Introducing the Not Buried Twice Facebook page

Facebook notburiedtwice

A homebirth midwife crowd sourced a life and death decision with her Facebook friends while a baby was literally dying. He’s not the only one who has died at the hands of homebirth midwives. Indeed, even the recent study from the Midwives Alliance of North America (MANA), the organization that represents homebirth midwives, shows that homebirth has a perinatal death rate 450% higher than comparable risk hospital birth.

The homebirth midwifery community has not merely been silent on this baby’s death (like the deaths of all the babies that have died at their hands), they have deleted and banned and attempted to erase the evidence that this baby lived and died. Their plan appears to be to do nothing about it, investigate no one, hold no one to account.

Let’s not let them bury this baby twice, once in a tiny coffin in the ground and then again by erasing him from public consciousness. To prevent that, let’s leverage the power of social media to finally hold homebirth midwives to account.

Introducing the Not Buried Twice Facebook Page.

Please visit the page, “like” the page, and share your thoughts.

If you haven’t done so already, please sign the Change.org petition expressing our revulsion to Jan Tritten, Editor of Midwifery Today, who was the midwife who solicited the advice of her Facebook friends while the baby was dying. 537 people have signed so far. Many have left comments, some heartbreaking.

Please keep sending Facebook messages, Tweets and emails to:

Jan Tritten
Jan Tritten’s Facebook page
@JanTritten on Twitter

Midwifery Today
Midwifery Today’s Facebook page

The Midwives Alliance of North America (MANA)
MANA’s Facebook Page
@MANACommunity on Twitter

and

Melissa Cheyney, CPM in her role as Head of the Board of Direct Entry Midwifery in the state of Oregon (where Jan Tritten lives).
Email: melissa.cheyney@oregonstate.edu (She does not appear to have a separate email address at MANA or the Board of Direct Entry Midwifery)

What should you write? I leave that up to you, but for those who aren’t sure, I have a suggestion:

Can you tell us what you plan to do to investigate the death of the home birth baby whose care Jan Tritten crowd sourced on Facebook?

Short, simple, polite and to the point.

In my judgment, the most important thing we can accomplish is to raise public awareness of the hideous death rate at homebirth, the fact that American homebirth midwives (CPMs, LMs, DEMs and lay midwives) are NOT real midwives, and don’t meet the standards for ANY other midwives in the industrialized world, and the fact that American homebirth midwives are trying to erase the existence of babies who died at their hands by deleting and banning on their own websites, message boards, Facebook pages and Twitter accounts.

Let everyone know that this baby, and many babies like him, die preventable deaths at homebirth and henceforth, we will make sure that these babies are #notburiedtwice.

  • auntbea

    Dr. Amy, I spoke with a friend of mine who works on state politics, to get information about state ballot initiatives. I am generally not big on ballot initiatives, because I think they often end up gumming up the legislative works in unhelpful ways. BUT they also draw the attention of media and politicians, even when they don’t pass. Just the process of getting them on the ballot requires petitioning and other means of mobilizing. There are firms that do this — they charge between $5-$15,000 to draft the initiative in a legal and appealing way, and then charge per signature gathered. It would be a serious commitment on our part to raise the money for this, but I am also not sure that we have the knowledge or skills to generate political change on our own.

    • deafgimp

      Plus, someone could start an account on GoFundMe.com or whatever it’s called to help raise money for this

  • Medwife

    The word about the horrific neonatal twin death rate found by the MANA paper seems not to have gotten out. This hit my FB newsfeed. http://megancrown.com/2014/02/welcoming-hazel-harland-elk-river-birth-photographer/ They were born in February. What the hell are those midwives thinking? Idiots.

    • manabanana

      How about this one? 9 1/2 hours between babies.
      TWIN HOMEBIRTH. WITH CPMs!

      Doesn’t that sound awesome?

  • Amazed

    “appalled20,
    you assume a lot and often from what I have read here. For you to pick
    out immediately that I was talking about you just emphasizes what I am
    accusing you of is actually happening, it isn’t my imagination.
    Defensive much? If your intentions were true to heart you wouldn’t be.
    If you TRULY supported home birth your posts would not all have
    something negative to say about it. Other than you CONSTANTLY saying you have nothing against home birth, every post here has been negative. You always continue that statement with a “but”. Do you know what but
    really means? But is the big eraser. But means: Forget what I just said
    THIS is what I really mean. You type out of both sides of your mouth.
    Obviously you knew exactly why I wanted a mod to contact me thus your
    1st post in this thread, makes me wonder if this has been brought up
    about you before now?

    I agree with facts. I agree with information and knowing all sides. I
    agree with being informed. I feel that happens here without fear
    mongering and being on a crusade AGAINST home birth, which is what I
    feel appalled20 is doing. And SAYING you have nothing against home birth
    and then only posting negative things about it are two TOTALLY
    different things. A person can say all day long they support a thing, or
    have nothing against a thing, all the while talking out of the other
    side of their mouth proving just the opposite.

    Assuming women don’t have the intelligence to do their own research
    and make their own informed choices without these negative posts
    combating home birth is insulting. These women don’t need you to bring
    the ugliest side of a thing to their attention in order to be
    “informed”. Do you run around telling women you meet in the grocery
    store planning a hospital birth all the bad things that could happen to
    them at the hands of their OB in your “sincere” crusade for fully
    informed mama’s?

    Some of the onus for the responsibility of your OWN care lies with
    mothers as well. Blaming everything on midwives or OBGYN’s when you have
    a mouth and should be advocating for yourself is crap.

    I have had 2 home births. I researched and made my own choices. That
    was MY responsibility. I am the only person completely responsible for
    me. If I sit around avoiding my gut instinct and closing my mouth when I
    could have been advocating for myself and something bad happens some of
    that is on me.

    Mothercat, I don’t think it is a
    matter of being “delicate” in beliefs, but as a midwife you know that
    fear effects labor and birth. There is a big difference between
    information based in fact and information that is at one far end of the
    spectrum used simply to scare people out of a thing. Surely when you
    talk to your clients you don’t show them the one midwife out of
    thousands that lost a baby last week (whether she was negligent or not)
    and say, “Are you sure you want me to deliver your baby, cause ya know,
    this could happen??” There is a difference in what COULD happen and what
    normally does happen. For every nightmare midwife story there are just
    as many horrid OB/hospital stories. Part of the reason I chose home
    birth so many years ago was because I met a woman who delivered a still
    born due to OB negligence. She was suing for malpractice. The fear
    mongering stories are available on both sides….both sides could scare
    each other all day long. What matters is where a mama feels comfortable,
    what she wants, and can have within a reasonable scope taking into
    consideration her circumstances, that includes researching who you pick
    for your care, that responsibility is on the mama. I don’t necessarily
    think it should be support only with a fierce conviction, but I do think
    someone should stand up for what MOTHERING has stood up for for the
    last 30+ years and protect this place of support and information from
    posters like appalled. If that can’t be done, then maybe support only is
    an option.

    I am no Pollyanna, I know complications happen, I know birth is not
    always perfect and pretty, and I don’t see the majority of women coming
    to this forum feeling any different than that. They come looking for
    information that is valid, real women experiences, and support, but I
    find this is being undermined here. Just like I wouldn’t go to a
    mainstream site like babycenter.com and post all kinds of horror stories
    about OB’s and hospital births, I wouldn’t go to the breastfeeding
    forum and post the new study that was done that concluded that
    breastfeeding has no long term benefits for kids, just to stir the pot. I
    feel it would be combative and missing the point of the forum,
    (support) and that is what I feel you are doing appalled20.

    I truly feel appalled20 is a mannerly troll who colors just enough
    inside the lines so they can post here undermining and crusading
    against home birth all the while saying they support a woman’s right to
    choose the birth she wants when it is abundantly clear they don’t.”

    Sorry for reposting this piece of drivel from our favourite nest viper, MDC, but I thought it would be interesting to us to see the reaction of the homebirth society to this tragedy. Support, support and mom is to blame!

    This was a direct reaction to the CC story.

    • yentavegan

      I used to think that I wasn’t brave enough, and that I did not trust my body enough to have a homebirth. So instead I chickened out and used a ob/gyn and a hospital to give birth in. But I supported and (gulp) encouraged other women to “go for it” and have that beautiful life affirming homebirth.
      How would a mother ever know on her own that the loss of amniotic fluid was an emergency situation?
      If her midwife all along was attentive and positive and always made the mother feel safe and cared for , why would a mother ever doubt the midwife’s scope of knowledge?
      This is the crux of the crime! How could parents ever know ahead of time when a heretofore normal pregnancy had veered far enough off course to warrant change of health care provider?
      The day this poor mother found out she had NO amniotic fluid was the day/hour/minute the midwife should have told her the baby’s life is in jeopardy and she needs to go to a hospital NOW.
      The midwife had no business calming/masking the emergency with all those extraneous sonograms and NST. Those tests are for when a normal pregnancy has hit a snag or a glitch, no amniotic fluid is an emrgency.

      • Amazed

        Yeah, it’s all “find a midwife you can trust!” and then, when the proveribial shit hits the fan, it’s all “why didn’t you educate yourself? Own your outcome!”.

        I might be too suspicious but I believe that in this case, tests were done to soothe the mother who otherwise might have gone to the hospital and Christy would have lost her as a client. Those were not tests to reveal whether there was an emergency – Christy’s bio and publications show that to her, there’s no such thing. Those were tests meant to convince mum that there was no emergency. At least that’s my stake.

        • Theodora

          I think midwives make sure they get paid before delivery. They make sure they get their money but they don’t make sure delivery is safe. Their reluctance to transfer stems from fear if losing future clients if they are labeled a medwife

          • Amazed

            Yes, that’s what I mean. Bad for business. In this case, though, it worked both ways – Christy was first scared she’d lose her midwife “status” in the NCB crowd, potentially losing clients, and then she got scared that she’d be labeled as a dangerously incompetent midwife (along with the bunch of others), potentially losing clients. So she played it both ways with sickening mastery.

          • Jennifer Delaney

            or the client might ask (rightfully so) for a refund if they transfer. Or perhaps the client hasn’t paid in full, and the midwife wants to make sure to get that last couple hundred bucks. Or she just really really hates transfers or lives in a “gray area” state where midwifery is neither legal or directly outlawed, so she wants to stay “under the radar” and by NOT transferring or by having the client or husband go alone to the hospital she avoids responsibility. Or perhaps they’re on PROBATION from another state, where they’ve lost their ability to legally work as a midwife, so they want to keep their practice in a neighboring state quiet. Or they have drunk too much koolaid and they are just completely under the delusion that Birth is Safe and Interference Is Risky. There are lots of overlapping reasons midwives do not like to transfer. Usually there is more than one reason. Oh, yeah, forgot another one… the midwife doesn’t want to affect her transfer rate/percentage. Or she just “really really wants this mom to get “her” homebirth. Or she doesn’t want to have to explain yet another transfer to all her more crunchy midwife peers at the next coffee klatch nee review. I guess there are lots of reasons. I can’t really find a VALID one amongst the above, but perhaps someone else could help me out?

          • Amazed

            Interfering with nature? I mean, we love evolution and evolution means survival of the fittest, no?

            For those who can’t find a valid reason for not transferring, I recommend a trip to MDC. For the sake of your keyboard, make sure you aren’t drinking coffee, tea or whatever. Then go and learn that most hospital teams are the villains who heroically rescue babies, condemning them to living with brain damage while a peaceful birth with a peaceful deadly outcome is far more preferable.

        • thepragmatist

          Victim blaming.

    • Jessica S.

      This is filled with such stupid that I feel I must lie down. :-S

      But this part especially jumped out at me: “fear effects [sic] labor and birth”. First of all, it’s AFFECTS. Grrr. Big pet peeve, not that hard to memorize the usage.

      But more on point, I’d be interested to hear from moms who have experienced precipitous births. (Am I using that term correctly?). I’m not a professional, but from stories I’ve heard from mothers who couldn’t get to the hospital on time, it seems that no amount of anything (outside the dreaded “intervention”, but that’s beside the point) could have stopped those babies from coming out. And I assume that there was a decent amount of fear and anxiety in those situations, emotions that did not stop the baby in its tracks? Please, correct me if I’m wrong.

      • Meredith Watson

        I’ve had three babies and each was different in terms of the amount of fear. There was zero correlation between fear and pain and fear and the progression of labor. The labor for which I was most relaxed was the most painful and slow to progress with three hours of pushing.

      • Melissa

        Exactly. While fear may affect labor, it is only one of numerous factors. Position of the baby, anatomy of the mother, and biology of the mother (pain tolerance, etc.) are going to have a much larger impact on the labor experience. Just eliminating the fear/anxiety through magical thinking won’t do anything for the rest of the factors.

        That being said, the mind is a powerful thing and I don’t doubt that a woman who defines herself via the NCB movement who has a successful homebirth will report the experience as being wonderful and perfect. Mostly because if they experience it as anything less than perfect they have to either believe that they did something wrong or admit that the NCB “trust birth” stuff in BS. People can convince themselves of a lot of stuff when they don’t want to face the alternative. I really thought that I liked Jazz when I was dating that Jazz musician, but in hindsight it was just that I didn’t want to have to tell him that he sucked.

      • deafgimp

        I know someone who had a baby born from first contraction to all the way out in under 20 minutes. She was terrified, the paramedics didn’t even make it on time and she had her other child in the next room while she gave birth alone in her bathtub. She did everything she could think of to keep that baby in there until she could get to the hospital. Obviously that was a big fat failure. She probably had one of the most scary situations for birth, totally alone with a small child to care for at the same time, working to make sure that child doesn’t freak out while she was freaking out. She had two phones, her husband on one trying to drive home and the EMS dispatcher on the other line. Her husband was frantic, even the dispatcher was scared and the paramedics were scared when they got there. There was enough fear going around that you could practically see it. Baby was fine, though, and the placenta was delivered before the paramedics packed her up!

        • Jessica S.

          Holy moly! I’m glad the baby and mom are good!

      • Happy Sheep

        I had a 2.5 hour precipitous birth and I was terrified. My terror at the thought of a natural birth did nothing to slow down my triple peaking, nearly non stop contractions, or my son from barrelling out, no matter how many times I begged the hospital to give me something for the pain or to help me regain control of myself or how scared I was.
        My natural birth also didn’t stop the shoulder dystocia or the resus my son needed after such a speedy delivery FTR

    • no longer drinking the koolaid

      BTW: I am mothercat in the above posting taken from MDC.

      • Amazed

        Really? I had no idea. But maybe it’ll be better if you delete this post. We know some of the posters of MDC read here and unlike you, many of them are still drinking the koolaid.

        Kudos to you for managing to keep yourself both here and there. I’ve long admired your self-control and patience to explain things that look so obvious. But then, that’s one of the reasons I am not a health-care provider or teacher.

    • Karma Kidney Stone

      I think MDC is going to make home birth support only, just like Babycenter did and they did with the not vaccinating forum. You don’t want those pesky facts getting in the way of your worldview.

      • anion

        Am I the only one who wonders how these women would react if other places were made “support only?” Like, if a drug education website became “support only,” and all you could do for someone announcing their decision to start shooting heroin was tell them the right way to do it and cheer them on? Or a woman who’d gotten hold of a syringe, a large quantity of Novocaine, and a couple of breast implants announced she intended to perform her own breast augmentation surgery with a good paring knife and some mirrors, and it was wrong to tell her that was a pretty risky thing to do because it’s “unsupportive?”

  • Stacy21629

    Great! You’re 100% right, the safety problems we saw on the Facebook thread are endemic to CPM midwifery as a whole. There were midwives from Hawaii, Oregon, Nevada, Virginia and Delaware that posted ridiculous suggestions or directly contributed to this baby’s death. This is NOT an isolated incident. It is a hallmark of the movement and must be stopped.

  • Trixie

    Dr. Amy, may I suggest that you try to get someone to volunteer to put some meme graphics together for this campaign? I think people need short, visual ways to understand some of these issues (like who MANA is, or how Christy Collins and Jan Tritten are related to the goals of this campaign) with some snappy, shareable memes.

    • Amy Tuteur, MD

      You are absolutely right. I think the most urgent need is for a way to educate people that CPMs aren’t real midwives. Check out the comments on the ios9 website or on Reddit where one of my posts is rising in the skeptic section. Virtually no one understands that CPMs aren’t the same as CNMs or European midwives.

      • Trixie

        I agree. Virtually no one I know in real life understands the difference between CPM and CNM or why CPM is bad.
        I’m thinking of the success that the page Refutations to Anti-Vaccine Memes has had in quickly educating people and I think replicating that would be a good goal. I wish I was good with graphics or I’d volunteer myself. But hopefully some of your readers will help out.

        • Certified Hamster Midwife

          RAVM has been so successful because the memes are based on currently circulating antivax memes and are very witty.

          • Trixie

            Exactly. There are plenty of circulating NCB memes too. And there are plenty of witty people around here. We just need to put it all together.

          • Karen in SC

            We should start finding them and sharing them on the Not Buried Twice page. Then we all supply an “Anti” quote that fits the picture. The best one wins!

          • Jessica S.

            Would that be ha-ha witty or nit-wit witty? I’m a little of both. ;)

      • Certified Hamster Midwife

        My favorite part is how the io9 commenters assume that Dr. Orosz is a man. I mean, this is the Internet, and the person has a doctorate degree. Must be male.

        • Anj Fabian

          There have been at least two high profile cases where a pseudonymous blogger was assumed to be male and there was a massive reaction when the online community discovered their assumption was erroneous.

          I’d ask “Haven’t they learned yet?” but I know it takes a LOT of work to reset cultural expectations.

          • Gene

            Was one of them “I Fucking Love Science”? If not, add a third.

          • Anj Fabian

            That was the second one. The first one was a political blogger.

            I can usually tell male from female online, although there’s a couple of men who I have thought were female. I don’t think I’ve ever thought a female was male. (Probably because I default everyone to female.)

      • areawomanpdx

        This confusion is the very reason they chose the name “Certified Professional Midwife.” They are trading on the education and experience of CNMs, and the CNMs are complicit because they aren’t doing anything about it.

        • Bombshellrisa

          It’s on the other thread but I noticed in my insurance provider handbook that all the midwives are listed as CNM even when they are only CPMs. Do they know they are listed this way and choose not to call attention to it? And anyone checking to see if they are preferred providers will see them listed as such and think that they are educated, qualified healthcare providers

          • Karen in SC

            That’s horrible! Would that open the insurance company to liability?

      • Meredith Watson

        How about some memes comparing the education and training of CPMs to that of other professions where there is less at stake but more training/standards…I’m sure there are many from which to choose, but I bet someone on here has some really clever ideas.

    • Christina Channell

      I think memes are a fantastic idea.

  • Abby

    Slightly OT (sorry!): what’s the difference between MANA and the North American Registry of Midwives? Are they completely separate? or are they somehow connected?

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

      NARM certifies midwives and is supposed to discipline them. MANA is a lobbying group for midwives.

    • Amy Tuteur, MD

      MANA, NARM, and MEAC are sister organizations. MANA represents midwives, NARM certifies them and MEAC accredits homebirth midwifery programs.

      • Abby

        Thanks!

    • manabanana

      They’re legally and technically separate – but both groups pretty much originated from the same group of hippies.

  • Ainsley Nicholson

    I’m probably going to lose a few facebook friends, because I shared to link to this page, along with the following:

    I had a wonderful natural birth with a highly trained CNM (nurse-midwife), and my sweet daughter is now in middle school. Unfortunately, people are now setting up shop as CPMs (“certified professional midwife”) who have no formal medical …training, no required education beyond a high school diploma, and they are promoting the idea that birth is just as safe in their hands as it is with a medical professional. Their lobbying organization, MANA, just released a paper that purported to “prove” that birth is safe in the hands of these untrained people. That paper actually proved that the perinatal death rate for untrained “midwives” is much higher than perinatal death rate for babies born with medical professionals in attendance. I’ve crunched the numbers myself.
    This week, another baby died because his parents were misled to believe in the “abilities” of untrained lay midwifes. This time, however, the midwife turned to social media while the baby was suffocating in utero…and the internet noticed.
    As someone with a strong scientific background, I find this situation baffling. As a mother, I am moved to bring this to the attention of my facebook friends. I believe that all mothers and babies deserve the highest possible quality of care, and that women will make smart choices for the health of themselves and their babies if they have real, scientifically-supported information available to them (rather than mysticism and half-truths).
    Please join me in this effort to make people aware that someone with the CPM “credential” is not a medical professional, and that choosing one of these people as their only birth attendant can mean they will bring home a coffin instead of a baby.

  • Erin

    My apologies if this is posted twice, this is my first time posting although I read your blog often.

    I just wanted to let you know that as a woman who has had a homebirth I also messages Jan with my deep concern and horror of how this poor baby’s death has been handled (or avoided, as the case may be). It’s unacceptable and there needs to be a change. I don’t have the time, nor do I want the attention, but if someone else creates a page, ‘homebirth mothers for safer homebirth,’ I would be happy to be involved.

    I can imagine that Jan and MANA fear that regulations will put restrictions and limit women’s choices, but it’s totally bullshit. Informed consent needs to be given by someone who is truly informed themselves.

    Thank you for everything you do Dr. Amy.

    • Montserrat Blanco

      I think you should visit safer midwifery for Michigan. I think that is the type of page you are looking for.

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

    Emailed the district attorney for Clark County, Nevada’s criminal investigation unit. There needs to be a consequence.

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

    I’ve contacted all the news stations and papers in vegas that I could find. I hope one of them carries it. Watching it happen on facebook in real time was pretty surreal.

  • NoUseForANym

    No mention of the christy collins? Jan sucks but christy sucks much more.

    • Amy Tuteur, MD

      She is a symptom of the problem. Jan Tritten is a source of the problem.

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

      Yes, and Christy reached out to someone with a trade magazine, decades of experience, and standing in the community. Whose responsibility is it after that? Jan possibly could have saved the baby by saying “induce immediately” or “transfer care immediately” or “this is outside of my scope of practice and I do not feel comfortable answering the question. You should consult someone with more training such as a CNM or an OB.” At a MINIMUM jan could have refused to participate in the negligence that killed someone, refused to have been associated with such actions, but instead she embraced it and now just wishes the whole thing would go away and deletes any call for review or responsibility. In my mind the person with more experience and standing bears a lot of responsibility once they have been involved. Pretend you were Christy before the death, but after the crowd sourcing- Jan’s reaction would no doubt embolden you to ‘trust birth’ because it was treated as a non-emergency.

      • NoUseForANym

        I agree that jan also holds responsibility here but I think you will lose people when they find out that we aren’t holding the accountable person accountable. So I think she should be mentioned. Also many nucb people will say you are just being mean jan wasn’t the midwife. So I think it’s important to hold both accountable.

        • NoUseForANym

          Not to mention it’s sorta letting christy off the hook and fuck that.

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

            Yeah well like I said I emailed the district attorney and hopefully she will be charged with something. You can only have one primary focus to be effective, and I agree with the #notburiedtwice campaign’s focus on the entire industry for enabling people like christy. Without the MANA’s and Jan Trittens of the world a person like Christy would not have an easy time being a midwife. They make it possible for the next Christy and the one after that to kill and get away with it.

          • Jessica S.

            Yeah, I was going to say something similar – that, sadly, there will be more “Christys” and that’s why it also has to be about the practice itself, not just a specific case. I’m horrified by ALL the comments (save for the few sane responses) on Jan’s original post, realizing that these women would/will take that horrible advice and turn it on their next client. So it’s got to be about all the ignorance.

          • guest

            There is no shortage of “Christy clones” at all.

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

          It isn’t about not holding christy accountable, its about holding the midwifery industry primarily accountable. They could have stopped this. When I complianed to a utah midwife who passed the midwifery act here about a death she tried to say it was a ‘rogue’ midwife, when I know she wasn’t. She was embraced by the community, and that is the same thing going on here. Focusing on christy only would really detract from the real problem- a profession where this kind of thing is normal, and the people in charge would rather cover it up than change it.

          • Amy Tuteur, MD

            Exactly!!

    • Amy Tuteur, MD

      I don’t want to think small. Of course I want Collins to be held accountable and I will do whatever I can to make that happen. But I don’t want even one person to think for even one minute that this is about a single mudwife who made a mistake. This is about HOMEBIRTH MIDWIFERY and the organizations and leaders of the profession. I want women to understand that this is not an aberration; it is standard operating procedure, practiced and permitted at the highest levels. I want women to understand that homebirth midwifery has NO safety standards and to force them to adopt some. I’m thinking big!

      • Meerkat

        I am curious about something. Let’s say that CPM credentials are abolished. I don’t believe these midwives will stop practicing, they’ll just be more careful. How will these unlicensed midwives be punished in the event of adverse outcome?

        • Amy Tuteur, MD

          If they cannot call themselves midwives, they cannot fool women about their lack of education and training. If some mothers want to be attended at home by lay birth junkies and pay for the privilege, they are free to make that choice. But at least women will know who they are hiring and homebirth “midwives” will have no access to insurance reimbursement.

          • Meerkat

            So will there be criminal reprecussions for the midwives who continue to practice without a license? It seems that now these “professionals” get away with murder. Literally. (Or would it technically be considered manslaughter?)

          • guest

            “babyslaughter” would be more apt but technically it would be medical manslaughter or some equivalent. Proving gross negligence is required. Not an easy charge to prove.

          • LMS1953

            Not acting on an AFI of ZERO at 42 weeks is grossly negligent using a hand held Doppler and telling the mom that the NST was grossly incompetent and negligent. The Sisters in Chains have a list of midwives mostly CPMs but a few CNMs and the San Diego Wonder Guy. There is a range of convictions from practicing medicine without a license to negligent homicide. Rarely is there jail time but lots of supervised probation and revocation of licensure.

          • Meerkat

            That’s too bad. They really should go to jail.

          • violinwidow

            There’s criminal repercussions in some states now, many “midwives” actually move to states where they can practice legally. I’ve read some victim accounts telling of illegal midwives refusing to let paramedics in to give aid to dying babies. Illegal midwives have dropped mothers off at the ER and driven away, or told the victims to lie about who was present at their birth gone wrong. Illegal midwives have altered labor records and told mothers to lie about how long their membranes were ruptured, or told them to tell ER staff that their fluids were clear. It’s disgusting how unethical some of them can be.

        • areawomanpdx

          Yes, I agree with Dr. Amy. The biggest problem with the CPM is that it fools your average mother who is drinking from the trough of woo into thinking she’s hiring a competent professional. These woman would not hire an unlicensed midwife because they are not stupid. There are a few fringe nutjobs who will hire a lay midwife or go unassisted no matter what. They certainly have that right and will be aware of what they are doing. I want to keep the otherwise unsuspecting basically mainstream women who are choosing homebirth because of NCB lies (and this is more than you might think) from being fooled. Abolishing the CPM will do that.

          • Susan

            So true. If the state is licensing someone as a professional to deliver your baby I think most people think it implies this person is reasonably “safe”. After all they are “professional”! It actually, to a layperson, may sound like a higher standard than certified nurse midwife.

        • guest

          South Australia recently legislated against any form of unregistered practise of midwifery. This was a direct consequence of the killer midwife Lisa Barrett’s actions (and inactions).

          • Christina Channell

            That is wonderful.

        • Stacy21629

          So because there are some women out there that will still seek a back alley wire hanger abortion, we shouldn’t outlaw back alley wire hanger abortion and institute strict medical and surgical training for doctors performing abortions? After all, some women are just going to throw themselves down the stairs, so why make it illegal for their friend to push them?
          Because we want women to be safe. Outlawing unsafe providers will not prevent all unsafe homebirths, but it will certainly take care of the vast majority of them and improve the overall picture of homebirth care.

          • Meerkat

            I understand all that, it’s obvious. My question was about accountability. I was curious if it will be easier to make these midwives accountable if they don’t have a license. Criminally accountable.

          • Trixie

            It varies so much by state. In PA, CPM Diane Goslin could not be held criminally accountable for her negligence, even though PA does not license non-nurse midwives.

          • Stacy21629

            I think it goes both ways. If there is no CPM altogether and only CNMs can attend homebirths, then really ANY action on their part in a birth is criminal. But at the very LEAST if very stringent criteria were laid out for risking out patients, it would make it easier to prosecute anyone “bending the rules”. I was reading news articles on a footling breech baby death in IL a decade ago I think. At the time there were no licensing criteria for midwives and the jury was mistrialed on the idea that “did the midwife directly act to cause this baby’s death” by not calling 911 the moment that first foot appeared (much less not referring her pre-labor for breech positioning). I think if it was strictly spelled out that ALL breech and at least ALL footling breech are mandated hospital births it would have been very easy to convict this midwife…but because there was no standard, they had to go on witness opinion about the risks of that child’s birth rather than a black and white letter of the law.
            Hope that makes sense…

        • lola
          • Meerkat

            It’s a start, but I think 5 months behind bars and 12 months probation is a joke.

      • guest

        Mudwife? I love it!

        • violinwidow

          It’s perfect in contrast to their “medwife” accusations towards midwives who actually use medicine. I think we have a new nickname for them.

      • LMS1953

        Bravo, Dr.Amy, bravo! I think you’ve got ‘em in an alligator roll now, like they say down on the bayou.

        • Amy Tuteur, MD

          I’d like to think so, but realistically we have a long, long, long way to go.

          • LMS1953

            I think you have a confluence of a Perfect Storm. The two studies garnered national attention. Now comes along an illustrative case fully documented in real time with nearly every card from the deck of Woo played by a nation wide cross section of CPMs. I had mentioned this before, but John Stossel has often gone after medical charlatans involved in consumer fraud. This is a time for realpolitik. I think Fox News would give this case sufficient air time. Other networks might pass on it or twist it in a way to fit into a crunchy agenda. I would love to see you on a split screen with Missy Cheney on the Megyn Kelly segment.

          • Christina Channell

            I volunteer to relentlessly badger Fox News.

          • Amy Tuteur, MD

            Fox News is the wrong demographic. We need to catch the attention of media that appeals to young women who might be considering homebirth, like website for mothers, or journalists for mainstream newspapers and magazines.

          • LMS1953

            The problem is that the media outlets that aim to the reproductive age group are very crunchy. They are much more likely to want to cast Rikki Lake and Kathy Perry in a favorable light than you. Please recall that when the MANA study came out – the mainstream media and HufPo had headlines – “Study Shows Home Birth As Safe As Hospital”. What I mean by Realpolitik is that the demographic that needs to be targetted is the conservative voter base their legislative representatives who will pass the state laws required to restrict or hopefully ABOLISH the licensure of CPMs. The Woo is very intoxicating and attacking it via the MSM will only serve to give platform to the crunchies to say: “There they go playing the dead baby card. Babies die in hospitals too”. I know you and many on your blog find Fox News odious. But it has million upon millions of viewers (lots of grandmoms to be) and political clout with conservative politicians who are very sympathetic to your cause and would be delighted to put a lid on the crunchies. Like they say, politics makes for strange bedfellows. Either way, time to strike while the iron is hot.

          • Amy Tuteur, MD

            It has nothing to do with the fact that Fox News is odious. I’ve been on Fox. It’s not useful because the demographic is old, white men. They aren’t in favor of homebirth in the first place.

          • LMS1953

            Dr. Amy, who do you think would be more likely to champion the cause of eliminating CPM licensure: MSNBC or Fox News; Senator Hankin (D-Iowa) or Senator Rubio (R/TP-Florida)? Liberal, progressive state legislatures in Vermont and Oregon have been at the spearhead to legitimize CPM licensure and facilitate their reimbursement with both tax-payer funded Medicaid and private insurance. Is that not what you are campaigning AGAINST? I implore you to review the headlines of the news outlets you admire when they reported the MANA study. I saw that they invariably put the MANA conclusion in the most favorable light. Do you really think those outlets will support your/our cause?

            Whatever. Keep up the good work and strike while the iron is hot. Public opinion needs to be addressed as do the opinions of state legislative representatives.

          • Amy Tuteur, MD

            I don’t need support, I need to convince young women that homebirth increases the risk of perinatal death. If they don’t watch Fox, Fox can’t help me convince them.

            This is not about me, and people agreeing with me. This is about reaching the target audience. Do you see many ads for baby products on Fox? No, so they can’t help us do what we need to do.

          • DaisyGrrl

            What about Glamour magazine? I know it’s not the New York Times, but they do cover serious issues (I first read about what the Taliban were doing to women in Afghanistan there). While the demographic skews younger, you’d reach young women who would then be aware to really research their HCP before signing on and it’s pretty mainstream.

          • Karen in SC

            What websites are read by young women? Besides Jezebel, I don’t know since I’m a grumpy old trout myself. LOL

            Salon, maybe, XOJane, People Magazine? We have some great writers among us, can someone pitch a guest blog post? I think our medical people here need to write “Letters to the Editor” in their professional journals, just to get the word out.

            Lastly, I’d love to see Nancy Grace excoriate Rowan Bailey during her trial, while bringing up the travesty of Valerie El Halta, Christie Collins and others who get away with killing babies.

          • Medwife

            Slate’s good. Salon too. Huffington Post I don’t like personally but it has a younger demographic I think.

          • thepragmatist

            Slate has a lot of potential. It’s taken pretty seriously. It really doesn’t matter because it’s the quality of the writing an WHO is writing that will get it disseminated. IMO. That’s how I share. I think that, as print media (and even television) dies, we look more and more to individual authors and the publication itself doesn’t matter quite as much. It’s content over brand in many ways. Slate is good because they will take a lot at things many people will not. I do believe they did a very long article on Tiller right before his death that was extraordinarily compelling. They take on vaccination too. So did Wired, and you know, don’t assume that a publication like Wired wouldn’t be interested on some level, even if the demographic is young men. Millennials share a lot more in terms of decision making around children. It’s the first generation in what is a vaguely post-feminist world. I know my ex-husband took a lot of interest in our son’s gestation and birth. So much so he would wake up, startled, looking for the baby, hearing him cry, and I think he got PPD.

          • auntbea

            The problem as I see it is that most mainstream publications are serving mainstream populations, who weren’t going to have a homebirth anyway. Publications catering to the homebirth crowd, specifically, aren’t going to be willing to publish what you have to say. The only solutions I can think of are journals that publish to young lefties, though not specifically women, like Mother Jones or UTNE. Or, skipping over individual womens’ decisions altogether and going straight to regulation, by trying to catch the attention of pre-existing advocacy organizations like Move.On.

          • Medwife

            I don’t think LMS is interested in changing young women’s opinions on home birth. He is not interested in what they think or know about it. He only wants to lobby the legislators who are indeed mostly old white men. I think he’s got a problem there because if all the old white legislators come against CPMs it just looks like part of their whole restricting choice schtick they have going on right now. If the bulk of the lobbying is coming from young women objecting against being preyed upon by incompetent frauds, that’s very different. It’s also less likely to result in women going to newly outlawed CPMs to “stick it to the man”.

          • recovered NCB advocate

            Sorry if I missed this point/claim being made elsewhere, but there is a significant demographic of my personal acquaintance with both Fox News politics (and viewership of Fox News on TV or online) and NCB ideology/skepticism of the medical “mainstream” (or just plain old real medicine). I’m sure you’re familiar with how many of the homebirth bloggers are what most would call conservative Christians. In my experience, their politics and the sources they trust tend to be the Fox News type, though of course there are variations on that.

          • recovered NCB advocate

            Oh, but there are definitely persuadables in there regarding medical/birth choices. I know you are probably not targeting the most hardcore ideologues, but not all of the women I’m thinking of are already. Quite a few look into homebirth after earlier hospital births have gone well, and not out of resentment of “imperfections” in hospital birth but because they’ve heard it presented as a safe, sensible idea.

          • AllieFoyle

            You have some valid points there. The home birth movement has some strange alliances on both sides of the political spectrum–sort of hippie/liberal in places like VT and OR and, on the other side, religious conservatives/fundamentalists–both with a dash of libertarianism.

            I had some proximity to the legislative movement to mandate payment for (and thus legitimize) CPM care in one of the states you mention. What you don’t understand is that the people involved, while mostly (though not entirely) on the liberal side, were not brainless ideologues. For the most part these people are bright, well-educated people who care about public health and are motivated to improve things for women and babies. Because the midwifery propaganda machine had a monopoly on the data that was available they really felt that they were doing a good thing. I’d say that in the course of a few years, thanks to social media and sites like this one, that situation has changed. I imagine that many of those people will be open to reexamining the issue in light of the safety problems that have become more and more evident. They are reasonable people who really do care about mothers and babies and events such as this last one will be difficult for them to ignore.

            These are the people you want to engage. They’re the ones who are interested in home birth because they view it as a healthy, safe alternative, but I think they’re also the most amenable to changing their views in light of new evidence that it isn’t as safe as it has been presented, particularly with the variable training and practice standards of CPMs. They don’t watch FOX.

          • thepragmatist

            It actually hurts the discussion to have it aligned with Fox News. Really. I don’t know anyone personally who takes Fox News seriously. Then again, I’m Canadian. In fact, if someone is associated with Fox News, it’s a strike against their credibility. (There was all that Iraq stuff, remember?)

          • thepragmatist

            I think that sending out peer to peer “minions” as we’re called out there is a successful way to touch millions of women. Women take advice from other women. There is a definite hierarchy, tool, amongst women, and if a group of women go anti-NCB it filters down. I’ve watched it happen from me to others. I’ve watched it happen with vaccinating and I get thanked a lot for steering women away from non-medical or non-scientific ways of thinking. I agree above that social media is the way to go. I think HuffPo would love to have a big, juicy disaster of an interview but the FACT remains these people will not show up. It will just be Dr. Amy and Sara or something. It could be valuable but if MANA is as devious as I have come to feel they are (up there with Wakefield, really) then I think it may be best to just keep pushing the research forward, mobilizing politically for standardization of care, and letting the message trickle down. I know, personally, I’ve touched a lot of people, I’ve been involved at the last minute in serious medical decisions as a sounding board with a reasonable understanding of birth now (thanks to this page and my own research around c-sections for me) and I know how to keep my opinions away from my facts (not here though!). I think Dr. A has it going on– she’s drawn me in with the way this site is run, its openness of dialogue, the potential for a good debate, and she provides some very good, factual posts that I search and use when I need to REALLY explain how something works to a woman.

            A woman often won’t ask her doctor. My generation (millenials) are not watching TV. We are on blogs, we are Facebook and Reddit, and we are highly peer-focused.

          • Jennifer Delaney

            Huffington post. I know, I know that many of their recent articles are massively pro-homebirth, but THAT will directly target the correct audience. And Huffpost LIVES to have a HOT story, no matter the “side”. There needs to be more than just Dr. Tuteur on the program, perhaps Sara from Safer Midwifery for Michigan would be willing to appear? No offense meant to Dr. T, but more voices than just hers need to be heard on the side of reason. She has the stats, the info, the scoop… but a mother of a CPM and CNM mis-managed non-hospital affiliated, non-accredited birth center baby death… THAT’s a hot story that the Huff would love to use. Guidelines would need to be in place or some type of creative control retained so that the TRUE story of what happens with “woo-wives” is told.

      • PJ

        What about 20/20 or 60 Minutes?

  • Marie

    MT Facebook link doesn’t work

    • Amy Tuteur, MD

      Fixed it.

      • Amazed

        Still doesn’t open for me. I can’t reach Jan’s page either.

        • Amy Tuteur, MD

          It won’t work if you’ve been blocked.

          • Amazed

            They’re getting paranoid. I never posted anything on either page – partly because I don’t use Facebook this much and mainly because I wouldn’t be able to say anything that wouldn’t get me deleted instantly.

            Blocking left and right just because? It’s now an official echo chamber there.

          • Squillo

            Midwifery Today could really use a good crisis management plan.

          • Amazed

            Hush now. Don’t give them any ideas.

          • wookie130

            Oh, they have one. It’s called “DELETE.”

          • wookie130

            And let’s not exclude Plan B…”BLOCK.”

          • Squillo

            It won’t work if you click the link from here. I can still see the pages if I go directly from Facebook. (Unless you’ve been blocked, of course.)

            Amended: Tritten’s page won’t work from here. I can get the MT page from this link.

          • attitude devant

            Oh, so they are taking a page from Gina and blocking links from here. Well done, ladies of Midwifery Today! Here I’d been laughing hysterically at how technologically clueless you were (cf, the Elder Midwives previously wide open FB page) but you CAN learn! Now could you work on your transport skills?

            Thanks! Signed,
            Not a Fan