To anyone distressed by Jan Tritten’s behavior in the preventable death of a baby

Tritten petition

Yesterday approximately 10,000 people followed a Facebook thread where Jan Tritten, editor of Midwifery Today, crowd sourced a life or death obstetric decision at the exact same time that the baby suffocated to death. Judging by my private email, Facebook and Twitter accounts, many homebirth advocates and homebirth midwives were deeply distressed by the incident, Jan’s behavior, the baby’s death, Jan’s response, the desperation of some homebirth midwives to absolve Jan from accountability, and, of course, Jan’s deletion of the entire thread.

I could offer reams of statistics about the hideous death rate at homebirth, and I often do, but no one does a better job of demonstrating the ignorance, incompetence and gross lack of professionalism than homebirth midwives themselves. Jan Tritten exquisitely and painfully demonstrated my adage that homebirth midwives bury babies twice; first in little coffins in the ground, and once again by trying to erase their lives and senseless deaths from public consciousness.

There were some minor consolations to the thread. Homebirth midwives and advocates spent hours arguing and interacting with me, and others similarly outraged by Tritten’s behavior. No one was turned to stone, became radioactive or was otherwise permanently harmed by engaging with me. I daresay that some people actually learned some things.

To any homebirth midwives and homebirth advocates who were willing to engage or even just read along I offer this: You are welcome to post here anytime, with any questions, or even just to argue. Your comments will not be deleted. They will be addressed. We may be on opposite sides of the debate, but we’re on the same side when it comes to saving the lives of babies.

To them and to everyone else, I also offer this: A petition to express our outrage and revulsion at Tritten’s decision to crowd source a life or death decision on Facebook, the death of the baby, the utter absence of any attempt to hold anyone to account, and the immediate deletion of the thread that exposed Tritten’s grossly unprofessional behavior.

You can find the petition at Change.org.

It is addressed to Jan Tritten:

We wish to express our revulsion at your unprofessional behavior and the resulting death of a baby.

And goes on to explain:

Jan Tritten, Editor of Midwifery Today, crowd sourced a life or death decision on Facebook, and a baby died.

American homebirth midwives are the only healthcare providers who have literally no safety standards and, therefore, no accountability. Recent publications, including statistics from the Midwives Alliance of North America (MANA), the organization that represents homebirth midwives, reveal that homebirth increases the risk of death of the baby by 450% of more. High risk homebirths (breech, VBAC, twins) had even higher death rates.

Despite these hideous death rates, no homebirth midwifery organization or executive has made any recommendations to improve safety. Indeed, homebirth advocates in both Arizona and Hawaii are currently arguing to enlarge scope of practice to include the EXACT SAME high risk conditions that homebirth midwives have demonstrated in their own paper to be utterly unsafe at homebirth.

It is time for the leaders of American homebirth midwifery, including Jan Tritten in her role as Editor of Midwifery Today, to acknowledge the death toll of homebirth, to investigate why these deaths are occuring and to hold the midwives involved to account.

Please take a moment to sign the petition. Tritten will receive an email each time someone signs.

We had tremendous success with our petition to force MANA to release its homebirth deaths rates. Perhaps we can have equal success at preventing more homebirth deaths.

  • MamaBear

    I normally do not sign potions on Change.org, but this one was too important not to. I hope something comes of this. There needs to be safety standards if women are going to birth at home.

  • Aki Hinata

    Signed.

  • Thankfulmom

    When my 14 month old son was in PICU, our pcp was called (he had seen our son the day before). He wrapped an arm around me and we both cried over my son’s death. He was at the meetings with the picu doctors to understand why my son died suddenly. He came to our son’s burial. Jan thinks “so sad the baby died” is enough? Our pcp cared enough to be there for us as we all processed his unexpected death.

    The wanna be health care providers don’t understand their lack of knowledge kills babies. Real professionals allow their medical care to be scrutinized. I would be so angry at the marginalizing “so sad” remark on fb.

    • NoLongerCrunching

      I’m so sorry for the loss of your son. I’m glad you had such a compassionate doctor.

    • DaisyGrrl

      I am so sorry for your loss and so glad you felt supported by your pcp.

    • Dr Kitty

      I’m so sorry for your loss, but it is a blessing that your doctors were a sorce of support for you.

    • Trixie

      So terribly sorry for the loss of your son.

  • attitude devant

    I am number 257.

    • theNormalDistribution

      Wow, it’s really getting up there.

  • AlisonCummins

    “To any homebirth midwives and homebirth advocates who were willing to engage or even just read along I offer this: You are welcome to post here anytime, with any questions, or even just to argue. Your comments will not be deleted. They will be addressed. We may be on opposite sides of the debate, but we’re on the same side when it comes to saving the lives of babies.”

    If anyone has any questions or doubts about how committed Amy Tuteur, MD is to freedom of speech, consider this: someone who threatened her and other commenters is still commenting.

  • Signed. This is truly horrible. When I was pregnant with my first baby, ultrasound the day before my due date showed very low fluid levels. After a reassuring NST, my doctor had me come back at midnight that night for induction. I have a healthy little girl because of it. My heart breaks for this mother because her baby didn’t have to die.

  • LMS1953

    http://legiscan.com/AZ/text/SB1157/id/932352

    Now here is one on the plus side introduced as Arizona Senate Bill 1157. Unfortunately, I am sure that many of you will dismiss it out of hand because it was introduced by one of those xenophobic, racist, sexist, conservative, right-wing Republican kooks:

    http://www.azcentral.com/news/politics/articles/20140212senate-bill-pursues-midwife-restrictions.html?nclick_check=1

    The sponsor is Dr Kelli Ward

    “I’m a pro-life legislator. I see the mom and the baby as two separate entities,” Ward said. “I would love to preserve the choice of the mother for their home birth, but that child also needs to have a choice … the choice not to die.”

    During Wednesday’s committee hearing, Ward said she introduced the bill because of concern from the medical community.
    “Infants born at home have more than a three-time risk of dying than infants born in a hospital,” she said.
    She said under the bill, certified nurse midwives, who must have a master’s degree, would still be able to deliver these mothers’ babies. It would just restrict midwives licensed through the Arizona Department of Heath Services.
    More than 150 people signed in against the bill at the hearing; 29 signed in support of the bill.
    Tory Anderson, who spoke on behalf of the Rights for Home Birth consumer group, gave the health committee a petition signed by 1,500 people supporting allowing licensed midwives to serve those women.
    “This bill will limit a mother’s personal heath-care choices,” she said. “Women and mothers are smart, informed and educated. We have a right to do our own research and make our own choices for our births.”
    Dr. Nathan Lepp, a local neonatologist, testified in support of the bill, saying studies indicate there is a higher risk for babies born at home to have lower Apgar test scores — a standard medical exam to assess the health of newborns — and a higher risk of seizures shortly after birth.
    “I appreciate women’s rights, but we also have to look at the interest of the child,” he said. “There is a long-term potential for neurological dysfunction.”
    Elizabeth Morton, who gave birth to her son with the help of a midwife, said she knew the risks of home birth when she made her decision, but argued there are also risks with giving birth in a hospital. She said the state’s current rules do have restrictions to help mitigate those risks, including requiring that the woman have had only one C-section. The woman also must live within 25 miles of a hospital.
    Marinah Farrell, a local midwife and president of the Midwives Alliance of North America, said that while consumers nationwide are asking for more access to midwives, state legislatures have begun trying to put more limits on them. She said statistics do not show hospital births are significantly safer than home births.
    “A planned home birth for low-risk women with a licensed, credentialed midwife is proving to be safe,” she said.
    The committee’s four Republicans supported the bill; the three Democrats opposed it.
    “We have to ensure public health and safety is complete,” said Sen. Kimberly Yee, R-Phoenix.

    • LMS1953

      Repeated for emphasis:

      The committee’s four Republicans supported the bill; the three Democrats opposed it.
      “We have to ensure public health and safety is complete,” said Sen. Kimberly Yee, R-Phoenix.

      • LMS1953

        http://ballotpedia.org/Kelli_Ward

        Yep, she’s about as Tea Party as one can get – pro-Second Amendment, pro-Border Control, anti-NSA, pro-Life, anti-Obamacare, pro-limited government. …… and anti-CPM.

        • MLE

          See right now you’re talking AT everyone, not with them. You’re dumping these long quoted passages on an unrelated post, making it hard for people to get to the comments actually discussing the topic at hand. You need to stick to engaging in discussions instead of drowning everyone else out with your non-nuanced, off-topic comments. The militant lactivists who can’t shut up on the old mother-friendly post can take care of the slogan-shouting, quote-heavy comments. Don’t be a lightening rod for anyone who thinks that old white OBs are tone deaf with no listening skills. Mine certainly wasn’t.

          • LMS1953

            Show me a SINGLE Democrat on ANY legislative level who has sponsored an anti-CPM bill. Tap on view to see a list of 6% of the entire 200 Democrat body of the House co-sponsored HR 1976.

          • Comrade X

            Look, this isn’t about left vs right, or party politics. We’ve got people here from all possible hues of the political spectrum. I’m a raving communist, and I don’t support allowing charlatans to claim qualifications they don’t have and provide fake “medical” services.

            At the risk of being personal – I don’t know what’s going on with you at the moment, but please cut out the vitriol and personal attacks.

          • Laura

            Here’s a different take on this issue: horrible, needless, preventable home births deaths on WANTED babies and legislated, supported, approved deaths in late-term abortions for UNWANTED babies. I don’t see politics in Dr. Ward’s stance. I see a logical conclusion to someone who doesn’t parse out “wanted” vs. “unwanted” babies.

          • Irène Delse

            Seconded. Trying to make the lack of legal restrictions on homebirth a partisan issue seems misguided to me. Didn’t we see examples in the comments of this blog of fervent homebirthers from the Quiverfull and other extreme right-wing religious movements, as well as in crunchy hippy liberals?

          • Yes! And in a forum where he is being begged NOT to.

      • LMS1953

        So, according to Dr Amy the 4 Republican senators on the Committee who voted FOR the anti-CPM did it for all the wrong reasons and will hurt the cause, whereas the 3 Democrats who voted AGAINST it did it for all the right reasons – and if we harangue distraught mothers by crucifying them on the caskets of their dead home birth babies for another 8 years, then her besainted liberal Democrats will finally see the light and vote FOR anti-CPM bills for all the “right reasons” as we all frolick with butterflies and unicorns in the Land of Libtards. Amy, your ridiculous argument is as morally decrepit and intellectually vacuous as the MANA’s interpretation of the hideous statistics. And it stems from the same foolish character flaw – blind adherence to dogma over fact.

        • Amy Tuteur, MD

          No, LMS. It’s not that they voted for it for the wrong reasons. It’s that they created a bill that has no chance of being passed and probably would be struck down as unconstitutional if it did pass because they were more interested in promoting their political views then in stopping CPMs.

          Instead of putting the focus where it ought to be, on the hideous death rates of CPMs, they bill allows the CPMs to claim that it is a violation of their reproductive rights and an effort to introduce personhood for the unborn.

          I’m really surprised that you can’t see this, LMS. They destroyed the chance of regulating CPMs because they were more concerned with abortion politics than with incompetent health care practitioners.

          As it happens, I spent nearly an hour on the phone with a reporter on Friday morning explaining why regulating CPMs has nothing to do with abortion politics. That was a discussion that wouldn’t have happened if the bill has concentrated on CPMs and left abortion politics out of it.

          • Comrade X

            Yup, by bringing abortion into it, they’ve given massive ammunition to the CPM “midwifery” crowd who want to make this all about how regulating THEIR QUACKERY is equivalent to “taking away women’s choice” or “interfering in women’s reproductive freedoms”.

            In reality, it’s nothing of the sort. Any more than mandating that landscape gardeners don’t get to advertise themselves as heart surgeons has anything to do with self-ownership or reproductive freedom.

            This is playing RIGHT INTO the “lay midwives” bait-and-switch schtick. It’s not the woman’s right to homebirth that should being restricted. It’s the “midwife’s” right to pretend to be a qualified health-care professional when they are nothing of the kind.

          • prolifefeminist

            “It’s not the woman’s right to homebirth that should being restricted. It’s the “midwife’s” right to pretend to be a qualified health-care professional when they are nothing of the kind.”

            EXACTLY.

          • prolifefeminist

            I’m pro-life, fairly liberal, and anti-CPM, and I completely agree with you, Dr. Amy. The legality of abortion and the legality of CPMs are two completely separate issues. It’s pure stupidity to try to outlaw CPMs on the basis of fetal rights, when a) any legislation passed on that basis will be fiercely opposed by well-mobilized abortion rights groups, and b) there is much more public support for regulating HCPs.

            We have to remember that HB/CPMs truly are a fringe group. They are a vocal minority though, and their supporters are organized and highly motivated to oppose restrictions on the ability of CPMs to practice.

            What the other side (that’s us!) needs is to keep building a network of people motivated to put pressure on lawmakers to abolish the CPM “credential” because it’s not a standard at all. And we need lawmakers to introduce legislation to abolish it ON THAT BASIS ALONE. Most people would support that.

    • Amy Tuteur, MD

      Perfect example, LMS!

      Instead of sticking to the obvious argument: CPMs should be regulated out of existence because they have hideous death rates, aren’t health care providers, and have no safety standards, some conservative legislator, who couldn’t resist making this about her and her conservative policies, has flaunted her unrelated philosophy and therefore grievously harmed the best chance at stopping these CPM cause deaths.

      Conservatives like you and that legislator need to decide whether they care more about babies lives or more about their politics. Apparently she cares more about her politics.

      • Trixie

        This exactly. She opposes it for the wrong reasons.

        • Amy Tuteur, MD

          I described it as far worse than opposing it for the wrong reasons. She actually risks letting CPMs win and go on to harm other babies because she was more interested in talking about her own political philosophy than whether babies live or die.

          • Sounds familiar. I am really tired of LMS and reading “libtard” and similar screeds. Again I say, he needs to take it back to GLP where it belongs.

          • An Actual Attorney

            What’s GLP?

          • If I told you I’d have to kill you.

            It stands for Godlike Productions. He’d fit in.

            I’ve said too much.

          • Trixie

            You’re correct. In the larger context of the correlation between states that limit CPMs leaning right/conservative, to the extent that there is one, the rhetoric is one of limiting women’s reproductive freedom overall. CPMs defend their practice as a reproductive/maternal choice, and they seem to have success with this argument among liberal state legislators. Which is the wrong conversation to be having, for the reasons you stated here and elsewhere. Mothers who start labor with a live baby presumably want to finish labor with a live baby also.

        • LMS1953

          Well then Tricks, show me a Democrat who supports it for the RIGHT REASONS. Do you have any understanding whatsoever how politics works?

          • Irène Delse

            Her name is Trixie. Making puns on the name or internet ‘nym of someone you disagree with is not clever if you’re over 6 years old. It doesn’t make your side of the argument look better either.

        • toni

          What’s the problem here? Her bill won’t help the cause because you think her motives are not 100% pure and altruistic and because she relates the issue to abortion and that would instantly make those in favour of abortion ignore her (even if her proposition is good)? CPMs are a public menace, I’d have thought any legislator (esp. a senator who is also a physician) drawing attention to the deaths they’ve caused would be a good thing.

          • Young CC Prof

            The problem is that she didn’t sell it as a simple question of dangerously incompetent people lying to the public, claiming to be health care providers, and inflicting terrible harm on pregnant women and newborns. Instead, she brought in a completely unrelated and highly political issue, and thereby REDUCED the chances that it could draw bipartisan support and actually pass.

          • Medwife

            They’re trying to weasel a toehold against Roe by way of “fetal personhood” language. Why am I not surprised this is going down in Arizona?

      • LMS1953

        Really? Could you please name ONE piece of legislature sponsored by a Democrat that would limit CPMs? You conveniently deleted posts where I showed that 6% of the ENTIRE Democrat House (13/200) co-sponsored HR 1976 to mandate Medicaid coverage for CPMs in states where they are licensed.

        Amy, you are as imbued in Libtard Woo as Ina Mae and MANA are in theirs. Politics is what it is. Candidate have to run on sound bites. Dr Kelli Ward won with 72% of the vote in her district. If you think there is a SINGLE Democrat on the national or state legislative level who would sponsor such legislation as SB1157, then you are more of a fool than you already come across as.

        • Dr Kitty

          “Libtard”…
          Really?
          You want to use THAT kind of language?

          • Certified Hamster Midwife

            Oh, that’s what passes for normal political discourse over here. Surprised no one has used “Rethuglican” yet.

          • auntbea

            Whoa. By “over here” do you mean America? Or SOB comment section? Also, I have never heard “Rethuglican” before.

          • Certified Hamster Midwife

            Over here = the US, in political blog comment sections at least.

          • auntbea

            I generally avoid those. Even though (or perhaps because) I am a political scientist.

          • Young CC Prof

            Almost everyone avoids THOSE, except the vipers. Which is why it’s just a giant pit of vipers half the time.

        • Trixie

          Klassy

  • Meredith

    Signed, and here’s the comment I left:

    “It would be worth trying to stop Jan Tritten from practicing midwifery even if she were only an aberration in an otherwise competent field. It is even more important to speak out against her because she is representative of how ignorant and dangerous homebirth midwives are, as shown by the number of people blithely giving her irresponsible and ill-informed advice on Facebook.”

    Thanks for creating this petition, Dr. Amy!

    • manabanana

      Well, not sure if Jan Tritten is practicing midwifery. Though she does publish a midwifery magazine rife with piss-poor advice.

      Yes, her behavior this week was horrifying, but really, not unexpected considering what gets published regularly in Midwifery Today.

      VBAC, HBAC, HBAmC, Footling breech, home twin deliveries with 33 hours between baby A and baby B. Home twin deliveries where the second twin suffered skull fracture. Post-dates. Dysfunctional labors normalized. Ultrasound touted as radioactive. Routine prenatal screenings decried as non-evidence based. Brewer diet worships. Recipes for placenta pills. Freebirth supported. “Conservative” management of retained placenta = meaning LEAVE THE PLACENTA IN SITU FOR MONTHS, THE BODY WILL RE-ABSORB IT.

      I wish, wish, wish I was making this nonsense up. If you think what appears on the MT facebook page, or on Jan Tritten’s facebook page is appalling, have a look at the printed version of MT. That’s where the real ‘gems’ are.

      It’s disgusting

      • Meredith

        I believe you that this week’s episode was just the tip of the iceberg. I can’t delve too far into the woo — whenever I try to, I end up ranting at my long-suffering husband.

        Even if she was channeling some other midwife’s situation, I do consider Tritten to be practicing midwifery, inasmuch as she appears to be offering her “expert” (there are not enough quote marks in the world) advice to other midwives.

        …Leaving the placenta in situ???? I guess I shouldn’t be surprised, given that these people seem to feel you should do the same with post-dates babies. Disgusting indeed.

  • Paula

    Signed.

  • LMS1953

    http://www.opencongress.org/bill/hr2141-112/text

    Here is another one that apparently died in the 112th Congress. The purpose was to make sure “evidenced based medicine” was used to guide the development of maternity services in the 21st century. We all know that the actual purpose was to allow MANA and their CPMs to massage the evidence and lie about it so they could advance their agenda under the guise of “science”. Of course, when confronted with the “science” of grade school mathematics, they dissemble and lie even more.

    Click on view for a screen shot summary

  • LMS1953

    https://www.govtrack.us/congress/bills/113/hr1976/text

    In a string below, I was asked to provide links to proposed legislation supportive of the CPM agenda. You can find them on the MANA site. This one is HR 1976 sponsored by Ms Chellie Pingree (D – Me). As best I can tell, not being lawyer and all, this bill is for the purpose of assuring that any state that licenses CPMs has to cover their services on Medicaid. Tap on view to see the list of about a dozen other crunchy Dems who co-sponsored it

    • Trixie

      There’s no question the far left is wrong about CPMs, just like they’re wrong about GMOs. The extremes of each side each have their own appalling anti-science agendas.

      • LMS1953

        Trixie, I would hardly call the dozen listed Democrat co-sponsors to be “far left”. They are all “main stream” Democrats who ALL live in states which LICENSE CPMs. How about that! These are not marginalized ideas on the fringes of the Democrat Party. They are part of the very fabric of that party’s agenda.

        • guest

          Dr. Amy, I know that you delete almost no comments, but this guy’s political rants are irrelevant, distracting, annoying, and I think seriously detrimental to these conversations. I’m a regular reader, though I infrequently comment, and I often just click away. I’m no precious snowflake, I just get so irritated that I don’t want to read anymore. Which is a real bummer.

          • manabanana

            I’ve made liberal use of the minimizing option.
            🙂
            Pun intended.

    • LMS1953

      Fortunately, it is given a 0% chance of being law (barring an Executive Order to enact it). Tap on view to see the reasons why. Chief among them is that it was a bill introduced by the minority party. While more than 5% of all Democrat reps co-sponsored the bill (that would increase the ability of CPMs to kill babies at home birth), there was nary a single bi-partisan Republican supporter. So, wail all the angst you will on the deaths of babies at home birth under the negligent care of CPMs. But a vote for a Democrat representative and you will increase the odds of that happening. And the blood of those dead babies will be proportionately on the hands of such voter.

    • You were also asked to stop trying to polarize and partisan this forum. How many times do you need to be told that this is a NONPARTISAN forum? And we WANT it nonpartisan.

  • Guest

    I am so afraid of these people. At least admit when you are wrong. http://www.midwiferytoday.com/articles/biophysical.asp

    • Mishimoo

      And what is with using lavender babies as advertising for a seminar at a conference?

    • Anj Fabian

      “Unity in Midwifery”
      With Jan Tritten as a speaker.

      http://midwiferytoday.com/conferences/Harrisburg2014/

      • Trixie

        I’ve been to that hotel, for a wedding. The food was….well, I guess I wouldn’t be too sad if Jan Tritten had to spend most of the conference on the toilet.

        • auntbea

          Having recently moved to PA, I have learned that, for the purposes of attracting tourists, 75% of the state is Amish country.

          • Trixie

            Wilkum.

      • manabanana

        “Midwifery is a different profession than obstetrics; one dedicated to authenticity, with what should be all medical professions’ foundation—to “first do no harm.””

        http://midwiferytoday.com/articles/knowledgebase.asp

        “And finally, never separate the baby from the mother.”

        http://midwiferytoday.com/articles/ed_babieshaverights.asp

        “Doctors horrendously make excuses, and the worst thing they do is to put blame back on the mom…”

        http://midwiferytoday.com/articles/ed_change_practices.asp

        Irony, thy name is Jan Tritten.

        • Young CC Prof

          I liked: “Medicalization is very seductive and clandestinely so. I know midwives
          who began as lay midwives, got their CNM training and slowly became
          indoctrinated into the medicalization of their practices.”

          So, that’s how she justifies ignoring all the medwives. That extra education just indoctrinated them, and now they don’t know how to be midwives any more. Real midwives should carefully avoid taking classes or reading books from the medical establishment, or even listening to people who belong to it, lest they learn something that would contaminate their pure and noninterventionist practice.

          Horrifying.

        • Young CC Prof

          And from the second one: “The baby needs her stem cells, and there are many other benefits of delayed cord-cutting as well.”

          I don’t know if “her” refers to mother or baby. Maternal cells (other than some antigen-specific antibodies) don’t belong inside the baby. And if “her” meant the baby’s, well, we all know how magic those free-floating stem cells are!

          So, you can’t take a course taught by a doctor or PhD nurse, but you can take a course on stem cells taught by a random wooster. Good to know what the rules are.

      • auntbea

        Ooh. I’m about 1.5 hours from Harrisburg. Does anyone want to go stand outside with me?

        • Young CC Prof

          That’s actually a decent idea.

    • Young CC Prof

      SIX HOUR kick counts? What the hell?

      1) I was told to lie on my left side and count 10 kicks, and call immediately if it took more than an hour to get to 10. Less than 10 movements in SIX hours in a baby past 41 weeks is terrifying.

      2) On a purely practical level, do you really think people can keep track of a kick number all day long, possibly while doing other things?

      3) Don’t you think that all-day kick counts would be kind of stressful? Don’t you think the mother would rather just get the baby safely out?

  • Still can’t sign, and don’t see that anyone else has, either. What am I doing wrong?

    • guest

      I am in Aussie an had no problem. Simply clicked on the link, completed and done and dusted.

      • guest

        Now at 188 signatures.

  • An Actual Attorney

    Now at 166 signatories. Good job! Hope Jan enjoys those emails. Maybe, just maybe, she’ll realize that her actions were appalling.

  • fiftyfifty1

    “No one was turned to stone, became radioactive or was otherwise permanently harmed by engaging with me.”

    Maybe a few who turned into pillars of salt?

    • MLE

      Regarding those who warn others against reading Dr Amy or coming here…can you ever imagine the situation being reversed? Dr Amy telling us never to read Ina May? It would be ludacris (purposeful misspelling to underscore just how ludicrous I find that idea).

      • KarenJJ

        I agree. I read bits from everywhere, but the BS from the NCB advocates is getting very difficult to stomach. Nobody here is saying not to read any other blogs. If anything we’re reading them more then we would just to see how bad their information is and how badly they treat other women.

        • She links to them, for Pete’s sake.

          • MLE

            And I guess since they do the best job of illustrating their chicanery in their own words as she often says, that makes sense, whereas sending anyone here would only weaken the NCB position. Default to avoid/ignore mode. Hopefully the contrast is obvious….

      • Young CC Prof

        And here, dissenting comments are not deleted. Disagreed with, possibly harshly, but not deleted.

        Reality-based sites do not fear opposing viewpoints. Yes, pro-vaccine groups get annoyed the 9,000th time someone shows up with the aluminum gambit, just like we get annoyed the 9,000th time someone tries to be terribly clever by quoting infant mortality stats at us, but we’re not afraid. Heck, sometimes I actually like explaining why infant mortality is the wrong measure, and what the real problems are!

        When you have to go deleting anyone who quotes or refers to opposing viewpoints, clearly you lack faith in your very own arguments.

        • MLE

          I love seeing the explanations repeatedly and from different approaches. In addition to being informative, it’s so nice to see the typical overwhelming “bibliography salad” diced.

        • Box of Salt

          I can’t help myself “quoting infant mortality stats”

          The antivaccine folks try that one, too, and it doesn’t work the for them, either.

          • Box of Salt

            ^Ooops. Extra “the” after work….

          • Young CC Prof

            True. Meanwhile, the infant and early childhood mortality stats from before most vaccines are a fabrication of Big Pharma.

          • Box of Salt

            You forgot to mention all the big improvements in sanitation – you know, the ones that occurred in the 1960’s, 70’s, and 90’s.

  • fiftyfifty1

    it should be “tiny coffins in the ground” not in the group, if nobody has pointed it out already.

  • anion

    Signed.

  • KarenJJ

    Signed. Keep the heat on. I hope other midwives also join in denouncing this reckless behaviour. Any person with half a heart would have been distressed by those incidents posted on Jan Tritten’s website yesterday.

  • Multi-Mom

    Let’s say it was all a poorly executed learning exercise. Why wasn’t she on the thread using it to teach, showing those who didn’t take it seriously what their errors were and helping people learn from this. If is was a question from another midwife, why the hell didn’t she email right back and say “are you effing kidding me, get that mother to the hospital STAT!!!!” And then post on the website scenarios where transfer of care is the only acceptable solution. Why not? Because it was her own patient and she crowd sourced the care through facebook and killed the baby.

    • Adelaide GP

      Perhaps the mother herself will be able to speak up one day and reveal whether Jan was the midwife involved or not. I don’t think such flimsy lies stand much chance of holding water for too long.

    • fiftyfifty1

      I don’t know if it was her patient or not. I think the reason she didn’t say “go to the hospital STAT” is because she truly lacked the medical knowledge to know how dangerous the situation of no fluid at 42+ weeks is. She was that dumb and/or that blinded by ideology.

      • MLE

        And she flat doesn’t care. “It’s always sad when a baby doesn’t make it.” NEXT.

      • Guestll

        I think she knew that the situation was dangerous and was hoping for good anecdotes to reinforce her shitty decision-making. And boy, did she get them.

        She didn’t give a fuck whether that baby lived or not, either.

    • Allie P

      I tell ya, the day I find out my medical provider is on FACEBOOK asking for advice while I’m facing a life or death situation is the day I call a lawyer… oh, wait, they have no redress for malpractice.

  • AdelaideGP

    This situation is mind boggling. What a toxic mixture of ignorance, arrogance, unprofessionalism, cluelessness, hubris, the list goes on. I am a shared care GP and routinely transfer care when a condition arises that makes the pregnancy no longer low risk. Gestational diabetes, breech, low lying placenta etc etc. it’s called practising within your scope of practice. Not failure on my part or a faux “respecting ” the patients wishes. As the professional in the situation you are suppose to advise them what course of action is indicated, not create a false sense of going on what the patient wants. They are the patient, they are not trained to assess the situation and they should not be expected to make their own medical decisions. There is so much that is wrong with this scenario it’s hard to know where to start. Thanks for continuing the good fight for safer care for women and babies, Dr Amy. Looks like your work will never be finished in the foreseeable future though. Such a depressing problem.

  • Amazed

    Signed. To think that this woman is in charge of a magazine these loons swear by…

    By the way, hereby I officially suggest that whenever we talk about Jan, wherever it is, we call her “midwife” Jan Tritten. She hasn’t been practicing since 1989, right? And they dare whine about Dr Amy’s license.

    • MaineJen

      She hasn’t been “officially” practicing since 1989.

    • I don’t want to legitimize her flunkies that much.

    • NatashaO

      or ‘dimwife’

  • Guestll

    Signed. Just so disgusted. To all of Jan’s supporters – it doesn’t matter if she was the midwife or not. She sought to crowd source care on freaking Facebook, when the only recourse was “deliver now.” No fluid is a medical emergency. Utterly repulsive.

  • Done, and husband signed too.

  • Dr Kitty

    If (currently) 75 emails telling her she should be ashamed of herself don’t work Jan might seriously want to consider seeing a mental health professional.

    So, for her sake, I hope she actually feels bad about this.

  • Comrade X

    Done.

  • Sara

    Signed. Thanks Amy, my heart aches for that little baby.

  • I don’t seem to be able to sign the petition :-((

  • MLE

    Signed. It doesn’t matter if she was or was not there. This was clearly not a retrospective case study as they are pathetically claiming. The 29 weeks discussion confirms that, as do numerous other requests for real-time advice on the page. There was never any follow up from her stating the appropriate course of action, which she would have done had this been a case study. There was no correction of the incorrect answers such as “consult a midwife friendly massage therapist.” But if for some reason she is idiotic enough to post something as horrific as that as if it were happening live and it wasn’t, then she is even more of a monster than I previously believed.

    • Anj Fabian

      I posted this link under Tritten’s “Oops” post. This is how one group does case studies.
      http://www.studentmidwife.net/hub/catch-of-the-day.76/

      • MLE

        Saw that. Maybe it will be educational in the long run. I am sure it is news to many of them. Rule #1: Do not toy with people’s emotions by pretending it’s a real-time, life and death situation! I don’t give the case study argument any credence.

        • Dr Kitty

          A few tips for Jan.
          If you use quotation marks (“”) or third person (he/she/they/his/her/their) your readers will know you are not talking about your own experiences.

          If you don’t use quotation marks and use first person (I/me/my/mine) your readers will assume you are relating your own actions an experiences.

          If you are presenting a case study you present it as a case study.
          “This is Scenario X. What is the next appropriate step in management? What ethical concerns or logistical barriers may need to be considered?”

          You don’t say “what do we really feel about the risks?” Or ask for “stories/opinions”.

          If t

          • Amazed

            Stacey, Jan ought to hire you as her consultant. Editing consultant, I mean, not a midwifery one, although I think you’ll do a better job than she did in this one, too.

          • Dr Kitty

            It was indeed Dr Kitty. 🙂
            I shouldn’t be in charge of editing anything.
            Have you read my posts?

          • Amazed

            I have. I have also read Jan’s quotation makr-less, comma-less, paragraph-less ramblings.

            You’ll be a huge improvement,

          • Dr Kitty


            If this was a case study it is one that falls into the category of Cautionary Tale.
            There was only one reasonable management option, it wasn’t done and the foreseeable and inevitable disaster ensued.

            The only appropriate learning is that anhydramnios or oligohydramnios after 40w requires immediate transfer of care and consideration of immediate delivery. The end.

    • Meredith Watson

      If it were a case study (which I don’t believe for a moment), it would seem to be a rather facile one that the majority of those responding couldn’t properly assess, no?

      • The Bofa on the Sofa

        That’s what I think, too. IF it actually were a case study, all it shows is that there is a serious problem in the field of midwifery, since such a large number of respondents botched it massively.

        Moreover, it isn’t even that hard of a problem. As I noted below, when my wife gets “CE case studies” in magazines, they tend to be more challenging cases, In these cases, there can be legitimate differences in opinions about how to proceed. However, none of them involve homeopathy.

        But this supposed “case study” is nothing like that. It’s an obvious emergency that needs to be dealt with immediately, and that is the only answer that is close. As others have noted, there is no question about what needs to be done, only in how to make it happen.

        That there were many who couldn’t even get that right? As I noted below, if this is a case study in anything, it is a case study of how big of idiots midwives are.

        • MLE

          Most responses ranked right up there with cinnamon breath and whoever was pulling this hypothetical stunt should be petrified by what came out of the woodwork. It wasn’t framed that way at all and it had the simplest of answers as you say, so this whole charade that the question wasn’t exactly what it seemed just shows that on some level they are aware of how embarrassingly atrocious this incident was.

          • Trixie

            Yeah, I think stevia was one of the suggestions.

          • Amazed

            It was. Their writing level was so expert, though, that I couldn’t understand who was supposed to do what with it. Mom, midwife? Consume it, stick it in the vagina like a garlic shower, what?

          • Dr Kitty

            Stevia…that would be the plant-based sugar substitute used by people who don’t understand that sugar is, in fact, made from plants?

            I’m guessing they were thinking that the Stevia would pull amniotic fluid in by osmosis….yeah…nope.

          • Stevia works wonders if used on the night of the full moon, as one walks widdershins seven times around Stonehenge.

            And you call yourself a doctor, Dr. Kitty? How could you not know this? Tsk, tsk.

          • Amazed – I just realized, I think you mean a garlic douche.

          • Amazed

            I have to admit that I don’t know what I mean. I cannot imagine such lunacy either way, so I cannot keep it in my memory for more than 2 seconds after seeing the words. It’s just how my memory works – I either understand, or fail miserably at memorizing. Alas, it doesn’t mean that I remember everything I ever understood. It works just one way.

          • Young CC Prof

            I also have trouble remembering things if I don’t understand them. And yes, the obstetrical uses of garlic are pretty incomprehensible. I think one is better off NOT knowing.

          • I thought it was linguistic – douche in French means shower. In this context, it’s the American usage of douche – washing out the vagina. “Obstetrical” usage, I’ve heard a whole peeled clove of garlic shoved right in “like a tampon.” I don’t think I’ve heard specifically of a garlic douche, but I have heard of vinegar.

            I only speak English fluently, but I have a geekness for idiom. 🙂

          • Amazed

            I cannot imagine it either way. Shower, glove, whatever – it’s putting something in a place it has no business being. Lunacy.

        • Meredith Watson

          Exactly, either way it shows a massive lack of knowledge doesn’t it? I’m not in medicine and I don’t read case studies, but it struck me as being a rather poor example of one anyway
          .

    • areawomanpdx

      To be clear, she never said it was a case study. It seems that the most likely circumstance was that someone emailed it to her and she posted in real time. I have no doubt that a baby died yesterday from this idiocy.

  • peanutmama

    i signed

  • Amy M

    Done

  • AlexisRT

    My suspicion (don’t shoot the messenger) is that she is going to claim that she was not the midwife, that she was not crowdsourcing, and that she was posting an old case as a “what would you have done” exercise.

    • Amy M

      Even if she claims she wasn’t the midwife, she can’t claim it was old, as she updated with info about the baby’s death a day after the original posting.

      • AlexisRT

        Sure she can. She can claim she was waiting for replies before posting the outcome.

        I’m not saying it’s true, but knowing enough about Jan, this is what I expect her to say. She’s unethical enough having posted it to begin with; do you expect she will take responsibility now?

        • Amy Tuteur, MD

          She can claim anything she wants, but who will believe her when the see the screenshots? I imagine legislators opposed to homebirth or extending scope of practice will love to see them.

          • Comrade X

            How must that make the poor mother feel? She loses her baby at the hands of this criminal nincompoop and then she has to watch said “midwife” shouting “IT WAS ALL PRETEND!! LOL!!

            And that’s YOU she’s talking about. Your case is pretend. Your pain is pretend. Your poor dead baby, whom YOU are going to have to bury and mourn and stay awake at night over with endless what-ifs is pretend.

            I think if I were the mother and I had seen that, I would want to disembowel her.

          • Oh god, I hadn’t even thought about that.

          • Meredith Watson

            Do you have plans to direct this information to anyone in particular? I hope you can.

    • clairelouise2

      this is exactly what has happened.

      • areawomanpdx

        please. we all know that is not what happened.

        • KarenJJ

          Looking at the facebook discussions today there are some fairly limp-wristed attempts at back-pedalling.

        • clairelouise2

          I didn’t say that that was actually what happened, but that is what Tritten is now claiming on her fb.

          • areawomanpdx

            ahh, my apologies to you!

    • Karen in SC

      And she claims to be an “editor.” ??? Very poor communication and writing skills if no one could figure out it was a case study.

  • no longer drinking the koolaid

    Done

  • Ceridwen

    Amy, so you have any insight into whether homebirth midwives are subject to HIPPA?

    • no longer drinking the koolaid

      All health care professionals are subject to HIPPA.

      • Ceridwen

        It’s not clear to me that they actually qualify as health care professionals though.

        • no longer drinking the koolaid

          If they are providing care (yes, I know, an arguable point) they are considered HCPs.

      • Staceyjw

        They aren’t considered HCPs, even when they provide maternity “care”, bill Mediciad, etc.
        It makes no sense.

      • An Actual Attorney

        We’ve been over this on another post, though I don’t remember which one. To be covered by HIPAA, one has to be a “covered entity” or work for a “covered entity.” A covered entity is defined as one that transmits insurance claims electronically. So, since most CPMs don’t deal with insurance or work for someone who does, they aren’t covered.

        And LMS, this is because the federal government can only regulate according to its specified powers, which in this case is the Commerce Clause, which gave Congress the power to regulate commerce that occurs between states. This is that limited government that you and your Faux News buddies claim to love so much.

        • onandoff

          This is confusing to me because I’m subject to HIPAA and my organization does not submit any claims to insurance or provide health care – we simply deal with medical records. But I’ve never looked at the law so maybe we just do it because we’re not assholes.

          • An Actual Attorney

            Forgot, transmit insurance or records. Sorry.. Typing sleepy.

          • Squillo

            http://www.hhs.gov/ocr/privacy/hipaa/understanding/summary/

            This summary might help clarify. I worked for a non-profit that connected people with free medical care. We were subject to HIPAA because we sent basic info on patient risk factors to our volunteer docs electronically.

        • LMS1953

          These days it appears the “federal government” does whatever BHO decides to blow out of his ass.

          • Trixie

            Your insights into obstetrics are quite interesting, but you really need to stop making every single thread about you and your xenophobic and racist political views.

          • Dr Kitty

            LMS, time and a place, dude, time and a place.

            You know that the majority of posters don’t agree with your politics, that this blog is generally apolitical and YOU STILL PULL THIS.

            You absolutely have the right to be a Libertarian-Truther-Birther-right wing cheerleader.

            But maybe keep it to yourself unless it is relevant to the point at hand?

            Your (generally good) signal is getting lost in the noise.

          • LMS1953

            You do realize that the only way to restrict CPM licensure is by political pressure, don’t you? Eight years of crucifying mothers on the caskets of their dead home birth babies hung over the Altar of Woo really hasn’t accomplished all that much. Meanwhile the crunchies are using Obamacare as an opportunity to get their Democrat representatives to sponsor laws to further their agenda. Cognitive dissonance is one thing. Stupidity is quite the other.

          • theNormalDistribution

            Harmful ideologies and stupid people can invade any political party. Republicans have teh bible and Democrats have woo. Tell me something I don’t know.

          • An excellent point. But political ideology isn’t what we’re here to discuss. We aren’t changing anything by dividing up by party lines. Why attempt to polarize a board we prize for being pretty damned nonpartisan? It is extremely rare to find such a diverse smorgasbord of educated professionals, engaging in open, fact – supported debate, about the very latest information about midwifery and obstetrical care in America (indeed, worldwide). It’s infuriating for many of us to have someone derailing the topic just to try and play Red vs. Blue.

            Instead of railing about the Obama administration, what about researching what states have bills coming up, and who is best to contact there? Practical, real things that people on this board can DO.

            tl;dr Take it back to GLP.

        • LMS1953

          Look, one of the potential reforms that you and your Libard buddies refuse to consider is the competition to allow medical insurance coverage ACROSS state lines. But I am sure there is someway for the Commerce Clause to regulate the INTRASTATE transmission of electronic claims.

          • LMS take your fucking politics out of here. Have you even noticed what a howl of anguish this baby’s death caused in our community? For once try to stifle your political agenda and quit this damn derailing. Nobody wants to hear your political pontifications right now.

          • Amy Tuteur, MD

            For you, LMS, and all the other self pitying conservative whiners.

            http://open.salon.com/blog/amytuteurmd/2009/03/26/conservative_republicanism_is_a_blight_on_this_nation

            It’s a little out of date, but I think you’ll get the point.

          • LMS1953

            Well, I guess since you wrote it, it must be correct. In a different forum I could easily disprove each and every one of your assertions. But you have so deeply fallen for the Liberal woo, it would be as much of a waste of my time as it would be for you to try to convince Ina Mae she was wrong. Please go to the MANA site and observe all the bills sponsored by Democrats to further the CPM agenda. I do not see a single one sponsored by a Republican.

          • MLE

            LMS: I am a conservative. There is a time and a place. On this post of all posts, quit being so tone deaf and save it for a blog with a different focus. It’s disrespectful.

          • anion

            I’m fairly conservative myself, and comments like the above make me cringe–especially in highly inappropriate situations like this. They’re why we sane and rational conservatives can’t have nice things.

          • The Bofa on the Sofa

            The prevention of selling medical insurance across state lines was in place long before Obama became president.

            And Bush was in office for 8 years, what did he do about it? Not a damn thing.

            Not selling insurance across state lines is not a liberal concept in the least.

          • Jessica S.

            No kidding!

          • The Bofa on the Sofa

            Actually, I just did some looking.

            In fact, states are perfectly able to allow out of state insurance companies in if they want. In fact, there are something like 5 states that allow interstate health insurance.

            You know what? It’s been a complete flop. It’s a logistical nightmare, and people reject the out of state companies. Moreover, not a single insurance company has been created to take advantage of that situation.

            Then again, for the most part, states DON’T participate in this type of activity, and I think for an important reason: the usual set up is that companies are not required to follow state regulations, but of those of the state in which the company resides. And this is the argument against it – insurance companies will just set up in the most favorable state, and can then usurp all the state regulations. Understandably, the states don’t want to be beholden to the insurance standards of another state – this is why they have their own.

            So what LMS wants, apparently, is for the federal government to force states to accept out of state insurance companies and the lowest standard of care.

            Amazing. When it comes to anything else, they are all “Small government!!!” When it comes to gay marriage, they are “state’s rights.” For healthcare? ACA = government takeover. So the alternative? Have the feds take over the states.

            Apparently, the problem with the ACA is that it doesn’t go near far enough in terms of government takeover. Funny, that’s what my liberal friends all say, too.

          • Jessica S.

            “Apparently, the problem with the ACA is that it doesn’t go near far enough in terms of government takeover. Funny, that’s what my liberal friends all say, too.”

            There’s the rub: when both sides of the political spectrum complain about the same problem (albeit, either unwittingly or for different reasons/motives), it is all but certain that no one is really getting what they want, what’s best for the citizenry or even getting what they’re being told they’re getting. The ACA doesn’t go as far as the right fears or the left hopes.

          • Certified Hamster Midwife

            I’m really glad that it looks like a typo meant you left out the “T” there.

        • LMS1953

          Why does this political baiting not bring forth howls of angst? The Faux News horseshit? Please note: restriction of CPM licensure will ONLY occur by political means. At this time there are several bills before the US Congress to advance CPM licensure – ALL SPONSORED by Democrats. At this time, the conservative backbone of America from Georgia to Alabama and Mississippi on to Oklahoma to Kansas to Nebraska and Iowa and on to South Dakota and North Dakota DO NOT license CPMs. The states that are most likely to support CPM licensure are most likely to spew Dr Amy’s anti-Conservative vitriol. I suggest y’all reconsider who your allies really are in restricting CPM licensure.

          • An Actual Attorney

            OK. What bills? Identify them so excited can oppose them.

        • auntbea

          For goodness’ sake. Don’t bait the man.

          • An Actual Attorney

            You are right.

    • In Utah they are not. I believe that it is a state-by-state decision, although the affordable care act may have changed that.

      • Squillo

        It’s a federal law. What matters is whether the provider is a covered entity or not. Many homebirth midwives don’t engage in the kinds of electronic communications that would make them subject to HIPAA.

    • LMS1953

      I was told on this blog in no uncertain terms that you only fall under HIPAA if you submit electronic claims. I still think that is a crock, but what do I know. Also, there was no specific identifying data that would make this a HIPAA case – different from the AOL CEO who complained about a couple of million dollar babies whose bills he got stuck with.

      • Guest

        No, the electronic transmission stuff is true in regards to health practitioners (from the HHS site http://www.hhs.gov/ocr/privacy/hipaa/understanding/coveredentities/). The reason for this is that HIPAA is a federal law and as such must be related to taxing, spending, or interstate commerce. The internet has been found in other cases to be a instrument of interstate commerce, so the use of electronic transmission is the interstate hook needed to fall under Congressional authority. It’s needlessly complex, but basically Congress generally can’t make laws unless it is about interstate commerce (which is very broadly defined since we include phones and internets and anything which has traveled in interstate commerce). The Supreme Court found that the ACA violated the commerce clause since it didn’t regulate interstate commerce, but was still allowable under Congressional taxing power. (I just got out of a 8 hour class so I hope that made sense)

    • An Actual Attorney

      Also HIPAA =/= obligations to protect medical privacy. That is a common law and, in many states, statutory obligation. That would depend on state law, but yes, most likely in most states, they are obligated under common law obligations to protect medical privacy.

  • Anj Fabian

    Signed.