Do we need to revisit the homebirth deaths at the hands of midwife Lisa Barrett?

Evil Concept

Over the years I have written many posts about Australian homebirth midwife Lisa Barrett, and the astounding number of deaths at her hands.

I was pleased to see that she was recently fined $20,000 and court costs and reprimanded in the strongest possible terms for her involvement in 4 preventable neonatal deaths.

Should that be the end of it? After reading the report from the Nursing & Midwifery Board of Australia v Barrett, I’m beginning to wonder if these deaths are worth a second look. While reviewing the 4 deaths previously investigated by the Coroner, the Board learned of ANOTHER death that occurred months after the release of the Coroner’s report. I had received information about YET ANOTHER death back in 2009, leading to an extraordinary total of 6 newborn deaths at Lisa Barrett’s hands.

Of these deaths, 1 was a shoulder dystocia, 2 were second twins, and 3 were breech babies. All of the situations were high risk, but even in high risk situations, most babies do fine. We already know that the deaths were preventable; that’s why Barrett has been disciplined. I’m beginning to question whether we need to investigate these deaths further to determine whether Barrett actually let these babies die. In other words, did Barrett fail to provide appropriate homebirth care and make only ineffectual attempts to save the dying babies.

Reading the timeline of the 6 deaths, as well as a near miss twin death described in the board report, and an extraordinarily story of twin birth that Barrett herself has bragged about (49 hours between the birth of the first and second twin), raises the possibility that these babies died not merely because they were born at home, but because of midwife neglect.

The shoulder dystocia death:

The medical expert opined that Barrett had not applied the appropriate maneuvers to deliver the baby:

Professor Pepperell is critical of the respondent’s attempts to extract the baby. The respondent described performing the McRoberts manoeuvre. Professor Pepperell in his evidence said that such a manoeuvre involves placing the mother on her back and lifting her thighs up to her chest so that the angle of entry in the pelvis is different and is bigger in the hope that by doing so the shoulders will then descend into the pelvis. Professor Pepperell when commenting upon the respondent’s evidence34 as to the manner in which she performed the manoeuvre stated that he did not believe that initial traction had been applied appropriately and that it did not appear that adequate suprapubic pressure was ever applied…

A friend of the mother eventually delivered the baby:

A friend of “S” present at the time was asked by the respondent to assist given it was an emergency. The friend was able to put her hand in to grab under the shoulder and was able to pull the baby out…

An experienced midwife was unable to deliver the baby, but a friend of the family simply reached in and dislodged the baby’s shoulder?

Negligent management of twins:

In the near miss twin case, the second twin was ultimately delivered by C-section 8 hours after the birth of the first twin.

As the Board notes:

To allow at least six hours without foetal monitoring of the second foetus after the birth of the first baby is just unbelievable.

In the story on Barrett’s blog, a healthy second twin was delivered 49 hours after the first twin.

Apparently Barrett’s approach to the second twin in these cases was to do absolutely nothing, including no monitoring to determine whether the second twin was in trouble requiring expedited delivery.

The breech deaths:

One breech baby died when Barrett inexplicably stopped checking his heart rate for 24 minutes prior to birth.

So in at least 4 of the 8 cases that I know about, Barrett provided either negligent care, ineffectual care or no care care at all in the midst of obstetric emergencies.

6 confirmed deaths and 1 near miss is an extraordinary amount of bad luck even for an incompetent midwife, and while there is copious evidence that Barrett was reckless there is no evidence that she is incompetent or unaware of the measures used to handle obstetric emergencies.

And these are only the cases that we know about. There could be more.

6 babies are dead and no amount of investigation will bring them back. Barrett has been disciplined under the assumption that her recklessness led to deaths that were unavoidable at home, though easily preventable in the hospital.

But were those deaths at home unavoidable? Or was Barrett’s unwillingness to provide appropriate homebirth care the real cause of at least some of the deaths?

  • TsuDhoNimh

    “An experienced midwife was unable to deliver the baby, but a friend of
    the family simply reached in and dislodged the baby’s shoulder?”

    Because hands in the vagina are a BAD THING. Good midwives never put hands in vaginas.

  • Danielle

    I tend to apply Occum’s Razer to questions like this. It would be extraordinary, but not impossible, that she’s actually trying to kill anyone or is in some way “getting off” on the experience. The simpler and more likely explanation would be that she has training, but has developed an idiosyncratic ideology about natural childbirth that makes her practices particularly dangerous. Perhaps that ideology includes a certain fatalism about baby death that allows her to move onto new cases without recognizing how shocking her previous ones were).

    Whatever it is going on, its clearly far beyond the pale.

  • Dr Kitty

    I humbly suggest a court-ordered psychiatric assessment the next time LB causes a death. Sadly, I think it is inevitable LB will kill again.
    There has been no evidence of remorse, no evidence she intends to change her practice, nothing to suggest she has learnt anything from these disasters.

    I think it is unfair to diagnose her over the internet with a mental illness or personality disorder, but I think that a mental health professional ought to be given the opportunity to assess her mental state if she continues to cause death and disability.

    “I don’t think I’m doing anything wrong” is not the best defence strategy, and her ongoing use of it needs some examination.

    One definition of madness is to keep doing the same thing over and over, expecting different results…

    • Anj Fabian

      Only ….
      LB doesn’t expect different results. She’s been present at deaths multiple times and appears to accept it as normal and natural, not something to be feared and avoided.

      It’s like a driver who keeps getting into accidents and thinks there’s nothing wrong with it. They can always get a new vehicle, so there’s no problem.

  • expat

    There are people who enjoy creating chaos. They are easily bored and enjoy the most dramatic moments in life. Death is a very dramatic moment. These people are called psychopaths. Given the behaviors described above and the training that was recieved early in her career, I don’t think it is too much of a stretch to speculate that Lisa Barrett knew the required lifesaving maneuvers but refrained from performing them. The grief and drama of a death was just too enjoyable for her to resist. Her ‘let nature take its course’ philosophies are just justifications for the real motivation – getting a kick out of drama and death.

  • Staceyjw

    She is a murderer, plain and simple. She just uses birth as the method, seeking out the highest risk moms to ensure she gets her death fix. There are likely so many more injuries, and probably another handful of kids with HIE. I wonder if she got kicks out of those too, or if they disappointed her for surviving?
    Sick.

    • yugaya

      Question: Is Oregon truly so much worse than any other state as it appears, or is it because they have mandatory reporting?

      edit: This comment should have went to your post below on Brenda Newport.

  • Staceyjw

    Deaths of 6 innocents by the grossest of wanton negligence is bad, but she isn’t even the worst of these killers. Brenda Newport of Ohio is on 8 deaths. One of which is Mary Beth, Bambis daughter. Another baby died in the exact same way later on, so its obvious she learnt nothing.
    She needs to be stopped. I’m sure she won’t be, until she dies. Hopefully that will be soon, before she kills any more babies.

  • Forgetful Guest

    The thing is, now that she’s “banned”, what are the consequences if she’s caught attending births anyway? Or maybe that’s just a question of “when”, not “if? She could still claim to be there as a friend or support person. The reprimand, I’m sure, will be like water off a duck’s back to her. Why would she care about something like that when she has shown such a callous attitude towards babies’ lives? And $20k isn’t a lot of money when you consider the damage she has done. In other words, I don’t think any of this will deter her from carrying on with her destructive work… it’s just not enough to have an impact on someone like her.

    I really do hope I’m wrong, but I think more babies will have to die (maybe not in SA, but somewhere in Australia or in the world) before someone really comes down hard on her and puts her in a position where she cannot do this anymore (i.e. puts her behind bars)… 🙁

    • Sue

      I suspect she would need to be criminally charged to be held accountable, as she is no longer a registered health care provider. There is also the offense of ”holding out” (holding yourself out as a registered health care provider).

      • MJ

        I read the ban as also applying to any birth related services so, hopefully, if she takes money for anything to do with a pregnant woman she might open herself up to charges.
        For me the main benefit to this ruling though is that it will be practically impossible for her to suck in the well meaning but unwary NCB parents. The only people who are going to hire her are the ones who truly don’t seem to care about the risks – and that’s a whole other battle.

        But yeah, absolutely nothing to stop her setting up shop in a U.S. CPM state.

    • Playing Possum

      From the findings:

      ‘It also includes working in a direct non clinical relationship with clients or others, working in management, administration, education, research, advisory, regulatory or policy development roles, and any other roles that impacts on safe, effective delivery of services in the profession and/or use of their professional skills.’

      I read that as not being allowed to do ANY kind of birth related education, admin, representation, conference gigs, celebrity appearances etc. At least in Aus. I knew that national board was going to be good for SOMETHING!!! I think any of those things opens her up for potentially being criminally charged for impersonating a midwife.

  • Comrade X

    Are we suggesting what I think we’re suggesting here? Because I’ve got a cold knot in my stomach now, and I feel sick.

    • yugaya

      That she as a lay midwife guru/psychopath gets off on watching babies die and get hurt so much that she still does nothing even when untrained someone who gets the human impulse to stop the horror jumps and yanks the baby out of momma? Yes I think that too.

      • Christina Maxwell

        Yes, I think that too. After all there is the idea that for some people (very few, luckily) the power of life and death is the ultimate kick. I feel sick too.

  • Aussiedoc

    Lisa Barrett was trained in the Uk as a midwife and before she went rogue worked as a maternity unit manager in a hospital in south Australia. In other words she had to be a competent midwife ( and anecdotally was). So she DOES have at least some idea or should about shoulder dystocia, time between twins etc,

    My mates in south Australia who’ve been on the end of many of her disasters (because there’s a nasty morbidity load here too that isn’t being counted in the numbers) can’t figure her out.(you know when they get past the rage).

    • Mer

      This is the part that scares me about her. She was trained and apparently competent, yet she goes and practices home birth as as if she knows none of that. Which means she’s either lost the knowledge completely (not likely) or is purposefully ignoring what she knows.

    • she had to be a competent midwife

      I’d be very surprised if she just became incompetent and reckless overnight.
      I just finished a book about the Dr Jayant Patel case and there was a clear pattern of escalation in his behaviour.
      I suspect there would be something similar with LB.

      • KarenJJ

        I’ve always been astounded by how she let a shoulder dystocia go for 20 minutes complaining of “hand cramps” so that the student midwife had to take over and deliver the baby. The student midwife sounded traumatised after that. So strange for an experienced midwife to have done that.

        • Sue

          I’ve always wondered whether those ”hand cramps” were actually carpo-pedal spasm from hyperventilation (over-breathing from anxiety). There’s a good chance she became de-skilled by infrequency of practice, lack of oversight and lack of a regulatory structure.

          (Ironically, the hand spasms from hyperventilation are known as ”main d-acoucheur” – obstetrician’s hands.)

        • expat

          Given the theory about psychopathy, she could’ve gotten hand cramps from preventing the baby’s birth.

      • Comrade X

        Is there any way we can access professional records of her time practicing legitimately in the UK?

  • This is going to sound awful – but there is less liability associated with a dead baby than a permanently disabled one. Perhaps she assessed that the parents would be far less able to sue as the damages associated with dead babies would likely make the case unattractive to most lawyers who work contingency.

    • Trulyunbelievable2020

      Do you really think she has any substantial assets to go after in the first place?

      • Ainsley Nicholson

        Probably not, but no one wants to lose everything they have and be massively in debt for the rest of their life, no matter how little they have.

        • Trulyunbelievable2020

          The point is that it doesn’t matter if it’s a $500K death suit or a $5 million damage suit. She doesn’t have that kind of scratch in her dreads.

    • fiftyfifty1

      Or maybe she just likes it when they die.

    • guest

      I agree, she was relying on the stillbirth defence to escape any scrutiny at all.

  • Lisa from NY

    OT: Dr. Wu claims none of her patients had a single miscarriage or down syndrome baby. Is this true? Is she another Dr. Spears?

    http://www.amazon.com/Fertility-Wisdom-Traditional-Medicine-Infertility/dp/1594861374/ref=cm_cr_pr_product_top

    • Young CC Prof

      Depending on the number of patients she’s seen and their ages, the latter is possible. The former is obviously impossible.

    • Dr Kitty

      How many patients has she had?
      Who dies she count as a patient?
      How hard does she follow up people who cancel subsequent appointments?

      I made an appointment with an OB before I chose to go with an OB who was a family friend and who would see me privately for free.
      After I cancelled, the first OB phoned me, to find out if I needed support for a miscarriage (really, she was very sweet).

      If Dr Wu doesn’t chase her no-shows or cancelled appointments too hard, I imagine she can say whatever she wants.

      • Lisa from NY

        Thanks so much. My crunchy friend tells me that I am not balancing my yin and yan properly like Dr. Wu says, and ice cream is birth control.

        • Young CC Prof

          Actually, I read one study that showed that one daily serving of full-fat dairy products like ice cream or whole milk can actually boost fertility.

          Also, ice cream tastes good, and yin and yang are interesting philosophically, but as a nutritional system they’re full of crap.

        • LibrarianSarah

          Ice cream is birth control? No wonder I can’t have kids.

          I REGRET NOTHINGGGGGG!!!

          • Sue

            Doesn’t it depend on where one inserts the ice-cream?

        • Dr Kitty

          I suspect ice cream is only a contraceptive if you use it in ways that would shock Ben and Jerry.

    • Guestll

      As a former long-time fertility patient, Dr. Wu and her ilk make me rage. Snake oil to the vulnerable, lies, omissions, more lies. None of her patients had a single miscarriage? How many patients has she had, 2? Or were they all just 25 year olds with perfect uteri and juicy ovaries? And even then, there were only 5 of them? Never a baby with T21? Did all of her patients opt to terminate? Does Dr. Wu have some magic for getting meiotic spindles to line up that she’d like to share with the rest of the world?

      Asshole of the first order, shilling shit to desperate women.

      • Houston Mom

        When we were undergoing treatment for infertility, my husband and I went to see a Chinese herbalist at the insistence of a Vietnamese girlfriend whose whole family used only TCM. We told the lady our problem (azoospermia due to mumps) and she told us to see a urologist. I was surprised by her honesty.

    • Sue

      Did you mean Dr Woo?

  • Alannah

    You’re right dr Amy, the numbers don’t add up. She’s not just unlucky or incompetent, she’s a serial killer.
    To take this to a whole new level of disgusting, let’s not forget that Lisa is very popular in the midwifery lecture circuit. Hardly a midwife conference without her name on the lineup.
    It would be the equivalent of doctors celebrating and honoring Harold Shipman.

    • Dr Kitty

      “Some elderly people just aren’t meant to live”
      “Giving a massive dose of IV morphine to someone who has left you money in their will is just a variation of the normal palliative care pathway”

      Said no Dr, ever, about Shipman.

      We have one sociopathic serial killer and the entire profession now has re-validation, appraisal, multidisciplinary feedback and much more stringent oversight as a result, because we know safeguards need to be put in place to stop it EVER happening again.

  • MrG

    I think she is just a bad midwife with all the breech deaths.
    Oh wait. Didn’t MANA just publish a paper with huge breech deaths numbers? Maybe the MANA midwives are bad too? Just sayin’

  • She is just totally indifferent to other people. WTF.

  • Guesteleh

    Do you think this is Munchausens by midwife? Or maybe a serial killer thing? It’s just so crazy and disgusting.

    • Christina Maxwell

      She’s a pure psychopath, I have no doubt of that. She also seems to have that mysterious charisma thing going on which makes her doubly dangerous.

  • Zornorph

    I hope this woman is hit by a bus, tonight. And suffers to death.

    • yugaya

      Tonight is too late too little.

    • Trixie

      Honestly being hit by a bus would inflict a lot less suffering on her than she inflicted on even one baby.

      • Amazed

        But also a lot less suffering on the next high-risk baby of the next idiot who decides to hire her because she’s so into nature and so persecuted.

  • guest

    So what happens now? Does she really stop providing midwifery services, as ordered? Does she somehow manage it on the sly? Does she move to another country? Does she change her name? Does she become a midwifery hero/martyr blogger, like that lady in Canada?

    • areawomanpdx

      She moves to the states and starts delivering babies in Oregon, Hawaii, Utah, or Michigan…

      • Amazed

        She consults Karen Carr and Christy Collins via Skype as to which state to move.

        • yugaya

          She gets appointed as Midwifery Today expert consultant.

          • Sue

            And crowd-sources her next shoulder dystocia.

          • yugaya

            Jan Tritten gets her to do a double blind study on the evidence-based natural child birth approach to shoulder dystocia (given the amount of life threatening woo on Midwifery Today, I would not be surprised to find that they have already published an article or two by Lisa Burnett).

    • guest

      As a direct result of killer Lisa, legislation has been introduced in South Australia making it illegal for any unregistered person to provide midwifery care.

  • How her conduct is anything other than criminal is beyond me. The whole report just made me feel sick to my stomach.

  • quark

    This woman needs to be in jail.

  • PrimaryCareDoc

    There was a lot of sickening stuff in that report, but the thing that really got me was how the mother who lost her breech baby still was so supportive of LB and would not have changed a think. It’s like Stockholm Syndrome.

    • Unfortunately, some are in fear and choose to maintain a public facade. If they speak up, they will be shunned and mistreated, they’ll lose friends, and lose their support. I’ve learned that this is the case a lot of the time. It’s fear. They see how other parents are treated and can’t put themselves there. I understand.

  • Mel

    Way back in the early 80’s when I was born, my twin sister and I were born precipitously at 29 weeks gestation. My sister was born 3 minutes after I was after the doctor performed what sounds like an external version since my twin was transverse after I slipped out and there were no open operating rooms of any kind. Most twins that I know or know of are born between 1 – 10 minutes apart with an occasional outlier up to 20 minutes.

    Most OBs are concerned about placental problems during delivery since twins can have all sorts of weird / freaky placental connections. To wait around in the absence of any sort of CFM and hope everything works out is psychotic.

  • The Quiet One

    Here’s another midwife playing the homebirth version of the dead baby card..if you succumb to the evil pitocin then your grandchild will not be born without medical inventervention. Ugh.

    http://www.mothering.com/community/t/1398557/met-midwife-last-night-had-interesting-info-about-pitocin#post_17588671

    • Staceyjw

      what she forgot to say was- at least you get to have the grandkid, instead of a dead kid that will never be able to have a baby.

    • Elaine

      That one irritated me. And it’s in a due date club, which is closed posting, so I couldn’t step in to tell them off. At least someone downthread pointed out that maybe the issue is that mom and daughter both have some tendency to need pitocin, rather than pitocin creating the problem.

      For the record, my mom had pitocin in labor with me (1st child) and I was nowhere close to needing it in the births of either of my kids. Of course, I ended up getting it during 3rd stage with my son to head off excess bleeding. So clearly I am totally broken because my mom got pitocin with me, and it would have been better if I’d ended up having a PPH. *eyeroll*

      (actually, that one puts me in mind of the recent c/s discussion. I don’t know that I NEEDED that Pit in 3rd stage. I might have been fine without it–or it could have totally sucked. I’m fine with the fact that I will never 100% know the answer to that question, and that I am alive and healthy to not-know.)

      • Young CC Prof

        “I might have been fine without it–or it could have totally sucked. I’m
        fine with the fact that I will never 100% know the answer to that
        question,”

        This exactly. When an intervention has few risks, like a little pitocin in the third stage, or, for that matter, the Vitamin K shot, it winds up getting used on a lot of people who maybe or even probably would be fine without it. We don’t have any idea which mothers picking their kids up from nursery school right now would have died without it. We don’t know which would have survived with terrible blood loss and required months of recovery, interfering with their ability to parent during the precious newborn period.

        I think just about all of them are glad they didn’t find out.

  • LMS1953

    http://data.worldbank.org/indicator/SH.DYN.NMRT

    The newborn death rate in Australia is 3 per thousand. Presumably, this is crude overall data, not vetted for risk, demographics nor gestational age at birth. LB would have needed to have performed 2,000 deliveries for her 6 newborn deaths to have been average. Let’s say she has done 50 per year for the past 10 years. That would be 12 deaths per thousand – in the typical 4 fold increase range. More likely, she attended to 25 home births per year – which would make her TWICE as dangerous as the typical CPM.

  • fiftyfifty1

    Sickening. Every single one of these babies would have lived in the hospital. It really is time to start asking whether this is intentional. Is she intentionally acting in such a way to make these babies die?

    • Anj Fabian

      The shoulder dystocia is mystifying. Since LB was trained and educated as a conventional midwife and worked for a time in a hospital in Australia as a midwife, it is reasonable to assume that she was trained how to resolve SD using McRoberts at a minimum. Woodscrew and reverse Woodscrew maneuvers should also have been familiar to her.

      McRoberts seems simple enough that even lay people could be trained to perform it.

      LB didn’t even perform McRoberts competently and a presumed lay person was desperate enough to put her hand into the mother’s pelvis in an attempt to free the baby.

      W!T!F?

      What is the point of having LB at that birth? To watch? To watch a baby die?

      • Anj Fabian

        I chose the shoulder dystocia case because there was a very obvious crisis. It wasn’t a matter of inadequate monitoring, of not knowing.

        LB should have had the skills to resolve the problem, but was either incompetent or unwilling.

        Another person, of unknown competency, attempted to resolve the situation and managed to do so.

        • RebeccainCanada

          But what made LB speshhh-url was that it was her signature method not to touch the baby at all. It’s been disseminated far and wide. I’ve heard mothers using her info about not touching the baby to scare mothers with breech babies, why they should avoid the hospital, because they are going to touch that baby.

          • attitude devant

            very interesting. That would explain a lot. What I wonder is just how out of touch with reality you’d have to be to hire her to attend your birth

          • Anj Fabian

            Apparently she is incredibly charismatic in person. A real saleswoman.

          • The Bofa on the Sofa

            Apparently she is incredibly charismatic in person. A real saleswoman.

            I’ve noted before that, pretty much by definition, every successful snake oil salesman has been very charismatic and personable. A unlikable used-car salesman is not going to be able to sell very many lemons.

            You see the same thing with chiropractors. They are great at PR and marketing. That’s because those who aren’t can’t survive.

          • I’ve heard this second hand as well.

          • Ainsley Nicholson

            Narcissistic sociopaths often are very charismatic.

          • RebainCan

            They scare these women, into being so afraid that the hospital is going to hurt them, they feel the only person with special knowledge winds up being the m/w.

            LB is a narcissist she wanted a name for herself, like Gaskin, I think they should consider the don’t-touch-the-entrapped-breech-baby-manoeuvre the Barette Killer Manoeuvre. She is so narcissistic she didn’t believe it when her manoeuvre didn’t work the first time it didn’t, that she kept experimenting and believing it would. What kind of midwife would she be if she just blew all her rhetoric out the window and tried to save the baby?

          • attitude devant

            The whole witch doctor dress/hair thing is arresting. We tried to discuss this once before, and people jumped down my throat for criticizing her look, as if the way she chooses to present herself (dreads, scarves, weird makeup) were irrelevant. I think she’s deliberately communicating her stance with her look—that she sees herself literally as a shaman, dealing with life and death, an intermediary for forces beyond our ken. If THAT doesn’t scare off parents I guess nothing will.

          • Anj Fabian

            She’s advertising her unconventional, non mainstream status.

            It will resonate with the people who are attracted to those ideas.

          • R T

            Exactly, it’s less complex than attitude deviant’s theory. She makes herself look unconventional and unconventional people feel more comfortable around her. For example, I have many tattoos and the perinatologist who did my emergency csection and cared for me, during my hospitalization, when my doctor was off is covered with tattoos. He also has a facial piercing. He removes the piercing at work, but I saw him out in town with it in. I felt even more comfortable around him and the other perinatologist in the group because I knew they obviously weren’t judging me for having tattoos since they were willing to partner with him! Now, I didn’t know he existed when I picked my perinatologist, but it was comforting the first time my husband and I met him. My husband’s entire body is tattooed other than his neck, face, hands and feet. We all shared stories about our tattoos and it was an nice ice breaker. I’m sure women who have an unconventional lifestyle feel more comfortable around Lisa partly because of her “look”.

          • Amy M

            I can’t wrap my head around this at all. A woman would have to really embrace the “sometimes babies just die” to accept LB continuing to practice, and even thinking of hiring her. They would have to believe that a baby being born should never be touched and that a woman in labor should be minimally disturbed. In that case, why hire a midwife at all? Why not just UC?

            I would imagine that anyone way off in NCB-la-la land who isn’t willing to UC wants someone there to intervene in case something goes wrong. If they just want support, why not hire a doula? Less expensive, and no pesky medical training. So why hire someone who won’t help? And what is the point of LB if she does nothing? Evidently, she’s quite the brilliant scam artist if she’s convinced multiple women that they should pay her a few grand to sit around and watch them give birth, regardless of the outcome. This makes no sense to me at all, unless the women in question really thought she’d do something to help them, and when push came to shove (ha!), her true colors came out?

          • Anj Fabian

            I think this is where the emotional manipulation discussion comes in.

            LB likely convinces the couple that they couldn’t possibly do this without her, that her support is utterly essential to their success. It’s a subtle game of planting anxiety and encouraging insecurity while promoting yourself as the solution to dealing with those problems.

            Why go into a cookie cutter hospital with those callous, by the numbers OBs and midwives? They don’t understand you like _I_ do! They won’t be able to give you what _I_ can! Once you walk through those doors, everything we have worked for will be lost!

          • expat

            She had dreadlocks, so she must be cool and in touch with magic and nature, duh.

          • Anj Fabian

            So she sells the whole “Do not disturb a laboring mother because zomg! you will ruin the labor, the birth and the bonding experience!”.

            Is that it?

            It sounds good – if you are utterly convinced that nothing ever goes wrong if you trust birth enough.

            Which leads to the troubling paradox that LB has seen enough babies die, that she KNOWS that birth does go wrong. And yet, she is uninterested in intervening even when the baby’s life is literally at stake – and she knows it.

          • Anj Fabian

            I dislike speculating, but one of the reasons that the deaths may not be worrisome to LB is that the only thing that could be more impressive than pulling off a high stakes birth (Victory! Stick it to the man!) is having a loss family be so loyal to you, that even losing their own child can’t break their bond with you.

            Baby lives, LB wins. Baby dies and the parents can be successfully kept as loyal defenders (LB empowered us to do what no one else would!) – LB still wins.

      • LMS1953

        How come the Gaskin maneuver from Saint Ina Mae is so rarely mentioned? I think it has something to do with putting the “client” into knee-chest position, but I have never seen it done. That position would seem to preclude the McRoberts Maneuver of known efficacy. Does anyone know if the Gaskin maneuver is “evidence based”?

        • Anj Fabian

          It has been shown to help resolve some cases of SD, but it isn’t as reliable as McRoberts – and since can involve significant position changes, it is more time consuming.

          OTOH, since McRoberts requires two people – something that only requires one person might sound better…

        • Young CC Prof

          I saw one paper (by an actual expert) that stated that getting the patient on to hands and knees probably had about the same effect as the McRoberts maneuver, but tended to take longer, and it’s sometimes difficult to get an exhausted laboring woman into that position at all.

          So, it’s a whole lot better than standing there watching a baby die, but not as good as what a hospital team can do.

    • RebeccainCanada

      LB “teaches” to never touch the breech baby. It’s because she believes all will be well if you just let the child come forth itself. She believes if you touch them, they will startle and lift their arms up towards their face. So that’s the reason she wouldn’t do vitals for 24 min on a breech baby being born. She’s a nutter! But this is her trademark woo. Same with the twins, her trademark woo, is what she uses to fish-in unsuspecting mothers.

      • Young CC Prof

        I’ve heard “hands off the breech” from actual real sources, but as I understand it that refers to not pulling on the baby until most of the body is out. It doesn’t mean literally don’t touch even to check for a heartbeat, and it doesn’t mean sit there and do nothing when it seems you’ve got a trapped head.

        Nothing like reading medical books you don’t understand, taking one line completely out of context, deliberately ignoring the rest of the book because it doesn’t agree with your birth-goddess religion, and then going off to use it as actual practice.

        • RebainCan

          I agree, from her blog: (her understanding)
          http://www.homebirth.net.au/2011/03/mechanism-of-breech.html

          • Young CC Prof

            Oh, my god, that baby is so blue in every birth-process picture. (yes, red in the LAST picture, luckily.) And of course it’s an incomplete breech rather than a frank breech, because, hey, if you’re going to go stupid, you might as well go stupid all the way. Just how long did the birth take, and how long did it take for the baby to breathe and pink up afterwards?

            Most of all, why the heck was someone standing there snapping pictures of this train wreck instead of DOing something?

          • Aki Hinata

            And for all the hands-off talk, their are hands _on_ that baby from about halfway through the pictures!

        • Sue

          Her approach seems to be to admire the beautiful design of how breech babies can get themselves out by rotating and flexing. Yep – very nice when it works. But what, then, do they need a MW for?

          • The Bofa on the Sofa

            Her approach seems to be to admire the beautiful design of how breech babies can get themselves out by rotating and flexing. Yep – very nice when it works. But what, then, do they need a MW for?

            There were three kids where I grew up that were out in the car, and there was a place where the road came to a T, and running parallel to the crossbar of the T, there was a ditch before there was an empty field.

            Well, being young, they thought it would be cool to “jump” the ditch, so they came racing up the road to the T, hit the edge and BOOM! over the ditch they went!

            That was really awesome. It was so much fun that they did it again.

            The short answer is, the reason I know the story is because this is what we learned from the one who survived the second attempt.

            Oh sure, it was fun when it worked. But when it didn’t? It was deadly.

            (the three guys were, when they were little, on the Little League team I coached)

            Yep, there’s a thrill in a reckless activity. But there’s also danger. Thrill seekers will take that risk (as Crush says in Nemo…”You’ve got some major thrill issues, dude!”). The problem with LB is that the “risk” is with a baby’s life.

      • NO midwife should be attempting breech or twin deliveries at home. It’s not illegal, IMO, in AUstralia, AFAIK, but it certainly is ethically criminal for a midwife to accept such a case.

        • Young CC Prof

          With Barrett, I’m sure the issue is accepting deliberate breech births out of arrogance, but I wonder how many breech homebirths are inadvertent. In the MANA paper, I wonder how many of the breech births were a surprise, and how many of the mothers transferred immediately once the midwife realized what they were up against. (About half the mothers transferred, most of them early enough that they wound up with a c-section.)

          Doesn’t matter, except that it might make planned breech homebirths look even worse than they already do.

        • MJ

          My lay person’s understanding is that it goes against practice guidelines and that all midwives whether practising in a hospital or independently are required to at least consult, if not transfer care, for breech or twins. I think if she hadn’t already relinquished her licence it’s the kind of thing you could be deregistered for (but, as I said, layperson’s knowledge).

    • SarahSD

      It’s really shocking and terrible. What would L Barrett’s own death rate at homebirth be? I’m sure much much higher than the MANA study. Dr. Amy is suggesting that some or all of these babies might even have lived at home with a competent midwife.

      • PrimaryCareDoc

        Well, if she attended 30 a year, which is probably more than she did, but let’s be generous. The deaths span 5 years- 2007-2012.

        So that’s 6/150- a 4% death rate. Which is unbelievable.

        • LMS1953

          4.4/1000 = 0.4% so LB at 4% is 10 times worse than the unvented US rate and at least 2 times worse than her CPM sorority.

          • PrimaryCareDoc

            D’oh! Thanks for the math check!

    • Mel

      My take is that she has such an overwhelming sense of her own power and a huge dose of hubris that she really thinks that she is capable of delivering any baby safely and since she’s incapable of error any baby that dies obviously was not meant to live.

      I don’t have words to describe how horrifying f#@%ed up she is….

      • Ash

        I think some HB midwives think of themselves as “priestesses” of birth. They think that pregnancy and birth is a divine gift, and fate decides who lives or dies. Their role is to witness and any adverse outcome is a representation of birth’s power over women.

  • Box of Salt

    OT: Orac’s post on the Grounded Parents’ (as he puts it) “kertuffle” is up. I am going to go read it now.

    http://scienceblogs.com/insolence/2014/03/13/neonatal-death-rates-after-home-births-and-a-strange-skeptic-kerfuffle/

    • Amy Tuteur, MD

      It’s a long song and dance, but the bottom line is that on all substantive points but one, Gorski agrees with me.

      Regarding my stint on SBM, I’ve kept silent all these years because Gorski has basically kept silent. He may think and he may say that I left SBM because of the moderation policy, but that was not my real reason.

      • RebainCan

        FWIW, he came off like a very smug jerk. Ultimately he agreed with you.

        • The Bofa on the Sofa

          Basically, the GP group ran to Daddy to for help, and he, well, acted like Daddy.

          • Amazed

            I’ve tried this with Daddy when I was a little girl. Alas, Daddy Amazed was not as trusting or devoted as Daddy Gorski. He investigated my complaints and each time he found I had been acting like a jerk, he refused to engage. Worse, he later scolded and disciplined me.

            So much for paternal love…

      • Trixie

        The post sort of comes off as “Dr. Amy was meeeeen to my fweeeeeind.” But yeah, on the actual numbers, he agrees with you. He seems not to believe that they were moderating and deleting your comments. And he took your “Can Women Be Skeptics” post completely out of context. Of course women can be skeptics.

        • yugaya

          “Dr. Amy was meeeeen to my fweeeeeind.”

          She’s meeen like that to everyone, and for a reason. You don’t tackle and deconstruct an entire industry of lies and get to play nice.People should get over themselves and look at what she is saying, not how.

    • LibrarianSarah

      Sigh… I really wish he didn’t get involved. This whole thing should have ended weeks ago and it should remain between Jamie and Amy. It doesn’t make anyone look good if you have to start bringing in a bunch of third parties. Especially ones that are not well versed on the subject.

      • Anj Fabian

        If Orac was honest, he would have concluded that the study had multiple flaws and could not be considered conclusive – BUT – that the results were troubling.

        This is the kind of study that raises more questions than it answers. It doesn’t answer any questions definitively due to poor design (self selection bias, incomplete data) but it highlights issues that deserve more study.

        The conclusion should be:
        This study highlights problems that deserve more attention and better research. MANA should create a new study that eliminates or minimizes the flaws found in this particular study.

        • LibrarianSarah

          It’s hardly surprising that the “study” is shit. Everyone who is familiar with the American homebirth knew that the “study” was going to be shit. It was designed to be shit. The surveys that our library does every few years are better designed and we don’t use those to make any life or death decisions.

          It’s not even a real study. It is an optional, anonymous, self-disclosed, survey. The midwives taking the survey had no incentive to be honest and every reason to lie about their death rates and MANA had no incentive to be honest and every reason to lie when reporting the results. And what do you get when that happens? Absolute shit.

          • Anj Fabian

            I forgot the other flaw:
            Data is not independently verified

        • fiftyfifty1

          “This is the kind of study that raises more questions than it answers. It doesn’t answer any questions definitively due to poor design (self selection bias, incomplete data) but it highlights issues that deserve more study.”

          I couldn’t disagree more. The MANA numbers leave no doubt that homebirth kills babies. The numbers are strongly statistically significant as well as clinically significant and are robust across multiple subgroups (breech, twins, VBAC, low risk vertex). The only question it raises is “The numbers are *at best* terrible. How much worse might they actually be?”

          • Anj Fabian

            If we had the full data from all the midwife attended homebirths – what secrets might be revealed!
            Show us the data!

          • fiftyfifty1

            Luckily we do have the full data from all the midwife attended homebirths in Oregon: Death rate 6-8X baseline.

            I sure wish all states required full data!

          • Young CC Prof

            Didn’t that requirement come out of the Abel Adams affair (and lawsuit)?

            But even in Oregon we don’t have full data, only neonatal and intrapartum deaths. Something very important has been lost in the wrangling over the death rate and absolute vs relative risk and whether an excess death rate of 0.1% or so really matter: There are bad outcomes other than death.

            The other bad outcomes haven’t made a single headline, but they might actually do a better job of dissuading home birth mothers. A 15% chance of hemorrhage! 5% chance of severe hemorrhage! Those are not risks small enough to shrug off. The risk of severe perineal tears in the MANA study seemed to be similar to hospital birth, but of course it was the midwives themselves grading the tears. If even a handful of women had severe tears that initially went undiagnosed, the consequences could be lifelong.

            And the birth injuries, oh heavens. No one is tracking those. How could we even begin to do so, when it sometimes takes years to fully evaluate those injuries? Hypoxia. Bell’s Palsy from shoulder dystocia. Hip injuries from breech births. Lasting lung problems due to poor initial treatment of meconium aspiration.

            Apgar is one marker for potential hypoxic brain injury, but in the MANA study, 2.4% of babies had no Apgar reported. Repeat, in almost one case out of 40, apparently no one bothered to take the simplest measure of newborn health. Another 100 babies had a low Apgar and weren’t transported to the hospital. “Breathing now, good enough,” eh?

      • Young CC Prof

        I am just so freaking tired of the arguments. And I’m REALLY tired of seeing the conclusions of the MANA paper cited by people unable to comprehend that they are a lie that has nothing to do with the data in the paper.

        At this point, I kind of feel the same way about home birth as I do about letting your infant sleep in your bed. If you understand the risk and feel the need to do it anyway, fine. Although it’s impossible to eliminate the extra risk, there are ways to reduce it, and people should know what they are. (Of course, most parents who co-sleep are doing it out of desperate exhaustion. Equally good reasons to home-birth are considerably less common.)

        My anger is reserved for people who go around literally or figuratively selling the idea that there is NO extra risk, or that home birth is actually safer for those elusive low-risk women, or that the extra risk is comparable to the genuinely miniscule risk of driving to the grocery store.

        • auntbea

          I am angry at people who get angry at us for getting angry about this.

          • LibrarianSarah

            I’m angry at numbers. There’s like …too many of them.

          • auntbea

            It’s like they’re infinite, or something.

    • PrimaryCareDoc

      I’m disappointed in Orac. I’m usually a big fan of his.

      • auntbea

        What he is not getting is that, while Jamie is correct in many of her points — such as that the comparison group is not a good one — the conclusion she draws — that Dr. Amy is intentionally overstating the risk — does not follow AT ALL. Orac, like others, is focusing on the validity of her minor points and not on her conclusion.

        • fiftyfifty1

          “What he is not getting is that, while Jamie is correct in many of her points — such as that the comparison group is not a good one ”

          This is a point that he and Jamie agree on, but with which I disagree. The CDC Wonder database is an excellent comparison group. It’s the best comparison group we are ever going to get in real life. It’s HUGE, it’s virtually complete, it’s reliable, it’s a population not a sample of a population (so no sampling error). The only downside to using the CDC Wonder numbers is that *in every way* they favor the homebirth group. The mothers in the MANA study were lower risk in every way: richer, more educated, whiter, thinner, less likely to smoke, drink, use drugs, be teenagers, be nullips, have malpositioned babies or a prior c-section. MANA basically starts off with a Dream Team in terms of the health of its mothers. But in the end MANA gets trounced by the hospital team.

          • auntbea

            Right. It is not a good comparison group, because it strongly advantages MANA. Therefore I support the claim that the comparison is not great, and refute the conclusion that this means Dr. Amy is overstating the risks of homebirth.

          • fiftyfifty1

            Sorry, auntbea! Total reading comp fail on my part.