Jan Tritten crowd sources a life or death decision and the baby ends up dead

Jan Tritten 1

Jan Tritten is the Editor of Midwifery Today, the “journal” of homebirth midwives.

I’ve never had anything other than contempt for her, but now she’s taken it to a new level.

All the while she was busy crowd sourcing a life or death decision for a 42+ week baby with no amniotic fluid on ultrasound, the baby was dying.

What would you do? Primip with accurate dates to within a few days who has reassuring NST at 42.1weeks, as well as reassuring placenta and baby on BPP, but absolutely zero fluid seen. 42.2 re-do of BPP and again, mom has hydrated well, but no fluid seen. Baby’s kidneys visualized and normal, and baby’s bladder contained normal amount of urine. We’re in a state with full autonomy for midwives and no transfer of care regulations past 42 weeks. Absolutely no fluid seen…what do we truly feel are the risks compared to a woman whose water has been broken and so baby/cord has no cushion there either. Cord compression only? True possibility of placenta being done although it looks good? Can anyone share stories/opinions? …

Many of the suggestions are appalling:

Wanda Smith Midwife absolutely no experience with “0″ fluid, but have had two go quite over with very low fluid (under 5), one was 18 days over, quite uneventful home birth, and one was 19 days over with heavy mec and true knot, that did give a us a little trouble, but she stilled birthed vaginally

Christy Birthkeeper Fiscer Fluid level readings can, and often are highly inaccurate at this point… yet often used now as indication for intervention. Can you FEEL fluid during palpation, or does baby have a “plastic wrapped” feel?

Erika Laquer Try a very good acupuncturist and midwife-friendly

Zuki Abbott-Zamora I would respect leaving things alone, and just because you cannot ‘see’ fluid does not mean there is none. I have seen babies come with as little as a tsp of fluids and be just fine.

Mary Bernabe Leave her be. I’ve had 3 bbs like that and all were just fine. Didn’t know till the birth though. All 3 were out of water births so I know for sure there was no fluid. Bbs did great and so did moms. Placentas were normal and healthy looking. She’ll go into labor when it’s time.

Has she tried stevia to possibly increase the fluid?

Lynn Reed what Zuki said:) Trust mom’s instincts too & who made up the 42 week law? Midwives or OBs scared of litigious times & distrust of mom’s owning their births

Jennifer Holshoe try a 1m dose of Natrum Muriaticum homeopathic to balance fluid levels. I have seen it work with one dose

There were other, reality based suggestions as well, including the recommendation to transfer care and induce.

And while Tritten and the rest of the midwifery stooges were contemplating reasons for ignoring the obvious signs of imminent death, the baby actually died.

Jan Tritten 2

Very sad? Very sad??!!

How about horrifically tragic and utterly preventable?

How about the completely avoidable result of mind boggling ignorance?

How about medical malpractice and criminally negligent?

Homebirth midwives are dangerous, witless fools and babies die as a result.

The CPM “credential” must be abolished and Jan Tritten is a perfect example of the desperate need to do so as soon as possible.

  • katt

    I had a midwife and I almost had my baby in the toilet and I told her the baby was coming but she told me to be quiet she was trying to find a heartbeat. well my sister grab my Iv I got on the bed one push she was out. my sister had a midwife and she told her she was fine. well she wasn’t the baby was stuck in the birth canow and she had to go get a c-cection they rip the top of her bladder off and what was suppose to take 2 hours took 6. when I went to see my sister she was very swollen and she and the baby was yellow. the baby had bruises on her hands and her head. my sister came home with bag to pee in and I went everyday to change her dressings. went back to the docters office and she got infection from all that and the reopen her c-cection. From my point view go to a regular ob docter. midwifes aren’t good if you have problems.

  • Ann

    “Homebirth midwives are dangerous, witless fools and babies die as a result.” I understand why you feel this way, but these kind of sweeping, vehement comments are no help to mothers like me as we navigate this issue and try to make an informed decision about how and where to birth. I can find similar caustic but unhelpful statements on either side of the debate. Rather, I would have like to have heard you say what would have been different had the mother received standard medical care (doctor/hospital.) Would standard care have known the baby had aspirated on meconium? How? And then what would they have done differently? I suspect many mothers find your website, when, like me, they are looking to make an informed decision. Having read many of your articles, I would encourage you to include explanations of what a doctor in a hospital might do differently in each of these different situations. It would be helpful and so appreciated!! Thanks!

    • Bombshellrisa

      For starters, the OB and RN staff would NOT have jumped on Facebook if they were trying to come up with a diagnosis. The midwife mentioned in this article was one who was on probation in another state for practicing as a midwife without a license. None of the remedies suggested by the group on Facebook have ANY value medically (stevia to increase AF?).

    • Trixie

      I’d encourage you to read through the Facebook page the mother of Gavin, the baby in this story, set up. Read about how her CPM midwife, Christy M Collins, lied to her, caused her baby to die, and then covered it up. Christy might have been successful if not for this blog.

      Then come back and let us know if you think Dr. Amy was too “caustic” in her assessment of the situation. https://m.facebook.com/GavinMichaelBrooks?_rdr

      This video also has more information: Home Birth – Not Buried Twice campaign: http://youtu.be/CRhkZKUNyMY

    • Karen in SC

      I’m not an OB but will try to answer your questions. Most OBs have a policy to induce on the due date, or at 41 weeks. After the due date, biophysical profiles are conducted often and when there is a “fail” (as in this instance), there would be a recommendation of induction or even straight to a c-section. In some instances, like high blood pressure or gestational diabetes, earlier induction or c-section may be recommended.

      When born, if there is mec present, the baby can be suctioned and/or resuscitated by a full team. Antiobiotics can be given. My baby had mec and a low Apgar; as I was pushing a pediatrician and others arrived to be ready for him.

      You can also ask your OB these questions. He or she will be able to answer based on your individual health history. Many midwives believe that a homebirth is always possible. They can’t do a full neonatal resuscitation, they may not even have anything but a tank of oxygen. Some homebirth tragedies contain the detail the midwife had a tank but it was empty, or still in the trunk of her car. If you are considering a midwife please read more, especially on Safer Midwifery for Michigan, What Ifs and Fears Welcome. Both have written a list of questions to ask a midwife.

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  • Ash

    Could this post be updated with the full screenshots of the FB thread? There are a few in the comments but I don’t see the full screenshots. People must know the appalling extent of this past thread.

  • schnitzelbank

    I have a colleague in Germany that birthed with midwives in a hospital there. They let her (primip) go 42+5, and three days labor. I was cringing with every Facebook update. She finally birthed a 10lb 11oz baby. Thanks given that they are fine. But I can’t imagine how awful she must be recovering from that. The baby looked in those fresh-newborn photos to be a month old already- robust and very alert. What a scary birth…

    • MrsHmmz

      I find it very odd that you see a baby being “robust and very alert” as a bad thing?! I had a similar experience with my most recent birth, I was 42+4, long (but not “scary”) labour, and my baby was 9lb 11oz. I have never met a newborn who was as alert & healthy looking as my daughter, she was very mature for a newborn but didn’t appear in any way to be “overcooked”; she has since gone on to be ahead of all of her developmental milestones and is an incredibly healthy child. It almost feels like it’s given me a new baseline of what is “normal” and I’ve begun to question whether in fact most babies are premature! Of course it’s easier to birth a tiny little runtling but personally I’d rather work a bit harder to push out a healthy & “robust” baby.

      • anion

        Wow.

      • Andrea

        Lol!!!

      • Amy Tuteur, MD

        So let me get this straight: You put your child’s life at risk and managed not to kill her and you think we should be impressed?

        You’re joking, right?

      • Stacy21629

        I find it very odd that you see a baby being 42+4 as, meh, no biggie.

        Mothers that wait that long also stand a higher chance of “working a bit harder to push out” a dead baby.

  • Sarah

    Just wanted to share my experience. I went 41&4 with my son. I was dilated to 4cm and 90% effaced for three weeks. I was with a midwife practice. No one seemed to be worried about anything or expressed concerned for go over dates. I was getting more and more uncomfortable, but the earliest I could get a scheduled induction was 41&5. My son decided to come before then on his own. Thank goodness, too. He passed mec in the womb, but was still healthy and didnt experience any complications. However his head was in the 98th percentile, and that caused me some issues. Now that I’m pregnant with #2, I have a doc this time and we’ve already talked about inducing me on my the EDD. It scares me to think what could’ve happened! And how could anyone trust a provider who has to go to facebook and ask a community questions about my care?!?!?!

    • anion

      Oh, I’m so glad your story has a happy ending! I was reading each word with mounting dread. SO glad it turned out well and you have a healthy son. Congrats on #2 and best wishes for a healthy pregnancy and safe, easy labor!

    • MrsHmmz

      It’s funny how a simple shift in perspective can alter our entire perception of what happened. I’ve heard stories very similar to yours from both ends of the spectrum; some reporting them as wonderful “success stories” and others like you who worry about “what could have happened” and see the fact that there weren’t any problems as merely a stroke of luck.

      Good luck with your next birth; I assume your care provider has discussed the possible complications of induction with you and that you are comfortable with taking that risk?

      • anion

        I think it’s clear from pretty much all science-based evidence that the fact that there weren’t any problems was indeed a stroke of luck. We know for a fact that the risk of fetal death rises sharply with every week past forty. We know for a fact that mecomium can cause serious problems for the baby. We know for a fact that the size of Sarah’s baby’s head caused her some problems with delivery, and that large babies in general tend to have more difficult deliveries, and that longer pregnancies can tend to produce larger babies. You’re commenting on a post about a baby permitted to go 2 weeks overdue, who did not survive–doesn’t that illustrate the seriousness of the issue right there? Are you really, seriously commenting on a post about a baby’s tragic death to argue that going postdates results in “success stories” so it’s just paranoid to see Sarah’s story as lucky, and also, “I hope you know how risky induction is because you sound kind of careless about it to me?” Implying that going postdates is better and safer than being induced, when induction would likely have saved this baby’s life?

        It sounds as if you’re saying Sarah is wrong to feel lucky, and that she’s just being a worrywart. But the mere fact that those overdue pregnancies of which you speak are called “success stories” instead of just “birth stories” acknowledges the risks. To use a different example: the only way my waking up in the morning is a “success story” is if there’s a very real risk that I may not wake up. I succeeded against the odds.

        Re induction, what risks and complications are you speaking of?

        • Karen in SC

          Risk of a c-section resulting in a healthy baby! Oh the humanity!

          Of course, c-sections have some risk, but are less risky for the baby, and should be done when the risk is lower that the risk of doing nothing.

          • anion

            Yep, that’s what I suspected. Because c-section is the worst thing that can possibly happen, and is a poor outcome all by itself.

      • Captain Obvious

        Inducing you at 4 cm would practically be a slam dunk for success. MrsHmmmz, you do realize the risk of failed induction is merely for FTM with a closed cervix. Please elaborate.

      • Stacy21629

        Seriously? “The possible complications of induction”? Being what? A C-section? How horrible!

        You realize a possible complication of post-dates is stillbirth right? A dead baby? And a possible complication of a 9-11 pound baby is shoulder dystocia? Another dead baby?

        Glad you’re so eager to err on the side with more dead babies. I’m happy to be on the abdominal scar + live baby side, TYVM.

        • Naji Wench

          Because no mother or baby ever dies from an emergency c/s after an induced labor (wait..I almost did!)

  • Greg

    This is sickening. In browsing this blog for the first time tonight, I can say that I don’t necessarily agree with how Dr. Amy chooses to verbalize her posts but she is within bounds in this case. I respect her passion.

  • Allie P

    “Nothing Good Happens After Forty Weeks.” That’s what my OB said to me, and induced at 40w5d. Baby was born with dry extremities, but otherwise A-OK. I know the NCB crowd is fond of saying babies aren’t library books, but that’s no reason to procrastinate.

    • NoLongerCrunching

      Library books dont DIE i increasingly greater numbers the longer you wait.

      • Dr Kitty

        Ask an NCB person if they are comfortable with 43w or 44w…

        They certainly DO believe that babies don’t cook indefinitely, they’re just much more laissez faire when it comes to a deadline.

        Despite plenty of evidence that 41+3 is a perfectly sensible deadline. EBM only suits them when the evidence says what they want it to say.

        • Karen in SC

          Birth junkies do “induce” – with castor oil smoothies and other non-science techniques.

    • Ceridwen

      My doctor said exactly the same thing. I got lucky and it was a non-issue since I went into labor on my due date but we’d have scheduled the induction at my 40w appointment if I hadn’t. Despite the library book crap I constantly see from NCB people I’ve seen no evidence that supports waiting around when dates are known with a reasonable degree of certainty. And in my case I had a my FAM charting, an ovulation test, and several early ultrasounds that all agreed exactly on my due date.

  • Lisa from NY

    Poor mother.

  • Maria Klein

    It is possible that she had a smartphone ultrasound attachment. They are about $7500.

  • CDN Midwife

    I am usually a lurker, and enjoy reading what Dr. Amy, and all you commenters have to say. I feel like I need to comment on this – for the love of god, how do you consider a BPP to be “fine” with an AFI of 0 (I am assuming it was 0 since the “midwife” indicated no fluid seen)? Had this mom and baby been in my care, I would have taken them to the hospital (where I have privileges because I am a real Midwife), where I would have consulted with OB and induced because of low fluid. They would have remained in my care unless another complication arose, again, because I am a real Midwife. It makes me shake with anger that these “midwives” are allowed to take care of moms and babies. I hate that these poor excuses for midwives are able to run around killing moms and babies, and making a bad name for those of us who took the time and put in the effort to be properly educated. It infuriates me. There. End Rant.

    • Guestll

      I delivered in Ontario with RMs. I was allowed to go to 41+5, and I was a month shy of 40, 3 prior miscarriages, narrow pelvis, first term pregnancy with an IVF pregnancy. My primary was all for letting it happen “naturally” with a homebirth, even though I was 5 cms/100% effaced for a week with a large, posterior baby. My secondary wanted to induce. The senior RM played the dead baby card, and my daughter arrived 9 hours after AROM (no further augmentation).

      It wasn’t until the senior RM explained to me exactly what was at stake that I saw the full picture. Nobody had bothered to let me know how risky this was. Had I known, I would have induced in week 40. I had great BPPs/NSTs, and my daughter was born with dry skin, long nails, skinny and long, lots of hair…and a placenta that was giving up the ghost.

      There needs to be a better standard of care up here, too. It’s not the disaster it is in the US, but the woo is creeping and it needs to stop.

      • Dr Kitty

        You were 5cm post dates for a WEEK!
        That seems…not so sensible.
        Not even a membrane sweep?

        Obviously, I’m the least crunchy, lemony-ist lemon, but I’m actually pretty happy that various factors mean that any future pregnancy I have will be considered too high risk for MW care, and that a CS will be the only sensible delivery option.

        • Guestll

          I had 4 sweeps, they didn’t work. Cervix was still posterior, they tried to “walk it down”, no dice.

          In addition, my BP, which was 100/50, normally, went up to 140/60 at the end, but since that didn’t meet the criteria for pre-e, and nobody asked, I didn’t know that the blurry eyes I was feeling (like a contact that had slipped) were not the result of spring allergies.

          As I said, primary RM was wootastic. Second was not, and when she took over my care at 41+4, she brought in the senior RM, which the primary had not done. I delivered the next day, and from what I now understand, primary RM had to meet with senior RM to discuss how my care had been managed (also to include telling me when GDM testing rolled around that “I will eat broken glass if you have GD” by way of saying I should skip the test, since I was thin. Because we all know thin women never, ever, ever get GDM.)

          Standard of care. There is one — SOGC is quite clear on postdates and induction offered at 41 weeks. Never happened in my case, not until my primary RM cycled off my care.

          • fiftyfifty1

            Sadly it’s not just CPMs who are ruining the good name of midwives…

          • Dr Kitty

            In what world is a systolic 40mmHg above baseline/140mmHg not atypical pre-e?

          • Guestll

            Primary RM asked only if I had a headache and was feeling unwell. I had no headache and other than tired, I felt fine. Nobody asked me about any other symptom, until primary cycled off my care. When secondary took over, and took my BP, that’s when she called in the senior. I delivered the next day — I would have delivered that day, except there were no beds available at the hospital.

            Since I had no other symptoms, according to primary, she wasn’t worried. See how that works?

          • Courtney84

            I felt totally fine, with the exception of a few shorts vied headaches when I found out my BP was 160/100 (I was induced a couple hrs later, 39+6) I had no idea that how “well” one felt subjectively was more important than what their BP is factually… Seems odd no one was concerned you had PIH or pre-e.

          • L & D RN

            In a world where it’s gestational hypertension? I’m not saying she wasn’t pre-eclamptic, but you can’t diagnose it on one BP of 140/60

      • CDN Midwife

        Oh my. I’m really sorry that happened to you. I guess it goes to show you that there are bad care providers and good care providers. You are correct, the woo definitely needs to be stopped!

        • Sue

          CDN midwife – why is it that we don’t see more of the professional or academic organisations of competent midwifery condemning these practises, setting standards of care and guidelines, and calling out the under-trained and the rogues?

          Why don’t your organisations lobby government and the regulators for minimum standards of care and training?

          • hmm hmm

            Appalled today to learn that one of the co-authors on the Cheyney study is a UBC faculty member, and UBC communications have been promoting this duplicitous study. It is so easy to assume that we have it solved in Canada and that this issue is worse in the US, and yet….

      • Desiree

        “my daughter was born with dry skin, long nails, skinny and long, lots of hair…and a placenta that was giving up the ghost.”

        Mine too. Only she was born by emergency c-section because she couldn’t tolerate labor. I think I’m one of those women who might have been able to avoid a c-section if my OB didn’t wait until 10 days past my due date to induce.

      • http://thefresstyler.blogspot.com/ Hannah

        Yup, this is happening in Australia with midwife-led care in hospitals. The amount of woo that is going on in HOSPITALS is really quite scary.

        I have a acquaintance who is a midwife in a Sydney hospital and she tried to tell me that it’s such a shame I am going with an obstetrician in the US, because OBs have ‘such a high rate of intervention, you are so much more likely to have a CS and an episiotomy’ and that they always ‘ruin births’.

  • Rochester mama

    I can’t help but think of the mother and wonder what she is like. Was she misled by current pop culture and celebrities bragging in People Magazine about their amazing home births, or was she knee deep in woo herself? I only know one “friend” from high school that has had a home birth (3 or her 5 kids). And while I hope if any of her future births go south she heads to the hospital in time, but I could easily see her waiting too long. Last summer she drove five extra hours to go to an ER she considered more accepting of alternative medicine when her son broke his arm climbing trees. Who let’s their kid sit in pain any second longer then they have to? She doesn’t vaccinate and homeschools. The only other person I know who has attempted homebirth is a current CNM student that ended up with a hospital induction at 41w4d because her blood pressure went sky high. I think she was just doing it for bragging rights.

    • Gene

      A parent who drives to an ED five hours away from home when their child has a broken arm is a HUGE red flag for non-accidental trauma (aka: abuse). And WTF does she think the “alternative” treatment for a fracture is?? Singing to the bone and wafting incense to help the fracture set better??

      • anion

        Cover it with seaweed?

        • Sue

          Definitely Arnica, 30C

      • Rochester mama

        I put friend in quotes because it’s someone I haven’t seen in person since high school and only interact with on Facebook on rare occasions.

      • An Actual Attorney

        I would hope that would be tops on the list of things to look at for the ER docs.

      • Anj Fabian

        Dunno about mandatory reporting, but if there are geographical limits on reporting or information sharing, she might have been attempting to get out of range of the local reporting system.

        Maybe one incident won’t trigger an investigation, but if this was another incident in a series…

      • Mishimoo

        Homeopathic comfrey drops, perhaps?

      • Allie P

        Yes! I can’t imagine the side-eye the parent got. They have to put their home address on the forms! Unless she made up some story about how they were away on a trip, and even then… Geez, and I thought I was nuts for going to the hospital 20 minutes away instead of the one 5 minutes away when I had my baby because that’s where my OB practiced.

        • Young CC Prof

          Yeah, I think the staff can tell the difference between a fresh injury and one that happened 6 hours ago and is now massively bruised and swollen. ARRG.

      • Jessica S.

        Stevia!

  • LMS1953

    Jan Tritten’s FB page says she lives in Eugene, Oregon. The post is confusing as to who wrote it. It makes reference to practicing in a state that has unrestricted CPM attendance to home birth. What state is that? Oregon? Her FB page has an alert that Arizona is trying to pass an emergency law to establish restrictions. How can we make sure that the legislature of the state where this tragedy occurred is aware of it. How do we demand that the crunchy reps respond to it and explain their disregard for public safety?

    Finally, by BPP, I presume she means a Biophysical Profile which requires an ultrasound and a fetal monitor if you want the complete 10 point scale. The label on the back of the ultrasound machine says it must be used under the supervision of a physician. How can a CPM order an OB Ultrasound. Are they done in free standing facilities? Or in the hospital Radiology Dept? What culpability do the radiology tech and radiologist have in this matter? Zero amniotic fluid is a contraindication for continuing a pregnancy at 42+ weeks. Is there a role to obtain an emergency restraining order since mom clearly poses an immediate “danger to herself and/or others”? And corresponding culpability if a physician does not?.

    • Anj Fabian

      The ultrasound confused me. If it was done by an experienced, qualified person – then what facility does US without a doctor ordering the test?

      If the doctor orders the test, they most certainly will want to know the results in order to make their care decision.

      • Anj Fabian

        Here’s the wikipedia ( I know.) entry on BPP.

        for a BPP score of 8, which is as high as is possible with low amniotic fluid, the recommendation is for induction if low amniotic fluid is found.

      • LMS1953

        A boutique strip mall 3-D ultrasound charade would be more than happy to do it.

      • Maria Klein

        It could have been a smartphone ultrasound attachment.

    • DaisyGrrl

      Quick overview of this thread to help catch you up:

      The facebook thread got deleted sometime last night. Jan posted a followup saying she was not the midwife in any of the cases on her page, but didn’t specifically disavow her involvement in this mess.

      Since Jan has claimed she is not the midwife in question, it could have happened in a number of states. Oregon allows unlicensed lay midwives to practice without restriction as long as they inform their patients that they are not licensed and they don’t advertise their services.

      As for the BPP, I think the current theory is that the mw got her hands on a US and preformed the test herself. Because seriously, what actual professional wants anything to do with that?

      This thread? Lots of rage at the midwife and concern that the mother had no idea that her baby was in danger because she hired an ignorant loon to attend her. Astonishment that the facebook post lasted as long as it did, but not surprised the deletion happened. Rage Rage Rage. And swearing. Lots of swearing even from the normally mild-mannered posters.

      • LMS1953

        Daisy Girl, thanks for the concise synopsis!

        I can imagine that a CPM might have an “in” with a free standing radiology center – frankly those guys will do anything for a buck. If the CPM got her hands on an USG machine, then she is clearly practicing medicine without license. If she somehow ordered the BPP and acted upon the results, then that is likewise practicing medicine without a license.

        The boutique 3-D ultrasound strip mall shops have been condemned by ACOG as there is no medical indication for such memorabilia, it is a misallocation of money, time, expertise and equipment. I found that many patients had absolutely no problem coming up with $300 for the bells and whistles of a 3-D sonogram while they were on Medicaid – which paid me all of $700 for the delivery.

        • Amazed

          Jan Tritten is an illiterate loon. She’s a bloody editor of the damned magazine midwives cherish most. I would expect that she’d be able to make it possible for readers to understand who she’s taking about – another midwife or herself. At least that. But no, not gonna happen. She can now write whatever she wants, and we’ll still never get the truth. An illiterate loon. Oh, and a “midwife” in retirement.

          Now, I also make my living from working with texts and I often cringe at reading my hastily written replies in the net. But I can swear that I am usually able to make people understand me just fine, even if past tense hates me.

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

            I can’t remember what your native tongue is, but is it one that does not use past tense? I was reading about how much that changes language just last week.

          • Amazed

            We have a past tense – several, in fact – but they are quite different from the English ones. The problem is that when I write my posts, I usually do it fast, without thinking and without proofreading – too much of that in real life. When I post in English, my past tense and some other details go off the rails.

            Even so, I think my posts are more readable than the garbage Jan posted. Ever heard of quotes, citations, commas, and other stuff, Jan the Editor? They do exist, I assure you.

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

            Infinitely more readable. I was shocked to learn you were a non native speaker!

          • Amazed

            I am a translator. I should be brilliant with English. Well, I am not. And I am faaar from brilliant in my online writing. But people get my meaning. Plus, when I come across names and phrases in a third language in my work, I don’t ask colleagues who don’t speak it what they think it might mean. I ask the ones who do and know. It’s quite simple, really, and I am quite pissed off than Jan and her fellow incompetents can’t grasp the concept.

          • An Actual Attorney

            Amazed, I wouldn’t have known you weren’t a native speaker. I’m so impressed. Plus, you understand commas. That is far beyond Jan. But, some commas weren’t meant to come pageside, I guess.

          • Playing Possum

            “some commas weren’t meant to come pageside”

            I lol’ed at this. The dog heard and came running to see what was so funny. I thankyou for my daily laugh.

          • Amazed

            Poor commas. You made me laugh heartily.

            Right, They weren’t meant to be. And quotation marks are a tool of Teh Man who cursed people for all eternity when out great-great-17-times-great grandfathers had the audacity to demand that reading should be for everyone, not just the Church.

          • Guestll

            Thank you for my first real laugh in over 24 hours. :)

          • schnitzelbank

            You have to simply trust that the verbs know what to do. If left alone, they will conjugate with reliable subject-verb agreement, tense and aspect. It’s only when the verb begins to doubt itself, that we see the cascading linguistic interventions: the gerunds, the dangling modifiers, and finally the dreaded linguist himself, slashing with his red pen.

          • guestguest

            Oh but that is how only people who have been brainwashed by education think an editor of a magazine should communicate – language has become too prescribed nowadays, there are too many unnecessary punctuation and pronunciation rules, our ancestors used to be free of such interventions and they were able to communicate without any problems! You must trust your language and free yourself from all that evil grammar, and the best way to achieve this is to hire a Certified Professional Teacher to empower you and reclaim your natural language through a healing illiteracy course.

            (Yes, I am being sarcastic – taking part in all of this has eaten up all of my reserves of niceness and good manners.)

          • Anj Fabian

            Why is a retired midwife writing about midwifery?
            How can she possibly stay current with the changes in modern midwifery?

            Silly me. There are no changes to keep up with, no changes in the scope of practice or standards of care (because they don’t have any) or any change in the care protocols (because they don’t have any).

          • Amazed

            Yeah. It’s a win-win situation for Jan and midwifery!

        • Ash

          From a quick Internet search, I found a facility run by “naturopathic doctors” in Portland, Oregon that offers a birthing center, “advanced IV nutrient therapy”, ultrasound, and some other whackadoodle services. From their website it appears the only staff are 4 NDs. It could be that the ultrasound was performed at a similar facility.

          • areawomanpdx

            Yes, NDs and chiros often offer this sort of service. That way, you never have to see a real care provider. Plenty of labs will do their blood work, too, if they order it in order to fool unsuspecting patients who think they are getting real midwifery care.

          • KarenJJ

            Scary…

        • Staceyjw

          3D/4D sonograms can be as low as $75. Often moms get these from relatives or friends as a shower gift, but even if they saved up and paid? SO WHAT. This doesn’t mean they don’t qualify for Mediciad.

          In my state you can make $500/wk+ and still qualify, so it’s not outrageous for mom to have a little money for this keepsake. Do you get mad when someone on SNAP buys a steak too? Is it mandatory they spend their little cash in a way you approve of?

          Please keep in mind that the patient has no idea what Medicaid pays you, and the cost of a birth is a lot, even if you don’t get much of that. If you don’t like the reimbursement, talk to the politicians in your state. It’s not Moms fault you get paid what you do.

  • aster

    They deleted the thread, finally.

    • Guest

      “Finally”? They deleted it because they’re being called out for their reprehensible negligence and can’t handle it. They’re cowards.

      • aster

        By “finally” I meant I was surprised they let it go on as long as it did since A) a majority of commenters were furious at them and B) they had the ability to make it all go away. They don’t exactly seem like they’re interested in “feedback” on how to modify their practices or beliefs.

        • DaisyGrrl

          I think that Jan must have been away from her computer (and phone?) for the day. There’s no way she saw everything unfold over hours and did nothing to stop it.

  • Durango

    I hope anyone planning a home birth sees this. And maybe gets a chance to see the FB comments on Tritten’s page (before the comments get deleted). I can’t believe how the midwives have just closed ranks, all the while crowing “you weren’t there, you don’t know everything” or “it’s the mama’s choice, people!” Of course it’s the mother’s choice, but she must understand the risks! And if mom is refusing to transfer, why ask Jan (who absolutely was involved, even if she wasn’t the midwife hired by the mother) whether or not to transfer?

    Thank god for these threads and for all the screenshots–people accuse Dr. Amy of making things up, but seeing what the midwives themselves say is shockingly eye-opening. I can’t believe I ever fell for their ridiculous shit.

  • Captain Obvious

    Dr Amy should offer her services for this documentary of Homebirth on Maui.

    http://community.babycenter.com/post/a47997493/documentary_-_home_birth_in_maui

  • attitude devant

    I’m always fascinated by how badly the midwives behave in these exchanges: editing posts, making assertions they later deny, deleting and banning. Speaks volumes about intellect and ethics.

    BTW, Jan has posted to say that she was NOT the midwife caring for that mom. And we have another thread with over a hundred posts. All the usual suspects have turned up , except for Jessica Weed.

    • Captain Obvious

      Doula Dani caught that Rachle girl editing her comment after she posted a link to those 17,000 Homebirth deliveries, when she removed the “can’t argue with those numbers” after everyone was showing her the difference between the MANA press release and the actual data. Too funny.

    • manabanana

      I don’t think that’s what she said. Read carefully.

      “They are not my cases.”

      Ok, I believe that. But when Jan states “my hands feel nothing but baby,” I believe that, too.

      I believe that Jan Tritten’s hands were on that patient. She was not speaking in 3rd person, she was not using quotes – this may not have been “her case.” But it sure appears that she was ‘consulted.’

      No where is she claiming that she wasn’t involved in that care and demise.

      • DaisyGrrl

        I’m not sure what to believe. The way it was written, it’s reasonable to think she was involved. But her writing on that page is quite unclear and I can give her the benefit of the doubt on whether she attended this woman.

        What I can’t give her the benefit of the doubt on is the gross irresponsibility she displayed in posting the question in the first place.

        1) If she received it as a question in her inbox, the proper response would have been, “is this situation happening right now? The patient needs to go to the hospital immediately!” She doesn’t say she did that. She put it out there for discussion. If she did advise appropriately, she needs to be clear that she did so.

        2) This should never have been posted for discussion. It asks midwives wwyd? and what are the risks? Midwives have no business treating this patient because the risks are too high. The only right answer to wwyd is hospitalize. The risks? Who cares – they’re too high for a midwife to be providing primary care.

        3) Some people in the follow-up thread are trying to pin this on the mother and saying that she must have refused induction/transfer because the midwife would obviously have offered these options to the mother. Bullshit. If that were the case, the op would have been very different. Not asking “what are the risks?” but asking “how do I convince her to transfer?”

        4) Jan Tritten’s page – Jan Tritten’s problem. She wasn’t clear about whether the case was hers or whether this was an active appeal for help on an ongoing case. Both are reasonable conclusions based on her post. If it was a case study for discussion, then she could have posted that in her op and said something like: “I’ll post how things ended up tomorrow.” She didn’t. She could have been clear that it wasn’t her patient. She’s still not being very clear on that. She deleted the thread rather than address legitimate questions about who the care provider was in thread (I may have missed that part. I was asleep when the thread was deleted). She’s responsible for putting herself in a position to be viewed in such a negative light, so I’m going to go ahead and castigate her for being a moron.

        • Squillo

          Jan Tritten’s skills as a writer are equal only to her skills as a midwife.

      • MLE

        It doesn’t matter if it was her case or not, and it’s a distraction by her defenders to say it does matter. It was reprehensible either way, and she’s just as responsible as if she was there herself merely by entertaining such questions.

      • Squillo

        It doesn’t even matter if she was directly involved. If she didn’t immediately e-mail the midwife back to say that it wasn’t appropriate to post on her Facebook page but that the midwife should transfer care immediately, she’s complicit. As is every person that chimed in with helpful anecdotes.

        • MLE

          This is why I should politely wait while “one other person is typing.” It would save me some chicken pecks on my iPad.

        • AmyP

          Exactly!

          If somebody emails you saying, “My house in on fire. Could you post this situation for discussion with your readership?” it’s not responsible to go along with that.

      • http://safermidwiferyutah.wordpress.com/ Safer Midwifery Utah

        she seriously just seems to copy and paste whatever is sent to her. Some of the questions start with “jan will you please post this” or an equivalent. And again, no formatting. But yeah, she is responsible because she enables this idiocy as a leader in the industry.

      • areawomanpdx

        I think the colon in the report of the baby’s death represents where her words stop and the other midwife’s begins.

  • http://www.antigonos.blogspot.com/ Antigonos CNM

    We’re in a state with full autonomy for midwives

    You know, I’ve never wanted “full autonomy” without any restrictions, as a midwife. Up to a clearly defined point and in clearly defined situations, yes — but I know my limitations, and once they are reached, I want someone with additional expertise either supervising me or taking the case over from me. The impression I repeatedly get is that these women do not realize that they have ANY limitations — like someone who has flown a lot as a passenger, or maybe even taken a few flying lessons believing that confers the capability to pilot a 747 without any assistance.

    • DaisyGrrl

      This really bothers me too. As a lay person, how am I supposed to know if I’m getting a provider who knows her limitations or one who thinks she’s omnipotent? Midwives are supposed to be experts in normal birth. When the thought leaders are encouraging discussions about situations that are clearly high risk and abnormal, I find it difficult to have confidence in the profession.

      • AmyP

        “As a lay person, how am I supposed to know if I’m getting a provider who knows her limitations or one who thinks she’s omnipotent?”

        Anybody who practices alone (or with one other person) in people’s homes is pretty much by definition a Lone Ranger who doesn’t know their limitations.

        There, that was easy.

        (Although it might genuinely be different outside the US where the midwife was actually educated and plugged into the health system or where a midwife was the best care available.)

        • DaisyGrrl

          Well, yes. CPMs are right out. But the problem is that the groups of more professional midwives are not doing more to distance themselves from these crazies. The thought of “variations of normal” is prevalent in midwifery in general.

          I’m in Canada, and I wouldn’t use a midwife(even though they’re university trained, provincially regulated and well integrated into the system). There was a newsletter put out by the Ontario midwives where they boasted about attending a homebirth an hour away from hospital. If this is the kind of behavior promoted by responsible professionals, what would they consider borderline?

          • fiftyfifty1

            It’s sad that it has come to that, but it has. I had thought there were a number of good CNMs who practiced at my hospital. But then they, as a group, hired a real woo-filled idiot. This has destroyed all my trust. It’s bad enough that one out of ten of them is clearly woo-filled. That’s a 10% chance that she will be the one on call if you deliver. But also what does that say about the other 9? They may not be as influenced by the woo as she is, but then again they hired her. So maybe they are woo-filled themselves and just hiding it.

            Until CNM leadership formally denounces CPMs AND until they weed out the woo from their own ranks, I can not and will not recommend them.

          • DaisyGrrl

            I want to like and trust midwives, I really do. And I know that my distrust of the profession is on the more extreme end of the spectrum here, but I don’t see any way around it. While I won’t tell friends and family to not use midwives, I will tell them my concerns about the NCB philosophy in general and why I wouldn’t personally choose a midwife for my own care.

            Should I see change from leadership towards more evidence-based practice, I would happily change my opinion of the profession.

          • KarenJJ

            I think we are getting similar problems in Australia, with midwives being seen as a standalone career instead of a nursing specialty. There are university courses for direct entry midwives and the lecturers and academics are people like Hannah Dahlen and the Thinking Midwife woman teaching this crop of direct entry midwives.

            Women should be demanding that midwives have a nursing background. Pregnancy is one of the first times a healthy young woman comes into regular contact with medical people. Certainly I was found to have a rare immune system syndrome and another friend was discovered to have Graves disease. Sometimes “healthy” just means “undiagnosed”.

          • another midwife

            I’m a new graduate (CNM), and my program was consistently requiring evidence throughout all classes. We had to always have proper citations from peer reviewed journals that were no older than 5 years. If someone brought up a brewer diet, or magnesium baths or whatever, it was tore apart by the professors.

          • Medwife

            I have had the situation of being forced to hand off patients to OBs who I KNOW are known to have a pattern of bad outcomes in the OR. Known by the other OBs as such. I do not go around saying you can’t use OBs because some of them suck. I trust in the system to see the pattern and weed out the bad ones (with help from reports). Your bad CNM won’t last. Hopefully neither will my bad OBs.

          • fiftyfifty1

            1 out of every 20 OBs ranks in the bottom 5% of quality. Similarly 1 out of 20 CNMs is also in the bottom 5% of ability in her profession. The difference is that Midwifery, as a profession, also is infected with a philosophy of woo. That goes beyond just an untalented individual. It’s a systemic problem. I wish it weren’t.

      • http://www.antigonos.blogspot.com/ Antigonos CNM

        Midwives are supposed to be experts in normal birth.

        Actually, this is not the way I see myself, or the profession. I am an advanced practice nurse who has specialized in all forms of maternity care, working in conjunction with others in the field, including doctors and NICU nurses . I am licensed to deliver uncomplicated, low-risk women within certain parameters without involving other specialist practitioners, but I am ALSO qualified to take care of ALL obstetric patients with appropriate supervision. And indeed, outside of the US, the position of “registered nurse in L&D” doesn’t exist; L&D units are staffed with midwives, but they are not always the primary caregiver.

        In a sense, no one can be an “expert” in “normal” birth because it is impossible to know whether a birth is normal [I prefer the term "uncomplicated"] until it’s over. That is why one needs either to be an expert in everything, or in a position to get expert help immediately.

        • DaisyGrrl

          I think that’s a very reasonable way to see yourself. However, it’s not necessarily how midwives are promoting themselves in North America or elsewhere. The US obviously has a problem with CPMs.

          In Canada, we have L&D nurses in our hospitals. I don’t know the details about licensing and such, but they’re definitely nurses with baccalaureate degrees. Midwifery has become more mainstream over the last 20 years, but I know there is a greater demand for midwives than can currently be fulfilled (at least in my city). And they absolutely bill themselves as experts in normal birth. Ontario midwives say so front and center on their website: http://www.ontariomidwives.ca/

          And that’s the problem I have with midwifery. I’d trust you, Antigonos, to attend my birth because I’ve read your postings here and know that you’re cautious and know your limitations. But I can’t extend that trust to all midwives because there is a very strong NCB undercurrent in how midwifery is practiced in North America and I can’t trust university-educated midwives here to practice evidence based medicine as a result.

          • http://www.antigonos.blogspot.com/ Antigonos CNM

            An “expert in normal birth” is like being a pastry chef who gets a job fully catering a 8 course banquet, including choosing the wines.

          • NoLongerCrunching

            Where the banguet includes fugu, raw sushi, and steak tartare.

        • Comrade X

          Midwifery is a noble calling and a respectable profession. I have the highest respect for you, your colleagues, and the job you do.

          It is not us “raptors” here who “disrespect” midwives or midwifery. It is the stubbornly irrational woo-meisters, and, most especially, those utterly unqualified charlatans who have the brazen audacity to call themselves “midwives” when they are nothing of the sort.

          I really think we should all start to refer to CPMs and LMs as “midwives” rather than midwives. With scare quotes. Like you might talk about people who bomb clinics and picket funerals as “Christians” rather than Christians. I can call myself Henry VIII King Of England, but it doesn’t make it so.

    • MLE

      Recently the husband of someone planning a HB that Amy blogged about came here to defend his wife and brushed off the risk by stating that planes can drop out of the sky at any moment. Clearly anyone who thinks a plane can randomly drop out of the sky has as much knowledge about the mechanics of flying as they do about birth. It’s illuminating into their mindset.

      • Jessica S.

        Or that the risk of being killed by a plane randomly dropping from the sky is equal to (or even REMOTELY comparable to) a home birth death shows they are not seriously considering the risks.

    • Anj Fabian

      The obvious response to that is to use Raymond’s line from Rainman regarding air safety where he insists that he will only fly on the airline with the best safety record: Qantas.

  • Young CC Prof

    I was just looking through the rest of her recent posts. They’re all pretty horrifying, except the cute dog and baby one, which just looks bizarre next to all the others.

    My favorite comment so far, from a post about short cords at delivery and how they can (oh the horror) make it impossible to put baby on mom’s chest without cutting the cord:

    “Vijaya Krishnan Was just at a birth with a tight short cord around the neck. No restitution, no space to bring baby out, color starts to turn a bit dusky. Do not know if it was the right thing to do, but i asked for a little suprapubic pressure to help advance the shoulders, could then somersault the baby out. Baby lay on mom’s lower abdomen and pubic bone and needed some resus with bag and mask.. 1 min APGAR 5. But, i am convinced that the little extra bit of the pulsing cord transferring blood to the baby, helped with the resuscitation efforts.”

    It’s not just the disasters, it’s realizing how routinely they escape disaster by the skin of their teeth and how little it bothers them.

    • MLE

      It’s like driving your car to the store and thinking you’re Mario Andretti because you only sideswiped five people and got in a couple fender-benders. Hey everyone lived right?!??

    • http://www.antigonos.blogspot.com/ Antigonos CNM

      Especially when, if you have a cord around the neck very tight, too tightly wrapped to slip over the baby’s head, the best technique is to clamp the cord in two places and cut it between the clamps, unwind it, then quickly deliver the baby before hypoxia sets in [hopefully]. At least she knows what restitution is; I’ve seen too many midwives who obviously don’t.

      • Young CC Prof

        Actually, you know what bothers me most about this quote? I am not a medical professional. Let’s say someone was in danger and I was the only person around to help. I wasn’t entirely sure what to do, but I did my best, and the person lived.

        I think when it was all over, I’d want to learn more about whatever happened, find out whether I’d done right, and what I should do if I ever encounter such a situation again. I’d go do some library research! Apparently didn’t occur to her…

        • Comrade X

          ^^This.

    • Jessica S.

      And how they can actually lament about trivial crap like skin-to-skin opportunities and cutting the cord “early” in the same breath as, well – BREATHING! Newsflash: all of that trivial crap doesn’t matter if you have a baby that’s not breathing.

      It’s almost as it’s not so much the woo they believe, but how vehemently they refuse to accept time tested medical practices.

  • MLE

    Dr. Amy should take the screencaps and make them a post so they are immortalized. No comment necessary. The callous disregard for anything except preserving the privileges of midwives to act like renegades is so shocking even after so many stories like this that it speaks for itself.

  • Trixie
    • Squillo

      My irony meter just got all ‘splody.

      • Trixie

        My brain just got all stabby.

  • Action

    Makes me wonder about that BPP. Was the baby moving well because it was agitated and suffering? Awful, horrible, nauseating thought.
    To me, this case could really break open the case against CPMs, especially on the heels of the MANA study, and especially if people realize that this death will be counted as an M.D. Death.

    • Stacy21629

      Makes the OB CDC numbers just that much more amazing – because they contain high risk births, congenital defects, etc…and complete clusters like this and still manage to be incredibly low.

      I was at an event at an historic-farm-turned-environmental-preservation-center last week – there was a picture on the wall of the original owner’s wife and a story about how her first child died at birth (1860s) and was buried under a tree on the farm. Today she almost certainly would have had a live child, no matter the cause. Thank GOD for unnatural birth that I will likely NEVER have to bury one of my children.

    • Stacy21629

      She probably did the BPP herself with a used etch-a-sketch US at a “birth center”…nothing surprises me anymore.

  • Guestll

    Sadness/tears giving way to rage. Where are you tonight, o brave warriors of the 101st Internet Division? Where’s your flagrant ignorance now? Why aren’t you here, blathering on about the terrible rates of infant mortality in the US, the friends who’ve gone to 44 weeks and it was no biggie, and how babies die in hospitals too?

    Are you reading this, Jan Tritten? Your “It is always so sad when a baby doesn’t make it.” is akin to what I said to my husband yesterday when I killed yet another houseplant. You make me sick with revulsion, I have literally been sitting her for the past two hours listening to my little one breathe on a monitor and struggling with tears and nausea. You knew fucking well that baby was in trouble but you wanted to hedge your bets, so you asked for anecdotes — on fucking FACEBOOK! — to shore up the decision you’d already made on behalf of a mother who didn’t know any better and whose job it WASN’T to know. That mother was no religious refuser, no forest-dwelling off-the-gridder, she had BPPs and NSTs and she let her DEAD BABY be cut out of her the moment it became apparent that you were a mendacious, ill-informed, manipulative tool who didn’t have her or her baby’s best interests at hand.

    They worked on that baby for 47 minutes. Do you know what that would have been like? Nobody likes to call time on a baby who should have lived. They cared more than you ever did. You should resign your position at Midwifery Today immediately and never offer care or advice to another dyad ever again.

    • http://www.antigonos.blogspot.com/ Antigonos CNM

      Well, but if they REALLY worked on the baby for 47 minutes [who was counting?], had they finally gotten the baby breathing, the infant couldn’t have had too many functioning brain cells left. It doesn’t take 40-anything minutes for a skilled operator and team to intubate and connect to a ventilator, AND get an IV running [usually an umbilical line].

      • The Computer Ate My Nym

        I expect they kept working long after it was obviously futile. They had a big, beautiful term baby with no birth defects who had, by report, had a heartbeat, if “a bit slow” not too long ago. They wanted to believe that this one would be the miracle, that they’d be able to save him or her. It probably took 1 minute to intubate and set the IV, 5 minutes to realize that it was futile, and 41 minutes to get over the denial that made everyone keep going anyway.

        • Jessica S.

          I feel for that team. If ever there is justifiable rage, and I believe there is/should be, these people are justified.

          • KarenJJ

            Me too. Someone on that team really didn’t want to give up on that baby.

        • http://www.antigonos.blogspot.com/ Antigonos CNM

          I will give the midwife the benefit of the doubt that what she heard was fetal bradycardia, not the mother’s pulse, btw.

  • Mom in EUGENE

    OF COURSE she is from Eugene, Oregon. OF COURSE.

    We have a special brand of dangerous, careless, negligent HB MW here, and they export their bad ideas from the petri dish of woo, all over the world. This is the home of Missy “Dirty Liar and Baby Killer” Cheyney, and a whole cast of reckless, often unlicensed, MWs. You know the ones, they fight to keep their ability to KILL without penalty, and brag about the safety of breech and other high risk HBs. They have had too much freedom from accountability, for way to long, and its gotten to the point of absurdity.

    You simply cannot imagine how pervasive, and overwhelming, the NCB/HB culture is if you don’t live here. It touches every little thing.

    The MWs are as ideologically stubborn and often totally dangerous, as they are, in part, because of the large, vocal,”birth world” (aka, CULT) here. NO ONE in their group (s) dares to challenge them, mostly because if anyone even starts thinking anything other then “HB MWs are the best-ets ev-ah” they are immediately, thoroughly, shunned. You may be considered emotionally “unsafe” to be around, due to your opinion. So people stay quiet until they are hurt, then they are simply blamed, hated, and marginalized.

    Why do people put up w this? If you are a natural minded, crunchy person, and they hate you, you will be lonely. If you aren’t, you may be harassed or smeared via gossip. It is a smaller town, so if the “queen bees” think you are “unsafe”, you will have to make other friends stat. This is easier said than done, and is especially hard if you have been in that circle your entire life. Few people will lose everything to say HB may not be safe, or that post dates kills (etc).

    If you aren’t in the cult, they just ignore you, threaten you, harass you, and even SUE to keep their secrets safe (the MWs SUED a hospital for reporting their bad stats and deaths. REALLY.). They are blindingly ignorant, and totally unwilling to examine the evidence. This mix of zero rules for HB, and a community that won’t dare speak out even about the most egregious of actions, makes for a potent, deadly situation.

    Just how ignorant and cultish are the followers here? An awesome friend of mine lost an entire group of close friends, ones that she had for years, that went through so much together, because she of NCB. She dared to say (kindly sweetly, and with great tact and humility) that maybe HB isn’t as safe, or safer, but the straw that broke the camels back was a comment she made about Ina “Pussy button” Mae not being super awesome.

    Side note: THIS IS WHY WE DON’T GAF ABOUT TONE. It is irrelevant. You can couch the facts in fluffy terms, covered in NCB lingo about how this is simply YOUR opinion and personal choice etc, but you are hated just the same. If you are loud and brash, at least they bother to argue, and that means they LISTEN.

    Anyway, just wanted to let people that aren’t from the center of the woo-niverse in on why it is the way it is. It is totally relevant, as its this community that foments the types of personalities that crowd source a deadly topic, then poo-poo the death they inevitably caused.

    • Karen in SC

      Would it be of any value to send these words to the local and state newspapers, along with the quotations from Tritten? Usually, newspapers will post letters anonymously if requested.

      It seems like being against polygamy in places where the cult like groups live. Quite an uphill battle. There are organizations that help women and young men escape polygamy, maybe there needs to be one for women whose gut feelings are leading them away from birth junkies…

  • Stacy21629

    So it wasn’t “her” case…she just facilitated passing on the stupidity of a midwife she works with…and then consulted intrapartum when decels were present (read: MASSIVE delay of transfer in the face of obvious fetal distress)…so OBVIOUSLY (/sarcasm/) she is SO not to blame here…

  • areawomanpdx

    I don’t understand the point of deleting it at this point. Blocking Dr. Amy, yes. But deleting it only proves her right. And they have to know there are hundreds of caps out there…

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

      Several commenters explicitly stated that they had screencaps.

    • Anj Fabian

      It shuts down the discussion and removes it from her page.

      If someone wishes to post the caps and add keywords to the images, it should come up nicely when people use a search engine.

    • http://safermidwiferyutah.wordpress.com/ Safer Midwifery Utah

      I posted my screencaps on my website. I anticipated her deleting her other threads so I kept my tabs open. I’m gonna have a lot of screencapping to do today. Oi. http://safermidwiferyutah.wordpress.com/2014/02/21/a-preventable-home-birth-death-possibly-in-utah/

      you can click the pictures for larger screen caps if you want your own copy, for whatever reason.

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

        Just wanted to thank you, for this and all the work you are so diligently doing. I know we butted heads a few threads back, but it all fades away (for me) in the light of this horror. I am sorry if I hurt your feelings.

  • Ceridwen

    One thing that bothers me is how they all clearly interpret these questions as requests for advice and anecdotes, based on the initial comments. But the second someone points out that this is an incredibly stupid thing to do they get defensive and start claiming that the questions were just “requests for statistics” or that the midwives asking them had already decided on a care plan or the case was already resolved.

    It’s evidence that they know just how fucked up this all is and are completely fine with that until they’re called on it. It’s despicable.

    • Jocelyn

      I hope they all feel the burden of this baby’s death. I’m sure they’ll try to rationalize it away, and some will be able to shrug it off. But I have a feeling it will be lurking over the consciences of at least SOME of them for a long, long time.

    • DaisyGrrl

      I was just reading the follow-up thread and noticed that same thing. “Oh, it’s a case study. Don’t get your panties in a bunch!” Except that it was pretty clear from the follow-up comment that this was happening in real time. This was not a case study with outcomes known. This was an emergency unfolding in real time!

      The most crazy thing to me is that the ONLY acceptable response to the op question of “what would you do?” is “hospital now”. And aside from the midwives bemoaning that they’d never have a case like this because of transfer regulations in their state, only ONE midwife treated it like the emergency it was and said that the woman needed to go to hospital and be induced asap. And she was a CNM.

      The initial responses (homeopathy! acupuncture! stevia!) to what was an obviously emergent situation (whether a case study or an ongoing emergency) show just how fucking dangerous these idiots are. This wasn’t a variation of normal. It was a highly dangerous situation that no midwife has any business attempting to treat. The outcome was absolutely foreseeable and the op midwife, Jan Tritten and all the other fuckwits involved have blood on their hands.

      • The Bofa on the Sofa

        Yeah, it was a case study in how clueless midwives are.

        Maybe that was her goal? To expose the idiocy of her readers?

        My wife gets a lot of “CE” type questions in magazines (“answer this question on-line and get an hour of CE”). The difference is twofold

        1) The cases they present tend to be pretty challenging, and take some real insight, and
        2) If the answers were as idiotic as what the midwives say, it would be considered a very bad thing

        • DaisyGrrl

          Yup. The only thing about this post that should be up for discussion is how to get mom to the hospital. Is she resisting transfer? Why? How do you convince her to get to the fucking hospital? Other than that? Nada.

        • Durango

          3) the questions aren’t being asked in real-time about a real patient in trouble

          I also can’t believe that they are even comparing an open FB thread to MDs consulting each other.

      • Squillo

        If it’s a case study, the result is the same. A baby died–either yesterday or some time ago–as a direct result of a midwife’s incompetence.

        Or are they implying it was all fabricated? In which case, the only point to it would be, as Pablo says below, to show how stupid some of these people are.

        • DaisyGrrl

          I think they’re telling themselves that the outcome had occurred before the post went up and therefore they have no responsibility for the outcome (including their beloved Jan).

          They’re desperately backpedaling because their cozy “safe space” has been invaded and they don’t like the questions they’re getting from the real world.

          • Squillo

            You’re probably right.

            Except that presumably some of them didn’t know it was just a “case study” and gave their moronic advice anyway. So it was only an accident that they didn’t actually kill anyone.

          • DaisyGrrl

            Just to be clear. I believe it was an emergency posted at the time of receipt. I think the other midwives believed that too and gave advice accordingly. The “case study” excuse only came up after the unwanted attention appeared. Whether they believe it now or not, who knows? They’re capable of unbelievable feats of cognitive dissonance, so it’s possible.

          • Squillo

            Cognitive dissonance indeed.

      • Jessica S.

        And even if it WAS a case study? Big fucking FAIL. You’re still dealing with the death of a baby due to 100% ignorance and the lessons learned are all the worthless recommendations, to be used in the future on another innocent baby.

  • Guestll

    I have the whole thread, including Dr. Amy’s comments.

    Reading it all now. I don’t even have words to describe my emotions.

    My heart just breaks for that baby and mother.

  • Stacy21629

    The whole thing is gone…but my PDF as of 10:20pm all the way through the 29weeks ROM comment isn’t. ;)

    • KarenJJ

      Is it worthwhile posting the pdf somewhere that it can be linked to from here? I think it would be useful for future reference for anybody that says that they can’t all be so incompetent and that this sort of event is “really rare”.

      • moto_librarian

        My husband suggested posting the caps on Reddit…

        • Karen in SC

          That’s a great idea! I don’t like Reddit, but many younger folks hang out there. We need to get the message out far and wide, to women before their childbearing years. And to me, too.!

          • http://safermidwiferyutah.wordpress.com/ Safer Midwifery Utah

            They may not understand any of the problems involved (like post dates or fluid levels). I don’t see why not though.

  • Amy Tuteur, MD

    Did Tritten just take down her entire page, or did she just block me from viewing it?

    • Jocelyn

      I can still view it.

    • areawomanpdx

      You must be blocked. The entire thread is still there.

      • Amy Tuteur, MD

        As if I can’t get screen caps.

        What I love about blocking and deleting is that is demonstrates consciousness of guilt, and Tritten ought to be feeling guilty indeed.

        • Sue

          Yep – and then it looks even worse when the screen caps are shown.

    • areawomanpdx

      I spoke to soon. The entire thread *with the exception of your comments* is still there.

      • Amy Tuteur, MD

        That’s why I laugh when people say no one is listening to me. They are listening alright, and they know what I write is both persuasive and true. That’s why they block me, but it only makes my blog more popular.

        • Jessica S.

          And the fact that you don’t in turn block people who attack your position (and more often, YOU) speaks volumes. You understand the validity in your positions and have no reason to feel threatened. They delete, block and ban – the behavior expected of someone who feels threatened.

      • KarenJJ

        I can still read it too, and Dr Amy’s comments are still showing for me.

        • KarenJJ

          Aaaand. it’s gone..

          Dr Amy’s last comment was this (from 4 hours ago):

          :Amy Tuteur I am glad that this thread hasn’t been deleted (yet). Many homebirth midwives have engaged with me and they haven’t turned to stone, become radioactive or otherwise been harmed. In fact, I think that people of good will have been given food for thought. I hope that these thoughts will lead homebirth midwives to demand safety standards from MANA and other homebirth organizations. YOU have the power to stop these senseless tragedies. Please take that power and use it.:

          • KarenJJ

            Nothing to see here, move along people, Dr Amy and her trolls were getting too meen again.

          • Amy Tuteur, MD

            This is what I mean when I say that homebirth midwives bury dead babies twice: first in tiny coffins in the ground, then by erasing the fact that they existed at all.

    • Nursey Nurse

      I can still see it

    • Nursey Nurse

      After posting this lovely update
      “The
      questions on this page are messaged privately to me and put up
      anonymously. They are not my cases. This is to help mothers, midwives,
      doulas and physicians in their work. it is to get opinions from many
      different practitioners and parents.”

      • http://www.antigonos.blogspot.com/ Antigonos CNM

        Don’t know the point of THAT. Garbage in, garbage out. IMO, it is a question that shouldn’t needed to have been asked. Any competent HCP should have known that the patient was no longer a suitable midwife’s case.

        And the original post certainly sounded like she didn’t know what to do, except that she didn’t want to transfer care to an OB.

      • Stacy21629

        It’s NOT to help physicians. They have DATA from SCIENTIFIC STUDIES to make their decisions, not the faceless opinions of Facebook commentators.
        These people clamor on about “evidence-based medicine” in maternity care and when faced with an obvious near emergency…turn to Facebook for “opinions”.

        • DaisyGrrl

          I don’t know…I’m sure Amos Grunebaum got a bit more insight into the kind of idiocy that populates the stats in his studies (the ones that get counted in the hospital column but are attributable to CPMs). It’s tragic, but I hope this piece of idiocy helps others see what the medical establishment is up against.

    • Jocelyn

      Is the thread still there, or did I just get blocked too?

    • areawomanpdx

      looks like she may have taken the post down, now.

      • KarenJJ

        It’s gone for me too.

      • areawomanpdx

        The “What should I do with a woman whose water broke at 29 weeks” post is still there.

        • KarenJJ

          I can’t find it. Has that one gone too?

    • attitude devant

      She seems to have hidden the comment thread…

      • Amy Tuteur, MD

        She deleted her post and all of the nearly 300 comments.

        • Guestll

          It was there, I was reading and “liking” some of the comments, then I lost the ability to like, but the thread didn’t vanish.

        • Squillo

          Of course. People were being meen to the poor midwife, who just experienced a devastating “baby not making it earthside.”

    • Trixie

      In the comments in her new post she talks about blocking and deleting you, although she doesn’t dare speak your name.

  • Amazed

    Did someone else notice the form of the 29 week ROM? “Beloved Jan Tritten… big huggggs.” Is this the way a professional should address someone they seek out for consulting without ever having met him?

    Ah, being a professional. A lost art.

    • MLE

      Dear jan I luv u, baby is not A-OK, send positive juju, next time I am in OR let’s go on a tandem bike ride.

      • Jessica S.

        Will they wear helmets? Or will they forgo such unnatural interventions, as the odds are better that they won’t crack their heads open than they will?

        And if they do wear helmets, I wonder if the risk of death during home birth is higher than dying of a head injury, that a helmet would’ve protected? I’d need Young CC Prof to run those numbers, like she did with car accidents. ;)

  • ashley L.

    I reluctantly admit…I agree with you dr. Amy. It was just yesterday that I swore I would not be back to your blog. But I thank you for pointing me in the direction of this Facebook post by the editor of the thinking midwife. I am suddenly realizing that there has to be a mandatory rule for transfer of care that midwives must follow. What a sad story..and so different because of who Jan is!

  • Rochester mama

    Jan has a post from TODAY about someone at 29 weeks whose water broke?? WTF it’s someone else’s question and it’s unclear if they are from another country without adequate medical resources but WTF????

    • Jessica S.

      In what world shouldn’t her response be “CALL 911″? Step away from the keyboard, Jan.

    • Trixie

      Dr. Grunebaum’s comments on that 29 week thread are wonderful.

  • The Bofa on the Sofa

    Among the mind-boggling things about this story is, we aren’t talking about some random MW whose incompetence story we found on the internet. This is the firggin Editor in Chief of “Midwifery Today”! She’s the one who gets to decide what midwives are getting to read. Yet, she is completely clueless.

    It makes the “not all midwives are idiots” comments ring pretty shallow. It may be true, but here is a real idiot who has a very high profile position in the field.

    You put her in charge of MW information?

    • manabanana

      NO

    • anion

      …and said editor is sooo experienced that she’s never heard of or dealt with oligohydramnios and has no idea what the risks are. What was that again about how you have so much training and education, midwives?

      • Anj Fabian

        Or even how to consult Google U in order to see what standard of care is for that situation.

        Although to be honest, the scary part was when Jan posted something describing decels in the fetal heart rate apparently without any contractions. Significant decels without being subjected to stress (other than being crushed by the mother’s body because of the absent amniotic fluid) is NOT GOOD.

        Which makes me really question the judgement of the midwife monitoring the situation. What was she waiting for? God to part the heavens and say “IT IS TIME. GO FORTH TO THE HOSPITAL.”?

        • Young CC Prof

          You know the old one about the guy praying to be saved from a flood? “But I sent three boats!”

          Yeah.

  • Lisa the Raptor

    Every single person who commented on that thread to stay home should be charged. This is sickening.

    • Jessica S.

      I wonder if all those women would stand by their statements knowing the outcome? I’m afraid to know the answer.

      • Lisa the Raptor

        Oh of course not!

        • The Bofa on the Sofa

          It’s not their fault…

        • Jessica S.

          Yep, that’s exactly what I was afraid of – it’ll get chalked up in the “some babies weren’t meant to live” column.

  • Squillo

    If the midwife had given a sh%t about the baby instead of her transfer rate, the question she would have posed wouldn’t have been fishing for ways to decide it was okay to wait, but:

    “Help needed ASAP! Anyone have advice for persuading a reluctant client that her baby is in serious trouble and she should go to the hospital immediately?”

    • Amazed

      If she had given a sh%t about the baby, she wouldn’t have written anything. She would have told the mother, “It doesn’t look bad, we’re going to the hospital.” This mom would have gone, just like she did when she was finally told that she needed transfer. She didn’t even try to avoid the horror of a C-section.

      • Squillo

        True.

    • manabanana

      I doubt Jan Tritten has a transfer rate. She rarely practices midwifery at all. She just preaches about it.

      Midwifery has been more of a hobby for her in the past 20 years.

      This was probably someone she did a special birth for. Came out of retirement for.

      Which is even more disgusting.

      • Squillo

        I’m guessing Tritten wasn’t the actual midwife. Just the brainiac the moron turned to for help killing this baby.

        • manabanana

          It’s hard to say.

          Plausible either way: Jan as midwife, or not.

          • Amazed

            Should we call her “midwife” Jan Tritten?

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

        Anion – source? I really would like to know if she is still doing births despite the “retirement”

    • realitycheque

      “[S]he would have posed wouldn’t have been fishing for ways to decide it was okay to wait”, that was exactly the tone I got as well, really fishing to be told that it was okay and not even approaching the situation in an impartial manner (which wouldn’t have been ideal given the seriousness of the situation, but is still better than an attitude that leans toward considering the pregnancy to be HB compatible).

    • staceyjw

      They do not care about their transfer rate, no one tracks it, and they just lie anyway.
      They really believe the shit they spew, and think they can handle anything with their magical intuition. When something goes wrong, they blame mom, and presto- they are still right and awesome!

  • Stacy21629

    “Oh, we should really make sure it really was Jan’s client. Maybe she was posting this for another midwife?”
    I’m sorry – as the EDITOR IN CHIEF of Midwifery Today if she received this as an email from another midwife her IMMEDIATE response should have been – “Why on earth are you asking this question about a blatantly obvious near emergency! Admit this woman for an induction!”
    Even if it wasn’t HER patient, the fact that she would pass it on to Facebook for another midwife is STILL an illustration of her own idiocy and incompetancy.

    • Anj Fabian

      This was a fascinating case! One commenter asked for the outcome so they could add it to her case studies.

      Please. Add this your case studies, so the next time you see low amniotic fluid you can look up the outcome and get the woman to a hospital.

    • MLE

      Dear Jan I fell out of an airplane, should I pull the ripcord on my chute? Dear reader, let me check with some people online and get back 2 u in a couple hours.

      • NursingRN

        No no no…trust your parachute. It knows when it needs to open and it will do it when it’s time. There’s no need for you to rush things along and intervene! I would suggest some deep meditation, some chanting and centering on your inner being.

  • theNormalDistribution

    Right click anywhere.
    Choose “Save As”.
    Now you have a copy on file that you can view in a web browser.
    Or if you’re using Chrome, you can just “print” the page to pdf.

    Either way, be sure to open all previous comments so you can see them before you save the page.

  • birthbuddy

    The worst thing about this is that it is just one example of what these idiots get up to on a daily basis.

    • Stacy21629

      That really is a horrific thought, isn’t it? Right up there with the fact that in MANA’s study only 20-30% of member midwives reported…so 70-80% didn’t. That’s a lot of homebirth deaths we still know next to nothing about.

  • Amazed

    Oh, we have another midwife at Facebook claiming that Dr Amy’s tactics don’t work.

    May I suggest those posters who Dr Amy’s tactics DID work go to the thread and say it? Please close Carrie Kimball’s fucking mouth. She poses as a moderate voice but in reality, she’s trying to hide the truth about the sitiation behind tone-trolling.

    • Amy Tuteur, MD

      So far 6,000 people have read this post today. If that’s a tactic that’s “not working,” I’ll take it.

      • NoLongerCrunching

        Just curious, is that 6,000 separate people? Or if one user goes to the page twice, does it count as two viewers?

        • Amy Tuteur, MD

          It’s probably about 4500-5000 unique viewers on this page alone and a few thousand more on on Facebook and Twitter.

      • Amazed

        It isn’t me who is in doubt, it’s the proud mamas on Jan’s page. Oh wait, there aren’t too many mamas there. Just midwives. Oh wait, they aren’t midwives either… Birth junkies, then? I hope the term isn’t insulting to their tender sensitivities.

      • Bambi

        Apparently we all want to abolish homebirth.

        • Amazed

          Don’t you feel cruel, Bambi? You persecuted your angel midwife for no better reason than she killed your baby. And now you want to abolish the right of the likes of her to make money off killing other babies. How could you!

        • staceyjw

          It would be fine if HB stopped happening, but I would never take away the right to do it.
          We just wanna take away the right of a “MW” to lie, practice without education, accou tibilty and insurance. You know, the very BASICS.
          Its just not that hard to grasp.

        • KarenJJ

          Homebirth exists in plenty of countries without fools like this pretending to be midwives.

          Plus when there is someone like this pretending to be a midwife:
          a) she can’t use the term “midwife” and
          b) if she has a string of preventable deaths happening the coroner gets involved to investigate.

          Homebirth is not perfect where I am but it’s a truckload better then what these morons are trying to do.

    • KarenJJ

      They *hope* that they don’t work.

  • Sue

    ”They worked on the baby for 47 minutes” – what tragic work imposed on the competent clinicians by the incompetence of the CPM.

    • anne

      The fact that those clinicians undoubtedly grieve the death of this baby more than this midwife really says something.

      • indigo_sky

        You never know, though. A day later and her post is there and she hasn’t even been back to defend herself. Perhaps this has shaken her up and will serve as a (too late) wake up call?

        • MLE

          I thought that too, but then again maybe she just doesn’t know how to delete it. Remember how the elder midwives had no idea how to make the page private… :(

    • Aussiedoc

      Yeah, thanks for the PTSD, Jan.

  • Sue

    ”that did give a us a little trouble, but she stilled birthed vaginally”

    There’s proof – it’s not about the baby.

    • realitycheque

      How can they even be considering mode of birth in the wake of such a tragic outcome? This reminds me of that case in which the mother died (or possibly the baby, I don’t recall exactly which, but I know there was a preventable death) following her HB, and the midwife was all, “Well, yeah, she died. But she had a lovely, spontaneous vaginal birth”. Like that matters??

      • indigo_sky

        That was one of the “success” story/advice replies posted before this baby died. Very scary post, but it seems to have a happy ending despite the bad choices and call. The baby who just died here say a c-section in the end, but already too late by the time the midwife realized baby was really in trouble.

        That the parents did get a c-section right away when the midwife got scared by the low heartbeat is pretty revealing though. If she had known and communicated his dangerous the situation was from the start, baby would likely be at worst recovering in the NICU now. Had she pushed them to induce at 41 weeks baby would probably be home with mom and just fine right now :(

        • Jessica S.

          It’s heartbreaking. There aren’t enough words to describe how tragically unnecessary is this loss.

  • KarenJJ

    Homebirth is “safe” in other countries, because homebirth is not practised in such a fucking negligent way. In other countries the mother would have been transferred long ago. How devastating. How unbelievably disgusting are these people to call themselves “midwives”.

    • realitycheque

      Exactly, they have “home birth is safe for low risk women” as their little catchphrase, then refuse to label even the most dangerous situations “high risk”.

      I’d like to know exactly which pregnancy complications/conditions these midwives would consider to fall outside of their scope of expertise? I’m placing bets on none. They will say, “It’s case-by-case for the individual” and then take on anyone in the name of “a woman’s right to choose”.

      • Young CC Prof

        “I’m allergic to nuts. Does this cake have any nuts in it?”

        “Oh, it’s fine!”

        “OK. Munch, munch–Oh, my god! Call 911! Why did you tell me this was safe?”

        “Hey, you chose to eat it. I didn’t stuff it down your throat. Own your outcome!” And walks away.

        • realitycheque

          How unfortunate that the poor parents will now not only have to live with the agony of losing their child, but also have to deal with being told to “own their choices” and be placed in a position where they mustn’t dare even consider holding their midwife accountable, lest they be told that they’re “persecuting” her and possibly harassed by other members of the “community”.

          Hopefully people will see the outcome of this birth and rethink the capabilities of these midwives; rethink how safe they are, or will be in their care.

    • http://www.antigonos.blogspot.com/ Antigonos CNM

      The fact is that, despite better standards, education, etc. homebirth ISN’T all that safe ANYWHERE. It’s a myth.

      50-60 years ago, before EFM and ultrasound, homebirth for selected women was probably not much more dangerous than hospital birth. Certainly this was true before antibiotics, and anesthesia, because, back then, homebirth was essentially managed the same way hospital birth was — which is not to say the situation was good. No one knew better, the technology was primitive no matter where one gave birth, “acceptable” losses were much higher than today.

      The only possible justification for homebirth today is that it’s “nicer” to be in one’s own home, but I’d take issue even with that*, because the tradeoff is higher mortality and morbidity, so that the two sides of the equation aren’t equal: “nice” vs. much greater risk of death and/or disability?

      *I’ve written about women who have had home births successfully and then nearly collapsed from all the extra work and lack of rest.

      • KarenJJ

        I agree. I’d never do it myself. I suspect it is offered here as a harm minimisation exercise. Certainly it is not a popular choice.

  • Stacy21629

    “I also don’t know many that would have handled this situation this way”
    I don’t Facebook…but anyone that wants has my permission to copy and paste this list for Ms. Carrie Kimball. The TWENTY-THREE people that initially responded to Jan discouraged induction, provided anecdata or recommended something else entirely. I don’t know if they’re all midwives…but still…there’s a LOT of folks following Jan that don’t know what they’re talking about:
    Margaret Burns, Heather Rische, Kathy McRae, Lynn Reed, Jennifer Holshoe, Elizabeth Noble, Alison Reid, Erika Laquer, Zuki Abbott-Zamora, Celesta Rannisi, Mary Bernabe, Bianca Kamnitzer, Wanda Smith, Thomas McGregor/Sharon Schlicher, Sue Turner, Samantha Rouse, Kristen Gibson, Christy Birthkeeper Biscer, Del Balgas, Sherri Holley, Beth Bailey Barbeau, and Camille Sorensen Wilcoxx.

    • DaisyGrrl

      I’m betting that Jan is getting a ton of messages begging her to delete that thread. I can’t believe it’s still up.

      • KarenJJ

        I agree. What’s going on there? I can read the whole thread still. Normally this stuff is long gone by the time I read here (odd time zone).

        • areawomanpdx

          I think it is possible she can’t figure out how to delete it. Remember the Elder Midwives? It took them a week to figure out how to take their group private.

          • MLE

            Haha we posted the same thing at the same time. Their Facebook skills are only outmatched by their midwifin’ skills.

  • Amy M

    Man, that rachel chick is a real asshole. Clearly she has no idea what she’s on about, and she seems to think, not only that a dead baby is better than hospital care, but that most women would agree with her. What a psycho. She also seems to be trying to say that all babies saved from certain death will be left seriously damaged which is EVEN WORSE. So her nightmare scenario from worst case to best case goes: Disabled baby>hospital delivery>dead baby.

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

      I had to delete my own reply to her before I posted, it was too profane. Even for my fucking usual limits.

      • auntbea

        I have never seen so many f-bombs dropped in this space as have been dropped in the past few hours. We are PISSED.

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

          It says a lot . Yes, there are those of us with worse potty mouths than others, but this is easily the most rage – filled thread I’ve seen here. And I’ve been reading for 5 nearly 5 years!

          • Amazed

            This thread does something very bad to me. Really bad. I mean, real, really, reeeally. It catapults me back to my childhood and makes me want to write all the childish insults I cannot really write because English isn’t my first language, childish insults aren’t something that is taught at the university and frankly, I am deep to neck in work and have no time to think of a suitable translation. I cannot keep myself from having a look here now and then, though.

            Childish insults. Worse than f-bombs. It’s humiliating. To me, I mean. But that’s exactly what I want to do.

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

            I know exactly what you mean. I guess that says it. I feel MEAN. I want to be mean, really vicious, in all the hideous ways the tone trolls claim we do. I want to show them what being mean really looks like.

            I’m very glad I’m not the only one.

          • Amazed

            Mean. That’s right. That’s how I felt. Mean… and silly. These women turn me into a child in rightful anger at the playground. Of course, to them, I’d look like a bully. But my, don’t they need one!

          • anion

            I generally try to watch my language here (as opposed to in my work or on my own blog/Twitter/Facebook, where I curse like a sailor) but yeah…this is just beyond the fucking pale.

    • areawomanpdx

      I do not believe that she actually has clients that would prefer a dead baby to a hospital birth. If so, they are in need of a psychiatric evaluation.

    • Stacy21629

      She honestly believes that in the face of a colossally stupid “wish” on the part of the mother that she is 100% obligated to still attend her.

    • Young CC Prof

      Never mind the fact that an intervention at the first red flag might have resulted in a healthy baby. That comment of hers made me absolutely sick, that you’d rather your child die than watch him stay in the hospital for a couple weeks. That you’d rather lose a child than undergo routine surgery.

      • mellissad

        I had pretty much every intervention under the sun due to pre-eclampsia, gave birth at 34 weeks, and my daughter spent 4 weeks in special care. She is now almost 3 and perfectly healthy. I’m looking at her right now and cannot fathom that someone would rather forego that treatment and have their baby die!

        • Young CC Prof

          The baby sleeping on my chest right now was the trifecta of unnatural birth: early scheduled c-section. He wouldn’t be here without it. Every time he peeps and shifts against me, I know I did right.

    • Rochester mama

      At least she has the balls to say she is ok with knowing a moms choice will lead to death and not stopping her and equating it with the right to abortion, apparently up to and including week 42. She is honest about her lack of moral compass.

  • Stacy21629

    “Follow the mother’s wishes”
    “Informed consent”
    Jan is obviously INCAPABLE of providing informed consent. And seriously – intrapartum decels into 60s, you recommend transfer, mom refuses and you’re NOT going to call 911? You just shrug and say “Ok, as you wish” and catch a dead baby? You might have “followed the mother’s wishes” but you’re still 100% complicit in the death of that child.

    • http://thefresstyler.blogspot.com/ Hannah

      Yeah, I think Jan missed the lesson on what ‘informed consent’ actually means.

    • Squillo

      All the suggestions that this was the mother’s choice and the midwife gave actual informed consent are total bullshit. The original post wasn’t asking for help getting a reluctant client to transfer, but looking for ways to reassure her it would be okay to wait.

      Unless she said to the client, “Your baby is in trouble. A homebirth is no longer safe and I will not attend you. If you don’t go to the OB/hospital immediately, there is a very real chance your baby will die” she is directly responsible for that baby’s death.

  • Stacy21629

    And this Susan Dinatale idiot (CPM in Dover, DE based on a Google search) STILL thinks it was ok for Jan to wait.
    There really is no way to express the unbelievable ignorance of these people.

    • Captain Obvious

      I’ve seen that idiot post before. Pure echo chamber. I would think a sentinel event like this would stimulate some thinking of a root cause analysis to establish guidelines to prevent this from happening again. Isn’t this the kind of incident that changes practice pattern for ANY profession. And all the crunchy are just, eh, it usually works out.

      • Sue

        That’s now responsible professionals work – but clearly not the hobby HBMW community.

    • realitycheque

      What ever happened to learning from your mistakes? It seems these midwives take absolutely nothing away from preventable deaths under their care.

      If I had a patient in my care die from preventable causes, you’d better believe that I would a.) Be absolutely devastated, and b.) Take strong measures to ensure that it NEVER happened again.

  • Amy Tuteur, MD

    I left this comment on Tritten’s thread:

    “You know what I really don’t understand: I practiced obstetrics for years and I know that even if even one preventable death occurred among my patients or their babies, it would have brought me to my knees. What I don’t understand is how homebirth midwives can preside over preventable disasters and dare to continue to practice without getting additional education and training.

    I just want to know: how many babies have to pile up in your practices before it occurs to you that you are dangerous and should not be caring for houseplants, let alone pregnant women and their babies? One, two, ten, no limit? Please “inform” me.”

    • aster

      Dr. Teuter- I apologize for going off topic here, but I didn’t see another place to post this. There is an issue with this blog where after the first bunch of comments, as you scroll down to read the rest, the screen background goes black and the type is like a dark gray over it and it’s difficult to read. I’m not sure what’s causing it, but I checked with Firefox and Safari on Mac and it’s happening on all the pages. Not sure if anyone else is having this problem, but thought I’d mention it. Thanks as always for the great discussion!

      • Dr Kitty

        We all have it.
        Minimising the comments helps. You can also read comments oldest first, then newest first, then minimise to read the ones in the middle.

        • Jocelyn

          You can minimize the comments by pressing the little “-” next to the flag when you hover over the top right corner of the comment.

      • Meredith

        I’ve found that reading the comments through the link in my Disqus account eliminates the problem.

        • aster

          Where is that found?

          • Meredith

            On your Disqus dashboard, it shows all your comments. Each one has a header “Discussion on [name of blog] [X number] of comments.”

            Click on “[x number] of comments”, and you’ll get a window that shows the comments, and they all look normal (for me, at least).

          • theNormalDistribution

            I find it easiest just to highlight the comments as I read them, which turns the text white.

      • NoLongerCrunching

        I just hit “subscribe” at the bottom, then comments are sent to my email address as they are posted.

      • http://thefresstyler.blogspot.com/ Hannah

        Yeah, I have this issue too. I just flipped it so the oldest comments are first and then flip it again. Occasionally the glitch doesn’t happen, but it’s there for me most of the time, too.

      • auntbea

        One of our commenters wrote a fix for this, at least in Firefox. First, install greasemonkey. Then go to http://userscripts.org/scripts and search for skepticalOB (no space) and you should get a layout fixer. Hit install and the greasemonkey box will come up and you can go from there.

        • aster

          will try it- thanks!

        • aster

          My goodness- that totally fixed it! Thanks!

  • Alannah

    Dr Amy, I have been reading your blog for years. Lately I was a bit put off by the abrasive tone and the name calling. But today you completely redeemed yourself. No-one could be up against this kind of monstrous stupidity and selfishness and maintain a polite tone. These babykillers deserve everything you called them and much more.
    How Jan Tritten gets to kill babies like this and still remain a community leader and journal editor is unfathomable. The midwifery community is morally bankrupt. Why on earth is this blog the only place where anyone has noticed?

    • Mac Sherbert

      I was just typing a post similar to this! How can you remain polite when you see needless death happening? Honestly, sometimes I don’t think she is harsh enough. Just look at all the needless suffering for the baby and now grieving family. Those midwives don’t even sound contrite. J

      • Amazed

        Staying polite when faced with the likes of those is near impossible to me. That’s why I don’t engage in Facebook discussion – rather sooner than later, I’ll call the spade a spade and then I’ll be the bad guy for hurting midwife’s poor littwle fweelings.

        I admire people like Doula Dani and many of the commentors here who can keep their cool when dealing with this horde.

        • http://thefresstyler.blogspot.com/ Hannah

          Yeah, I do not have the ability to engage rationally with these people. I get so upset that my husband had begged me not to get involved in the conversations because I get so angry and stressed out and being a ‘meanie’.

          I wish I had Dr Amy’s patience and I have never once thought her anything but justifiably blunt about the negligence and willful ignorance that these ‘professionals’ insist on engaging in.

      • Jessica S.

        Yes! This is a perfect example of why I defend being “mean”. What other rational response is there?

    • Jessica S.

      How she’s able to preside over what I can only assume would be, in the *actual* medical field, a well-documented case of malpractice and yet NOT suffer consequences of any sort – I’m without words. I just don’t understand how this is not criminal negligence.

  • areawomanpdx

    Another ridiculous thing on that thread? No less than two different “midwives” who think the placenta makes amniotic fluid.

    • AlisonCummins

      A blog post explaining where amniotic fluid comes from, where it goes and why it’s a problem when there’s not enough of it would be helpful for laypeople to understand the context and why professionals are getting all upset.

      People who know better know this is a ridiculous thing for a midwife to think but most people don’t know better. And it’s the people who don’t know better who are most vulnerable to being told ridiculous things.

      • Karen in SC

        There’s never a shortage of topics for this blog. Which is unfortunate.

      • Captain Obvious

        Low AF
        Amniotic fluid exchanges daily. Fetal urine, tears, saliva, sweat, and lung efflux as well as transudation across the cord and placenta add to the volume. Fetal swallowing and reverse transudation and ROM can subtract from its volume. AF allows room for growth, development, and movement. Aids in pulmonary development and has antibacterial properties. AF peaks at 34-36 at about 1000ml and then gradually declines as placenta function deteriorates.

        Oligohydramnios is associated with congenital abnormalities like renal agenesis and other renal abnormalities, fetal anuria, chromosomal abnormalities, IUGR, PROM, post maturity, HTN, and preeclampsia. Complications of this can lead to cord compression and fetal hypoxia, limb contractures, pulmonary hypoplasia, increased infection risk, and thicker meconium, poor fetal outcome.

        When some discuss low AF, the usual response is to drink more fluid and you’ll be fine?! Really? The study usually refered to suggest that women who are dehydrated may increase their AFI by 2 or maybe 3 at best. When your AFI is 4, this doesnt help much, does it. Well hydrated women did not show increase in AFI volumes. And most women are already well hydrated so I wouldn’t expect any improvement. It doesn’t matter how much fluid your drink if your placenta is no longer able to transfer it to the baby.
        I just cannot understand why so many don’t appreciate the risk for a failing placenta calcifying up, not being able to transfer fluids and nutrients to the baby, leading to shunting of blood and fluids to the fetal brain and core from the extremities leaving the baby to have restricted growth (asymmetric IUGR), contractures, and risk cord compression.

        • Playing Possum

          Yup yup yup yup with you 10000000x on the dying placenta. The baby may not be a library book but the placenta is.

        • AlisonCummins

          I just cannot understand why so many don’t appreciate the risk for a failing placenta calcifying up

          Because they don’t know it?

      • Are you nuts

        I have no idea where amniotic fluid comes from, I don’t know where it goes, and ya know what? I don’t care too much because I have a doctor who I pay to know stuff like that for me. I would be extremely troubled if my doctor had to “phone a friend” after my due date to ask if my fluid levels were a problem. Unfortunately, this mom put her trust in the wrong person who had no f-ing clue.

        • Are you nuts

          Let me amend this to say… I do know that “low levels” are a problem and sign it’s time to get the show on the road. But I don’t think it’s up to me to know any more than that.

        • AlisonCummins

          Would you be extremely troubled by your midwife explaining that amniotic fluid comes from the placenta?

          What if your friend was with you during your appointment and started yelling at your midwife for thinking something so ridiculous? Would you tend to think your friend or your midwife was more reliable?

      • Rochester mama

        You don’t have to have medical training, other than reading What to Expect or any other mainstream pregnancy guide to understand low amniotic fluid is a problem. The problem is not believing in mainstream medicine, believing that there is always some crunchy alternative if you only search the internet enough.

      • AlisonCummins

        Amy Tuteur, MD wrote a post back in 2011 called “Why Does Childbirth Hurt?” http://www.skepticalob.com/2011/01/why-does-childbirth-hurt.html

        I remember people thanking her because they hadn’t known the pain wasn’t psychological.

        I don’t need to know about amniotic fluid or about visceral and parietal pain: I’m not a healthcare provider. But if someone is ranting about how someone else is ridiculous for not knowing these things it’s just nice to know what they’re ranting about, is all. This blog is targeted to a general audience.

        • areawomanpdx

          amniotic fluid at 42 weeks mostly comes from the baby’s urine — that is why the original post was talking about kidney function. A low AFI can sometimes indicate a kidney or bladder problem. The rest comes from the mother’s blood. None if it is made by the placenta.

          • Young CC Prof

            Of course, if the baby has working kidneys, low fluid is often a sign of a crummy placenta.

          • areawomanpdx

            This is true. Perhaps I should give them the benefit of the doubt and allow that this is what they mean.

      • areawomanpdx

        You are exactly right. Lay people who hire a care provider shouldn’t have to know where amniotic fluid comes from. But if that care provider is in the business of delivering babies, then the care provider sure as shit should know that. The fact that these two (or more…couldn’t get through the entire thread) don’t speaks to just how little the CPM education is actually worth.

        • AlisonCummins

          Sure — and a little blog post explaining this very basic thing could demonstrate to laypeople how inadequate CPM education is. They can’t evaluate their CPM’s education, their CPM explains away their differences with obstetricians as a turf war, but a companion post to this one showing where exactly the ignorance was could just be a little object lesson. Obstetricians worry more because they know more, for example: _____.

      • http://thefresstyler.blogspot.com/ Hannah

        All you need to read is a basic book on pregnancy to know that. It kills me that these supposed professionals do not know basics that my husband learned from a What To Expect app and the ‘You Pregnancy And Birth’ book our OB gave us.

        • anion

          I had a friend who was pregnant with her first when I was pregnant with my first (she was a couple of months ahead of me). She was diagnosed with polyhydramnios at around four or five months, and despite not being experts on pregnancy we both knew that was problematic and could mean all sorts of things. As you said, any halfway decent pregnancy book provides enough basic info to know that amniotic fluid is important, and that when that level is off it’s not a good thing.

          (My friend’s baby came at 34 weeks, and had [what they thought was] severe GERD which required a feeding tube for almost a year, until they figured out she had a blockage in her pancreatic duct.)

      • Jessica S.

        I see what your saying, Alison, and I totally agree.

    • Stacy21629

      I caught this too…

  • Amy Tuteur, MD

    Jessica Weed entered the Facebook conversation. For those who may not remember, she’s the idiot who presided over this disaster:

    http://www.skepticalob.com/2012/09/jailed-midwife-yet-another-example-of-why-the-cpm-credential-must-be-abolished.html

    • Amazed

      Was she the author of the immortal meme, “Just enjoy your baby”? It was told to a mother who had just had a brain-damaged baby (the one from the link, I believe).

  • AutonomyOB

    This reminds me of a request I just received. I support patients who want to labor naturally, so apparently this doula thought I would support life threatening stupidity. She has a client nearly 42 wks with breech baby who was planning to home birth. I thought she was calling me to do the section, but oh no, they wanted me to be her emergency back up! I was absolutely dumbfounded. Completely horrified that people are willing to pay Russian roulette with their children’s lives!

    • Are you nuts

      How did that birth turn out? I can only imagine ambulance ride + emergency c-section? I guess that’s really the best case scenario.

      • Trixie

        Sounds like maybe she hasn’t given birth yet.

      • AutonomyOB

        I haven’t heard yet. I am afraid to. I was wondering if there was somewhere to report her midwife. Our state has laws to prevent VBAC home births, would hope they ban breech as well.

  • areawomanpdx

    This death rests fully and completely in the hands of that midwife and the rest of the idiots in that thread. The mother agreed to a BPP. You don’t agree to something like that unless you’re willing to act on the results. If, based on the results, your midwife strongly recommends an induction, you do it. This mother was not informed as to what could happen to her baby. Even if you’re a blathering idiot of a CPM, you pay lip service to the idea that the role of the midwife is to fully inform the client. THAT DID NOT HAPPEN HERE. A good care provider has to play the “dead baby card” every once in a while, because that’s part and parcel of giving birth.

    • NoLongerCrunching

      Agreed. If the mid wife had been forthcoming about the risks the post would’ve read “I recommended that the mother transfer to the hospital, and she refused. How do I convince her to do it?”

      • Amazed

        Looks like they are paid to only listen to gut feelings – and the mom’s, at that. Not even their own.

        Come on, let’s blame mom’s gut, not midwifery care. If only her gut was OK, she would have had a living child. Now, where can I get my 4000 $ cheque please?

        • Comrade X

          I’m actually even cynical that mum’s “gut” was telling her all was well. I wouldn’t be particularly surprised if mum was asking nervous questions in a pale voice about whether everything was still OK, and being warmly reassured by the wise older matriarchs. And now that all that warm reassurance turns out to be bullshit, and mum is left devastated with empty arms, it’s all mum’s fault, all mum’s to “own”. Just thinking about that is making me feel violent.

          • Amazed

            About two weeks ago, I officially lost my manners on this blog and wrote a reply to a “fucking babykiller” to “close her lying trap” or something like that. These posts tend to have this effect on people.

            For the records: manners still sadly lacking. Each time I think they are trying to slink back, something like that happens and it’s a lost cause.

            P.P. Jessica Weed, another glorious babykiller, is posting to support poor Jan. I could shake her so hard that she’d be left without any teeth to lie through.

          • moto_librarian

            I thought I recognized that name!

          • anion

            I love her “What makes you think this was preventable?” Um, the fact that we’re not idiots? The fact that we actually understand that pesky cause/effect relationship thing? The fact that it doesn’t take a genius to know that a baby with no fluid is a baby who should probably come on out, and if that baby is two weeks postdates that “probably” becomes “really definitely right now?”

          • Amazed

            Because her gut tells her it wasn’t preventable. They all seem to suffer the same bowel malady.

          • anion

            Gastroentewrongis.

          • Amazed

            Thanks. As a lay person, I didn’t know the actual name of this highly contagious disease.

          • Mishimoo

            CBS – Compliant Bowel Syndrome. Instead of being irritable and disagreeing with you, it tells you whatever you want to believe.

          • Squillo

            That,and maybe the fact that the baby was alive after the first BPP that showed “absolutely zero fluid.”

            So it was only unpreventable in the sense that dying in a fiery explosion after hitting the brakes before plowing into an oil tanker is unpreventable.

          • Sue

            “What makes you think this was preventable?”

            The fact that intra-partum deaths are almost unheard of in hospital.

          • Jessica S.

            Support for the midwife. Because that’s the priority. (Sarcasm, in case that isn’t obvious.)

          • Amazed

            Oh, they are all there to provide their competent support to the poor midwife. Pity they don’t have competence to provide to the families choosing them.

            Looking at their photos, I can see that some of them are my age or even younger. I cannot help but see them as spoiled kids who stomp their feet and throw tantrums. They never worked for that ridiculous degree of theirs, yet they feel so competent.

          • Comrade X

            I wish people would understand that it’s much more important to be “good” than to be “nice”.

          • staceyjw

            This happens all the time Comrade X, several HB disaster I know of IRL played out just like you described above.

            Situations like this are the reason I think UC is safer than a HB with a MW. A UC mom won’t have an idiot “professional” sitting there and telling them all is well, to stay home. The MWs aren’t helpful, and they are often actively dangerous. A decent one might help, but who knows what you are getting?

    • Laura

      Ironically, it wasn’t the “dead baby card” the midwife would have played here, but a foreboding of reality! Really, really sad.

      • KarenJJ

        Yes, playing the “dead baby card” looks completely different when there is an actual baby that has actually died.

    • auntbea

      Sorry…BPP is what, again?

      • Young CC Prof

        BPP= biophysical profile, essentially checking fetal vital signs on ultrasound. Movement, etc.

      • girlonavespa

        biophysical profile…an assessment that takes into account various factors to ascertain risks to baby’s wellbeing. Measures things like movement, heart rate, fetal breathing, fluid levels etc, if I am not mistaken. I’m not a pregnancy or obstetric professional so I could be wrong.

  • AlisonCummins

    Is this a reflection of a misunderstanding of the idea of competence? OBs expect that a competent midwife is one who can immediately recognize signs of possible trouble and transfer immediately and efficiently to “specialists in abnormal birth.” Untrained midwives feel that a competent midwife must be one who doesn’t need to transfer.

    Or something?

    • Anj Fabian

      It’s an echo chamber doing what it does best – to enforce the community norms.

      In this case, the CPM dogma is “It’s a variation of normal. Wait and watch.”.

      • Are you nuts

        These people need to get on the same page. MANA released its paper a few weeks ago stating that homebirth is safe for low risk women. We can debate that point, but, what’s not up for debate is if this was a low risk birth (or a variation of normal) at 42 weeks + with no fluid.

        This was not a freak accident. This was a car headed towards a cliff at 5 miles an hour from 10 miles away. They had hours, if not days, to put on the brakes and drive away from the cliff… but they didn’t. They ignored every sign that said, “Cliff ahead!!” and drove off anyway. As long as there are midwives out there who will be so reckless, I don’t know how you could possibly have any confidence whatsoever in a home birth provider.

        • KarenJJ

          But some of those midwives knew people that had survived driving off cliffs and therefore it was all going to be fine.

    • Sue

      Competence in some of these HBMWs seems to be measured by the ability to help the mother resist transfer, no matter what.

      That’s why I think freebirth could potentially be safer – at least nobody would try to stop the family bailing out. And, apart from a better outcome, the money saved could help pay the hospital bills.

  • MaineJen

    I just want to say to this mother, if she should ever read this…I am so, so sorry. This was not your fault. I am sure I speak for everyone when I say that you have our COMPLETE sympathy and support.

    • RebeccainCanada

      Completely agree.

    • Are you nuts

      Absolutely. Even if the mom was anti-intervention, the midwife should have done everything short of get down on her hands and knees and beg for the woman to transfer. I can’t imagine the mom knew the kind of danger she was in, or this would have ended very differently.

      • fiftyfifty1

        But you wouldn’t have even needed to beg this mom. This mom was getting BPPs, this mom consented to a c-section. She cared about her baby. All you need to do is see those BPP results and tell the truth to the mom. You don’t have to put on a show. That amniotic fluid result is terrible. Just tell it like it is and this mom will understood: “Hi [mother's name], I’m calling with the results of your baby’s BPP. It does not look good at all. We need to go to the hospital now. I will meet you there. Don’t pack, leave now”.
        ….that’s all she needed to say. Wish I could turn back the clock.

        • Mac Sherbert

          If this mom was getting all this testing, wouldn’t the professional doing the test have told her how bad it was? Would there not have been an OB to explain and talk to the mom? Most of the mom’s I know who had bad results from a test like that were sent straight to the hospital.

          (I’m just wondering how all this works, if you aren’t using a OB or CNM affiliated with a hospital.)

          • fiftyfifty1

            “wouldn’t the professional doing the test have told her how bad it was? Would there not have been an OB to explain and talk to the mom?”

            The way it worked at the hospital where I delivered babies was that the test was done by a tech, not a doctor. If the test looked bad, the patient was told to wait there and the tech would page the ordering provider with the results. The ordering provider then would talk to the waiting patient and tell her the results and what needed to be done. So it would come down to the ordering provider to make the medical decision of “go to L&D, I’ll meet you there”, or (sadly in this case) “hey, go home and drink some water while I consult colleagues about you case”.

            I remember one case that scared me to no end. The patient was a nullip at almost 41 weeks. Her interpreter did not show up at the test, and the test was not good (although wasn’t as bad as this one!). The patient misunderstood the lab tech and thought she was told to go home, not wait. So she went home. When they called me, I tried to call her and her phone was disconnected! I felt SO GUILTY because my usual habit at the time was to ask every OB patient at every visit to update their phone number and ask whether their phone bill had been paid etc. and jot this at the top of their visit page, but I hadn’t done that at the last visit. So there I was just frantic and calling every single contact number and emergency contact number that I could find written anywhere in her chart going way back (this was before electronic medical records). The majority had been disconnected but some had answering machines and there I was saying in very slow English “If you see [patient name] tell her to go to the doctor right now. Her baby needs to be born now!” (screw HIPAA).

            One of the messages was put on a very old number of hers that turned out to have long-since been re-assigned to someone else, but by chance he knew one of her relatives and the message got passed on and I got the call from the hospital in the middle of that night that she had arrived! I cried I was so relieved. Went in, started the induction which worked like a charm. She ended up with a vacuum assisted delivery that went well, and a nice baby girl on X-mas eve! Some signs of postmaturity but otherwise healthy.

          • Jessica S.

            What a great story! Your patients are very lucky to have such a compassionate doctor.

          • Dr Kitty

            This is where being a GP helps, because quite often relatives are registered patients and we can get messages through to people who have changed addresses or phone numbers without telling us. Either that or our receptionists have local knowledge and will know where they work or who their new girlfriend is…

            Often it is either phoning someone’s mother and asking for their new address and phone number, or driving the streets looking for them…if it is important enough they need to be contacted immediately, you hope they’ll excuse the breach of confidentiality.

          • Comrade X

            Contrast this with the attitudes of the “midwives” killing babies with impunity. You were stressed as fuck, desperate, running around like a headless chicken, prepared to break the law – all to make sure that this woman and her baby were safe.

            Homebirth “midwives”? “Meh, dead baby, whatevs, shit happens…”

            But they’re so caaaaaaring…. #disgusted

    • Dr Kitty

      I don’t for a moment think the poor mother was properly informed about the risks she was taking.

      • anion

        Nope. I bet she was told, “I’ll do some research,” and then, “We can give it another day, there are lots of stories of babies born with low fluid.” With no mention that “research” in that case = “I’m going to ask some bozos on the internet.”

        Just like Lisa Barrett and that hippie couple with the twins and the sex and all, where Lisa “researched” the matter and came back with the astounding fact that the average length of time between twins being born is 47 days. Because even the most cursory second of thinking can show how true that little bit of info is. I mean, who *doesn’t* know a set of twins born a month apart? Whereas if you meet twins born within an hour or so of each other, well, that’s something we just don’t see very often.

        • Dr Kitty

          Yeah.
          Pretty sure most people think twins=same birthday.
          LB and that birth story is probably the most wrong thing I have ever read on the internet.

          • anion

            Isn’t it? I can’t fathom someone actually believing it, let alone someone who claims to know everything about birthing babies.

      • Meredith Watson

        It seems like that would have been impossible, considering her midwife was on facebook trying to get that information for herself.

    • anne

      I always wonder about the support these women receive when their babies are hurt or die. The vast majority of people do not homebirth and understand that it is dangerous which could lead to judgement against the mothers.

      If anything this blog has made me more sympathetic towards woman who homebirth because I know understand the level to which they are manipulated and deceived.

      • anne

        now, not know.

      • KarenJJ

        And it becomes even more of an indictment of the type of women who choose this style of “midwifery”. They are not to be trusted, I don’t care how “nice” and “warm” and “motherly” they are.

        • Sue

          You have to wonder at the motives of the ”loners” who won’t work in a team in hospital.

      • http://momofmanyfeet.wordpress.com Bambi

        I had lots of support initially. When I questioned, support withdrawn. I was alone. Then I met Dr Amy and I began getting support again. I offer my support to others as well.

        I do know that there is a subset of women that do not publicly question or speak out, but do so privately due to the fallout they will receive. These are the ones we really need to focus on.

        Then you have those that really don’t care. I’ve seen two of them.

  • http://safermidwiferyutah.wordpress.com/ Safer Midwifery Utah

    Does this get counted as a hospital death in the CDC wonder database?

    • Squillo

      Most likely. Even if the certificate stated that the intended place of birth was home, the birth attendant was an M.D. and the death occurred in hospital.

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

        It will be correctly attributed if it happened in Oregon

        • Squillo

          The WONDER database doesn’t include an “intended place of birth” category, though.

      • Florence

        and that is maddening!!

    • Young CC Prof

      Depends whether the baby still had a pulse when pulled out. If so, yes. If not, it’s a term stillbirth and not an infant death at all.

  • Amy Tuteur, MD

    Tritten has inadvertently given us a crystal clear view of what (homebirth) Midwifery Today really looks like.

    • Durango

      A bunch of ignorant rubes playing with lives. I am shocked and disgusted.

      • anion

        I love the midwife who commented in that discussion about a baby she delivered with low fluid, and says, “Where does it go?” Gee, where DOES it go, genius? I guess the birth fairies are sneaking into the amniotic sac at night and sipping it like sweet, sweet nectar. Or maybe the mother used a hairdryer on her belly and that dried it all up (someone further downthread on FB suggested that ultrasounds somehow evaporate the fluid. Which, were that the case, I wouldn’t have had to interrupt my first US to use the bathroom because I took the “come in with a full bladder” thing extremely seriously). Maybe the mom stood to close to an oven? Or went outside on a windy day? Maybe the baby is more of a dry-heat fan. Or maybe the baby is Kryptonian and somehow managed to evaporate the fluid with his or her laser vision.

        Where the fuck do you THINK it “goes,” Midwife Astonishingbrain? Do you even know where it comes from? Do you think there’s a faucet in there that runs at conception and then turns off, so what you’ve got in the first month is all you’re going to get? And yet you’re delivering babies and claiming you’re an expert. SMH, man.

        • Comrade X

          I know precisely fuck all about amniotic fluid, where it comes from, or where it goes. As a result of this and other deficiencies in my knowledge-base, I am not offering to provide expert care to pregnant and labouring women in return for financial remuneration. I have no idea how to fly a plane either, and therefore I do not attempt to persuade people to give me money to be their pilot. It’s really not that hard to not be a mendacious life-risking conman.

          • KarenJJ

            Once you know stuff like that you become a “medwife”.

  • Are you nuts

    For the rest of her life, this woman will be thinking, My baby would be here now if I had consented to an induction a day or two earlier. Or she should at least.
    Not saying it’s all Mom’s fault. Ironically, she thought she was making the safer decision for her baby because of the lies these women tell. It’s absolutely disgusting. If puppies or kittens were treated this badly, there would be reports on the news, committees formed, money raised… but instead, here the midwife community will rally around the MIDWIFE, not the victim, and work to ensure that her reputation and finances aren’t tarnished.

    • Young CC Prof

      I know. Just so awful. I really hope she can get out of the cult, but nothing will ever get her out of the grief.

    • DaisyGrrl

      I imagine the mother will blame herself because that is the message that NCB will be sending her. If only she had done some magical thing that would have resulted in a healthy baby (eating kale, positive affirmations, castor oil, whatever else). There’s always a tendency to wonder what you did wrong in the aftermath of a tragedy. Sadly, the NCB community will encourage her in this thinking instead of placing blame where it belongs.

      I really hope there’s someone in her life who can provide her with support during this tragedy.

  • Medwife

    I FUCKING KNEW IT. I knew it!!! I knew this would happen. I saw it coming. Now I wish I had laid into these idiots while the baby was ALIVE. Oh I am so angry. Idiots!

    • moto_librarian

      They wouldn’t have listened. It is pretty clear to me that man had made up her mind and was only seeking validation.

  • Squillo

    Question for medical professionals:

    Pretend for a moment that Tritten is a competent, ethical practitioner. She does the BPP, notices the apparently severe oligohydramnios, and actually advises her client to transfer care ASAP, plainly stating the real risk that the baby will die if it is not born soon. The client refuses and states her intention to wait for spontaneous labor and continue with a homebirth.

    Other than document, document, document, what should she do? Can she dismiss her as a client and refuse to attend her? I’m not aware of any regs that prevent that (unlike for a physician), and there’s no real risk of of either action against her non-existent license or a lawsuit, so there’s little risk to actually attending the client and hoping to persuade her to transfer.

    • Dr Kitty

      You’d have to judge whether firing her as a client would be more or less likely to result in a safe outcome.

      As an NHS GP I don’t get to fire people unless they physically assault me or are verbally abusive. Sometimes I wish it was otherwise.

      • Squillo

        Thanks.

        Reason #1000 I couldn’t be a physician or midwife.

    • Gene

      If she is an adult and mentally competent, there isn’t much you can do unless you get into legal issues. I’ve had competent adults leave my ED who I seriously thought might die, but had no means to involuntarily admit them. And document, document, document with multiple witnesses. Even then, she could still successfully sue.

    • Stacy21629

      I don’t know if this is realistic as I’m not a *human* medical professional…but sounds like Jan had 1-3 DAYS to push mom to seek OB care. If she was actually concerned but mom refused induction, she had DAYS to call OBs, call the local hospital maternity ward, document, document, document and THEN when mom called to tell her she was in labor she would have had one more opportunity to tell her – NO! Go to the hospital! And then she could have called 911 to report a distressed mother in labor. I doubt that ANYONE could look at that series of events and claim that the midwife, in the face of a dangerous birth, did not do EVERYTHING she could to get proper medical care for the mother.

    • anne

      Hearing that she absolutely needed an induction would probably have more power being spoken by a woo practitioner than coming from an OB. Having a midwife absolutely dedicated to homebirth telling you that you need an induction now is powerful if you are fully in the “non-interventionist” mindset.

      This midwife probably had more power to get her to a hospital than anyone else and chose not to.

      If I choose homebirth, hire someone to do it, and that person tells me it’s impossible I will probably listen because they are so dedicated to the opposite.

      My guess is that this poor mother was not told to go, continued to trust in her midwife and suffered the fatal consequences.

      • Jessica S.

        Which makes it all the more contemptible that the midwife DID NOT urge for transfer. She had the life of that baby in her hands and chose to do nothing. Worse than nothing. Giving “nothing” a name: natural and normal.

    • fiftyfifty1

      That mom was ready and willing to transfer as soon as her MW recommended. When Tritten finally did recommend transfer, the mom went and consented to a CS. The problem here wasn’t mom, it was that Tritten did not have enough medical knowledge to recognize that zero amniotic fluid is a MEDICAL EMERGENCY.

      This knowledge is BASIC knowledge. And yet the editor of Midwifery Today didn’t even know it!!! This is the editor of the journal for homebirth midwives. This represents the supposed BEST of what CPMs have to offer.

    • birthbuddy

      You withdraw your care and offer a list of other practitioners.

    • Montserrat Blanco

      You have no obligation to provide anything a patient asks for. If you are sure that it is agaisnt best practice you can withdraw care and provide a list of other practicioners. You have to document that. Basically if someone asks you to cut their head off you do not have to do it.

      • Captain Obvious

        Abandonment is a tricky thing. Doctors can get sued for abandoning a patient during an active/open disease process or pregnancy. You can give a 30 day notice after the 6 week post partum period so that you don’t have to take care of that patient with the next pregnancy, but it is not as easy as saying she is making decisions against medical advice so as of now I won’t take care of you. Providing names of other practitioners isn’t enough either. I believe (and anyone who knows more please chime in) you actually have to get another practitioner to accept her as a patient, then you can stop seeing her and obsolve yourself of the risks she is taking upon herself. Otherwise you are stuck with her and need to document, have her come in and offer a second opinion consult, or an ethics committee meeting with the doctor, head of OB dept, hospital, nurse, lawyer etc.

  • Ash

    Disgusting!!!

    It’s somehow more appalling that she ordered the ultrasound and chooses not to act on the results than never ordering it at all. Clearly no amount of catastrophic results from the ultrasound would prompt her to refer the patient to medical care. The midwife must know that what she was doing was wrong, otherwise, why would she be asking random people for advice?

    The Facebook user Rachel C S says “Informed consent…
    Most of my mothers refuse any ultrasound.” Ah yes, the platitude of “We are OK with ignorance no matter whether someone lives or dies”

    • fiftyfifty1

      “It’s somehow more appalling that she ordered the ultrasound and chooses not to act on the results than never ordering it at all.”

      Absolutely! This is another example of a woman who would have been better off planning an unassisted birth. When 42 weeks came, her nerves would have gotten the best of her and I bet she would have gone to the ER to be checked out. They would have done the BPP, seen the horrible results, told it to her straight, and there would have still been time to save that poor baby.

  • Amy Tuteur, MD

    From Tritten’s Facebook thread:

    • Dr Kitty

      Well said Amos and Barb.

      • fiftyfifty1

        Well said Amos.
        Not so well said Barb: Come on ladies, shame shame, LEARN from this, try NOT to make this mistake with your own patients!

        Once a homebirth midwife, always a homebirth midwife. They may tisk tisk their own, but they’ll never come out and tell the truth: these women must be prohibited from practicing.

  • Lindsay Beyerstein

    Jan Tritten’s “Midwifery Today” bio says she “was in active practice from 1977–1989,” I wonder what prompted her to come out of retirement. I saved a version of the bio, in case it gets taken down later.

    • http://safermidwiferyutah.wordpress.com/ Safer Midwifery Utah

      I am not actually sure it is her client. I am trying to find out for sure. She seems to post a lot of questions on her facebook page on behalf of other people without indicating it directly.

      • Julia

        Good question. It’s not clear from the initial posting, but later in the comments she writes:
        “Very
        sad news on this baby: The baby didn’t make it. [...] I listened to baby afterwards and heart rate
        was on the low side. We came in, chose a c-section, and they worked on
        the baby for 47 minutes.”
        Doesn’t her use of the first person imply that it was her?

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

          Agreed. Her on behalf of questions are not. And you’d definitely want to make something this glaringly fucked up clearly not you (if it wasn’t and you were her)

        • http://safermidwiferyutah.wordpress.com/ Safer Midwifery Utah

          I am leaning toward it being Jan’s client, but I don’t know for sure. She uses such god awful formatting on her facebook page that there is a lot that is often unclear if she is quoting someone or not. Other midwives who are commenting seem to think it was someone elses client. I hope this gets cleared up. If nothing else Jan has a share in the responsibility for facilitating the crowd sourcing instead of encouraging swift action.

      • Lindsay Beyerstein

        It might not be her client. But this line of her Facebook status update makes it sound like she’s taking a hands on role: “But, my hands feel nothing but baby (who again….is doing well and recovers well after spordic contractions).”

        • http://safermidwiferyutah.wordpress.com/ Safer Midwifery Utah

          I think I’m going to assume it’s jans client unless she provides more info.

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

            Don’t take it the wrong way – I agree it’s essential to know if it is or is not Jan directly acting as the midwife, and who it was if not her. I am also assuming it’s Jan’s client because of the first person accounting. But definitely a grain of salt with that specific fact, eh?

            It’d be easier if they weren’t all such liars.

          • http://safermidwiferyutah.wordpress.com/ Safer Midwifery Utah

            Yeah or if she would use some punctuation. She edits a trade magazine, FFS. If I got a detail wrong she is free to email me or comment on my post and I will correct it ASAP. If its not her I suppose she should make it clear next time.

          • Squillo

            Could she have been precepting an apprentice midwife?

          • Trixie

            Not just liars, but liars who are bad at Facebook. I mean, it took them weeks to realize Dr. Amy was mocking Elder Midwives, right?

          • Young CC Prof

            And then they couldn’t figure out how to change the settings for a while, either.

      • MaineJen

        She says something toward the end like “I listened to the HB just before and it was a little low,” which confused me. Was it her, or not?

      • AlisonCummins

        If she’s doing a copy-and-paste from an email then it would be in the first person even if it’s not her.

    • Sue

      Retirement sounds like a great plan for her.

    • auntbea

      She’s RETIRED from active practice? That means no one in the NCB should possibly believe a word she says, right?

  • Amazed

    God, can’t they be just greedy? Many of them take the money well before the birth and it isn’t refundable if mother transfers. Why is it so important to keep proving their fucking worth and the worth of “natural” birth at such a high price?

  • R T

    I had a friend who was very caught up in the woo while we were both pregnant. I was stuck on hospital bedrest just hoping my son would make it to term and she would come visit me and talk about her plans for a homebirth. She ended up going to 42.3 and her midwife transferred her care at 41.3 and she was devastated. She asked me what I would do and I told her I would absolutely induce ASAP. However, she couldn’t let go of the idea she was doing something horrible to her child by inducing and having a hospital birth. At 42.3, her OB finally talked her into an induction. She got fully dilated when they realized her son was in severe distress. She had a crash csection and he was born very sick from meconium aspiration. His finger nails and skin were stained from floating around in the poop for so long. He spent the first week of his life in the NICU. She was in the same hospital I was in and I got wheelchair privileges to visit her. She was so depressed and guilt ridden. She kept saying it was all her fault and she should have consented to the induction or a csection weeks ago. She was distraught her beautiful baby was stuck in the NICU struggling to breath. She told me she would never be able to forgive herself. It was really rough and her baby lived and is completely vibrant and healthy! I can’t even imagine what the mother in this case is going through!

    • The Computer Ate My Nym

      I don’t want to imagine what she must be going through. Horrid. The time after birth is so vulnerable even in the best of cases and this…

      • Amazed

        I fervently hope that no well meaning “friend” will point her at this post because that will mean that she’ll realize just what kind of care and competence she received from the provider she chose with trust.

        So sorry for the mother and family. Fuck you to Jan.

        • Young CC Prof

          Let me echo that. If you know who the mother is, do NOT name her. Do not let her know about this post. If you do, you are an asshole.

          • Amazed

            This.

            At the same time, I’m scared just what the mother will think if she does not see the post. If she does not realize what had happened. The midwife and Jan won’t tell her, now will they?

            God, she might come out convinced that the midwife saved her own life. That homebirth will be the only answer for her next child.

            I suppose it’s easier when you don’t have such conflicts. Lucky midwives. They are convinced that there is just one side – homebirth good, bereaved mom bad, midwife awesome.

            I’ll be back as soon as I’m done vomiting.

          • fiftyfifty1

            I disagree. That mother has already suffered the ultimate loss and is likely blaming herself. She needs to know that it was NOT her fault, that important information was kept from her (yes, perhaps she was told that the fluid was gone, but she was not told what it meant). This midwife killed that baby.

          • Young CC Prof

            True. Maybe she does need comfort from some reality-based people outside the HB community. But I really do hope her name is never made public.

          • anion

            I kind of hope it is made public, as part of Tritten’s trial for negligent homicide. (Because public records and all.) But ONLY in that context, and only because it would/will mean this murderer faces criminal charges.

          • DaisyGrrl

            This is one of the few posts that I think could benefit the mother if she saw it (not right now…but maybe as she starts to ask questions about what happened and why).

            The post and comments are so universally condemning of the midwife and sympathetic to the mother that it could help her see that what happened was not acceptable in any way shape or form. This time it’s not about home vs hospital. It’s about dangerously stupid vs wishing the baby had had a chance.

  • Anj Fabian

    Someone do me a favor – screen shot all of this and send it to the UK midwives at Catch of the Day. I’m sure it would be very educational.

    • Stacy21629

      I’ve been saving it as a PDF every so often…figure she’ll delete it eventually. Most recent save at 3:00pm…going there again now to see if new responses.

  • Anj Fabian

    This makes me want to go full Mamet on her:
    [fbombs ahead]
    When it is obvious, even to YOU Jan Tritten, that you are out of your fucking league, that your knowledge pool is not fucking adequate, that all you have to offer this patient is fucking ignorance – the smart move would be to ask the fucking EXPERTS who have more experience, more education and more training than you do.

    Not people who have fucking LESS of all that!

    This is when you call your OB who you rely on to help with the tough cases. And you trust their fucking professional opinion and accept it and act on it.

    Fucking ship of fucking fools, calling on the fucking Coast Guard.

    • Amy Tuteur, MD

      A-fucking-men!!

    • Lindsay Beyerstein

      First prize is healthy baby. Second prize is a set of steak knifes. Third prize is: You’re fired!

  • Amy Tuteur, MD

    I asked @JanTritten on Twitter if she’d care to comment on this preventable death. I’ll let you know if she responds.

  • Amazed

    Someone take a screenshot?

  • Squillo

    Jesus wept.

    I’m sure the prayers are appreciated, Jan, but you know what would have helped that family more? A little fucking competence.

    • ngozi

      But even Jesus bothered to heal people.

    • Are you nuts

      God gave us brains.

    • auntbea

      I realize it’s just a saying, but I am pretty sure that Jesus is actually weeping. And I don’t even believe in Jesus.

  • Zornorph

    Sigh – I don’t know if this makes me more angry or sad. The mother trusted her ‘midwife’ to know what she was doing and it’s clearly obvious that she didn’t. That’s what all those monitors in the hospital are for, to pick up on things like this.

    • The Bofa on the Sofa

      All the information in the world doesn’t matter if you don’t know what to do with it.

      Jeez, she KNEW that the mother was past 42 weeks and had no amniotic fluid! She was too stupid to know that something had to be done.

      That’s what a health care provider’s whole job is. I tell my doctor that my arm hurts, he is supposed understand what that means. Finding out that my arm hurts is the easy part.

      • CognitiveDissonaceHurts

        Bofa, what is the standard procedure of care for a situation like this? How off the mark was Jan T.?

        • The Bofa on the Sofa

          Get thee to a hospital! Stat!

          • CognitiveDissonaceHurts

            Induction? C-section? WWBD? (What Would Bofa Do?)

          • The Bofa on the Sofa

            Bofa wouldn’t be sitting around at 42 weeks with no water. Came across it?” Depends how long there has been no water. If I don’t know, I’m doing a c-section NOW

          • auntbea

            Bofa, aren’t you a physicist? I’m not sure you should be doing c-sections, now or otherwise.

          • The Bofa on the Sofa

            Not a physicist, but not a doctor, either. Which is why this is so scary – it’s so friggin obvious that even an ignorant goob like me knows what to do.

            Induce at 41.0. OK, maybe if all signs are good you can let things progress, but only if all signs look good.

            No water is not looking good.

          • me

            Exactly. This whole debacle hits close to home for me. All three of my daughters were born at 42 w. I had numerous u/s and NSTs towards the end of each pregnancy and everything looked great. Had anything been off (and from what I was told, fluid levels are among the MOST important things to look at) I would have induced ASAP. With my first child I was induced, because it was 42+1. Everything looked perfect, but we had waited as long as we reasonably could. The other two came on their own at 42+0, but the inductions were already scheduled.

            Of course, I had competent care providers that I could trust. This poor woman…. There aren’t words to describe my feelings here. She trusted these bozos and they killed her child. My heart breaks for her.

  • The Bofa on the Sofa

    Once again, we see the consequences of patients not having the ability to sue non-providers like these.

    I know that most non-idiots shudder at the story in this post, and, shoot, I’m sure a lot of idiots do, too. The care provided was so far away from standard of practice that it isn’t even funny. A doctor who did this would be sued so fast and hard that it would leave a mark.

    But this dingbat floats along merrily, with no consequences whatsoever.

    • Julia

      I don’t understand the US legal situation that well – but is there any way to sue her for this? Or for practicing illegally or whatever?

      • The Bofa on the Sofa

        She can be sued, but there’s nothing to get, so no one will do it.

        • manabanana

          There’s nothing to get.

          Also, there were no standards that were ignored.

          There are no practice standards.

          Because Oregon, infamously, has no practice standards for unlicensed midwives.

          And this is perfectly legal.

      • Rabbit

        Most plaintiffs’ attorneys who do malpractice litigation work on a contingency fee – the client doesn’t pay anything unless and until they win. If there is no one to collect a judgment from, the lawsuit isn’t going to happen, unless you find an attorney willing to do it pro bono (unlikely), or you can pay the attorney out of pocket.

        • Melissa

          Also, in malpractice cases negligence is often determined by violation of the standard of care. What would other doctors have done in this situation? If you are too far outside of that it is negligent. Because midwives have no guidelines, it is harder to prove standard of care has been violated. You just bring in enough midwives who say “I had a similar case and everything was great” or “I wouldn’t transfer in this circumstance” and then you create reasonable doubt in the jury.

          A contract case might be easier to win than malpractice. You’d allege that the midwife misled you about their ability to handle these things and it would be some type of fraud in the inducement. But the types of recovery are different in contract cases, and the family that hired the midwife may be grilled on why they made the decision to go with a midwife. It would be a bit like suing a psychic when they couldn’t actually tell the future. They may have lied, but the court is going to wonder why you believed them (or, in this case, why on earth you rejected the medical establishment).

          • DaisyGrrl

            I’m curious, would it make a difference if the midwife is licensed by the state? Since the state is licensing the practice, this gives it the veneer of safety and mainstream health care (especially if insurance covers the costs). Would a client/mother be expected to know they’ve chosen a health care provider who does not practice according to a standard of care if the state licenses them?

          • Melissa

            Not really. If the state negligently licenses someone the state is liable for the lawsuit, not the person with the license. Imagine that the state said that to be a doctor all you needed was to own a DVD set of Grey’s Anatomy. Someone follows these rules and get’s their medical license. Things predictably go wrong. They followed the rules, but the state it the bad actor.

            Except, states have legal protections for things that they do in the scope of governing. I do remember someone tried to sue the state (Utah maybe) for negligent licensing, but the sovereign immunity of the state prevented the case from going to trial.

            I agree that it is unrealistic to expect a mother to know the difference between a licensed direct entry midwife and a licensed nurse midwife, especially when both just call themselves licensed midwives. But I’m not sure that a court would care that the state has created a situation that leads to confusion for mothers (sovereign immunity again), although if a DEM did create intentional confusion and lead a patient to hire he thinking that she was a nurse midwife that might lead to a bolstered contract case, although not a malpractice case. The malpractice case is all about if the actions of the defendant were negligent, not about the expectations of the plaintiff. Contract law, on the other hand, would care more about expectations of both parties.

            But contract cases have different remedies. Usually you can only sue for the price of the contract (i.e. what you paid the midwife) and only under special circumstances can you sue for the things resulting from that bad contract (i.e. the expenses of medical care in the hospital you had to go to because of the midwife screwing up). I think that a contract case against a midwife would be pretty easy to win, but it is small comfort to be able to end up with the few thousands you paid the midwife for having to go through the expense and emotion of a trial.

          • DaisyGrrl

            Thanks for the explanation! I knew that midwives were essentially judgement proof since they generally don’t carry malpractice insurance, but I didn’t know about the standard of care issue. It makes their refusal to establish standards appear even more cynical and self-serving than I had previously thought.

      • manabanana

        I believe Jan lives in Oregon. And I also believe that Jan is NOT a CPM, nor is she licensed to do anything…
        In Oregon, unlicensed midwifery is LEGAL.
        What recourse is there in this situation?

        No licensing board.
        No professional credential. (Or “professional” credential, if you will.)
        No regulations.
        No stipulation requiring malpractice insurance.

        What recourse is there?

        There is none.

        None.

        That’s the biggest crying shame.

    • The Computer Ate My Nym

      I’m not a big fan of lawsuits as a method of keeping the quality of care up: it’s too random and there are too many false positives and false negative (i.e. lawsuits for doing nothing wrong and idiots getting away with grossly negligent care). That being said, at least it provides some control and the DEM situation shows all too clearly what happens when that control is not there. And I’ve used “we can’t do that, we’d be sued” to block more than one poorly thought through administration idea in my time. So I guess maybe I’m more pro-lawsuit than I think.

      • Julia

        Not a big fan of lawsuits either, but it just seems so wrong that someone can get away with murder (literally).

      • Young CC Prof

        Theoretical lawsuits: Enforced ethics.

        Actual lawsuits: Often messy and awful.

      • Melissa

        If the tort system worked perfectly then lawsuits would be as effective at quality control as government regulation. You can look up something called the Coase Theorem to learn more about the concept (it is very law and economics based). The problem is that in the real world not everyone who is harmed sues (because the transaction costs of a lawsuit make it impossible) and that sometimes juries will incorrectly find liability with a party who did not actually cause the harm because of legal wrangling or sympathetic juries.

        Of course we now have a system that both places limits on the tort system and refuses to use strong government regulations creating the worst of all possible worlds.

  • MaineJen

    “It is always so sad when a baby doesn’t make it.” What the…just…I mean…OMG Not only does that not sound sincere, it sounds flip. It sounds as though infant death is a normal, routine part of life (as indeed it used to be…100 YEARS AGO), nothing to get worked up over. Completely heartless and chilling. And to do all of this on Facebook. Ask advice ON FACEBOOK on something that you know damn well should have been transferred. I just…NO.

    • Comrade X

      The “always” makes it sound like some kind of annoying weekly occurence too. Like stubbing your toe, or stepping on lego. If the women she was “caring” for were actually receiving competent medical attention, a vanishingly small number would lose their children at birth – far far too few to make the whole experience “old hat”. This is just so callous I can’t even properly get my head around it.

      • anion

        It’s always sad when I run over people with my car. Prayers for them!

        • anion

          Oops, I clicked the arrow too soon. It was supposed to go on to say, “Time to go shopping now, ttyl!”

          • Amazed

            The man who almost run me over with his car did it wrong. He was actually concerned about me. Between cursing at me and wiping his forehead, he wanted to take me to the hospital.

            I was the dumb pedestrian who tried to cross a six-way boulevard and he was the great driver who managed to only send me flying in the air. He wasn’t even to blame. Somehow, he didn’t think it would be “sad” if I was seriously hurt, he was panicked and eager to prevent complications.

            Jan Tritten can take a leaf out of his book.

          • anion

            Oh, you mean he was a normal human being with feelings and stuff, not a psychopath?

            I used to have a nightmare where I accidentally killed someone. It was a horrible dream. I’d wake up feeling absolutely sick, and then suddenly realize it was only a dream and I hadn’t been responsible for someone else’s death. I cannot imagine actually being responsible for the death of another person–a baby, no less!–and just being able to flippantly go, “Oh, yeah, it’s always sad, you know. What’s for dinner?” the way this woman has done. How do you live with yourself??

          • Amazed

            Years ago, I was in the car with a friend and we were driving through a small village. On the sidewalk, an old man suddenly let go of his grandson’s hand and the little boy ran right in front of us. The driver hit him.

            I don’t want to remember the panicked drive to the nearest town hospital, the horror, the fear, the self-blame. Fortunately, there was only a slight commotion. My friend, he was driving within the limit and I think that’s what saved the child. Still, the next day he sported white hairs.

            What the hell is wrong with Jan and her ilk? There wasn’t a stove lit that dried the amniotic fluid in 3 minutes or something. That was a decision the midwife made consciously – and she just waves it off.

            I suggest a scan to verify her ailment: absolute lack of conscience.

          • DaisyGrrl

            The other difference? I bet your friend and the grandfather both spent time reflecting on what happened and what they could have done differently (even though it sounds like a genuine accident). If the child had been killed, there would have been an investigation to determine whether there was any blame to be assigned or whether the street had safety issues that needed to be addressed. I’m guessing that these midwives won’t change their practice and they certainly won’t look to assign blame or address safety concerns.

          • Amazed

            Oh yes. Naturally, I know more about my friend that the grandfather but I can safely assume it was the same with him.

            Actually, for a while I was convinced that I was to blame because, you see, in this well-kept village there were rows of roses between sidewalk and road. I was admiring a bunch of splendid yellow roses and I wasn’t looking at anything else. If I had looked only a meter downward, I would have spotted the child making his dash. Of course, I know it wouldn’t have changed anything but it didn’t feel like it.

            Midwives won’t change their practice, of course! It would have happened in the hospital, too. I read through this death thread and all I could think was, “A bunch of Lysa Barrett’s wannabes.”

          • AlisonCummins

            Also the parents would decide that they wouldn’t want to blame the grandfather if anything terrible happened in the future, and decide to prevent worrying about that by not letting the grandfather walk his grandson alone any more.

    • Lori

      In the hospital, it’s so rare for a baby not to make it. So “when”? Does this happen a lot? It’s kind of horrifying. If it doesn’t mean that, then what?

  • Elaine

    Then there’s this:

    “I would think inducing her with Cervadil is not a good idea. Induction is stressful and forces the body before it is ready. It often puts babies (and mothers) into distress. Also, placentas really do not have a use-by date. You can see a fine healthy placenta at 44 weeks and a shredded one at 39. Also, once you start with the unnatural means of induction like Pitocin or Prostaglandins, the mother’s natural oxytocin is generally switched off and the drugs must continue to make labour happen. The curve of perinatal mortality is not exponential, either – though quite possibly there is more than one conclusion to that sort of study. The Cochrane Collaboration, which reviews many hundreds of research papers to try to reach a conclusion (which is frequently “needs more research”) indicates that the “safest” time statistically to be born is 39 weeks, where the rate of mortality is about 1/900. The rate rises to about 1/600 by 43 weeks. This means that, even at 43 weeks, 599 mothers will have a live healthy baby. It is much better odds than some other stats – such as: Induction of a primip has a 70% chance of ending in C/section. I believe they have had an NST and obviously the mother would be monitoring movements etc. The routine use of ultrasound has not shown to improve outcomes – it must be judged on a number of different indicators, and above all, we need to listen to the mother.”

    So a 1 in 600 risk of a dead baby is less of a risk than a 70% risk of a c/s? Only if you think a dead baby and a c/s are equally bad outcomes. *bangs head*.

    I have even less patience for this crap since the birth of my son 2 weeks ago. Totally healthy pregnancy, no risk factors, short natural labor & birth. Low-risk as can be. I bled enough that my midwife (CNM) wanted to actively manage 3rd stage, and ended up having to manually remove the placenta. It was unpleasant, to put it mildly, and if she hadn’t done it, I might have been fine, but then again, I might not have. People don’t seem to realize that all complications are just something hypothetical until they aren’t, and you don’t know when that’s going to be.

    Both of my children would have been totally fine if I’d had them at home, but I only know that in retrospect. I’m the one who would have had problems. I think they would probably prefer me alive & healthy.

    *headdesk*

    • Young CC Prof

      In other words, “Sometimes 43 week babies are OK, so just ignore all evidence that this one isn’t.”

      Kind of like discussing how rare death by lightning strike is while climbing trees in a thunderstorm. Watching the heart of the storm come closer and closer.

    • http://momofmanyfeet.wordpress.com Bambi

      I don’t see how you can compare mortality rates for a baby against c-section stats for a mom. “Well, baby has this chance of dying, but ERMAGERD, mom has this chance of a c-section with a living baby”. Really??

      • KarenJJ

        Any midwife that says something like that should be suspected of eugenicist or sociopathic tendencies. Seriously. It is not a normal thing to think that a baby that can’t be born vaginally is a baby that shouldn’t live. People like that should not be midwives and definitely should not be midwives where they are caring for women on their own in their own home.

        • Comrade X

          Yup. Normal people would choose a 100% “risk” of a C-Section over a 0.1% risk of a dead baby.

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

    According to her facebook, Jan Tritten is in EUGENE, OREGON

    • Carolina

      Send all your friends that way :) Homeopathy! Acupuncture!
      Aside: my sister and BIL are moving to Eugene in July. He’s a pediatric neurologist and is already shuddering about the homebirth injuries he’s expecting.

      • Lori

        It sounds like he could do a lot of good there but that his work is cut out for him. Good luck to them!

    • http://safermidwiferyutah.wordpress.com/ Safer Midwifery Utah

      Her bio said she quit practicing midwifery a long time ago. She posts questions on behalf of other people. I ask in the thread if this was jan’s client or not. We’ll see I guess.

  • http://safermidwiferyutah.wordpress.com/ Safer Midwifery Utah

    Does anyone know of a place other than Utah where this would be legal? I don’t want to blow it out of proportion if there is something I am overlooking, but I just can’t think of a different place bc everyone has mandatory licensing except us. Thanks Holly Richardson, you freaking jerk.

    Holly Richardson bothered to reply to me (in private of course, can’t let the public see her answer for her part in these deaths). She tried to say “there ARE restrictions on unlicensed midwives”. Uh yeah, they can’t say they are licensed and they can’t give out drugs, but I am willing to bet there are zero prosecutions for either of those things. The unlicensed midwife I reported for misrepresenting her credentials never got in trouble. None of the ‘restrictions’ prevent these morons from attending a 43 week VBA8C breech with a GD mom, now do they? What good are these regulations?

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

      Oregon. She’s from Eugene.

      • http://safermidwiferyutah.wordpress.com/ Safer Midwifery Utah

        Oregon requires licensing now. SInce this past summer. And practice guidelines (as far as I know, I will double check).

        • DaisyGrrl

          Midwives in Oregon aren’t required to be licensed (per the state midwifery board).

          • http://safermidwiferyutah.wordpress.com/ Safer Midwifery Utah

            ARG I thought they were! I guess now you have to give a scary letter to your client beforehand and you can’t advertise at all.

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

          Not really, we still have “exemptions”

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

          Can you post anything anything that shows this? I don’t disbelieve you, but I cannot endure looking through that thread again.

          • http://safermidwiferyutah.wordpress.com/ Safer Midwifery Utah

            On midwifery today she says she was a midwife a long time ago (1977-1989). Lots of posts on the thread say they feel bad “for the midwife” (instead of directly feeling bad for jan). I kind of assumed it wasn’t hers because of that? http://www.midwiferytoday.com/bio/default.asp?name=tritten

          • MaineJen

            They feel bad…for the midwife???

          • anion

            Well, sure. The midwife is the one who suffered a loss here: no birth-junkie high!

            /sarcasm

            I’d feel bad for the midwife if she was a genuinely qualified healthcare provider who’d done everything modern medicine could possibly do. I do not feel bad for an idiot who turns to Facebook for help, and who is genuinely at a loss to know what to do about a situation that any halfway intelligent layman knows is dangerous.

          • manabanana

            Jan Tritten still attends births occasionally. And she’s written about it in her magazine.

            She has no credential or license as a midwife.

            You can’t assume anything. You just can’t.

        • DaisyGrrl

          re: your edit. Jan is talking in first person in her update. Most of her other posts mention who is asking the question, so I don’t think it’s unreasonable to assume that she’s acting as an unlicensed midwife in this particular situation.

        • areawomanpdx

          No, Oregon does not require licensing. They require licensing to advertise. This death is on the hands of the Oregon legislators as well.

    • MaineJen

      Maine does not require licensing. Alas.

    • Bomb

      Nevada doesn’t have any rules for quack midwives.

    • Medwife

      This could and does happen everywhere. Unfortunately.

    • manabanana

      Minnesota is another state that has voluntary licensing for CPMs.

      Maryn Leister, CPM, from Arizona relocated to Minnesota where she could practice midwifery without those pesky restrictions.

      http://www.sistersinchains.org/our-sisters-in-chains.html

    • manabanana

      Does anyone know of a place other than Utah where this would be legal?

      (I thought I’d answered this – but there are a lot of comments here)

      Oregon, Utah, Minnesota, perhaps Ohio. Ask Marlene Waechter, CPM.
      Perhaps Missouri, too.

      These are states that specifically allow unlicensed midwifery to be practiced.

  • EllenL

    Notice how Jan can’t use the words “dead” or “death”? “The
    baby didn’t make it.”

    Makes it sound like it’s the poor kid’s fault. That baby wasn’t up to snuff.

    “Had aspirated meconium a while back they believe.”

    Always, always, whatever killed the baby happened “a while back.” So you see, it wouldn’t have made any difference if we’d gone to the hospital hours, or even days, earlier.

    “I listened to baby afterwards and heart rate was on the low side.” Egad, woman.

    “We came in, chose a c-section, and they worked on the baby for 47 minutes.”

    There’s obviously a lot left out here – all of it horrible. Hence the focus on “they worked on the baby for 47 minutes” (we did everything!).

    “It is always so sad when a baby doesn’t make it. Prayers for the family!”
    OK, let’s move on!

    Indeed, how do they sleep at night?

    • Young CC Prof

      Of course, as we discussed on another post a couple days ago, most babies with meconium aspiration syndrome can be saved by hospital care…

      • The Bofa on the Sofa

        Shit, it was the midwives who were claiming that meconium is no big deal. Now the midwives are complaining about it? Get your stories straight, morons.

    • Medwife

      We came in and chose a c/s huh? How nice. Somehow I don’t think it was a little “so what do you ladies feel like doing about this? C/s or just drink coconut water?” They pulled out a goddamn dead baby. A baby that would have been born alive a few days earlier. Of course they worked for 45 minutes. It’s so unfair, a baby dead for no cause, you never want to stop the code. I feel so bad for that team.

    • moto_librarian

      Forgive my ignorance, but I thought babies could not aspirated meconium until/unless they breathed? Did she mean to say that the baby inhaled it, or is she just covering her ass?

      • Playing Possum

        Intrauterine agonal gulping due to severe oxygen deprivation. I was wondering (if the MW was the one doing the US) if that was what was mistaken for normal breathing movements on the scans.

    • auntbea

      “On the low side” –> “worked on him for 47 minutes.” I think “on the low side” might be “zero”

  • Trixie

    What were those MANA guidelines? “Letting go is an art?”
    If I have to pick the most disgusting part, I think it’s the calls to support the midwife through this difficult time.

  • Mel

    Did the midwife tell the mother that she was crowd-sourcing her answers?!?! That’s so…..I don’t have enough words for this crap.

    • Young CC Prof

      “Let me consult with my expert colleagues.”

      • Lori

        Imagine if doctors were like: Hmm. I’m not sure if we should do a C-section or not. Let me ask my friends on Twitter!

        • Anj Fabian

          Jeevan Kuruvilla did actually post an internet consult (gas gangrene, you can search for it).

          The answers came back roughly – you can aggressively treat it with this or that, but if the condition doesn’t improve promptly, amputate it.

          • Lori

            In that instance, you could try hyperbaric oxygen, but wouldn’t most doctors know that?

          • Dr Kitty

            Jeevan is in rural India.
            He’s lucky if he can get relatives to donate blood or buy antibiotics.

            Hyperbaric oxygen ain’t gonna happen,

          • Lori

            I did not realize that. Ah, okay. That makes more sense now.

          • Dr Kitty

            I did an elective in a hospital in Jeevan’s organisation when I was a medical student.

            We re-washed latex gloves, used cotton thread to suture wounds and the lead surgeon was an obstetrician who did general and orthopaedic surgery because she had to.

            Crowd sourcing treatments makes sense when you’re in that situation.

            When you’re in the USA and your patient can see a specialist…not so much.

          • Dr Kitty

            I firmly believe, BTW, that scooping pus out of a tuberculous paravertebral abscess while wearing recycled gloves and staying in accommodation which has running water for 4 hours a day, and where the bathroom consists of a bucket and a tap is a character building experience all doctors should experience.

          • Mishimoo

            Nowhere near as messy, but I firmly believe that people who want kids should volunteer in an animal shelter first because I worked in a vet surgery before having kids. Surprisingly, quite a few of the skill sets transfer over rather well. I also ended up with a new found appreciation for antibiotics and vaccinations, as well as learning about the wonders of synthetic oxytocin.

          • fiftyfifty1

            Amputate it!?
            No, I recommend Stevia instead!

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

          To wikipedia!

        • Medwife

          There are professional message boards out there. But… They’re not like Jan’s Facebook page.

  • violinwidow

    That Zuki person is also posting on that page, asking about a mother with ROM at 29 weeks. I’m the only one who suggested transferring her care.

    • Young CC Prof

      Um, ROM at 29 weeks = hospitalization in a place with a good NICU?

    • violinwidow

      My mistake, it was not Zuki, but some other idiot.

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

    Another question – how was this murderer (oops! I mean “midwife”) performing NST and BPP and visualizing the placenta, kidneys, etc.? Wouldn’t an ultrasound be necessary, and wouldn’t that include at the least a US technician? Or was it “visualized” with her third eye while meditating or some other bs? Can you do a NST with a doppler? Where did this happen, a birth center? A living room?

    Sorry to keep posting, I’m slow when I’m enraged and I can’t stop thinking about this.

    • Anj Fabian

      Polyhydramnios made for the world’s best ultrasound images.

      I’d assume that zero fluid would mean the opposite, getting good images would be very difficult.

    • Squillo

      And why bother if you’re just going to ignore the results?

      • NoLongerCrunching

        Because it makes the MW look like she is monitoring appropriately.

  • snm rose

    this is HORRIBLE. I’m almost embarrassed to call myself a (future) midwife (cnm) after seeing what these hooligans who call themselves midwives do. completely reckless and irresponsible. that midwife should be prosecuted!

    • Medwife

      The fact that you are horrified means you should HANG IN THERE. Note my user name. If providing care that results in live babies means being a medwife, wear the label with pride.

  • Young CC Prof

    “Technology
    isn’t perfect and I like Gloria Lemay’s visualization of a glass tub
    above you…how much water will you actually see below someone in the
    bathtub?”

    For one of my ultrasounds, there was a medical student observing. The doctor explained to her how fluid measurement on all 4 pockets provides very high intra-rater and inter-rater reliability.

    But, you know. Tool of the patriarchy and all that.

    • Dr Kitty

      Argh! Gloria LeMay, that isn’t what an USS is though!
      It isn’t a single picture from one angle.

      You can do slices and change the angles and see whatever you need to see.

      • Young CC Prof

        You can see freaking blood vessels and valves in the beating heart of a one-pound fetus, of course you can see the fluid!

  • areawomanpdx

    There are no words to describe this. The strongest, most vile language I can think of doesn’t even begin to cover it.

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

    I will be interested to see if we get parachute trolls on this one. I would truly love to see how they defend this one.

    • areawomanpdx

      Pretty sure there aren’t going to be any parachuters here. What could they possibly say?

      • Rabbit

        The typical. None of it will be accurate or relevant, but they’ll say it anyway.

        1) Dr. Amy is mean: Dr. Amy is exploiting the story of this poor woman and her family; this is a private matter; you don’t have permission to share this story; etc.

        2) This would have happened at the hospital too. Doctors told us the baby aspirated meconium days/weeks/whatever ago, when baby was still looking fine. No one could have done anything differently.

        3) If hospital hadn’t been so c-section happy/impersonal/mean/induction happy, mom wouldn’t have been forced into homebirth/would have gone to hospital earlier/some other excuse. It’s all the OB’s fault.

        4) Some babies just die.

        • NoLongerCrunching

          At least the hospital wouldn’t have looked to facebook for ideas on how to treat a patient. And it’s OBs who don’t follow evidence based guidelines????

        • Young CC Prof

          I dare them to try #1 on a story that ISN’T coming from the poor UNNAMED family but from the midwife who totally deserves public shame.

          • Amazed

            Public shame? I think you mean “love and healing”?

            I love how they are so sorry “for you and the family, Jan.” See who comes first?

          • Trixie

            No, the midwife needs our love and support because every midwife loses babies!

        • Squillo

          If the lethal meconium aspiration happened “some time ago,” would the NST have been reassuring at what appears to have been 24 hours before death?

      • DaisyGrrl

        Someone on Facebook has already done the “mother needs to own her outcome” line. So there’s that.

        • Carolina

          I’d love to punch that person. Searing, surging rage just ran through my body.

          • Comrade X

            Yup, all the swearwords ever invented just don’t seem to do justice to how rage-inducing that level of irresponsible victim-blaming fuckbaggery is.

        • The Computer Ate My Nym

          WHAT????? Ok, the mother didn’t push for immediate admission to the hospital, but she’s the fucking patient! She’s supposed to be getting expert advice, not providing it.

          • DaisyGrrl

            I’ve noticed that lay midwives are “health care professionals” when it comes to mandating insurance reimbursements, but “space keepers” and totally *not* health care professionals when it’s time to take responsibility. Hence the dump and runs at hospitals when things go south, not needing malpractice insurance or standards of care, and of course, the mother needing to “own her outcome” when things go wrong.

          • Elaine

            I want to upvote this 1000x. They want all the perks and none of the responsibilities.

          • Medwife

            She didn’t go for an induction because her “midwife” blew smoke up her ass. You know that couldn’t have been an informed decision.

      • The Bofa on the Sofa

        “Not all midwives are bad”

        So here’s the question: did ANYONE, in response to her question, tell her to get her to a doctor now?

        • AlisonCummins

          From the post: “There were other, reality based suggestions as well, including the recommendation to transfer care and induce.”

          • The Bofa on the Sofa

            See? Not all midwives are bad…

          • DaisyGrrl

            Interestingly, the midwife advocating most vigorously for induction in that thread was a CNM…

          • The Bofa on the Sofa

            Hey, but Jennifer Holshoe says that 1 ml of a homeopathic solution can create lots of amniotic fluid…

          • Dr Kitty

            Ummmmhmmm magic water is magic

          • Medwife

            I hate myself right now for not chiming in. There are just so many horror stories presented, I just took a deep breath and tried to let it go. These women are crazy and they don’t seem to have any clinical judgment whatsoever. And then they don’t listen to professionals.

      • Amazed

        Mother’s choice! Women autonomy! The state is to blame. Babies die in hospital, too. Feel free to keep the list going.

        You’re a better person than I am, areawoman. You give them too much credit.

        • MaineJen

          ‘But the mother prefers to do nothing,’ she was careful to add. Covering her ass.

          • Amazed

            Yeah, let’s not important who’s really important here.

      • Medwife

        Something something abortion!

  • Dr Kitty

    There are these people who spend eight years in college and lts of years in residency and have lots of experience with AFV and NSTs and BPP.
    Why not ask one of them what they think?

    Oh, that’s right, because they might tell you something you don’t want to hear.

    You can still ignore their advice you know.

    But yes, you’re right it IS harder to justify ignoring an expert’s opinion.

    So…you don’t want to get expert advice because you know you won’t like it, and if an expert has told you that your preferred course of action is dangerous you can’t pretend you were unaware of this risks…gotcha!

    And people say Drs practice CYA medicine…
    CPMs seem to be of the opinion that if they are unaware of a risk/feel it to be safe/haven’t investigated the risks, well then the risks simply do not exist.

    Idiotic, unethical, unprofessional lying liars who lie.

    • ngozi

      It is so much better to ask your facebook friends. DUH? Didn’t you know that?

    • Dr Kitty

      And clearly I’m too angry and upset to proof read. You guys understand though, right?

    • The Bofa on the Sofa

      As I noted below, talking about CYA? How about putting it as the responsibility of the mother?

      “Mom’s own their own birth” = “don’t blame me if something goes wrong, it’s what she wants”

    • Mel

      I think it’s even sicker than that. I think the midwives actually believe they have the same level of understanding/training as doctors. The more I read of shit written by these women the more I really believe this is some kind of sick power trip.

  • Meredith

    This whole affair is horrifying but two things jump out at me: First, “Can anyone share stories/opinions?” Ah yes, that high standard of care known as “someone on the internet told me a story and gave me their opinion.” And second, “Technology isn’t perfect…” Well, it’s sure as hell a lot more perfect than stories and opinions!

    • The Bofa on the Sofa

      First, “Can anyone share stories/opinions?”

      My wife is a vet, and there are cases where she’ll go to the internet and ask about it – on a listserver that is populated by other veterinarians.

      The idea of posting it on Facebook? That’s beyond fathomable.

      • Meredith

        Exactly. It’s one thing for a professional to consult other professionals. In fact, it’s a good thing! For a non-professional to “consult” other non-professionals? Talk about the blind leading the blind…

        • KarenJJ

          Yes, On occasion my specialists have rung the heads of other departments or specialists in other hospitals to get further information on something. Never gone to facebook though.

      • Amazed

        Sure I can share. Is there anything proving that I’m a midwife and not a 15 year old boy who wanna have fun at that weird old lady’s expense?

    • Anon1

      I wonder how this is not considered a violation of HIPAA. I’m pretty sure my employer would fire me if I was caught even vaguely talking about patients on FB.

      • nomorequestionscatherine

        Are lay midwives/CPMs actually subject to HIPPA?

        • EmbraceYourInnerCrone

          Probably not unless they do any electronic transmission of patient information/results.
          Funny how they call themselves health care providers but are not subject to the rules everyone else is.

    • KarenJJ

      Technology was perfect enough for their facebook page to work, but not good enough to tell them that a baby is likely to be in trouble.

      • KarenJJ

        Oh I know different technology and all that, but honestly their “traditional” approach to birth includes facebook. So much like those “granny midwives” of past…

        • anion

          Well, you need the internet if you want to find the really good knitting patterns.

  • Julia

    This is beyond horrible. Something is profoundly wrong with a system that allows this woman to be a “health care provider” without any liability.
    And what’s also wrong is the fact that I (not a health care provider) seem to know more about this than she does!? Even I know that 42 weeks and no fluid is not a wait-and-see situation.
    That poor baby.

    • Florence

      But but but…mom was feeling everything was fine…..so much for trusting your guts….. sad indeed!

  • staceyjw

    This just cannot get worse.

    I am sure mom wanted a nice NCB, preferably at home, and to avoid the dreaded CS. Obviously she wasn’t too against technology because she had BPP’s.
    I bet she didn’t know her “MW” couldn’t assess them properly (I wonder that the tech thought when she saw this?).
    I bet she thought that the BPP’s meant she was fine- if it wasn’t they would know, right?
    I know this idiot “MW” sure didn’t tell her what the BPP said- how could she? She didn’t know!
    I wonder if mom knows her “MW” went to FB for advice on her case?

    In the end, mom got BOTH the dreaded, emergent CS, AND A DEAD BABY.

    I feel worst for the baby, who never got a chance to live.

    I am sure this will be brushed right up under the rug, along with all of the other post dates deaths.

    3rd world deaths in a 1st world nation- thats HB MWery!!!

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

    Question: when did this happen? Yesterday? A week, a month?

    • Amy Tuteur, MD

      Yesterday.

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

        I hope you’ve screen capped everything (of course you have!). I don’t even have words.

        • http://safermidwiferyutah.wordpress.com/ Safer Midwifery Utah

          I did if Dr Amy did not. I’m going to blog about it on ex home birthers.

  • Florence

    I expect that thread to quickly be deleted , hope you gals have screen caps!

  • nomorequestionscatherine

    Horrific.

    Quoting “Lynn Reed what Zuki said:) Trust mom’s instincts too & who made up the 42 week law? Midwives or OBs scared of litigious times & distrust of mom’s owning their births”

    So many things wrong with this statement. Well of course the midwives aren’t scared of “litigious times”. They carry no malpractice insurance & are rarely held legally accountable.

    42 week “rule”. Try reading some evidence based scientific research and practicing it.

    Also love how she throws in the zinger about mom’s owning their births. Sell that “empowerment” midwives. Then when your failure to provide adequate care to the mom ends in the death of her baby you can square the blame on her. “Own your birth (and the consequences resulting from it)”

    Unspeakable.

    • The Bofa on the Sofa

      “mom owns her own birth” = “it’s her fault the baby died, not mine”

      That’s what it sounds like to me.

      • Dr Kitty

        No sounds like it to me. That is what it IS.

        This may surprise you, but people ignore my advice all the time.
        “Patient reports unilateral leg swelling. Strongly advised to attend hospital to rule out DVT, which could be fatal if left untreated. Patient not keen on hospital, declined to go” is a scenario I have encountered more than once,

        I respect patient autonomy, the difference is that I don’t pretend that everything will be OK if we do what they want.

  • Rochester mama

    Just looked at her Facebook page, what a quack! I can imagine hiring her to walk my dog, let alone provide medical care!

  • Ennis Demeter

    She killed that baby. I have no words.

  • staceyjw

    I don’t know if I can come up with a reply to this other than WTAF, this woman is a criminal! Crowdsourcing this info? GTFO. That has to be criminally negligent behavior.

    THIS IS WHAT YOU GET WHEN YOU GIVE FAKE “MWs” TOTAL AUTONOMY TO PLAY WITH PEOPLES LIVES.

    I think it’s telling that “MW Autonomy” was even mentioned in her first post, but I am glad she did. Its illustrative. Even the most basic rules and protocols may have pushed her to make the right choice here, saving this life. Its obvious that without such rules, plus enforcement, these fakers won’t do the right thing.

    Even I KNOW that she ought to have induced almost 2 weeks before, and even a total layman knows that zero fluid is a BAD SIGN. Why get a BPP at all if you are just gonna ignore the findings? Those tests are useless without the clinical knowledge to assess the results.

    SO MANY of these disasters are so very obvious, I feel like I could do a better job as a HB MW by simply going on what I know now, and avoiding these idiots in the woo echo chamber.

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

      “I mean, it’s okay; I won’t get busted or anything, so y’all got any ideas?”

      She’s a murderous cunt. And I do not use that word often or lightly.

      • Amazed

        “I mean, it’s okay; I won’t get busted or anything.”

        I hope it isn’t and the bitch will.

    • ngozi

      I at least have a college degree. Maybe you and I could practice together. At least we would have common sense, which it seems many of these midwives do not.

      • Meredith

        We could be great homebirth midwives. All we have to do is direct all calls to a message that says, “You’ve reached ABC homebirth service. After reviewing your situation, we recommend that you give birth in a hospital. Our fee is a photo of the healthy mom and baby.”

        • Young CC Prof

          Reviewing the situation = reading your pregnancy test.

          I like it!

          • Meredith

            “At ABC homebirth service, we believe in reducing the number of interventions you are subjected to. We promise that we will never recommend a needless intervention to any woman who is not, in fact, pregnant.”

    • Trixie

      I’m really good at scooping poop out of bathtubs (just got another “catch” last Sunday!). So I’m qualified, right?

  • Lawyer Jane

    Oh, let’s also note that this is a death attributable to midwife care and planned homebirth, but in the statistics would probably be counted as a hospital birth.

  • http://www.antigonos.blogspot.com/ Antigonos CNM

    I don’t really understand why Tritten had to ask advice. This woman stopped being a midwife’s case and became high-risk once she went past 40 wks.

    I would have sent the patient to L&D immediately — and I’m not even sure she was a candidate for induction with such severe oligohydramnios. In my experience, most OBs would have elected for C/S.

    • R T

      In SoCal, a licensed midwife can continue care until 42 weeks. Most of them will transfer care before 41.5 though.

  • Lawyer Jane

    Holy shit. That is all I can say.

  • DaisyGrrl

    From Jan Tritten’s post: “Mom feels everything is fine and wants to leave things alone.”

    IT IS YOUR JOB AS A HEALTHCARE PROVIDER TO EXPLAIN THAT EVERYTHING IS *NOT* FINE AND RECOMMEND A COURSE OF ACTION!!! Holy shit, this pisses me off so much. The mother has never been pregnant before – would she really think that everything is fine if her midwife had explained the seriousness of the situation?! What about the fact that her midwife is crowd sourcing her next steps on Facebook?

    That poor mother, I hope she comes to realize how seriously substandard her care was and manages to hold her midwife accountable. Unfortunately, she’ll probably be told to own her outcome and that the baby just wasn’t meant to live.

    • staceyjw

      I had many BPP’s with both kids, and had no clue what was going on. I assumed if something was very bad, they would tell me, right?

      With my DD, the last NST and BPP took a long time because nothing would wake her up. Her heart was beating, but she would not move for anything. I was panicking. When they finally rowed her, it was decided that it was a good idea to get her out, even though she was 7 weeks early.

      I cannot fathom being left to my intuition on this. WHY HIRE A HCP if you aren’t given any info or course of action? A UC would be safer.

      • Young CC Prof

        I also had a bunch of BPPs. By about the third one, I actually knew some of what they were looking for, and looked for it myself. Not that I didn’t trust them, I was just stressed and I liked seeing the fetal respiration, the normal blood flow in the cord, and knowing my baby was hanging in there.

        By the way, I had an NST and BPP 2 days before my c-section. Other than slow growth and fluid at the bottom of the normal range, everything looked perfect. The doctor had a feeling, though, and told me to deliver by the end of the week, since I’d just hit 37 weeks.

        The baby was kicking hard the whole time. They had me on a monitor for a few minutes in pre-op, heartbeat fine. Pulled my son out, he was fine, just skinny. Later, they examined the placenta… It was on the brink of total failure.

        Very low fluid in a full-term baby is grounds for immediate delivery. Not tomorrow, not hydrate yourself and check again later, not go home and think about it, go directly to L+D so the doctors can decide whether to do an emergency c-section or induce labor.

        • CognitiveDissonaceHurts

          “Very low fluid in a full-term baby is grounds for immediate delivery. Not tomorrow, not hydrate yourself and check again later, not go home and think about it, go directly to L+D so the doctors can decide whether to do an emergency c-section or induce labor.”

          And yet I have heard moms being told by lay midwives that all they needed was to go home and drink lots of water and be rechecked.

          • Young CC Prof

            I hang out on a board for pregnant women with intrauterine growth restriction and parents raising IUGR babies.

            That’s what they’re told when the scan at 22 weeks shows low fluid. Go home, rest, drink lots of water. It’s not going to fix the problem, the problem is the placenta. But it might help a little, and if it doesn’t, there’s nothing the doctor can do so early in the pregnancy.

            That is NOT what you freaking tell someone with a full term completely viable baby.

          • Dr Kitty

            At 22 weeks it is really important you keep the baby inside for as long as possible.

            At 42 weeks it isn’t.

            CPMs seem incapable of understanding this.

    • anion

      When my undiagnosed stomach ulcer ruptured and I was in the ER with surgeons telling me I needed a major operation, I remember saying something like, “Can’t we just give it a few days and it will heal, or maybe there’s another option?” Because that’s what patients–even intelligent ones who would never dream of telling a friend with a hole in their stomachs to “wait and see,” but would wrestle them into the hospital immediately–do, because we’re scared. We *want* there to be some other option. We *want* to believe we can just wait it out and things will be okay.

      The ER doc (oh, he was a cutie) and the surgeons informed me in no uncertain terms that NO, there were no other options, and that if we waited I’d probably die, so I needed to get used to it real fast because they were prepping the OR as we spoke (they even bumped other surgeries to get me in immediately). Because that’s what actual healthcare providers do; comforting bedside manner is nice, but their job is to save lives, and if they have to scare the shit out of you in order to do that, then you’re getting the shit scared out of you.

      What the surgeons did NOT do is hold my hand and say, yeah, maybe your stomach will heal itself before peritonitis sets in, we can give it a couple of days. What they *definitely* did not do is go on fucking Facebook to ask a sampling of hobbyists if they had any stories about people who survived just fine with their stomach contents leaking into their gut, and use “The patient says she’d kind of like to hold off on having us play around with her innards if possible, so we’re covered there,” as an excuse for letting me die an agonizing death.

      In other words, they didn’t just wash their hands of my actual care, and then still have the nerve to pass themselves off as wise healthcare providers who are just doing what the patient wants. Because that’s why they went to medical school, you know: to be lackeys who just obey the dictates of terrified people no matter what foolishness said people want. Hell, at that point, I was so tired and weak and drugged up that I would have thought having a bunch of Elvis impersonators do a dance around me while breathing cinnamon candy in my general direction was worth a go, if it meant avoiding general anesthesia and weeks of difficult recovery. And I’m the daughter of a nurse and the sister of a pharmacist, who damn well knows better.

      • DaisyGrrl

        It’s reasonable to ask if there’s other options. No one wants surgery for the fun of it. But when time matters, it’s the responsibility of the doctor to impress the gravity of the situation on the patient – not say, “gee, maybe you could wait. Let’s ask Facebook.” Mind you, when told I had appendicitis my reaction was along the lines of “My appendix is trying to kill me – let’s cut that freeloader out!”

        • birthbuddy

          That’s called ‘playing the appendix card’.

  • Ra

    There was no reason for this baby to die. It’s not “sad”–it’s horrifying in the most extreme manner possible. An infant was in clear need of help, help was available, and Jan Tritten chose to ignore it and carry on with her life. Jan’s life is the same, and the baby is dead.
    It’s like she watched a toddler wander out into the middle of a busy road and then just calmly walked on by because she felt that the child’s mother should be the one to decide if the toddler needs to be rescued or not. The kid’s in the middle of traffic. Get him out. The baby needs help. Get him out.
    THIS STORY is the perfect representation of why CPMs need to either get real training or find a new hobby–preferably one that doesn’t leave them responsible for the death of other people’s children.

    • Young CC Prof

      Actually, it’s worse than that. It’s like taking a babysitting job and then letting the child wander out into traffic.

      The mother paid this woman real money to supposedly care for her unborn child.

      • DaisyGrrl

        I’ll one-up that. It’s like taking a babysitting job, letting the child wander out into traffic, and then telling mom everything’s fine when she calls to see how things are doing. Then, having reassured the mother, posting on Facebook “little Jimmy is playing in traffic. Any thoughts? FYI, he’s on the Interstate. I told the mom he’s fine, anything else I should do?”

        • Amy Tuteur, MD

          I’ll one-up that. It’s like looking out the window and seeing Jimmy playing the interstate and then asking on Facebook: Is it possible that he’s not really on the Interstate? What are the chances he’ll get off the Interstate before he gets mowed down by a vehicle?

          • Meredith

            “I think I saw Jimmy playing on the interstate, but eyesight isn’t perfect, and I don’t hear him screaming in pain, so what do you all reckon?”

          • KarenJJ

            It’s OK, you’re only 5 minutes away from the hospital should anything go wrong.

          • anion

            If he gets hit by a car, well, some children just aren’t meant to live. Sad! Prayers! Hey, is that pie?

  • The Computer Ate My Nym

    According to up-to-date, a zero for amniotic fluid on BPS means a risk of fetal asphyxia of 89/1000, even in the absence of any other concerning sign. A score of 8/10 with zero for amniotic fluid already puts you at a nearly 9% risk of fetal asphyxia. It took me two minutes with the internet to determine that continuing the pregnancy is not the right thing to do and I’m not an OB or a specialist in any kind of birth, normal or otherwise. How could someone representing herself to be an expert not know this or at the very least not be able to find it out?

    • Young CC Prof

      You just have to assume that all published obstetrical information is a lie, put out by obstetricians to scare women into their clutches.

    • staceyjw

      So, the baby would have been brain damaged had it lived, due to no fluid?
      I thought no fluid was so obviously an emergency.

      • The Computer Ate My Nym

        I assumed that they meant fatal asphyxia, but must admit that I’m not sure. It’s way too high a risk, even if the 89/1000 number is “only” for hypoxic brain damage.

    • anion

      No, no, those sites with “facts” and “science” are just the voice of the evil patriarchy that tries to force women to think logically. Women have “other ways of knowing.” Of COURSE a group of random goofballs online should be the place you go before any sort of science- or fact-based website!

      What are you, some kind of rationalist? Why do you hate women?

  • The Computer Ate My Nym

    Ok, one question I have to ask: Do you think the BPP was really “all right” or that the midwife simply didn’t know how to read it? Apart from apparently noticing that the fluid was extremely low and just blowing that off, I mean.

    • Captain Obvious

      AFV is one component of the BPP. With no AFV, the best it could have been was 6/8. So the BPP was not perfect.

      • The Computer Ate My Nym

        To be fair, my paraphrase…wasn’t. Fair, that is. Tritten said the baby and placenta were reassuring (is the placenta part of the BPP? not clear to me) and the NST was ok, and did acknowledge that the fluid was abnormal. But could the fetus possibly have been moving and breathing normally in no fluid or did she simply have no idea how to read the thing?

        • Anj Fabian

          Yes, it’s hard to imagine that the BPP and NST were showing perfectly normal conditions and perfectly healthy with zero amniotic fluid.

          • The Computer Ate My Nym

            Even if they were, up to date gives an almost 9% chance of fetal asphyxia (I presume fatal asphyxia) with an 8/10 BPS with a zero for amniotic fluid. That’s NOT a chance I can see any woman who has suffered through 41+ weeks of pregnancy wanting to take.

          • The Computer Ate My Nym

            Also, I agree that it seems unlikely that that 8/10 with 0 fluid happens all that often. Does the baby continue to move normally in no fluid? Maybe for a little while, but continuing for days? I suspect misreading.

        • birthbuddy

          The placenta is not part of the BPP.

    • Karma Kidney Stone

      Fluid levels are part of the BPP, so it could not be perfect. And I find it hard to believe that the baby did the required breathing movements with no fluid. OB’s is that even possible? Since they are practice breathing in fluid.

  • http://safermidwiferyutah.wordpress.com/ Safer Midwifery Utah

    PRETTY sure this was in Utah. All the other states here now have practice guidelines and mandatory licensing. If nothing else, there is nothing preventing this level of negligence. There is nothing to punish this level of negligence. Its unbelievable. The woman responsible for the appalling midwifery laws here is running for office again, and the local media isn’t grilling her about her role in preventable deaths of infants. I am so angry right now. http://safermidwiferyutah.wordpress.com/2014/02/21/a-preventable-home-birth-death-possibly-in-utah/

    • http://safermidwiferyutah.wordpress.com/ Safer Midwifery Utah

      LOL Holly Richardson says I ‘don’t know what I am talking about” and deleted my question on her facebook page. I asked what she plans on doing about the direct entry midwifery bill to prevent the next tragedy.

  • Lindsay Beyerstein

    What were they hoping would happen if they did nothing? Were they hoping the baby would just secrete more amniotic fluid and everything would be okay?

    • http://safermidwiferyutah.wordpress.com/ Safer Midwifery Utah

      They were hoping everyone would live and then they could brag about how they attended a birth with that many risk factors. Then all their vapid little friends would say stupid things about the inherent safety of birth or how nature is awesome. I want to vomit.

    • Amy Tuteur, MD

      I know you asked this as a rhetorical question, but I think it has a real and illumating answer.

      Tritten was crowd sourcing this decision because she knew what was going on: the baby was showing signs of being at risk for imminent death. Tritten wanted to gamble and she was asking for the odds. What were the odds that the ultrasound was wrong? And what were the odds that the baby could be born vaginally before it would die of placental insufficiency? She chose to gamble that the woman would go into labor before the baby died. She guessed wrong, but no big deal, right? Just a dead baby.

      • Elle

        Apparently she forgot that she’d have to give a public update no matter what happened.

  • Susan

    That’s just beyond awful.

  • Meredith Watson

    “What would you do?” Call a professional.

  • The Bofa on the Sofa

    “It’s always sad” when a goldfish dies. That’s not the response I would have to the loss of a baby.

  • Something From Nothing

    It astonishes me how these so called midwives can delude themselves into thinking everything is ok so they don’t have to transfer care. The self deception is incredible. Dr. Amy, thank you for having the energy to tirelessly fight this uphill battle.

    • CognitiveDissonaceHurts

      I actually think that Jan WAS having doubts but let the mother’s desires and the support of the midwifery community that she consulted with give her some comfort that this was just a “variation of normal”. Otherwise she wouldn’t have posted with all the details of the tests and results.

      • Anj Fabian

        I asked the guys at my local bar what to do and they said everything was fine. How was I to know anything was wrong?

        • CognitiveDissonaceHurts

          It is part of the sisterhood thing – the sharing of Common Wisdom – and social media makes it oh so easy.

          • http://momofmanyfeet.wordpress.com Bambi

            What wisdom???

  • ngozi

    Ok, I have no medical training at all, but when I saw “42.1 weeks” and “zero fluid” seen then it was pretty obvious that this baby was in trouble. Why would you even have to ask? How could you know this, and then think everything is “fine”?!?!?
    To me, this is worse than being a midwife that didn’t know about a problem with her patient (or customer, whatever). She knew this and didn’t know it was a problem?

    • http://thefresstyler.blogspot.com/ Hannah

      I think she knew it and just didn’t care because it didn’t fit her agenda. She even noted that there was ‘full autonomy’ in the state.

      • moto_librarian

        And her legislators need to realize that this is what happens when there is zero accountability for midwives. I feel ill.

        • Amy Tuteur, MD

          The worst part of this horrible situation (beyond the fact that an innocent baby suffocated to death needlessly) is Tritten’s cavalier attitude:

          You win some; you lose some; and some babies just end up dead.

          • moto_librarian

            She sounds an awful lot like Lisa Barrett. As far as I’m concerned, they both should be in jail.

          • birthbuddy

            There are a lot of Lisa Barretts out there.

          • Captain Obvious

            But that was one necessary cesarean.

          • Young CC Prof

            Which probably would have been prevented with a dreaded 41-week induction.

          • Susan

            yeah, been there with the crunchy doulas for C/S for fetal distress where the doula’s like… the baby’s screaming you liars… and been there when we are bagging the baby and the midwife doesn’t seem to put it together that this ISN’T the goal, to know the C/S is needed 100%.

          • Anj Fabian

            Allow me to quote my OB and his black humor joke again:

            When is the best time to deliver a dead baby?
            The day before it dies.

  • moto_librarian

    An ethical provider would have been honest with this woman about just how risky this situation was. If there was ever a time to “play the dead baby card,” this was it. Most providers would have been doing everything in their power to convince Mom to have this baby, but it sounds like Jan was perfectly content to let things ride out. Do you really think that she had an honest conversation with the mother about just how dangerous this was? I sincerely doubt it.

    • The Bofa on the Sofa

      Hey, they are in a state of midwife autonomy, so no damn doctor is going to tell them how to deliver no baby. Random opinions on social media, however? We’ll listen.

      I wonder if she actually contacted an acupuncturist?

      • vitaminC

        And don’t hold back on the stevia! Not clear if this was recommended for the midwife’s coffee or the dying baby.

        • Susan

          Yeah, the stevia… ( the midwife broke bad a long time ago)

        • ngozi

          I was really confused by the stevia as well.

    • Something From Nothing

      This is really the crucial point. Women have the right to make decisions in their care, they even have the right to make bad decisions. They should have all of the facts on which to make those decisions. I’m tired of our midwives implying that we obstetricians don’t respect women’s autonomy. Autonomous decision making involves having a trusted care provider give you accurate information. This patient should have been advised that without immediate delivery, her baby was at very high risk of intrauterine death. If she chose to wait despite knowing all of the risks, there is not much anyone can do. She has to live with her decisions, as we all do. How tragic to lose your child while some clown tells you that everything is just awesomely normal.

  • http://thefresstyler.blogspot.com/ Hannah

    This is horrifying. I cannot believe the way she says ‘it is always sad when a baby dies’…she seems to see them as livestock that, sadly, die sometimes. How can she not be feeling utterly responsible for this avoidable, tragic death?

    • Ennis Demeter

      She should be in jail. She presents herself as an expert and was asking for advice on how to treat a dying baby on Facebook.

      • CognitiveDissonaceHurts

        It’s not the first time that has happened. We’ve read questions from midwives looking for help and advice on Facebook and other social media before.

  • moto_librarian

    I am incapable of rational thought after reading this. The fucking editor of Midwifery Today thought it was fine to let a postdates pregnancy continue despite the absence of amniotic fluid?! The baby is dead, and it’s “sad?!” Anyone with a shred of morality would be contemplating a career change after an event like this, but for her, life just goes on. She should go to jail for this.