The Internet never forgets

iStock_000015742038Small copy

As promised, here’s the Tritten post with comments so everyone can decide for themselves what actually went on and whether Tritten’s behavior was unprofessional and unethical.

Tritten thread

  • Karyn

    OK… can anyone tell me why someone would be on facebook asking what to do here? As a nurse… that just seems a clear violation of not only law but just a moral failure overall…. do the laws that I have to follow regarding confidentiality not apply to CPMs?

    • Young CC Prof

      Law, it depends. If the midwife has no official status as a HCP, then it isn’t illegal to talk about what she does on Facebook any more than gossiping about your friend’s illness on Facebook is illegal.

      Morally, absolutely wrong.

  • LisaL

    UGH, I had to stop reading. The arguing w/ the Rachel character is making my blood boil.

  • Captain Obvious

    Talk about captain obvious…”Sherri Holley there has to be some water or her baby would get baby out. If there was no water, the cord would have been compromised and would have gone into fetal distress. I agree with the Nat. Mur.” Well guess what Sherri?

  • Guesteleh

    Amy, a suggestion: rather than linking the thread as a .doc, can you link as a .pdf? It will be more credible if people can see it in the original Facebook formatting.

  • Jessica S.

    This comment by a paramedic, Beth McDonough, cracked me up and made me cheer:
    “As a paramedic, if I responded to a woman’s house, and was told by her midwife that her baby was at risk but she refused transport, here’s how it would have gone. I would have parked that ambulance outside until we got that mother sectioned and she went to the hospital against her will. Baby safe, mom can pound sand.”

    • Jennifer Delaney

      Not to mention that PD would have been on-scene rapidly, and they would have been informed that the mother could be a danger to herself or others, she could have been taken into protective custody and transported to the hospital against her wishes. (But usually, we try to talk the patient into just going willingly, as it’s in their best interests)

      • Amy Tuteur, MD

        But we have no reason to believe that the mother wouldn’t have gone to the hospital immediately if Jan had advised her to do so.

        • Squillo

          Exactly. The mother apparently consented to an NST and two BPPs; why would she have done that if she hadn’t been prepared to act on them had she been made aware of the seriousness of the situation? Moreover, she went to the hospital after the midwife noticed that the FHR was “a little slow” and consented to a c-section to try to save her baby’s life–presumably once someone told her the truth about the danger her baby was in.

        • Sarah Moderati

          Yes, the most devastating thing was the last sentence in Tritten’s post. “Mom feels everything is fine and wants to leave things alone.” She felt everything was fine based on…her midwife not advising her appropriately. She wanted to leave things alone based on…her midwife not advising her appropriately. Devastating.

          • Bombshellrisa

            Mom feels everything is fine and wants to leave things alone reads to me like she has been talked into leaving things by the midwife playing the “big scary intervention” card.

      • Jessica S.

        I imagine that 9 out of 10 times, reason (and sheer fright of being given it straight) wins out. Big hearts are common in emergency response, I suspect. 🙂

  • Burgundy

    My friend posted this on his FB today, I think the image is kind fitting here.
    The midwives have no clue what science is.

  • I just want want to say that there’s a silver lining here – for me anyway. It is nice to see commenters who have gotten quieter over the years coming back and posting. And all these lurkers speaking up. It’s a good thing. IMHO of course.

    • Staceyjw

      I think that a lot of us regulars that had been posting daily, then went back to just reading and lurking, did so because we get tired of repeating the same argument 100x. I can only rewrite the stuff so many times. I still read every comment, but don’t answer near as many as I would have before I cracked my skull from head desking. 😉

      • The Bofa on the Sofa

        I can only rewrite the stuff so many times.

        Never stopped me, apparently.

        • Sue

          Nor me 🙂

  • Ash

    I’d put money on no one will formally reprimand Tritten for this event. MANA is not going to do anything. What’s the likelihood that someone will bring it up at one of the midwifery conferences Tritten this year? Or that someone in her state’s association for midwives will question her?

    IMHO the only chance this will happen is if the grieving parents find the archived FB thread on this website and take it to the media.

    • Trixie

      I assume people are scouring the usual forums for any clues as to who this midwife was?

      • Ash

        Midwife is Jan Tritten (although she lies and says she did not attend the birth). She appears to live in Oregon, which does not require that midwives are licensed (?!)

        • Trixie

          If she did actually attend, there a appears to probably have been one other midwife involved. I want to know who that was. Also, Jan Tritten seems to travel a bit, so if she was physically there, that doesn’t necessarily mean it was Oregon.

        • Staceyjw

          Jan is local, and has been retired a while, so it’s plausible that this is not her case. I really doubt it was her, because no locals have mentioned it, not the HBers or the HCPs. A death in Eugene, esp a transfer, is hard to miss.

          This is a small town, and the HB circle is very tight. I would have seen this loss discussed on one of the local AP boards, so mom could get a meal train and support (from the same people who helped kill her baby w lies, but I digress). Even if mom hadn’t been involved w any other moms, I would have heard that there was a HB loss (with no other details) from a HCP.

          IT DOES NOT MATTER.
          I wish we knew who it was, but it could really be any one of the 1,000+ deaths every year do to HB. that she posted such a question, without adding “this is an emergency!” makes her totally unethical.

          • Bombshellrisa

            So the homebirth community is willing to listen to a retired midwife with no license, but Dr Amy who is retired is so hopelessly out of the loop that she couldn’t possibly know anything pregnancy and birth? Wow.

    • Squillo

      There’s no one to reprimand her, nor the midwife in question, assuming it wasn’t Tritten. “Full autonomy” state indeed.

  • Guesteleh

    This is a weird thing to focus on, but I’m amazed that Amos Grunebaum weighed in on the Facebook thread. He not only authored the recent study on homebirth deaths, he’s director of obstetrics at New York Weill Cornell Medical Center. I’ve worked with people in academic medicine for over a decade and it is almost unheard of for people at his level to participate in a public forum in this way, much less on Facebook. The fact that he was moved to comment speaks volumes about what a horror show this whole situation is.

    • Anj Fabian

      I knew the name sounded familiar. Thanks for placing it in context.

      • Karen in SC

        Didn’t he publish the homebirth Apgar paper, too?

        • Danielle D

          Yes.

          • Dr Kitty

            Dr Tuteur is clearly not the only one who is mad as hell and not going to take this any more.

    • The Bofa on the Sofa

      I’ve worked with people in academic medicine for over a decade and it is almost unheard of for people at his level to participate in a public forum in this way, much less on Facebook.

      Especially using his own name. I’m not much into Facebook, and to the extent I am, I avoid using my own name. And I’m not nearly as high profile as Dr. Grunebaum

    • Staceyjw

      I am sure he has a Google alert set, and has a ton of friends and coworkers that know this is his interest.
      That he cares is awesome. For too long OBs have been quiet.

    • Guesteleh

      This is what Grunebaum posted:

      I am so so sorry for this poor mom and her family. My thoughts are with them. The responsibility of this tragic event is clearly with the midwife who took care of her and Jan Tritten. “Nothing in the world is more dangerous than sincere ignorance and conscientious stupidity.” Martin Luther King, Jr.

  • Mel

    Allison Reid’s comments are the most alarming and particularly telling.
    She says that a C-Section is a worse outcome than a baby dying.!
    Then after learning of the baby’s death she says “we are not in control.” Then what the f was she being paid for in the first place? If she can do absolutely nothing to affect the outcome (such as recognize danger when this situation had red flags waving right in front of the midwife’s face early enough to do somthing) she has no business charging for her services.

    • moto_librarian

      You know what the worst outcome really is? Having a c-section to deliver a dead baby. If this had happened a week or two ago, there would be some complaining from the midwife about an unneeded c-section, but the baby would almost certainly be alive.

      • Amazed

        I am afraid that even now, there will be those who will feel sympathy for the mother because of the C-section and the loss of the peaceful vaginal birth, not the loss of the baby!

        • Jessica S.

          “Peaceful vaginal birth” – is there such a thing? 😀

          • moto_librarian

            Yes – with a strong epidural!

          • Jessica S.

            Good point! I was imagining unmedicated. 🙂

          • Amazed

            It’s amazing how many things people can have you convinced of if their livelihood depends on it. Just look at the last post about breastfeeding. We’re fighting for our money. Hear us roar!

          • Jessica S.

            I’m their poster child of laziness and sloth: I didn’t breastfeed my son b/c – gasp – I didn’t want to. And I’m not going to breastfeed this one I’m currently hosting, either. I didn’t jump in over there, but I did read that one particularly rabid commenter say that while she doesn’t shame women who can’t BF (yeah, right) she absolutely mentally judges women who simply won’t try. Ha! Judge away, Judgey McJudgerson. I know myself and my (at times, rather delicate) psyche quite well at this point and breastfeeding would’ve made me a horrible, terrible mother. I’m sure women like her think I shouldn’t have been a mother at all, but well – I’m sure you can dream up plenty of things I’d say to that! 🙂 Thank god for formula that is very nearly as good as BF and for living in a country with clean water.

      • God, the c section hand wringing really gets to me. Ffs, it was just not that damn big a deal.

        • Josephine

          All the NCB fussing about the horribleness of c-sections always makes me think of those historical accounts of a group of young women/teenaged girls in some sleepy New England village saying they were witches consorting with the devil. It’s like this mass mental panic mostly created out of boredom (in this case, the boredom of having quality, safe medical care nearly always available). Obviously not all c-sections are a cakewalk, but for heaven’s sake.

          Brb, creating a support group for appendectomy victims.

          • Bombshellrisa

            Lol and I wondered how to raise some extra cash! I think I am going to be a life coach and aromatherapy counselor for people who were traumatized by their childhood vaccinations and for those who feel they were over prescribed antibiotics. I am absolutely sure that there are people with enough money to pay out of pocket, maybe I should put up a flyer at Whole Foods : )

          • Mishimoo

            I was over-prescribed antibiotics thanks to a very manipulative doctor shopping mother. Please send lots of love and light to cure my trauma that was totally caused by those nasty chemicals!

        • Dr Kitty

          I feel that perhaps instead of Ricki Lake documentaries, what NCB people actually need to do is watch the Doc McStuffins episode “Frida Fairy Flies Again” which tells pre-schoolers how to cope with scars.

          • RebeccainCanada

            Doc McStuffins is required watching at our house! We got our vaxes caught up last year and it really helped our kids face getting all the pokes. Doctors and Nurses are there to help us! But I truly used to not think so. Shame on me! I’m glad they will grow up not thinking so.

          • Bombshellrisa

            You hit the nail on the head. Coping skills, that is what these women need. They need to learn that there is no magical formula for a glitter filled peaceful unicorn birth and be realistic about what things can go terribly wrong during a birth. Things aren’t going to go according to your wildly unrealistic birth plan, GROW UP and if the worst thing you have to worry about is a SCAR then you are so much better off than many of the women who will give birth around the world today.

          • Ducky7

            People are worried about a lot more than a scar, the NBC promotes a whole lot of other risks (some real but overblown, others not all that real) of csection and benefits of vaginal birth. Women are made to feel they are really missing something and not doing what is best for the baby in general. The persuasion is very powerful. If you want to change minds you have to recognize that.

            And to be fair, repeat c-sections do carry risks to the mother. I can see why people who want big families might be legitimately worried about this.

    • Staceyjw

      Wonder if her patients, er, victims, know that she believes this?

    • rh1985

      I can’t understand it at all. My daughter born Thursday is sleeping next to me now. I had a c-section for medical reasons after originally planning to have an elective one. After the doctor took her out she said there was no way an induction would have worked with how high up she was. And I had preeclampsia so no waiting it out. I was never one to care about a natural birth but I still don’t get how anyone can be that against a c-section.

      • Dr Kitty

        Congratulations!
        I’m so happy she’s arrived safe and sound.

      • Trixie

        Congrats!

      • Bombshellrisa

        Congrats on your baby girl! So glad all went well!

      • Sue

        Congrats and welcome to the tiny one!

      • fiftyfifty1

        Thrilled for you!

    • Captain Obvious

      Just couldn’t believe her comments.

      Alison Reid @Donna Tabas, 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…. 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.

      Jan Tritten Very sad news on this baby: The baby didn’t make it…

      Alison Reid I hope the mum does not blame herself in any way. it is so easy to be judgemental when, in reality, we are not in control.

      WTF? “We are not in control.”? We, had an opportunity to save this baby.

  • Amy M

    All my upvotes seem to have disappeared. I imagine that is a disqus problem? Lame.

    • Karen in SC

      Recent Disqus change – no more down votes. You can click the down arrow, but the total will not display anymore. Something about keeping the discussion civil…

      • auntbea

        So, I can click the downvote because…I want to make myself feel better?

        • Guestll

          Downvoting this.

          • The Bofa on the Sofa

            I already did!

          • auntbea

            Everyone here is so mean.

          • The Bofa on the Sofa

            I voted that comment down, too (ok, I’m stopping now)

      • Amy M

        I didn’t downvote anything though, just upvote.

      • Jessica S.

        F*** that s***!! 🙂 I’m down-voting all you all! 😉

        Seriously, though, I did wonder where the down votes had gone.

  • anion

    How many comments does that go to? I can’t d/l it on this computer, and I saved the discussion to 251 comments myself.

    • Karen in SC

      Can’t see that they are numbered, but the document is 53 pages.

      • anion

        Sigh, thanks. 🙂 My primary computer died so I’m on a netbook with limited capabilities for the foreseeable future.

  • R T

    Why do they talk about the midwife as if she’s a victim? She was incompetent, unsafe, deluded and contributed greatly to the death of a baby and the destruction of the family. All I can think is, they do this because every single one of them is just a ignorant and unsafe and always on the verge of making a similar mistake. They’re a terrifying group of women always ready to join hands, while they bury their heads in the sand.

    • Captain Obvious

      Probably because they can all see themselves in that midwife’s shoes. They probably don’t want to burn any bridges in case they end up in that situation and have no one to support them. Just like the old boys club they condem, they preserve those tactics for themselves.

      • The Bofa on the Sofa

        I’ve always suspected this. When we ask “why don’t midwives criticize bad practitioners?”, how much the answer is, “Because, deep down, they know they would have done the same thing,”

  • MrG

    I do not understand why everybody is so much up in arms. We all get upset because we treat MANA and their CPMs and homebirthing attendants as “professionals”. Which they are not. Once we all realize this, then it becomes more clear what’s going on.

    MANA and their so called “CPMs” hide behind “I am not responsible”, “It’s the woman who makes the decision” and “nature decides”. They don’t want rules, they don’t want to be told they must transfer a patient in trouble they don’t take responsibilities. They blame the mother (“she wanted it”)

    By any definition, they are not professionals as defined by any way form or shape.

    “A professional is a member of a profession. The term also describes the standards of education and training that prepare members of the profession with the particular knowledge and skills necessary to perform the role of that profession. In addition, most professionals are subject to strict codes of conduct enshrining rigorous ethical and moral obligations.”

    “The etymology and historical meaning of the term professional seems to indicate an individual whose philosophy and habits have been conditioned by a professor. So, a professional is the follower of a professor. Plumbers [and CPMS] are therefore not considered professionals. While they certainly make a living doing what they do, with a particular expertise, and with a certain expectation of manners, plumbers do not acquire their skills through a professor, or even through a professional professor. They learn from private firms that distribute the knowledge, or they learn from friendly association with a master plumber.” (From Wikipedia)

    But even plumber carry liability insurance, whereas CPMs refuse to do so. That in and by itself should tell us what they are.

    CPMs etc have insufficient education and training and no strict codes of ethics or morals. And refuse to do so. They are just not professionals. They are lay people trying to pass off as professionals but they are not.

    They are more like members of a pseudoreligion or maybe a cult. With Ina May and Stephen Gaskin and maybe Jan Tritten as the cult leaders. In their pictures online, specifically Jan’s picture on Facebook with devoted followers around her (on red square in Moscow?) they definitely could pass as cult leaders.

    We all are upset at them for being “unprofessional”, but what’s been clear now for some time now is they aren’t professionals.

    Once we all understand the difference, and once we stop looking at them them as professionals, which they are not, then we can stop having certain expectations and start looking at them as what they really are.

    They are members of a pseudoreligion or a cult. Now let’s talk about their crimes.

    • AdelaideGP

      You’re quite right MrG. Agree with everything that you say in this thoughtful comment. The only problem is that the patients hire the CPM in the capacity of a health care professional and expect them to guide them in this way. What a horrible misplacement of their trust!

      • MrG

        I say only 3 words: snake oil salesmen. They have been around forever and need to be exposed for what they are

    • Captain Obvious

      I wonder if the midwife got paid?

  • Sue

    Cell salts, Stevia and homeopathic Natrium Muriaticum (aka sodium chloride) – a parody couldn’t have done better!

    Thank you, Amy, for exposing this. (Anyone still want to say that Dr Amy is just being MEEEEEEN?).

    • Sue

      And the woman who suggested the homeopathic NaCl identifies herself as Jennifer Holshoe, whose website says she provides ”CHildbirth education, birth photography, birth pool rental and placenta encapsulation.” The whole packet of woo, in one easy step!

    • Adelaide GP

      So true Sue! I’ve noticed in the probably more than 900 comments over the past 4 posts concerning this horrifying debacle that there are hardly any of the usual HB apologists parachuting in to trot out the usual tropes and “educate” us trolls. Where are they now? Given how extreme this case is, if anything it looks like Dr Amy is not nearly meeeeen enough !!!

      • Amazed

        Oh, from time to time they make an attempt to reemerge at the NGM’s page where they are eviscerated in a moment. Two, at least.

        • Sue

          Kudos to NGM!

  • MLE

    Rereading this makes me want to vomit all over again. CPMs: Mothers and babies are not your test subjects, you aren’t living vicariously through them, and it’s not a fucking game.

  • In the thread a lot of home birth midwives say something like “What, if I weren’t there she would be unassisted in childbirth. Is that better?” But then a whole bunch of midwives proceed to offer a lot of very stupid advice that will not fix the problem, or assurances that things will be fine if nothing is done. THAT IS SO MUCH WORSE THAN BEING UNASSISTED. How can they not see that? A person who does not know any better is more likely to reach out to the hospital for help when they don’t know. Having an authority figure tell them everything is okay is so, so much worse. I don’t understand how they can feel like having anything to do with a preventable death is superior to refusing to be complicit in it. OH wait, now I know- if you are involved you still get paid. Sickening.

    • anion

      Exactly. The thing is, of course there’s going to be a percentage of women who will go unassisted if denied midwife “care.” But there’s also going to be a percentage who’ll think about it and say, “Okay, all the midwives say this is too dangerous and they won’t be a part of it, so maybe I should at least TALK to a doctor.”

      Not to mention the number of infant deaths we’ve seen even here on the blog where women are begging their midwives to call an ambulance and the midwives are insisting everything is fine. If those women were alone, they would have gone to the hospital. (I’m not saying it’s good or better to go unassisted, just that not having any help often makes people seek it out when they’re in danger. I know lots of people who dislike and distrust the police, but when they feel they’re in danger, who do you think they’re calling? Not a midwife, that’s for sure.)

      It’s very easy for them to say, “These women will just go unassisted and that’s even more dangerous.” But it’s not always true. Agreeing to help someone do something dangerous and foolish is as bad as doing it yourself; there’s a reason why people are charged as accessories to crimes.

      • Danielle D

        Only the True Believers will go unassisted – everyone else is attempting home birth because they think it is “safer” and is trusting their midwife to know when “pain and fear” is no longer in mom’s head and is based in reality.

      • Comrade X

        And it’s more than “helping someone do something dangerous and foolish”. It’s ENCOURAGING someone to do something dangerous and foolish by FAKING EXPERTISE and then PERSUADING THEM that it’s NOT dangerous and foolish. It’s actively fraudulent.

    • Jessica S.

      Agree 100%.

  • sarahh.rosanne@gmail.com

    She is very obviously lying. I discussed this privately with a friend who is an NCB/Homebirth advocate here in TN. Her response to me was that the family “bore the responsibility for doing their own research” (presumably on the internet) “choosing a homebirth professional they trusted.” I try to maintain an attitude, or at least a facade ,of “agree to disagree” and “live and let live” but I can’t accept that this is a “difference of opinion” issue.

    • Rochester mama

      To me that means she agreeing that home birth midwives are like dirty used car salesmen. If you don’t do the research and find out the car has a washed title and was a prior total loss, it’s not their fault when it falls apart.

      • sarahh.rosanne@gmail.com

        Pretty much. In one of the most vulnerable and ultimately uncontrollable situations in which a woman is ever likely to be, she is responsible for googling her own “research”. The baby in this situation was an accessory to the process and was treated with little more value or reverence than a used car. The car might have been “transferred” to a mechanic sooner.

        • anion

          And when the baby dies, the midwife just rolls back the odometer and erases the whole thing.

          • Mac Sherbert

            And says… It’s always so sad when a car doesn’t make it.

    • Danielle D

      That betrays very poor expectations from health care providers. I am I supposed to learn all about birth myself, so I can tell when the provider is giving bad advice? I am supposed to vet my midwife and detect holes in her education or logic? I am supposed to understand that there are a cadre of practicing midwives without proper expertise and a cadre who are well-informed, as a reasonable state of affairs? How do I tell, as a layperson? (And if I can tell so easily–if there’s so little to know about birth–why I am paying a midwife again?)

      • In effect, if one takes that view, then all doctors and midwives are redundant. The guy who got you pregnant ought to deliver you, as he is the “expert in causing pregnancy”.

        • Young CC Prof

          One of Jan’s followers let the guy who got her pregnant deliver her 36-week mono-di twins with major size difference. (Surprisingly, both twins survived.)

          • Anj Fabian

            He’s an expert on twin birth!

          • Karen in SC

            He could advertise that and charge double!

      • Sarah Moderati

        Exactly, you can’t tell. That’s why we have licensing and standards of care for medical professionals. This is the most disgusting thing about the culture of lay midwifery in this country…that they put all responsibility for the outcomes on the patient, when they are supposed to be the professionals.

    • I’m not so sure that she is lying. Basically all the information on her says she stopped being a midwife a long time ago. She doesn’t need to be lying in order to be responsible. Imagine you are a young inexperienced midwife with the problem outlined above, and you think “Hey, I’ll contact the editor of Midwifery Today to help me”. She says “cool I will post the problem on my facebook anonymously to protect the young inexperienced midwife”. Most of the midwives say “do nothing” or to do something stupid like use stevia or EO. Then the baby dies. Who is at fault? A mix of people- but all of them midwives. The whole thing could have been halted when Jan got the question sent to her, she could have said “WOW way outside of the scope of practice for a midwife, consult an OB immediately”, or “I don’t feel comfortable asking other midwives about this issue because of privacy/liability reasons”, or ANYTHING except agreeing to post the question. Even in the best case she acted in a completely irresponsible manner as someone who edits the trade magazine for the profession. If you are in charge of a trade publication you have a responsibility to represent the profession in the best manner possible, to demonstrate the integrity of your profession and magazine. That isn’t something Jan cared about. She doesn’t even care enough to clarify when she is posting someone else’s question or not. Formatting should not be a weak skill in someone who edits a magazine, but it is for her!

      • AlisonCummins

        Yes yes yes yes.

      • sarahh.rosanne@gmail.com

        I assumed because of her grammar that she was in attendance so it is possible she was reposting the question. I accepted the format at face value because she is an editor. She seems very eager to “reframe” the event and as a Certified Professional Human Being Who Has Lied (my self-issued credential), I find that suggestive of dishonesty. I should not have made a definitive statement, but I would be willing to bet.

        • Sue

          If she wasn’t involved, what would be the significance of writing ”my hands feel nothing but baby”?

      • Sorry, I don’t buy it. All Tritten had to do was to preface her question with something like “I’ve been asked the following question; would like input” and it would be obvious she was only being asked for advice. I also, reading the original post, was quite sure she was personally involved in the situation.

        I’m also surprised, as she is supposed to be a professional, that she didn’t know the answer. I delivered my last baby in 2001, although I’ve only retired from work in a different area of maternity care in 2012, but I do remember what I was taught.

        • Susan

          Yes, exactly. It just doesn’t make sense. I am going to write lets say, a Dear Abby column but Abby is going to pretend all the problems she is sent are her own personal problems and say they are happening to her?

          • Sue

            Tritten announces the death like this: ”Very sad news on this baby: The baby didn’t make it. Had aspirated meconium a while back they believe. Even after another BPP that showed everything was fine today. 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.”

            Why would she use “I” and ”we” if she wasn’t there?

          • Danielle D

            She could have very sloppily been speaking in the first person for someone else (i.e. basically quoting them), which is sloppy. It will be impossible to ever know with 100 percent certainty. The take away message is the same, however: ask a group of midwives what to do, and more than 50 percent say there is no big deal, and a few suggest the most bizarre home remedies as treatments for a serious medical situation. Then the attendent–whoever she is–in fact doesn’t push transfer, and the baby dies. It’s so sad that they had multiple points where a c-section could have been sought, and they were passed over. Couldn’t she have transferred care ‘just be sure,’ when she realized she didn’t know if the situation was dangerous? Just horrible.

          • Sarah Moderati

            Even if some other midwife had asked her this question, there is only one correct answer…transfer immediately. As a more experienced midwife, that’s what she should have said. So, even if she wasn’t anywhere near this mother (which I doubt is the case), her actions were unethical, unprofessional, and demonstrate a lack of understanding of risk and the appropriate response.

          • Durango

            Yes, even as a case study this was terrible,too. There’s only one answer, with no ambiguity. Transfer immediately, you’ve waited too long already.

      • Well said! I have come around to thinking that Jan probably wasn’t the birth attendant personally. Still may have been, but either way, you’ve summed it up.

      • manabanana

        Midwifery Today is much more like a ‘ZINE than a trade publication. She owns it, she writes it, she edits it, she publishes it.

        Remember ZINES from the 90s? I ‘subscribed’ to some great ones.

        Journals have peer reviewers and editorial boards. And standards for publications.

        Let’s not make her out to be more than she is.

        • sarahh.rosanne@gmail.com

          One thing that is alarming to me about Midwifery Today is that it has been present in the waiting room of two CNM practices to which I’ve been within the last year. I have seen it cited as a source in the mainstream news media as well.

          While it is essentially the “ZINE” of childbirth quackery, Tritten successfully projected a legitimate facade to many who should see past it. Myself included. I have an almost useless English degree with an emphasis in technical writing, am a usually reasonable woman who has worked as a publishing assistant and proofreader for an academic journal (though not in the field of Science or Medicine), yet I’ve spent several years of my life emotionally suffocating in this ideology. Worse, I was under the impression that it was based in ethical and legitimate research.

          But I also used to mail-order grunge music fanzines from Europe so there is a parallel pattern of stupidity.

    • anion

      The mother may be “responsible for doing her own research,” but it’s the job of a birth professional to know when that research is WRONG, and to advise accordingly.

  • fiftyfifty1

    This is the original unedited thread?! This is not just a collection of the “wrong” answers? This is incredible! Even the answers recommending transfer are horrific in their lack of medical knowledge and lack of ethics.

    Here’s an example:

    “Sue Turner. We are not allowed to care for any woman over 42 weeks in CA as of Jan 1, 2014 so I would have to refer her out. Typically induction is done due to cord compression if AFI is under 4. I would wonder why there was no fluid at all.”

    She’s implying she would keep her at home if she could, and she’s only referring her out because State regulations force her to of Jan 1st (those pesky practice standards!). The only reason she can come up with for induction is the risk of “cord compression”, and sits there scratching her head about what caused the lack of fluid. It’s as if she has never heard of a PLACENTA! Can you imagine the tongue lashing that even a first rotation medical student would receive if his or her replies expressed such minimal knowledge?!

    Or even this one. This is the response coming from the *strongest* voice for transferring care:

    “Donna Tabas. Induce! Zero fluid indicative of declining placenta function and will not have reserve to tolerate labor. What’s her bishop score?”

    So she at least seems to understand the biology behind the risk, but then she jumps to the bishop score. The bishop score?!! Who cares! Should this sway the midwife’s decision? It doesn’t matter what her bishop score is-this placenta is failing right now, this baby is dying!The days of caring whether mom will get her vaginal birth are long long over.

    And these are the BEST responses! I googled both of these midwives and they are Certified Nurse Midwives, not CPMs. These responses are better than the ones from the CPMs, but still not acceptable. Not acceptable at all.

    • almostfearless

      I did a rough count of responses before the baby’s death was announced and about 21 leaned towards doing nothing, and about 8, including the ones you mention above, were leaning towards transfer. That’s 72% of responses got it wrong, and even the ones that got it right had flaws.

      A homebirth with a CPM is no better then using Google as your care provider. You can enter “zero amniotic fluid” into Google and get better information.

      • I’ve heard that in utah about 30% of midwives choose to get a license. Maybe that is roughly the % that have any sense at all.

        • Staceyjw

          Nah. OR has similar rules, and licensure makes zero difference in quality and professionalism.

          I would be willing to bet it’s the few “MWs” that do more than 2 births a year that are licensed: they can get reimbursed by insurance, maybe even Medicaid, and the cost of licensure is worth it to them for this reason.

          OR tracks births by MW, and a full 90% of all OOH (non CNM) births are done by only 3-4 MWs. There are 2-3 more MWs that do 5-10 births per year, but the majority (about 80%+) of MWs only do 1-3 births. Licensure is a fee, even though it’s low, it is a lot if you only do a few births a year.

          Side note- with most lay/cpm MWs doing 1-3 births a year, if even that many, that is a LOT of totally inexperienced so called MWs out there spouting opinions as if they were experts.

      • Certified Hamster Midwife

        It’s not better information if it doesn’t tell you what you want to hear.

      • Sue

        ”a CPM is no better then using Google as your care provider”

        No, Google would be better – it won’t talk you out of transferring, and won’t charge you anything.

        • Young CC Prof

          Yeah, in this case, for most searchers, Dr. Google would probably get it right: Emergency, go to the hospital NOW.

          • almostfearless

            Here’s a test. Search midwiferytoday.com for a pregnancy complication, then search google. Compare the first result on each:

            1. High blood pressure while pregnant. Midwifery Today says: The Prenatal Water Workout. Google gives the NIH page that talks about the risks of pre-eclampsia. MT: 0, Google: 1.

            2. Breech presentation. Midwifery Today says: breech birth is unusual, but it is not abnormal (suggests homebirth) Google points to Wikipedia page for Breech birth which warns of the risks. MT: 0, Google: 2.

            3. Pre term PROM. Midwifery Today says (well technically second entry, first was a book list): you can prevent it by not working a high stress job or by using vinegar or yogurt douches. Google points to the AAFP page on Preterm PROM which warns, “It increases the risk of prematurity and leads to a number of other perinatal and neonatal complications, including a 1 to 2 percent risk of fetal death.” MT: 0, Google: 3.

            It’s not really fair because almost everything on Midwifery Today is going “don’t worry, woo it up”, but they are charging for advice that is largely worse and less accurate than what you could find by using Google’s “I’m feeling lucky” button.

          • Young CC Prof

            Actually, in general, if you turn to Dr. Google to find out “Hey, is this worth an ER trip, or can I wait until morning?” and you click on the first three hits that look official, MOST of the time you’ll get a pretty reasonable answer.

          • Anj Fabian

            Hell, I usually avoid wikipedia, but in this case I checked to see what wiki had to say for oligohydramnios – and wikipedia got it right:
            Postdates
            BPP good
            No amniotic fluid
            Induction

            Wikipedia is crowd sourced and subject to the influence of ideology, and it is STILL better than crowd sourcing with a group of people who think they are experts in that topic!

  • Jen

    If you don’t know this, you’re NOT a competent care provider. You’re just NOT. –From another midwife (Lay Midwife) “I
    had this happen not low fluid no fluid . Where did it go?”

    • Young CC Prof

      I don’t know, maybe it evaporated. Maybe the goddess Birth took it back because your rituals weren’t done correctly. Maybe it leaked out through the drain, or maybe the mother puked it up!

      • Mishimoo

        Personally, I think it was the lack of unicorn sparkles. She should have massaged them into her kale more thoroughly!

        • DaisyGrrl

          No no, it’s quantum midwifery. Just because you can’t see the fluid doesn’t mean it’s not there. It’s just hanging out in a parallel universe!

          • KarenJJ

            Like Schrodingers cat. Nobody knows if it’s there or not until you open the box.

            Actually, considering Schrodinger’s cat is either dead or alive this is actually heartbreakingly true of “quantum midwifery”. They just choose to believe a baby is alive because they haven’t found out otherwise yet…

    • MLE

      That one really slated me. She had seen it before but was STILL mystified!!!!!! What in the world happened with HER patient????

  • almostfearless

    Really great quote from a one-time CPM hopeful on Jan’s page “My point being, lay midwives are often hostile to the medical system. They’re often hostile to additional help/support. And this is a tragedy that plays out across the country with lay midwives, because they, themselves, have refused to become a part of the medical system and have thumbed their noses at it. I KNOW. I used to be a student CPM-hopeful. Then my eyes were really opened, by several preventable deaths.

    I had the privilege of being an EMT prior to studying midwifery and I was trained in that chain of command. Recognizing the lack of accountability, seeing how it affected patients AND midwives, it was enough for me. My midwife-teacher and her partner were subsequently arrested for practicing without a license, following SEVERAL infant deaths.

    The homebirth community, predictably, rallied around them. I was part of that first rally, and I just kept wondering, what about the PARENTS? Who is there for them? Who rallies around them and supports them? No one. I went home from that rally in deep thought, and as I learned more, became convinced that the only way for lay midwives in this country to provide homebirth safely is for the midwives to become more educated and safer, become PART of the medical community and get an actual license that holds them accountable. Either a CNM or a CM license would be a huge improvement.

    It’s not perfect, homebirth is still much more dangerous for babies than hospitals, but it’s a good start.”

    • ArmyChick

      I totally agree.

    • Jennifer Delaney

      That was me. And I stand by every word. Thanks for quoting me. I hope it makes a difference somewhere. Becoming a paramedic and being an accountable and responsible part of the medical community is so important to me, especially because of what I’ve seen in the crunchy lay-midwife community. They’re birth junkies of the worst sort, because they consciously side-step acountability.

      • almostfearless

        Thank you so much for speaking out.

      • The Bofa on the Sofa

        I liked your comment a lot, Jennifer, because you hit upon one of the most important themes that we discuss: accountability and responsibility. The fact that midwives are not accountable for outcomes is one of the scariest things I have learned from this blog.

        As you note, even when something bad does happen, the response is not “wow, that was bad, let’s figure out how to prevent that from happening again,” the response is to rally around the midwife to protect her delicacies.

        Horrible.

        In my profession, we want to get rid of the bad practitioners. For midwives, they protect them. It’s mind-boggling.

      • Sue

        So well put, Jennifer. Paramedics know as much as anyone what it means to be part of a team.

        You have to suspect the motives of loners who refuse to cooperate with others.

      • Comrade X

        G-d bless you, Jennifer. Thank you.

  • Alannah

    Dr Amy, I strongly suggest you take this document to mainstream media. This could develop into a big story.

  • yentavegan

    I am having restless moments thinking about how this mother must have suffered. She trusted her midwife to be the conduit to a new life for herself and her baby. Al the technology made available to this mom was for naught because the midwife ignored all the warning signs and then the midwife has the gall to blame the mother for wanting to trust birth and wait it out until of course it was too late…and too late is too late for the doctors to save the baby.

    • areawomanpdx

      And she is still suffering, no doubt. I just cannot imagine.

    • Mac Sherbert

      I know just thinking about the unbearable pain this mom must be in hurts me. I hope she has a lots of support from outside the crunchy circles. I hope her family isn’t actively blaming her. And in the end I almost hope part of her healing is to get really angry and take these mid-wives down.

      • rh1985

        I just had a baby on Thursday and I feel so sad for this mom. It didn’t have to happen! I hate that midwives like these make natural birth the most important thing rather than the baby.

  • AL

    Repulsive. And I am not a doctor but I even know that some of their statements regarding the placenta making more fluid when her water already broke is absolutely ridiculously ill informed. Stevia? ARGGGH!!! This is such a great example of wow, they really don’t know what the f**k they are doing.

    • Danielle

      I’m with you. I am not nearly educated enough to understand the intricacies of what the more astute, pro-transfer comments got wrong. But they comments that basically said “no big deal, we can ignore/fix this” were mouth dropping. Stevia? STEVIA?

  • moto_librarian

    I am glad that this whole revolting conversation is available for everyone to read. It is disgusting when laypeople are more aware of how risky a situation is than the supposed medical professionals presiding over it. I stand by everything I said on that thread. I can only hope for some semblance of justice for this baby and its family.

  • Monica

    That thread is infuriating! Anyone who comes here and says Dr. Amy attacks loss moms, please read this and see who’s blaming the loss mom.

  • Irène Delse

    Great job Dr. Amy and all who made screencaps! I hope many, many people see this, especially lawmakers.

    • Amy Tuteur, MD

      I hope that journalists see it also. It could be the basis of a fabulous expose on American homebirth.

      • almostfearless

        The CPM credential should be abolished. This is clear as day. This screen grab proves they lied. It’s impossible for them to talk their way out of this. A baby is dead. Quote from Jan Tritten: “Very sad news on this baby: The baby didn’t make it. Had aspirated meconium a while back they believe. Even after another BPP that showed everything was fine today. 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.”

        • Dr Kitty

          The use of the words “news” and “today” are strongly indicative of a real time situation.

          I’m beginning to wonder if Jan’s horrible formatting and grammar is a way of playing the “I didn’t really say that…sorry about the punctuation fail!” card any time she gets called on her nonsense.

          • Karen in SC

            But she’s a magazine editor! Horrible formatting and grammar? Is that a paid position? The publisher should fire her immediately.

          • Dr Kitty

            Which is my point. If she can do it right, doing it wrong strikes me as trying to be deliberately ambiguous so that she can shrug it off as a grammar misunderstanding if she gets called on it.

          • anion

            Kill Edward not to fear is good.

            (Anybody recognize that? It was the note written in 1327 instructing Edward II’s guards at Berkeley Castle to kill him. Masterfully done; if the note was discovered, its authors could claim it was supposed to read, “Kill Edward not, to fear is good,” and it was all just a big grammar misunderstanding. Whoopsie! But of course, the killers knew what it was supposed to say, so they did the job.)

          • Amazed

            Oh my, I know it. And even knowing it, my first thought was about Twilight. I haven’t even read the books (I tried to give the first one a try). I haven’t watched the movies. But it’s everywhere around me. It’s osmosis, I guess. I think the whole LWN (Let’s Worship Nature!) thing starts in a similar manner.

        • toni

          It’s moral turpitude imo. This has probably already been said but imagine being that woman and seeing that thread with all those ninnies scrabbling to give even more ridiculous advice than the last poster to the person you have trusted with your baby’s health and then see her claiming there was no baby it was all just an exercise or that she wasn’t even really the midwife anyway or whatever ever else she’s saying now. Can’t imagine the anguish of losing a child like that but for the person responsible to then claim they never even existed. Just loathsome!

          • realitycheque

            I’m really hoping the mother comes forward at some stage and leaves Jan with nowhere to hide. No doubt they are busy at work manipulating her to stay quiet, or even convincing her to stand by her negligent “care provider”.

        • realitycheque

          With a comment like that, how can she possibly expect us to believe that a.) This was not her client, b.) It was not happening in real time, and c.) That it was little more than a “case study”. She really does take us for fools!!

          • almostfearless

            I suspect that anything after the colon was a quote from the other midwife, that she wasn’t actually attending, but yeah, I find it far fetched that this was a staged case study.

          • realitycheque

            True, having another look, it does seem possible that this wasn’t Jan’s client, but it was so obviously not a case study and so clearly happening in real time.

          • anion

            Plus–and correct me if I’m wrong–wouldn’t an actual case study provide the actual outcome? By which I mean the true cause of death, determined by autopsy and examination of the mother and the medical records and the placenta and whatever else? It wouldn’t be, “Oh, they think maybe the baby aspirated meconium a while ago,” it would be, “The ME determined that the placenta was deteriorated and X and Y contributed,” or whatever.

            And then a responsible healthcare provider would–again, I imagine and expect–inform the “students” what the actual proper procedure would be in this case and how to prevent another tragedy like it.

            Oh, but what am I thinking? Midwives don’t actually discuss how to prevent tragedies and improve their level of care. They just “trust birth” and shrug about how some babies just aren’t meant to be born, oh well, prayers and stuff!

          • Kat

            I don’t know. Grammatically, that is not the case. The information following the colon fits with proper colon use without any information being cited. I absolutely did not see the colon as being cited information until someone pointed it out. It’s possible, but that’s not what it says. Then again, I don’t really expect someone this stupid to use a colon correctly anyway…

        • Meredith Watson

          Even if this wasn’t her client, there is still plenty of evidence for abolishing the CPM credential on that thread. I do hope that this makes this into the hands of both the mainstream media and legislators.

  • DaisyGrrl

    Thanks for making the whole thread available. I saw the first half of it but not the rest. I’ve been thinking about this mess all weekend and nothing in that thread changes my mind about what I saw unfold.

    Jan Tritten and friends: This entire fiasco is your fault. From all appearances, you posted about a medical emergency that was under your personal supervision. Everything you wrote made you appear unaware of the dangers involved so it appeared that you had deprived the mother of informed consent. Her baby died as a result of your actions. If you were not involved, if this was not happening in real time (which, btw, I don’t believe for a second), then it was incumbent upon you to make this clear from the outset. Regardless, the reaction of the midwifery community was one of breathtaking incompetence. The *only* issue up for discussion in the scenario you posted was one of how to convince the mother to go to a hospital. Instead we were treated to suggestions of accupuncture, homeopathics, and stevia (wtf?). The near universal inability to recognize an OBVIOUS INDICATION FOR INDUCTION (it’s on wikipedia for crying out loud!), does not inspire confidence in the CPM credential. That this unfolded on the Facebook page of the editor of Midwifery Today shows that these opinions/thoughts are not outliers in the community.

    Jan, as an editor you can appreciate the power of language. When you post to your Facebook page a situation that appears to be an unfolding emergency under your supervision, we are going to take that at face value. Your deletion of the thread and subsequent half-assed backpedaling does not make your initial post look like an innocent mistake – it makes you look guilty of breathtakingly unethical behaviour.

    Here’s what I want from you Jan: a full and clear explanation of what happened. I want to know when you received your initial email, when you posted the “scenario”, the contents of any communications you had with this midwife, and when you learned of the baby’s death. I was horrified to watch the thread unfold as it did. I was horrified by the suggestions of the midwives, your hands-off attitude, and your sickening follow-up. You opened yourself to this, now put it right. Explain to us all what happened, what went wrong, and what you are doing to make certain that this type of outcome never happens again. Make this fiasco the subject of your next editorial and publish it in Midwifery Today as an object lesson on what not to do.

    • Amazed

      Own your outcome, Jan. You conceived this monstrosity and like a good little homebirth decided to do a live birth. Alas, it ended in death.

      Own it, Mom.

  • Rochester mama

    I hope this becomes a mainstream stink beyond the internet

  • Kat

    I’m glad this has been documented. To me, it reads as if Tritten was indeed attending. Her post about the baby’s death reads: ” 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.” The distinct use of the personal pronoun there is pretty damning.

    • Anj Fabian

      Yes, why wouldn’t Tritten make it very clear that she didn’t author that particular post?

      • Kat

        I think it’s odd that someone would even directly quote that information. If Tritten was updated about the baby’s condition, it would make more sense to me for her to paraphrase the information into a comment. I think most people would do that, instead of directly quoting. Furthermore, I think most people would tag the information as a quotation in the comment, so like introducing the statement “I just heard from the midwife, … dead baby.” Connecting your quotations into the text is proper citation by any formal system, and also I think the way that information is usually conveyed in casual speech.

        She’s trying to cover for her mistake, but the syntax pretty much reveals the truth of the matter.

      • …because she is stupid? When I covered the Utah Midwives Organization meeting I was alarmed at how dumb a lot of the people were. There were so many technical problems that were easily solvable but no one managed to fix them. Others have very poor writing skills. Also, the data for their organization was on a computer that got taken as police evidence in a raid, and no one thought to back anything up soooo they had to start from scratch.

        • Young CC Prof

          OK, when you have no records because they’re all in police evidence, that’s like the kind of problems organized crime would be ashamed to have, much less an actual organization that purports to do something productive.

          • Dr Kitty

            It worries me that Criminal gangs and paramilitary organisations are run by smarter people with better record-keeping and communication structures than American Homebirth Midwifery.

            The mafia has Omertà, but these ladies are too dumb to know that just maybe the internet never forgets and you shouldn’t broadcast your fuckups too widely.

            Jan could have Googled, telephoned, emailed or posted to a private forum and we’d have been none the wiser.

            Nope, crowd sourcing info on a public Facebook page from sources with unchecked credentials!

          • Well shit, just making it a members – only board would have made moressense. Basic logic: midwives ain’t got it.

          • R T

            You should be glad they aren’t run by people as smart and successful as those who run the most profitable criminal gangs on the world! They may not be legal, but they’re some of the most brilliant power CEOs we got! Also, the term paramilitary can refer to auxiliary police forces like SWAT teams who are highly trained and organized so of course the people running them have better credentials than CPMs, lol!

    • Susan

      I saw that as well. If it’s just some sicko educational exercise and opportunity to make readers anxious and sad, why say “I” and “we”. Nah, it smacks of this…

      http://www.youtube.com/watch?v=WTbgsoHDc24