How homebirth midwives respond to a baby’s death

Interracial Medical Business Team Meeting in Boardroom

If you needed any more evidence that homebirth midwives (CPMs, LMs, DEMs) are not medical professionals, compare the way that they respond to the death of a term baby with the way that real medical professionals respond.

For doctors and certified nurse midwives (CNMs) there would be a lot of soul searching both informal and official. At a minimum, the case would be presented at weekly Grand Rounds and discussed with the entire department. The obstetricians and CNMs involved would most likely be required to meet with the head of the Obstetrics department to explain what happened and to determine how to prevent it from ever happening again. There might be grief counseling for the nurses, midwives and physicians and there would be teaching conferences arranged to reinforce safety procedures.

Contrast that to the response of the midwives involved in the debacle of crowd sourcing a life and death situation on Facebook while a baby was literally dying. Christy Collins, CPM was the midwife caring for the patient, and Jan Tritten, Editor of Midwifery Today, crowd sourced the case on Facebook and provided real time follow up on the death of the baby. The mother was 2 1/2 weeks over her due date, and ultrasound revealed that there was no longer any amniotic fluid, a sign of severe fetal compromise and impending death. The appropriate treatment was to induce this mother as soon as possible, and, at the first sign that the baby was not tolerating labor, to proceed to an emergency C-section.

Let’s leave aside for the moment the asinine comments of the homebirth midwives who were discussing the case on Facebook. Stevia? Accupuncture?

Let’s look at how these midwives and the homebirth community as a whole responded to the preventable death of a baby.


1. Violating patient privacy by sharing details on Facebook




2, Lying. I asked Christy on her own Facebook page whether she was the primary midwife in the case. She responded by deleting my question, deleting the entire area on her Facebook page where people can ask questions, and she sent me a Facebook message:

No, I’m not, but enough details had been passed around to select midwives to realize it was not what got created on Jan’s page, and it was NOT Jan. Someone needed to say something …


3. In an unspeakably insensitive and witless move, linking to an idiotic poem (??!!) implying that there is no danger to a baby in a pregnancy that goes overdue.


Home Sweet Birth poem

This is the poem:

Pregnant Pause

My baby’s not a library book,
So he’s not overdue.
My baby won’t take too long to cook
‘Cause he’s not veggie stew.

My baby’s not an elephant.
And I am not fit to burst.
The time and date aren’t relevant –
We’re blessed with days, not cursed.

My baby can’t read dates yet
Because he’s very new.
There’s no cause to fuss and fret
If he doesn’t come on cue.

So stop your worry.
Stop your asking.
There’s no hurry.
We’re just relaxing
In this golden pregnant time,
This pause… just his and mine.

Now, you leave us be…
We are just fine.

~Rachel Pritchard

Collins linked to this only 4 days after the baby died, possibly even before the baby was buried.


4. Sending a letter simultaneously admitting guilt and attempting to blame the mother.

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. You might have been really pissed at me for pushing you into a corner where you felt you didn’t have a choice, but … I wouldn’t care… I am angry at myself for being the midwife who tried to be as firm but gentle as possible when advising to go in when I could’ve waved the dead baby flag …

I blame me. I would rather have you hate me for pushing you harder into a bad birth experience … so you could hold a live baby instead.


How about Jan Tritten, the midwifery clown who thought the appropriate response to a baby showing every sign of imminent death was to discuss it with the other midwife clowns who are her Facebook friends?

5. Tritten deleted her Facebook post and all the responses. But the Internet never forgets and you can download and read the whole thing here:

Tritten thread


6. Tritten disappeared. She has been conspicuous by her absence. She is apparently hoping that she can ride out this disaster by ignoring it. She did surface to say that she is “praying for me” even though I am Satan.


Waechter 2


7. Tritten has offered no apology for her grossly unethical, unprofessional behavior.

How about the wider midwifery community?

8. With the exception of one homebirth midwife, there has been absolute silence from the midwifery community. Indeed one might call it a conspiracy of silence. Homebirth websites have refused to discuss the tragedy and have deleted posts and comments from those who have tried to discuss the tragedy.

9. Professional homebirth organizations, including Midwifery Today and the Midwives Alliance of North America have refused comment despite being bombarded by Facebook messages and Tweets.


The bottom line is that the homebirth community, both the midwives who were involved, and the organizations and individuals who promote homebirth have invoked standard operating procedure: Bury the baby in the ground and then bury the fact that he ever existed so no midwife will be held accountable for the death, and no American women will learn that homebirth midwives are ignorant, incompetent fools who let babies die preventable deaths.

But this time, we’re not going to let homebirth midwives bury a baby twice. We are not going to let Christy Collins and Jan Tritten avoid accountability. We have started a petition drive (557 signatures so far), a Facebook page for the Not Buried Twice campaign, and one particularly brilliant commentor devised the perfect Twitter hashtag #notburiedtwice.

Next step?

Convince skeptic bloggers, mommy bloggers and mainstream websites like Salon and Slate, that babies who die at the hands of homebirth midwives are worthy of their concern.

205 Responses to “How homebirth midwives respond to a baby’s death”

  1. RudyTooty
    March 10, 2014 at 8:51 am #

    Did you see this? A couple in Missouri lost one of their twins during a home birth with a CPM. The CPM didn’t come to the ‘peer review’ because she (the midwife!) apparently filed a restraining order against the father. How crooked. How heinous. How despicably unprofessional. This is how a CPM responds to the death of a baby under her care. How low can you go?

    • Trixie
      March 10, 2014 at 9:21 am #

      Filing the RO against the father also smacks of racism.

      • RudyTooty
        March 10, 2014 at 10:06 am #

        Indeed! Oh, it’s vile.

  2. Heather Dalgety
    March 5, 2014 at 8:35 am #

    Having read that you found my comments nasty & bullying , here’s my suggestion . Repeat your original comments to the Senior Obstetrician wherever you are training & stand well back.
    You continue to treat the other bloggers here as a bunch of dull primary school children in need of your advice .
    Other commenters have suggested you stick around and learn.
    That is unlikely to happen when you already know so much ; ” Ob’s bad – only midwives give informed consent. ” seems to be your mantra .

    • Karen in SC
      March 5, 2014 at 8:53 am #

      CNM educators and Senior OB residents where CNMs are trained should take note of this thread.

      • Heather Dalgety
        March 5, 2014 at 8:54 am #

        Lets hope they do !

  3. Stacy21629
    March 5, 2014 at 5:29 am #

    SNM1 –
    I think the biggest concern folks have with your post is that, despite being a student NURSE midwife, you are espousing many views in common with the same home birth midwives that are to blame for this baby’s death.
    1. Women are made to give birth
    2. Doctors perform large numbers of C-sections out of convenience
    3. Large numbers of women are requesting C-sections out of convenience
    4. C-sections should only be done when medically necessary
    5. A C-section is a terribly dangerous surgery with unacceptably high rates of maternal death and complications that should be avoided if at all possible
    6. Babies die in hospitals too

    The babies that die in hospitals are almost exclusively those that were already high risk. The idea that a low risk mother and low risk baby could walk into a hospital and be “rushed” by a doctor and the baby end up dead because “bad things happen in the hospital too” is absurd. Such a thing would be a horrible tragedy and spark a thorough internal investigation and M&M, +/- professional liability/civil/criminal proceedings.

    I don’t have any studies on this, but I highly doubt that babies that die as a result of obstetric intervention could have been saved by doing…nothing.

    • SNM1
      March 5, 2014 at 5:55 am #

      For the sake of argument, if women’s bodies are not made to give birth then why not just perform a csection for every pregnancy? I never said they perform large numbers out of convenience but I have seen it happen. I actually worked with an old school doc that cut every woman she delivered (she either got a section or episiotomy, evidence be damned!)… According to the NIH the estimate that 18% of sections are done per maternal request. Not sure on the validity of that number, but it was part of the discussion when trying to come up with guidelines I primary ELECTIVE csections. I NEVER once said that sections should be avoided at all costs and have said MULTIPLE times that there are times when they are indicated. I do and will continue to stand by my belief that they should not be done out of convenience and only done when necessary as defined by ACOG. I never said it was terribly dangerous, but like everything else in medicine, the benefits of the procedure should outweigh its risks. I actually addressed some of this in a comment below.

      Finally, I distinctly remember a story back in December of a baby dying because an OB crushed its skull and damaged its spinal cord with forceps. This same OB had been in trouble before. Babies do die and no matter where and why it is horrible and it is sad. Hospitals and birth centers are the safest places for women to give birth. I am not an advocate of home birth (I mentioned that in my original post). I by no means am standing up for the midwife in this case. She should be punished and held accountable and the fact that they are trying to cover up this death is reprehensible!! But one thing I have learned in my life is that one side is rarely all right or all wrong and there has to be something in our maternity care system that frightens these moms to the point where they are willing to try to avoid hospitals, doctors, and even some CNMs. Many of them are very well educated and many have had bad experiences with the OB provider. Just like there are good and bad midwives there are good and bad doctors and just because they have a title behind their name doesn’t make them qualified. And being a nurse-midwife doesn’t mean that I can’t believe that women should be empowered and given choices (withjn reason)… That is actually core to ACNM defined midwifery care.

      • Stacy21629
        March 5, 2014 at 6:06 am #

        Why not section every woman? Because there’s a medico-legal term for that – overutilization of services.

        And the baby with the crushed skull? The mother BEGGED for a C-section and the doctor told her no.

        Women are frightened away from medical interventions out of a belief that interventions are excessive because…’women’s bodies are made for birth.’

        • SNM1
          March 5, 2014 at 6:27 am #

          I should have made myself more clear in my post about the babies death. I was just pointing out that Drs also make mistakes and that babies death was avoidable!! Of course she should have had a section! Have I said, even once, that sections are evil and women who have them selfish? My concern isn’t the section, the pitocin, the ( fill in intervention here) it is the lack of a thorough informed consent!! Some women really don’t know the risks of what the doctor/midwife is suggesting and the provider is responsible for educating her! Is it a pain in the ass and can it take longer than 5 minutes? Yes it is and yes it SHOULD! I have heard doctors and midwives downplay risks and it drives me crazy!! Give them the info and trust them to make the decision that works for them. As a CNM I will not recommend an elective section to my patients but if she wants one, and I have educated her on the risks and benefits, and she still wants it then I will scrub in and hold her hand if she wants me to. And for those who want a natural birth I will encourage them in that too and empower them to get to their goal AS LONG AS it is SAFE for both mom and baby to try to meet the woman’s desires. You mentioned choice, and unfortunately that is lacking in many women’s OB care, regardless of who is providing it.

          • Stacy21629
            March 5, 2014 at 6:45 am #

            Here’s the issue with mentioning the crushed skull baby death – you are decrying the risks of “rushing” women and convenience C-sections…but then give an extreme example of a hospital baby death that is actually an example of TOO LITTLE intervention.

            The mother was small and the baby well below the 5000g cut off you mentioned and the baby had obvious signs of fetal distress, was posterior, undescended, mom was febrile. That was a prime case FOR intervention.

            That doctor’s mistake was TOO LITTLE intervention. Again, how many low risk mothers and low risk babies are “rushed” through labor with TOO MUCH intervention and one or the other ends up dead? That seems to be the crux of your argument.

          • AllieFoyle
            March 10, 2014 at 10:19 am #

            Also, that doctor’s mistake has been recognized, publicized, roundly decried, and he will certainly face serious consequences as a result of his action (which, it should be pointed out again–were driven by the desire to *avoid* a c-section).

            There is no similar system for holding CPM/lay midwives accountable. That’s the difference.

          • The Bofa on the Sofa
            March 10, 2014 at 10:39 am #

            Maybe this should be added to the “12 Things Not to Say Unless You Want to Look Foolish”?

            “Oh yeah? Well a doctor crushed a baby’s skull and killed him!”

            Answer: Yeah, that doctor messed up big time, but here’s the key
            1) The Doctor’s mistake was not in doing an intervention, but doing the WRONG intervention. Moreover, he did it poorly. There is nothing to suggest about that case that he would have been better off not doing anything, as a midwife would want. The reason he messed up is because he was trying to avoid a c-section. If he had just done a c-section, which is the better approach in that situation, most likely the baby and the mother would be just fine.
            2) Even so, that doctor has been roundly criticized in all circles, including the medical community. There are no doctors rallying to protect him, nor trying to convince him to “forgive himself.” We don’t know how he is feeling about it personally, but others in the medical community are working to make sure it is not forgotten and that it doesn’t happen again.

            How is that an argument for midwifery?

            (feel free to correct any technical or factual errors I’ve made)

          • anion
            March 5, 2014 at 7:06 am #

            No, you haven’t said that sections are evil, but you have said more than once that you don’t think women should be allowed to just choose them, and they should be avoided at all costs. Unfortunately, it’s that sort of thinking that directly led to the death of the baby in the above-mentioned forceps case: the avoidance of c-section was so important that it led to a tragedy, and the mother’s begging for a section was ignored because women aren’t allowed to choose the method of birth they prefer.

            Now you seem to be saying that if the mother knows all the risks, you will support her in an elective c-section? I think that’s awesome.

            Unfortunately, I do think there is indeed something that scares women away from hospitals and into the dubious care of uneducated CPMs, and I think that something is the lies and propaganda spread by the NCB community and false “documentaries” like the Business of Being Born. They tell women that hospitals are only concerned with money, that they won’t be allowed to labor naturally (the childbirth educator at the hospital where I took my birth classes when pregnant with my first informed us all, point-blank, that the minute we arrived at the hospital we’d be hooked up to IV pitocin with no chance to refuse. This was an absolute lie, with not a speck of truth in it, but it sure scared some of the other mothers in my class!), that they’ll be forced to lay on their backs the entire time, that they’ll be shaved and given enemas. The same NCB community also lies to them about the “cascade of interventions” which they claim (with no evidence) will lead directly to a c-section. They lie and say mothers won’t be allowed to hold their babies immediately after birth or that the babies will be kept in a nursery most of the time and not allowed to room-in; they claim the hospitals will force formula feeding on them; they claim c-sections make it almost impossible to breastfeed; they claim doctors are desperate to perform c-sections so they can get to their golf game. None of those things are true.

            Oh, and they try to scare women by telling them “C-sections are MAJOR ABDOMINAL SURGERY,” and “It takes six weeks to recover from the pain of a c-section,” when in fact they only qualify as “major” surgery because they’re abdominal–they’re actually pretty straightforward and simple, and don’t involve any of the major organs (i.e. liver, pancreas, stomach)–and recovery is generally quite easy, with severe pain abating after a couple of days and residual, easily tolerable pain rarely lasting more than a few weeks.

            It’s not hospitals which are scaring women away from hospitals, it’s the NCB rhetoric which paints a completely false picture of what happens in hospitals today.

            (And when you’re talking about how 18% of sections are performed at maternal request, how many of those are second births? My doctor offered me VBAC for my second; before he could even finish telling me what a good candidate I was I informed him that I was absolutely not interested. He offered it again near the end of my pregnancy and I told him again that I wanted a scheduled c-section and did not want TOLAC, no way, no how, no thank you. So some of those maternal request sections could be women like me, who were very happy with their sections, who did not want to take the increased risk of rupture associated with TOLAC, and who simply didn’t see the point of having a second part of their body changed or damaged by birth, even if the idea of vaginal birth was appealing or interesting, which it was absolutely not for me.

            If our general section rate is 34%[?] and 18% of those are repeat or maternal request…that would mean, loosely, that most women who have a section with their first request one with their second, correct? Which should say something about how women feel about them.)

          • Stacy21629
            March 5, 2014 at 7:14 am #


            I had a *lovely* home birth transfer, tyvm.

            Unrealistic scare tactics are not the way to inform women of risk.

          • Karen in SC
            March 5, 2014 at 7:21 am #

            I was surprised to learn (from this site) that muscles are not cut during a c-section.

          • Stacy21629
            March 5, 2014 at 7:26 am #

            ETA – answered my own question

          • Stacy21629
            March 5, 2014 at 7:29 am #

            Ah, I see, they’re separating the muscle planes.

            Pretty much all veterinary abdominal surgeries are on midline…there are a few folks out there doing flank spays…but I do ER work…so no more OVHs for me (yes!)

          • KarenJJ
            March 5, 2014 at 7:38 am #

            Same (although I wasn’t really a good candidate for VBAC I was offered a trial of labour).

            If C-sections are so horrendous why do so many women decide against VBAC? Many of us have already experienced both sides of that debate and chosen the option that suits best. And for the vast majority of us it was another c-section. I had absolutely no interest in a VBAC either. And I’d read Dick Grantley-read’s book twice!?!?!) as well as attended a hypnobirth course.. My first labour was straight forward (albeit unproductive) but I had zero interest in repeating it.

          • SNM1
            March 6, 2014 at 11:37 pm #

            The 18% I was referring to is a number that (as I said above) I am unsure of the validity of, but is the rate given by the NIH. It only pertains to the primary (first) c-section. I have no problem with women choosing to have another csection once they have had one. The problem is that too many women who want a TOLAC are not provided the opportunity for one, and many are denied based in policy or a lack of provider following evidence based practice. Further, doctors are also part of the problem. It isn’t just the NCB community, it is MDs as well who don’t respect a woman’s right to choice in all aspects if her care. It is not wrong for women to want to be educated and asked before a doctor or midwife shoves their hand up their vagina (frequent vaginal checks HAVE been shown to increase infection risks not to mention the violation if the woman’s trust and the trauma that would cause a survivor of sexual assault. I have seen multiple people also suggest that I keep saying a csection should be avoided at all costs. I have never, and will never say that. There are reasons that a section is necessary. They save lives and I have seen women come in who waited too long and baby ends up in NICU or worse! One thing I would like to point out is that I have seen multiple comments that women should be allowed to choose a csection because it is their body, regardless of the risks to them or baby (and studies do show that it is not without risk). But (please keep in mind that I am not a big home birth supporter) women who want the choice to labor and deliver at home are selfish because it has risks. I just think that mindset is a bit hypocritical. So every woman who wants a non-medically indicated section should get to have one but a woman who wants to birth in their home should not? How do we decide who has a right to choice? I worry that is a slippery slope. Not all doctors are bad. I love my OB/GYN who I have seen for years. I have been at births where the doctor was incredibly supportive of the woman’s choices. But I have also seen forced vaginal exams and women who were automatically hooked up to IVs and pitocin and pressured into epidurals they said they didn’t want. There is no innocent party in this debate. Just a divide in who people think should be making decisions. I respect women who want to say that the doctor is trained and knows best. I just worry because 1). Doctors are human and therefore make mistakes and 2). When and if something goes wrong they often blame the provider. I personally like being a partner in my care decisions.

          • Playing Possum
            March 7, 2014 at 12:50 am #

            So women are denied TOLAC or breech VD because of policy. Who makes those policies and what do you think they base their decisions on? It’s the people who have to care for them and manage the consequences. Those decisions aren’t based on ideology, it’s based on careful analysis of risk and allocation of resources, and based on the desire to first do no harm. Should women who are good candidates be offered these in well equipped hospitals with 24h OR and tertiary NICU? Sure. But not every facility can offer that. It’s not cost effective or a good use of everyone’s time if there is a much less risky and easily performed alternative. It’s not unreasonable to have to travel or pay more in order to access extraordinary care. Patients travel to silos of expertise all the time to get the best outcomes, I’m so sick of hearing about the process:outcome imbalance in obstetrics.

          • Young CC Prof
            March 7, 2014 at 2:51 am #

            The most recent studies show that planned caesarian birth is at least as safe for the child (as long as the due date is known well enough to avoid iatrogenic prematurity). The risk of serious harm to the mother is small enough that data sets of thousands are insufficient to measure it, or to demonstrate that it differs from planned vaginal birth.

            The biggest medical reason NOT to have a c-section is the desire to have a large family, since each one increases the risk of the next pregnancy and birth. If a woman is absolutely sure that she wants no more than two children, and is old enough that she is unlikely to change her mind, then that argument doesn’t apply.

          • AllieFoyle
            March 10, 2014 at 11:02 am #

            I think you are incorrect about the 18% number. True maternal request c-sections with no other medical indication account for at most something like 1-2% of sections from everything that I’ve read. But I’d like you to try a thought experiment: what if it were 18%? or 50%? 90%? What would your objection be if that many women genuinely did prefer and request c-sections after receiving informed consent and weighing the different risks of each mode of birth?

            Cesareans have risks, of course. No one here denies that. Many of us though, feel that the risks of c-section are often overstated and overweighted while the risks of vaginal birth are downplayed or completely glossed over. Vaginal birth presents a number of dangers to the baby–many of which can be reduced or eliminated by a pre-labor c-section. C-section babies in contrast, may have a higher rate of some breathing complications. It’s a reasonable tradeoff and no woman should be made to feel that a c-section is a selfish choice because it is in fact as safer or safer than vaginal birth for the baby.

            In terms of the mother’s health, some women would prefer the clear and predictable risks associated with c-section to the unpredictability of vaginal birth. The risks of c-section are well known and oft-stated. Vaginal birth often (always?) causes some degree of damage to a woman’s genitals, urinary structures, and rectum. Few women are given truly informed consent because almost no one tells them beforehand the possibility of this sort of damage, or the devastating effect it can have on your life to become incontinent and/or need reconstructive pelvic surgery in your 20s and 30s. There are serious complications that can occur with c-sections such as infections and blood loss, but those things are rare and can also happen with vaginal births. I’ve read several stories of women dying of horrible infections following vaginal births lately. Why do post-surgical infections and injuries count as a mark against c-section but post-birth perineal injuries and infections not count against vaginal birth? Placenta accreta and percreta are genuine concerns, but the risks increase with subsequent pregnancies. It should have no bearing on the risk evaluation for a woman who is planning no future pregnancies. And for a woman planning a small family, as most women in the developed world are these days, a planned c-section is a very reasonable choice.

            I have not even touched on the fact that vaginal birth can be tremendously damaging psychologically. PPD and PTSD are real concerns, and if a prophylactic c-section can avoid giving a woman a potentially traumatic experience isn’t that worth something?

            I had my children with CNMs in a hospital. I was not given pain relief or access to a c-section (which I desperately wanted the second time–I spent my pregnancy in a state of crippling fear and anxiety). It left me physically and psychologically altered. I had subsequent reconstructive surgery and spent much of my last child’s infancy and toddlerhood in a fog of depression, shame, and anger.

            Please reconsider your views on the superiority of vaginal birth. If you truly believe in the importance of informed consent and compassionate care, please don’t coerce or force women into births that leave them mentally and physically damaged.

          • Karen in SC
            March 10, 2014 at 11:14 am #

            Well said, excellent comment. I wish more student midwives came to this site and read the comments. They would learn so much from all the different points of view, and hopefully apply this real world knowledge.

          • AllieFoyle
            March 10, 2014 at 11:36 am #

            Thank you.

          • Karen in SC
            March 5, 2014 at 8:43 am #

            Don’t forget to educate them on the risks of vaginal birth: PPH, shoulder dystocia, fistulas, tearing, incontinence, negative effects to sexual function, etc. Not to mention PPD from the intense unrelenting pain.

            Maybe it *should* be the vaginal birth that is elective 🙂

          • FormerPhysicist
            March 5, 2014 at 8:55 am #

            What constitutes thorough informed consent? I spent a few minutes listening to my OB, and said “yeah, I didn’t go to med school, not going now, my first birth, your zillionth, your call here.” A list of risks (even with percentages) wasn’t going to do me enough good that I should make that call. I took 12 years of post-graduate education, I know how much I learned in my field and I respected his education and experience.

            Do you really want to deny me the ability to outsource my medical decision to a trained professional?

          • Stacy21629
            March 7, 2014 at 10:25 pm #

            Pretty much no layperson is qualified to be making their own medical decisions. Not that doctors shouldn’t talk through the rule outs, diagnostics, prognosis, risks, etc…but seriously, they have no idea. If the final decision is up to them and the doctor provides no guidance at all they are going to act on emotion.

          • Arwen
            March 6, 2014 at 1:21 am #

            The solution to bad care is not less care, or lower quality care. The solution is to fix the bad care, and provide more and higher quality care.

          • AllieFoyle
            March 10, 2014 at 11:21 am #

            Will you also let women know the risks of vaginal birth? All the risks? And will you tell them that they can choose a c-section? I literally had no idea it was possible when I had my first child, and I absolutely would have chosen one if anyone had given me that choice.

      • DaisyGrrl
        March 5, 2014 at 9:32 am #

        You say you believe women should be empowered and given choices, but it seems to me that you argue the choices available to mothers should only be the ones you agree with. You mentioned physical indications for c-sections, but what about the mental ones? Should a woman who has been sexually assaulted never have a baby because she won’t be allowed a say in mode of delivery? Control and agency might be very important to her, but she may not express it in a way that you would. Even if there’s no other indication for c-section other than maternal request (ie: she has weighed risks/benefits and is otherwise low-risk), what’s the problem? People chose surgery all the time for all sorts of reasons, including purely cosmetic reasons. If I can chose to have a tummy tuck, why can’t I chose to have a c-section?

        Every woman has their own personal mix of reasons for deciding how they hope to give birth. Some will make decisions based on factors that may seem silly to you or me, but are very serious to them. While I wouldn’t expect you to facilitate a course of action that you feel is inadvisable, I would expect you to provide a balanced picture of what risks are present in any given treatment option. I think we can agree that the midwives in Dr. Amy’s post are not doing that and it’s the patients that suffer for it.

      • Trixie
        March 5, 2014 at 9:33 am #

        Your basic premise is a massive logical fallacy. No one’s body was “made” to do anything. We are products of evolution. Evolution makes things good enough for survival under specific environmental circumstances. A pretty large maternal and infant death rate in childbirth is perfectly compatible with that. Massive suffering and death is perfectly compatible with evolution. Nature doesn’t design things perfectly. I can think of a lot of design enhancements that could be performed on the body if we were starting from scratch.

      • March 5, 2014 at 12:13 pm #

        Sure. And we’ll also remove every appendix and pair of tonsils and gallbladder, give everyone corrective lenses and hearing aids and put every person on insulin.

        Because bodies are perfect or broken.

        No shades of gray.

        Great argument. Got any useful points?

      • March 5, 2014 at 7:31 pm #

        You know, I used to think midwives were great about informed consent too. I went to the biggest birth center in town and told them I was a survivor of sexual violence and was very concerned about informed consent. They agreed and said all the right things, until I went into labor. Then it was forced vaginal exams and gross inappropriate touching. When I complained to the owner she blamed me for what happened. When I sued them for giving me PTSD other midwives said that it was standard operating procedure in midwifery care to ignore women begging for an exam to stop. The midwives in the community have rallied behind my abuser, they congratulated her for passing her NARM exam and refer patients to her. I really believed midwives were going to respect me more than MDs, but it just didn’t pan out that way. I came to find out that even if they had negligently killed my baby the reaction would have been the same. Midwives privilege each other over patients.

      • Arwen
        March 6, 2014 at 1:21 am #

        My body was made to attack itself. So I guess according to people like you, I should just go au naturale, stop my meds, and let my body deteriorate until I die an early, and very painful death.

      • Deena Chamlee
        March 7, 2014 at 1:12 am #

        Love this thread. Love student midwives who have a voice and want to be heard! Its why I love teaching….

        • Stacy21629
          March 7, 2014 at 10:23 pm #

          You “love” the promotion of falsehoods?

      • The Computer Ate My Nym
        March 10, 2014 at 10:06 am #

        And being a nurse-midwife doesn’t mean that I can’t believe that women should be empowered and given choices

        Just not the choice to have a c-section if they want one?

  4. Heather Dalgety
    March 5, 2014 at 4:01 am #

    Dear little student midwife , there are a mixture of people who read this blog , many ( like me ) have been involved in maternity care since before you were born . Personally , I’ve had 2 c sections, ( prim breech & severe PET) and amazingly enough am still alive .
    Get your head out of the books & get a few years experience & humility under your belt . Then you can come back & lecture us !
    And BTW a c section WOULD have saved this baby’s life if done earlier !

    • SNM1
      March 5, 2014 at 4:51 am #

      First, you don’t know me. You know nothing about my experiences or my background. I never said that csections have no place in obstetric care. Actually I said it is an amazing life saving procedure that is done too often. I never made excuses for the midwife in this case. She was negligent and the entire situation is awful! You obviously did not read my entire comment and, instead, decided to spew nastiness and hate at a complete stranger, maybe because you feel that the Internet forum gives you the freedom to speak to me in a way you most likely would not to my face. You were condescending and rude, and considering that my original comment was none of these things, your response seems a little over the top and incredibly uncalled for. There was no lecturing done or intended. I was merely pointing out that several people had said that csections are harmless and low risk. They are not. There are serious risks to having the surgery and therefore it should only be done when medically necessary. If you choose to be offended by my comment because you had two csections (which based on what you have said would be perfect examples of when it is an appropriate intervention) then that is your problem. Being nasty rarely brings others around to see your point of view. BTW, I happen to agree that induction before the baby was post dates or a csection done when the oligo was diagnosed would most likely have saved this precious baby. My heart breaks for the family because I have felt the pain of loss. In the future save your nastiness and hatefulness for someone else as I have little tolerance or patience for bullies.

      • Stacy21629
        March 5, 2014 at 4:58 am #

        “There are serious risks to having the surgery and therefore it should only be done when medically necessary.”
        I want to take issue with this statement.

        If I am in labor, I would rather my doctor step in and say “You know, you’ve been in labor for X number of hours with little change, it’s time to consider a C-section” then wait until a section is NECESSARY because my baby goes into distress and has massive decels and now it’s a crash section and I’m going under general. No thanks.

        Dr. A has written about this exact thing – hospitals, particularly in
        the UK if I recall correctly, with increasing numbers of baby deaths
        because C-sections are so strongly discouraged. Unfortunately, hindsight is 20/20. There are going to be women that receive a C-section that ultimately might have delivered vaginally. But waiting until that C-section is medically necessary will also result in delayed care to babies and increased mortality.

        • Anj Fabian
          March 5, 2014 at 6:18 am #

          As one person who had an emergent c-section and a planned c-section, I always recommend the planned c-section. The experience is almost always superior and the research shows that the outcomes are also better.

        • Karen in SC
          March 5, 2014 at 7:08 am #

          This is such an important point. It’s better to do a section to avoid delivering a baby in distress! And no one has a crystal ball.

          LMS recently told a few stories about how just having a “feeling” about a labor led to a c-section where it was discovered that the baby was in distress. Sometimes it’s the pediatrician’s tests that reveal things were not optimum (cord gases, etc), and some that were in attendance JUDGING the OB may never know the OB was really a hero.

          • Stacy21629
            March 5, 2014 at 7:11 am #

            That “feeling” is a very important thing in medicine. I have found that I ignore that little voice in my head at my (and my patients’) peril.

          • anion
            March 5, 2014 at 7:12 am #

            You’d think the woo crowd would love that, wouldn’t you? 🙂

          • Stacy21629
            March 5, 2014 at 7:15 am #

            Just trusting my “womanly intuition”.

            Gag. 😛

          • anion
            March 5, 2014 at 7:55 am #

            You have “other ways of knowing.”


          • Dr Kitty
            March 5, 2014 at 9:19 am #

            Except it isn’t intuition it is lots of book-learning and lots of clinical experience that lead to very, very good pattern recognition skills, where you can assimilate the data on a subconscious level.

            Good nurses and Drs will looks at someone and say “he looks sick”. Once you have time to consciously break it down you’ll note the stigmata of chronic liver disease, or the ureamic glow, or the high JVP or the peaches and cream complexion, or the signs of rapid weight loss…but at the time you’ll just get a gut feeling that the person is unwell.

            It’s why very experienced ER docs and nurses will sometimes glance around the waiting area and call a patient in when it isn’t their turn…that person just “looks sick”.

          • anion
            March 5, 2014 at 9:39 am #

            I completely agree, I was just making a little joke.

          • Comrade X
            March 8, 2014 at 1:11 pm #

            “Except it isn’t intuition it is lots of book-learning and lots of clinical experience that lead to very, very good pattern recognition skills, where you can assimilate the data on a subconscious level.”

            I’m pretty sure that 99.5% of the time, that’s exactly what “intuition” IS. We are pattern-spotting animals, we learn from experience, we pick up more data than we can always consciously process. I think most strong “intuition” is probably a “shortcut” function of those factors.

          • Young CC Prof
            March 5, 2014 at 7:38 am #

            My son was fine after his scheduled c-section. It was only when the placenta was dissected that we learned he had just about run out of time entirely.

        • Danielle
          March 5, 2014 at 10:45 am #

          I do not have the medical knowledge to comment on this issue, but as a mother it is interesting to me. My first birth experience went like this (please note that this is just how I remember it, and I was extremely tired, so it may be that I am misconstruing or misremembering something!):

          I had a nonprogressing labor during which my son was going into distress. The labor nearly ended in a c-section. Instead of c-section, the hospital staff introduced pitocin (because I wasn’t dialating, was stuck at 2 cm for ages), but then stopped because the baby didn’t respond well; while waiting on my body to get the show on the road, the nurses repositioned me, put fluid back in my uterus, etc.; finally, it was decided that we would bring the pitocin back in force in an attempt to get me deliver before the baby began to have worse problems. Shortly after that decision, I was informed that the baby needed to come out, and that if I didn’t dilate enough in the next half hour, a c/s was advised. I think was to 8 or somewhere about there – I’ve forgotten – much further along than I’d been just an hr before, but not enough to push.

          Just a minute or two after the doctor stepped away, the nurse monitoring me recalled the OB and a crowd of staff came with him. He said they were going to get the baby out immediately, and finding that I’d just hit 10 cm, he delivered my son vaginally.

          My son was born with a APGAR of 0 and had aspirated meconium. The pediatrician team revived him and he was fine (APGAR 9 or 10 at 5 minutes) – he only needed breathing assistance for a few hours, and he were discharged after a four-day NICU stay. I’m sure his case was a common one that the staff of this hospital has handled many times with good results.

          So far as I can tell, that’s a success story. They were cautious. I didn’t get a c/s. My baby recovered wonderfully.

          So I don’t question the judgement calls that were made. But in retrospect, I wish I knew the answer to the following question: If I’d gotten an “unnecessary” c/s, wouldn’t that have made things easier for my son? Obviously I don’t relish the idea of getting a c/s. But I relish the idea of my baby being being in distress and needing to be resuscitated even less. If it’s that vs. an incision for me, I might opt for the incision.

          • Elizabeth A
            March 5, 2014 at 11:50 pm #

            That sounds harrowing. It turns out okay in the end – you went home with a healthy baby – but you could quite possibly have been spared the 4 days in NICU by a more prompt move to c-section (before the second run at pitocin, perhaps).

            That said, I have no idea what resources the doctors were working with at the time. They may have been doing the best they could with limited OR facilities, or anesthesia being stuck with someone else. So there may have been reasons why they did not go to surgery at any of the points when they considered it, but I don’t think those reasons had anything to do with whether going to surgery was a good idea.

      • Playing Possum
        March 5, 2014 at 6:07 am #

        “I have little tolerance or patience for bullies.”

        You may want to consider a career change then. I’ve always found wards quite the hotbed of snark, especially if one is unwilling to learn or be taught. This is not bullying by any stretch of the imagination. You stated your interpretation of ACOG through a vaguely woo-ey lens, we gave you our version of it through a skeptical lens, with a good measure of personal experience and practice.

        You mention ‘medically indicated’ interventions. Maternal exhaustion sounds like an indication to me, as does analgesia, or induction to improve the chances of vaginal birth. These are things than can only be definitively assessed as ‘indicated’ in retrospect. It is a real time decision between a care provider and their patient, based on many factors that nobody else is privy to. And I would hope that the care provider would err on the side of caution, given what’s at stake. I would LOVE to be out of a job, I really would.

      • guestguest
        March 5, 2014 at 6:12 am #

        IF you have felt their pain then make sure you NEVER EVER advise based on anything else but SAFETY of the baby and mother as your PRIMARY concerns once you are a practicing CNM. And make sure you ask the mother in which order her safety and all of her other concerns are – only a tiny fraction of expectant mothers will tell you they want you to place their own safety before the safety of their unborn child. Only a tiny fraction of homebirthing mothers will state that they place their birth experience before life of their child.

        Please take that as something you adhere to in all your future work as CNM. Other more qualified people here will have a lot of advice to give you that you should listen. I can only offer what I know I did when I was weighing my options:
        have the mother make a list of her priorities as part of her birth plan, sth like …my priorities in regard to birth are: 1.) , 2.)…, and think hard whether you have the knowledge to make sure her choice of priorities is given the best care possible with you as her midwife. If not, advise and transfer care.

        I congratulate you on choosing such an important career. I admire your choice to obtain proper qualification and education. But please make sure that you have the knowledge and mechanisms in place and follow protocols that will ensure you never ever harm a family in your care like quack lay midwives Jan Tritten and Christy M. Collins CPM who killed baby Gavin Michael harmed them.

      • An Actual Attorney
        March 5, 2014 at 7:33 am #

        You are right. No one knows you. They only have your words to read. And you will be judged by your words. That’s not bullying, that’s engagement.

      • manabanana
        March 5, 2014 at 9:00 am #

        Hey SNM1. Nice to see you here. There are a few midwives who read this blog – I’ve reverted to participating in comments here because MANA is so quick and skilled at deleting any inkling of dissent.

        I would love nothing more than to engage in a conversation among midwives – much like you are attempting to do here.
        I currently work in a hospital – after having a background in OOH birth – and yep, I have criticisms of both in-hospital and OOH birth. We can do better across the board. But no one here – or the majority of folks posting here, wants to hear about surgical complications after a c-section. And that’s OK.
        For one, it’s OK with me because ACOG addresses their shortcomings – as a professional organization – and continuously seeks to implement best-practices. And yep, there are individual OBs who will ignore these guidelines, You bet that happens. But I also see physicians holding each other accountable and implementing changes that improve outcomes.

        Ever read the Green Journal? There’s usually an article that unflinchingly looks at outcomes – “When we do XYZ, we have more complications than when we do QRS.” This is what a responsible, ethical profession does.

        It would be so refreshing to have midwifery do the same thing. I think many midwives would participate in that discussion. Too many midwifery organizations want to squelch dissent – the ACNM has been engaging in a bit of this, too, lately! I don’t agree with everything posted on this blog, but at least comments aren’t deleted.

        That said, sometimes this is the page of celebrating “all things obstetrics.” And that’s OK. I’m not here to tell anyone their MD wasn’t god, and their c-section wasn’t AWESOME. Hey, who am I to refute that experience?

        I’m not going to change anyone’s mind about doctors or c-sections – but I very much appreciate the discussion around OOH midwifery. This conversation needs to happen.

        I, for one, appreciate your voice here, and your participation. We need more midwives in dialog. I hope you’ll stick around.

      • Arwen
        March 6, 2014 at 1:18 am #

        Let’s flip it around: how do you know we’re not doing *enough* c-sections? You say we’re doing too many–by what means are you quantifying that? What criteria should be changed, and why? Unless you can quantify it, you can’t use numerical judgements about a situation.

  5. SNM1
    March 5, 2014 at 3:41 am #

    As a student nurse midwife this situation is very upsetting and me and other students are discussing it and learning from the horrible loss of this baby. However, I would ask that we not say that csections pose little risk. That is untrue and evidence supports this. A cesarean is a great life saving tool that is unfortunately overused and too often waved away like it is no big deal. It is a major abdominal surgery that increases a woman’s risk of death and loss of future fertility. Please do not portray it as a simple, risk free procedure! Recent evidence has also shown that Friedmans Curve is not necessarily the best method to determine if a labor is “too long.” Many studies have shown that it really can’t be applied to women today and that the progress he defined had many flaws. As a future CNM I implore you all to educate yourselves on the actual evidence and not just what you read online or in a blog!! Education goes a long way in preventing tragedies like this one!!

    • Young CC Prof
      March 5, 2014 at 4:10 am #

      The new ACOG recommendations were discussed here:

      If you haven’t read the whole report, please go to the ACOG website and do so, it said a whole lot of things that didn’t make it to the popular press.

      As for the claim that c-section increases a woman’s risk of death, that’s a bit difficult to evaluate. Yes, maternal death is more common after a cesarian than after a vaginal delivery, but a great many of those deaths had more to do with the complications that necessitated a cesarian birth in the first place.

      The issue of future fertility is quite real, although it’s not really a consideration for the many modern women who only want one or two children. For those who want four or more children, however, cesarian delivery early in the reproductive career can indeed limit family size. It’s just something people ought to know.

      And if this irresponsible midwife had followed the latest ACOG recommendations and induced labor at 41 weeks, the result would most likely have been vaginal delivery of a live baby.

      Stick around! We love new folks, and we love learning!

      • SNM1
        March 5, 2014 at 4:31 am #

        Thanks for the links… I have already read them as part of my studies. Being evidence based in my practice is important to me! I have read multiple articles and recommendations on cesarean recently for an assignment, so those points were fresh in my mind! I worry that our culture has turned csections into something that is ” no big deal” and I worry because I have seen nasty infections, hemorrhage, even dehiscence, etc. as a result of this “simple” surgery. There are true medical reasons for one and even as a student I recognize how irresponsible this midwife was. That baby did not have to die and the midwife should face severe consequences for her gross negligence. I do not plan to attend home births because I don’t believe the evidence supports them. I am a big advocate of birth centers which have been shown to be safe and of making hospitals and even ORs more family centered so that women can birth in a safe and comfortable environment. That being said, bad things happen in hospitals too (albeit less frequently and with better resources). Just like there are bad midwives there are also bad doctors. I have seen doctors rush women through a process that is not meant to be quick and easy. I have heard doctors say things like “she needs to deliver by (insert time here) so I can get home because I have plans. And some providers do play the “dead baby” card a little too freely. Women’s bodies are made to reproduce. They don’t always do what we want them to do or think they will. That is where doctors and technology should come in. Our birth culture needs to change to make things safer for everyone involved.

        • Stacy21629
          March 5, 2014 at 4:51 am #

          I think you need to define “safe” for this discussion.

          Our “birth culture” (not really sure what that means…) in the developed world is the safest it’s ever been in the history of the world in terms of maternal and fetal deaths. Lumping C-sections into a discussion of maternal and fetal survival is exactly the concern some of us have – they are not even on the same level. Certainly a C-section is a very serious surgery but implying that a life-saving procedure somehow makes birth less safe is…odd.

          Dr. A has also posted previously on the fact that in countries/hospitals where inductions before 39-40 weeks, C-sections, other interventions are actively discouraged that more babies die compared to those in which life-saving interventions are more readily used.

          Women’s bodies are not “made” to reproduce. A HUGE percentage of conceptions fail – especially between conception and week 12. Then there’s all the dangers of pregnancy, labor and delivery. If you are training to be a CNM you are training specifically to recognize and treat “failures” in a women’s ability to reproduce. That is the POINT of having a “birth attendant” – to avoid the death rates of millenia. Evolution doesn’t move toward absolute perfection, just the simple math of more surviving than dying.

          • SNM1
            March 5, 2014 at 5:04 am #

            When a csection is medically indicated its benefits outweigh its risks. The problem starts when doctors perform them out of convenience (I have seen this happen) or the mother requests it so that she doesn’t have to labor or can pick the due date (risks far outweigh any benefits) and no education on the risks of this is done. The more we talk about it being simple and no big deal the more we get away from it being done for the right reasons… And what happens when the unnecessary csection delays the emergent one because it has tied up the OR? And, if we are going to talk about statistics, we can’t pick and choose only those we like. Women who have csections have higher rates of death and other complications. While there are many factors involved, this doesn’t change the risk. Babies are more likely to have respiratory issues, especially if dating is off even by a week or two! Yes, birth is safer then it has been in the past, but there is still much to do because even one baby lost is too many! Again, I do not have any problem with csections! They have an important place in obstetrics and save many moms and babies!!

          • Stacy21629
            March 5, 2014 at 5:08 am #

            Can you please provide me with the data on elective C-section being “far” more dangerous than vaginal birth? For whom?

            Can you outline for me the specifics on what you believe defines an “unnecessary” C-section?
            Can you outline for me the specifics on what you believe defines a “medically indicated” C-section?

          • SNM1
            March 5, 2014 at 5:30 am #

            A necessary section is one that meets the criteria for a medical indication as defined by ACOG. Examples would be placenta previa (and other abnormal placental attachments), fetal distress, maternal distress, breech presentation (when the provider is not comfortable or trained to do a vaginal breech delivery and has at least discussed the option of an external cephalic version per ACOG), etc.

            An unnecessary section would also be based in ACOGs guidelines as to when it is and is not medically indicated. Examples of this would be convenience, desire to avoid pain (I have never known anyone who didn’t think a section was painful during recovery so this reasoning for wanting one doesn’t make sense to me but to each his own I guess), suspected macrosomia (unless estimated weight is greater than 4500 grams in a diabetic woman or 5000 grams in a no diabetic woman in which case a section should be offered- again this is per ACOG).

            Research has been done on primary elective cesarean a and no benefits have been found for the baby and in fact, cesarean birth without any labor increases the risk of respiratory issues (I believe this was also in the ACOG guidelines but may also be from ACNM). There is no evidence to support benefits to mom to an elective section and there are known risks. No studies have been done that compare primary elective sections (no medical indication based on ACOG guidelines) with vaginal birth so it is unknown how this impacts the benefits/risks relationship. What we do know is that sections increase risk for abnormal placental placement, decreased fertility, increased risk for ectopic pregnancy, increased risk for infection, etc (discussed in ACOG and ACNM guidelines on elective sections). I am on my phone so can’t link the articles here but I will try to remember to do it later.

          • Stacy21629
            March 5, 2014 at 5:52 am #

            From the ACOG statement on “Cesarean Delivery on Maternal Request”:

            “In epidemiologic models, cesarean delivery on maternal request by 40 weeks of gestation would reduce fetal mortality because planned vaginal delivery could occur at up to 42 weeks of gestation”
            Benefit for the baby.

            “Potential short-term maternal benefits of planned cesarean delivery compared with a planned vaginal delivery included a decreased risk of postpartum hemorrhage and transfusion, fewer surgical complications, and a decrease in urinary incontinence during the first year after delivery”
            Benefit for mom.

            Regarding respiratory issues following requested C-sections, the statement also outlines:
            “The risk of respiratory morbidity, including transient tachypnea of the newborn, respiratory distress syndrome, and persistent pulmonary hypertension, is higher for elective cesarean delivery compared with vaginal delivery when delivery is earlier than 39–40 weeks of gestation”
            So the respiratory issues are more a problem of prematurity than the C-section itself.

            I’m not advocating all pregnant moms run out and demand C-sections at 39-40 weeks, but your blanket statements and belief that there are NO benefits to mom or baby is blatantly false. EVERYTHING has risks and benefits that must be weighed. If mom is certain on her dates, had early dating ultrasounds, is educated on the risks of complications and doesn’t plan a large family, she should have the right to request a C-section. She should not be forced to deliver vaginally if she does not want to.

            I weigh 108 pounds pre-preg…should I be denied an elective C-section because my baby is measuring 4500g and not 5000? Good grief, if my baby is measuring 4500g cut me open! Especially since measurements of large babies are statistically more accurate than measurements of smaller babies.

            Here’s the thing about “guidelines” and “standard of care”…patients don’t read the book. EVER. Patients should and MUST be treated as individuals – yes, keeping those statements in mind, but those are not hard and fast rules to practice by either.

          • SNM1
            March 5, 2014 at 6:10 am #

            One point of fact is that measurements of large babies are often very inaccurate and u/s is more accurate if baby is small, not large. This is why they don’t advocate for csection based on the ultrasound in suspected macrosomia (that is from ACOG and multiple studies that have shown how inaccurate u/s can be for weight in big babies). Yes, by all means request a section if you want one. But educate yourself I. The risks and benefits FIRST. Most doctors are not thorough when the do informed consent and too often csections are portrayed on tv and movies as “no big deal.” Women need to know the risks because there might be a risk she doesn’t want to take. And most women are not sure about their dates given that 50+% of pregnancies are unplanned and the date of actual ovulation is not often known. Even early ultrasound can be off by a week which is why ACOG stated that elective sections shouldn’t be done before 39 weeks. However, I have seen them done at 35 with no medical indication because the doctor or the mother had a vacation planned. Because no studies have been done on primary elective csections compared to a normal uncomplicated vaginal delivery the risks are really unknown. More research should be done. All I want to see is actual “informed consent.” If that is done then women should pick whatever is right for them. My original point was just that we shouldn’t paint it as though there are no risks to a section, because there are. It is the providers job to make sure that women know these risks and can really choose for themselves.

          • guest
            March 5, 2014 at 7:37 am #

            An elective C-section at 35 weeks for only a vacation? There are a lot of subtleties to medical decision-making that many students are not aware of. Perhaps that is the explanation. Who are you deciding there was no medical indication? But, no way a reputable doctor electively sections a 35 week singleton in the U.S. for no other reason than vacation.

          • Karen in SC
            March 5, 2014 at 8:13 am #

            If true, that is wrong. But, that’s only one birth out of the hundreds or thousands done at that one hospital. Surely not a reason to get up in arms.

          • Dr Kitty
            March 5, 2014 at 9:27 am #

            Perhaps the “vacation” the mother was planning on taking was to see a dying parent.

            That is a possibly justifiable reason I could see for agreeing an early delivery- giving someone the chance to say good bye to their child and meet their grandchild before they died.

          • anion
            March 5, 2014 at 8:07 am #

            I’m sorry, you really saw a c-section done at 35 weeks because the doctor had a vacation planned? A vacation which would presumably last more than a month so the section couldn’t be scheduled after his or her return? (I won’t even address you saying “because the doctor or the mother had a vacation planned,” because no woman in her right mind schedules a long vacation for her 35th+ week[s] of pregnancy; leaving aside the fact that she wouldn’t be permitted to fly and a long car ride at that point wouldn’t be exactly comfortable, who uses up whatever vacation time they or their spouse might have then, instead of saving it for when the baby comes?)

            35 weeks is premature. I simply cannot believe any doctor out there agreed to remove a baby five weeks early, and likely necessitate a NICU stay, because of his or her vacation plans, with no other reason at all.

          • PrimaryCareDoc
            March 5, 2014 at 8:12 am #

            I’m sorry, but I’m calling bullshit. There is NO WAY you saw an elective 35 week section done for physician convenience.

          • Dr Kitty
            March 5, 2014 at 8:27 am #

            True story.
            My mother (a doctor) chose an ERCS at 37 weeks with her own OB, who she trusted, over waiting to see what would happen with the OB on call while he was on vacation.

            Of course, this was after the disaster of my birth (PROM for 48hrs without ctx at 42 weeks, FTP with 6 hrs of pit, foetal bradycardia and a crash CS when they got me out within 10 minutes of deciding to go to theatre).

            She was at 37 weeks with a long closed cervix, a baby swinging merrily between OP and OA and showing no signs of engaging. All signs pointed to a repeat performance, and she wanted the safe hands of someone she had known since medical school and the calm of an ERCS.

            I can’t blame her. Apart from the spinal not working and having to have a GA (my mother tells this as “that time I had to tell them to stop cutting because I could feel it”) it all went perfectly.

          • Houston Mom
            March 5, 2014 at 12:41 pm #

            And how many mothers plan vacations with premie newborns?

          • An Actual Attorney
            March 5, 2014 at 5:58 pm #

            I have heard of MRCS at 37 or so weeks when spouse was shipping out to Afghanistan. Perfectly reasonable to me.

          • Karen in SC
            March 5, 2014 at 8:51 am #

            Early u/s off by a week? Why are they called “dating u/s” then? OBs don’t give informed consent? There are other issues to macrosomia – ratio of head to abdomen. Where are you getting this stuff?

            I note that you didn’t address Stacy’s excerpts from ACOG about the BETTER outcome to babies in an elective c-section.

            You keep deflecting, moving goalposts, etc. I hope you are early in your education and get to see many many more births of all kinds. Including wonderful c-sections.

          • Young CC Prof
            March 5, 2014 at 7:35 am #

            “when the provider is not comfortable or trained to do a vaginal breech delivery”

            A provider who plans for and condones vaginal breech delivery in a first-world hospital with an OR readily available is making a reckless choice so far outside the standard of care as to be indefensible, both legally and morally.

            2% risk of death to the child. Increased risk of severe tearing or PPH for the mother. 100% unnecessary.

          • SNM1
            March 7, 2014 at 12:04 am #

            If this is the case why has ACOG changed their stance on vaginal breech? Breech presentation is an indication for csection. I said that above. I also said that women should be OFFERED ECV, I never said they should be forced. Some women would prefer ECV over a section while others would not. I personally know someone who wanted to try ECV and her MD outright refused to do it or find someone who would. She ended in with a section that she really didn’t want that could have possibly been avoided had the doctor respected her wishes. My problem isn’t necessarily the medical interventions (I am all for women choosing what is right for them). My problem starts when their choices are not supported or completely ignored. As a mother to an adopted child who suffered many years of sexual abuse in her childhood I worry about these doctors or midwives who will ignore her history and fears and force her into interventions that make her uncomfortable or are traumatic for her. This happens all the time and will continue to happen as long as people sit back and just assume that the medical provider has all the answers. They may know your medical history but they don’t always know who the woman really is. It is really hard to get to know someone in a 15 minute visit, especially when it may be the only time you meet them. More needs to be done on both sides to find a safe, healthy middle ground where women choose what they feel is best for them.

          • Amy Tuteur, MD
            March 7, 2014 at 12:27 am #

            Maybe there were medical contraindications for an ECV.

          • Deena Chamlee
            March 7, 2014 at 1:34 am #

            Maybe just maybe ACOG realizes they have an ethical responsibility to protect the public!

          • Deena Chamlee
            March 7, 2014 at 1:45 am #

            The Breech study I am sure you have read. I did as a student back in 2000. It is deeply flawed, we all know this. Women know this and are seeking vaginal breech in a very unsafe environment with very narcissistic attendants. Both have safety issues for the public. ACOG is actually looking at ACOG. Just like ACNM needs to look at ACNM.
            Every educational structure for CNMs and CMs should include OOH birth. End of story. There is not anything such as “homebirth midwife”. There is MIDWIFE and that means the following: a practitioner who believes in informed choice/shared decision making where the client is the central theme of care. The client chooses site of birth with shared decision making. The midwife shares in this decision by practicing in all three settings; home, birth center and in hospital.
            In the US one must have a graduate degree to have hospital privileges and it should be no less in a higher risk environment such as birth center or at home. AAP and ACOG recommend CMs and CNMs as providers in these settings for a very good reason. Education, Regulation and Accountability.
            It is time for change. Read about OSHA, Joint Commission and ACOG perinatal credentialing for hospitals nationally. Read about World Health Organizations recent dialogue in regards to addressing midwifery nationally and globally. Midwifery has to change, we have no choice. We are at a crossroads.

          • Young CC Prof
            March 7, 2014 at 2:45 am #

            You know, some abuse survivors are actually more comfortable with planned c-section. Everything is under the woman’s control, she knows exactly what will happen, and no one needs to touch her vagina. This doesn’t necessarily work for all abuse survivors, or all women who have anxiety about the birth process, but some are terrified of natural birth anywhere under any circumstances.

            And I really found that my hospital birth with an obstetrician WAS that middle ground. Sure, I saw her for fifteen minutes. Except it was 30 minutes the first visit, and I went there probably 20 times, so we got to know each other plenty.

          • Stacy21629
            March 7, 2014 at 10:30 pm #

            Maybe the OB’s last attempt at ECV ended in a crash section and permanent neuro damage for the baby. You have NO idea what motivated the decision. Here’s an idea – instead of ASSuming and guessing (in a way that always supports your preconceived ideas), how about you further your education and ASK the OB?

          • araikwao
            March 7, 2014 at 4:55 am #

            Yet there is a small shift back towards vaginal breech deliveries here..but in very select circumstances only.

          • Dr Kitty
            March 5, 2014 at 7:57 am #

            And in a 42 year old primip who has her first successful pregnancy after multiple miscarriages and several rounds of IVF, exactly how relevant are the arguments against CS that relate to complications in future pregnancy?

            If it is your only baby, all your eggs are in one basket and you’d probably choose the option most likely to result in a healthy, neurotypical child, wouldn’t you?

            That option, BTW is a planned pre-labour CS at 39 weeks.

          • Dr Kitty
            March 5, 2014 at 8:00 am #

            If the mother is 4’11” and wears clothing sized for 10 year olds, how comfortable are you with the 5kg cut off for macrosomia?

          • Dr Kitty
            March 5, 2014 at 8:02 am #

            Guidelines are guidelines.
            They are NOT commandments to be blindly followed.

            You know the handy tip for medical school MCQs?
            If the question contains “always” or “never” the answer is false. Medicine very rarely has absolutes.

          • Elizabeth A
            March 5, 2014 at 8:34 am #

            A necessary section is one that meets the criteria for a medical
            indication as defined by ACOG. Examples would be placenta previa (and
            other abnormal placental attachments), fetal distress, maternal
            distress, breech presentation (when the provider is not comfortable or
            trained to do a vaginal breech delivery and has at least discussed the
            option of an external cephalic version per ACOG), etc.

            I had a c/s for placenta previa, and every time I see a comment like this, my hackles my go up. It’s like getting a drink with a friend and being approached by a guy who wants us to know that he usually doesn’t like mouthy broads, but… What you’re really saying is that I get a pass, this time, but I can go back on the shit list any time you decide.

            Midwives of various kinds usually acknowledge that how women give birth cannot and should not be entirely up to doctors. Unfortunately, many of those midwives seem to substitute the belief that how women give birth should be up to midwives.

            Why should women with breech babies have to take on the risk and pain of external version if they’d prefer to have c-sections? Why should women with prior c-sections have to agree to trials of labor if they’re not interested? Why should women who prefer the risks of surgery to the risks of attempted vaginal birth be forced to take on the set of risks that YOU prefer?

            There needs to be a dialogue here, and women’s needs and desires need to be considered, and you cannot make assumptions about what those needs and desires are.

            (Not planning more babies. If I were planning more babies, I’d have a planned c-section. I’d pick the day of the week so that I got out of the hospital on Monday, and could rest up with the baby while the underfoot kids were at school.)

          • moto_librarian
            March 5, 2014 at 9:47 am #

            In general, babies born at early term are more prone to respiratory issues. My naturally birthed eldest child (SROM at 38 + 3) had TTTN and did a brief stint in the NICU. I daresay that most parents would prefer the minor inconvenience of observation in the NICU over a dead baby. Besides, if a section is planned, that allows the mother adequate time to get steroids on board if there is any question of lung maturity.

          • Young CC Prof
            March 5, 2014 at 10:08 am #

            On an only slightly related note, a bunch of my fellow IUGR mommies were discussing the fact that none of our late preterm or early term babies seemed to have any lung troubles. Someone claimed that the stress of eking out a living on a bad placenta actually caused their lungs to mature faster. It sounds biologically plausible, but I wonder if there’s any evidence for it.

            I suppose it’s a testable hypothesis if one can get access to enough medical records, just look at the outcomes of slightly early inductions or sections due to IUGR, and see how many of those babies developed TTTN or other newborn breathing issues. The relevance, of course, would be in helping obstetricians decide which week to induce.

          • anion
            March 5, 2014 at 11:37 am #

            Hmm. Forgive my ignorance if this is something commonly known, but I wonder if the idea that a poor placenta = lung development has anything to do with general development in utero?

            In other words, do you think maybe an infant’s lungs develop and strengthen near/at the end of pregnancy because that’s when the placenta starts to degrade (for lack of a better term)?

            (I don’t expect you to have an answer, unless, again, this is something that’s already well-known to medical professionals. It’s just something your comment made me wonder about.)

          • Guestll
            March 5, 2014 at 9:51 am #

            What if the provider is trained/comfortable with vaginal breech delivery, and will discuss the option of ECV, and the patient a. does not want a vaginal breech delivery and b. is not interested in ECV?

            What if the provider is trained in breech delivery, but the patient is a poor candidate?

            What if the patient lives an hour away from the hospital, and her last two births were precipitous?

            What if the patient is 40 years old and is not planning on having more children?

            What if the provider and dyad don’t fit into your box? What then? Do you approve of a section then? Can you see past your bias?

          • Comrade X
            March 8, 2014 at 1:34 pm #

            “desire to avoid pain” is not trivial, by the way.

          • anion
            March 5, 2014 at 5:35 am #

            Risks outweigh the benefits for you. Not for me. There is nothing wrong with a mother who requests a section to avoid labor or pick the due date; we should be allowed to do so. I understood there was a risk to c-section (and I did not actually choose mine for my first baby; my labor was induced on my due date because my baby hadn’t dropped and she was in danger of becoming too large for me to deliver. My doctor was well aware of my desire to have a c-section, so when I’d pushed for an hour with no movement he offered me one and I took it gladly) but I also understood the risks of vaginal birth.

            I really don’t want to be rude here. I appreciate your viewpoint and as I said above I definitely appreciate that you and your fellow students see what happened in this case and acknowledge all of the mistakes made. But if I or any other woman wants a section, for whatever reason, I don’t think it’s anyone else’s place to tell us that’s a “problem,” or to view it that way and talk about my sections as being “unnecessary.” They were necessary for me. I don’t understand the idea that women are entitled to choose what happens to their bodies, except when it comes to giving birth, in which case we must be forced to deliver vaginally regardless of how we feel about it.

          • Karen in SC
            March 5, 2014 at 7:19 am #

            Who are you to say the risks outweigh the benefits? There are risks to vaginal birth as well.

            You have seen c-sections done out of convenience? REALLY? A doctor has directly told you, a student midwife, that she is performing a c-section for convenience? Maybe there are other reasons – availability of anesthesia, maternal exhaustion, maternal preference if it’s her OB on call now but not later, or just a “feeling.”

            Remember that the OB’s reputation and livelihood is on the line with every birth. If that makes them risk-adverse, so be it. That is our medical-legal culture.

          • Stacy21629
            March 5, 2014 at 7:23 am #

            “Remember that the OB’s reputation and livelihood is on the line with every birth. If that makes them risk-adverse, so be it.”
            THIS – exactly.
            Birth is SO safe in America. Sure would it be “better” for mom to have a vaginal birth…maybe. But the fact is, that doctor KNOWS he can section that baby now and it will be alive and healthy and A-OK. Or he can wait another 12 hours and the risk increases with exhaustion, fetal distress, PPH, etc.
            So…section mom NOW and KNOW you’ll have a relatively easy C-section and an all-but-guaranteed live healthy baby and live healthy mom…or WAIT and HOPE for a vaginal birth but possibly end up with a crash C-section and significantly increased risk – if not realization – of severe complications or death for mother or baby.

            When YOU are the one making that call…I can see how option A looks mighty good. Being in charge is a weighty thing.

          • March 5, 2014 at 12:21 pm #

            What about women who chose csection? Why aren’t they allowed to make the choice that’s right for THEM? Because YOU don’t like it?

        • Guestll
          March 5, 2014 at 9:20 am #

          I guess I am not a woman then, since my body categorically rejected the notion of reproduction without major medical interference. I could not conceive and sustain a pregnancy without intervention, nor could I deliver a live, healthy baby without intervention.

          It truly saddens me that people who espouse the “women’s bodies are made to reproduce” bullshit are sometimes involved in caring for women…especially those whose bodies are clearly deficient in your fucked up worldview. Take your biological essentialism and shove it.

          • Comrade X
            March 8, 2014 at 1:21 pm #

            Me too, Guestll. I have two separate (and obviously undersized) uteri, two cervices, and a partial vaginal septum. I am at obviously increased risk for second trimester miscarriage, and would never be able to give birth vaginally. My brother’s crunchy ex who gave birth in an inflatable pool in the living room once told me that these factors should lead me to consider that “some women (ie ME) aren’t meant to be mothers”.

            To that I say: FUCK. OFF. Fuck directly off. Do not pass Go. Do not collect £200. Take your revolting essentialist eugenicist bullshit and ram it firmly up whichever orifice is most immediately convenient. I do not serve “nature”. I do not serve “evolution”. I do not serve “the gene pool”. Your amazing womb and your amazing vagina are not signs from the G-ds of how wonderful and worthy you are compared to me.

          • KarenJJ
            March 8, 2014 at 9:03 pm #

            From someone that is clinically infertile (although it’s a long story and can be found in a medical journal called “Inflammation”), a great big “fuck off” from me too. Two thriving kids polluting the gene pool.

            Someone from my mother’s group had the same condition as yourself and has two gorgeous little boys (after some heartbreaking miscarriages, she was closely followed by an obgyn for her pregnancies). She didn’t realise and it was found during a pap smear and she had to pay for two of them!

        • March 5, 2014 at 12:20 pm #

          I am disgusted by anyone pulling this “your body isn’t a lemon” crap. You. Don’t. Get. It. Bodies are imperfect, bodily systems fail all the time. Stop blaming mothers!

        • Deena Chamlee
          March 7, 2014 at 1:22 am #

          tell me SNM1 what needs to change? Let’s not concentrate on “them” let’s concentrate on “us” since “us” is all we have control over.
          Why do you think our CULTURE has remained such for 50 years? I know the answer, but want your opinion. This is from a CNM who is deeply involved in changing “us”….

    • Stacy21629
      March 5, 2014 at 5:00 am #

      Dr. Amy recently discussed the Friedman’s curve. You should read about it. No one here is advocating following it. Dr. Friedman doesn’t even and never has.

    • anion
      March 5, 2014 at 5:25 am #

      While I disagree with your basic premise (and I have had two c-sections and a major abdominal surgery, and I can promise you the sections were walks in the park compared to the abdominal surgery), I am very glad that you and your fellow student CNMs have been discussing this case and learning from it. It’s nice to know that none of you, at least (hopefully), will ever tell a woman with no amniotic fluid to go home and “rehydrate and take a bath,” or act as if the situation is not a medical emergency.

    • moto_librarian
      March 5, 2014 at 9:43 am #

      You know, we all here about the risks of “major abdominal surgery” from NCBers all the time, yet very few of them acknowledge that vaginal birth has plenty of risks as well. I had a “textbook” unmedicated delivery with my first child, and still wound up with a massive pph, cervical laceration, and 2nd degree tear. I have had my complications brushed off by NCBers with shocking regularity. No one in that community wants to hear about a planned natural birth that wasn’t empowering. If you didn’t find it to be a transcendent experience, you must have done something wrong. That is bullshit.

      I was so afraid of complications during my second birth that I seriously considered changing to OB care from my CNMs so I could have an elective c-section. Fortunately, my midwives took my concerns very seriously, and we formulated a plan to help prevent recurrence. I should not that an epidural was the major piece of this plan, because being able to control my pushing would likely prevent another cervical laceration. They also knew that the pain of the birth itself was not something I wanted to experience again. They repeated often that it was my birth, and their job was to support whatever I chose.

      You had better learn some empathy during your training. If you can’t, find another profession.

    • Karen in SC
      March 5, 2014 at 10:12 am #

      The Friedmans Curve had nothing at all to do with the death of Gavin Michael at 42+ weeks. I hope that isn’t part of your discussion regarding this case. The issue is postdates and CPMs dismissal of the risks.

  6. guestguest
    March 4, 2014 at 2:00 pm #

    How homebirth midwives respond to a baby’s death?

    This is how Jan Tritten, editor of “Midwifery Today” responded so far to allowing a lay, “alegal” CPM midwife Christy M. Collins to crowd source on Jan Tritten’s facebook page opinions on how to handle a medical emergency situation, the course of action which ended with a baby dying because of midwife negligence:

    -she deleted the original thread posted on her Jan Tritten facebook page.

    – she posted three times a kind of disclaimer statement on that same page that the questions she posts are case studies only, when in fact it was already known that the situation and death of this baby due to midwife negligence occurred in real time. When the comments in response were unanimous in asking for a statement and taking responsibility for the role that she played, she would delete the whole thing and post the same thing again and again before giving up and now there is no mention at all.

    – she deleted all traces of discussion on all of her own and Midwifery Today pages.

    – she never in any form addressed what had happened and has not managed to even say that it is at least unethical to do anything except transfer care to real medical professionals if you are a midwife who does not know what to do in an unfolding high risk medical emergency situation.

    There is a note on Midwifery Today website from 2012 in which Jan Tritten clearly encouraged her fellow quacks and snake-oil selling brigades to do exactly what happened in this case – in lack of regulation, protocols, guidelines and education and without any trace of ethics she advises them to use the internet :

    “The speed of social media enables us to share ideas instantaneously.
    Use it to brainstorm projects. Let everyone know what you are doing and
    how they can help. — Jan Tritten, mother of Midwifery Today”

    And that is precisely what Christy Collins did – she used Jan Tritten’s help and facebook page to *brainstorm*. A baby died because of that.

    Your baby’s life if your baby dies is nothing more than a midwifery “brainstorming project” to them that they will delete because the questions of responsibility and gross negligence look bad on their web page.

    Think about that before you hire a lay CPM midwife like Christy Collins who in her own words is not an illegal health care practitioner simply because she is “alegal” and unregulated in the state where she currently practices( yes, she is still in business, not charged with anything or suspended from practicing pending an investigation – “alegal” means exactly that).

    Think hard about what happened to this family before you place you child’s life into hands of these amoral and uneducated *natural birth experts*.

    • guestguest
      March 4, 2014 at 4:48 pm #

      update: One of Jan Tritten’s quack buddies just posted this on her page :

      people do not realize that while social media is a great way to share
      information, it is also a place where information is gathered, and can be
      used against you in a court of law. Please keep this in mind before
      sharing anything that you would not want used against you or the
      midwifery profession.”

      So their only reaction is – be more careful next time !


      • Guestll
        March 4, 2014 at 4:53 pm #

        English to English: You idiots need to be more careful when you’re crowd sourcing life and death stuff, or we could be in deep shit. Watch what you say because the pressure is on and we wouldn’t want anyone to delve even more deeply into our unregulated birthy hobby.

        • Karen in SC
          March 4, 2014 at 5:00 pm #

          Discovery in a court case may not be limited to public FB pages either. Probably would take computers into custody and find everything.

          • Amy Tuteur, MD
            March 4, 2014 at 5:01 pm #

            And they can just subpoena Facebook for the posts.

  7. Ennis Demeter
    March 4, 2014 at 12:33 pm #

    Meme makers: I would live a meme that compares years of study of an OBgyn and CNMs to CPMs.

  8. lawyer jane
    March 4, 2014 at 10:34 am #

    Just found this 1985 study on intrapartum fetal death. I have no idea if it’s still relevant, but the conclusion is that “Fetal deaths that occur in labor, as contrasted with fetal deaths
    occurring before labor, constitute a perinatal outcome that is
    especially sensitive to level of obstetric care.” So it seems like homebirth (no matter the attendant) is likely to have comparatively high levels of intrapartum deaths.

    Also, this article demonstrating that electronic fetal monitoring was correlated with a sharp decrease in intrapartum deaths in Finland.

    I know that it’s a challenge to compare intrapartum deaths by birth setting since that data is not always specifically collected. But it seems reasonable to conclude that homebirths may very well increase risk of intrapartum death.

  9. Karma Kidney Stone
    March 4, 2014 at 9:41 am #

    No surprise, MDC deleted the Jan Tritten thread.

    Also, the celebrity homebirthers thread has more views than any of the threads on safety. Coincidence?

  10. yentavegan
    March 4, 2014 at 8:09 am #

    We are all forgetting that homebirth midwives are so in tune with the mother and her developing baby that if something should go awry, the midwife is able to detect it way earlier than an ob/gyn could and therefore the mother can get help in time to avert a disaster, right? I mean that is part of the ‘Why homebirth is a safe choice” narrative…..

  11. Amy Tuteur, MD
    March 3, 2014 at 10:46 pm #

    An article by Christy Collins:

    • MLE
      March 3, 2014 at 11:24 pm #

      She is an imbecile who shouldn’t be allowed near a birthing cat.

    • Danielle
      March 3, 2014 at 11:47 pm #

      1. The claim that the 49 countries scoring better than the US all have the same practices–Collin’s version of “evidence-based midwifery”–sounds dubious on its face. No one else cares about the Friedman’s curve? Europeans don’t often suffer from postpartum depression? Really now.

      2. Let’s say that it is true that concerns about malpractice suits make OBs especially risk-adverse. That is OK, with me, as I am also risk-adverse. If a little pitocin or even a c-section means cutting down on risk of harm to my baby, and there is little risk to me, then Sign Me Up.

      I suppose Collins would want to reply that the interventions are themselves dangerous — ah, but if that were really true, then by the logic of her argument the risk-adverse OBs, always hounded by lawyers as they are, would not want to do them unnecessarily.

      • anion
        March 4, 2014 at 5:15 am #

        I love the constant use of “risk-averse” as a pejorative for doctors. Like what you really want in a doctor is some reckless goofball running around with a glove on his head shouting, “What are you so worried about, man? You’re bringing me down! My plan for a skydiving birth can TOTALLY work! Now just let me finish smoking this bowl and we’ll get that kid out of you. Whoo-hooo!”

        • Comrade X
          March 8, 2014 at 1:49 pm #

          Exactly. “Risk Averse” is most definitely a quality I want in someone who has my life in their hands.

    • Trixie
      March 4, 2014 at 7:25 am #

      The safest birth is one without Christy Collins in attendance.

    • PrimaryCareDoc
      March 4, 2014 at 7:57 am #

      Wow. The arrogance of her ignorance is astounding. Do you think that she’s aware that South Korea has the third highest suicide rate in the world? She should really not choose that country to demonstrate excellent mental health.

      I also like how she says that OBs could lose their malpractice coverage and not be able to work. But she has no problem working without coverage.

      • anion
        March 4, 2014 at 8:29 am #

        Of course she’s not aware re South Korea. She’s not aware of anything that isn’t part of the special Christy-world where facts don’t exist.

        And she doesn’t need malpractice coverage, because she’s not like those silly risk-averse OBs who are only in it for money. She’ll take any risk with anybody’s life! She doesn’t care about the money, she’s in it for the megalomaniacal thrill of choosing whether other people get to live or die.

        • Trixie
          March 4, 2014 at 8:47 am #

          And yet she opens the article complaining about how she’s broke, and closes it by trying to drum up business for herself. Who’s in it for the money, Christy?

      • MLE
        March 4, 2014 at 2:24 pm #

        Reading this again, I’m wondering if she is confusing South Korea with North Korea, since she classes SK with Kuwait??

        • guestguest
          March 5, 2014 at 10:17 am #

          Halfwits like CHristy Collins CPM throwing numbers around as if they know what these numbers mean at all to just to make themselves sound *educated*.

          I actually LIVE in and come from the countries which have in their minds almost perfect c-section rate ( all scored under 17% in this 2010 published report on ‘The Global Numbers and Costs of Additionally Needed and Unnecessary Caesarean Sections Performed per Year’ :

          These c-section rates ought to be reflecting a healthy, natural-birth friendly, progressive medical systems in place we should all aspire to? Well they do not.

          These less than 17% c-section rates in my region reflect poverty, corruption that beggars belief, lack of resources, lack of trained medical professionals and everything else you would not wish upon your worst enemy when it comes to pregnancy care and childbirth.

  12. fiftyfifty1
    March 3, 2014 at 9:43 pm #

    Yep, if your baby dies or even if there is a “near miss” in the hospital you can be assured there will be a full investigation and root cause analysis and an M&M meeting. (And unlike in the above stock photo, I can assure you nobody attending will be drinking coffee).

    • Haelmoon
      March 4, 2014 at 12:07 am #

      I work in a smaller level three hospital. I have to admit our m&m rounds actually look a little like the photo. We all have coffee too. The exception to the rule was an intrapartum fetal death and that triggered a serious external review and recommendations that went all the way up to the board. No smiles there.

  13. March 3, 2014 at 9:03 pm #

    Senator Debbie Smith is interested in this issue and will be bringing it up with the state sentate. Thank you debbie! YOu are a champion of the rights of new borns.

  14. desiree
    March 3, 2014 at 7:41 pm #

    I still don’t understand WHO did the BPPs/NSTs. Jan Tritten’s original FB post said “baby’s kidneys visualized and normal” and that there was urine in the bladder. And somewhere else, someone said they left the hospital and went to another one for care. If it was a pay ultrasound place that was near, but not in, a hospital, did Christy read the ultrasound herself? Like she knows a normal kidney from an abnormal one?? This is all just utterly heartbreaking.

    • Ash
      March 3, 2014 at 9:53 pm #

      If anyone ever pulls all the medical records, I’m sure there will be even more strangeness than what we know now. There were just so many odd and bizarre things that occurred (and with a tragic result, of course)

      • Ihateslugs
        March 4, 2014 at 3:33 am #

        I certainly wouldn’t be shocked if Collins revises the medical records in this case. Once again, another example of the lack of professional standards of practice in lay midwifery. (Didn’t a guide for midwives to avoid litigation advocate for this very thing?). Anyway, I highly suspect there will be limited documentation of the red flags in this mother’s chart, and I would expect she includes plenty of narrative about mother’s refusal to seek medical care.

        • Karen in SC
          March 4, 2014 at 7:45 am #

          For new commenters and visitors, Ihateslugs is referring to the ebook, From Calling to Courtroom. Main advice – be sure you hire an experienced lawyer.

          Once again, the irony burns!

  15. Coraline
    March 3, 2014 at 5:59 pm #

    What a disgusting show of deep immaturity and a ghastly lack of professionalism in talking about Dr. Amy in that way on Facebook — “Begone Satan”?!?! Are you kidding me? What self-respecting person treats their critics like that?

    • Zornorph
      March 3, 2014 at 6:57 pm #

      Well, Jesus himself said ‘Get thee behind me, Satan.’ Of course, he actually WAS talking to Satan.

      • RebeccainCanada
        March 4, 2014 at 10:49 am #

        no, he was talking to Peter.

    • ngozi
      March 4, 2014 at 9:52 am #

      The kind of person that can’t deal with the facts at hand, knows they have done somethinig wrong, and resorts to name calling because they have nothing else.

  16. March 3, 2014 at 5:42 pm #

    Here are the ways to get a hold of local news in LV.

    The emails might be more effective if you send em one by one instead of to everyone at once. Kind of tedious but possibly worth it.

    • Meerkat
      March 3, 2014 at 8:09 pm #

      Does anyone know if the family is OK with all this publicity, especially in their area? They might not be in any shape to talk to the reporters.

      • March 3, 2014 at 8:13 pm #

        The family’s identity isn’t public and would be hard to find out about. The focus will be on christy collins and the facebook fiasco bc that is all public information and is the shocking part of the story.

      • March 3, 2014 at 9:10 pm #

        also- WHAT ABOUT THE BABY? The family is apparently not angry about this death, but the baby deserves some kind of a voice.

        • Trixie
          March 3, 2014 at 9:19 pm #

          The family IS upset, did you see the comments of the family member (or someone claiming to be a family member) on the other post?

          • Ihateslugs
            March 4, 2014 at 3:35 am #

            I missed that. Which other post?

          • anion
            March 4, 2014 at 7:37 am #

            Yeah, I hate to sound like That Girl, but the family certainly didn’t ask anyone to stop discussing the case or fighting to get it addressed. They specifically said they’re hoping for justice to be served.

            Granted we don’t have proof that the commenter in question truly is related, and granted they might not have thought to tell us to lay off…but *somebody* forwarded that email to Dr. Amy, and that somebody has to be close to the family (I doubt they sent something like that to everyone in their address book willy-nilly), so somebody sure as hell wants attention drawn to this, even if they’re not ready to start the fight themselves (which would be totally understandable).

        • Meerkat
          March 3, 2014 at 9:36 pm #

          I am totally with you on this and justice has to be served, but it is their story and their grief, not to mention lots of very personal info. If this story is reported locally, it’s not going to be very difficult to put two and two together and figure out their identity, especially for the people who know them. They might also want to do it on their own terms, or they might want to press charges. Dr. Amy has the family contact, maybe it’s worth checking with them.

    • Jocelyn
      March 4, 2014 at 1:16 pm #

      I emailed all of them!

  17. Alannah
    March 3, 2014 at 3:39 pm #

    Has anyone tried pitching the story to a news agency or a local LV paper? I can’t imagine it’s not newsworthy. We WATCHED A BABY DIE LIVE ON FACEBOOK for pete’s sake! How can this not be great media fodder? Why isn’t it all over the news yet?

    • March 3, 2014 at 3:54 pm #

      Yes I emailed all the stations and news papers. I am sure that if more people contact the news stations it will be more likely to become a story.

    • desiree
      March 3, 2014 at 4:09 pm #

      Yes. This is practically like live-tweeting a homicide. Surely someone can be charged with something here??

  18. anion
    March 3, 2014 at 3:20 pm #

    Wait! Is that another (previously uncommented on) lie I spot there?

    “They were at a hospital with those three BPP’s[sic], so wenr[sic] promptly into an emergency c-section.”

    No, they were at a hospital with those BPPs, sure, but instead of going promptly into an emergency section at that hospital (which is what you are clearly and obviously trying to claim is the case), you loaded them into your car and drove them half an hour across town to a totally different hospital. Between leaving the first hospital, getting into the car, driving, and getting into the second, you probably wasted almost an hour at minimum.

    That is NOT prompt. And you’re a damn liar.

    • March 3, 2014 at 4:02 pm #

      Half an hour with that last 20 minutes in it. I saw that too but easy to lose stuff in the comments.

      What else can we be doing?

      • anion
        March 4, 2014 at 8:17 am #

        Submit it to various sites which report on social media news?

  19. Trixie
    March 3, 2014 at 2:51 pm #

    I wonder if playing up the anti-vax views of most CPMs would help give a hook for other skeptic bloggers to pick up the story?

  20. MrG
    March 3, 2014 at 2:39 pm #

    I truly don’t understand what all this fuss here is about the CPM midwife-led baby death.
    After all, CNMs and MDs are professionals and care providers and they truly feel they care for patients. They have responsibilities, even when there is an adverse outcome.

    CPMs? Not only are they not professionals. It’s worse.

    According to their “core competencies” they are not even care providers:

    “The woman is the only direct care provider for herself and her unborn baby; thus the most important determinant of a healthy pregnancy is the mother herself.”

    So if the mother is the only direct care provider what does it mean for “CPMs”?
    CPMs cannot be blamed for a bad outcome. Ever. They are not the provider. It’s the mom who is responsible. Always.

    So if “CPMs” are not care providers, what are they?

    • MaineJen
      March 3, 2014 at 3:01 pm #

      Scam artists.

    • Sue
      March 3, 2014 at 8:27 pm #

      If the woman is her own ”direct care provider”, why would she pay for someone else to watch?

  21. Are you nuts
    March 3, 2014 at 2:21 pm #

    Here’s what the original “crowd sourcing” facebook message should have said: “I am overseeing the birth of a woman who is 2.5 weeks overdue and there is no amniotic fluid. I’ve told her that her baby is likely to die, but she won’t listen. If I call the police, can they make her go to the hospital?”

  22. Zornorph
    March 3, 2014 at 2:12 pm #

    There was once a midwife from Nevada
    Her medical training was nada
    A baby boy died
    Because of her pride
    Let’s make her persona non grata!

  23. March 3, 2014 at 1:53 pm #

    I emailed the homicide unit of LVPD today to alert them of the death, as well as the successful prosecution of cases like these in north carolina and utah. It seems like they would be legally required to look into it if a report is made (even an informal one). Heres hoping!

  24. PenFox
    March 3, 2014 at 1:46 pm #

    I fixed the poem:

    My baby’s not a library book,
    Books don’t inhale poop when they’re overdue.
    If my baby takes too long to cook
    He might not live to see me.

    A placenta is a living thing
    That can falter if you’re post-date.
    I’d rather hear my baby sing
    Than wait for some terrible fate.

    My baby can’t read dates yet
    Because he’s very new.
    That’s why a hospital’s the best bet–
    They can deal with in utero poo.

    So stop your worry.
    Stop your asking.
    There’s no hurry
    (Unless baby’s in distress.)
    My doctor keeps a close eye on me
    So I can enjoy my pregnancy stress-free.

    Now, you leave us be…
    My doctor is here for me.

  25. Guestll
    March 3, 2014 at 1:31 pm #

    Hey Christy, if you’re reading this, how badly does it suck to be caught in your own web? Did you really think you were going to get away with it, that Dr. Tuteur wouldn’t figure out who was responsible for this disgraceful death?

    The buck stops with you, Christy. Enough. It should have stopped a long time ago for you though, shouldn’t it? You’re proof positive of the idiom “some people just don’t know when to quit.”

  26. March 3, 2014 at 1:30 pm #

    I’ve found that this is how midwives respond to *any* negative happenings under their care. They can’t seem to be accountable for anything that happens. I’ve started to wonder if this line of work attracts sociopaths. ASP people are bored with normal life and thrill seek to feel alive, and seeing how far you can go with high risk deliveries sounds like a great way to fulfill that need. They can pack up their lives and start over in new places because they lack the normal feeling of connection that most humans have toward each other. They can kill someone and blame the baby or mom without skipping a beat. They can inspire trust using charm and reassurance (until the check clears). Seems like the business to be in for female sociopaths.

    • thepragmatist
      March 4, 2014 at 2:49 pm #

      Anywhere there is power, you will find a subset of people in it purely for the power, and the CPM is so easy to achieve, OF COURSE, it is not surprising at all to me that it attracts these sorts of women. But something I am coming to learn (very slowly) that women like us (on this page) are not in the majority. When we talk about average IQs, it is truly AVERAGE and people are not very bright. It is very possible that we are watching someone who is really not very bright just screw up based on a rigid adherence to dogma (something the not-very-bright need, in order to feel settled). I have had to learn to not read so much into people’s behaviour, because I am too smart and creative, so everyone has some complex malevolent intent, when really they’re probably just motivated by banal self interest and stupidity. Ain’t that depressing?! In a way, the banality of evil is more depressing than a concerted sociopathy, because it means that it’s much more human and much less divorced from each of us than we would like. At least, that’s my take. I’ve slowly realized this in my personal life, where I once read all kinds of complicated motivations into the behaviour of those who harmed me, when really, I think it was just stupidity and self-interest and greed.

  27. me
    March 3, 2014 at 12:24 pm #

    Just FYI – there is no #8.

    • Amazed
      March 3, 2014 at 12:37 pm #

      Hi and welcome (you might not be new to the site but you’re new to posting here, aren’you?) Thanks for telling your story, you are an example of what I always say when we have people parachuting here to tell us that we won’t change the minds of the hardcore homebirth advocates (although we’ve had some posters who shared that their hardcore mind had been changed): we have a better chance with women who are simply interested in the woo, looking for options, or are even slightly in. They can be reached without much effort on our part, simply because the idea of the homebirth “truth” isn’t so firmly planted in their minds and they can be shocked out of it.

      I think giving a site more visits pushes it forward in search results but I am not sure. I am going to right now, just in case.

      Sorry, meant for another poster. Disqus hates me again.

      • NoUseForANym
        March 3, 2014 at 12:38 pm #

        Linking pushes it up in search ranks so link everywhere you can.

      • Certified Hamster Midwife
        March 3, 2014 at 1:28 pm #

        Visiting a site does not push it up in search results. Linking to it does, but linking to it from a comments section may not – I don’t know a lot about Disqus.

  28. NoLongerCrunching
    March 3, 2014 at 11:55 am #

    Does anyone have the actual screenshot of Christy saying “no” when Dr. Amy asked if she was the MW? I saw it with my own eyes, so I know it happened, but I’d love for this post to have Christy’s bald-faced lie right there in living color.

    • Amy Tuteur, MD
      March 3, 2014 at 12:02 pm #

      Here it is:

      • Trixie
        March 3, 2014 at 2:10 pm #

        Dr. Amy, could you put some of the most relevant screen shots, like this one, over on the Not Buried Twice Facebook page? It might be good for people who casually happen upon that page but don’t feel like clicking a bunch more links.

        • The Bofa on the Sofa
          March 3, 2014 at 3:26 pm #

          I think it needs the comment directly above, the one to which she responds, “No I’m not.”

  29. Mel
    March 3, 2014 at 11:47 am #

    God, that poem sucks.

    “My baby won’t take too long to cook / ‘Cause he’s not veggie stew.”

    That makes no sense. When you cook stew, you cook it until its done. If you keep cooking after it’s done, it burns and is inedible. With babies, they need to gestate until they are mostly developed. If they keep developing in the mom’s body after that point, the energy drain starts wrecking everything and the baby can die.

    “My baby’s not an elephant. / And I am not fit to burst.”

    You’re right – you probably won’t explode or give birth to an elephant. (Duh.) But longer gestation lead to bigger babies. Bigger babies do have rougher labor and delivery potential. In our cattle, we induce at 40 weeks and 3 days to reduce obstructed labors. In fact, some very popular bulls produce calves that are born at 39 weeks instead of 40 – a 10 pound lighter calf is so much easier to deliver and has the same survival rate.

    • Certified Hamster Midwife
      March 3, 2014 at 11:52 am #

      Wait, so people and cows have the same gestation time?

      • Mel
        March 3, 2014 at 1:29 pm #

        Yup. It’s one of those weird convergences in the animal world. I’ve told my husband that if I ever get pregnant I’m putting up FB updates of relative size of the growing embryo and a calf that will be born on the same day….

    • Elizabeth A
      March 3, 2014 at 12:05 pm #

      A lot of stews actually improve with time in the pot – as long as there’s enough liquid in there.

      That wasn’t intended to be painfully on the nose when I started typing, but now that I’ve written it, I’m letting it stand.

    • LovleAnjel
      March 3, 2014 at 1:07 pm #

      “My baby won’t take too long to cook / ‘Cause he’s not veggie stew.”

      This is just weird for the premise of the poem.

      “Shall I make some stew?”

      “No, that takes too long to cook. I have some Kraft Mac n Cheese here that will only take ten minutes.”

      The use by the author (this person does not earn the title “poet”) implies that the baby will be here sooner rather than later – it won’t “take too long” to gestate.

      • Mel
        March 3, 2014 at 1:34 pm #

        Plus, I find the entire poem clunky. There’s not much imagery in it – baby compared to veggie stew and elephants. I tried to read it aloud and the first three verses kinda flow, but then the last two were hard to find a rhythm for – which is odd for a poem about all things having an unique rhythm.

    • Are you nuts
      March 3, 2014 at 5:51 pm #

      I love your farm anecdotes!

  30. Elizabeth A
    March 3, 2014 at 11:46 am #

    Hate the graphic.

    The people in the morbidity and mortality review (okay, in the clip art labeled “medical professionals”) are way too fake, and way too calm.

    One of the things that NCB advocates say they fear is that doctors and hospitals won’t care about them and their babies. Those people do not look like they care about anything, except distributing the creamed and uncreamed coffee to best aesthetic effect for an overhead shot.

    • Certified Hamster Midwife
      March 3, 2014 at 11:53 am #

      That’s the problem with using stock photos – everyone are models. I can’t picture a homebirth midwife with a manicure anything like the bottom photo.

    • auntbea
      March 3, 2014 at 12:24 pm #

      They look pretty happy to have the chance to meet over coffee, quite frankly. I found some better images — though not of doctors — by searching for crisis meeting.

    • BeatlesFan
      March 3, 2014 at 3:11 pm #

      I agree. The top picture should at least feature some balled-up tissues on the table, and a few people who look like they haven’t slept.

      The bottom picture should have blood under the fingernails.

      • Elizabeth A
        March 3, 2014 at 3:59 pm #

        Yeah. There should be more people in the room (every doctor and nurse who was involved), and far more exhaustion and agony on display. Less makeup. A grim and disheveled legal advisor. White knuckled grips on coffee cups. No saucers.

  31. Marie
    March 3, 2014 at 11:38 am #

    Thanks for this and all the great memes from yesterday.
    In case anyone is not aware, Christy Collins has several mostly not-yet-rebutted comments on Navelgazing Midwife’s fb page. They are a week old, so I assume old news. But I’m just so furious reading them that I thought if anyone here is allowed to post there, they might head over. It’s under the heading NGM posted about the petition on February 22.

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