Homebirth midwives and the art of emotional manipulation

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I have not forgotten about Gavin Michael and our efforts to hold midwives Christy Collins and Jan Tritten accountable for the preventable tragedy of his death. I have been in correspondence with his parents and they are currently determining how best to proceed. It may take some time, especially since they are still reeling from the loss of their baby.

Gavin Michael’s story is in many ways all too familiar to those of us struggling to educate the public about the increased risk of death at homebirth. A mother choose homebirth because she thinks she is making a safe and loving choice for her baby. Other medical professionals point out the risks, but the mother does not take them seriously. Family and friends express their worry and concern, but the mother assures them that she knows what she is doing. The situation grows steadily worse, either because a pregnancy complication is being neglected, or because a stalled or ineffective labor is being ignored. Ultimately the baby is injured or dies, even though this is the last thing that the mother imagined or wanted to happen.

The death of baby Gavin is chilling in a myriad of ways, especially because his struggle to survive played out in real time on Facebook. One aspect that I find particularly chilling is illustrated by this quote from Christy Collins apparently written in response to Gavin’s death.

Instead of … telling you to “be prepared that the perinatologist doing the NST is likely to tell you that your baby could die if he doesn’t come out;” those should have been MY words.

It’s chilling because in one sentence Collins captures the emotional dependency that she and other homebirth midwives strive to induce in their clients. Collins deliberately cut Gavin’s mother off from any medical personnel who might have helped her or Gavin by inducing such profound distrust that even if a doctor looked Gavin’s mother in the eye and told her that her baby was in imminent danger of death, she had been carefully coached in advance to reject medical advise that was both excellent and true.

I have written in the past that homebirth advocacy bears many of the hallmarks of a cult. It creates almost religious devotion to the philosophy of homebirth, places birth at the level of a deity by constant reminders to “trust birth” and demands sacrifice from acolytes, in both pain and potential injury to the baby. The most cult like aspect, however, is the emotional dependence that homebirth midwives strive to induce in their clients.

It’s no secret that 100% of the income of homebirth midwives comes from homebirth. But the economic motivation is only one factor in the determination of untrained lay people to masquerade as “midwives” even though they cannot be bothered to get a real midwifery degree. Providing medical care is not the goal for a homebirth midwife; gaining emotional power over and adulation from clients is an equally powerful goal.

The blueprint of midwife manipulation appears to be this:

To maintain your power you must always be needed and wanted. Make women depend on you and only you. To do that, you must convince the client that medical professionals are ignorant and only want to hurt her and her baby. You must explain ahead of time exactly the medical advice that these professionals will give so she will be prepared to ignore it. You must also work assiduously to isolate the client from her family and friends, emphasizing that their apparent concern is just a reflection that they are not as “educated” as she is. Makes her self-esteem utterly dependent on your approval, for the moment she trusts someone other than you, your power over her is ended.

Consider this explanation of emotional dependence and how to create it*:

Inducing Emotional Dependence

People become emotionally “hooked” on those persons who can truly satisfy their never-ending need for human understanding. The key … is to first get that person to become emotionally dependent on you… As you learn to satisfy a person’s deep-rooted emotional need for understanding, you will in time find them becoming emotionally dependent on you.

  • Be There (In Person)!
  • Listen Reflectively
  • Avoid Being Critical
  • Express Genuine Admiration And Praise
  • Supply Sympathy

It sounds like a primer for homebirth midwives, doesn’t it? Hence the hour long appointments for prenatal visits, the careful nurturing of the “friendship” between midwife and client, and the endless infantilizing praise — You are so educated! You are powerful, mama! You are a birth warrior goddess!

It’s all carefully constructed (though not necessarily consciously) to make the mother emotionally dependent on the midwife and likely to look to her for everything — medical advice, guidance, praise, support, self worth.

But like any serious attempt at inducing emotional dependence, it doesn’t rest solely on the positive. Destroying trust in others is key to maintaining emotional control. Hence it is critically important to demean modern obstetrics (“not evidence based”) and obstetricians (“they recommend C-sections only for money and convenience”) at every turn. Whether consciously or unconsciously, homebirth midwives recognize that obstetricians know far more about pregnancy and childbirth than homebirth midwives do. Therefore, it is imperative to make sure that the mother is kept as far as possible, both physically and emotionally, from real medical professionals. To that end, the midwife must be the gatekeeper between the mother and obstetricians. Only the midwife can decide whether and when the services of an obstetrician and hospital are needed. Until that moment, all her persuasive power will be bent toward keeping the mother at home.

The homebirth midwife understands (consciously or unconsciously) that the mother’s reliance on her family and friends for comfort and support threatens the exclusive power relationship that the midwife is seeking. Hence the midwife is always working to marginalize and create distrust of parents, in-laws and friends who can supplant her. They are marginalized by pointing out their lack of “education,” their culturally determined “fear of birth,” and their pathetic submission to authority figures. When all else fails, the homebirth midwife moves to have family and friends excluded from the birth itself, and in extreme situations, will physically isolate the mother and refuse entry to all others.

Christy Collins appeared to play that role to perfection in her relationship with Gavin’s mother. She even used the midwife’s trump card, the “dead baby card” to inoculate Gavin’s mother against the possibility of listening to an obstetrician. Every homebirth midwife knows that a mother will do almost anything to prevent the death of her baby. Since Christy understood that a doctor would tell Gavin’s mother that her baby might die, as zero amniotic fluid is indeed a sign of impending death, Christy prepared the mother in advance to ignore his counsel.

Christy knew that Gavin might die. She understood both that a doctor would tell that to Gavin’s mother and that it would be true. Inevitably she would lose emotional and physical control of Gavin’s mother, who would turn to an obstetrician, so she neutralized that possibility in advance by deriding the warning as the “dead baby card.”

Then Christy approached Jan Tritten, in her role as Editor of Midwifery Today, to gain support for her desire to risk Gavin’s life in order to maintain control over Gavin’s mother. Surely Gavin’s mother would go into labor soon, right? Surely Gavin would survive until then, right? Or maybe Jan and her Facebook friends might think of a way to induce labor without requiring Christy to give up emotional control of the mother. It apparently never occurred to Jan Tritten to tell Christy to place the baby’s well being over her own emotional needs. In my view, Tritten’s failure to warn Christy wasn’t merely buffoonish ignorance on Tritten’s part; it was implicit recognition and acknowledgement of the “real” task at hand, maintaining emotional control over Gavin’s mother even if at the cost of Gavin’s death.

Homebirth midwives are not medical professionals. They are laypeople who, to fulfill their own emotional needs, masquerade as “midwives,” allowing them to create emotional dependence and worship in mothers. That’s why medical knowledge is irrelevant for them. It’s not about babies and it’s not about safety. Homebirth midwifery is about homebirth midwives, and their need for power, control and adulation. Babies who die are nothing more than unavoidable, though regrettable, collateral damage.


*The explanation and list comes from a website that purports to teach people how to make others love them.

254 Responses to “Homebirth midwives and the art of emotional manipulation”

  1. Coraline
    March 11, 2014 at 2:31 pm #

    Great piece. I am just SHOCKED (maybe not shocked…more utterly disgusted) that Christy Collins flat out LIED when asked if she was the midwife…because how can you EVER trust a word that comes out of Christy’s mouth when she flat out lied about her role in this case when asked point blank?! If that’s what Christy does–and it’s caught on screenshot–I can only imagine this is a common practice of other CPMs. This should be a warning to any other mother who is considering hiring a CPM.

    • The Bofa on the Sofa
      March 11, 2014 at 2:43 pm #

      I agree, the fact that she denied being the midwife is very disturbing.

      I interpret it as (another) admission of guilt. She knew what she did was wrong, so much so in fact that she had to try to hide it.

      If she really thought she had done the right thing, she would have defended it unapologetically. It’s like what Dennis Miller said about Bill Clinton when asked if he smoked pot. Instead of “I didn’t inhale” he should have said, “Yeah, I smoked it. And then I drank the … bong water.”

  2. Lawyer Jane
    March 11, 2014 at 10:27 am #

    You know, the cult comparison is actually factually true in some respects, not just an analogy. Ina May is ACTUALLY a cult leader for a fertility/marriage/sex cult, and I’m pretty sure that the midwifery thing was an outgrowth of the cult controlling its women. The cult, lead by Ina May’s husband, believed in group marriage, no birth control, and the “cosmic energy” of sex & childbirth. When Ina May first started delivering babies it was because they were basically a nomadic group before they settled on the Farm and did not want to stop for women to deliver babies in hospitals. When you read Spiritual Midwifery it becomes clear that they see childbirth as a religious rite.

  3. yentavegan
    March 11, 2014 at 9:44 am #

    You know what gets my ire ? Hospitals and ob/gyn’s have to bear the burden of calculating these infant mortality numbers due to midwives’ negligence. When pro-homebirth supporters cluck about “babies dying in hospitals too”‘ I feel like needing to say , yes but how many of those heart wrenching unexpected deaths were due to home birth midwife mistakes?

    • Young CC Prof
      March 11, 2014 at 10:11 am #

      To be fair, the overall number of home births are still small enough that it probably isn’t throwing off the hospital statistics that much, except maybe in Oregon. (And if you count Portland.)

      • yentavegan
        March 11, 2014 at 10:23 am #

        how would we know? A full term infant with an otherwise healthy mother shows up at the hospitals without records, without an ob/gyn with an infant who isn’t going to make it..perhaps the overall numbers are small but they would still be calculated as hospital deaths not as home birth deaths…

      • LMS1953
        March 11, 2014 at 6:57 pm #

        A grown man was afraid of a house cat in Portland. He barricaded his family including a 17 month old son who was probably home birthed in the bedroom and called 911 to have the police rescue them. Portlandia fosters fear of a cat, yet they don’t bat an eye risking their newborns very lives and neurological function with home birth bullshit.

  4. Captain Obvious
    March 11, 2014 at 7:49 am #

    I must be a bad dad. I don’t think that often of my kids births anymore. I think about their grades, sports, homecoming, prom, driving, their friends, how they help out around the house, their bad days, their good days, but not so often of their births.


    • Trixie
      March 11, 2014 at 9:05 am #

      Omg. HBA2C in labor for 110 hours? Sure, midwives transfer when appropriate….

      • The Bofa on the Sofa
        March 11, 2014 at 9:13 am #

        Well, not all midwives are like that….

      • The Computer Ate My Nym
        March 11, 2014 at 9:17 am #

        To be fair, she later said it was only 18 hours of active labor. So she may have been counting early and prodromal labor in the 110 hour number. Or…not.

        • The Bofa on the Sofa
          March 11, 2014 at 9:23 am #

          For sure, far more impressive to say that labor was 110 hrs. If you are trying to impress someone that is…

  5. Amazed
    March 11, 2014 at 3:14 am #

    I have to admit I wonder about one thing… Just how influenced are the mothers who have already chosen homebirth when new studies come out, invariably pointing out the higher risk? I suppose midwives are the one doing the “interpreting” for them and at this point they are too much invested in the romantic birth and all other cutesies to consider reason?

    • Durango
      March 11, 2014 at 9:24 am #

      Don’t you think that the vast majority of homebirthers tell themselves that *their* midwives are the exception and everything will be fine? And, of course, the absolute number is small, so they will reassure themselves with that.

      • March 11, 2014 at 12:47 pm #

        Absolutely! A dear friend (former friend? She stopped speaking to me) took this line, even when i pointed out her midwife had prior bad outcomes (plural) and the “decade of hospital experience” said midwife claimed were actually because the midwife irked in HOUSEKEEPING.

      • manabanana
        March 11, 2014 at 1:25 pm #

        “homebirthers tell themselves that *their* midwives are the exception and everything will be fine?”

        Yes. YES. YES. 1000x yes. This is what they believe. And this is what their midwives will have them believe.

      • manabanana
        March 11, 2014 at 1:27 pm #

        Randompersonscomment is a perfect example of this:

        “I have had 3 pregnancies with midwives and can tell you that they are
        extremely cautious and will not even allow a home birth if there is a
        shadow of a doubt that the pregnancy isn’t the perfect medical model.
        They will tell you to go to a hospital in a heart beat if anything seems

    • Dawn
      March 11, 2014 at 10:05 am #

      Well, I have been very influenced by new studies on home birth. When I had my 3rd daughter at home almost 10 years ago, I believed it was safe based on some statistics I saw that showed that midwives had a lower neonatal mortality rate than doctors. When I became pregnant with my 4th daughter, I wanted to have another home birth, but it was not possible financially. I found Dr. Amy’s blog during that pregnancy and started to question if home birth was really as safe as I thought it was. Some things happened during my 4th pregnancy that made me really question the claims of the NCB movement in general. (That is another, long story) When I became pregnant again, I initially began to plan on another home birth (as it was financially possible for us at that point), but changed my mind. I had been reading Dr. Amy for several years at that point, and although I wasn’t convinced that she was right, I was no longer sure that home birth was as safe or safer than hospital birth. I figured that I had much more to lose by home birthing if she was right. If she was right, I faced a higher risk of losing my baby to a preventable death by home birthing. If she was wrong, then I just might have an unpleasant experience in a hospital, but I would probably still go home with a healthy baby. I knew from my experience in the hospital with my 4th baby that the hospital was not nearly as bad as some NCB advocates claimed it could be. (Maybe hospitals are bad in other places, but my experience was great) So, I finally decided on hospital birth and decided that I would no longer consider home birth for any subsequent births. I’ve continued reading and only become more and more convinced (as more studies come out indicating that home birth is much less safe than hospital birth) that I made the right decision. I only ever considered home birth because I thought it was as safe or safer than hospital birth. I liked being in the comfort of my own home and not having to get in the car and go anywhere during labor, but laboring in a hospital and enduring a car ride during labor are minor inconveniences. I would never choose to have a slightly more comfortable environment over the safety of my baby. It makes me sick to think that’s exactly what I did, though, for my 3rd daughter, although I didn’t actually know I was doing that. I am so glad we were lucky and that everything turned out well for us.

      • Coraline
        March 11, 2014 at 2:36 pm #

        Wow, thank you for sharing this. I am wondering, though, if your experiences during your 4th pregnancy that made you question the claims of the NCB movement happen to be written anywhere publicly? I know at least for myself (having been formerly wooed by the NCB movement) it would be very beneficial and encouraging to read others’ experiences in that regard!

    • Danielle
      March 11, 2014 at 10:15 am #

      I think home birth / natural birth ultimately relates so strongly to people’s worldviews—including how they think about personal agency and how they view professionals and institutions–that it takes a lot of evidence before the scale “tips” and the underlying assumptions come into question.

      And to be fair, it would take the same accumulation of evidence to undermine my own basic trust that obstetrics is based on the best research we have at this time, and has earned my trust.

  6. randompersoncomment
    March 11, 2014 at 1:01 am #

    This is the most bullshit article I have ever read. Midwives are educated, probably more than doctors who just come in and “catch” a baby as it is coming out, or better yet, to cut women open. I have had 3 pregnancies with midwives and can tell you that they are extremely cautious and will not even allow a home birth if there is a shadow of a doubt that the pregnancy isn’t the perfect medical model. They will tell you to go to a hospital in a heart beat if anything seems off. People want home births to stay away from extra and unnecessary medical intervention, not to be part of a cult. Many hospitals do not inform families of the drugs they place in IV’s for instance. Often times, c-sections are performed out of time limitations placed on labor, and the standard time for labor has been greatly underestimated. People just want a choice. In the hospitals, you are at the mercy of “the man” so to speak. You can’t even deliver the baby in the position your body was meant to labor in: moms have to push on their backs, it’s basically illegal to squat, and if you have ever had a baby both ways (which I have), you would know that squatting is much more natural. I can’t believe that midwives have ill intentions. For what reason? They make very little money compared to doctors and hospitals. I feel that much of this article was written biased and without evidence, because there are many babies who die in the hospital…more than in homebirths. You take a risk no matter where you choose to birth. The risks are just different.


    • MJ
      March 11, 2014 at 1:11 am #

      Welcome. Can I ask what you think about the death of poor baby Gavin Michael? His midwife not only didn’t transfer care at the first sign of trouble, but asked for advice on Facebook while he was dying inside his mother. Can you appreciate that people are angry about that and asking why it happened and how it can be prevented from happening again?

      Unfortunately a lot if what you say is simply not true and if you poke around in this blog you’ll find evidence for just about all of it. But if you prefer anecdotes, I can give you this one. I have had three children in hospital. Two of them were attended by excellent, highly trained midwives. During none of those labours was I forced to lie on my back. BUT for every single one of them that is where I was most comfortable. Didn’t squat for a single one of them because it certainly wasn’t more natural for me.

      One last question – are you in America? This blog is primarily about American midwives, specifically certified practising midwives who do not have any formal medical/nursing qualifications and would not be permitted to practice anywhere else in the industrialised world (like Australia, where I live).

    • Lisa from NY
      March 11, 2014 at 1:14 am #

      The babies who die in hospitals are mostly of mothers who don’t bother with prenatal care. Women who do drugs, for example.

      • Young CC Prof
        March 11, 2014 at 9:00 am #

        The home birth neonatal death rate is actually pretty close to the (full-term) neonatal death rate of hospital mothers who were known to have gotten no prenatal care. Except with the hospital no-care group, we aren’t talking about kale-eating earth mamas, we’re talking about mostly poor young women with no access to proper medical care, like you said possible drug use, very little support structure, vast majority unwed, etc. Interestingly, half of these mothers live in Texas.

        So the results that the hospital can produce on the most challenging population is about what home births do on a really healthy population where basically no babies should be dying.

        • The Computer Ate My Nym
          March 11, 2014 at 9:40 am #

          Interestingly, half of these mothers live in Texas.

          Texas has little to offer women in way of free or low cost medical care, including care during pregnancy, has an active misinformation campaign going on with respect to birth control and how to avoid pregnancy, and extreme restrictions on abortion. It’s no mystery why there are so many neonates dying in Texas.

          • auntbea
            March 11, 2014 at 9:43 am #

            I don’t know why, in the face of all that has happened here recently, this particular piece of information just makes me rage. Stupid ^&$@& politics killing babies.

          • The Computer Ate My Nym
            March 11, 2014 at 9:47 am #

            In the name of “life” no less. They’re very hot on saving embryos. Babies, not so much. (Not meant as a condemnation of the pro-life movement overall. Just the Texas lege.)

          • Young CC Prof
            March 11, 2014 at 10:20 am #

            Not only is Texas not-so-great with reproductive health care, keep in mind it’s also the largest state with a weak safety net overall, which means more severe poverty and fewer resources for the poor. (CA and NY are what we call “high-service states.”)

          • The Computer Ate My Nym
            March 11, 2014 at 12:52 pm #

            If you look at life expectancy by state high service states have a higher life expectancy. Why anyone favors the low tax/low service model I really don’t understand.

          • Guesteleh
            March 11, 2014 at 1:13 pm #

            Because “those people” don’t deserve it.

          • March 11, 2014 at 11:13 am #

            As far as I can see, Texas has little to offer women, full stop.

          • Trixie
            March 11, 2014 at 12:32 pm #

            Big hair?

    • thankfulmom
      March 11, 2014 at 1:15 am #

      This blog is written with tons of evidence. Please stick around and read the evidence which Dr. Amy clearky explains.

    • Trulyunbelievable2020
      March 11, 2014 at 1:16 am #

      Please note that while your comment will inevitably be criticized and your premises and claims challenged, no one is going to ban you here.

      If history is any guide, you’ll maybe give one or two incoherent non responses and slink away. But you’ll be given every opportunity to buck this trend.

    • Trulyunbelievable2020
      March 11, 2014 at 1:20 am #

      “I have had 3 pregnancies with midwives and can tell you that they are extremely cautious and will not even allow a home birth if there is a shadow of a doubt that the pregnancy isn’t the perfect medical model.”

      If this is true, then your midwives are to be commended. If you stick around here (or read the archives), you’ll see that there are many midwives who don’t have the same sensible philosophy.

    • Jocelyn
      March 11, 2014 at 1:56 am #

      If midwives are more educated than doctors, why do they send you to the doctor if something is going wrong?

    • March 11, 2014 at 2:11 am #

      You have had three pregnancies with midwives. On that you base your quite inaccurate statements. You literally don’t know what you are talking about.

      Homebirth midwives are NOT experts in anything.

    • yugaya
      March 11, 2014 at 2:18 am #

      Define: educated.

      No seriously, there is going to be no sane discussion if by educated at the same time I mean three to four years at least and university, and you mean five minutes and Google.

    • schnitzelbank
      March 11, 2014 at 2:28 am #

      My hospital experiences were nothing like this. I was monitored both externally and internally, encouraged to change positions and have oxygen, all in attempts of preventing c-section. Same with my second, who turned transverse at 38 weeks. I was offered a ECV to avoid a c/s.
      I was always informed of what was going on with myself or the baby. Every medication and procedure was explained in advance and I was able to give consent, at every step of the way.
      I wasn’t aware of any time limit. The determination of c/s came down to whether or not my babies were tolerating labor. They did.
      I labored in whatever position I wanted. There was a birthing stool, those bars to lean on, however I wanted to move was fine. The nurse was great at helping me get into position for more comfort. At no point was it mentioned that squatting was “illegal.”
      Infant hospital mortality statistics include the babies that died post homebirth transfer. And the preterm, the critically ill, etc.
      The risks are not just different…. the risks of homebirth are tremendous.
      Please keep reading here, randompersoncomment!

    • Christina Channell
      March 11, 2014 at 2:37 am #

      I have had three hospital births with obstetricians. For the first two births, I had a detailed birth plan and every last request was granted cheerfully, from the labor positions to providing ice for the cooler in which I transported my placenta home for encapsulation. With my third, I had a planned medicated birth and not only was the hospital staff accommodating, but they offered the low-tech options again just in case (natural pain relief methods, etc. – no thanks, never again). It was then that I realized that perhaps I’d been lied to by hysterical doulas and “childbirth educators” about what modern hospital birth looks like. And hey, my babies survived the process, so that’s pretty sweet! Stick around here and you’ll soon discover that there’s a sinister side to modern birthing – and it’s not what you think it is.

    • March 11, 2014 at 3:09 am #

      Yep just erase the experiences of women who had bad midwives, because that’s cool.

    • Amazed
      March 11, 2014 at 3:11 am #

      “The risks are just different.”

      Right. A 4 times greater chance of my baby dying via 99 % chance of the curtains not being to my liking and 99% chance of getting a potentially life and brain saving intervention.

      You’re free to take thee 4 times higher risk. I’ll stick to the 99%.

      • yugaya
        March 11, 2014 at 3:51 am #

        No, curtains are evil, babies need the flow of undisturbed Mother Earth energy through open windows to be born properly!!!!!!

        (Unless you buy special curtains from a lay midwife’s website which have sacred ancient birthing runic inscription, these help turn breech babies, I bought two sets, prayed my breech mantras into them them twice a day for three weeks and it worked!!!)


        • Trixie
          March 11, 2014 at 7:59 am #

          There was a birth story linked to not that long ago where I think the father complained about how traumatic the hospital birth was because the delivery room didn’t have windows.

          • Durango
            March 11, 2014 at 9:30 am #

            A commenter complained a few months ago how OBs wore PPE (personal protective equipment, aka mask, gloves, gown) and she was going to insist that the OB not wear it because it freaked her out. I’m sure that request went over well. (kidding!)

          • Comrade X
            March 11, 2014 at 11:42 am #

            Crikey. In Japan, I believe, wearing a mask while going about your daily life when you have a cold (in order to reduce the chances of you infecting someone else) is just considered common good manners. And that’s not just for medical professionals, that’s for, like, the checkout operator and the bus conductor. How can anyone freak out over doctors not wanting to spread their germs all over the place?

          • The Bofa on the Sofa
            March 11, 2014 at 1:08 pm #

            Masks aren’t all that good for stopping the spread of germs, are they? They are more for particulate matter, I thought

            (my understanding is that the Asian approach of everyone wearing a mask is pretty much not all that effective; washing your hands a lot is far better)

          • Sue
            March 12, 2014 at 12:05 am #

            Masks are not bad for stopping the spread of virus-containing droplets from sneezes and coughs.

    • OBPI Mama
      March 11, 2014 at 6:31 am #

      Evidence pointing to the too low transfer rate of US midwives’s clients (compared to the transfer rate of midwives in other countries) suggests that midwives do not tell moms to go to the hospital the second they think something is wrong. And I totally wanted to believe midwives won’t see a client if your pregnancy is anything less the perfect and low-risk, but that is wishful thinking. I hear more and more women tell me they are having a homebirth who are certainly not low risk. Midwives call them “variations of normal”… I thought as you did once (even had a homebirth with the all-wonderful, all-knowing midwife who knew more than doctors…too bad for my son the midwife proved me so wrong in my thinking). Once statistics started coming out, I had to change my view because it was proven false. It gets easier to change that view when we meet homebirth trauma victim after homebirth trauma victim though.

      • JennG
        March 11, 2014 at 1:03 pm #

        Midwifery Today in fact is supposedly featuring twins in its next issue. That says a lot about the regard for safety guidelines. Unless it says, don’t.

    • Playing Possum
      March 11, 2014 at 7:11 am #

      ‘ I can’t believe that midwives have ill intentions.’

      And this is the killer line. Why do you believe it of doctors? I’ve never met a doctor (or a nurse midwife) who had ill intentions. Doctors are not the money grubbing butchers you make them out to be, and it’s frankly untrue and unkind. Do you know how hard training is? How draining to be the bearer of bad news? To devote your life to a vocation that is cruel and unusual, thanks to the whims of Mother Nature? It’s insulting, that after the years of training, exams, rotations away from home, constant relocation, interrupted sleep, tragedies, paralyzingly scary crises, absent social life, people seriously believe that doctors do things out of spite, or for convenience, or for the money.

      • March 11, 2014 at 7:18 am #

        Paranoia is the simple answer, and I think homebirth midwives exploit it when their antennae sense it.

        • Anj Fabian
          March 11, 2014 at 10:52 am #

          A woman comes to a midwife and says “I don’t trust doctors. I loathe hospitals.” and now the only thing left to do is getting the woman to sign the check.

          An attitude like that means that much of the midwife’s work is already done.

    • Trixie
      March 11, 2014 at 7:57 am #

      I remember delivering on my back at my last hospital birth. The midwife and the nurses kept saying, “are you sure you want to be on your back? We can try other positions!” But I was not comfortable squatting.

      It was an unmedicated VBAC and all of the hospital staff was 100% supportive, including the backup OB and the anesthesiologist who stayed past the end of his shift waiting for me to deliver in case I would have a medical emergency. After the birth my baby didn’t leave my chest for an hour, at which time the nurse did her weighing and measuring right there in the room,, and handed her back for another hour. We were asked our consent before every procedure was done to her, such as vitamin K, eye antibiotic, and the bath. No one put anything in my IV except for antibiotics for GBS, which were necessary to prevent infection of my baby. Multiple IBCLCs checked on us to make sure breastfeeding was going well, and no one gave her a bottle or pacifier.
      So yeah, my hospital delivery was really full of “the man” keeping me down. The only difference is my baby was at virtually no risk of dying at the hospital…whereas she had at least a 1/200 risk of dying at home, according to MANA’s own VBAC stats.

      • Mishimoo
        March 11, 2014 at 8:14 am #

        I wasn’t comfortable squatting or on all fours either, it made my back labour that much worse. The bed ended up being adjusted so that I felt like I was reclining on a throne and the absurdity of the situation nearly made me giggle.

        • OBPI Mama
          March 11, 2014 at 3:08 pm #

          I pushed horribly while squatting, on all fours, one leg on the bathtub ledge, on a birth stool, on the toilet and it hurt much more in my back too (back labor as well)… the only position I could push effectively and feel half sane was reclining too!… Now I did have to rotate to my legs and semi-squat when his head was out, but shoulder were stuck. It felt awful. I kind of wonder if so many women chose to push while reclining because it just felt better to them and they could do it more effectively… who knows. I was always taught it was “the man” coercing us to push this way.

    • PrimaryCareDoc
      March 11, 2014 at 8:10 am #

      So, do you actually have any experience with hospitals, or do you just regurgitate what you read from Jennifer Marguilis or watched in the BOBB?

      1) You are not at the mercy of “the man”. Most OB/GYNs are women. You always are able to decline any intervention.
      2) You can deliver the baby any way you damn please. For my first, who was OP presentation and damn stubborn about delivering, I pushed for almost 5 hours. No pressure for a section, because he was doing fine. I pushed in every position under the sun. “Illegal” to sqaut? WTF? Illegal according to what law? And whom? Squatting is more natural? Again, according to whom? The “noble savage” trope. I’ll have you know, for my OP baby, squatting did squat. You know what finally got that kid out? Good old purple pushing on my back with my knees pulled up to my chest.

      • The Computer Ate My Nym
        March 11, 2014 at 9:36 am #

        My sister delivered in a squatting position, three times, in hospitals. So much for illegal to squat. I’d point out, of course, that such anecdotes say nothing about how frequently women are allowed to (or want to) squat during delivery in the hospital except that random doesn’t seem to have even an anecdote, just an unsupported accusation and anecdote trumps no data at all so my data quality is higher than random’s.

        • auntbea
          March 11, 2014 at 9:39 am #

          Just because your sister squatted three times doesn’t mean it’s not illegal. You have not provided information about whether or not she is currently in jail.

          • The Computer Ate My Nym
            March 11, 2014 at 9:45 am #

            Given that her children are now 17, 22, and 24 and that I’ve visited her and she’s visited me between the time when her children were born and now and I talked to her last week, if she’s in jail for squatting during childbirth and I just don’t know about it, the conspiracy is too all encompassing for me and I’m just going to give in and do what The Man wants.

      • March 13, 2014 at 4:05 pm #

        No, you are not always able to decline any intervention. You are supposed to be able to, but you aren’t. There are no consequences unless they botch whatever they force on you. I know from experience. I know hospitals are the safest place to give birth, but don’t tell people things that just aren’t true.

    • guesting
      March 11, 2014 at 8:51 am #

      Another voice here that doesn’t think you’ve experienced what you’re talking about with such authority. I went so far as to inteview midwives before choosing hospital birth (midwives don’t have NICUs) and for years believed I just wasn’t enough of a woman to try homebirth. Pushing in the hospital, twice, was nothing like you talked about. I was discouraged from getting an epidural too early for one birth. I was encouraged to try any pushing position I wanted. The only position that worked and I tried a bunch – my next birth was no epidural, they barely had time to put an IV in before I started pushing so it’s not as if I was hampered by anything – was on my back, purple pushing. And I felt guilty because my Ina May books, my Bradley classes and books, Spinning Babies, and my Hypnobabies “education” all educated me and I thought that back purple pushing was The Enemy. But it was THE BEST. I still think of those glorious rests between contractions…being able to lay on my back. 🙂

    • Durango
      March 11, 2014 at 9:25 am #


      So much in just one post. (wipes tears)

      • Sue
        March 12, 2014 at 12:01 am #

        ”in one post”? It’s all in ONE PARAGRAPH.

    • The Computer Ate My Nym
      March 11, 2014 at 9:34 am #

      They will tell you to go to a hospital in a heart beat if anything seems off

      And why would they do that if hospitals are so evil?

    • Danielle
      March 11, 2014 at 10:59 am #

      There are a lot of generalizations about medical practice in your post that are misleading. For example, if you are concerned about specific issues, such as “what is in your IV,” you will certainly be told if you ask the question. The information is not secret. I do think in some cases medical professionals don’t explain everything in the detail the patient would have liked, partly because they don’t regard a measure they are taking as extraordinary (they do it dozens of times a week). Also, only some patients want detailed explanations. I suspect some people are confused or offended by too much commentary: “Darn it, make the pain STOP. I DO NOT CARE WHAT YOU HAVE IN THERE!” But these issues of communication that can be overcome.

      In my own (very positive) hospital experience, I realized later that I wish I had known more detail about certain things that were happening. For example, I didn’t fully understand that there was a chance my baby was going to be born unresponsive and need a NICU stay. This caught me off-guard, it wasn’t until the final half hour of the labor that I really realized were had a significant problems. The root of this was innocent: to the hospital staff, my complications were potentially serious but also very textbook, and they were being well managed. Therefore I picked up on sense of alarm from them and didn’t realize that I would want to know more. Consequently, they couldn’t have known that might have wanted to know more, either. Given that I was being monitored by a nurse much of the time, I’m sure I could have asked her all kinds of things; I just didn’t. Ultimately, this didn’t matter–my baby was fine, because the staff knew exactly what they were doing. It’s just something I realized later would have been a “nice thing to have.” The second time around, I’ll be experienced enough to realize what I want to know.

      On your other points, even if you are correct that the time tables imposed on labor are insufficient (etc, etc), they are not a conspiracy against you or the birth process. Even if they turn out to be imperfect, they are intended for your and the baby’s protection.

      Some of your concerns – that a natural birth and maternal movement isn’t allowed in hospital – are overblown as well. Maybe there are hospitals where medication is pushed and staff are too dictatorial. But there are also a lot of hospitals were moms give birth naturally when they want to do that. Usually, people are allowed to bring a doula. I’ve not been through the experience myself, but I know people who did this, even in fairly traditionally-minded hospitals. In many areas, a little shopping around ought to head off issues.

      When it comes to “education,” your comment that doctors aren’t educated about child birth is patently silly. Doctors are very well-trained in dealing with many, very critical medical aspects of birth and have far more specialized knowledge than midwives do. Just on number of cases alone, it takes years of work as a midwife to approach the number of deliveries a doctor has seen during residency and the first years of her career. There might be some softer, less critical areas where a midwife has spent more time on education– such as how to coach you through the experience of an unmedicated birth. That does not make her a good replacement for your doctor, and it doesn’t make her as educated as your doctor. She may have tout such “ancient skills” as “how to deliver a baby breech, but even if she were very, very good at this, there’s simply more risk in attempting a vaginal breach birth than moving to a C/S. In this case, your “uneducated doctor” isn’t actually inexperienced–they just don’t believe in the unnecessary risk.

      • The Bofa on the Sofa
        March 11, 2014 at 11:25 am #

        On your other points, even if you are correct that the time tables imposed on labor are insufficient (etc, etc), they are not a conspiracy against you or the birth process. Even if they turn out to be imperfect, they are intended for your and the baby’s protection.

        Actually, there is a very good reason for following the “generic” timetables – unless there is an actual indication not to, that is what leads to the best results.

        This is the gambler’s fallacy. Probability theory tells us that the best strategy is to always play the best odds. However, we have a tendency to not want to do that. For example, imagine a game where you roll a die and you have to pick whether the roll will come up 1-4 or 5-6. Most people will think that, since 1-4 comes up 2/3 of the time and 5-6 comes up 1/3 of the time that you should mix up your guesses, and guess 5-6 1/3 of the time. However, that is not the best strategy. The best strategy is to always pick 1-4. That’s how you will be right most often (2/3 of the time).

        What happens if you mix up your guesses? Let’s say you have 90 rolls. If you choose 1-4 all of the time, you will get 60 right. However, if you choose 1-4 and 2/3 of the time (60) and you choose 5-6 1/3 of the time (30), you will only get 60*(2/3) + 30*(1/3) = 50 correct.

        The same thing happens in medicine. Absent (actual) information to indicate otherwise, doctors are best to act in accordance with the best odds. Yes, every patient is different, but if those differences cannot be associated with different outcomes, then they don’t affect the strategy.

        The challenge that the doctor faces is to figure out how do I interpret these conditions in light of the probability of a good outcome? Have we reached the point where the probabilities using this approach are not sufficient, and we should resort to something else? These decisions need to be made based on the medical information available, and they can be subtle (this is the “art” of medicine – choosing the highest probability of success pathway). What can a doctor see that allows them to run off standard play? It’s the medical equivalent of counting cards, or knowing that the dice are loaded.

        But the short answer is, following the time tables is absolutely the best strategy, unless there is a reason to think otherwise. In that respect, “they follow the time tables too much” is a meaningless statement to me, because I don’t know how much they should or shouldn’t be. I know the default position SHOULD BE to follow them. For that reason, I would need to see an explanation why they shouldn’t be following the time tables to a large extent. “Every person is different’ is not an adequate justification. In fact, that is the whole premise of using thetime tables in the first place – because everyone is different, we need to attack the problem from a population perspective, and can’t say enough about the individual. And if you try to guess, you are going to increase your chances of being wrong.

        • Danielle
          March 11, 2014 at 11:42 am #

          And this is why I trust them. The time tables are not conjured out of thin air. They minimize risk.

          If or when it is discovered that risk can be further mitigated by adjusting the time tables, then they’ll be revised. And perhaps they will be down-the-road…if OP’s assertion that they are ‘too short’ is born out by some kind of evidence.

          But from what I can tell, natural child birth advocates aren’t really addressing the logic of the time tables, or suggesting their revision; they’re just gun-shy of trip wires that trigger “interventions,” and therefore don’t like the fact that there are time-tables. That’s exactly why I don’t want a person deeply committed to natural birth telling me to ignore the time table, they’re opposition is philosophical/emotional. If someone who believes in the time table wants to make suggetions on my individual case based on vast clinical experience, I would trust that “instinct.”

          • Danielle
            March 11, 2014 at 11:43 am #

            *THEIR opposition
            (sorry for the vast number of types)

          • Young CC Prof
            March 11, 2014 at 12:11 pm #

            “If or when it is discovered that risk can be further mitigated by adjusting the time tables, then they’ll be revised.”

            This is exactly the strength of science-based medicine, which its critics wrongly read as weakness. Look at the new guidelines for statin therapy. Critics say, “See? Changing their minds again, the experts don’t know anything.”

            In fact, the bottom line on statins hasn’t changed. If you have high cholesterol, a statin drug will reduce your risk of heart attack, but the drugs do have some side effects. The new guidelines just help doctors determine exactly who is most likely to benefit from a statin and who probably doesn’t need it. In another decade or two, maybe we’ll have even more precise guidelines. Or maybe we’ll have a whole new class of drugs for cardiovascular disease that makes statins obsolete.

            What matters is that science based medicine means doing the best we can with the tools and information we have now, and being reasonably certain that outcomes are improving overall, even if things are still imperfect.

          • The Bofa on the Sofa
            March 11, 2014 at 12:18 pm #

            I always view “changing the guidelines” as “narrowing the pool to whom it will apply.”

            Before, the guidelines said “The best approach is to treat everyone with condition A.” That’s the best odds (see my comment above about always playing the odds).

            However, after doing that for a while and testing it, we find out that there is a subset of group A that does not respond, and they all have condition B. So we narrow the group – treat everyone with A UNLESS they have B.

            Notice the effect of this – you are first going to stop treating a group that does not benefit. That’s good from a cost/benefit analysis (if there is no benefit, then any cost is too much). But you are also going to end up with a higher success rate among the people you do treat. If the number of successes is S, then S/A is less than S/(A-B). Now, you don’t actually increase the absolute number that are successful (S doesn’t increase), but you eliminate the ineffective stuff. Your goal, of course, is to aim for a success rate of 100%, where you treat everyone who will respond, and the ones you don’t treat wouldn’t have responded.

    • March 11, 2014 at 12:09 pm #

      I have had 3 pregnancies with midwives


    • Stacy21629
      March 11, 2014 at 12:27 pm #

      As politely as I can say it, you have no idea what you’re talking about. For one thing, you’ve had 3 homebirths. Have you ever even been IN labor and delivery in a hospital? You are basing your opinion on what happens in a hospital on hearsay, lies and conjecture.
      Please go back and read the last 2-3 weeks worth of Dr. Amy’s blog posts. Here’s a rundown of what you’ll find:
      1. a mother asking about distance-learning CPM courses
      2. CPMs are only required to have a high school diploma/GED
      3. CPMs looking to Facebook for transverse, breech, post-dates, PPROM
      4. CPMs accepting, delivering transverse, breech, post-dates, PPROM
      5. the financial incentive of CPMs
      6. and last but not least, a baby DYING because a CPM didn’t know that he was extremely high risk and then tried to cover up his death.
      Not a single thing you said is true. Please take the time to educate yourself.

  7. Amy Tuteur, MD
    March 10, 2014 at 9:56 pm #

    Australian midwife Lisa Barrett has been fined $20,000. It’s not enough, but it should give pause to any midwife contemplating attending high risk homebirths.


    • MJ
      March 10, 2014 at 10:26 pm #

      Absolutely. Especially those who want to keep their registration, and in Australia it’s not legal to call yourself a midwife without it.
      It is at least some relief to see “Lisa Barrett” and “permanently banned” in the same article.

    • Playing Possum
      March 10, 2014 at 11:50 pm #

      She’ll declare bankruptcy, right?

      And then move across the pond and slide nicely into a job in Oregon?

    • LMS1953
      March 11, 2014 at 12:29 am #


      I am afraid to ask, but what is Lisa Barrett wearing around her neck? I have never seen anything like it. I would not be surprised if it were a desiccated POC – like dried and woven umbilical cords or something along those lines.

      What is the status of the proposed legislation in Australia?

      • realitycheque
        March 11, 2014 at 2:46 am #

        I could be mistaken, but I think it’s part of her coat.


    • guest
      March 11, 2014 at 3:26 am #

      Will it change anything? If she does this stuff without being registered, what’s to stop her? Also, whatever happened to the I support her and that’s final page?

  8. AAAA
    March 10, 2014 at 9:56 pm #

    “To maintain your power you must always be needed and wanted. Make women depend on you and only you…..You must also work assiduously to isolate the client from her family and friends, emphasizing that their apparent concern is just a reflection that they are not as “educated” as she is. Makes her self-esteem utterly dependent on your approval, for the moment she trusts someone other than you, your power over her is ended.”

    This could describe Dr. Sears’ spiel equally well! Don’t trust your mother-in-law who suggests you take a little break from the baby and get some sleep; she is old-fashioned and hey what does she know? Don’t trust medical professionals who are in the pay of formula companies; they will always try to push formula on your no matter what.

    It is amazing what a crook this Dr. Sears is!

    • Trixie
      March 10, 2014 at 11:01 pm #

      I actually think the Sears machine has even more to answer for on the vaccine side of things than the NCB side. He’s why I’ve got acquaintances who haven’t vaccinated their 2 year old against MMR.

    • Therese
      March 11, 2014 at 2:45 am #

      Did Dr. Sears really say not to trust your mother-in-law? I do not remember that part in his book at all. I think you are confusing Dr. Sears with what some of his followers have decided to do.

      • Busbus
        March 11, 2014 at 11:07 am #

        Well, the whole attachment parenting ideology is based on the belief that babies are HARMED by pretty much everything your mother, father, mother-in-law etc. did. They don’t say, co-sleep if it appeals to you – they tell you how this (and every other AP recommendation) is the only way for your baby to gain trust and become a truly happy person. So yes, I would say that Dr. Sears is big on not trusting your mother-in-law.

  9. Vyx
    March 10, 2014 at 6:22 pm #

    One of the moms in my due date club is now at 44.1, and still planning a homebirth. It is unclear whether she is receiving any monitoring or not. Everyone has been urging her to go to the hospital to be induced, but she is not willing to listen. My heart is breaking after watching how Gavin’s story played out.

    • Jessica S.
      March 10, 2014 at 6:32 pm #

      Terrifying! 🙁

    • fiftyfifty1
      March 10, 2014 at 6:37 pm #

      a Poe?

      • Vyx
        March 10, 2014 at 7:15 pm #

        I can only hope.

        • Karen in SC
          March 10, 2014 at 7:29 pm #

          Your due date club? Did you recently deliver? We like hearing about babies, please share 🙂

          • Vyx
            March 10, 2014 at 7:55 pm #

            No, she’s just jumped onto my club from February, though she’s been active in the February club for quite awhile. I’m due in 17 days!

          • Mishimoo
            March 10, 2014 at 7:56 pm #

            Oooh! Best wishes for a healthy and safe delivery of your munchkin.

          • rh1985
            March 10, 2014 at 8:00 pm #

            and I thought some of the moms in my Feb club who held out til 42 weeks were stubborn…

          • Amazed
            March 11, 2014 at 3:03 am #

            Best wishes! Do stick around and tell us when your little one – or big little one – is born “naturally”, via c-section, without a single intervention, with a cascade of interventions… Just safe and sound, both of you, in the easiest way possible.

          • ihateslugs
            March 11, 2014 at 2:17 am #

            Just had a healthy baby boy three weeks ago! He’s a darling, turning into a little chunkster. But, this mother of two thing (I have an almost three year old daughter) is pretty hard! Definitely overwhelming at times.

            Now, if I had just saved my magic placenta and had it encapsulated, perhaps I would already have mastered caring for two very needy little people…

          • moto_librarian
            March 11, 2014 at 11:04 am #

            It will get easier! My older son was three months shy of his third birthday when his little brother was born. They are now four and almost two, and life is good.

    • Certified Hamster Midwife
      March 10, 2014 at 7:15 pm #

      I can only hope that she actually has no idea when she conceived.

    • rh1985
      March 10, 2014 at 7:59 pm #

      Ugh… I hope the due date is really, really wrong. There were a few stubborn moms in my February group on Babycenter, but I think they pretty much gave in at 42 weeks.

    • March 10, 2014 at 8:37 pm #


    • Elizabeth A
      March 10, 2014 at 11:13 pm #

      Are you sure she’s pregnant?

      44.1 could be a case of incorrect dates, and/or with a lackadaisickal midwife. I don’t know where the exact tipping point is, but somewhere between weeks 44 and 46 of an internet pregnancy, I go from thinking maaaaaaaaybe just off on dates, to thinking, yup, that’s UC-enabled pseudocyesis.

    • Lisa from NY
      March 11, 2014 at 12:28 am #

      Isn’t there a fiction book claiming that a woman was pregnant for a year? (Before days of ultrasound, so???)

      • Busbus
        March 11, 2014 at 1:18 am #

        Oh, that was common in the past. Also, the occasional very big preemie. I guess you could say that one of the very few upsides of being pregnant in a society without medical care and pain relief is that it gave you a little more leeway when it came to framing the circumstances of the conception…

        • Dr Kitty
          March 11, 2014 at 3:39 am #

          Lots of “premature” 8lb babies born seven months after their parents eloped. That sort of thing.

  10. LMS1953
    March 10, 2014 at 4:02 pm #

    Back in November, the American Board of Obstetrics and Gynecology issued an executive order that diplomats would lose their board certification if they treated men. The reason given was that there was a shortage of health care providers for women and that OB/GYNs should not be wasting such a precious resource as their ABOG certification doing liposuction or low-T hormone replacement for men. Several restraint of trade lawsuits were filed and there were weekly modifications and exceptions. Finally, the edict was withdrawn in February – director Dr. Larry Giltrap explaining that it was becoming too much of a distraction (not to mention an illegal restraint of trade). Anyway, the point is if ABOG felt they had the right to issue that edict to further the cause of woman/maternal health – they would be on much firmer legal ground to enforce a policy that diplomats would lose their board certification if they “backed-up” home births (especially by CPMs). Gavin’s case implied that at least one and maybe two physicians were involved in his antenatal surveillance. Collins’s website stated that she had OB physician back-up. If this is true, then these physicians should be held accountable for enabling substandard care – if nothing else having their board certification suspended for a while while they accrue CMEs in the dangers of home birth.

    • SD
      March 10, 2014 at 4:35 pm #


      • attitude devant
        March 10, 2014 at 4:47 pm #

        Diplomates. Those who are Fellows of the college.

        • SD
          March 11, 2014 at 4:32 am #

          Aahha! Thanks. So not constructed out of Duplo, then. Or friends of a diplodocus.

    • CognitiveDissonaceHurts
      March 10, 2014 at 4:46 pm #

      Back in the late 80s, the Canadian Medical Association circulated letters to their doctors telling them not to see any patients who were planning homebirths or using midwives. I understand that it was a tactic to try and eliminate midwifery, or at least, that is how it appeared to those who were seeing midwives and planning homebirths. It only helped to prove the “us vs. the doctors” mentality that often exists in these cases. If the intent was to “stamp out” midwifery, it did not work. Midwifery was legalized and now more women than ever use the services of midwives, whose fees are paid by the socialized medical system.

      • LMS1953
        March 11, 2014 at 12:52 am #

        I think there is a significant distinction between backing up home births and backing up an appropriately degreed midwife. What are the corresponding stats for Canadian home births that we have discussed here as a 450% increase in the perinatal/ neonatal death rate and a 10 to 12 fold increase in low Apgar scores? There really isn’t anything about having a CNM in attendance at a home birth that will get you below the baseline 2 to 3 fold increased risk of newborn death. I also get the idea that, internationally, women don’t have the birth warrior mentality that CPMs foster in the US and are more willing to be risked out of home birth, especially if the midwife will lose her license if she practices outside her scope of practice: 42 Wks post dates, TOLAC, multiple gestation, breech, etc.

        • Busbus
          March 11, 2014 at 1:15 am #

          I agree with the American homebirth community being different – there is a maverick touch to it all. At least where I am from (I had a homebirth in Europe, as well), with well-educated midwives, there was no question that if they risked you out, you were going to give birth in a hospital. The idea that you would beg and run to 5 different providers to get your “healing homebirth” would have seemed ridiculous to most people even within the homebirth community. Every homebirth midwife I interviewed in Europe stressed that she can only work with me if she can trust me that I will go to the hospital if she tells me I need to.

        • CognitiveDissonaceHurts
          March 11, 2014 at 2:00 pm #

          This was before Canada had set up midwifery education, so many were degreed from Europe but there were those that were lay midwives and getting their training in the States.

  11. AnotherGuest
    March 10, 2014 at 3:52 pm #

    Good post, lots of useful insight. The emotional dependence part made me think of doulas aswell. Although I’m sure there must be good ones out there, and doulas can be helpful to some, if anyone is reading this and considering hiring a doula, just be sure to pick very, very carefully. You really don’t know what sort of person you are letting into your family’s life at a vulnerable time.

  12. Cold Steel
    March 10, 2014 at 2:32 pm #

    Wonderful post. Absolutely insightful and the best on this blog in a long time (and that’s saying something as they’re nearly all excellent).

  13. March 10, 2014 at 2:20 pm #

    This is why we need a strong health education curriculum – one that educates women/men on how to best interact with the health system and to understand the different providers and their qualifications. Can you imagine if every high-school student knew a CPM was merely a high-school graduate with some additional (possibly distance education) training, versus the qualifications of a CNM, a family doctor or an OBGYN? How many would be willing to choose that provider if they knew what they were actually choosing?

    • March 10, 2014 at 2:35 pm #

      I have been saying this for years. A lot of patients do not know they can ask questions or refuse a procedure or test. I also think that it would be prudent to teach some basics of the law to people in school. I don’t think its going to happen though, the educational system is riddled with so many problems already.

    • LMS1953
      March 10, 2014 at 3:32 pm #

      Actually, what we need are intelligent state legislatures who don’t have sh!t for brains and who don’t fall for the Woo. The only way to solve this problem is to lobby each and every state legislature to BAN anyone from calling themselves a midwife unless they have the CNM degree. Let them know in no uncertain terms that services provided by CPMs endanger public safety to a degree that would be unconscionable in any other aspect of consumer protection – and that if they continue to enable it the blood of these senseless deaths of the most vulnerable and innocent among us will be directly on their hands.

      • March 10, 2014 at 3:39 pm #

        I’d agree with that! There’s no way medical services should be less regulated than hairdressing.

      • March 10, 2014 at 5:27 pm #

        Hey LMS – Thanks for your insights sans the polarizing! Greatly appreciated

  14. PrimaryCareDoc
    March 10, 2014 at 1:58 pm #

    I can’t imagine what needs to be done in a prenatal appointment that takes an hour. Seriously. For people who like to constantly fap about how natural birth is a how it’s not a medical condition…what the hell are they talking about for an hour????

    • Trulyunbelievable2020
      March 10, 2014 at 2:01 pm #


      • Elizabeth A
        March 10, 2014 at 2:14 pm #

        Quite possibly yes. Take a look at this link, for example, the dietary recommendations from what I hear is a popular midwifery practice in DC: http://www.gwdocs.com/midwifery-services/nutritional-guidelines

        What do you think these people talk about at appointments? How many low-income families do you think they serve? My guesses are “kale,” and “not a bleeping one.”

        • March 10, 2014 at 2:57 pm #

          There is actually a clinic in utah called ‘the community health clinic’ which offers low income midwifery care (except deliveries). It is a front for ‘the community school of midwifery’ to give its students some free poor people to practice their skills on. Its super gross. They do not warn you of the student aspect of the program on their page. Its ran by that woman who tried to diagnose me with a personality disorder based off my blog posts (a real professional!).

          • Laura
            March 10, 2014 at 3:17 pm #

            I actually considered going there for counseling, but decided that they were too far, didn’t take my insurance, and I didn’t have a good feeling about that same woman. I actually went to a class she taught once, incidentally, about PTSD and birth trauma. I’m very glad I didn’t go to her clinic. Very, very glad.

        • Therese
          March 10, 2014 at 3:18 pm #

          It probably all depends on if you can use Medicaid for midwives. In my state you can, so it’s not unusual here for low income women to use them.

        • R T
          March 11, 2014 at 12:31 am #

          I know families on welfare that saved up money to pay for a homebirth or asked for gifts of money to pay for their home birth instead of gifts at their baby shower. Also, occasionally someone can get Medicaid or Tricare to cover at least part of it.

          • AmyP
            March 11, 2014 at 2:30 am #

            Worst gift ever.

    • Lawyer Jane
      March 10, 2014 at 2:02 pm #

      Although I agree with Dr Amy’s thesis that midwives may cross boundaries, it is true that pregnancy is a time that makes many women vulnerable and extra “social support” by caregivers can be totally valid. Especially for lower income or other vulnerable women, prenatal care is an important time to support them so that they can make healthy choices for themselves & the baby. It really is different from other kinds of medical care. Part of this is because we have such crappy social supports for mothers in this country in general, so their OB or midwife may be one of the few people looking out for them, but I digress …

      • lawyer jane
        March 10, 2014 at 2:03 pm #

        Also, it’s is this precise vulnerability of pregnant women that makes it even MORE important that they be protected from charlatans …

      • Elizabeth A
        March 10, 2014 at 2:07 pm #

        I would be way more impressed by the long appointment as a means of providing low-income women with social support if there were compelling evidence that midwifery care was meaningfully available to low-income women.

        My OBs, and later, my child’s pediatrician, did a lot to try to ensure that I had adequate and appropriate social support. Our pediatrician, in particular, went all out to hook us up with helpful resources at a time when our family income was zero. Prenatal care within the hospital system can be a powerful tool for helping families, but it is not clear to me that midwives (who work mainly with well-off women) are as capable of providing their clients with connections.

        • lawyer jane
          March 10, 2014 at 2:45 pm #

          Good points. This is far beyond my field of expertise, but I do know that there is at least one CNM birth center in my city that is supposed to be focused on low-income mothers … but guess what, it is now mostly high-income mothers who use it!

        • March 10, 2014 at 2:55 pm #

          But social support in a professional capacity needs to be done with a lot of training in counseling or social work. Most midwives do not have that.

    • Elizabeth A
      March 10, 2014 at 2:03 pm #

      They’re getting to be friends. Which is a selling point if you want friends. But not a selling point if you think it through too much.

      I think there is a real complaint that the long appointment is intended to address – doctors are very busy and appointments are often rushed. But I think the long midwifery appointment is, at this point, fetishized well beyond it’s effect on quality of care.

      • OBPI Mama
        March 10, 2014 at 2:38 pm #

        Most of the talk is not about care. It might be about birth (your attitude towards it, how you’re feeling about it, etc), but it’s not about your care.

      • PrimaryCareDoc
        March 10, 2014 at 3:48 pm #

        See, and I am firmly of the opinion that you should not be friends with patients. Respectful, kind, empathetic-yes. Friends- no. Because a good part of being a doctor is telling people things they don’t want to hear. For me, it’s that I have to tell people to exercise and lose weight and take their medicine and NO I WON”T GIVE YOU VICODIN.

        For a midwife, you might need to tell a patient that she is going to have to give up her dream of a vaginal, med-free birth.

        And we don’t like telling our friends what they don’t want to hear. That’s why there are professional boundaries.

        • Elizabeth A
          March 10, 2014 at 4:07 pm #

          I have frequently received excellent care from doctors and nurses who never met me before and are unlikely to ever meet me again. It is far more reassuring to me to know that there are professionals who care for everyone then it is to feel that I am paying someone to be the kind of “friend” who won’t help if I can’t pay or she’s annoyed at me.

        • StaCeyjw
          March 10, 2014 at 6:17 pm #

          It is so strange to me that anyone has a dream of having a NCB. What a weird world, where the most privileged women dream of labor w out pain relief, like the “ancients” and “tribal people”…..
          just what came to mind reading your comment 🙂

        • MJ
          March 10, 2014 at 7:45 pm #

          The medical clinic I attend has lots of doctors and they’re all great, but my favourite is harsh. At the end of one appointment many years ago now she said ‘come with me’. We walked down the hall, she pointed at the scales and I got on. When we got the measurement she just looked at me and raised her eyebrows (yes, I was quite overweight). She might not do that with everyone but I loved that she knew she didn’t need to pander to me, or give me a lecture, or make me feel like a naughty child. She treated me like a grown woman who knew the implications and knew what had to be done. In my appointments with her since then she’s always asked the hard questions. Bluntly. And because of all of this, I trust her implicitly.

        • The Bofa on the Sofa
          March 10, 2014 at 10:08 pm #

          I used to think that it would be easier for me, as a patient, to open up to a doctor if there was a more personal relationship. However, over time, I’ve come to realize that, that’s exactly wrong. It’s a lot easier to tell your most embarrassing personal issues to a complete stranger, as long as you recognize that the person is a medical professional (no, I won’t start telling you if we meet on the street).

          It’s a lot less embarrassing to be naked in front of someone who has seen a zillion naked bodies and you are just another than by someone who is a close personal friend (but not that close).

          Who would you rather give you a rectal exam? A close, personal friend (but not that close)? Or someone who is doing his 8th rectal of the day? Who is going to make you more embarrassed? I gotta say, I don’t want my friends sticking their fingers in my butt.

    • AlisonCummins
      March 10, 2014 at 2:16 pm #

      They are confirming that they have the same priorities.

      When your friends are pregnant, it’s exciting. When you are pregnant, it’s the most important thing in the history of the universe. Your midwife agrees with you about how important your pregnancy is. You want to talk about it, she does too.

      • AlisonCummins
        March 10, 2014 at 2:20 pm #

        (I’ve never been pregnant. I’m basing this on a combination of observation and what it feels like to be in love — can’t think/talk about anything else! — and what it felt like when my mother died — really? people endure this thundering tragedy all the time? how do they do it?)

        • RebeccainCanada
          March 10, 2014 at 3:29 pm #

          For me a lot of the reason why I once chose midwifery was because my OB was cold and impersonal, and in a huge hurry. The staff at hospital were unkind at times, hurried and impersonal. They didn’t treat you like a care partner. My frustration was when they provided poor care, like not offering me meds after a vaginally birth, then later when the pain was too much lying on my chart saying I turned down pain meds. My husband was furious. I felt I just got poor care.

          My midwife used the time just like Dr. Amy said to teach you to mistrust everything your OB did, “did he pull on the cord?” Then tell you that was so dangerous, and that she would never do that…. It also took her time to try to talk me out of testing, ultrasounds (she couldn’t convince my dh) then to gently encourage me that it was my decision, not dh’s….. Took lots of time to try to lull you to sleep, and only trust info that came directly from her. That’s where her loaning library came in. 😉

          • Karen in SC
            March 10, 2014 at 3:47 pm #

            I have been in the hospital for two births, four surgeries, and two overnight observations for chest pain. I don’t remember any kindnesses. I understood that each nurse has the responsibility for multiple patients and I’m okay with no kindness.

            Professionalism, expertise and respect, yes. One ER doctor answered my questions thoroughly and when I asked based on her experience, was I having a heart attack she said no, and I felt immediately better. I’m sure some of my care was delivered hurriedly or impersonally, but just as much wasn’t.

            Poor care should be reported, even rushed care, but impersonal I’m okay with.

          • RebeccainCanada
            March 10, 2014 at 3:55 pm #

            What I mean is nursing staff forgets to bring the package with peri bottle, all the while saying that “you’re an expert, you’ve done this before” so I thought I wasn’t getting one because it was for first time Moms. Then when I mentioned it the nurse seemed annoyed and told me I should have asked for it right away. Also yelling at a patient for carrying a baby instead of wheeling the heavy basinnet and the iv pole? I really have seen them be downright rude. And chastising me for refusing meds and letting the pain go too long, when it was clearly a lie? Patients should be treated kindly, it’s part of nursing professionalism. They certainly shouldn’t be bullied. My sister and mother are nurses and talk about this stuff all of them time. Good care/bad care.

            I’m sorry but it happens. I like the hospital here, I’ve only seen respect for patients shown.

          • Karma Kidney Stone
            March 10, 2014 at 5:24 pm #

            Not to be rude, but, why does it matter? I’ve had 4 hospital births, and I’ve had snippy nurses. With my first birth, I progressed really fast, even though it was a premature induction. I told the nurse I had to push and she rolled her eyes, and gave me the sure you do honey look. By the time she got around to checking the baby was crowning and she had to go running for the NICU staff and OB. Meh. So what? She’s a jerk. I didn’t decide to risk my life or my baby’s life by having a homebirth because of it.

            It’s a mixed bag, I’ve had some great care providers, too. As long as I’m taken care of medically, I can turn to my family to support me emotionally. I’m not there for an ego boost, but for medical care.

          • Guesteleh
            March 10, 2014 at 11:12 pm #

            It matters because not everyone is as self-assured as you. Many patients in the hospital system are poor, illiterate, uneducated, chronically ill and primed to distrust authority and institutions for extremely good reasons (for example, African-Americans, who have the history of the Tuskegee study). Rudeness is not something they will brush off. Instead they will avoid the hospital until they are very ill and have no choice.

            I’ve worked with doctors and nurses for years and the good clinicians I know aren’t rude to patients. They may not be warm, fuzzy kumbaya besties with you, but not rude, not mean, not contemptuous. That’s just abusive. No excuse.

          • RebeccainCanada
            March 11, 2014 at 10:35 am #

            Being kind to patients is now about an ego boost? Please don’t deal with the public!

            Why is it when you’ve just had a baby and it’s a very happy moment people should be kind? I’m not referring to kindnesses (see PrimaryCareDoc’s comments that kindness and empathy are required) but being kind, not rude, not taking your bad day out on patients.

            When you need some compassion, because you are scared, you’ve had devastating news? But hey, the nurse providing your care is A-ok to treat their patients any way they like.

            Birthing Centers are growing in popularity, homebirth is growing in popularity, it’s consumer driven. Would you put your kids in a Day Care where staff was snippy with them but got the job done? Or would you rather the environment was a kind one, where bringing your bad day and your attitude to work was ok? This isn’t insecurity of patients, it’s expecting better. And we should expect better from Professionals!!!

          • RebeccainCanada
            March 10, 2014 at 3:58 pm #

            See PrimaryCareDocs comments below.

          • Erin
            March 10, 2014 at 4:06 pm #

            I love this! As an ER nurse it is infuriating to me when “good service” scores are based upon being nice. F that, I want a competent provider that can save my life in an emergency situation.

            I wish more patients had your outlook on the medical field.

          • RebeccainCanada
            March 10, 2014 at 4:11 pm #

            Apples and oranges though. In ER services our trauma situations I’m not advocating for kindness in all situations, although it’s still part of professionalism.

            We are discussing L&D, and obstetrics and maternity care.

            I had a 12hour stay in ER this fall, and I was very grateful for the compassionate care I received from the Doctors and nurses and my husband did too. Because you aren’t always getting good news.

            If you want people to come back to hospital emphasis on this would help enormously.

          • Klain
            March 10, 2014 at 10:00 pm #

            A kindness I had was when visiting emergency in England with an 8 & 4 year old and while they were still running tests on me one doctor went and got sandwiches for the kids as it was dinner time.

    • AllieFoyle
      March 10, 2014 at 2:19 pm #

      Read the page Dr. Amy links to above. They’re building trust and rapport with the woman so that she will shower them with adoration and respect and hang on their every word.

      • Medwife
        March 10, 2014 at 8:59 pm #

        I have found CPMs to be quite open about the fact that having close relationships with their clients protects them from being sued. They don’t see anything wrong with that line of thinking. Pretty awful.

    • March 10, 2014 at 2:21 pm #

      When you’re playing lay-psychologist at the same time – I can see how that could take an hour.

      • Bombshellrisa
        March 10, 2014 at 6:07 pm #

        It must be the life coaching they do as well as being “birth workers” coming out there.

    • OBPI Mama
      March 10, 2014 at 2:35 pm #

      They talk about how messed up doctors and what they believe are (guilty), how horrible hospitals are, they talk about home life stuff, they talk about birth stuff (yes, from first visit and on), herbs/supplements/nutrition, etc. Just about everything! You leave the appt. feeling like you had a visit with a friend (except for the peeing in the cup and listening to heartbeat).

      • CognitiveDissonaceHurts
        March 10, 2014 at 4:50 pm #

        At our clinic, there would be snacks, books, and other pregnant or newly delivered moms and babies to socialize with. It was a social event, not an appointment.

    • March 10, 2014 at 2:52 pm #

      Their fears and hopes and everything that makes them human. I never used up an hour but it was really nice to know the time was there in case I wanted to talk. Not everyone who is into that approach is into NCB, Gabor Mate is probably one of the best physicians I’ve heard speak about humanizing care for his patients. He works with drug addicted and HIV patients with a high rate of homelessness, so he isn’t saything this as someone with patients who are easy to deal with. The attraction of personalized attention is a huge draw of virtually all alternative medicine. Just being prioritized and treated kindly can make people feel somewhat better.

      • AlisonCummins
        March 10, 2014 at 2:59 pm #

        Good doctors can communicate kindness and their focus on this patient right now into their routine appointments. It doesn’t have to take an hour, it just takes more skill to do it in ten minutes. Someone (not me, but this is exactly how I feel) wrote this about my GP on an online doctor-rating site: “Dr. N____ is warm, careful, conscientious and makes me feel as though taking my blood pressure is the most important thing she has to do right now. I trust her with my life.”

        • RebeccainCanada
          March 10, 2014 at 3:19 pm #

          Seattle Mama Doc seems to be a great Doctor and talks about the moment she gets to the door knob as the moment the biggest questions come out. No ten minutes isn’t enough especially when there’s stuff to do, and you haven’t had a chance to ask a question yet. She readily admits this as being a big problem as a pediatrician. Also the factor where a question is asked and the Dr doesn’t have an answer, yet. Many Doctors feel the pressure to have an answer so might try to fudge it or give you a brush off. Neat how much time she explained she would put into the evening follow-up call (calling a colleague for consult, doing some reading and finally calling up the patient) I listened to her interview with the reporter Seth Mnookin (Panic Virus) Great stuff! She had some great points.

          • RebeccainCanada
            March 10, 2014 at 3:21 pm #

            I also think when they are willing to step away from the door and sit back down to listen at 12min mark, you’ve got yourself a good Dr there. 😉

          • Dr Kitty
            March 10, 2014 at 5:48 pm #

            I have had 10 minute appointments turn into 45 minute ones, when the have to.
            The actively suicidal person, the really sick person who doesn’t want to go to hospital, the victim of domestic violence, the person who has just got a terminal diagnosis…
            Those consultations take as long as they take.

            You apologise to the subsequent patients, explain you were dealing with an emergency, and hope they take the hint that today they should maybe just deal with their big issue, and reschedule to talk about minor things.

            If anyone makes a fuss, I just tell them that if it was them who needed the extra time they would want me to spend it, and while I apologise for their inconvenience, there was no way to be quicker without compromising care. Then they get it.

          • KarenJJ
            March 10, 2014 at 7:21 pm #

            I’ve spent an hour at some of mine or my child’s specialist appointments. But there was a lot of information to be going over at these appointments.

          • Amazed
            March 10, 2014 at 7:40 pm #

            My mom still thinks one of the kindest things someone ever did for her was what that old grumpy professor who treated my brother did. His pancreas almost killed him when he was seven and he survived against all odds (his vital signs were about 54 times over the limit) but even after he was proclaimed on the mend, it was hard. Partly because she had a very active 7 year old who simply couldn’t understand why his life was so changed and his activities cut so short. I think he really forgot just how sick he was, the months he spent in the hospital and so on. He wasn’t making it easy for her and he was having the hell of a bad mood and being rebellious as they waited at the professor’s office. The professor and the nurse both saw that my mother – who was not their patient – was in a poor way and gently but firmly suggested that she left. She did so, reluctantly, and guess what? She came back a little calmer. He had calmed down, too. And his results showed that he was getting better.

            Those were doctors who didn’t know her all that well. They knew her only as that sick kid’s mom. But they knew what they both needed at that moment – and it was caring of them without being friends.

          • Haelmoon
            March 10, 2014 at 9:07 pm #

            I am a perinatologist and I routine book 30-60 minute appoints for first visits. But these are usually complicated cases. I take their history, do an ultrasound (sometimes a full repeat anatomy scan) and review results with the patients. I then make plans for follow-up. Some of these patients don’t even need all of that time, even when I turn their worlds upside-down. I could not imaging each and every visit lasting this long. Longer visits are useful when needed, but when seen in follow-up most moms just want to know things are fine and then go on with their day.

          • R T
            March 11, 2014 at 1:00 am #

            My first appointment with my Perinatalogist he spend almost three hours with me! His office closed at 5:30pm and he stayed with me until 7pm. All the staff went home. When my friend and I left the appointment there was no one left in the building. I had a medical record as thick as a book and he poured over it in detail with me. He did two different types of u/s and he discussed my options with me. It was the most amazing experience! I couldn’t believe he would take so much time! I had been begging his office staff for an appointment for 5 days for an emergency second opinion for a SCH turned partial abruption at 20 weeks. The MFM I was seeing wanted me to abort due to my blood loss and refused to do anything to stop contractions I was beginning to have. She told me the pregnancy would end within the week. I finally got a call saying he’d had a no show if I could be there in 30 minutes! It was so lucky because I ended up having a huge bleed the very next day and he hospitalized me and took over my care. He had told if I had a major bleed within 24 hours I needed to go back to the first hospital because they had blood ready for me. However, when I showed up at his hospital the next day bleeding and crying telling him I wasn’t going back there, he took over without hesitation.

          • Haelmoon
            March 11, 2014 at 1:04 pm #

            Thankfully, I am on salary, but that does not stop me from staying late. I am normally scheduled from 8-4 in the clinic, but I rarely get home until six because I visit my inpatients too. Recent I went in on a Saturday to talk to a family in the ICU – I was there for six hours. I was not there to be their friend, but to help them make difficult decisions. I have been the patient of a perinatologist too (helped me decide to do a fellowship, as I was a resident at the time), I don’t want them to be friends with their patients. There are too many difficult choices to be made.

          • Mishimoo
            March 10, 2014 at 7:54 pm #

            We had that with one of our GPs who announced to the waiting room once everything was done: “I apologise for the wait, but someone just tried to die on us, which I simply couldn’t allow. Damned inconvenient things, heart attacks. We’ll see you all as soon as we can.”

          • March 10, 2014 at 9:34 pm #

            As a nurses kid I know this, so I’m always the patient waiting…patiently. I’d rather know that if *I* need extra time I’ll get it.

          • AlisonCummins
            March 10, 2014 at 5:46 pm #

            Ten minutes may or may not be enough for an appointment, but it should be enough to communicate to your patient that they are valued.

          • KarenJJ
            March 10, 2014 at 7:19 pm #

            “Doctors feel the pressure to have an answer so might try to fudge it or give you a brush off. ”

            This happens a lot I think. I’ve had a doctor say “maybe my red blood cells don’t last as long as other people’s” in response to a negative test for Thalassemia where the lab report said “anaemia of chronic disease”. And thenI was out the door… In retrospect and knowing what I know now that needed further investigation. When I tell this story to other doctors they cringe, but I thought it must be something that happened regularly enough with the off-hand way it was delivered.

    • March 10, 2014 at 5:30 pm #


      I got almost as much “therapy” in cult as I did getting deprogrammed from it. It might not get called that, and it hardly matters, as what it really is is more like Grooming & Indoctrination.

      • Mishimoo
        March 10, 2014 at 7:51 pm #

        “Here, let me pull apart your mind and reassemble it in a way that is more pleasing to me.”

    • R T
      March 11, 2014 at 12:28 am #

      In my experience, the midwive talks for half an hour about her recent amazing vacation to France where she did acid and MDMA. Then moving on to discussing, for about 25 minutes, how the mother needed to work on healing her emotional trauma from her own birth by csection so she wouldn’t end up giving birth the same way. Finally, she listened to the baby’s heart tones for a few minutes. Yep, that was the whole hour!

      • March 11, 2014 at 2:27 am #

        You’ve got to be flexible. Some women are perfectly happy to stand on the scale, stick out an arm for the BP, pee in a cup, and goodbye.

        Others are not. A “casual” question about sex by a patient can lead to a discussion where one discovers there is domestic violence, or a patient needs dietary advice, or she is having all kinds of anxieties…there have been times when I’ve needed a great deal of time with a patient. One of the things I love about my profession is that I have to wear a multiplicity of hats.

        During NSTs, for example, there is time to talk, and it’s quite amazing sometimes what patients bring up.

    • mamaellie
      March 11, 2014 at 11:47 pm #

      At my postpartum appointment we talked for a while about my midwife’s husband’s lack of employment. Apparently he had been unemployed for over a year. I didn’t make the connection right away between her allowing me to go to 42+3 without even a NST, and her dire financial straits.

  15. Happy Sheep
    March 10, 2014 at 1:56 pm #

    Dr Amy, you mentioned that you are in contact with the parents of Gavin, please send them my compassion and empathy.
    I have cried many tears over this tragedy, and I know this is nothing compared to the river of tears shed by the family, but I hope they know there is a whole community here crying with them and sending our thoughts to them.

  16. Captain Obvious
    March 10, 2014 at 1:40 pm #

    Midwife by proxy, I mean Münchausen’s by proxy, or by Internet, or Münchausen’s by pretending to be midwife.

  17. Jennifer Delaney
    March 10, 2014 at 1:37 pm #

    Dr. Tuteur, the only argument I have in your post above is this “Christy knew that Gavin might die. She understood both that a doctor would tell that to Gavin’s mother and that it would be true.” Having been in that culture, I can testify that many many midwives actually do not know and are utterly shocked and devastated when the baby dies. They truly have bought the entire “Trust Birth” fallacy, as I once had, and although they do know that the Dr. will likely tell the patient that the baby could die, they, themselves have the ultimate (and wildly optimistic and foolish) faith and belief that everything will end up just fine and everyone will come out alive. It’s absolutely un-believable, to most logical persons, but it’s absolutely true. It’s what makes the current homebirth culture in America extremely scary and dangerous. Many of these midwives truly cannot fathom, until it happens to them, that the baby could actually, truly die. Writing this just feels ridiculous, because how could someone be so incredibly brainwashed and in turn, brainwash their clients/patients? But it is what is happening. And every birth where there was a close call, but mother and baby survive, every birth that goes easily, a “butter birth”, every time there is “success” measured by the zero mortality, not lack of injury, reinforces this cult-belief that Birth is Safe and Interference is Risky. Carly Hartley, Jan Tritten and Ina May, not to mention scores of other “birth professionals” have created a modern midwifery scene that includes most of what you can read on “Natural News” and other bunk websites touting their latest products (follow the money, always) and contantly puts women and infants at risk of DYING. But there are more and more women lining up to plop down upwards of $2,500 per to experience this amazing, magical, mystical thing that is homebirth. Their marketing, tinged as it is with a healthy dose of cult behaviors and mystical things that must be believed rather than proven, is rather amazing. Thank you for continuing to fight for the unborn, the nearly-born, the just-born. Thank you. I know it must be incredibly taxing and emotionally draining to continue on, in the face of constant new tragedies. I ache, as so many others do, for these newest loss parents. I am devastated anew for the loss of yet another perfect baby who WAS meant to live.

    • Captain Obvious
      March 10, 2014 at 1:43 pm #

      Then why did Christy go for BPP and handheld NST’s? Why did Christy even bother to contact Jan? Apparently, Christy didn’t completely trust birth.

      • March 10, 2014 at 2:05 pm #

        It could be that she just literally had no clue what she was doing, and thought the handheld doppler NSTs were what a professional would do. A lot of people go through the motions in life when they are clueless. I don’t think there is a way to know someones intentions with any real certainty, she is either callously unconcerned with the well being of others or she is just deluded about her professional capabilities. Either way people like her represent a danger to the public.

        • Amy Tuteur, MD
          March 10, 2014 at 2:29 pm #

          I suspect that she was desperately attempting to minimize the possibility that Gavin’s mother would leave her. It was bad enough that there was no fluid on ultrasound and that one doctor had told the mother that the baby might die. If she let Gavin’s mother go for an NST, she would undoubtedly come in contact with another doctor who might tell her that he baby would die. And there was also the possibility that the NST might be non-reactive, making it even more likely that Gavin’s mother would “abandon” Christy for the hospital.

          • NoUseForANym
            March 10, 2014 at 2:42 pm #

            Or even worse prove christy didn’t know what she was talking about and that doctors actually do. She probably spent a good deal of time disparaging doctors to the family and here own worldview was also at stake. To me that’s more likely than this borderline personality type frantic attempts to avoid abandonment. Remember one of the biggest betrayals in the homebirth community is to start thinking doctors and hospitals actually are safer. These people make homebirth their God and their ‘knowledge’ and everyone else’s ‘ignorance’ another God.

      • AllieFoyle
        March 10, 2014 at 2:16 pm #

        The handheld doppler is an accoutrement that reinforces her position as an authority figure, a real professional. It’s not consistent at all with the trust birth dogma, but midwifery seems to be practiced buffet-style. Some of them are completely hands-off, some use weird herbs, others do prenatal testing and carry medical devices and medications (How many times have we heard “My midwife carried blahblah, just like a doctor”), but often it seems they don’t actually know what to do with the information they receive. It’s really just an accessory for playing dress up.

      • Jennifer Delaney
        March 10, 2014 at 2:18 pm #

        within that mindset, yes, there are doubts, there are those who only partially believe the mantra, or perhaps she was acting to pacify the parents? Perhaps she felt that to help them homebirth, getting reassuring BPP’s would be something to use as evidence that “everything is fine”. I really don’t know. I can just tell you from my own experience that most of them truly do not believe it will happen to them. Willing suspension of disbelief and creating a “superhero” out of the idealistic midwife and then the actual midwife. When things fall apart, such as a death, they REALLY fall apart, because the family, the midwife and others have completely bought into this scenario. The hero ALWAYS saves the “victim”. When it doesnt happen, then the dissonance is more than some people can handle. Some midwives have stopped practicing (thankfully) after one loss. Others are brainwashed, in the cult environment, to keep going, that THEY are wonderful midwives (superheros) and such a loss was simply totally unpreventable. They accept that lie which is easier to swallow than disrupting their entire life-view.

        • yugaya
          March 10, 2014 at 3:11 pm #

          I have been reading a lot of what is out there and I agree that there are a lot of brainwashed midwives that truly find themselves in shock when something that conflicts their system of natural child birth beliefs happens, like a tragic death of a baby that modern medicine would have not allowed. But the scary part is that there is also a very menacing conslusion one can logically derive from the bulk of writings, statements, manner of communication and even actions of the upper ranks leaders like Ina May Gaskin and Jan Tritten, which is also the view of the most extreme followers be it midwives or mothers – that there were, are and will be babies who are ‘just not meant to live’ because they cannot survive unmedicated natural child birth.

          How many mothers would trust the natural child birth cult(ure) or their own lay midwife if they understood the deranged, sick nature of what these people believe are acceptable risks and outcomes of a pregnancy? Not many, or at least not as many as we see buying into it.

          • Amy Tuteur, MD
            March 10, 2014 at 3:48 pm #

            The homebirth midwife definition of a baby “not meant to live”:

            A baby who could have survived if the midwife hadn’t valued her own emotional fulfillment above the baby’s need for expert medical assistance.

    • Trixie
      March 10, 2014 at 1:56 pm #

      I’m not buying that in Christy’s case. I don’t know (can someone find out?) what the circumstances were that led to her conviction in CA in 2011, but it’s almost certainly tied to a previous very bad outcome. She knew what she was doing and made a calculated decision to move to the state where she was least likely to face legal consequences the next time shit hit the fan.

      • yugaya
        March 11, 2014 at 4:43 am #

        I was thinking, what kind of people after getting caught doing something wrong and having been put on probation just move to a less regulated place in order to be able to stay in the same line of work? Certified Professional Criminals.

    • Amy Tuteur, MD
      March 10, 2014 at 2:21 pm #

      I agree that many homebirth midwives are surprised when a baby dies, but there are several reasons why I don’t think that Collins was surprised in this case.

      First, she emailed Jan. She was looking for reassurance that the baby would survive until labor began. She would not have sought that assurance if she wasn’t worried about the possibility that the baby was going to die in utero.

      Second, she ordered 3 BPPs in 2 days. That’s way outside anyone’s standard of care. You don’t order 2 BPPs in a day unless you are trying to stay one step ahead of a baby you believe is in imminent danger of dying.

      Three, she essentially admits that she should have told Gavin’s mother that her baby was in danger but didn’t do it because she didn’t want to compromise the relationship (“you would hate me”).

      Fourth, she understood that by telling Gavin’s mother that the doctor would tell her the baby was at risk of dying, she was deliberately engineering mistrust of the doctor, attempting to prevent Gavin’s mother from leaving her care.

      I’m not saying that Christy Collins is an evil, heartless person who wanted Gavin to die. She didn’t want Gavin to die at all. But it was more important to her to maintain the relationship of emotional dependence that she had created and she was willing to risk Gavin’s life to do so.

      • Trixie
        March 10, 2014 at 2:25 pm #

        I don’t know, seems pretty evil to me.

      • March 10, 2014 at 2:28 pm #

        There is so much about knowing and understanding that is behind the scenes though, there are always nagging doubts or unarticulated thoughts that drive our behaviors. It isn’t as though any of us have a clear picture of our own minds at any given time, there is no such thing as total self awareness. Christy’s actions don’t seem to make sense a lot of the time, it leads me to believe that she is trying to deal with some cognitive dissonance regarding her beliefs about birth. It just smacks of someone in way, way over their head.

      • AllieFoyle
        March 10, 2014 at 2:34 pm #

        She reminds me of a gambling addict. She knew the stakes were high and she could lose big but she just couldn’t stop herself and put all her chips on home birth even though the baby’s life was at risk. She should never have had that power.

        • Comrade X
          March 10, 2014 at 5:05 pm #

          “She knew the stakes were high and she could lose big….”

          Problem is, the stakes weren’t hers to gamble, and she isn’t the one who lost big. Gavin lost big. Gavin’s mum and dad lost big. Gavin’s extended family lost big. She’s now basking in sisterly hugs and good wishes and working on “forgiving herself”. And she probably fully intends to “gamble” again. With someone else’s life. With someone else’s much-wanted child.

      • Amazed
        March 10, 2014 at 5:53 pm #

        Fifth, she was a Sister in Chains. She already had a less than stellar outcome with a baby other than Gavin. She actually moved because she was “persecuted”. By the way, how am I supposed to believe that those poor midwife have nothing (so you cannot truly sue them) and help mothers only out of altruism when they can move at the other end of the country and start anew every time they feel like it? I cannot do it and I don’t even pretend to be poor.

  18. AllieFoyle
    March 10, 2014 at 1:30 pm #

    I think you are really getting to the crux of the issue. It’s all about emotional manipulation. It’s never felt right to lay the blame at the feet of the mothers choosing home birth. In my experience, most women are simply choosing something they think will be best for the baby. Why do they think this? Because it’s what they’ve been told over and over…by midwives and natural birth proponents (who, up till now, have cornered the market on childbirth propaganda/disinformation).

    These people want to control the whole conversation. They’ve framed the issues in language that makes the medical community seems suspect (“cascade of interventions”, “unnecesareans”, “non-evidence based practices”, convenience deliveries, “impatient to cut”, etc.). They worship their (bizarre) leaders in a cult-like fashion. Discussions can only take place in protected spaces where dissenting voices have to be stifled. And ultimately, they seek to control the thoughts, behaviors, and emotions of the women they are supposed to be serving by limiting any outside influences or sources of information.

    In any other context, their need for obedience and adulation, their narcissism and ignorance, their utter inability to think critically and act ethically would be cause for ridicule and failure, but because midwifery for some reason is still allowed to be practiced without consistent standards and regulations–unlike any other medical or health-related practice–these people are allowed to continue inflicting their dangerous practices on innocent women and babies, with horrible results.

    • March 10, 2014 at 1:38 pm #

      Agreed. I don’t think it’s always the money, although we’ve seen plenty of evidence that money is a motivator. I think a lot of people aren’t able to recognize that emotional power and control over other people is absolutely a stand alone motivator. Hate to use my cult leader as an example yet again, but… He escapes culpability because he is accused of seeking money, but in actuality is happier being completely broke; it makes him seem humble, and gives him an out. “YOU know ME, I don’t care about MONEY…”

      • NoUseForANym
        March 10, 2014 at 2:47 pm #

        The adulation…adoration, respect, power and money. Even more, it’s about being RIGHT. Think how much time homebirth advocates spend in echo chambers and how much they refuse to allow any dissent or ‘negative’ information in. It’s exceptionally important that they’re right and everyone else is wrong, as that is the root of their power, prestige, etc.

        • Karen in SC
          March 10, 2014 at 2:50 pm #

          And all those close calls mean they are RIGHT.

          When it goes wrong, as it inevitably will, then it must be the mother who was wrong.

      • Comrade X
        March 10, 2014 at 5:15 pm #

        Am I correct in thinking that many of these “midwives” (I refuse to call them midwives, for they are not) are paid up-front well before the point of delivery of the child?

        If that is the case, and it were *ONLY* about the money, then transfer rates would be very high. After all, you’ve pocketed the cash, mum and dad aren’t getting a penny back, might as well offload mum onto properly-trained people ASAP rather than risking anybody’s life and/or reputation, right? So the extreme unwillingness to transfer does seem to speak of something else going on besides a simple desire for remuneration.

        • yugaya
          March 10, 2014 at 5:43 pm #

          Transfer is considered to be a rather unfortunate outcome, not because lives were in danger but because when transfer happens there is no more ‘beautiful’ homebirth. And no one wants to hire a midwife with such poor (high transfer) track record, which in their minds is kinda proof that she probably does not ‘trust the birth’ enough.

          So I think that the money argument here is that a midwife will get more clients based on how low she is willing to go before dialing 911.

        • schnitzelbank
          March 11, 2014 at 12:02 am #

          No, it’s not just the money– it’s about the glory of holding a new life in the balance. It’s a total ego trip for the midwife. I had two hospital births with different OB’s, and they both seemed to have a smidgen of that triumph when my kids were born, too. I can see the draw: the process is awe-inspiring. The difference between the gleeful CPM and gleeful OB: the OBs actually have the training and facilities to save lives, when shit goes sideways.

    • Busbus
      March 10, 2014 at 11:45 pm #

      Let me just say right now that this post is absolutely great, and the discussion here in the comments is amazing. Thank you, Amy, and all the posters here in this incredibly meaningful discussion!

  19. March 10, 2014 at 1:21 pm #

    I think they control other people so they can brag about how they delivered some crazy high risk pregnancy ‘safely’. Its madness. Its betting on other peoples lives.

  20. The Computer Ate My Nym
    March 10, 2014 at 1:02 pm #

    t apparently never occurred to Jan Tritten to tell Christy to place the baby’s well being over her own emotional needs.

    Perhaps because Collins might lose faith in Tritten and be less under her emotional control if Tritten suggested bringing in an OB?

    • yugaya
      March 10, 2014 at 1:20 pm #

      The pattern of behaviour that shows how Jan Tritten and Midwifery Today have been actively encouraging, promoting and supporting lay midwives crowdsourcing on their forums and web pages for ideas what to do in medical emergencies in real time has been well documented. On this blog people have dug up year after year of individual cases in which they did exactly the same thing. Same perpetrators are also guilty of systematically downplaying the risks associated with post dates pregnancies over and over again. The most repulsive example of that is MIdwifery Today front page – in light of what happened their response is to recycle an old article that says that post dates pregnancies are a variation of normal:

      “Trick of the Trade WEEKLY FEATURE 2014.3.9 NEW!

      According to the medical literature, human gestation ranges from 36 to 44 weeks. That is a two-month range, not the EDC plus or minus two weeks. The mean length of time plus or minus one standard deviation gives the 38- to 42-weeks range, with 40 weeks the average, or mean…”


      I hope that there is a prosecutor out there who will bring charges not only against Christy M. Collins CPM but against Jan Tritten too. I hope that there is a jury out there that will award Gavin Michael’s family compensation sum big enough to shut down Midwifery Today permanently.

      • Karen in SC
        March 10, 2014 at 1:25 pm #

        It happens on Babycenter and Birth Without Fear as well, with equally tragic results.

      • Amy Tuteur, MD
        March 10, 2014 at 1:37 pm #

        Did you notice that the landing page also mentions knitting (!!) and includes a piece by death dealing buffoon Judy Slome Cohain who made up the idea of “treating” group B strep colonization by shoving garlic cloves in the vagina? It is impossible to know just how many babies have been killed by her nonsense.

        When you read Midwifery Today looking for medical knowledge, it is criminally ignorant. When you read it recognizing that it is a road map for ensuring emotional dependency of pregnant women and emotional fulfillment of homebirth “midwives,” it is nothing short of brilliant.

      • AllieFoyle
        March 10, 2014 at 1:38 pm #

        And I hope that legislators and public health officials take notice and do something to ensure that anyone presenting herself as a care provider to pregnant women has adequate training, clear practice standards, insurance, and meaningful accountability.

      • Trixie
        March 10, 2014 at 1:58 pm #

        It’s just a big FU to those poor parents, isn’t it?

    • March 10, 2014 at 1:24 pm #

      Oh, SNAP! And an excellent point. It’s a Pyramid Cult

    • Busbus
      March 10, 2014 at 11:57 pm #

      It really seems to me that once you stop “trusting birth”, everything unravels. That’s how it was for me, as a patient. Once I started to open my eyes to the fact that birth (especially birth without medical backup and supervision) is truly NOT safe – not least due to this website – I eventually had to start changing my complete belief system. Therefore, no midwife can ever say that. Ever. Not to her patients, not to other midwives, not in private, not in public – never. Once you admit that birth isn’t safe – that’s the end of homebirth midwifery. A few brave souls who started as homebirth providers have ventured there – see, for example, navelgazing midwife. But most will not be willing to take the consequences of going there. So they must live with the cognitive dissonance of kind of knowing that various situations and complications are dangerous but not being able to do what any other reasonable person would do, which is to seek (or recommend) medical care that is safe.

  21. Ra
    March 10, 2014 at 12:49 pm #

    I do not agree with the premise of unassisted childbirth, but this link in the unassisted childbirth section on Mothering.com shows even more of the same emotional attachment: http://www.mothering.com/community/t/1398172/midwife

    ” It feels like firing a really nice friend and I don’t want bad feelings.”

    “Except, we feel like friends and dont want hard feelings. how do I say “we don’t need or want you” in a way that doesn’t burn bridges or cause offense? I don’t want her to feel like I am dismissing her profession.”
    I’ve moved several times in the last decade, whih means that I’ve also switched healthcare providers many times in the last decade. Never once did it even cross my mind that I was causing bad feelings by switching. There is one doctor that I truly miss though; but, it has nothing to do with us being friends. He was able to accurately diagnose a condition that had evaded others, and that diagnosis really helped me out. If I lived closer to his office, I would still go to him.

    • R T
      March 10, 2014 at 3:28 pm #

      Some people say my Perinatalogist is too cold and not friendly enough. All I know is he saved my life and my son’s life! I wrote a review online for him and said

      ” I know some people say Dr. C is abrupt or cold, but I think he has a great sense of humor, he always makes me laugh, and he is very efficient. He seems like a busy man who is very good at what he does and wants to give you the most pertinent information in the time he has. I didn’t choose him because I wanted a friend to socialize with! I hired him because he knows what he is doing and I believed he could help me and my unborn child! I was right!”

      I don’t get why people think feeling like their midwife or OB is their “friend” is so important. I’m much more concerned about their knowledge and ability. One Dr. C’s back up doctors was extra friendly and would hug you and talk about his personal life and I vastly preferred Dr. C’s style!

      • CognitiveDissonaceHurts
        March 10, 2014 at 4:19 pm #

        If you look back at the history of midwifery, it was a neighbour who was called upon to attend the communities’ births – that is where the friendship aspect started and continues to this day. Women seek this kind of care precisely because it offers a different kind of connection and relationship than they would get from an OB. I know that it is one reason why I did.

      • Josephine
        March 10, 2014 at 4:57 pm #

        I dunno, I adore my MFM doctor (who is acting as my main OB in this pregnancy as well) and I feel like we would be great friends in another context. I haven’t had that experience very often in my life with HCPs. HOWEVER, that’s only a nice perk and a bonus. I certainly do not expect to get along with everyone who provides care for me – the only thing I care about is getting the standard of care and being treated with respect. And no, respect does not require coddling and nursing my feelings, merely listening to my concerns as if I am a reasonably intelligent adult. There’s another doctor in that office who is definitely NOT a people person (she comes off a bit cold and efficient like your doctor does to some people), but I don’t mind it. She does her job well and if I occasionally have to see her, so be it. She’s never treated me poorly.

    • Awesomemom
      March 10, 2014 at 3:38 pm #

      It can happen in conventional medicine too.

      We are moving and going to be in an area where in theory we could still keep seeing the peds cardiologist that has been looking over my eldest son since birth. It is a bit hard for me but I think we are going to ask her from a referral to someone that will be closer to our new home.

      I had to encourage my sister in law to pick a new surgeon for my niece that was born with out her esophagus connecting. My SIL was worried about hard feelings and I told her that a surgeon that would explain things better and do a better job was more important.

    • yugaya
      March 10, 2014 at 6:35 pm #

      I am starting to believe people are actually gambling with better odds in unassisted homebirths – anyone other than a lay midwife is more likely to panic sooner and call and ambulance.

    • An Actual Attorney
      March 10, 2014 at 7:31 pm #

      I feel guilty when I cheat on my hair stylist. But, you know, she’s a hair stylist.

  22. OBPI Mama
    March 10, 2014 at 12:45 pm #

    My jaw dropped as I read this. This post could not be more true. My experience to a tee. I saw my former midwife last week as I was taking my son to his therapy appt at Children’s Hospital… she went for a hug and I hugged her back and exchanged pleasantries! Why??? Sigh… As she left I wanted to slap myself. I had wanted to ignore her the next time I saw her. Not say anything mean or whatnot, just to slip into the background. I was in a funk for a few days after that. I just typed out a letter I am thinking of sending her, asking her to ignore me next time she saw me. That it would make our journey a little easier because talking with her leaves me melancholy and kind of relive some of the feelings I’d rather not (or would rather do on my time and when it’s best for me). I wanted to read it to my husband to make sure it wasn’t rude or anything, but he did not want to hear it at all or talk about it… We’ll see.

    These midwives leave women a mess. An emotional mess. It’s horrible.

    • Trixie
      March 10, 2014 at 12:50 pm #

      I think you’d be entirely justified to be as rude as you want. You’d have been entirely justified if you flipped her off when she tried to hug you.

      She hugged you because she got off on still having enough power over you to force you to hug her. She wanted to test you to see if she could still manipulate you. In front of your son, at the therapy appointment for the injury SHE caused? She’s a psychopath.

      • OBPI Mama
        March 10, 2014 at 3:11 pm #

        Hmmm… I think power plays into it for sure. And I think she can rid or absolve herself of any guilt when her bad judgement calls cause injuries, death, and trauma; WHEN she can still be well received by the parents. She’s attended funerals of her client’s babies, she’s went to visit at a couple of her client’s baby’s deathbeds (they both ended up living… severe cp/brain damage)… she hugs us and then she thinks, “It all ended up as it should, maybe. They still love me, they will all be okay.” If no one makes her *feel* bad and welcomes her with hugs and pleasantries then she doesn’t have to feel guilty. I think that runs through her mind at least. That lady leaves me feelings so confused, frustrated, flabbergasted… I guess I don’t know what to think.

        Oh and the baby that died because they transferred to the hospital too late… a friend (an old, now distant friend of the couple) is in so much denial over the fact that homebirth caused it, she thinks it was a generational curse because there was an infant death in the family a generation ago… I wanted to beat my head against a wall when she said this.

        • Jessica S.
          March 10, 2014 at 6:59 pm #

          “And I think she can rid or absolve herself of any guilt when her bad judgement calls cause injuries, death, and trauma; WHEN she can still be well received by the parents.”

          Yeah, this is more what I was thinking when I read your original comment, that it’s an effort to assuage her guilt and reaffirm her work. I totally agree that she should be treated with the cold reception she deserves, and her past actions deserve, which is likely the worst punishment a person like that can imagine: rejection. I mean seriously, if this woman had a shred of self-awareness, she would’ve tried to avoid you. At least that would’ve shown she’s capable of experience some amount of shame.

          THAT SAID – while I’ve never been through what you have, I still know what it’s like to freeze up in those situations, and not use the voice you wish you could have. Confrontation makes me so uncomfortable, and I hate the idea of someone not being “ok” with me, even if I shouldn’t want to be ok with them in the first place! 🙁 I wish I was able to take the advice I can so easily offer to others. 😉

          • OBPI Mama
            March 10, 2014 at 11:37 pm #

            What’s weird is that she totally distanced herself from me after my son was born. She would not return phone calls and whatnot… then, if I ran into her,, she would be huggy and seemed like she cared about what was going on… I would say that is strange, but another friend of mine’s midwife did the same thing to her. No return visits, no phone calls to check up and see what happened, but then when she saw her in person it was all, “Oh, how are you? I think about you all the time? etc” hugs and all.

            Anyway, we are very similar in wanting others to be “ok” with us… I’m learning that sometimes though, it’s just not worth it. 🙂

    • MJ
      March 10, 2014 at 7:52 pm #

      I completely understand your reaction. A number of years ago I was put into a situation where I was going to see my estranged (for over a decade) father. I was poised and prepared, I knew how I was going to play it. But all that went out the window when I realised the old guy I’d been making small talk with for five minutes was actually my father whom I hadn’t recognised. In that moment I didn’t know what the f#*k to do so I leant in and hugged him. HUGGED him.
      Be gentle with yourself, OBPI Mama. You were caught off guard and flustered and it is to your credit that your instinct is to react with kindness and not hostility – no matter how undeserving of kindness your target was.

      • OBPI Mama
        March 10, 2014 at 11:38 pm #

        I’m so sorry for your story and also glad I’m not alone in my reaction!

  23. Trixie
    March 10, 2014 at 12:45 pm #

    Semi-OT: Dr. Grunebaum is still fighting the good fight on the MT Facebook page even though they keep deleting his comments. This lady is high risk with a rare condition and everyone else is suggesting rainbows and unicorns.

    • March 10, 2014 at 1:22 pm #

      wtf they deleted comments where he tried to help someone prevent another stillbirth? Just when you think they can’t get any worse…

      • yugaya
        March 10, 2014 at 3:42 pm #

        The original poster did not appreciate the doctor commenting and urging her to go see a specialist.

        That would be the same lady who left two different comments in that same conversation stating two very different things: in first comment she is asking if she should get a referral for a high risk OB which implies that she has not seen one yet; in second one she is getting all defensive about how her (wonderful) midwife has already referred her to a high risk OB whom she is seeing.

        • MLE
          March 10, 2014 at 4:16 pm #

          I wonder if someone messaged her to say that she could get her midwife in trouble by revealing that she hadn’t been referred. Trouble being scrutiny from the SOB.

  24. Zornorph
    March 10, 2014 at 12:45 pm #

    This is a very good post and it does explain a lot. You see so many women with CPMs talking about how ‘wonderful’ she is and how she couldn’t do it without her, etc. During my journey to becoming a parent, I certainly made some friends along the way. The head nurse at the IVF clinic, my contact person at the agency and of course the surrogate mother herself. And I’ve maintained this friendships, but I certainly wasn’t emotionally dependent on them at any time. I do wonder how many of those midwives retain a close friendship with the mother after the birth? I suppose some do – it would be a good source of referrals after all. But the way the midwives have been documented in some cases directing the mother to a hospital that was further away simply because a closer hospital wouldn’t allow the midwife in the room really does prove the point, doesn’t it?
    Overall, it just seems a bigger part of some weird cult of the perfect ‘motherhood’.

    • OBPI Mama
      March 10, 2014 at 12:49 pm #

      One of my dear friends told me that if K (the midwife) couldn’t get me to breastfeed, then it really must not have been possible! What the heck? Like she held some sort of secret knowledge that other lactation consultants and doctors didn’t have that would have enabled me to grow milk glands! sigh. There is definite midwife worship in homebirths… A definite dependency.

  25. AlisonCummins
    March 10, 2014 at 12:43 pm #

    “those should have been MY words”

    No, those should have been the perinatologist’s words. That’s why the perinatologist was doing the NST and not Collins.

    Collins’ words should have been something like, “I’m very concerned. If the perinatologist says your baby needs to come out now, listen.”

    I often have a very hard time when Amy Tuteur, MD ascribes motives to people she’s never met and of whom she has never conducted a clinical psychological examination, but for the life of me I can’t come up with an alternate narrative that could account for Collins’ need to be the only one her client will listen to.

    • Elizabeth A
      March 10, 2014 at 1:07 pm #

      I keep thinking, why even go for a non-stress test if you start out by warning the parents to ignore the peri? How do you sell that?

      And then I realize that the parents probably sought the NST because they were worried (being post-dates and all) and I come right back around to thinking Collins is evil.

      • Amy Tuteur, MD
        March 10, 2014 at 1:30 pm #

        Collins and Tritten are both profoundly unethical, but the fact that they can operate the way that they do has been institutionalized by MANA, NARM, Midwifery Today and a host of individuals from Ina May Gaskin on down.

        It seems to me that critical to abolishing the CPM is explaining to the public that these women are not medical professionals. They are lay people exploiting pregnant women for money and emotional fulfillment. That’s why MANA has no safety requirements, because safety is irrelevant. MANA essentially sanctions anything a homebirth “midwife” wants to do to maintain her hold over a patient.

        Homebirth midwives are, in a very real sense, emotional parasites. They cannot receive either money or adulation unless they control women by keeping them ignorant, sowing distrust of real medical professionals and isolating women from the family and friends who actually care about them and their babies.

        The ultimate “successful” homebirth midwife is one who kills or injures a baby but gets the mother to say that the midwife was awesome anyway. That is truly evil.

        • Comrade X
          March 10, 2014 at 5:24 pm #

          “Parasites” is definitely the word. I’ve actually had the word “vampiric” going around my head reading about all this.

        • Busbus
          March 11, 2014 at 12:59 am #

          I agree with stressing that they are not medical professionals, especially when it comes to communicating with people who are not at the core of the NCB movement. So far, everyone I’ve mentioned this to got kind of… quiet. These were not people in the NCB community, but still people who had been generally supportive of my homebirth. None of them had any idea that my midwife didn’t have a real medical education or anything I could follow up on. It made all of them uneasy.

          I don’t know, however, how much the argument helps with the true NCB-believers. Thinking back, I know that both the content and the general value of a “mainstream” medical education itself was seen as so questionable, as something that “indoctrinated” doctors and midwives into seeing childbirth as dangerous when it really wasn’t, as something that by its nature would keep you away from the “inner wisdom” and the “trust” which were all you really needed to make birth safe… In this world-view, having a medical education makes you a less desirable provider, not a better one. (Writing it out makes it seem really foolish, doesn’t it. And no one ever comes straight out and says that – but it’s the clear conclusion to draw from NCB literature and it colors the narrative of every NCB birth story I’ve read.) And that’s where the culture of avoid the hospital, avoid tests, don’t go in until the very end, lie to your HCP about when your water broke, etc. comes from.

          This is one reason I think it is important to keep talking about the babies and families that were hurt by homebirth. For me, at least, it was those heartbreaking and horrible stories that broke through my bubble first. Once I realized – really realized – that birth can, and sometimes does, go wrong, even if you do everything “right” from an NCB standpoint, even if you “trust” and no cold machinery is “messing up the process”, and furthermore, that you will be in a bad, bad, BAD place if that happens to you at home… that’s when it started to occur to me that the biggest tenet of the homebirth movement – that birth is inherently safe – is nothing but a fallacy, and a dangerous one at that.

    • March 10, 2014 at 1:29 pm #

      …Except that Christy Collins DID do the “NST” – with a handheld doppler! The peri did the “BPP” although I don’t know what was actually done – or how the peri office can possibly do BPP and NOT NST at the same visit.

      • Anj Fabian
        March 10, 2014 at 3:22 pm #

        Who ordered those tests? One of the many unanswered questions…

  26. Mel
    March 10, 2014 at 12:33 pm #

    “Instead of … telling you to “be prepared that the perinatologist doing the NST is likely to tell you that your baby could die if he doesn’t come out;” those should have been MY words.”

    That sentence to me shows a level of calculation that increases her moral culpability in my opinion. Collins KNEW that a medical professional would recommend immediate treatment (induction; C/S) and poisoned the well – in a nearly textbook fashion. This isn’t ignorance; this is active deception.

    • Jennifer Delaney
      March 10, 2014 at 2:22 pm #

      Active deception to protect her own self-deception. I honestly know that many of these women do this because they think, truly, that they are saving the woman and baby from unnecessary interventions. It’s sick, but it’s so so true

      • Anj Fabian
        March 10, 2014 at 3:21 pm #

        Yes, the rhetoric about the evil hospital and the dread interventions aren’t just fairy tales to midwives, they believe them.

        • Comrade X
          March 10, 2014 at 5:26 pm #

          Can anyone believe it to the point that they really truly think it’s BETTER to DIE than to be born by caesarean, or born with an epidural, or born with proper monitoring?

          • yugaya
            March 10, 2014 at 6:26 pm #

            Not just to the point where they think it, they will educate others too, because C SECTION KILLS YOUR BABY’S BRAIN CELLS!!! Everyone should be educated enough to attempt a breech home birth!!!

            I believe this is from spinningbabies dot com:

          • Mer
            March 10, 2014 at 11:40 pm #

            Her opinionis just so much more educated and evidence based isn’t it? She considers 39 weeks to be early, so in her world it is. Uh huh, even the 39 week nazis let the babies come at 39 weeks. Then the brain cell thing, yeah sure coming early will totally deprive your baby of more brain cells than hypoxia from depending on a possibly failing placenta during labor, sure just bend reality to fit your wants.

        • Busbus
          March 11, 2014 at 1:06 am #

          I fear that a lot of midwives do really believe it, or at least justify their less-than-safe behavior by thinking that, on the whole, avoiding tens of “unneccessarians” is in their patient’s best interest, or is what their patients want from them. Remember, these are people who never went to medical school – just like any dodo with an internet connection, they can believe whatever they want and will never be challenged on it by anyone unless they actively seek out other opinions (and, frankly, how many people do that?).

  27. The Bofa on the Sofa
    March 10, 2014 at 12:29 pm #

    Christy knew that Gavin might die.

    I mentioned this the other day as a real horrifying issue: even if we take Christy Collins at her word in her letter, the conclusion? She knew the baby was in danger, and was at risk of dying. However, she didn’t tell the parents because she didn’t want them to hate HER. It was about protecting HERSELF. Not them.

    That’s some real slime.

    The parents should be through the roof livid.

  28. March 10, 2014 at 12:25 pm #

    Well written and chilling. As the “designated cult survivor” (so to speak), you’ve really captured the tactics.

    • MLE
      March 10, 2014 at 12:31 pm #

      Your post on this should be a guest post.

    • Susan
      March 11, 2014 at 3:16 am #

      Kumquat, I don’t know if you remember but I share that designation.

      • March 11, 2014 at 11:09 am #

        That you do, along with others. I didn’t intend to isolate my fellow survivors – I meant the “designated cult survivor” as a bit of facetiousness since that’s primarily what I blog about and the aspect that I’m most apt to comment on. I’d never claim to truly be the only one, I’m just a snowflake in a blizzard 😉

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