I believe your baby Thor died because of you


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.