A baby is dead. Do you hear what I hear?

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On Friday I wrote about the death of a baby that occurred while Jan Tritten, Editor of the homebirth “journal” Midwifery Today, crowd sourced Facebook for suggestions for management of postdates with no amniotic fluid, but unruptured membranes.

Since then nearly, there have been approximately 25,000 visits to the post, and it is being discussed on a variety of message boards, Facebook pages and Twitter streams by lay people, doctors, skeptics and pretty much anyone else but homebirth midwives themselves. 329 people have signed the petition expressing revulsion.

Let’s listen for the reaction from the professional homebirth community. Do you hear what I hear?

That’s right … NOTHING!

Where is the Midwives Alliance of North America? Shouldn’t they be promising a public investigation of Jan Tritten for possible negligence and possible malpractice, not to mention serious unprofessionalism for crowd sourcing a life or death situation in real time?

Where is Melissa Cheyney, CPM, Director of the Board of Direct Entry Midwifery of Tritten’s state of Oregon? Shouldn’t she be promising a public investigation of Jan Tritten, as well as a root cause analysis to determine how to prevent future deaths?

Where is Ricki Lake, spokesperson for all things homebirth? Ricki was out there front and center defending an obstetrician who lost his hospital privileges and subsequently his right to practice because of egregious errors in the care of patients. Why hasn’t she come to Tritten’s defense?

Where is Aviva Romm, MD who recently confided this:

I will also readily admit that there are quite a few not so great home birth midwives contributing to not so great birth outcomes. In fact, in reaction to the problems found in medicalized birth settings, there’s a bit of a midwife ‘wild west’ out there – anyone can get “the calling,” attend some births, and call herself a midwife. Caveat emptor! It’s not black and white. A poorly planned home birth or a less than competent midwife (or physician, though most home births are attended by midwives), in the rare event of a complication, can be disastrous…

Ya think? So what are you going to do, Dr. Romm, when one of your homebirth buddies lets a baby die as the results of her grossly unethical actions? Will you be publicly condemning her? How about warning women to stay away from her. Or are you just going declare “caveat emptor” and let the tiny dead bodies fall where they may?

Where are the bloggers from the Lamaze blog Science and Sensibility? Will we be treated to cries of indignation from them, calls for investigation, calls for analysis of what went wrong?

Where are the homebirth bloggers, like Birth Without Fear, Monica Bielanko of Babble, Tracey Cassels of Evolutionary Parenting, The Feminist Breeder, etc.? When will they be discussing this tragedy and trying to learn from it?

Where is Jan Tritten? According to her pathetic attempts at backpedaling, this was supposed to be an opportunity for learning. Why did she delete the case just when we could have learned the most? When will be hearing from her on just what she learned from this tragedy and what other homebirth midwives can learn as well?

I’m going to go out on a limb and guess that we are going to hear from all these professional homebirth advocates and organizations at the exact same time …. NEVER!

And why will we never hear them demand an investigation, release the results, and condemn the mistakes?

Because homebirth midwives don’t care about safety. They only care about homebirth midwives.
The Midwives Alliance of North America has literally ZERO safety standards. Not only do they have no safety standards, they are quite explicit about this horrific stance. As far as MANA is concerned, it is up to each homebirth midwife to decide for herself what is safe. An official stance like that only makes sense if you are a lobbying organization, working tirelessly for the economic benefit of your members. What about the life and health of mothers and babies? They can fend for themselves and “own” the decisions that led to the deaths or permanent injuries of their babies or themselves.

But all is not lost. There is a way that the rest of us can learn from this preventable tragedy.

To any women contemplating homebirth, I ask you to imagine yourself in the situation of this mother:

  • In the face of imminent disaster, her midwife assures her that doing nothing is the best course.
  • In the face of imminent disaster, her midwife is so clueless that she is soliciting medical advice from her Facebook friends.
  • When your baby dies she insinuates that it is your fault for listening to her.
  • When confronted by others about her role, she pretends that your baby, his life and death, was posted on Facebook for the edification of everyone in the known world except you.
  • And then she deletes even that, to cover up her own role in his death.
  • Finally, as you make funeral arrangements, the homebirth community will rally around the midwife, not you. They will never investigate her actions; they will do everything possible to protect her.

Now ask yourself:

Is this what you want for yourself and your precious baby? A woman who calls herself a midwife, though lacking the most basic education and training, who cares more about her experience than whether your baby lives or dies?

As Dr. Romm, pointed out, “anyone can get “the calling,” attend some births, and call herself a midwife.” So take Aviva’s advice, caveat emptor, and choose hospital birth. Whatever the failings of the hospital may be, at least the professionals there care about whether you and your baby live or die.

  • Captain Obvious

    Apples and oranges. BBC has a thread from the crunchy NUCB VBAC/HBAC types condemning the risks of cesarean by using a newspaper post of a maternal death after CS. Even Haleysmom1 comments (remember her telling a GDM mom not to induce only to end up with an ante partum stillborn). I can’t figure out what their alternative would have been? Should she have tried delivering at home? We all know CS has risks, and sometimes it is the reasons you’re doing the CS that contributes to those risks. This 39 year old women had twins that went into preterm labor at 27 weeks. The paper states she had a PE. We don’t know if it has a thromboembolism, air, AF, or fat embolism. I believe there are using this story to inform the rest of the dangers of cesarean as opposed to VBAC or Homebirth. An I missing something?

    http://community.babycenter.com/post/a48064117/trigger_warning

  • Sue

    And meanwhile, where are all the educative posts in the midwifery community about the significance of amniotic fluid volume, so that these disasters can be prevented?

    Any other profession would be saying something like ”If we want to continue to practice home birth, we need to work hard to make it as safe as possible. That means minimum qualifications and training, clinical practice guidelines, audit and review of outcomes….etc etc”

  • olivia

    Let’s be clear, MANA represents the USA only. I wish they would take “North America” OUT of their names. They do not represent us in Canada or those in Mexico or other NA countries. I don’t always agree with Ms. Tuteur, however, American midwives need to cleanup their act. It’s a disgrace. We all have our issues professionally, but it’s such a trainwreck in the USA as far as professional standards, scope of practice, and education standards are concerned. What a damn mess and a blot upon the professionally trained midwife’s name. Get it together or stop calling yourselves midwives.

  • vitaminC

    Holy crap. I’d rather have a horse doc than some of these midwives. Truly frightening.

    • Mishimoo

      I’d rather have a vet too, they care more about pain management and safety than these midwives do.

  • areawomanpdx

    For care providers who are constantly claiming to value “evidence-based” care, these people sure are reliant on anecdata.

  • CanDoc

    Yes, this. Exactly.
    And let the tiny bodies fall where they may. How many more until this craziness stops? That you, Dr. T, for refusing to be complacent.

  • Allie P

    “Your job is to inform, the mother’s job is to choose. Informed choice, people!” This is the midwife’s rallying cry. But this is how it shakes down in real life: the mother is in extreme pain and exhaustion, the family is clueless, they turn to the person they THINK IS THEIR MEDICAL PROVIDER for advice. She says, “well, there have been cases where this is the situation and it turns out fine.” (You know, according to some people I just asked on Facebook.) They reasonably interpret this as “it’ll be fine” and do nothing. Disaster strikes.

  • Mishimoo

    What I hear: A whole lot of guilty people calling intelligent people ‘trolls’ for saying that babies shouldn’t die due to negligence.

  • Hannah

    Off topic, but since this place is frequented by neonatal professionals I wondered what people’s views were on this:

    http://www.walesonline.co.uk/news/wales-news/tiny-rohan-rhodes-died-after-6740865

  • Alannah

    Could anyone link to the blogs and message boards where this incident is being discussed? I’m interested to see what’s being said?

    • lola

      I just put up a post in Big Issues Debate on Ravelry to see what the reaction is. I’m genuinely curious, since they’re super pro-homebirth there. In the past, when homebirth has come up (in my due date clubs), I’ve mentioned that people should be very careful when checking out their midwives (not saying not to homebirth, just to do a bit of background checking), and there’s been a huge backlash. I’m curious how they would react to something like this.

      • Jessica S.

        Yes!! I’m on Ravelry and I’ve witnessed that, too.

  • Votre

    I have a very modest proposal: Prosecute for manslaughter or negligent homicide. (Are there any State Attorneys listening out there? This is doable.)

    • Young CC Prof

      It’s doable if the baby was declared a live birth. And if the neonatal team worked that hard, there’s a good chance the baby was technically alive when drawn out.

      • Jessica S.

        Heartbreaking. Ugh. I can barely think about it without wanting to scoop my boy up and smother him with kisses until he succeeds at squirming away. 🙂

    • Anj Fabian

      Two cases are up this year:
      Judy Jones
      Rowan Bailey

  • Sara

    If any homebirth midwives are feeling traumatised after killing a baby here’s a self care two day love-in designed just for you! http://www.oregonmidwives.org/retreat/

  • almostfearless

    Abolish the CPM.

    1. In all 50 states certified nurse midwives can be your care provider, there is no need for lay midwives.

    2. Lay midwives or CPMs, use the term midwife but there is nothing medical about what they do. They only offer two services: catch your baby when you have an entirely uneventful birth or transfer care. The good ones transfer care on time. The bad ones wait until it’s too late. Neither are providing medical services — in some states just calling yourself a lay midwife is all the qualification you need.

    3. For people using lay midwives for religious reasons because they never intend to go to the hospital, then that’s an exception. A lay midwife is better than being alone, but it is not medical care.

    4. CPMs refuse to self-regulate because the service they are selling is not about medical care, it’s about avoiding medical care. They are experts in helping you avoid the doctor. That is their service.

    5. Most people shopping for a birth provider, whether OB, CNM or CPM, don’t know the difference between a lay midwife and a nurse midwife. We don’t have Doctors and Lay Doctors. The terminology is confusing. It needs to be abolished because when presented with the facts, most women would never choose a CPM.

    • The Bofa on the Sofa

      1. In all 50 states certified nurse midwives can be your care provider, there is no need for lay midwives.

      This is such an important point.

      Why do we even NEED CPMs?

      If you look at, you realize that the only reason to have CPMs is because there are some things that OBs and CNMs tend to not do.

      However, the reason OBs and CNMs won’t do them is BECAUSE THEY ARE TOO RISKY!

      So here’s the result:
      There are some things that are too risky for OBs and CNMs, and so we “need” CPMS, who are less qualified practitioners, to do them instead.

      Seriously, THAT IS THE ARGUMENT for CPMs!

      And it’s completely mental. Usually, when you have a more dangerous situation, you want better prepared people handling it, not less qualified!

      • almostfearless

        They are risk-enablers. They are comfortable with the two-faced “committment to safety” because they believe they are champions of letting women take risks in the name of choice — and they will hide deaths from the public to protect women’s right to take outrageous risks with childbirth. In a way, I get it, if someone wants to be reckless, it’s her body, her baby. The problem is that most women who chose them don’t understand what they are getting.

        • Mel

          Exactly! Most of their customers do not share their philosophy. But they aren’t aware of the significance if this divide.

    • Mel

      Number 4 really articulates the issue here. Someone think they are hiring a medical professional when whom they are actually hiring an anti- medical care. This philosophical divide is shamelessly exploited by MANA et al. I would suggest they encourage keeping their clients in the Dark reguarding what is essentially religious belief masquerading as education.

    • lola

      Canada DID get rid of the CPM credential. Yes, our midwives are all super woo-y (big on homeopathy, accupuncture, etc.), but since they’re regulated health care professionals, they can work in the hospitals, have relationships with OBs, and MUST transfer or risk losing their credentials.

      Of course, we also have Gloria Lemay, so can’t brag too much…

      • manabanana
        • AlisonCummins

          Gloria Lemay whenI feel myself getting drawn into dark places, I remind myself “Gloria, it’s only Facebook, you won’t remember any of this in a week.”

          No, it’s not just Facebook. That’s the problem.

          • Squillo

            I bet Jewel Voth still remembers her dead baby.

          • MLE

            Holy Smokes.

      • Zornorph

        You also inflicted Justin Bieber on the world.

  • I wish I could get all these home birth advocates in a room and ask them, what would it take for you to make some safety and accountability standards? WHAT WOULD IT TAKE?

    • Young CC Prof

      External force.

    • Amy Tuteur, MD

      They’ll never do it because only professionals have safety standards and they aren’t professionals. They are lay birth junkies who want to get paid for enjoying their hobby. Safety standards would interfere with their enjoyment.

      Never forget: this is all about the “midwives,” the patients be damned.

      • The Bofa on the Sofa

        I think MANA’s advertisement reads, “Midwives: all of the rights, none of the responsibilities”

        I mean, it could just as well be Lite beer

        • anion

          “Less safety!”

          “More death!”

          • The Bofa on the Sofa

            Too bad Rodney Dangerfield isn’t alive to do the commercials.

            Ob: Harold Ramis salute:
            “I collect molds, spores and fungus.”

            Sad, both Harold Ramis and Doug Kinney are gone. Such great writers.

          • anion

            I feel bad laughing, because I love Ramis and am so sad, but the image of Dangerfield delivering a baby in a birthing pool is just too amusing. Imagine the things he’d say!

            Or the lines Ramis could have written for him. 🙁

  • Alenushka

    This is so sad. I hope poor parents sue.

    • Susan

      It’s cringeworthy to think of what the parents might feel upon reading what the midwife wrote and how they have responded… or not.

    • guestopher

      Even sadder is that suing is practically impossible. They carry no malpractice or liability insurance. And it turns out DEMs are experts at hiding their assets.

      • sarahh.rosanne@gmail.com

        During a small speaking engagement for healthcare professionals and educators, a very prominent spiritual midwife of whom you have all heard was asked by a student nurse about liability concerns. She stated that “the women who come to us know that we don’t have anything to take. There is nothing to sue for.”

        • That actually gives me chills.

  • attitude devant

    Funny, I’m still waiting, in the wake of the MANAstats release, for them to come out against home vbac and home breech, since their own data show the death rates in those situations to be outrageous. But I’m still hearing nothing.

    And don’t forget, Melissa Cheyney, Oregon State faculty member and former chair of the Oregon Board of Direct Entry Midwifery has known about these deaths for YEARS and has done nothing.

    Caveat emptor indeed.

    • Staceyjw

      They are CURRENTLY pushing legislation in 2 states to EXPAND their scope, to include these very things. And this is after seeing the stats.
      They simply do not care.

      • Karen in SC

        Is that in AZ and Hawaii? Any other states?

        If you live in those states, you can ask the state League of Women Voters to take on the issue. The organization will study both sides and publish a position paper that goes out to their membership. They also organize debates, usually among candidates. This would be a good topic for local section meetings.

        I am a member and happy to suggest this as a program if SC is one of those states. Our Representative did sponsor a bill against CPMs but I think it did not get anywhere.

    • MaineJen

      Seriously, what were the stats on home breech again? Something truly horrifying. Yet we have heard crickets from MANA as far as recommendations.

      • Young CC Prof

        5 deaths and 3 “unknown” out of 222 births. Incidence of low APGAR, HIE, other birth injuries, maternal PPH or severe laceration was not reported.

        Because the kind of midwife reckless or illegal enough to attempt a home breech is the type to run when 911 is called and not even bother to find out what happened later.

        • AlisonCummins

          They know perfectly well what happened to those babies. They just don’t want to admit it.

          • Jocelyn

            This makes me so angry.

        • Hannah

          Or to put it another way, that’s 1 in 44 of all known outcomes. That’s not a good figure.

          • MaineJen

            And these are *self-reported* stats. Meaning they didn’t capture all the data they could/should have.

    • Sue

      ”I’m still waiting, in the wake of the MANAstats release, for them to come out against home vbac and home breech”

      But they didn’t set up the audit to improve safety, they set it up to show how safe it ALREADY IS!