I believe your baby Thor died because of you

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American homebirth advocacy is filled with mistruths, half truths and outright lies.

The biggest lie, of course, is that homebirth is safe. It’s not. American homebirth has a death rate 2-9X higher than comparable risk hospital birth, depending on attendant.

The second biggest lie is that homebirth advocates take responsibility for their decisions. Yes, they are happy to take credit for decisions that ended up with a live mother and a live baby. When it comes to bad decisions, however, if their baby was one of the many babies who die at homebirth, they shed responsibility like water off a duck’s back. It was everyone’s fault but their own.

Some women are more creative than others in avoiding responsibility. Elizabeth Heineman, currently promoting her new book Ghostbelly, the story of her son Thor’s death at homebirth is more creative than most. Heinemen “educated” herself and purposefully chose homebirth. Thor is dead as a result. Who does she blame? Why, politics, of course:

I believe that my nurse-midwife Deirdre is an excellent practitioner. I believe her hundreds of successful deliveries and the intense loyalty of her clientele demonstrate that she provides an important service. I believe her practice of non-invasive birthing for low-risk preg­nancies contributes to a necessary movement toward more sen­sitive forms of reproductive health care.

I believe that after decades of successful practice and no bad outcomes, Deirdre made the wrong judgment call in not referring me to a doctor once I was a week postdate. I believe that judgment call resulted in Thor’s death.

I believe the likelihood of her making the wrong judgment call was heightened by the fact that she felt under siege. I believe the warfare between the medical profession and out-of-hospital midwives made her reluctant to refer a low-risk pregnancy with no sign of trouble to a doctor…

In other words, it isn’t Deidre’s fault; and it certainly isn’t Heineman’s fault. But Heinemen is wrong. I understand that the impulse to denial is monumental in a case where your baby dies because of the decision that you made. But if you are going to elevate your denial to a book length plea to be absolved of responsibility, other people are going to offer different interpretations.

Here’s what I believe:

I believe that Elizabeth Heineman made the choice to deliver at home, far from emergency equipment and personnel. I believe that Heineman chose to ignore standard medical advice of obstetricians. I believe that in choosing a homebirth midwife, Heineman chose a practitioner who valued her personal autonomy above all else, and, as a result, let a baby die. Therefore, I believe that Thor died from his mother’s desire to have a certain kind of “birth experience” and that politics had absolutely nothing to do with it.

Saying that Heineman bears responsibility for Thor’s death at homebirth is not incompatible with feeling sorry for her loss. It’s no different than grieving for a child who went through the windshield and died because her mother didn’t buckle her into a carseat. That mother is no doubt devastated, and no feeling person can failed to be moved by that devastation, but that doesn’t change the fact that the mother, through her action or inaction, is ultimately responsible for the death.

Heineman’s description of the proximate cause of Thor’s death is both elegant and haunting:

I believe that Thor died in excruciating pain. His brain, deprived of oxygen, each cell suffocating, withering into itself, crumpling, collapsing, but still struggling, alerting the nerves that something was terribly wrong. The nerves suddenly plunged into burning acid, receiving the frantic message, send­ing that information in a useless loop back to the very brain that was under siege. The brain screaming in increasing des­peration to the lungs that they should try something, anything. The lungs naively expanding, opening, to pull in relief, to pull in the cool air whose oxygen molecules it will quickly trans­mit to the bluish blood, re-reddening it, re-energizing it, so the blood can rush to the brain, restore it. The lungs instead getting meconium-filled amniotic fluid, choking the blood by transmitting precisely nothing, the blood by now dead but still pumped by the heart that hasn’t yet learned that it is all over, the heart sending the useless blood to the brain cells now wrung dry as they complete the act of withering, crumpling, collaps­ing …

And, to her credit, she does acknowledge one of the real reasons for Thor’s preventable death:

…I believe her most fundamental reason for not referring me to a doctor was much simpler: in her evaluation, it wasn’t medically necessary.

In other words, Deirdre was wrong to ignore the risk factors in Heineman’s history, but Heineman still tries to absolve her:

I believe the likelihood of Deirdre’s making a mistake was heightened by her professional isolation. I believe that isolation reduced the opportunity for informal, day-to-day talk with colleagues to remind her of risk factors that rarely come into play but which can be critical, like the dramatically higher incidence of stillbirth for women over 40 starting at 41 weeks’ gestation.”

But again Heineman has it wrong. I believe that the likelihood, indeed the near certainty of Deirdre’s ultimately making a fatal mistake, was heightened by her desire for professional autonomy. You don’t need “informal, day-to-day talk with colleagues” to understand the difference between high risk and low risk and act accordingly.

What really killed Thor?

I believe that natural childbirth and homebirth advocates (including some midwives) are perpetuating a series of big lies: that childbirth is inherently safe when the truth is that it is inherently dangerous; that childbirth without interventions is “healthier” when the truth is that it is riskier; that birth is a piece of performance art when the truth is that women have little or no control over what happens during labor; that women should judge themselves by whether they can give a specific birth performance of unmedicated vaginal birth refusing any and all interventions along the way when the truth is that how the baby is born is irrelevant, what matter most is that it is born safely.

I believe that these big lies are being perpetuated by an industry that profit from them: natural childbirth lobbying organizations like Lamaze International and the Childbirth Connection; an army of homebirth midwives, doulas and childbirth educators who would have little if any business if it weren’t for the disinformation campaign of natural childbirth: and a group of women who believe that ignoring medical authority is a demonstration of their “education” when it is nothing more than a sign of their gullibility.

I believe that babies die when celebrities with no medical knowledge like Ricki Lake evangelize and profit from their endorsement of quackery. I believe that babies die when midwives value professional autonomy over common sense. I believe that babies die when mothers locate the center of their worth in their vaginas and the transit of their progeny through them, rather than in their brains that have the power to prevent the deaths inherent to childbirth.

Simply put, I believe that babies die when their mothers choose homebirth.

And I believe that babies will continue to die preventable deaths at homebirth as long as women like Heineman refuse to take responsbility for those deaths.

  • Geo

    Poor baby! Infinite thanks to my husband who found this blog…who was always against the idea of home birth and sank in desperation when I went through it anyway…that when I was laboring at home he was in contact with my OB…than when I passed out during contractions took me to ER…and thanks to his persistence my baby was born alive. With Jaundice and some other issues..but alive

  • vicole

    Who’s fault is when babies die during hospital births? or when mothers die during childbirth? Would you say it was the doctor’s fault? Can you like your doctor but accept that the baby died? Yes, I do know three women who went to the hospital to give birth and came home without babies and I never heard any of them blame their doctors. In Massachusetts within the past year, two women at the same hospital just outside Boston died during childbirth. Young, apparently healthy women. it happens even in a hospital, even with an MD.

    • RN who has seen too much

      Really? That seems like a lot. How did the babies die? I’m curious because we hardly ever lose a baby unless there is prematurity, Pprom, severe infection, or a medical condition. You personally knowing 3 people seems….odd. The two women dying in the hospital were complete freak cases from what I’ve heard.

      • Mac Sherbert

        I agree 3 does seem odd. I know one woman who lost a baby at term she started bleeding – rushed to the hospital where she was given an immediate emergency c-section, but they just weren’t fast enough. In her case the hospital didn’t kill her baby it just wasn’t able to save it, but they did save her life and she now has other children.

        Sounds like she travels in crunchy circles. We could speculate that these were women who started out at home and transferred, or maybe they were postdates, or they were extremely premature or had a birth defect in compatible with life? Without details who knows…

        And I believe at one point those cases in Boston were discussed here and everyone was demanding answers and trying to find out why that happened.

        • RN who has seen too much

          Right, I mean I do see fetal demises in the hospital pretty regularly unfortunately, but usually they are not term, and the babies are lost before labor even starts, such as a sudden placental abruption. In fact I can only think of one close call, and that was a shoulder dystocia, but with a great NICU code team, that baby survived and went home with his family.

          • birthbuddy

            Exactly, the difference is that perfectly healthy term babies are dying during labour in homebirth.
            This is almost unheard of in hospital.
            This is the point they completely miss.

      • birthbuddy

        It’s not odd, it’s unbelievable.

      • drsquid

        i know one friend whose wife had a stillborn. i dont know details. and a bunch who had preemies who are doing well. i just dont buy that there are tons of women losing otherwise healthy full term babies

    • Lilin

      Let’s put it this way. If you are driving down the road and hit ice and crash and your child dies, it’s always tragic, and in some ways it’s nobody’s fault. However, if you hit ice and you haven’t strapped your baby into a car seat and it dies, you are most likely partially to blame. Saying otherwise would be as ridiculous as saying, “But babies who are strapped into car seats also die sometimes!”

      Nothing is one hundred percent sure. That being said, you take greater risks, you bear some of the responsibility when things don’t go your way.

    • birthbuddy

      There is a very fundamental difference.
      Unlike homebirth hobbyists, doctors and hospitals have no choice about the risk of the patient they have to deal with.
      Despite this (all risk vs ‘low ri’sk’) homebirth babies still die at 3X the rate as in hospital.
      Go figure.

    • The Computer Ate My Nym

      Who’s fault is when babies die during hospital births? or when mothers
      die during childbirth? Would you say it was the doctor’s fault?

      It depends. Sometimes it is absolutely the doctor’s fault or the hospital’s fault. That’s why hospitals have morbidity and mortality conferences and root cause analysis meetings. And why doctors are required to carry malpractice insurance to compensate victims of malpractice. And why outside organizations like JCAHO regularly evaluate hospitals.

      So, how much scrutiny do CPMs undergo? If a baby or laboring woman dies under their care, who analyzes the death to see if they were at fault? What compensation can they offer the survivors? How often do they change their practice when one practice proves to be unhelpful or dangerous?

  • Anj Fabian

    I would like to point out that Heineman started with a CNM practice at the hospital.

    She had Real Midwifery(tm) care and gave a few flimsy excuses why she preferred to have a home birth. They can be summed up as delivering in a hospital and a whopping 15% cesarean rate.

    The real reason is that she wanted to be in control. No mention of extenuating circumstances, no sexual assault, no PTSD, no previous unpleasant experience in a hospital, no previous unpleasant experience in child birth, no anxiety disorder, no mental health issues. Her previous delivery was in Berlin, Germany with midwives.

    Her biggest complaint was any and all “unnecessary interventions”. One of her anxiety inducing scenarios was having her baby taken to the NICU – for trivial reasons of course. Her nightmare scenario was not that her child might need intensive care, just that she might be separated from him.

    [sigh]
    I will say that she was most impressive since she managed to push Thor out when she was only dilated to 8 cm, tearing her cervix in the process. She was certainly in good shape.

    • fiftyfifty1

      “They can be summed up as delivering in a hospital and a whopping 15% cesarean rate.”

      And lower for a woman like her with a proven pelvis.

  • NursingRN

    …I believe her most fundamental reason for not referring me to a doctor
    was much simpler: in her evaluation, it wasn’t medically necessary.

    Huh…interesting that someone who is kinda on the opposition of medical anything can judge when something is medically necessary. Hey, you know something? I asked my son if since he’s such a picky eater and won’t eat anything but hot dogs and cereal if we ought to go get his hemoglobin and weight checked. In his “educated” five year old opinion…it’s not medically necessary. :-)

  • Amy Tuteur, MD

    We haven’t addressed the fact that Heineman carried her baby’s dead embalmed body around with her for nearly a week, taking the body to the playground, etc.

    That hurt no one, but it suggests someone who likes to pretend that reality is something very different than what it is.

    • araikwao

      ..Or just that she was grieving

      • attitude devant

        Yeah, well, I’ve taken care of lots of women who’ve lost babies from all sorts of causes. And if you read the article, her behavior was truly over the top, even for such an extreme situation. Such weird fantasy-inspired behavior. Showing him his brother’s room. Showing him the diapers that his grandmother had bought and telling him family stories. Telling him he’ll be buried next to the forest at the edge of their lawn so bunnies will visit. It’s a bit much even if you’re comfortable with grieving mothers, which I am.

        And she just makes stuff up! She talks about how it used to be that women didn’t get to see their dead babies. Umm and when exactly was that? Because I’ve been on labor wards since the mid 80s and every single one I’ve been on has had a “whatever you want and forever how long you want” policy for parents wanting to keep their children with them.

        • Dr Kitty

          Not all parents want to see their baby.
          Hospitals where I worked take photos and make memory books for everyone, and keep them with the medical notes for those that decided they didn’t want them at the time, in case they ever changed their minds.

          The matron on a ward I worked on had tiny Moses’ baskets from toy shops for the second trimester losses, she also knitted tiny blankets and hats.

          Things are different these days.

        • araikwao

          Oh wow….definitely did not read all of that. I didn’t want to assume that just because she has made such huge errors in reasoning re the cause of her baby’s death that she is therefore nuts about everything, but that sure sounds beyond the spectrum of normal grieving…

    • Medwife

      Oh my goodness.

      Now, I know it is common and usually necessary/therapeutic for a family to take time with their baby’s body after a perinatal death. There is _nothing_ wrong with it. But at some point, within 12 hrs or so, the baby is kissed goodbye and the body goes to the morgue. AND DOES NOT COME BACK. I don’t understand this lady, walking the body around for a week is NOT healthy grieving behavior.

      I haven’t read her writings and I don’t know that I can bring myself to. It seems a study in abnormal psych and I suppose I could learn a lot from it, but… It’s gonna be a tough read.

    • http://momofmanyfeet.wordpress.com Bambi

      I can honestly say I think I understand. I remember wishing I could bring my daughter home and yeah, even thought, I can put her on the hutch. Your brain thinks all kinds of things. This is your one and only chance to create some type of memories. When you’re holding your baby, I don’t think your heart and brain are thinking “hey, your kid’s dead here”. You’re just focused on your baby being in your arms until your head and heart interject with the reality you are living. Perhaps this doesn’t make sense unless you’ve been there.

    • Deena Chamlee

      PTSD WITH SIGNIFICANT LOSS IN REALITY. I am surprised she was not admitted to inpatient treatment.

      • Anj Fabian

        She had multiple people suggest therapy. She made three attempts at it and finally joined a writing group.

        Every time she asked the litany of questions (sleep, spouse, work, friends, diet) with positive answers. All this while she was making nearly daily trips to Thor’s grave to talk to him.

    • yentavegan

      Thank you for telling us this. I will not be reading her book.

  • Amazed

    OT: Would someone PLEASE inform this gorilla that she ISN’T supposed to bond to her c-section baby because interventions and so on?

    http://www.dailymail.co.uk/news/article-2590481/The-heartwarming-moment-doting-mother-introduces-baby-gorilla-born-rare-C-section-troop.html

  • Anj Fabian

    Most amusing part of the book is the fresh new CNM finding out that the insurance company she is billing doesn’t want to pay her unless she has a supervising physician. (She doesn’t have one. No surprise there.)

    I suspect that was one of her main motivations of getting her CNM accreditation – being able to get insurance reimbursement.

  • Anj Fabian

    I’m reading the book now and the author sounds initially like you would expect an older and well educated woman to sound. In fact, she keeps that facade up for half of the book.

    Then, all the tropes and memes come pouring out: Unnecessary interventions, having to “fight” against hospital policies, being uncomfortable, fearful and anxious about being in a hospital. Quibbling about due dates and basing inductions on them. Not about relative risks such as “Is it worth it to have an induction if it means minimizing bad outcomes for the baby?”. Nope. Inductions are bad. Why are they bad? Irrelevant. Inductions are bad and the people who do them shouldn’t unless they absolutely have to.

    • attitude devant

      So is this “My Baby Died but my Midwife was Awesome” dressed up as a literary memoir?

      • Anj Fabian

        She does write well.
        She does rail against the perceived unfairness of the medical establishment and she gives a glowing description of her midwife.
        She even says that after two perinatal deaths that she ‘believes’ that her midwife changed the way she practices.

        Before those two deaths, the midwife had no problem allowing a previous client going to 43 weeks and used that a reassuring anecdote. Heineman doesn’t talk about that in the light of the later deaths or how the midwife changes her practice to be more like the way that OBs practice.

        Heineman is all for the ideal midwife, the one who cultivates a personal relationship, the one who allows the clients to dictate their own care, the one who is warm, friendly, comforting, reassuring. She loves this paradigm – while not discussing if that this kind of care allows a midwife to deliver sound, evidence based care to every client.

        • Anj Fabian

          In a painful irony, the second perinatal death happens when the midwife does not wish to allow her client to go past 41 weeks – and the client refuses to do what the midwife desires.

          Is it a success because the client got the care they wanted, but an outcome they did not want? If you allow a client to believe they are in control, and they insist on having that control – did you make a mistake?

          • Medwife

            But they ARE in control. You can’t, and shouldn’t be able to, force a woman to be induced. You can say, in the plainest, bluntest words, that the baby has an x chance of death, that she actually has a lower chance of cs if induced at term (if that’s the case for her circumstance, and all the consequences for being post dates. You can’t fire a patient. Thinking it through, though, you can ultimately say that your license does not allow you to attend a home birth under certain circumstances, and deliver her in the hospital if you can. If you can’t, I suppose you could document your ass off, refer to an OB, and call it a day.

          • Anj Fabian

            But that’s not the dominant home birth paradigm.

            The dominant paradigm is that OBs are reserved solely for zomg-impending-disaster situations and that midwives can handle everything else with a few words of encouragement, a warm bath and a cup of tea.

            If a midwife has sold that bill of goods to a patient and then pulls what looks like a bait-and-switch, why would her client be receptive? One day, a reassuring story of delivering a baby at 43 weeks (unreliable due dates, babies decide when they are born) and the next, sorry I no longer go past 41 weeks.

        • birthbuddy

          She may write well but it is a pity her baby had to die as part of the marketing of her book.

  • C T

    I think the reason that so many are OK with placing blame on Heineman is that she is a university professor. She even teaches classes on gender and sexuality. She knew how to get to real studies about stillbirth risk and had free, easy access to them; after all, she references studies on hospital infections, which aren’t even in her field. As a history professor, surely she has more than an inkling of the historical death rates associated with pregnancy and birth. As a gender and sexuality professor, she can’t possibly have missed the fact that women’s fertility and childbearing success declines with age. She’s probably far better educated (in terms of years of study and research ability) and possibly more intelligent than her midwife. Why think that she is justified in blindly accepting what her CNM said when she doesn’t blindly accept OB protocols? This is a questioning, intelligent woman who turned off her skepticism at a most inopportune time.
    My husband works at a college, so I can access scientific journals through its library. Because of what I’ve found in studies on stillbirth rates, I’ve decided to request an induction prior to 40 weeks because I’m 39 years old now and I know peers who have lost children to stillbirth. This is a big deal for me, getting an induction. I had all four of my children med-free. But the actual science and stats on this subject–which are easily accessible to a university professor and comprehensible by someone with a PhD–have convinced me to admit that my aging body can’t be trusted to birth this baby in time if left to itself.
    I can be sorry for someone’s loss, which I am in this case, and still think she’s at fault for making a foolish decision to trust her nurse when a simple database search would have turned up clear information indicating her elevated stillbirth risk.

    • MJ

      Hi CT – in my experience an induction does not necessarily have to equal pain medication. After three kids and three inductions I’ve found that induced labour is very intense – contractions come thick and fast, often with little build up – but it can also be quite short.
      I had a blessed epidural with my first eleven hour labour (post-dates induction of a big boy). With my second and third boys (40 week induction after SROM and no labour & 37 week induction for the same reason) each labour was only about 3-5 hours and I didn’t really get tired enough to feel that I needed anything.

      There’s no objective reason not to have an epidural (mine was great and I was pretty scared of them all the way through pregnancy), but it’s not inevitable.

      • Medwife

        I love multips (women who have had babies before) :)

        • MJ

          And I love medwives! I was attended by hospital midwives for all my labours, but for my last pregnancy my antenatal care was also provided by a hospital midwife. She managed my induction and all our newborn/maternal care. She was professional, skilled, thoughtful, collaborative and an absolute credit to her profession. Having had experiences like these with midwives in Australia is what makes me care about the travesty of the system in the US. There is no excuse for substandard midwifery.

  • Cold Steel

    Chiming in again with an analysis of the names. I think it is extremely telling that this woman referred to her CNM as ‘Deirdre.’ First name. Implying friendship, or at least a close personal relationship. Again with the horrifying blurring of professional boundaries unique to NCB. If she had an obstetrician instead, I’m sure she would have named ‘Dr. Smith’ in the subsequent lawsuit rather than ‘Jane,’ as would be appropriate when any competent practitioner presides over the intrapartum death of a healthy, viable fetus.

  • RN who has seen too much

    I don’t think it’s ok to blame the mother. I live in Oregon, and have friends who homebirth. They are so wrapped up in the woo nothing I say can change their mind until something bad happens….which unfortunately it has. Then they blame themselves. Really, we depend on our obstetritians to guide us in the best course of action, and we should ask the same of homebirth midwifery, only they don’t have the expertise to know what they are doing. The patient doesn’t know that unfortunately, having being fed a steady diet of lies from their friends to the mainstream media about how safe birth is. They explain my horror stories from work as an L&D nurse as being problems with hospital interventions etc. They just DON’T KNOW. and it’s sad, but they shouldn’t be blamed for their ignorance.

    • Trixie

      Okay, but after your friends have something go wrong, would they then publish a book about it defending the home birth midwife and themselves, and blaming the hospital?

      • RN who has seen too much

        Yes, they do, they find some reason to blame someone else. It’s disgusting. And bofa, I do feel like they are so ingrained in what they believe that nothing can change their opinion. It’s easier to do than you think.

    • The Bofa on the Sofa

      They are so wrapped up in the woo

      Isn’t this their problem?

      It sounds to me like you are saying, “We can’t blame them. They believe really stupid things.”

      Like they have no choice to believe in really stupid things?

    • Hannah

      She knows now, though. She knows it was dangerous and her baby died as a result and she has now written a book that essentially explains away her midwife’s incompetence as being the result of the medical establishment being meanies. It’s not ‘poor Dierdre’s’ fault. It’s the mean doctors who don’t want to do Dierdre’s job for her.

      That’s when the pass ends. She has learned nothing despite objective evidence that refutes everything she claims.

  • The Computer Ate My Nym

    From the original post: “I believe that studies showing roughly 100,000 preventable deaths every
    year due to infections intro­duced in hospitals demonstrate that
    unnecessary deaths occur in hospitals on a massive scale.”

    The studies showing major iatrogenic mortality in hospitals were conducted in the early 2000s. Since that time, changes in policy have reduced the number of iatrogenic infections and continued monitoring and changes in policy are reducing them further. What has MANA done since the early 2000s to make home birth safer? What changes have they undertaken since their own data demonstrated an increased risk of mortality at home birth?

    • The Bofa on the Sofa

      Now it’s only 100K? I thought it was 700K? Or 250K? That number is different every time I see it.

      And I would add, how many babies/mothers die each year from infections introduced by the hospital?

      You’d think that, given how big of a problem it is claimed to be by the HB crowd, that they should be able to pull this number out easily. Yet, at least here, despite talking about a lot, the only ones who have actually even tried to come up with an answer are CC Math Prof and myself.

      The “100 000K die from hospital infections” is a great example of a worthless number.

      • The Computer Ate My Nym

        Death from hospital acquired infection in an otherwise healthy woman who had had a normal delivery, including by c-section, or an otherwise healthy baby would be extremely rare indeed. Given that only a few hundred women die in childbirth from any cause and infection (acquired by any method) is a minority cause of death, I’d say that the number of women dying of iatrogenic infection after delivery can’t be more than perhaps a dozen a year and may be as low as zero. Not that that’s much help.

        • The Computer Ate My Nym

          Actually, maybe it is zero. Again, from Klevens et al, in 2002 there were 19K infections among newborns in well baby nurseries. The mortality rate from bloodstream infections, surgical site infections, and UTIs was 0%. That still leaves about 10K “other” infections, probably including GBS from a colonized woman whose status was not identified for some reason. Such an infection would probably be counted as hospital acquired, but not in any way due to the baby being born in the hospital.

        • Cold Steel

          Exactly. The majority who die of hospital-related infections are frail elderly with multiple medical problems and prolonged hospital– often ICU– stays. They die of things like Ventilator-Acquired Pneumonia or catheter-associated UTIs. Both of which *are* preventable and both of which are seriously tackled, but neither of which affect healthy term neonates or recently postpartum women with no medical problems.

        • The Bofa on the Sofa

          From the maternal mortality stats posted some time back, CC Math Prof estimated that the TOTAL number of mothers who die from infection – ANY infection mind you (including viral infections, such as the flu) is something like 60/year.

          That is the upper limit to the number of maternal deaths by hospital caused infection.

          Again, you never hear this from the hospitals-cause-infections crowd, this is from anti-HB people, actually looking into it.

          • Lizzie Dee

            A hospital birth does not guarantee you a good outcome for the simple reason that birth is unpredictable. The idea that staying away from hospital changes that would be comic if the consequences weren’t so sad. Most homebirthers gamble and win, this lady gambled and lost. She has my sympathy – but writing a book which ignores that simple truth is a BIT much.

    • The Computer Ate My Nym

      I found the 100,000 number. The actual number is about 99K in 2002. And I found it in an article that notes a decrease in incidence every year between 2005 and 2008.

      Reference.

    • Mr.G

      Let’s be clear here. The 100,000 number mentioned is not due to infections but to errors. Not infections per se. Errors that can happen at home too or even more so because of incompetence.
      This includes adverse drug events and improper transfusions, surgical injuries and wrong-site surgery, suicides, restraint-related injuries or death, falls, burns, pressure ulcers, and mistaken patient identities.

      Infectioins are not even on top of that list.

      • The Computer Ate My Nym

        The 99K number is specifically for hospital acquired infections in 2002, according to Klevens et al. Other issues can contribute to overall hospital mortality, as you note.

  • attitude devant

    Way, way back in college, I read a paper about the paradox of power and blame in social work. It turns out that if you want people to care about those who are unfortunate, e.g., poor people, you have to present them as being blameless in their plight. However, people are more likely to be able to change their own lives and benefit from help if they believe themselves to be in control of their lives. So the trick is to present the ‘victim’ to others as not having any control, but to have that person see THEMSELVES as having the ability to change things for themselves. Dr. Amy chooses a different road here: sympathy for the loss, but firmly pointing out that the loss stemmed from EH’s choice.

    I have dealt with a dead or nearly dead baby more than once at a homebirth transport, and sometimes a nearly dead mom. While in the moment, I would NEVER blame these mothers (it’s my job to help them, after all), in reality I firmly believe that the MOTHERS are the best hope at changing things in the midwifery world. They are the stakeholders here, the decision makers, the ONLY ones who can protect their babies from the crazy. THEY are the locus of control.

    As parents, our first job is to protect our children. We can’t delegate that responsibility to anyone else. Period.

    • Deena Chamlee

      Nice debate. But I hold out hope for midwifery. And that responsibility for change stays with midwifery.. Not with medicine or mothers.

      • Bystander

        ROT. If the mother and baby are not safe and well, nothing, absolutely nothing else matters. The first priority, second priority and third priority is safety. And if being safe means that midwives can’t make a living that way, that’s too bad.

        • Deena Chamlee

          I am the midwife who contacted OSHA and Joint Commission. I agree with you FYI.

    • http://Www.awaitingjuno.blogspot.com/ Mrs. W

      Agree – and mothers deserve consumer protection. American homebirth is often just a different shade of unassisted birth – not that the women think that’s what they’re choosing but that is what they are getting. A strong PATIENT/MOTHER centred organization is needed to advance and lobby for changes. There’s a lot of mothers who see what is going on, and are apalled.

  • AllieFoyle

    I strongly disagree with the title and premise of this piece. This woman was not responsible for her son’s death. The fault lies directly at the feet of the midwife who cared for her — the person who was entrusted with the professional responsibility to ensure that she and her baby received the care that was necessary, safe, and appropriate to safeguard their health.

    To some extent Heinemen is right that politics was at the core of the issue, but it’s the lack of standards of practice, accountability, and informed consent in midwifery that is the problem, not some fault of obstetrics for not accommodating the unsafe practices of poorly educated, lesser-trained providers.

    She’s wrong to shift the blame from her midwife, and midwifery in general, to some vague indictment of medical culture. Again though, it’s easy to understand why she did so if you think about the ways in which grief and guilt can lead to torturous rationalizations. It also probably has to do with the emotional dependence that midwives often use as a tactic to gain and maintain loyalty.

    I imagine that the choice of title reflects some attempt at shock value more than a sincere attempt to shame or punish the mother, but I think it’s cruel and misses the point. Women should not be expected to be experts in obstetrics any more than we expect people to be experts in cardiology or nephrology. When she hires a legal, licensed provider she should be guaranteed a standard of care and informed consent. If her provider gives poor or negligent care and there is a bad outcome, the fault lies first with the provider and second with the system that allows such providers to practice without adequate standards and accountability.

    • Guestll

      Knowing that you’re 45 years old does not equal being expected to be an expert in obstetrics. Heineman’s age was the obvious risk factor here. The risks associated with AMA pregnancy are well documented and given the rate of increase in births to AMA women, this is hardly non-news. It seems improbable to me that a college professor, already the mother of one, was unable to recognize her own age as a major risk factor.

      • AllieFoyle

        Well, I consider myself pretty knowledgable for a layperson, and I know that AMA is a risk factor in general, but I always thought that was mainly related to increases in genetic defects as egg quality decreases and maybe a general increase in medical conditions as one ages. It wouldn’t necessarily be obvious to someone that labor and delivery itself might be riskier in someone who is older but in good physical health and with a previous easy delivery.

        But in any case, the CNM should have made the call.

        • Guestll

          There are a number of reasons why AMA pregnancies are more risky, but the fact is, even if she was in good health, with a previous easy delivery — she was still 45 years old. There is no “might be riskier”, it is demonstrably riskier and that is a consequence of extreme age on either end of the spectrum. http://contemporaryobgyn.modernmedicine.com/contemporary-obgyn/news/modernmedicine/modern-medicine-now/advanced-maternal-age-and-risk-antepartum

          I don’t disagree with you that the CNM should have made the call. That doesn’t mean that Heineman isn’t responsible for the outcome.

          • AllieFoyle

            You’re absolutely right. I just don’t think that Heinemen should be held responsible for knowing more than her health care provider though. Maybe she gets more judgement because she’s well-educated. I can’t imagine people judging someone who was poorly educated or didn’t speak english for not having obstetrical knowledge and placing trust in her hcp.

          • Amy Tuteur, MD

            Let’s suppose that Thor died of pertussis because Heineman didn’t vaccinate him. Would you hold her responsible for that?

          • AllieFoyle

            I would, though my allocation of blame would vary depending upon the extent to which she was misled by anti-vax activists. I do believe though, that in general there is more and better information available to laypeople about the risks of not vaccinating than about the risks of home birth.

            If she had gone to a licensed medical provider and been advised that forgoing the pertussis vaccination was a safe and healthy thing to do then I might also reconsider where the bulk of the responsibility lay.

          • Amy Tuteur, MD

            What if her provider were a naturopath? Would she be absolved of responsibility because her naturopath told her it would be safer to refuse pertussis vaccination?

          • AllieFoyle

            Eh, I would think it was unfortunate that she didn’t know better than to go to a naturopath. I don’t really understand the obsession with placing blame when someone is trying to do the right thing but makes a poor choice through ignorance or poor guidance. I think the care provider in any case should be held to a much higher standard in terms of knowing and advising the safest course of action. If a care provider gives unsafe care the responsibility falls on him or her. If we as a society allow unsafe practioners to practice and cause harm then we also bear some of the responsibility.

          • birthbuddy

            But she did know better. She is clearly a fruitloop and was woo-infected before this event. She was not an innocent who was caught up in something she did not understand.

          • Guestll

            She is responsible for eschewing an OB and having a homebirth with a midwife, despite the fact that she was 45 years old. Has nothing to do with knowing more than her provider and everything to do with acknowledging risk, a risk that she likely chose to ignore or mitigate.

            She SHOULD get more judgment because she’s well-educated. And I wouldn’t personally judge her in the same way had she been a 19 year old immigrant whose first language was not English.

    • Medwife

      I think perhaps Amy is going for the “name and shame” approach with home birth moms as well as midwife. There is a threat of public ridicule on top of the catastrophe of a dead child.

      Not to mention, it drives up traffic to the page. This post just went up yesterday and there are 262 (263 including this one) comments, and who knows how many more page views.

      • Guestll

        Heineman wrote a book. She’s hardly in hiding.

      • Amy Tuteur, MD

        No, I am not going for the “name and shame” approach to homebirth deaths. I’m am going for the “rebut the lies of homebirth advocates” approach. When Heineman chose to write a book refusing to take responsibility for her own choices, she put herself in a different category from nearly all other homebirth loss mothers.

        • Medwife

          I have reconsidered now that I know more details. Your wording is still shocking, and I hope it won’t cause more homebirth loss moms to stop coming forward with their stories, but the author is spreading half truths and bad info and should not be sheltered as if she was a total martyr.

      • Trixie

        We’ve seen Dr Amy respond with incredible sensitivity to homebirth loss (and near loss) families time and time again. The times when she hasn’t been so nice, it’s because the mother persists in spreading NCB misinformation for her own self promotion and financial gain.

        Heineman is in the same category as Ruth Iorio.

      • fiftyfifty1

        Name and Shame? She wrote a book all about it with her name attached. This is not a private matter.

    • Amazed

      When someone makes money by lying – or even by deluding themselves in a book – they place themselves under a closer scrutiny than your average mom.

      Knowing that giving birth at 45 is dangerous hardly qualifies as being an expert in obstetrics. When I see a professor, I expect them to know the basics of grammar, maths, chemistry, and biology. Including how their own body works. And knowing that boasting that they were “extremely healthy” at 45 didn’t make them more fit for birth than a not so healthy 23 year old.

      I am terrified that a professor demonstrates such a lack in basic knowledge – and that commenters equal knowing basic things about human body with being an expert in obstetrics.

      If nothing else, this mother’s education should have prompted her to seek the care of an expert, not a family physician, no matter whether she knew what kind of expert care they would offer her.

      • Lizzie Dee

        boasting that they were “extremely healthy” at 45 didn’t make them more fit for birth than a not so healthy 23 year old.

        Actually, I think it might. 45 is pretty elderly, but the risks of post dates stillbirth shouldn’t be treated lightly by anyone. I can understand wanting to avoid induction – but check how your baby feels about it please.

        I find the passage about her baby’s suffering astonishing. Doesn’t sound like “Not my fault” to me – more like anguish at what she allowed, unwittingly, to happen.

        • Amazed

          It might but history has showed over and over that women in all shades of bad health have given birth to healthy babies. And history has also shown that women over 40 giving birth when they weren’t famously fertile before was considered a real miracle (Anne of Austria comes to mind, as well as poor Constance of Cicily. Now, that’s a woman who was a true hero, sustaining a delivery in a freaking tent on the market under the scrutiny of every woman in the town willing to attend, just to prove that SHE was the one giving birth at 41 and give her baby the best chances in life). It wasn’t as if this was some kind of special OB knowledge.

          And her age was the first thing that should have pushed her to consult an OB in the first place, not fawn over her own “extre,e helt’. With proper care, all problems that developed later could have been mitigated.

    • Lizzie Dee

      It does seem cruel to openly blame a bereaved mother – but does she take ANY responsibility in her book? Presumably, she bought into the idea that babies are not library books, and scorned any need to take sensible precautions. Apparently, she is an educated woman, who should have been aware of the risks, and, in my opinion would be better warning other women rather than encouraging them with horror stories about the “system”. It isn’t great. It does a pretty good job of keeping babies alive against the odds though when things do go badly.

      • AmyP

        By reason of her academic background, she is perfectly placed to blow up the whole homebirth world, if she wrote a different book. She has the history and the stats at her fingertips and she’s got the credibility to get people to listen to her.

        But that’s not what she chose to do.

        • Anj Fabian

          I have to wonder what “feminist” and “feminism” mean in academia today. I keep seeing those ideas tangled up in reproductive issues in ways that demand that all choices should be supported unconditionally, without examining the consequences of that choice.

          I wish I could think of a better example, but the one that comes to mind is that if a woman wants to pursue a career as a sex worker, she not only should not be criticized, but every law restricting prostitution and pimping should be abolished because if a woman chooses to do something, everyone else needs to support her. Oh sure, sex workers are assaulted and killed at rates much higher than the average, but any woman going into the trade knows that she’s likely to be raped, beaten or killed.

  • LisaL

    Kind of OT…. a forum I frequent, a bunch of women started patting themselves on the back for homebirthing. The last post I read before stopping was of a woman that had a ‘perfect’ birth at home. Her and baby were totally fine… until baby wasn’t and had to be taken to the ER where it almost died and then was stuck in the hospital for weeks recovering. But that didn’t matter b/c the woman had her perfect birth at home away from that evil hospital… that saved her son’s life.
    I will never understand why women put SO much importance on the “birthing experience.” I was almost caught up in it while I was pregnant, but thankfully this blog opened my eyes to how ignorant I was.

  • Rlbobg

    I am an Obgyn who has been in the delivery room when several home births “went wrong”. By the time the mother was brought in, the baby was almost dead and once or twice, so was the mom. I believe in a woman’s autonomy. And I believe in evidence based medicine. And of course I am seeing only those “unsuccessful” home-birth-transfers. But WHY can’t these home birth “practitioners” recognize that when something is going wrong, they need to recognize it early and get that mom to somewhere that someone can intervene before a tragedy occurs?! And that they don’t have much time to do it?!

  • Zornorph

    What a shame :( Poor little Thor.

  • http://whatifsandfears.blogspot.com/2012/12/the-business-of-being-misled.html Doula Dani

    I don’t know Elizabeth Heineman. I don’t know what “type” of person she is. I don’t know anything about her other than the few articles I have read regarding her book and another one quite a while ago where she talked about taking her baby’s body home afterwards.

    She claims she was told she was low risk by hospital midwives and her family practice doctor. Only she knows if that is the truth… or if it is an embellished version of the truth… or even if it’s a lie. All I know is what she said so I’m taking her at her word: she was told she was low risk. So she believed it. Even though she wasn’t.

    She acknowledges that her midwife should have referred her to a doctor… which makes me feel that had this mother actually known about the risks she was taking, she would have heeded her midwife’s advice and gone to an OB. If she was the “home birth at all costs” type (if that exists, for a pregnant woman, that is), she wouldn’t blame her midwife. She would protect her midwife completely.

    I don’t agree at all with the blame she is trying to place on the system. There is no reason at all her midwife shouldn’t have risked her out. What is ethical trumps what the mother desires for her birth experience and it certainly trumps the midwife’s desires/feelings (monetary gain, personal philosophy, feeling “under siege,” or whatever).

    I don’t agree with the title of this piece. I agree with a lot of what is said in the piece but I don’t agree with the title.

    I don’t agree with blaming the mother. I know there are extremes but even for extremes, unless a woman is prohibited from going to a hospital (for religious reasons or whatnot), most women who carry a baby to term, who make any effort to take care of themselves during pregnancy for the sake of their child, very badly *want* that baby. And they will listen to their doctor/midwife/hired care provider and do what they suggest in order to keep the baby safe.

    Yes, this mother chose home birth but so many women think home birth is just as safe or safer as hospital birth. Look at what this woman says “I believe that studies showing roughly 100,000 preventable deaths every year due to infections intro­duced in hospitals demonstrate that unnecessary deaths occur in hospitals on a massive scale” — she doesn’t have a clue about the reality of giving birth in a hospital in the USA.

    If home birth propaganda were built on the truth and if women truly understood the risks and the mortality rates, then home births in the USA wouldn’t be rising, they’d be declining. Who knows if Thor’s mother would have even chosen home birth had she made a truly informed choice. Based on what I’ve read, it doesn’t seem she was informed at all. That is the fault of the midwife. That is the fault of the lies that home birth midwifery are built on in the USA.

    TLDR I know, I know….

    • Deena Chamlee

      I never blame the mother. The reason why is: I as a graduate prepared midwife, who is ethically sound , is accountable and responsible for outcomes. Somethings occur without fault, but these are rare.

      The sooner midwifery wakes up, the sooner babies will stop dying unneccessarely. It starts with change in leadership unfortunately, and sadly.

    • LMS1953

      With unrestricted autonomy comes responsibility. You can’t have it both ways. If we must grant women complete reproductive autonomy then women must accept responsibility for their decisions. It was her fault. Period. End of story. Because if they don’t have the responsibility, they are not worthy of the autonomy.

      • Deena Chamlee

        Yes this may be true, unless your reality is altered by other’s manipulation. The midwife was and is responsible in my opinion. Period end of story. Blaming victims doesn’t help things.

      • KarenJJ

        Can’t you still have full autonomy as a patient and still be a victim of malpractice? Not saying this is the case here, but in general.

      • http://whatifsandfears.blogspot.com/2012/12/the-business-of-being-misled.html Doula Dani

        If a woman wanted completely unrestricted autonomy, she’d UC. She wouldn’t even bother with a midwife. It was her midwife’s fault and the fault of the propaganda and the community.

      • birthbuddy

        If you but into the BS, you buy into the responsibility. It’s part of the deal. My sympathy is with the brainwashed innocents.

        • birthbuddy

          ”buy” not ”but”

      • AllieFoyle

        Really? Another lame attempt to inject your backward political views into the discussion?

        I assume you’re somehow suggesting that allowing women access to reproductive choices like birth control, abortion, home birth, and MRCS somehow renders them completely responsible for the failures and medical negligence of their obstetrical care providers.

        If your PSA is high and your urologist offers you the choice between conservative and aggressive treatment options, he is still required to act ethically and professionally and will be held responsible for any mistakes he makes, particularly if the mistakes were avoidable and caused harm. This is as it should be. Patient autonomy does not preclude professional responsibility. You’re trying to create a false dichotomy.

        But I think really your issue is that on some level you aren’t comfortable with allowing women to control their own bodies and reproductive choices.

        • Medwife

          “We” must “grant” women complete reproductive autonomy. It’s not yours to grant, buddy. Maybe you’re in the wrong line of work.

          • S

            Thank you. That sentence bothered me a great deal. What’s the alternative to granting women autonomy over their own bodies?

      • birthbuddy

        Autonomy does not include the right to kill your baby for your experience. Late term abortion is still illegal in most countries. Autonomy is not unfettered.

    • Lisa from NY

      “Most women who carry a baby to term… very badly *want* that baby.”

      True. But we have seen on this site stories of women who convince themselves that it’s safe to do risky things if you stay away from bad Dr. Amy and her fearmongering.

      On every parenting web site are discussions of how inductions are bad and always lead to C/S which is the ultimate tragedy.

      • http://whatifsandfears.blogspot.com/2012/12/the-business-of-being-misled.html Doula Dani

        Completely agree. Which is why it is so important that care providers are held to the highest ethical standards. This midwife should have had a very honest conversation about the risks involved and should have referred/risked her out. The midwife didn’t.

    • attitude devant

      My memory from reading excerpts from her book elsewhere is that never explicitly asked her doctor or the hospital midwives if she was a good candidate for home birth. So, I call foul on her claiming everyone told her she was low risk. If she’d been my patient I would’ve told her I expected her to do well, but that we’d be watching her extra special careful just in case. BUT I NEVER would’ve told her she was low-risk for HB.

      • http://whatifsandfears.blogspot.com/2012/12/the-business-of-being-misled.html Doula Dani

        It sounds off to me, too. I have a hard time believing she was actually told she was low risk. Regardless, even if they did tell her she was low risk, even if an OB told her she was low risk and a good candidate for home birth (didn’t happen), her primary care giver was her home birth midwife. Once she passed 40 weeks, the midwife should have been monitoring this mother extensively given the fact that the mother was 45.

  • Deena Chamlee

    BPP biweekly at 41 weeks if BPP 6/10, induce. At 42 weeks induce. Why is this so difficult. Let this be known at the beginning of care with client. If client does not accept these terms for management of postdates, do not accept her into your practice. It is called boundaries. There is much too much enmeshment.
    What is this so difficult?

    And anyone titled midwife has a graduate degree with admitting privileges. Simple really. Instead we are completely dysfunctional because of leadership. It has got to change.

    All midwifery educational structures need to include didactics on co dependency.

    • Guestll

      The client in this story was 45 years old. Does that change your course of action? It should.

      • Deena Chamlee

        I did not know the age. Testing begins at age 39 and do not plan a homebirth with someone 45 years of age. Serious judgment issues.

      • Deborah

        Hell, for a 45 year old, otherwise totally healthy, I’d be doing 2x/wk BPP’s starting at 32-34w!!! (And so often they’re NOT otherwise totally healthy . . . )

    • staceyjw

      The most common HB tragedy that I have heard of, both losses and injuries/brain damage, are due to post dates. It is so very common, it is a heartbreaker. It may be a fetal death at 42W, asphyxia, failing placenta, meconium in the myriad of ways it harms babies, etc. The list is long, but the solution is simple and well known, if you just get your head out of NCB lala land….

      This idea that waiting it out is the best way is so seriously dangerous. If we were able to break down the numbers of deaths/HIE/and NICU stays from HB disasters, I would be willing to bet that postdates issues would come out on top, overall. Sure, breech and VBAC have higher risks, but the sheer number of women going seriously postdates is startling.

      A wise OB once told me “nothing good happens after 40 weeks”. She was right. Having a stillbirth at the very end has to be one of the very worst things that can happen to a mom, the small overall risk is irrelevant, when it happens to you. And if its preventable. Trading a tiny-to-small risk of a CS, when the cervix is favorable, in order to induce at 39/40 weeks seems worth it, at least to me.

      Reducing the odds of a CS by inducing at 41 weeks seems like a no brainer, even for NCBers. By avoiding induction at 41 weeks, they invite CS AND tragedy. It is too bad all these NCBers are to busy with their eyes on the “prize”- an unmedicated VB- to even consider the evidence. In their minds “intervention = bad, doing nothing = good”. It is totally ridiculous, IMO.

      Waiting until 42w is no longer common (in the USA anyway), – except in NCB steeped MWery. MANY MWs simply do not follow evidence, the more dedicated to NCB they are, the more they make “exceptions” and use the outer limits of guidelines as starting points. HB MWs seems tone the very wort about being reckless and taking needless chances in order to have that fantasy HB.

      And waiting that long in a woman of that age? Criminally reckless if you ask me. Even I know that you induce closer to 39 weeks at that age, because 39 is more like 42 when you are 40+, no matter how fit you are, no matter how pristine your diet is (and most of them lie and exaggerate this stuff too).

      I don’t think moms really understand the risk outweighs the benefits when it comes to going past 41 weeks. I cannot imagine any mom thinking an increase in the odds of CS, and possible death or injury to baby, is worth waiting.

      IDEOLOGY should never be placed before evidence.

      • Playing Possum

        “Reducing the odds of a CS by inducing at 41 weeks seems like a no brainer, even for NCBers. By avoiding induction at 41 weeks, they invite CS AND tragedy. It is too bad all these NCBers are to busy with their eyes on the “prize”- an unmedicated VB- to even consider the evidence.”

        This really resonated with me – so many interventions are done to improve the chances of VB, and by refusing them the NCB crowd really do end up cutting off their nose to spite their face. Ick.

    • Laura

      You bring up a compelling point, Deena. What is troubling is the emotional enmeshment these hb midwives have with their clients. This makes professional objectivity difficult and “towing the hard line” even tougher. This dynamic is what makes hb midwives so attractive to some women, too. But it is not healthy or good for best outcomes. I suspect the author of this book highlighted today has not “unmeshed” from her midwife yet.

      • staceyjw

        I sure with this one website was still up, out of Oregon. The mom described this so well, it was perfect. The stockholm type of trauma bonding that happens with HB MWs, and how they set moms up for this on purpose. ugh.

        Ever read their How to get out of a lawsuit book? It is available online. You will be horrified by the emotional manipulation they openly suggest. I forget the name, but someone else will post if you want o read it (and puke, or have a rage stroke, or both).

        • Dr Kitty

          From Calling to Courtroom:A Survival Guide for Midwives

          http://www.fromcallingtocourtroom.net

          It is quite hard to read. Mostly because of the author’s sentence structure and dislike of paragraphs.
          Once you’ve fought with that, the creepy hits you.

    • Deena Chamlee

      I did not know her age. If 45 testing begins at age 39.

      • Medwife

        My practice begins weekly NSTs at 36 wks for AMA moms. We offer/encourage iol at 39 weeks. If she wants to go over, after discussion of increased risk of stillbirth, we do an ultrasound for AFI and EFW weekly. A 45 year old patient I would not expect to go past 40 weeks.

  • Lisa from NY

    Dr. Amy, Elizabeth Heineman’s is wrong.

    NCB people who are TOLD by OB’s to be induced often refuse. I know of stillbirths that resulted.

    • Lisa from NY

      Anyone who googles “induction postdates” will be fed some BS about how unnecessary inductions are. I know of two stillbirths of women who refused inductions from their OBs.

      This whole article is moot.

    • birthbuddy

      Because babies aren’t library books apparently.

  • Deena Chamlee

    Somewhere meaningful on the Atlantic…..but the beat goes on.

  • toni

    OT(ish)

    I’ve just been on Facebook for the first time in ages and seen that an old friend is planning a homebirth. Baby is due end of April. She had one “fear based” caesarean for breech four years ago and successful VBAC in a hospital two years ago but didn’t like that they pushed interventions on her and wouldn’t let her labour in water etc etc. She wants a completely unhindered delivery this time so she’s hired some unlicensed midwife to attend her at home. I’m so scared for her. I’ve been arguing with her for hours but she believes so much rubbish it’s hard to know where to begin and what to focus on. She said American mortality rates are ‘extremely high’ (because of interventions), Dutch death rates are great, we shouldn’t fear birth, fear causes complications, I need to read Ina Mae’s book.. the usual. She makes much of the dangers associated with caesarean but very dismissive of risks of out of hospital birth. Only a ‘tiny percentage’ of women can’t deliver vaginally but a huge number have life threatening complications from interventions she tells me. I’ve shown her the MANA numbers and linked her to Dani’s and Lisa Murakami’s blogs and I believe I’ve made the best case for just doing the VBAC in the hospital like last time but she’s absolutely determined to go through with it. She hasn’t withdrawn her statement about death rates but she has moved on to how much better she felt after her vaginal birth compared to her caesarean which suggests to me she realises her assertions were false and wants to change the subject. I guess she believes the risks are still so low in absolute terms that it’s worth the gamble to get what she wants. I think when some people see a risk or something written as zero point whatever they just assume that’s such a low chance it will never happen to them. Anyway there is a question here… what is the likelihood of having a uterine rupture with second VBAC? She must have a pretty good chance of success having already had one VBAC

    • Trixie

      The chances of rupture are about half as high as they are for a first VBAC, I think. Which is still higher than the risk for an unscarred uterus.
      Is she delivering with a CNM?

    • Laura

      Ask her what her midwife has told her about possible complications from an HBAC. Ask her to see what her midwife would do in the event any of those complications arose. Have her ask her midwife where she might transfer her, what doctor will be seeing her in the hospital, if the midwife makes her get pre-registered at the hospital so that all of her necessary medical info (blood work, known allergies, obstetrical history) is already there, alternative ways to the hospital in the event of traffic, etc., etc, etc. Start there. I am so curious as to how wide-eyed your friend will get. When she tells you, “Oh, nothing bad like that will happen” it won’t be hard to find stories of HBACs that went very, very badly. Why take that risk, you should ask her. Arguing about facts that she will dispute can be a waste of time. Educating her as to why

      HBACs are dangerous might streamline your tactic.

      • AmyP

        “Have her ask her midwife where she might transfer her, what doctor will be seeing her in the hospital, if the midwife makes her get pre-registered at the hospital so that all of her necessary medical info (blood work, known allergies, obstetrical history) is already there, alternative ways to the hospital in the event of traffic, etc., etc, etc. Start there.”

        That’s very good. Also, if the midwife mentions a specific doctor, ask if your friend has talked to the doctor’s office. As we know, some midwives cite doctors as their backup that have never even heard of them.

        • Laura

          I was just getting started! Other questions: who is the doctor’s back up doctor? Do you know her/him? How about the nursing staff? Have they ever heard of you? How about your backup midwife? What are the signs of a uterine rupture? Have you ever seen one? How about your backup midwives? What experiences do they have? And statistically speaking, her friend probably WON’T have a uterine rupture. But the fact that her first baby was breech is important to watch out for this third pregnancy. Was her 2nd breech too? Does the midwife know how to properly assess breech babies in labor? My problem with home births, even low risk ones, is the lack of support and help in the event of any problems, even small ones. And the fact that no midwife can GUARANTEE that she will be at the this person’s birth is troubling too. In the hospital you have a whole staff of people that are trained to deal with issues as they come up, so the pressure to provide appropriate and safe care doesn’t rest on just one or two people’s shoulders.

          • toni

            Thank you to everyone for the information/suggestions. My friend deleted our whole discussion on FB. I’m going to let the hare settle for a day or two and try again.

          • Maria

            When you try again, maybe do it via direct messages rather than on her FB wall. She might feel less defensive if she knows what she says is not going to be read and scrutinized by her other FB friends.

        • Trixie

          I had a VBAC with CNMs in a hospital, and the backup OB group had to personally meet me and have a consultation with me. As did the anesthesiologist. And I had to sign consent forms. And I had to have ultrasounds for placenta location. No “backup OB” would back up an HBAC without that stuff,would they?

    • thankfulmom

      Ask her how far the nearest hospital is. If she says “ten minutes” ask her to try holding her breath for 10 minutes. That’s what she would be asking her baby to do.

    • Mr.G

      The risk of uterine rupture remains the same whether she had 1,2, or more VBACs. It is 100-200/10,000, which is about 50,000+% higher than driving a Cobalt.

      • realitycheque

        Are you sure? I could have misunderstood, but I could have sworn that a while back I asked the question here (or possibly on the Fed Up FB group) about the risk of uterine rupture following a successful VBAC and the overwhelming consensus seemed to be that once you had a successful VBAC, your risk of uterine rupture was similar to that of a woman who had never had a c-section.

        I was asking as a friend of mine was having a home birth following a hospital VBAC and I was worried.

        • toni

          I hope you’re right. She is about 40 minutes from a hospital. Is a rupture at home always fatal for the baby? Guessing there’s no such thing a moderate, non emergency uterine rupture

          • realitycheque

            I believe there can be partial and full uterine ruptures, but I don’t know a lot about the prognosis for either type, other than that in a full uterine rupture the baby has a very low change of surviving at home.

            I’m sorry to hear about your friend and hope she either changes her mind or ends up with a positive outcome.

            I feel like you sort of can’t win in these situations. Obviously you don’t want anything bad to happen to the mother or the (completely innocent) child, but you just know that if everything goes fine it will reaffirm all of their beliefs and encourage them to tell other people how “it worked for me!” and move others to make the same irresponsible choices… eventually someone will follow the advice and have a bad outcome.

          • theadequatemother

            the mother has a low chance of surviving a full uterine rupture at home too.

          • AmyP

            “She is about 40 minutes from a hospital.”

            That’s terrible.

          • staceyjw

            It really does not matter much, baby will die even at 10 minutes away, even at 5 minutes.
            The risk of being that far is that SHE DIES. Her baby dying if she ruptures, well that is a given.

            Once again, a VERY bad choice, a MW that thinks it fine, and they are ignoring all of the things that the UK and Netherlands risk out. Being a few minutes from the hospitals a huge one, as is NO HBAC.

            Its like she wants to kill her baby and herself, at minimum, be trapped at home if she is in pain or during an emergency. I wonder how much she has even thought this through. ONE DAY of unpleasantness for a lifetime of your baby, seems like a pretty decent deal.

            And no one can tell me that 40 min from a hospital, with an HBAC, is a variation of normal and moms think this is totally safe. No way she doesn’t know. She may not think it will happen to HER, magical thinking and all, but its obvious enough she has to know, even if she denies it and makes excuses.

            Showing her the “Birthplace Study” out of the UK may help. It shows good stats with a LOT of qualifiers. Maybe that will clue her in?

            I hope she chickens out, or is in so much brutal pain she transfers. I am sure she ill be fine, her baby will be fine, and she will be BRAGGING in no time. Insufferable, that is what she will be after an HBAC. A real wombyn warrior” indeed.

          • araikwao

            That would be scar dehiscence

          • toni

            How would a midwife know if there has been a rupture or dehiscence? Would the mother just be in a lot more pain all of a sudden? I imagine the haemorrhage wouldn’t be seen like with a PPH because the baby would stop up the flow..

          • araikwao

            The most reliable sign of rupture is baby’s heart rate dropping, which is why VBACs are supposed to be on continuous monitoring. The abrupt-onset constant abdo pain isn’t always present. The actual qualified docs on here would be better placed to answer re the dehiscence – I understand it can be found incidentally at CS, and that the uterus can even contract down sometimes in spite of dehiscence

          • moto_librarian

            She is 40 MINUTES away from a hospital?! NO ONE should be opting for a homebirth without a closer hospital, and no midwife should take on a client in this instance, particularly no one who is VBACing.

        • Trixie

          I’m pretty sure Mr G is a well regarded OB so I’m going to defer to whatever he says.

          • realitycheque

            Fair enough, I wasn’t trying to undermine his opinion, just felt confused by the conflicting information I had encountered (also, didn’t know he was an OB).

            This information just reaffirms the recklessness of my friends decision… I felt less worried when I believed that uterine rupture wasn’t as much of a major risk, but if the risk didn’t go down following VBACs, then there is no excuse. Those numbers are outrageously high. I can’t believe the midwife would support such a choice.

          • staceyjw

            OF COURSE the MW will support this! Variation of normal and all that. They really think this, and often tell moms that they have a BETTER chance of a successful VBAC OOH! Keep in mind that success means baby comes out the vagina, not that thee baby lives, undamaged.
            Rupture is only one of the things that kills with HBAC, post dates also is a big one. Other issues can crop up that she may not catch with an amateur doing her prenatal care……

        • staceyjw

          Nope, it is lower, but not the same as never having a CS at all.

          The worst thing is that a rupture at home is a death sentence for baby. At BEST, rarely, baby will get brain damaged. They look at stats for actual deaths, and think “not too bad”, but do not stop to realize that those deaths are not too numerous simply because the technology and access to CS SSAVES babies.

          None of those things are available at home. Rupture there, baby dies/ is permanently damaged. Period. MANA stats are grave on HBAC, and I am sure that those are not even counting the very worst of the MWs, that refused to participate, or who didn’t add every patient into their stats.

      • toni

        So one to two percent? She linked me to this during the discussion. It says 0.45 percent chance of rupture for second VBAC or 1/222 but I suppose this organisation would go with the most charitable estimate wouldn’t they? Tbh 1/222 is not a risk I would be comfortable with. What other than HBAC has a 1/222 chance of certain death for your child? Throwing him out of a moving car maybe? Feeding him raw chicken would probably be less risky but she would never dream of doing such an awful thing I’m sure

    • LMS1953

      How come CPMs get a free ride when it comes to pre certification for third party reimbursement for their services. As a physician, I have to notify the insurance company of the OB admit. Failure to do so can result in denial of payment. Make the CPM call Medicaid, BC/BS whenever they are call to attend a homebirth. No call, no pay. Then they have to show that the “client” does not have any exclusionary criteria (which women in Europe seem to have much less of a problem abiding by). If the CPM violates exclusionary criteria she will be denied payment and subject to sanction for practicing medicine without a license, since such high risk pregnancies are indeed the practice of medicine. If the client and CPM try the circumvent the process with under the table cash payment, then that will be sanctioned as fraud and tax evasion.

      • LMS1953

        The point being that several states Medicaid offices recoup payment for an “elective” delivery at 38w6d that has a negligible impact on neonatal or maternal morbidity/mortality. Whereas CPM shenanigans have a 5 to 12 fold impact. Goose and gander ethics must apply here.

        • LMS1953

          Please also note that Medicaid and private insurers seldom pay for “experimental” drugs and procedures. A case in point was Medicaid’s treatment of 17-P which was not covered until it was FDA approved as Makena. The expert organizations (AAP and ACOG) have reviewed waterbirth and have advised that it is an experimental procedure. By what duplicitous hypocrisy can Medicaid and other third party payors now reimburse for a waterbirth?

          • birthbuddy

            Goose and gander ethics – so true, love it.

      • toni

        I don’t know how she is paying the midwife. Surely no insurance/Medicaid would pay for the services of an unlicensed midwife? So I assume it’s gratis or cash payment.

        • LMS1953

          Toni, I know for a fact that Vermont passed a law, I think in Oct 2011, that mandated that CPMs get reimbursed by Medicaid AND third party payers such as BC/BS. The rub was BC/BS said “fine, as long as the CPM has malpractice coverage and a written transfer agreement/protocol with an OB and a hospital”. The later part did not sit well with the legislature.

          • vtguest

            The irony there is that VT already had very crunchy care options with hospitals that prioritize natural childbirth, many CNMs, water births, etc. In some areas, it could be difficult to get more mainstream care (epidurals, careful medical management) than to have the hippie dream birth. It’s a situation akin to what is happening in the UK–the focus is on maximizing the chances of a natural experience and avoiding interventions, but at the expense of safety and the mental/physical health of women who would prefer and benefit from the choices that a medicalized system provides. I think a more useful and appropriate piece of legislation would have limited the scope of practice of midwives (including CNMs) and would have ensured that pregnant women be given information and access to ALL the medical options for testing, management, delivery mode, and pain relief — not just blindly being forced down the road toward natural childbirth no matter what.

        • staceyjw

          They do not pay if they are unlicensed, but they may pay for LDEMs and CPMs. The MW here in Oregon were not supposed to be getting OHP (Medicaid) payments, but found a loophole called “open card” and exploited it. They were out there telling moms how to manipulate the system in order to get the HB/non accredited BC birth they wanted.

          Total abuse of the whole idea. You see, “open card” was a safety measure for women that did not have a provider at 29 weeks,or lived in an area not covered by a managed care plan. This was to ensure they got coverage, and to ensure the OBs got paid when they took on a late/out of area patient. MWs would make moms wait until 29 weeks in order to get this open card, and even had some pay up front in case they were denied OHP!

          Most disgusting of all, when the ACA came in, the rules changed. Out went the open card, but not without a fight- these HB MWs has the NERVE to act like that was a legitimate way to get paid, rather than an unethical way around the rules that no one planned, or wanted. They are STILL fighting to get their payments, even though all the other providers must be part of a CCO, and have a huge list of things, like malpractice, etc. They really think they ought to just get paid, with zero rules! Because they are special.

          In order to keep their ILL GOTTEN GAINS (which had greatly increased the number of OOH Births, as half of all moms get OHP) they literally harassed every lawmaker they could, wrote letters, made sure to get their “plight” in the newspapers, they showed up with their babies en masse at the statehouse (we protested them!), they were loud.

          They are such a determined bunch because they feel TOTALLY ENTITLED to have their HB MWs, with no rules, no accountability, and no malpractice, get paid by the STATE. It is the craziest thing I have ever heard. They are organized and effective because they are ZEALOTS, and their income depends on it. Moms won’t get their HB without it.

          Like so much of politics, the small groups that are very loud, but want things that don’t cost much politically, are used to getting what they want. Until our group came in, no one cared if they got paid (well I am sure some docs did, but it was not priority), no one even knew how law the rules were, so their demands were easily met. It was an easy win for these politicians, with a group that would otherwise make them miserable.

          NOW, we are changing this. They get NO MORE FREE RIDES politically. They must fight for every victory, it costs them every time, and we will make sure they do not get what they want. It is a real pain, but ti is worth it. They have abused the system too long, killing and maiming on the taxpayers dime.

          I am sorry, but CNM MWery here is already fully covered, we do not need to pay fakers. An OOH BC in this town is covered because it is staffed with CNMs, accredited, and owned and operated by the hospital. You can have water birth, whatever. They are not persecuted, they have been catered to so long they are like petulant children throwing a tantrum.

          And they are so very out of touch with the mainstream, with the medical establishment, and with actual laws, they have no idea what they are doing. They merely whine “WE WANT OUR HB ON OHP” and then try to co-opt reproductive freedom to con people into thinking its needed.

          NOPE, HB is not needed, it is a luxury and Medicaid ought not cover something so dangerous and unnecessary. I cannot get tooth colored fillings, certain medications, and other things, because Medicaid only pays for the basics, but these fools want the full cost of HB covered? SOME NERVE. SO ENTITLED

          Thank you ACA, for giving Oregon the tools to stop these frauds. It is in the works, but once everything is done, it will be some story to tell.

          (WOW, was THAT a rant!)

          • birthbuddy

            And they talk about the integrity of the medical profession! Good rant!

          • staceyjw

            HA, integrity. They have NONE.

            HB MWs here are some of the sneakiest, shadiest liars ever. They love to be rebellious and give the man the finger- all while being protected and paid by the system. They feel ENTITLED to whatever they want.
            Dr Amy is dead on about their antisocial, childish rebel behavior.
            They are disgusting, and the way they treat loss moms is a disgrace.

          • Deena Chamlee

            So why when the Oregon DOJ was made aware was this issue not addressed and homebirth restricted to CNM’s only? WHY?
            I tell you why? Who headed up the legislative workgroups? Fellows of the College, Judith Rooks. That is why.
            The fellowship of the ACNM was created in 1992, and now has over 204 members. The FACNM is ACNM’s commitment to honor “OUR OWN”.
            ANTISOCIALS ACROSS THE BOARD THAT IS WHY! ALL MANIPULATING OTHER’S REALITY OF WHO THEY REALLY ARE!

          • Karen in SC

            One thing that might be done in Oregon and other states where midwives get paid by insurance is to write to the large insurers in your area and remind them of their obligation to send a 1099-Misc to the IRS. Or inquire how that is handled.

            Anyone here work for an insurance company?

        • Trixie

          If you find out she’s paying cash, actual cash, you can always anonymously report the midwife for tax evasion.

          • Therese

            Is it really that easy to get the IRS to investigate someone? They probably have so many people filing false reports out of revenge and I just wonder if “This person is committing tax evasion because they get paid in cash” is going to sound like someone just out for revenge if you don’t have any concrete details.

          • Trixie

            Well obviously if you don’t have first hand knowledge, you shouldn’t report them.

          • Karen in SC

            It might be easier than you think. The IRS is fully computerized and upon receipt of an anonymous form can quickly determine if the person in question has filed the proper form for self-employment income (Schedule C) or if a business has filed. At a minimum, I’d think a form letter would be sent out.

            When you pay in a large sum of money to a sole proprietor, you can also send them a 1099-Misc, with the original sent to the IRS. I don’t believe it’s mandatory for personal services, but when I was a technical writer I received them from my clients.

          • Therese

            So all a midwife would have to do would be to report some of her income and she’s unlikely to be investigated further if a Schedule C is on file?

      • Bombshellrisa

        CPMs in WA state bill insurance and accept Medicaid. Makes me ill to think that women who have health insurance only for their pregnancies are seeing these midwives for care and getting no care that is worthwhile at all.

  • Guest

    With all the time spent discussing the obvious imminent HB disasters attempting breech, multiples, HBAC’s and postdates, I wonder how much we are missing of another subset of risk factors that women rationalize into being healthy conditions just by virtue of frequency and denial. I have spent countless visits discussing inherent risks of AMA, obesity and chronic HTN with mothers who truly believe they are low risk based on their yoga endeavors and kale ingestion. More often than not, I cannot determine whether the blank stare response I receive are a display of being offended at calling out the elephant in the room or shattering their self-perception of health and risk status.

    If HB midwives are so dependent on the development of an intimate (if not dysfunctional) relationship with mothers, is it their ignorance or desire not to displease in that these risks seem brushed aside?

  • Anj Fabian

    From a blogger’s comment:
    “I would strongly suggest to those who are so opposed to home birth,
    those who believe it is unsafe, …, lobby for obstetricians to not be allowed to refuse to be
    backup for midwives;”

    I can’t come up with a coherent response to that idea, other than wondering how she thinks that would work.

    http://turnthepagelisa.wordpress.com/2014/02/28/ghostbelly-by-elizabeth-heineman/#comment-920

    • staceyjw

      LOL, force OBs to back up MWs that refuse to hold to any sort of standards, or have any sort of insurance, so OBs can take on HB MWs negligence and their malpractice burden, while the HB MWs take in cash and get their birth fix.
      RIIIIIGHT.
      How about you MANDATE MWS GET A FREAKING CLUE INSTEAD? That is much easier and won’t infringe on others.

      Who are these people that are so stupid? If you need OBs so bad you have to force them to help out HBers, WHY NOT JUST HIRE THE OB?????????

      AHHHHHH. I know, all these caps, but that is how I am hearing it in my mind.
      Head desk until concussion time.

      • Guest

        Years ago, a HB midwife made a request of me to accept her transfers as a hospital based CNM. No! Then a father planning a HB of twins with HB midwife called a year later to request back up in event of hospital transfer. Even went as far to reassure me they wouldnt be ‘a bother’, as it was only if things went ‘wrong’. Huh!? No! Another HB midwife asked if I would accept a return transfer of a previous mother now at 42weeks with oligo. No! Commence head desk concussion.

        Why? Why exactly would you even consider accepting the transfer a HB midwife has already gone down a bad road with? It’s not the malpractice burden I am concerned with (although it is a major factor), I don’t want to try to fix what your ignorance has broken. No, my dear, we are NOT sister midwives.

        • Guest

          I suppose this is an appropriate time to admit ACNM called to renew a membership I lapsed years ago. As it was Friday night and I was snuggling with my ACOG Compendium at the moment, I did my best to refrain from expelling a litany of reasons why in good faith I could not subsidize my own professional organization, especially after MANA studies published in JMWH. Pathetic.

          • staceyjw

            You really need to tell them all of that stuff, loudly and clearly. Otherwise, they think you are complicit, or just have no opinion and aren’t trending for another reason.
            If CNMs don’t want their org to kiss up to CPMs, then they must speak out!
            But do it on a MOnday afternoon, not when you are snuggled in bed with a good read :) you need as much righteous anger as you can muster.

      • Laura

        I can’t blame your frustration. Heard of a situation where an OB did an u/s for a pregnant mom for free. Mom chose a non-nurse midwife for a home birth then showed up at the hospital with a placental abruption, a dead baby, and a CPM who is insisting the OB was responsible because he did an ultrasound. I don’t even think this OB was this woman’s backup, because what OB in their right mind would back up a CPM?!?! And yet he/she is being held responsible. These kinds of situations are so galling, so infuriating, SO UNFAIR.

        • realitycheque

          By what mechanism is the MW proposing the ultrasound led to a placental abruption?

          “And yet he/she is being held responsible.”

          At least not by anyone with half a brain. I can’t imagine any of his/her colleagues would be pointing the finger at anyone, or anything but the home birth and the nitwit midwife.

          • Laura

            As far as I understood, the CPM was pointing to the doctor despite any evidence of the OBGYN being responsible in any way, other than the u/s given out of the goodness of his/her heart. I don’t have many more details, but it is not the doctor’s colleagues pointing the finger. People can bring all sorts of harrassing charges and suits to blame doctors because they don’t want to take any responsibility themselves. And, unfortunately, there are too many people Dr. Amy has discussed that seem to have only half a brain. *commence head banging*

          • birthbuddy

            Any bets on this OB getting involved in the future? There is fortunately (sadly) a growing population of OB’s that have been burnt.
            I for one, will never act in a back up capacity for these liars.
            I also don’t buy into their blackmail to go UC if I refuse.

          • Laura

            I knew an OB who was named as a backup provider in a lawsuit a client brought against her hb midwife. This doctor was nowhere near the birth. But he was named in the suit and his malpractice insurance promptly told him to never back up hb midwives again. And so he didn’t. Smart man.

          • meglo91

            I wonder if the CPM is one of those folks who thinks that ultrasound disrupts things on a cellular level somehow. I have heard this advanced as a theory and basically screamed at someone on my SIL’s facebook page who tried to tell her to refuse a (recommended, medically necessary) ultrasound.

        • theadequatemother

          Is the CPM blaming the US or is she saying that because the OB saw the woman once, he or she owed her a duty of care and so the outcome is ultimately the OBs fault?

          • Laura

            From what I understand it is the “duty of care” argument.

          • birthbuddy

            The OB should clearly define and document the relationship. Just like a lawyer stating “I will have no further part in this”.

      • AllieFoyle

        Yes, it’s just so pathetic and stupid and desperate that they always try to shift the blame for midwife incompetence and lack of safety onto OBs.

        If a midwife screws up and something bad happens, it’s never the midwife’s fault. They have such distorted logic and such a persecution complex that they believe their own mistakes and incompetence are actually the fault of some vast medico-obstetrical conspiracy.

    • Dr Kitty

      “I would strongly suggest to those who are so opposed to Botox given by untrained people, those who believe it is unsafe…to lobby for plastic surgeons to not be allowed to refuse to back up for uncertified aestheticians”.

      “Back up” doesn’t mean “I will fix this mess” which the OB will do anyway, it implies that they support the clinical decision making which lead to the mess.

      Your plumber will fix your bathroom if your DIY attempt to re-plumb your bathroom goes wrong. You don’t call them, tell them you’re going to re-plumb the bathroom without their advice and help, and certainly without paying them, but would like them to “back you up”.

      Just…no.
      This person has no understanding of medical ethics or malpractice insurance works,

    • Trixie

      The part where lay home birth midwives get hospital privileges — someone should turn it into a skit. Something along these lines, but with an NCB bent: https://www.youtube.com/watch?v=HMGIbOGu8q0

      • Laura

        Nice comic relief!

    • Deena Chamlee

      I have one. When you become part of the solution, in other words have a voice then maybe we can truly begin to address the issue. AAP and ACOG have OPINION PAPERS published. Follow the opinions and possibly open up dialouge.

    • thankfulmom

      Why should OB’s who know homebirth is riskier backup lay midwives who are putting women and babies lives in danger? If they are backup for midwives, they get the births gone wrong with dead or severely damaged babies by the time the midwife decides to transfer to the hospital. Who will get sued for the lifetime care of a disabled baby? The midwife who took the risks and doesn’t have malpractice insurance or the backup doctor who has malpractice insurance?

    • attitude devant

      Ridiculous that she thinks that would help. The midwives don’t know enough to come to the OBs for help before disaster is unavoidable.

    • Mr.G

      No hospital can refuse a patient that is transferred from an attempted homebirth to the hospital. And they are supposed to do this in a non-judgmental and compassionate way.
      If midwives want hospital privileges, then they should apply for them through the same way as other practitioners do. Their credentials are evaluated on their own merits. CNMs deliver about 1 in 14 hospital births, so they are already in hospitals. There is one problem though: Hospitals require practitioners to have malpractice insurance which homebirth lay midwives usually do not have. And they require that practitioners have a license to practice their profession and have the educational requirements and follow guidelines.
      Uncheck that for DEM midwives.

  • staceyjw

    I posted this as a reply below, but think it ought to have its own entry.

    Her excuse about the MW not being part of the medical system is not only total BS, but a poor excuse indeed.

    If she had a CNM, which is looks like she did, the MW could have had all the access and integration that she could ask for. CNMs are in demand, and can have privileges wherever they want, if they simply follow some rules. Even if they want to be in solitary practice without any rules, they can still have a working relationship with OBs and hospitals, this is easy enough to do if you are willing to offer mutual respect.

    There are even OBs that will work with LDEMs, their clients, and hospitals that work to take their transfers as seamlessly as possible. Areas where there is a high amount of HB have hospitals bending over backwards to make these relationships in order to get these patients in before bad things happen.

    Any HB MW (CNM or otherwise) that is not totally reckless, and is willing to make relationships, CAN have working relationships with the medical system, in most parts of the country. CNMs have NO excuse.

    If this MW didn’t have relationships, it was because she CHOSE not to have them. And a lack of integration is no excuse anyway- if you cannot be part of the safety system for backing up YOUR births, DO NOT DO HB.

    In reality, what the HB MWs want is to be able to do as they please, when and where they please, then dump patients onto hospitals and OBs whenever they please, and have the hospital staff and OBs/NICU docs smile and say how wonderful they are, while never mentioning anything they may have done wrong, or that HB was a factor in the train wreck.

    They do not want their disasters and negligence reported, collected, studied, or even addressed, and will SUE to ensure the hospitals keep their dirty secrets (and sometimes they even WIN). There is a reason Oregon added “intended place of birth” to the birth certificates- they couldn’t get info any other way, and saw the deaths and disabilities adding up, but needed proof.

    This type of HB MW really does avoid hospitals because they are afraid of people being “meeeeaaaan” which is the most insane thing I have ever heard, but understandable when you come from a culture where you are worshipped and no negativity is allowed.

    NOT ACCEPTABLE.
    The MW was negligent, she ignored what is common knowledge (I know better as a layperson, FFS), and killed the baby. Mom chose HB, and Mom hired her. I blame the MW most of all, but if you can claim the positives of HB as choice, you get the bad stuff too. I think mom was working from bad information, personally. Still, it was her choice to birth at home- as all HB advocates crow all the time.

  • fiftyfifty1

    “her practice of non-invasive birthing”

    Notice how the ante has been up’ed. It used to be that homebirth midwives were helping you avoid interventions. Now they are helping you avoid “invasions” apparently.

    • Laura

      Almost comical if it wasn’t so tragic and maddening.

    • AllieFoyle

      It’s just a fancy way of describing laziness and incompetence. Being non-invasive basically means doing as little as possible.

  • Dr Kitty

    OT
    http://thecarousel.com/anna-told-birth-denial-think/
    Anyone read the book?

    For this extract, I think I like the sister…

    • Anj Fabian

      Have your experience when you aren’t in labor…

      Possibly the smartest thing I have ever heard. I could have had the Chronos Quartet playing live in my room during labor. Would I have cared? Not likely. Leonard Cohen serenading me. Between contractions – maybe.

      • Comrade X

        Back off, Anj, he’s MINE!! :p

    • fiftyfifty1

      I liked it.

    • realitycheque

      “‘The medicalisation of childbirth is about the pathologisation of the female. Studies show that male doctors repeatedly engage in excessive penetrations during labour.’”

      WHAT studies? That is a serious and repulsive thing to suggest.

      • birthbuddy

        Anything to sell the product.

    • http://gamesgirlsgods.blogspot.com/ Feminerd

      Yeah. From only this snippet, at least, I want to meet this sister. She sounds awesome.

  • Dr Kitty

    I don’t buy the professional isolation excuse.

    I know single handed GPs who manage to be safe, up to date, cautious doctors.
    Yes, they are professionally isolated.
    No, they don’t use this as an excuse for not keeping up to date.
    They can look after 2000 patients with lots and lots of medical issues and manage to do it well, with no guarantee of what any day will throw at them.

    Surely a HB MW, seeing 50 women a year, doing exactly the same thing with all of them, can manage to remember her scope of practice and a simple list of risk out criteria (no multiples, no breech, no HBAC, no PROM, no GBS, no GDM, no pre-e, no post dates, AMA makes everything riskier).

    If you ARE professionally isolated you make extra efforts to keep up to date.
    That might mean conferences or courses or journals or online learning or a small informal group of peers and a monthly chat over wine. But you do it.

    You do not get to be lazy and complacent if your job involves life or death decisions, and you don’t get to whine about “politics” being the cause of you not meeting your own educational needs.

    • fiftyfifty1

      The reason the midwife didn’t refer wasn’t because she practices in isolation. It was because she practices in an echo chamber.

      • Dr Kitty

        You know, sometimes I wish I was a specialist and not a generalist.
        When I sit down and write a list of things I need to know…it gets big…quick.

        Also, there is an unspoken rule-if you hate it and find it hard, you need to study it more.
        Unfortunately, for me, that means I don’t get to skip the bits I dislike. I don’t see why anyone who purports to be a professional gets a free pass on keeping up to date on basic knowledge.

        News flash-if you read a journal or complete an online learning module in the privacy of your own home, no-one is mean to you…and you learn stuff.

  • ArmyChick

    A lot of the time I hear “it’s the woman’s body. It’s her choice”. It sure is! So time to take responsibility for the choices we make regarding our body. You can’t say it’s -YOUR- choice and then refuse to take responsibility for the consequences.

    • birthbuddy

      Most, I think, don’t require much convincing. I still have sympathy for those that are lied to and don’t know any better.

    • AllieFoyle

      I don’t think we should hold someone responsible if they hire and place their trust in someone who presents herself as a professional and has credentials and legal standing as such. This care provider made a poor choice and the woman’s child died as a result. It’s not the patient’s responsibility to have enough obstetrical knowledge to second-guess their provider. People should be able to hire professional health care providers and trust that they will operate within a standard of care.

  • http://safermidwiferyutah.wordpress.com/ Safer Midwifery Utah

    She says “in part due” to politics. Cut her some fucking slack her child died.

    • Trixie

      “Politics” just means the CNM acted selfishly and not in the best interest of the baby. She didn’t want to refer to a doctor because she might get yelled at or reprimanded, and that was more important to her than the life she was supposed to protect.

      • Karen in SC

        Sadly, my suspicious nature wonders if the midwife just wanted bragging rights. Even though the risk was higher at AMA and postdates, there was still a high probability it would be just fine. That thinking forgets that the wager is the life and health of the baby.

        ETA and the mother’s life and health, too.

        • Guest

          At 41 years old, the IUFD risk at 39weeks is equivalent to the IUFD risk of a 26 year old at 42 weeks. AMA risk at postdates was substantially and recklessly higher.

          • Karen in SC

            An IUFD sort of gets the midwife off the hook, doesn’t it? As in “some babies just aren’t meant to live.”

          • guest

            Yes and that leaves my heart racing, tears welling and goosebumps quivering as that belief is beyond nauseating & reminding me of a recent incident pulling the ‘dead baby card’ because that baby was meant to live.

          • birthbuddy

            If she just followed the very simple established principles, the baby would be alive. Unfortunately, they were ‘doctor rules’, so totally unacceptable.

          • birthbuddy

            The infallible “stillbirth defence”. Stillbirth = no questions. Our friend Lisa Barrett tried it repeatedly.

          • Medwife

            And to imagine taking the risk of going post dates and having a home birth at FORTY FIVE YEARS OLD. Not 41. 45. The risk goes up every year! It was amazing to have conceived at all. Then to go through nine+ months of pregnancy, labor, and have the baby die.

          • EmbraceYourInnerCrone

            I feel horrible for her , for the loss of her baby, but I don’t understand? How can anyone think that giving birth at 45 is low risk? And if it’s your first baby, that makes it even higher risk. Is it because modern obstetrics has actually made such strides in making riskier pregnancies somewhat less risky (in a hospital, under expert OB care) that people now think that the risk magically disappeared? Because of “organic” food, yoga, “affirmations”, exercise?

            Is it because modern medical advances have made pregnancies that used to be impossible, possible so people think that since they got pregnant and have no obvious issues(no GD, no Hypertension) that they are not at higher risk ?

          • Guest

            Somehow misread her age in the original post…45? Dear God, this midwife was beyond reckless. My oldest parturient at 50 years was in for antenatal testing every 2-3 days for the final 3-4wks of her pregnancy and you can be damn sure she delivered by 39 weeks. If you’re too damn old for there to be guidelines on HOW to manage antepartum surveillance and risks at 40-44 are high…50 is too damn high to mess around with.

        • fiftyfifty1

          “Sadly, my suspicious nature wonders if the midwife just wanted bragging rights”

          Sadly MY suspicious nature wonders if that’s the main motivator behind ALL homebirth midwives.

    • T.

      She is writing a book about it. No slack here. If she was mourning in private, it is her own business. If she tries to suck other people into Homebirth, it is not anymore.

      This reminds me of the women who have autistic children and are convinced vaccines did it. People often say to cut them slack, they have autistic children. Well, no. If you try to spew anti-vax nonsense, you don’t get slack. If you write, I quote ” I believe that part of that reform must be to integrate out-of-hospital midwives into the profession rather than marginalizing them from it.” you don’t get slack. Sorry. Nope. I am not letting my feelings interfere with, oh, trying to save other babies.

      • Trixie

        I completely agree with this. I know someone who is very vocal who blames vaccines for triggering her son’s autism and other delays. Funny she never mentions the massive amounts of ecstasy she was doing in the first trimester. (I realize there’s no evidence that MDMA causes autism, either, but if you’re going to blame a pharmaceutical, why the vaccines?)

    • Amy Tuteur, MD

      Cut her some slack? When she wrote a book length denial of responsibility for her child’s death?

      Would you advise cutting her some slack if she wrote a book length defense of her decision not to buckle her child into a car seat and he died as a result?

      • staceyjw

        I probably would cut a mom some slack directly in the aftermath of a child’s death, even if it is entirely her negligent fault. But after writing a book about how its someone else’s fault? Nope.

      • AllieFoyle

        I think there’s a big distinction between disagreeing with the premise of her book and blaming her for her child’s death.

    • Laura

      “intense loyalty of her clientele” I believe this known dynamic of the midwife/client relationship is key to how this woman is processing her baby’s death. I feel terribly sorry for this woman and her loss, but what will bring her the most peace in the years to come? I think it is fully processing the entire situation – which necessarily includes looking at the NCB philosophy her and her midwife ascribed to. I think the “slack” you’re referring to points more to the time this processing takes and hopefully exposure to a more evidenced based look at postdates and all that can go wrong. I really do sincerely and hopefully desire that this woman finds healing in the truth in the years to come.

    • staceyjw

      I think people here DO cut a lotta slack towards HB loss moms. I can’t think of many that will even say that the moms choice makes her responsible, because there is no need to kick someone while they are down. We also know that their choice was frequently a bounded one, made with inaccurate information, and chosen from false choices.

      Still, HB moms DO love to take full responsibility for good outcomes and positive, empowering” experiences. They claim their intuition, education, choice of MW, diet, or whatever magical thinking crap they used made their HB a success.

      And HB loss moms DO know that their choice, no matter how misinformed they were, no matter how well intentioned, was still their own. They DO know it is partially their responsibility, and they ALL blame themselves- even when its clearly the HB MW to blame. Stating this fact is not as cruel as you think.

      In this case, mom wrote an entire book, I think addressing her is totally fair.

      • Jessica S.

        “In this case, mom wrote an entire book, I think addressing her is totally fair.”

        Agree 100%.

      • AllieFoyle

        I don’t have a problem saying that HB moms are wrong in both cases–they are not responsible for either the good or bad outcomes (except in the cases in which they were completely aware of the risks and willfully made a dangerous choice, but these cases seem vanishingly rare to me–it’s much more common that women are simply not informed of the risks). Most of it is luck, and the rest is provider skill and timely access to medical treatment when necessary.

    • fiftyfifty1

      “Cut her some fucking slack her child died.”

      i.e. this woman who has experienced trauma must never be taken seriously again.

      • staceyjw

        OI wonder if people would say the same to a Dad?

        • fiftyfifty1

          I do think there is a sexist double standard. Women who have experienced trauma must be tiptoed around and there is no statute of limitations.

          • AllieFoyle

            You can take someone seriously while also having compassion and trying to understand where she is coming from. I disagree with her attribution of responsibility, but I don’t hold her personally responsible for what happened and I understand why she might feel the way she does. She’s obviously anguished by what happened to her son.

            If there is a double standard here, I think it is in our desire to hold women responsible for their own obstetrical outcomes in a way that we don’t for other areas of medicine. Patients are not perfect and they shouldn’t be expected to know everything. You hire a professional and expect them to provide good care. We don’t hold people responsible for being victims of medical negligence in any other sphere. Why only in pregnancy? Isn’t that a double standard?

          • Elaine

            So this seems salient here–the CPMs I interviewed but didn’t use make a point of saying in their literature and their up-front consultation that they are not medical providers and that the patient is responsible for their outcomes. I have a hard time believing that these are the only CPMs out there who have this view, either–MANA has something in their ethics statement that points this direction.

            I think this is total garbage. It plays into this view that anybody can learn enough to be an expert. Whereas in reality, people often don’t even know enough to know how much they don’t know. WHICH IS WHY WE HAVE TRAINED MEDICAL PROVIDERS. Jeez.

            May not have been an issue in this particular case, but still.

          • The Bofa on the Sofa

            Patients are not perfect and they shouldn’t be expected to know everything.

            HB, even in the crunchiest of areas, runs what, 10%? And it’s not like childbirth is rare. Therefore, someone choosing a HB knows very well that what they are doing is uncommon. That should at least trigger a bell that says, “Why?”

            Women aren’t randomly getting duped into a homebirth. They may be fed a bunch of crap by the midwife, but if they aren’t applying any scrutiny to something that is so out of the ordinary, then they are absolutely walking into a problem.

            And make no mistake, the woman in this story is not some poor dupe. There is more information coming about how she is “unusual.” Why did she choose HB? Because she really thought it was safer for her? No, it can’t be that, because you have said that she can’t be expected to have medical expertise.

            And I agree. She did it because she is “edgy.” She’s not one of the 99% who do things the usual way.

          • AllieFoyle

            I think you are projecting your own experiences and values onto the situation when that may not be appropriate. There’s no reason at all to assume that she chose home birth to be “edgy”– that’s putting the worst possible interpretation on her motivation. Homebirth, while uncommon, is frequently seen and promoted as a very healthy option. She apparently hired and was advised by both a medical doctor and a CNM, both of whom supposedly thought she was both low-risk and a good candidate for home birth.

          • The Bofa on the Sofa

            There’s no reason at all to assume that she chose home birth to be “edgy”– that’s putting the worst possible interpretation on her motivation.

            But it is consistent with the other descriptions of her, like that of her being “unusual.”

            Homebirth, while uncommon, is frequently seen and promoted as a very healthy option.

            In VERY limited circles. I’m sorry, you can’t claim this is anything NEAR a mainstream view.

            I have two kids, have hung out with parents extensively for the last 6 years, and have never heard anyone talk about homebirth, as any option. There was even a friggin BirthRite where our kids were born. I never saw a car there, and didn’t have a clue what it was. My wife knew, but knew no one that went there.

            The only places HB is seen as a healthy option is if you eschew the medical community.

            She apparently hired and was advised by both a medical doctor and a CNM, both of whom supposedly thought she was both low-risk and a good candidate for home birth.

            Do you honestly think the doctor told her that she should do a HB? Or did she go to the doctor asking for his approval? Did she say, “I want to do a HB. Can I?” Or did she say, “Should I do a HB?”

          • AllieFoyle

            So what? Your experience is no more relevant than mine, and I know lots of people in my community who have had home births or chosen midwives. These are mostly well-educated people who believe they are making a safe and healthy choice, and there is a good deal of “infrastructure” built into the environment that supports that assessment–from the prenatal classes taught by NCB zealots to NCB friendly doctors and hospitals. It would not surprise me at all if she believed she was making the safest, healthiest choice for her child and was supported in that belief by the health care professionals she saw.

            From what I’ve read of her book (not a great deal), it’s obvious to me that Heinemen is an intelligent woman who cared deeply for the well-being of her child and is anguished by what happened. She had some legitimate concerns about hospital-acquired infection and expected a simple, safe, and healthy delivery and was never adequately counseled otherwise. Your determination to paint her as making a selfish or superficial choice is unnecessary and unfeeling. You seem to feel that she deserves censure simply for not being mainstream enough, but no one deserves to have their child die because of negligent care, mainstream or not.

          • The Bofa on the Sofa

            So what? Your experience is no more relevant than mine,

            HB accounts for less than 1% of all births in the country.

            Who’s experience is going to be more common? The one that does not encounter HB, or the one does?

            Yes, my experience IS more relevant, because it is consistent with HB being a very rare thing in the US.

          • Amazed

            She apparently hired and was advised by both a medical doctor and a CNM, both of whom supposedly thought she was both low-risk and a good candidate for home birth.

            I am not surprised her doctor accepted her decision to homebirth. There is a certain tendency among these circles to doctorshop until you find the right MD quack. My GP, for one, doesn’t endorse alternative treatments for cancer. Of course, she isn’t popular among those who want them and is a GP for very few of them. Dr Sears would happily advise a parent to skip a vaccine and hide in the herd. He, too, has a very selected – and self-selective – group of clients.

          • fiftyfifty1

            Censoring discussion and criticism of a woman who has *published a book and given talks* regarding her son’s death because we have to “cut her some fucking slack her child died” is infantilizing and doesn’t take her seriously as an academic, an author or a person.

            I also disagree that we are holding this woman responsible for obstetrical outcomes in a way we don’t in other areas. I actually knew a dad who didn’t buckle his kid in properly and his kid ended up with a closed head injury and some brain damage. This dad got criticized for that and going too fast on an icy day despite the fact that he himself died in the crash. Or the in-law of mine who went off of anti-retrovirals to treat himself with alternative medicine under the care of a AIDS-denier naturopath and promptly developed Valley Fever but refused to go back on his drugs and died. Everyone was very clear who was to blame for his poor outcome–mainly stubborn, arrogant, too-cool-for-Western-Medicine him. Partly the huckster he sought out to treat him, but mostly him.

    • Guestll

      1. She wrote a book assigning blame. She’s not entitled to having fucking slack cut.

      2. She was 45. Right there, at the outset, that was a huge, standout risk factor. What were the politics involved? What should we be listening to? It’s what she’s NOT saying that matters here. She was 45! Jesus.

  • Becky05

    I don’t think this is quite fair. I’m almost certain that I’ve heard your mention exactly the facts she points to — that integration into the medical system is an essential component of safety for midwives, and that the lack of this in the United States is one reason why we can’t look to large studies in other countries for info on how safe out of hospital birth is here.

    I absolutely agree that the natural childbirth philosophy contributed here by making intervention seem like a negative thing instead of the medically appropriate choice, but I do agree with the author that the adversarial relationship between out of hospital midwives and doctors in the United States is a fundamental part of the problem.

    And really, “Your baby died because of you” is beyond the pale.

    • Sullivan ThePoop

      It is a problem in the US that home birth is not a part of the medical establishment like in other countries, but I believe the midwives isolate themselves because they do not want to follow good practices, have insurance, or any responsibility. The mother is laying the blame on the medical establishment. I do not believe they are to blame.

      • http://safermidwiferyutah.wordpress.com/ Safer Midwifery Utah

        She lays the blame a lot of places, because it lies in a lot of places. God did anyone besides me actually read the piece?

        • T.

          I have. She lays the blame everywhere but in the hands of the midwife, and the whole post is about how her own and the midwifes herself responsabilities are somehow attenuated by the fact that the Hospital System is mean to midwife. The ideas that maybe it is so because out of hospital birth is dangerous doesn’t seem to compute.
          I’ll say it again. If you drive drunk and smash in a lampost it is because the lampost was here, it is perhaps because the street wasn’t as well mantained as it should have been, it is perhaps because the bartender kept serving you drinks.
          But mostly it is because you drank, and drove once you were drunk.

          • http://momofmanyfeet.wordpress.com Bambi

            That is an excellent analogy.

          • Hannah

            Could not have said it better myself. Sure, she is laying blame all over the place, none of which are in the hands of the incompetent midwife she chose, CHOSE, to hire. The places she lays blame are not at fault.

        • Anj Fabian

          If she went to court and tried to name all these other actors as codefendants in a wrongful death or medical malpractice suit, she’d have a helluva time doing that.

          The idea that she didn’t do something or that the midwife didn’t do something because of prevailing conditions isn’t plausible unless the prevailing conditions made it extremely difficult to do so.

          Why didn’t her midwife transfer her care at point A, point B or point C? It wasn’t nigh impossible at any point? It would take some effort, but it could have been done. There are LAWS in place to ensure that women in labor can get the care they need.

        • stacey

          There is blame for miles.

      • Karen in SC

        The reason homebirth is not integrated into our medical system is because our system uses evidenced based practices. Insurance coverage is a huge part of our system, too. Some carriers are paying for homebirth due to birth attendants’ lobbying efforts. I believe this will backfire when insurers have a data base of their own to study outcomes and costs.

        There are midwives that are integrated into our systems – CNMs who practice in hospitals.

        • Trixie

          There are areas of the country where CNMs who provide homebirth are integrated into the hospital system. It is rare but not impossible to find.

        • Sullivan ThePoop

          Well, I think we might do it if enough people wanted it. I am not saying we should do it.

        • Michelle

          The CNM who delivered my first son (2008) was hospital-based and also had a home birth practice, as did a few of her CNM colleagues. This is a large teaching hospital in Portland, OR.

      • Alenushka

        In the countries where HB is part of medical establishment, the stats are not so good. Who would blame our OBs on not wanting participate in activity that increases the risk. US OBs are risk averse and hooray for that!

    • Medwife

      It is an unbelievably cruel thing to say.

      • Trixie

        On the other hand, Heineman chose to publish a book about it. She’s not just a private person processing an experience.

        • birthbuddy

          Exactly, she wasn’t sucked in by the woo. She believed it in the first place and is now defending it.

      • Amy Tuteur, MD

        Why? It’s true.

        • http://whatifsandfears.blogspot.com/2012/12/the-business-of-being-misled.html Doula Dani

          Yes, this mother chose home birth and a midwife who practices recklessly. Had she chosen hospital birth, it would have been a different outcome.

          However, it is not her fault for not having informed consent – which is what directly led to her babies death. I doubt this mother would have chosen to stay he had she had a real sense of the risk. It is just like Gavin Michael’s mother. This mother didn’t know and her midwife failed her. This mother has probably since been manipulated by her midwife to convince the mother the fault lies in the system, not the midwife, just like Gavin Michael’s mother was manipulate by her midwife afterwards.

          • Trixie

            Okay, but, again, she’s now publishing a book, doing media publicity, etc. At a certain point if you’ve got the wherewithal to secure a publishing deal, you should be able to, like, Google the risks of going postdates at age 41 and realize your midwife lied to you. This goes beyond processing an experience on a little blog or in your private life. She’s now an active participant in (and profiting from) the system that killed her baby.

          • Amy Tuteur, MD

            Right. Think about how much good she could do by warning women of the dangers of homebirth. Instead she is affirming that she believes that homebirth is an excellent decision.

          • The Bofa on the Sofa

            Jeez, she could even make a strong statement that, until the system is changed, HB is a bad choice.

            That’s a reasonable conclusion, in fact. I don’t know, maybe that is what the book is about – how do we change the system to make HB safer?

            Of course, the answer is not to just accept midwives, it’s for midwives to change their behavior to conform to appropriate medical practice.

          • almostfearless

            You can hold it against her though that she didn’t react to the death of her child in the exact way you would have wanted.

          • Amazed

            Making money by defending the incompetence of the midwife who killed her child is nowhere near the way I would have wanted.

          • Laura

            How people react to horrible tragedies varies quite a bit. When I have faced tragedies I am most comforted in the long run by an honest assessment of as many “hows” and “whys” and “what should have beens” as possible. That’s how I process grief. I also figure out if I could have done anything differently to have had a better outcome. I don’t think that Dr. Amy is holding it against this mother for not reacting in the “exact way” Dr. Amy would have wanted. Rather, this mother’s assessment of what went wrong, which she PUBLISHED IN A BOOK, is based on false premises of how HB midwifery works – or doesn’t work – in this woman’s situation. How is it helpful to reach conclusions based on false premises? Like I wrote before, I really do feel badly for this woman’s loss, but processing her grief in this very public way does open her up to scrutiny. I hope that she is somehow helped by all of this.

          • almostfearless

            I am torn on this. The book is a memoir though, which is different than say Jennifer Margulis’ “The Business of Baby”. I haven’t read GhostBelly but it doesn’t sound like it’s prescriptive.

          • Laura

            Memoir or not, anytime you publish anything, or comment on a blog post – anything public – you open yourself up to scrutiny. What was the point of her memoir? Was it to help her process grief? “Expose” hb midwife difficulties in getting appropriate transfer of care? Something else? From her quotes cited above whe is drawing conclusions about what went wrong. Her assumptions are not entirely based in fact. It isn’t helpful to this woman for her to draw conclusions based on false premises of hospital-based care for AMA, hb transfers, obgyn attitudes towards hb midwives, etc. I think that her relationship with her midwife might be more personal than professional at this point and dealing with those relational dynamics is very, very painful. I could be wrong, but it’s my sense…

          • staceyjw

            Well, yeah, people are allowed to have their own opinions. ANd some will find this book a bad idea, and find criticizing it appropriate.

          • Guest

            I agree, Dani, that blaming the mother is too harsh in this situation. But what comfort can be given to her, given that she chose this option for her baby’s birth provider and birthplace, and the results were unnecessarily fatal? How do other home birth loss moms process the grief of an incompetent midwife and their choices? Perhaps those women’s voices will provide the most sensitive and considerate answer in this discussion of “blame.” I chose an excellent OB for my last birth and the experience was NOT GOOD. (But the outcome was ok.) Was I to blame for choosing him? Yes and no. It is a complicated answer, but I have learned a lot and for those hard won lessons I am grateful.

          • http://whatifsandfears.blogspot.com/2012/12/the-business-of-being-misled.html Doula Dani

            Processing the situation doesn’t change who is to blame for what happened.

            If this mother ended up choosing to become an advocate against dangerous home birth midwifery practices (like Sara Snyder, for example), it wouldn’t change who or what is to blame for the death of her child.

            I would never say “your babies death is your fault” to this mother, or to Sara Snyder, or to Kristine Andrews, or any of the many women whose babies died b/c their midwives were negligent and/or incompetent…. regardless of what the mother did (or didn’t do) afterwards.

          • staceyjw

            It’s not a matter of thinking one mom is (in part) responsible (this author) while another is not (Sara, for example). It’s a matter of saying so (or not), based on what happened next.

            This author went on to write a book about HB being OK, while Sara went on to be an advocate to help stop the deaths. The authors wrong ideas NEED pointed out, so they do not do more damage, while Sara has only helped prevent HB losses from happening.

            Both moms made the *choice* to have an OOH birth, and that is a choice that they have to live with. Indeed, it is the very reason why HB loss is so much harder than a typical still birth- these moms KNOW their choices were key in the tragedies of their children.

            Knowing how badly they were tricked, that they meant to do what was best, that they made choices from misinformation, and that its really primarily the fault of the MW and the NBC/HB community, is really no comfort to them (though it should be). They know full well that they sought out OOH birth, and even though they did everything as right as they could have, that was the start of the tragedy.

            We ALL make bad choices, often because of bad information. Sadly, this does not mean that the consequences are not real.

          • Becky05

            No, she is arguing for systemic change that will make homebirth safer.

          • Amy Tuteur, MD

            Safer than what?

            The reason why OBs don’t want to get involved with homebirths is because they think they are inherently unsafe. And the reason they don’t want to back up midwives at homebirth is because they think those midwives have bad judgment.

            Why should obstetricians work to make homebirth safer than it is when they already have an option that is safer than homebirth can ever be?

          • http://whatifsandfears.blogspot.com/2012/12/the-business-of-being-misled.html Doula Dani

            Yes but judging by what this woman is saying here in her piece she *clearly* has a very skewed version of the reality of hospital birth in America and the home birth midwifery system here as well. She does say that her midwife is in part to blame, she perhaps now *does* know the risks in going post date, especially for a woman over 40. But did she know at the time?

            I think it is far too harsh to say “it’s your fault your baby died.” If she was completely aware of the risks involved in her situation, that’d be one thing…. but from what I’ve read about this woman and the death of her child, she was lead to believe she was low risk and a good home birth candidate, even considering her age. Her midwife should have risked her out. She didn’t. Her baby died b/c of it. I just can’t see how she is to blame.

            I’m not behind this woman’s message at all… it is clear to me that this midwife was completely negligent… *especially* considered the risks for women over 40 going even passed 39 weeks, let alone going over 41. Like I said, to blame the system is not right. But to blame the mother, I can’t get behind that either.

        • almostfearless

          Not really. I mean come on, if you walk out the front door with your kid and a drunk driver runs your child over, are you to blame? I mean yes, technically you could have stayed home that day, but this women had no reason to think her midwife was going to let her baby die. The midwife is pretending to be a care provider and conned her. I think this post should be called, “Your baby died because your midwife is a con artist”.

          • Laura

            But even in my area where HB CPMs and CNMs are easy to hire, home birth is still a radical, fringe choice for where to have your baby. How can any woman who has access to the internet not find information about the dangers of home birth and be able to intelligently decide what is best for her and her baby? That is why Dr. Amy has this website. I am not blaming the mother for her baby’s death because the midwife was negligent, but how can anyone claim ignorance as to the risks of HB in our internet age?

          • almostfearless

            I don’t know, there’s tons of pro-HB coverage out there. I just googled “homebirth New York Times” and the articles are “balanced” they don’t outright warn about it:

            http://www.nytimes.com/2011/08/09/health/09birth.html

            “Only women who are having smooth, uncomplicated pregnancies that go to term and who are free of diabetes, hypertension and other obstetric complications should consider a home birth, experts say.”

            http://www.nytimes.com/2012/05/27/magazine/ina-may-gaskin-and-the-battle-for-at-home-births.html

            “Mommy Wars: The Prequel
            Ina May Gaskin and the Battle for at-Home Births”

            http://well.blogs.nytimes.com/2013/10/25/home-births-pose-special-risks/

            “It’s not necessarily so that home births are bad, but women need to think about the trade-offs,” said the lead author, Dr. Yvonne W. Cheng, of the University of California, San Francisco School of Medicine. “Home births have fewer interventions, but the baby is at higher risk. And obstetric problems are often emergencies.”

            Plus you have MANA spinning the death rate as a positive, outright lies. It is a fringe movement, but it’s spun as doing something even safer and better with your birth, not only is it not risky, it’s risk-reducing. It’s a compelling narrative that is obviously working.

          • Durango

            And now this mother has published a book adding to the home birth oevre that home birth is just peachy, even if your baby dies. What do you think the response should be?

          • Laura

            You make a very compelling point. BUT there is still information available online that will educate honestly about the risks. It makes the information in this website all the more crucial to have available. Dr. Amy’s recent post about her brash tactics – her shtick – was very eye opening because those tactics get a wide audience. To that extent, her “shtick” has been effective.

          • Anj Fabian

            I do searches and SOB often shows up on the first page. Dr. Tuteur is doing real good in making sure that people have a chance of finding information about the real risks of home births and lay midwives.

          • almostfearless

            Yes I should have mentioned, this site was the #1 result when I did that google search above. So things are definitely improving.

          • Trixie

            Did you turn off search optimization? I’m pretty sure google knows where you fall on the issue, KWIM?

          • staceyjw

            Last year, I would ave agreed with you. 2 or more years ago, I would have said moms had no way to know better.
            But over the last year, LOTS of good info has come out about the dangers of HB. You cannot claim total ignorance anymore.

          • Hannah

            I think there is a lot of covering one’s eyes and ears because NCB offers women with a sense of control over something that is scary and unpredictable. It’s much easier to be told you’re designed for something than to know, objectively, that our bodies are not that well-designed for birth.

          • Guest

            That’s not a good comparison – something like that would be a tragic accident, almost unpreventable, and completely unpredictable. The results of driving drunk or going postdates when AMA are both predictable and preventable.

          • almostfearless

            Let’s be clear, the results of going postdates when AMA are predictable and preventable by the care provider. If her OB had given her the same advice no one would have blamed her. Yes, she chose the midwife, but there’s also an entire community including several midwifery organizations that actively lie and try to con women into believing homebirths are safe and HB midwives are competent.

      • T.

        But it is true.
        If I choose to drive drunk with my sister as a passager, I go into a car crash and she dies, it is true that she died because of me.
        If I start to try to give the responsability to everything from lampost to street manteinance crew to my bartender, I am wrong, or at best just partially right. I chose to drive while drunk, with passagers, and they died. It is because of me.

        • fiftyfifty1

          And (as Bofa would remind you) driving drunk is statistically WAY safer than birthing. Especially birthing at home at age 40+ with an overdue baby.

      • ArmyChick

        Yes it is horrible to point out the truth. But it can’t be sugar coated. I think it is a natural response to want to blame other people for YOUR choices. But it doesn’t solve any problems. It doesn’t change the fact that her choice is what ultimately caused this. “My body, my choice” is not only when the outcome is good.

        • Lizzie Dee

          I don’t think it is natural to want to blame other people. I think it is understandable to try to find any way of rationalising the things you did or didn’t do because living with the consequences is so terrible.

          I think babies die and get damaged because we have forgotten (or never knew) that bad outcomes are just as “natural” as the lovely births, and neither are within our personal control.

      • birthbuddy

        It is unbelievably cruel to allow a perfectly normal baby to die because of your pride, philosophy or stupidity.
        This baby did not need to die – simple as that.

    • Amy Tuteur, MD

      Her baby DID die because of her and more babies will die because of homebirth until we acknowledge what actually happens when a baby dies at homebirth.

      • http://whatismyreferer.com/ MikoT

        If her story can be used to prevent more babies dying, then it should be.
        I’m not discounting the emotional cost to the mother, but it ranks a distant second in my book.
        She had her chance.

    • http://whatifsandfears.blogspot.com/2012/12/the-business-of-being-misled.html Doula Dani

      I don’t believe it was the mothers fault. But I believe her trying to blame the system is not right. There is so much fear mongering in what she wrote…. The 100,000s that die in hospitals, for example. There are not nearly as many *babies* dying preventable deaths in hospitals as there are at home, as we all know. Furthermore, there are *plenty* of home birth midwives (typically CNMs) that have a good working relationship with an OB (which is different than a relationship with a PCP or family doc or such), an OB who serves as a legit back-up. No, it’s not the norm for home births. But is that the fault of OBs? Or the fault of midwives? What OB wants to be liable for choices like these, to not risk out a 40+ year old woman who goes post date? This midwife took unnecessary risks — and that is *not* this mothers fault. It is the midwife’s fault. It is the midwife’s fault for not risking this woman out.

      I think an important piece here is why this particular midwife doesn’t have an OB as backup.

      • The Bofa on the Sofa

        But is that the fault of OBs? Or the fault of midwives?

        Midwives.

        US HB midwives don’t WANT to work within a hospital system. That’s because the medical system will tell them, no, you can’t do a breech delivery, and no, you can’t do a HBAC.

        The hospital is going to constantly be telling them what they can’t do. In a hospital arrangement, they will actually have responsibilities, and will be beholden to guidelines set by others? Why accept that, when the current system let’s them do anything they friggin want?

        Remember, an entire tenet CPM midwifery is that there are no standards!!!! It’s in their friggin mission statement that they don’t answer to anyone. Everyone gets to set their own standards

        • http://whatifsandfears.blogspot.com/2012/12/the-business-of-being-misled.html Doula Dani

          Yes I completely agree. I meant those two questions to be asked /considered rhetorically. This woman thinks her midwife didn’t have back-up bc of a flawed system. Reality is there are midwives who do have OB backup and who risk out when needed. Why doesn’t this midwife have backup? She is a CNM. One can’t help but wonder if it’s due to the risky choices she makes and/or risky choices she prefers to make.

          • The Bofa on the Sofa

            Oh, I know these were rhetorical questions, but I just needed a lead in.

            Our points are the same – her lack of hospital backup is not because of a flawed system, but because of the choices made by the midwives.

          • http://whatifsandfears.blogspot.com/2012/12/the-business-of-being-misled.html Doula Dani

            Ok I gotcha. Good. :) Just wanted to make sure it was obvious that I wasn’t trying to make excuses for the midwife.

      • Durango

        The mother surely knew that she was considered to be high risk by the medical community. She chose to ignore that. I am sorry that she had such a horrific loss, but to write a book saying that the politics of midwifery vs obstetrics and not her choice to avoid conventional care is what led to her son’s death is too much.

        • http://whatifsandfears.blogspot.com/2012/12/the-business-of-being-misled.html Doula Dani

          I read in another article that she was told by her family doc that she was a good home birth candidate. At least I’m pretty sure I did, unless I’m confused on the stories…. let me see if I can find it…

          • Anj Fabian

            In the back of my mind, every time people say “family practice” I’m hearing “chiropractor”, “naturopath” and “osteopath”.

          • AmyP

            You are a smart cookie, Anj Fabian.

            I think there’s at least a 50% chance you’re exactly right.

          • http://whatifsandfears.blogspot.com/2012/12/the-business-of-being-misled.html Doula Dani

            I do when they are home birth “backup”

          • Laura

            But I see a Family Practice doctor and she is a legitimate, highly trained, excellent doctor. She is in no way alternative like a chiro, DO, or osteopath. That’s why I would want to know the name of this woman’s family practice doctor to see if he/she legitimately a fp doc. An fp should never have told her she was low risk.

          • staceyjw

            That is not what Anj meant.
            Anj meant that the mom said the doc was a family doc. But we often hear them use “family doc/GP” for what is REALLY a NP/ osteopath/ Chiro.

            This is typical in the PNW, where we love our woo, and actually license NPs/Choros, and most insurance plans cover these quacks. People do use them as GP’s and call them this. Usually you only find out someones GP/ped is an NP, instead of an MD, because they bring up not vaccinating and talk about how they chose this NP because of it. Many a conversation has started by wondering what doc would ever approve such nonsense, only to find that their loved family doc is really an NP……

            We also give NPs prescription privileges, though not for the hard stuff… They can kill babies, and deliver them, use vacuums on stuck babies even with no training, but NO WAY can they give out a narcotic!!! That is too dangerous..…

            It is a real problem.

          • Trixie

            I think you’re on to something there…with the caveat that there are lots and lots of mainstream DOs that are responsible family practitioners, and OBs, for that matter. But I’d be willing to bet she was seeing some kind of “holistic” doctor.

          • staceyjw

            I don’t think I believe her, unless it was an NP. People OFTEn call their NP their GP/family doc here, even though it is in no way the same thing.

            Memory is a funny thing.

        • http://whatifsandfears.blogspot.com/2012/12/the-business-of-being-misled.html Doula Dani

          “Indeed, regardless of her “advanced age,” she’s extremely healthy and fit and is deemed “low risk” by the hospital midwives she sees through a good part of her pregnancy, as well as her family practice doctor.”

          http://turnthepagelisa.wordpress.com/2014/02/28/ghostbelly-by-elizabeth-heineman/

          • The Bofa on the Sofa

            But I thought she was post-dates?

            Was she still “low-risk” at that point?

          • http://whatifsandfears.blogspot.com/2012/12/the-business-of-being-misled.html Doula Dani

            Yes, she was postdate. She wasn’t low risk anymore at that point…. but did *she* know that? Did her midwife tell her?

          • The Bofa on the Sofa

            Apparently she couldn’t…for “political” reasons or something….

          • Empliau

            Yes, but in the article you linked, she was 45, with a child already – so presumably some experience with birth. Even if her family practice doctor did call her low risk, wouldn’t anyone check with an OB? No matter how much yoga you do and kale you consume, 45 is AMA.

          • http://whatifsandfears.blogspot.com/2012/12/the-business-of-being-misled.html Doula Dani

            But her MD and hospital midwives told her she was low risk…. if she didn’t know anything was wrong, why would she seek another opinion? Her CNM home birth midwife, her hospital midwives and MD all agreed…. I can’t say I’d see myself seeking out someone else if all these people were telling me the same thing.

            If a woman is seeing hospital midwives, they likely aren’t seeing an OB as well. They’d only go to an OB if the midwives risked or referred her to one.

          • Laura

            What OB would say she is low risk?! She’s 45. I would be curious as to who her OB was that called her “low-risk” at 45 and what he/she would say now. Would this same OB have allowed her to go past term? I don’t now the details of the story, but I have a hard time believing any obgyn worth their salt would say she is low-risk at age 45.

          • http://whatifsandfears.blogspot.com/2012/12/the-business-of-being-misled.html Doula Dani

            She didn’t see an OB — a huge part of the problem. She saw a family practice MD.

          • Laura

            That family practice OB should be called to account for not following evidence based guidelines. Where I volunteer I am in the resident’s lounge on the antepartum unit for Family Practice interns, residents and medical students. I see their education board and all the info they have about risk factors. At least in my area I am familiar with their training, so this family practice doctor really screwed up.THAT is unfair. Does this doctor know the outcome of this patient’s pregnancy and delivery? I sure hope so.

          • http://momofmanyfeet.wordpress.com Bambi

            My family dr way back, she was completely supportive of my plans. Now, *gasp*. I should of run.

          • Trixie

            My family practice will treat low-risk women in the first trimester of pregnancy, after that, nope, you’ve got to find yourself an OB.

          • http://whatifsandfears.blogspot.com/2012/12/the-business-of-being-misled.html Doula Dani

            My family practice doctor in my first pregnancy saw me for a significant chunk of that pregnancy b/c I didn’t have an OB as I was waiting for insurance to approve my home birth request. She signed off on a letter to my insurance to “ok” my home birth…. she didn’t have a clue what any of it was all about, really. She didn’t know I wasn’t seeing a non-nurse midwife… she didn’t even know there were any other types of midwives out there. At the time I thought she was amazing for supporting me, now I realize she was signing off on something she didn’t “support” or “not support.” She was just trying to appease me.

          • Trixie

            That’s nuts!

          • Becky05

            My first two children were delivered by my family practice doctor. I absolutely would have trusted his opinion, he spent a lot of time delivering babies.

          • Empliau

            If the reviewer is to be relied upon – and I know that’s a big if – “It is not a decision Lisa makes lightly; she agonizes over it, researches it”. What kind of research makes her think, at 45, a family practice physician’s opinion should be sufficient? In about 2 minutes on the net, I found on the ACOG site that AMA has a greater risk of preterm birth and stillbirth. Some research – and now she’s using her mad skillz to blame the medical establishment. No thanks.

          • http://whatifsandfears.blogspot.com/2012/12/the-business-of-being-misled.html Doula Dani

            But you can use the internet to find danger in *everything.* I wouldn’t trust the internet over my hired professional care givers.

            I cannot believe her hospital midwives and family doc didn’t inform her of the risks of being 45 and pregnant — that is INSANE to me. But I cannot fault this woman.

            I can’t fault any woman who believes her home birth midwife — there is a lot of cherry-picked, dangerous information out there supporting these horrible, dangerous practices… we all know this.

          • staceyjw

            I do not believe they did not tell her. I can believe they said “your age increases the risk, but you are in pretty good shape”. I can see her asking the GP about HB, over and over again, until she got a statement that she could take as a promotion of HB for herself. That, or all of her care providers are total NCB HB loving quacks….. also possible, but not as likely with hospital CNMs.

            We hear what we want to.
            Even those of us that try to faithfully reproduce the conversations between our care providers and ourselves, after the fact, fail most of the time. When the conversations were happening, we weren’t planning on a book (story, whatever), so we didn’t record it. Our faulty memories did the best they could, but bias is a big part of that.

            I know I have tried to remember the run up to the emergency with my DD at 19 weeks. What was on the US screen, what the tech said (or didn’t say), how the MFM explained the issue, and how they managed to get me into the hospital even though I wasn’t sure what was happening. Even with the details after the fact, all that is still fuzzy. I still cannot fully explain what happened. I am sure I missed so much- and I knew it was a bad event, and attempted to understand and remember it well.

            So, I am SURE looking back, her mind has altered certain details. Even with this, she would have known her age was an issue- what woman doesn’t know this? Come on, thats just denial, e ALL KNOW having babies over 40yrs is more dangerous, and carry risks they do not when you are younger.

          • Cartwheel

            Just today, I called the owner of a dog I have hospitalized and told her as clearly and concisely as I could in lay terms what I thought might be going on and what I thought we ought to do next. Then I listened as she held the phone away from her face and told her husband what she thought I had said. Her interpretation (twenty seconds after my explanation) was not entirely different from what I had said, but did use technical words I had not used and described a condition that I did not think to be present. I think I resolved the miscommunication, but it’s hard to tell, because when I asked if she had any questions both the first and second time she said “no” with confidence (and it’s only sometimes appropriate to ask clients to repeat what I just said back to me).

            I always take the “… but another health care provider said [insert unlikely-sounding thing]” with a massive grain of salt. Quite likely the HCP in question said nothing of the sort.

          • Empliau

            You cannot fault her for what? On this site there is a strong current of sympathy for loss moms who were misinformed, lied to, and the victims of incompetence and malpractice. And I wholeheartedly support this.

            I don’t support her writing, and publicizing, a book about how it’s not her fault, nor the midwife’s fault. Somehow it’s the evil medical establishment’s fault. In my book (sorry!) someone who takes on the responsibility of a nonfiction book has a responsibility to get the facts right. I don’t think I’d be as critical of a simple memoir, although her contradictory claims of My research! and It’s not our fault! would still annoy me. But she also is prescriptive about what the medical system should do, and that’s what makes me very cross with her indeed. You don’t get, based on your “research”, to tell OBs what to do with babies’ lives.

          • http://whatifsandfears.blogspot.com/2012/12/the-business-of-being-misled.html Doula Dani

            I don’t support her writing a book placing blame on the hospital, either. Not at all.

          • The Bofa on the Sofa

            I cannot believe her hospital midwives and family doc didn’t inform her
            of the risks of being 45 and pregnant — that is INSANE to me. But I
            cannot fault this woman.

            Thinking about this, there is something I don’t understand.

            Her claim is that the problem was “politics” in that the midwife couldn’t work with the medical system. But I have to ask, how did that cause the problem?

            How does the inability of the midwife to work with the medical system lead to the midwife not telling the patient that her situation (45 yo and post dates) is not safe?

            Even IF someone told her initially that she was low-risk, there was NOTHING preventing the MW from updating her situation when it happened.

            IOW, I am calling bullshit on her entire story. It just doesn’t add up.

          • http://whatifsandfears.blogspot.com/2012/12/the-business-of-being-misled.html Doula Dani

            I completely agree! I think the midwife takes the blame here.

          • AmyP

            “What kind of research makes her think, at 45, a family practice physician’s opinion should be sufficient?”

            Yeah–45 is OLD to be having a baby.

            I think there’s a lot of self-delusion with regard to what “healthy living” buys you in terms of reversing the effects of aging.

          • attitude devant

            I don’t believe they actually said that, Dani. No matter how healthy you are, after 40, your have increased risks for premature delivery, IUGR, PPH, c/s, stillbirth. That is just reality. Elizabeth Heineman doesn’t accept it but it IS reality.

          • fiftyfifty1

            She was really considered low risk by them? Like they refused to bill her under the code for advanced maternal age? I’m not buying it.

          • meglo91

            Yeah, me neither. My understanding is AMA never equals low risk.

          • Anj Fabian

            I roll my eyes every time I hear “extremely healthy”.

            No. You are just “healthy”. You can be very fit, incredibly strong but “healthy” isn’t the same thing as physical ability.

          • KarenJJ

            I thought I was “extremely healthy”. I rarely got sick with colds etc, was relatively fit, ate fairly healthy food, was smack-bang in the middle of a healthy BMI for my age, got decent sleep every night.

            Sure I felt a bit off every now and then, was very susceptible to cold temperatures and had a couple of odd things going on with “allergies”..

            Turned out I wasn’t healthy at all. When I was finally diagnosed with a rare disease I was very anaemic, had an enlarged liver and spleen, swollen optic nerves and the starting of joint damage in my knees. A lot of this stuff can bubble away and like a frog in a pot of boiling water you don’t notice the incremental changes in your health – you adapt to them – until suddenly you and/or the doctors realise that things are not looking good at all (all good for me now thanks to good medication).

          • AllieFoyle

            You know that and I know that, but I have no idea why she was expected to know it, especially as the professionals she had hired to care for her obviously failed to inform her of the fact.

          • Durango

            I wish we could have a better feel about what the doc said–that little excerpt certainly glosses over it. The book review further says that she’s unconventional, so I suspect she was looking to validate her desire for a home birth. But, it’s true, every midwife and MD should have been strongly emphasizing that she was high risk and therefore not a good candidate for HB.

          • Anj Fabian

            The CNM practice refused to label her “high risk” by reason of AMA unless she had an active, rather than passive risk factor such as hypertension or obsesity.

      • Lisa from NY

        Get real. I know people like Elizabeth Heineman. They don’t listen to their OBs and refuse inductions.

        • http://whatifsandfears.blogspot.com/2012/12/the-business-of-being-misled.html Doula Dani

          I know home birth moms who just want what was best for their babies and who would induce if their midwives told them they needed to.

      • Becky05

        How easy it is for a CNM doing out of hospital births to have a good relationship with an OB and to have a good OB back up is heavily dependent on the laws of her state as well as the medical culture in her area. CNMs are in fact constrained from practicing to the limits of their expertise in many states, either by laws or by demands placed on hospitals by malpractice insurance companies. There really is a systemic problem.

        • http://whatifsandfears.blogspot.com/2012/12/the-business-of-being-misled.html Doula Dani

          Be that as it may, it doesn’t give the midwife any good reason to not risk this mother out. I don’t see how a better system could have saved Thor. A better midwife could have (one who appropriately risks out). Or a planned hospital birth could have.

        • AllieFoyle

          In what way are CNMs constrained from practicing? Can you give some examples? My experience with CNMs made me feel as though they weren’t constrained enough.

      • birthbuddy

        She can’t help herself, she repeats all the same NCB crap. Babies die in hospitals too, homebirth is safe, 45 is a variation of normal (OK she didn’t say that but its implied).
        Her true colours are showing, she is part of the NCB cult and she is looking for excuses to justify her mistake. Cult rule #1.

      • AllieFoyle

        I completely agree, except that I think the whole concept of OB backup is completely irrelevant in this case. If there were consistent, enforceable standards for midwifery practice then this tragic situation, and a number of others that have been discussed on this site, would not have occurred.

        • http://whatifsandfears.blogspot.com/2012/12/the-business-of-being-misled.html Doula Dani

          Right. It’s possible she doesn’t have OB backup bc she prefers to practice recklessly like this. OB backup in this case would only help if it meant this woman needed transferring and/monitoring at a certain point. I’m not convinced this midwife would have transferred even if she had OB backup. I’m not convinced this midwife wouldn’t pull a Christy Collins and scare the mother away from what an OB might say had she had monitoring once she passed her due date. To not transfer care bc the midwife felt “under siege” is quite damning. The baby died bc of the poor midwife’s feelings?? Disgusting.

          • AllieFoyle

            Describing midwives as “under siege” so unnecessarily overdramatizes things. I mean really, I assume most OBs are just…doing their thing, taking care of their patients…but I guess midwives consider not being eager to enthusiastically facilitate substandard care and assume financial and legal liability for other people’s negligence the equivalent of an act of war.

    • staceyjw

      Her excuse about not being part of the medical system is not only total BS, but a poor excuse indeed.

      If she had a CNM, which is looks like she did, the MW could have had all the access and integration that she could ask for. CNMs are in demand, and can have privileges wherever they want, if they simply follow some rules. Even if they want to be in solitary practice without any rules, they can still have a working relationship with OBs and hospitals, this is easy enough to do if you are willing to offer mutual respect.

      There are even OBs that will work with LDEMs, their clients, and hospitals that work to take their transfers as seamlessly as possible. Areas where there is a high amount of HB have hospitals bending over backwards to make these relationships in order to get these patients in before bad things happen.

      Any HB MW (CNM or otherwise) that is not totally reckless, and is willing to make relationships, CAN have working relationships with the medical system, in most parts of the country. CNMs have NO excuse.

      If this MW didn’t have relationships, it was because she CHOSE not to have them. And a lack of integration is no excuse anyway- if you cannot be part of the safety system for backing up YOUR births, DO NOT DO HB.

      In reality, what the HB MWs want is to be able to do as they please, when and where they please, then dump patients onto hospitals and OBs whenever they please, and have the hospital staff and OBs/NICU docs smile and say how wonderful they are, while never mentioning anything they may have done wrong, or that HB was a factor in the train wreck.
      They do not want their disasters and negligence reported, collected, studied, or even addressed, and will SUE to ensure the hospitals keep their dirty secrets (and sometimes they even WIN). There is a reason Oregon added “intended place of birth” to the birth certificates- they couldn’t get info any other way, and saw the deaths and disabilities adding up, but needed proof.

      This type of HB MW really does avoid hospitals because they are afraid of people being “meeeeaaaan” which is the most insane thing I have ever heard, but understandable when you come from a culture where you are worshipped and no negativity is allowed.

      And beyond the pale? Writing a book about it, then not expecting to hear that yes, your choice makes it your fault (in part) is beyond the pale.

    • birthbuddy

      This adversarial ‘doctor-midwife’ relationship is not unique to the US. It exists in Africa, the UK, Australia, NZ, the Netherlands and I daresay it is universal in some form or another.

  • Karen in SC

    I’m sorry, only on Planet Midwifery is an age 40 post-dates mother low risk. How the mother was unaware of this fact when doing her “research” is a mystery.

    And her midwife never had a loss before? That doesn’t mean it won’t happen!! As many baseball fans know, St. Louis Cardinal Ozzie Smith never hit a left-handed homerun in 3,009 left-handed at bats until he did – in the bottom of the 9th inning in a NLCS Championship game in 1985.

    • Sullivan ThePoop

      it is because just like the antivaxxers they are not researching. They are scouring the web for anything that agrees with their bias. That is the opposite of research.

    • Karen in SC

      I forgot to mention I was in Busch Stadium when it happened.

    • ArmyChick

      Maybe she wasn’t unaware. Maybe she knew but refused to think a tragedy would happen to her.

  • Medwife

    I feel terrible that this woman was lured into going post dates and having a home birth by having hired a nurse-midwife. The fact is, if a CNM chooses to ignore safety parameters and standard of care for referral, the mother is no better off than with a CPM.

    • Guest

      Exactly. Had this mother been under the care of a provider who understood the risks, evaluated and appreciated the need for MUCH earlier antepartum surveillance of AMA…we might not even be discussing Thor. If 39 weeks at 41 years old is a comparable risk to 26 years old at 42 weeks and this CNM was unable to comprehend the associated risk, why even bother calling it providing any care at all. Senseless and needless loss of a baby. Disgusting.

      • The Bofa on the Sofa

        Had this mother been under the care of a provider who understood the
        risks, evaluated and appreciated the need for MUCH earlier antepartum
        surveillance of AMA…we might not even be discussing Thor

        I’ve said it before, if most midwives actually understood the risks, evaluated and appreciated the need for timely antepartum surveillance in all high risk cases, this blog wouldn’t exist.

        It is the incompetence of US midwives that underlies this whole thing.

        • Guest

          As a medwife who GETS the risks, I don’t GET the ignorance of others either. As AMA is increasing, I would like to see ACOG take a firmer stance on AMA risks and management.

  • Anj Fabian

    For those who don’t know what the term “medically necessary” means in the home birth world:

    Medically necessary means that the shit has hit the fan and there is a clear and immediate need for intervention. In other words, it’s a medical crisis.

    This is why home birth midwives will take on patients with known risk factors. Because until that HBAC attempt results in a uterine rupture, a hospital birth isn’t “medically necessary”. It might be the smart, proactive, cautious choice – but it isn’t necessary.

    A few late decels don’t mean that intervention is “medically necessary” but once the fetal heart rate drops into the danger zone, intervention is “medically necessary” – and the interventions are out of reach, far away in the hospital.

    • Lisa from NY

      Ditto with PPH and hypovolemic shock.

    • Captain Obvious

      As in “Dang, the baby ended up in the NICU for over 2 weeks. That cesarean was so necessary.”