore!

          • The Bofa on the Sofa

            Didn’t you know? OOH birth is safe for low-risk patients.

            Therefore, it only makes sense to let a patient with pre-e do it.;

        • AlisonCummins

          If your friend had preeclampsia she needed to deliver right away. It can kill the mother. It’s lovely she was fine but it’s not because of the care she got.

        • moto_librarian

          If I hear one more fucking person claim that eating a chunk of placenta is the cure for postpartum hemorrhage, I am going to scream. Your friend was fortunate that she wasn’t having a severe hemorrhage because if she had, eating her placenta wouldn’t have done dick to stop it. I would have died of pph had I delivered at home, and at least 3 NCBers have suggested that eating my placenta would have been the cure. This is idiotic.

    • jimmy

      You were lucky. My yoga teacher decided to go all “natural” with her pregnancy and delivery. You should understand that due to the nature of her work this was very much expected. She would have been considered “not legit” if she opted for a hospital birth.

      The pregnancy went nearly a month past due date. She did not want to go in for a cesarean. So, most likely scenario, the fetus matured to the point where it defecated into it’s amniotic sac and the lungs were infected. Or, the lungs were contaminated since the mother’s fecal matter purged into the birthing pool during labor. The result was that the baby went suddenly unconscious while resting on the mother’s breast shortly after the birth. The baby was rushed to hospital and went into a coma. After one week, the mother had to make the gut wrenching decision to end the baby’s life.

      Maybe this would not have happened if the mother was not so dead set on a natural birth that she refused to have a C-section as the due date passed. But that’s the problem with the natural birth movement: Women are considered to be failures if they have to go to to the hospital. They must not have eaten correctly. They must have stressed themselves. The ones that do go in for emergency C-section birth are often depressed over this because all their friends had a home birth.

      • Macsen Rutledge

        yea, if you’re having complications maybe just do the hospital. otherwise i would go with the home-birth to avoid legal issues with the doctors/cops/nurses/cps who can get real pushy if they don’t like you.

        • Trixie

          Could you give a specific example of what legal issues you’re talking about?

          • Mishimoo

            Hazarding a guess: Either vaccine/Vitamin K refusal or positive drug panels, and the consequences thereof.

          • OBPI Mama

            I refused Vitamin K (cringe, I know) and Hep B with 2 sons that were born in the hospital and the medical staff just asked me to sign a form… No glares, no cops, no pushiness. I learned more the risks of not doing Vitamin K (my first son was really the one who should have had it, but midwife convinced me of it’s evil) and Baby Girl got the shot. Point though, is that we are told the hospital staff will hate us, condemn us, call cops on us, etc. to scare us away from the hospital… in reality, they might tell us why they think our babies need things, but they leave the decision to us.

          • Mishimoo

            Yes, that seems to be the main difference between alt-med and medical professionals. One lot goes for a mix of fear tactics and reassurance while the other gives you facts and viable options.

        • The Bofa on the Sofa

          OK, this is bullshit.

          Come on, tell us all about those “legal issues” that you think you are going to avoid? REAL information, not some bullshit that you heard third hand.

    • Trixie

      “Please do look up Ina May Gaskin.” Oh honey. Oh sweetie. She’s a cult member who freely admits to sexually abusing her clients in labor. Try searching her name on this blog, you might learn a few interesting things.
      I’m glad your baby was born healthy. Please stick around.

    • Anj Fabian

      “For anyone reading and not sure what to make of the information I say go
      with your gut. Do the research and make an intelligent decision based
      on how you feel about…”

      For anyone reading who has serious problems with anxiety, I suggest talking to a mental health professional who will be able to help you to “feel safer, calmer and able to be in control”.

    • Monica

      You should also check out Hurt by Homebirth. You will see how there are lots of women who just like you thought they were getting the greatest care only to then lose a baby and then find out just how awful their midwife actually was. Do you know how many babies have died under your midwife? Is there even a way to find out? Because doctors can’t sweep this information under the rug, there are public records of what happen, but you read those Hurt by Homebirth stories and see how many times a perfectly nice wonderful BFF of a midwife then turns into a complete bitch when the birth goes wrong and they fear that there might be some sort of legal repercussion or bad press for them. Suddenly your best friend isn’t talking to you anymore or acknowledging you or she’s sending you nasty messages twisting everything that happened. And you’re left picking up the pieces of the homebirth gone wrong left to live on with the pain of knowing that your child died or was seriously injured and there’s nothing you can do about it because there is no malpractice insurance and there are no laws which hold an untrained and unlicensed person responsible. Your midwife couldn’t prescribe medicine you said, so what would have happened if you needed something during labor, or immediately after? What would have happened if you were bleeding so much and the midwife couldn’t get it to stop and she couldn’t give you any medication to stop it? Seriously, this is the equivalent of having someone trained in first aid perform surgery. You can’t just put a bandaid on something and hope it goes away. Think about that, stick around, read some more things because your wonderful experience might be another woman’s worse nightmare come true.

    • Captain Obvious

      I am an OB, practicing for the last 21 years. There are plenty of anecdotal easy deliveries that I have performed that could have been delivered at home or have had a 12 year child attend and successfully deliver. Your story may very well be included in that group. What MANA is know admitting, that has already been acknowledged, is that your chances of having bad outcomes is multiple times greater at Homebirth. And worse, MANA published their data but are stating that even though we show the outcome are relatively 4.5x greater, the absolute risk shows that most of you will be fine. Are you really ok with that?

    • The Bofa on the Sofa

      My husband and I also did a lot of research on home birthing including researching Ina May Gaskin’s midwifery career as she is one of the most beloved midwives in the country. Please do look her up.

      And you should look up “Pablo’s First Law of Internet Discussion” before saying anything so stupid.

  • Joshua Greenwood

    As a Father of three children (two of whom where home births – one with a midwife and one unassisted) and a Pastor, I can say this article is a SHAM and worthless reporting. Based on what figures would they come to this conclusion?! There are infinitesimally smaller rates of home births compared to births at a hospital. We’re currently ranked what like what, #34 in the world for infant mortality and you want to compare the 1% to the 99% and then say that the rate is 450% higher?! Lord have mercy, as a Church here in Oregon, I am going to make it my mission to make EVERY Christian midwife in America an associate Pastor representing our Church and thus making them an unregulated TAX EXEMPTED ministry. I will DESTROY your abilities with the law on my side and with our attorneys to represent them and completely take them out from the insane regulations and bring them under the auspice of the Church. Remember that old 1st Amendment? The one about the separation of Church and state? The one where Congress SHALL MAKE NO LAW for the establishment of any religious denomination?! Notice that our Congress doesn’t pass laws against Churches and neither do local state governments?! We’re going to UNINCORPORATE these Midwives, bring them under the Church, minister to them how to set up their tax exemption numbers and then minister to them how to set up their bank accounts so they can start receiving donations. get them OUT from the incorporated state laws and FREE them to have more home births than EVER before. Get these parents out of this sick, disgusting $25,000+ per-birth madness you and the Hospitals are running. Midwives are mentioned in the Bible as far back as Genesis and therefor it has both Canon and Ecclesiastical precedence that WILL hold up in any court her win America. If your a midwife, reach me at empowerment@corporationsole.org

    • Clark

      You are legitimately psychotic, and your viewpoints hurt out country,

      • Guest

        Thankfully we’re BOTH protected by the 1st amendment to have such stances! I have 36,000 followers on Facebook.com/corporationsole, 20,000+ twitter followers and 13,000 Churches that are associated with our ministry that we email daily. I think I am going to share our strategy and give this to ALL of our Pastors this week! In fact, I will draw it out completely and prepare everyone of my staff as well for this. No, we’re taking this country BACK from this disgusting health care system and placing it under the Lord where it belongs. Give these mothers a true choice of what they want in a safe environment where they do not have to fear like they do when they go to a hospital. If God trusted his own son Jesus to be born unassisted in a manger, then I think that midwives will do just fine. The law is a wonderful thing when it comes underneath the Church.

        • Guestll

          You just do that, crazy megalomaniac fundie dude.

        • Dr Kitty

          I’m pretty sure the US Constitution has a thing about separation of Church and State…

          Ok, you and your followers leave hospitals and pharmaceuticals to us Jews and Unbelievers and Muslims and Hindus and Buddhists and Sikhs and the less Kerazy Christians and Go and Trust in The Lord…and we’ll see how it pans out for you.

          Isn’t there something about not testing G-d?
          I’m not sure, but I think deliberately choosing minimal prenatal care and giving birth remote from medical help with a minimally trained assistant might fall into the “testing” category.

          But hey, I’m a medical doctor, I really have no business messing in theological issues I don’t understand…if only the converse were true.

        • Stacy21629

          You’re going to end up like that pastor down south who discouraged his congregation from vaccines, had a massive measles epidemic and had to host vaccine clinics in his church. Once you’ve buried a handful of your congregant’s babies, come back and tell us how that worked out.

        • T.

          And this is why I am happy to be an atheist.
          Thanks for the link. Me and my atheist buddies love to have new fundies site to laugh at.

          • Trixie

            Is this guy on FreeJinger so I can just read the synopsis?

        • Mishimoo

          It’s people like you that contributed to my disillusionment with the church. Congratulations on alienating the younger generations; you’re such a shining light for the Lord.

        • Squillo

          God trusted his own son Jesus to be born unassisted in a manger.

          Yeah, he let him get nailed to a cross, too.

        • Squillo

          The law is a wonderful thing when it comes underneath the Church.

          Like Sharia.

          Remember that First Amendment to the U.S. Constitution that you (mis)quoted in your other comment? It’s the basis for secular law that enables you to practice whatever whacked-out version of Christianity you subscribe to.

        • PrimaryCareDoc

          I’m tempted to upvote this just because it is literally the most amusing thing I have read all day. Thank you, Pastor, for brightening my day!!

          If it was good enough for Mary and Jesus 2000 years ago, it’s good enough for those uppity women today! There’s an argument that will take you far!

          Also, there’s nothing like outlining your nefarious plot for country-wide healthcare domination via tax fraud on the internet for all to see.

    • http://vocino.com Travis Vocino

      I’m not sure you understand how statistics work.

    • Stacy21629

      I am a Christian. Please stop saying you are. You’re nuts.

    • Stacy21629

      WAIT WAIT WAIT WAIT – “Congress SHALL MAKE NO LAW for the establishment of any religious denomination” – (which BTW – is NOT what it says, if you’re going to reference the constitution, try not to look like an idiot by referencing it WRONG)…so you want government out of religion…but you want your happy little tax exempt status? You can’t have it both ways. Get our government out of your religion, give up the tax exempt status.

    • anion

      So…tax fraud is very Christian, I guess? That whole “thou shalt not steal” and “thou shalt not bear false witness” thing doesn’t count for you?

    • OBPI mama

      I am a daughter of the King, I love the Lord with all my heart… what ever happened to “render unto Caesar what is Caesar’s”??? We can’t pick and choose what we want to believe from God’s Holy Word. As a Pastor I would think you would know that! For the record, because of my old midwife, my son’s hospital bills number over $160,000 and keep going up every year. My hospital births were around $10,000 for c-sections. Where is fundraising to help me and my husband (Christian farmers who donate to charity, volunteer in the community, and pay outstanding medical bills)??? Not saying, we would accept help (we assume the responsibility of choosing a homebirth, but the offer would be nice). You would think your church would be focused on serving the poor, the wounded, the sick…. hmmm…

    • Squillo

      I am going to make it my mission to make EVERY Christian midwife in America an associate Pastor representing our Church and thus making them an unregulated TAX EXEMPTED ministry. I will DESTROY your abilities with the law on my side and with our attorneys to represent them and completely take them out from the insane regulations and bring them under the auspice of the Church.

      Nice of you to help the feds out in their tax fraud investigations by posting your dastardly plan here.

    • C T

      Seriously? “Midwives are mentioned in the Bible” because modern medicine, antibiotics, electricity, etc. were unknown concepts. Rachel died giving birth to Benjamin!! Death has been associated with childbirth since the beginning, too. I’m sure Jacob/Israel would have loved to provide the benefits of modern medicine and OB training to his beloved wife rather than see her die. Keep your prehistoric practices separate from my religion, you dangerous man.

      • Mishimoo

        The ones that always make me cringe are Jacob and Esau (Twin-to-twin transfusion syndrome + nuchal hand) as well as the births of Pharez and Zarah (Where Zarah poked his hand out first, drew it back in, and then Pharez was delivered first instead)

  • Orion

    How about focusing the graph on *actual* risk. It paints a very different picture if you do. I’m not arguing the numbers, or that hospital birth is safer(for the birth in specific). Here is a true to scale graph showing actual (not *relative*) risk. http://imgur.com/pZsXzzZ

    • http://vocino.com Travis Vocino

      That makes for a bold graph but that context is not relevant. You don’t include overall deaths in the US when analyzing what is worse: smoking-related or stoke-related for example. Of course both would look insignificant when graphed against overall deaths similarly to your image.

    • Young CC Prof

      Yup, that’s nice. I could make a much bigger graph like that for the risk of driving my baby to Grandma’s house with and without a carseat. Does that mean we should abandon carseats, and accept the claim that driving without a carseat is safe?

    • jimmy

      Here’s another way of looking at that: The risk is still 5 times higher with home births. If something goes wrong and the baby dies, and you chose the best hospital care, at least you know you did everything possible if the baby dies. If you have a home birth into a kiddie pool and the baby dies, what then? As i mentioned elsewhere in the comments, a friend of mine had to go through all that, and even had to decide to pull the plug on her coma baby, all because she wanted the perfect all natural birth.

  • Patrick Dale Moorehead

    Dear
    Dr. Tuteur,

    Your write up is failing to consider the “all risk” category for
    hospitals.

    I wonder if you are failing to include such a category because it would
    invalidate many of your arguments.

    If I am not mistaken, and since you are using CDC statistics, the
    hospital “all risk” category would be very near the infant
    mortality nation wide as most children are born in hospitals. With
    CDC stats the U.S. Infant mortality rate is 6.1 deaths per 1000 live
    births. What you seem to point out but somehow have completely
    forgotten… the numbers tell at least two stories.

    The MANA numbers at 2.06 per thousand is quite a lot less than the 6.1
    per thousand national average, meaning if we were only examining
    these shallow statistics hospitals would be nearly 300% more
    dangerous.

    I am not making the claim that hospital births are nearly 300% more
    dangerous than home birth, I am not making this claim because even
    though some grouping of numbers taken outside of context supports the
    statement to make such a claim would be unethical and foolish.

    Your analysis is just as shallow as mine and they completely disagree, but
    use the same data sources to back their claims, so what’s wrong with
    both of our arguments?

    They are shallow, and they are manipulative distortions of the truth – we
    are both lying.

    I am lying to show how data can be taken out of context to be
    misleading. (What are your motives for lying?)

    Both of our statements are based on established data from the same
    sources: your “home births are 450% more dangerous”
    and my “hospital births are almost 300% more dangerous”…
    I’m really glad that neither one of us is right.

    If I had to take a guess at why you are distorting the truth to make
    hospital births look safer than they are is because you are scared. I
    feel you are scared for a few reasons and it is my impression that a
    few of your reasons are more than justified: Issues like what you
    mentioned for breech births, these are real facts which were
    frightening enough left non-manipulated.

    I’m studying medicine, it troubles me how many people are adopting
    homeopathy and alternatives to modern medicine, but midwifery is not
    homeopathy or alternative medicine. Midwifery is medicine just as
    obstetrics is medicine. The two fields could greatly benefit each
    other and offer decreased risk to expecting families if the two
    fields worked together.

    For example if patients were welcomed to get prenatal care with a doctor
    many of the tragic lives lost to breech births attempted at home
    could have been prevented.

    Additionally if midwives were referred by doctors to birth more babies perhaps risks associated with higher induction rates could be avoided.
    Perhaps risks associated with infections contracted in hospitals
    could be lessened if less births were had in hospitals.

    Perhaps is an unfortunate word, lets try ethnocentrism: a reasonless belief
    in superiority of ones own group.

    The way things are done in the United States is not always the best way
    things can be done, in fact, especially with healthcare… we are not
    always a good example and with healthcare we Americans are a bad
    example.

    Your wiliness to be misleading (and/or delusional but it is my hope you
    are intentionally trying to deceive) is one of the reasons healthcare
    in the United States is in such need of improvement.

    The Dutch, have us beat when it comes to most if not all measurable
    markers of a “good” healthcare system. The Dutch have a ton of
    home births at roughly 30% yet they have a much lower national
    average for infant mortality… for smart people, who also happen to
    be honest – examples like the Dutch inspire curiosity.

    Note:
    likely the Dutch having better healthcare than Americans is a
    combination of several factors but the dutch also have an obesity
    problem and a westernized society. Chances are we Americans could
    learn a lot by examining not just the Netherlands but other portions
    of the world.

    Please somehow remember your honesty. I can tell by your writing that you
    are smart, why not be also honest?

    If you wanted to be honest the actual numbers paint a fairly grim likelihood – poverty is the single most dangerous risk factor anyone alive or being born in America could posses. Followed closely by being a minority. An in-depth look at the study you claimed to have read would have shown you that of the home birthing women 92% of the women were white 58% had completed 4 or more years of college and 64.4% of the these mostly married technically healthier and probably wealthier than average women could PAY their midwives out of pocket… these women are not
    representative of national averages.

    Hospital births are often safer (such as with breech births), but unfortunately home births according to the actual numbers are often safer as well, because home births avoid high risk aggressive birthing activities such as forceps.

    Lets make one thing perfectly clear:
    Hospitals should be the safest place to have a baby, they aren’t or
    at least can’t make such a claim with the current data as it is
    publicly available. If hospitals learned to do the things midwifery
    embraces such as listening to and respecting the wishes of the
    mother, and having the patience to, most of the time, let the patient
    birth at a natural pace in a natural way; then more lives could be
    saved.

    Some reading for you -

    http://www.cdc.gov/nchs/fastats/infant_health.htm

    http://www.expatica.com/nl/health_fitness/healthcare/why-the-dutch-cherish-home-births–43528_9488.html

    https://www.cia.gov/library/publications/the-world-factbook/rankorder/2091rank.html

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2569641/pdf/jnma00203-0041.pdf

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2569641/
    (in case the pdf does not load)

    oh and the research article you claimed
    to have read

    http://onlinelibrary.wiley.com/doi/10.1111/jmwh.12172/full

    If you would like to come and be critical of my writing I would enjoying reading your responses, my blog http://dadsagainstmedicalnegligence.com/

    Personally I make a selfish attempt to be honest because I find it easier and better for not just myself but for those around me. When it comes to matters such as those you were discussing, honesty means more than personal integrity, your dishonesty will likely lead to the death of infants, and this fact
    makes you a monster. Please sit down, use every once of intellect you
    have and actually analysis what is more dangerous about home births;
    real effort in this regard could lead to life saving improvements.
    You should be ashamed of yourself.

    Knowledge Empowers,

    Persistence Makes History,

    and Kindness is the Best Science –
    Patrick Dale Moorehead

    • Young CC Prof

      6.1 per thousand is the INFANT mortality rate, including all deaths of children through age year. MANA’s 2.06 number included only deaths up until age 1 month. In addition, most infant deaths in the USA happen to very premature babies. Home births of premature infants are very rare, and in the hospital, deaths of full-term babies are very rare.

      You’re right about one thing: An awful lot of infant deaths in the USA are caused by poverty and inequality. But look at who’s home birthing: Privileged women, for the most part. Women who should have access to the resources to keep their babies safe, but walked away from those resources thanks to the pernicious lie of natural childbirth.

      And you make reference to Dutch numbers, as usual. The infant mortality rate is the wrong measure. Look at the perinatal death rate, that is, 3rd trimester still births and deaths through 1 month of age. In the USA it’s 7, in Britain and the Netherlands it’s 8 per thousand. Yup, the USA is actually doing better at caring for pregnant women and newborns!

      “actually analysis what is more dangerous about home births” Been done many times. Home births are more dangerous because:

      1) Less equipment (no fetal heart monitor) and limited skills on the midwife’s part means it’s harder to detect problems.

      2) When problems do occur that require a c-section or other high-tech intervention, the need to transport delays intervention.

      3) When babies are born in need of resuscitation, the only person available to do it is the midwife. Even if she’s trained in it, she may never have done it on an actual baby before, and her equipment is limited. In a hospital, a quick call will fetch a TEAM of staff members who have done it many times before.

    • Guestll

      Hey smarty, while you’re studying medicine, you’ll undoubtedly come across something called statistics. Pay special attention in this class, please. And learn how to differentiate between perinatal, neonatal, and infant mortality before you pontificate on something you clearly know very little about.

    • AlisonCummins

      You neglect to suggest that perhaps midwives should be trained, licensed and carry insurance.

      American midwives are allowed to practice and charge money for their services without any of these things. There is a qualification — CNM — that provides sufficient training but most American midwives don’t have it and MANA opposes requiring it.

      MANA doesn’t define low-risk birth because their policy is that it should be up to individual midwives to determine their own comfort level. Because of their lack of knowledge, many untrained midwives feel comfortable attending high-risk births at home.

      When OBs induce labour, it’s because it’s safer and has been proven to save lives. Forceps are rarely used any more because c-section is much safer. When c-section is recommended it’s because it has been proven to save lives. When a midwife allows a woman to labour

      So you see, what you suggest has already considered.

    • theNormalDistribution

      If you are studying medicine, then you should know that infant mortality is a measure of pediatric care, not obstetric. You’re right, comparing infant mortality in hospitals to neonatal mortality in homebirths is unethical and foolish. Your statistic is a lie. You have yet to actually explain how Amy’s is.

      The reason why all risk categories are not included in the hospital to homebirth comparison is that women with high-risk pregancies are not candidates for homebirth. Including high risk births in the hospital group artificially inflates the mortality rate, giving you in inaccurate impression of actual risks. You need to compare like with like to interpret statistics correctly. What makes this your argument really pointless is that even if you include all the high-risk hospital births, the numbers are not in favor of homebirth. Even your beloved Dutch midwives attending low-risk births at home have worse outcomes that Dutch obstetricians attending high-risk births in the hospital.

      Try to learn some critical thinking skills instead of making hilariously aptly described “selfish attempt[s] to be honest”.

    • An Actual Attorney

      Patrick,

      I read some of your blog. I am so sorry about the loss of your beautiful daughter.

      Please read a little more before accusing anyone of being a monster.

      You have suffered an unforgivable tragedy. But that doesn’t mean you don’t have a lot to learn here.

  • Tina Miller

    Question: Why is the rate only being compared to low risk white births? Are only white women also doing homebirths. I think it is a way to play with numbers to make the gap seem even greater. Statistics are used to present information in a particular manner.

    • Mtbakergirl

      Please read the comments. This has been asked and answered at least twice.

      • ChaosandOrder

        I have now read all of the comments…and man there are some negative people who like to make huge assumptions and bash others.

        • Guestll

          I remember my first day on the internet…

          • ChaosandOrder

            I was actually just pointing out that even though one may have a degree and experience, it does not mean they have integrity and moral standing.

          • Guestll

            Is that what you were just pointing out?

            Thank you for your concern.

          • Stacy21629

            Funny, seems that’s true for those with NO degree (i.e. midwives) as well.

    • areawomanpdx

      Because 93% of the women in the MANAstats database were white. So yes, homebirth is almost exclusively white women. You have to compare like stats with like to get the most accurate comparison.

    • Captain Obvious

      Homebirth advocates would love to include ALL races and ALL risk patients to “play with numbers to make the gap seem even greater”. You need to compare like with like. And yes MANA themselves say over 90% of their data was white women.

  • Alissa

    It looks like almost 2/3 of the reported deaths occur intrapartum, even after taking out the truly scary breech numbers.

    I wonder if there’s a way to get a good comparison with the hospital rate, vanishingly small though that rate is. I just did a quick and dirty search on the CDC site for low risk white women whose babies died in the first hour as a rough proxy and the number was very low: .02-.05 per 1000 depending on method of delivery.

    The difference between that and even a conservative number like the 1.06 per 1000 for vertex intrapartum death would add another order of magnitude more risk.

  • fiftyfifty1

    I had looked forward to the release of the MANA stats. I thought they would never be released. I always said “Wouldn’t I like to get my hands on those stats”. Now they are here and it’s so depressing. Just confirming what Dr. Amy said all along, but there’s no sense of victory in it. It’s a bunch of dead babies and devastated families. Just too depressing.

  • melindasue22

    I am worried though. People are already going crazy posting this saying it is safe. Even huff post has an article. They attempted to show both sides but disnt do that well. http://m.huffpost.com/us/entry/4696665/

  • Jen

    Am I understanding correctly you’re more likely to die with a US home birth than giving birth in Yemen???? Or am I looking at the wrong stats? I would love to see these stats compared to other countries!

    • Young CC Prof

      These are the death rates for the baby. In the USA, even at home birth, maternal deaths are quite a bit rarer.

      • Jen

        Thanks, do you know where can I find the stats to compare countries for the periods given by mana?

      • Certified Hamster Midwife

        The USA is not so much into child brides.

  • Edgar

    Amy, please tell mehow you got the CDC Wonder rate? There is no ‘low risk’ option, and for the life of me, I can’t replicate.

    • Amy Tuteur, MD

      The beauty of the CDC Wonder database is that you can set the parameters
      to find specific information and control for various risk factors.
      Therefore, it is possible to look specifically at neonatal mortality (death within 1 hour to within 28 days of age) for babies of white women (almost
      all homebirths are to white women) ages 20-44, singleton pregnancies, at
      term (37+ weeks), not suffering from intrauterine growth restriction
      (2500+ gm).

    • Squillo

      Not Amy, but I ran the numbers using the following perimeters:

      In-hospital (no unknown)
      Attended by MD/DO/CNM (no other midwife or unknown)
      Gestation 37 weeks and up
      Singleton and Twins
      2005-2009 (since MANAStats includes November 05-Dec 09)
      Death from <1 hour to 28 days of life

      I got a neonatal morality rate of 0.84
      Excluding deaths from congenital anomalies: 0.40
      Excluding deaths from congenital anomalies, "special causes" (terrorism), and external causes (vehicle accidents, poisonings): 0.37

  • Elle

    Question: you state the CDC rate is the neonatal rate, but have said before that neonatal is the wrong statistic, and that we should use perinatal instead. Just wondering why…

    • Rebecca

      Perinatal = intrapartum + neonatal (first 28 days).

      You’re thinking of infant mortality (first year).

      • Elle

        Okay…. I thought neonatal mortality was the first year, and perinatal mortality was the first month… not sure why. Thanks!

      • Young CC Prof

        Actually, perinatal = 3rd trimester stillbirths +intrapartum + neonatal.

  • KarenJJ

    This is great! Well done with everyone, especially Dr Amy, involved in keeping on the pressure. Now that they have published the numbers, what is MANA going to do to:
    a) improve data collection reliability
    b) improve birth experiences and outcomes for the mothers and infants that are under the care of their midwives
    c) identify and fix the holes in their midwive’s education and training so as to improve the professional standing of the midwives they represent?

    OR
    are these just numbers to throw around by “educated” midwives and mamas to stick it to the “man”?

    ie, is midwifery under MANA a “profession” or a “hobby”?

    • Sue

      What is MANA going to do? Spin, dodge, obfuscate….everything other than trying to improve safety, I suspect.

      Normally a review of safety in a specific area of health care leads to suggestions about how to improve safety.

      The professional and responsible approach to this would be to recommend that HB should only be contemplated with;
      - Hospital affiliated CNMs
      - Strict, audited risk-out criteria
      - Transfer communication and protocols in place
      - Automatic exclusion of first-timers, twins and breech.

      (I won’t be holding my breath).

      • http://www.antigonos.blogspot.com/ Antigonos CNM

        And any regulation/supervision would have to be on a Federal level to be consistent. As others have noted, impossible, at least for the foreseeable future.

    • http://www.antigonos.blogspot.com/ Antigonos CNM

      Even with the best will in the world, which MANA hasn’t got, MANA can’t do a lot to improve its data collection, since it is voluntary. Only if ALL persons attending births as midwives are legally required to keep full records [and how are you going to track down "fugitive" or non-cooperative pseudo-midwives?] are you in a position to claim to have even reasonably complete statistics.

  • Squillo

    One thing that would seem to make it difficult to compare these stats to hospital stats is the fact that MANA gathers their data on pre-term birth thus:

    These data come from 2 questions on the 2.0 data entry form. The exact wording of the questions are: “Any clinical evidence that baby is preterm?” and “Any clinical evidence that baby is postterm?” Further instructions were not given to midwives.

    • auntbea

      Those aren’t even complete sentences.

    • http://www.antigonos.blogspot.com/ Antigonos CNM

      And what does one do with women who avoid pre-natal care? Obviously they won’t have clinical evidence of anything.

  • Guesteleh

    You know what’s remarkable? That there are more than 371 posts in a few hours. Statistics-based articles don’t usually generate this kind of traffic. The fact that so many homebirth advocates are parachuting in here to argue the numbers says they must be shitting their pants over these results.

    • Young CC Prof

      I wish my students were this excited about statistics!

  • CNMNTN

    This is classic manipulation of statistics. Nice job creating the story you wanted to make by twisting the numbers. The sad thing is that so many aren’t educated enough to see through your typical presentation. Absolute risk vs. relative risk makes a huge difference. Furthermore, you applied limitations that the studies did not, thereby giving you the exact picture you want. You can make it seem anything you want, but it doesn’t make it true. If OBs would take a step back and RESPECT women and their wishes and learn to take evidence for what it is rather than manipulating it into what they want it to be, women wouldn’t be so desperate to give birth elsewhere.

    • Amy Tuteur, MD

      If the MANA data really show homebirth is safe, why did they wait 5 years to tell us? They boasted about the C-section rate, intervention rate, transfer rate, but hid the death rate for 5 years. Why?

    • Guestll

      Of 222 babies presenting in breech position, 5 died either during labor or the neonatal period.

      Please explain.

      • Certified Hamster Midwife

        Maybe those babies were in Portland, which doesn’t count.

        • Guestll

          I was about to laugh, then I remembered…there were people who actually said this when the Oregon data came out.

    • Stacy21629

      Obviously the major issue here is respect for women, not dead babies. As long as I understand your priorities right…

      • http://shameonbetterbirth.wordpress.com/ Shameon Betterbirth

        It can be both! I do not personally think physicians should withhold their interpretation of research findings when a patient is making a decision based on that research. Physicians review this kind of material more often than lay people, and have training in how to interpret results that the majority of people do not have. Keeping pertinent information to yourself as an MD is the opposite of respect. its saying “you’re on your own!” instead of “let me help you”.

    • Dr Kitty

      AR vs RR?
      Really?
      Dr Tuteur has used both.

    • The Bofa on the Sofa

      OK. Please give me an “absolute risk” based reason why I shouldn’t stop by the bar on my way out tonight, get drunk, and drive home.

      Come on. Try it.

      (hint: you will fail)

      • http://shameonbetterbirth.wordpress.com/ Shameon Betterbirth

        there are, unfortunately, real drunk driving advocates. google “getmadd”.

        • Young CC Prof

          Just when you think something is too crazy even for the Internet… It isn’t.

    • attitude devant

      What’s REALLY classic, really twisted, and completely disgusting is the way that the authors of this dataset (and we will not name them here) obfuscated the most important finding: that HB increases the death rate by 4.5 time. But nice try Miss CNMTN.

    • Young CC Prof

      So, the absolute increase in risk of death from home birth is more than 1 in 1,000. This does not include the risk of injury or a stressful and costly emergency transfer.

      1 in 1,000 sounds small, but it’s your child’s life. A 1 in a million risk I’ll shrug off, but a totally avoidable risk of 1 in 1000 doesn’t sound like a smart idea to me.

      • FormerPhysicist

        1/1000 is 2-3 kids at any given time in my high school. Pick, for instance, cancer, that means any old year you walk into the high school, there are 2-3 kids with cancer there. I don’t call that small.

        • Young CC Prof

          Exactly my point. A 1 in 1000 probability of disaster is not small, and it’s definitely worth planning for. The probability of a house fire is similar to that, but people still buy fire insurance!

          • DaisyGrrl

            It’s also about the consequences. A 1/1000 risk my house will burn down? Yup, fire insurance (I can’t afford to rebuild otherwise). A 1/1000 risk my iPhone will crap out? No extended warranty for me because I can more easily afford a replacement.

          • FormerPhysicist

            Yep, just adding a small illustration for the more innumerate.

    • Guestll

      Missy, is that you?

    • Rebecca

      You to talk about want absolute risk? Fine. There were 3,953,590 live births in the United States in 2011. Let’s pretend for a moment that they were all low-risk births. That’s the most generous assumption we can grant to Team Homebirth.

      Now imagine every one of these births occurred in the home setting in 2011. The excess death rate for low-risk homebirth over low-risk hospital birth is 1.23 per 1000.

      An extra 4862 babies would have died.

      See? Homebirth still loses.

      • Tina Miller

        and 210,000 people die a year because of mistakes made in hospitals. That number came from Scientific American. There is no fool proof method for anything, so why try to convince others their are only two sides to this option? We need to all be working together and not jumping on defensive positions.

        • theNormalDistribution

          210,000 out of how many being treated?

        • Houston Mom

          Mistakes in hospitals have repercussions.

        • Stacy21629

          And for many of those mistakes, there will be full investigations with records review. If a gross error was made, medical malpractice comes into play. Doctors could even lose their license. Such review and repercussions are extremely rare in the CPM world.

        • Captain Obvious

          MANA’s own results are telling you the RATE of mistakes that are made with Homebirth are higher than the rate of mistakes that are made at the hospital. So if more than 0.5% of people were attempting Homebirth, say like 80%, what do you think Scientific American would be reporting as absolute numbers of Homebirth mistakes?

        • ChaosandOrder

          Rebecca said 4862 babies would have died vs. the 210,000 that did. That was my point. Not some percentage. I am not talking about births or statistics, I am talking about overall deaths of people. How about the people dying of cancer because we have saturated our environment with chemicals? How about all the lives lost from wars because someone has to be in power? We know humans can birth babies because we have been around for more than 30,000 years and we are still going strong. So strong we are overpopulating our world. What happens if all women have happy births in a hospital and all those babies live just to die from the pollution in our environment? You people need to get off of your high horse and let God do his job while we clean up our major cluster fuck of a society.

          • Stacy21629

            Wow….just wow. “Don’t worry ma’am it’s ok that your baby’s head was trapped and it suffocated in your vagina, because at least that’s better than getting cancer from environmental chemicals.”
            Dear God. You’re hideous.

          • Guestll

            Said no one ever whose baby died during childbirth.

          • OBPI Mama

            Yep. This person is evil. And I have to say that if they believe in God, God says He is the Giver of Life, that children are a reward and a blessing! And that Satan comes to steal, kill, and destroy. So her remark of “God doing His job” would mean that women who cherish life that He gives, acknowledge and use the gifts of technology. He gave people talents and minds and they used them for good to drastically cut down on the amount of lives lost.

          • Young CC Prof

            Wait, did you just say that we should let some babies die to prevent overpopulation?

            1) That’s horrific.

            2) That’s factually wrong. The birth rate drops only when women are educated and have access to contraception, and infant and child mortality is reduced to the point that families can expect all their children to live.

          • An Actual Attorney

            “let G-d do his job”??? Go fuck yourself!! If I had let nature take it’s course at birth, Actual Kid and I would have both died. What happens if he dies later from cancer? I will be broken, but not more broken than if he never lived. I treasure every day with him and you and your eugenics can go crawl up your ass!

          • Happy Sheep

            It wasn’t 210,000 babies dying, it was an estimated number from the whole population.
            I truly hope that you don’t apply that logic to your own life and your children’s health, because by your logic, you will not be seeking medical help for cancer or even illnesses and that is a terrible terrible prospect.

          • Young CC Prof

            And of course, most of those who die from medical mistakes are very sick already and would have died sooner without medicine. That doesn’t excuse the mistakes, but it’s not like many people are going to the doctor for a cold or a broken wrist and dying of a prescription error.

        • An Actual Attorney

          And, still, with that, FIVE AND HALF TIME MORE BABIES DIE in homebirth than in the hospital.

  • Amy Tuteur, MD
  • Squillo

    According to the CDC Wonder database, the neonatal death rate for low risk white women at term from the years 2004-2009 is 0.38/1000

    Amy, did you exclude lethal anomalies? The MANAStats paper did.

    • Amy Tuteur, MD

      No, I didn’t exclude anomalies. There is no justification for MANA exclude congenital anomalies, except to improperly make their stats look better.

  • Medwife

    “The authors have no conflicts of interest to disclose.”

    *raises eyebrow*

  • s@bable.com

    Did you actually read the research article? No-where does it say that the rate is 2.6 per 1000. In fact, it says it’s 0.41 during the early neonatal period, which is statistically the same as the 0.38 that you report (which may or may not be accurate). It does say that the figures for breech, TOLAC and multiple gestation are not as good which is why most people don’t recommend home birth under those circumstances.

    Here’s the link so that you can read it yourself: http://onlinelibrary.wiley.com/doi/10.1111/jmwh.12172/full
    Looking forward to reading your correction.

    • Therese

      The .38 includes early and late neonatal period though.

      • Therese

        If you only look at early neonatal deaths among full term women with CNMs giving birth in the hospital the rate is .24

        • Squillo

          Excluding lethal anomalies, the intrapartum, early neonatal, and late neonatal mortality rates were 1.30, 0.41, and 0.35 per 1000, respectively

          The really shocking statistic is the first one.

          • The Bofa on the Sofa

            This whole parsing death rates down as an attempt to make them look better is pretty sickening.

          • attitude devant

            I’d vote THAT comment up a hundred times if I could, Bofa.

          • Jessica S.

            Ditto!!

          • Sue

            Yep – and that’s the reason why the absolute death rate is just as important as the relative – because of the extreme SEVERITY of the outcome (ie dead baby)>

            If one is looking at the rate of getting excess cases of nausea from an antibiotic, then a 450% increase on a very small number is still insignificant.

            When looking at outcomes like babies dying, however, both relative and absolute risks are significant becasue the outcome is devastating.

            I am familiar with research aimed at improvement, not at excusing poor practice.

          • fiftyfifty1

            You are right, that intrapartum mortality rate is especially sickening. What that number means is that for every 769 women who start labor with a perfectly healthy baby, one will deliver a dead baby who has suffocated during the birthing process*. THIS DOES NOT HAPPEN in the hospital. This is why there is fetal monitoring in the hospital!

            *And this is in ADDITION to the babies born so damaged by the birthing process that they die a fews days later AND in addition to the babies who die a stillbirth before their moms even go into labor due to poor prenatal care AND in addition to the babies who survive the whole process but live with permanent damage.

    • Pillabi

      s@bable.com, are you kidding?
      Dr. Amy’s article doesn’t say 2.6 but 2.06, which is – oh surprise! – the sum of 1.30, 0.41, and 0.3, i.e. intrapartum, early neonatal, and late
      neonatal mortality rates respectively. Data come just from the research article.

    • Jane Lucas

      s@bable.com I look forward to reading your correction.

  • Squillo

    The fact that MANA’s own web page touts every outcome BUT the mortality rate (as they’ve been doing for years) should tell even the most casual observer everything they need to know.

  • guest

    “According to the CDC Wonder database, the neonatal death rate for low risk white women at term from the years 2004-2009 is 0.38/1000.”

    I have searched this database and the web trying to find these numbers. I can’t find it anywhere. I am also wondering why the numbers you’ve included single out white women. I am not a proponent of home birth.

    • The Bofa on the Sofa

      You are pretty familiar with the scene, Martha, what’s the demographic breakdown of HBers?

      • Martha Reilly

        Most HBers are white. Even MANA admits that. As for the Wonder database, the best explanation I’ve seen on line on how to use it to study HB death rates is on the blog 10centimeters.com.

        • The Bofa on the Sofa

          Most HBers are white. Even MANA admits that

          Yep. So doesn’t that answer your question?

          I am also wondering why the numbers you’ve included single out white women.

          Since there is a strong racial correlation with risk, it is important to compare similar demographics.

          • attitude devant

            Bofa, who are you talking to? Martha isn’t the OP in this thread, even though she answered your question

          • The Bofa on the Sofa

            Discus failure

      • Therese

        According to the MANA stats, 92% were white.

  • Martha Reilly

    Thank you for this interesting analysis. I must say it is very gratifying to have two decades of mental consternation laid to rest. I take many homebirth transports in Eugene, Oregon, and I have always been alarmed by some of the things people were trying on at home (prolonged ROM, meconium, far post-dates, breeches, twins, VBACs). And when I would remonstrate with the transporting midwife, she would assure me that homebirth was safer than hospital birth and that the data showed it. I thought this couldn’t be so, if only because I was seeing the negative outcomes on a regular basis, and I knew our own hospital mortality/morbidity stats were terrific by comparison.

    We knew MANA was collecting data, but Missy Cheney kept refusing to release it, citing various ‘privacy’ and ‘peer review’ issues and claiming that we OBs were a hostile audience who only wanted to hurt midwives and avoid competition. (Trust me, Missy, our part of Oregon is so medically underserved that we couldn’t care less about competition!)

    And here we have it. And it is just as I would have predicted. Right down to the claim that these are good numbers. I don’t know whether to laugh or cry at that, but I am glad the numbers are out. Thank you.

  • Jane Lucas

    So there is this little note in Table 5 looking at death rates “There are 4 singleton pregnancies, 3 of which were breech presentations, for which all birth outcomes data are unavailable. These women began labor at home and then transferred to the hospital prior to birth. The midwives of record were contacted, and in each case the midwife did not accompany the mother, nor did the mother return to the midwife for postpartum care.” Aside from the unprofessional behaviour revealed here in not accompanying a transferring woman to hospital, does it also suggest that the breech death rate could perhaps have been worse?

    • Busbus

      Good catch.

    • Siri

      If a midwife hasn’t bothered to check if the baby lived or died, I think it’s safe to say the odds aren’t good. What kind of midwife behaves like that? Takes the money and can’t be arsed to find out how the birth ended?

      • The Bofa on the Sofa

        Remember, midwives are “with women” and provide compassionate care.

        Unless things go sour, when they abandon you.

        • Siri

          Indeed. I must admit, though, managing to avoid all knowledge of the outcome takes some doing. Unless … they were only pretending not to know. What think you, Bofa?

          • The Bofa on the Sofa

            Are you suggesting that a midwife was LYING?

            Actually, lying is the hallmark of a quack. That’s one of the big differences between legitimate professionals and quacks – legitimate professionals tend to be honest. Quacks just lie.

          • Siri

            I don’t think quacks have hallmarks; they’d have to be made of sterling stuff, and we know they’re not. Is there an opposite of hallmarks, applicable to rubbish and frauds (the image of Andy Wakefield just popped into my head; do you think I have a brain tumour?)?

          • The Bofa on the Sofa

            Watermarks?

            Stretchmarks?

            RichardMarx?

          • Siri

            Quackmarks?

          • Amazed

            Andy Fakefield? Siri, now I am really concerned about you. I’d recommend an eye surgeon. If that doesn’t help, go for a brain scan.

            Take care. Time is of essence. Imagine being stuck with Fakefield before your eyes for the rest of your life?

          • The Bofa on the Sofa

            As Ahnold says in Kindergarten Cop: “It’s not a tumah!”

          • attitude devant

            Groucho Marx!

    • Dr Kitty

      There is “did not attend the MW for postnatal care” and there is “doesn’t even check the local paper’s birth and death announcements to see if the baby lived or died”.

      Going out on a limb to say that those were not good outcomes (but not necessarily deaths).

      • Amazed

        Of course they were not good outcomes. That’s 4 homebirths lost! 4 times midwife magic failed! As we know, it’s all about the process and midwife magic.

        Oh, you meant the babies? Right. Homebirth is supposed to end up with a live one. Pity that gets forgotten so often.

        • Medwife

          Either the reported c/s rate would have gone up or possibly the intrapartum/neonatal mortality rates might have. Since the c/s rate being low is at least as important as the mortality rates, to these authors, it could have been either way.

      • Informed Mother

        Utterly ridiculous conclusion. The reason that midwives sometimes don’t attend hospitals with their clients is because of the witch hunt started by people like the quack that writes this blog. If midwives had hospital privileges and were appropriately respected for their expertise, OF COURSE they would be there.
        As for whether there were bad outcomes — OF COURSE the midwife would find out if there had been an adverse outcome. Do you really think that a grieving mother would simply not let the midwife know what happened? Babies don’t die frequently. It simply doesn’t happen.

        • attitude devant

          Hmmm. And yet these midwives claimed not to know what the outcome was. Why? Could it possibly be that they knew it was bad and PRETENDED not to know?

          • informed mother

            More likely that it was UNREMARKABLE (e.g. normal) and they didn’t find out, despite following up with their patient.
            I’m not saying this is ideal. Clearly it is not, but you have to look at the system in which midwives are often forced to operate, almost underground. If they were better regulated and licensed and integrated into hospitals this kind of loss of information would not happen.

          • AlisonCummins

            It’s unlikely to be unremarkable. There were only four pregnancies that were lost to follow up and three of those four were breech. It’s theoretically possible that this small subset of high-risk pregnancies just happened to be lost to follow-up by chance, but it doesn’t pass the smell test.

          • Amazed

            What about breech strikes you as unremarkable?

            Your user name suggests you like to be informed. What about signing yourself in a survey that’s supposed to prove your profession’