I wrote yesterday that Monica’s friends insisted that her baby, the 7th baby who died at homebirth last week, died of multiple congenital anomalies. I promised to publicly apologize to Monica if there truly was an autopsy report detailing the anomalies.
Within the past hour, Monica’s friend Cassie Elizabeth forward the fetal death certificate that lists the cause of death as multiple congenital anomalies. It’s not an autopsy report, but it’s good enough for me. Of course it doesn’t tell us whether those anomalies were incompatible with life, but I didn’t stipulate that in my promise to apologize.
Therefore, I apologize to Monica for sharing her baby’s story in a way that implied that the baby’s death was a direct result of her decision to have a homebirth. Homebirth may have been a contributing factor, but the actual cause was the anomalies.
I still consider Monica’s story a cautionary tale.
Congenital anomalies occur in hospital, too, but unless the defect is known to be incompatible with life, doctors don’t throw up their hands and deprive the baby of their best effort to ensure every possible chance at survival. Doctors are as committed to the wellbeing of disabled babies every bit as much as unimpaired babies.
Of course, even if we remove the death of Monica’s baby, that still leaves 6 deaths, hardly a cause for rejoicing.
Nonetheless I hope my apology helps lessen any distress that I may have caused Monica, her family and her friends.
Monica, if you happen to read this: I am so sorry for your loss.
I was originally going to post about how adequate pre-natal care could have given Monica the chance to make an informed choice about her son’s care, but I see from the Facebook page that she had a 20-week scan. How terrible that all this still came as a surprise, depriving her not only of her son, but of the chance to make different decisions about his end-of-life care, if that’s what she wanted.
The only good news–insofar as any part of this tragedy could be called “good”–is that Monica and her family have some answers about her son’s death. Too many families, regardless of where they have their babies, never get that kind of information. I hope it helps her find peace.
What happened to Monica and her baby is a double tragedy. Even if his death was inevitable regardless of location, Monica was denied the opportunity to make informed choices about her care and his.
If she had had adequate prenatal care, the chances are very high that she would have known about the seriousness of his condition and could have decided on what kind of care, if any, she wanted him to have. Instead, it sounds like he got futile attempts at resus, which were likely quite unpleasant if he was alive during the attempts. Even if he was (mercifully) dead before he even arrived at the hospital, Monica got an agonizing period of uncertainty before finding out that her baby could not survive.
Sounds like Monica and her family got the worst of all worlds.
This made me too emotional last night to comment, But I will do so now. I cannot imagine the heartache and pain that Monica and her family are suffering at this moment. To lose a baby unexpectedly for ANY reason is tragic and horrible. Monica, I’m sorry for what you’re going through and my heart goes out to you. I know that any of your friends coming out to “defend” you are doing so out of love, and I can’t say I wouldn’t be doing the same if you were my friend. I am truly, truly sorry if these discussions have added to your pain in any way.
I still can’t get behind unassisted birth. No matter what the particular circumstances were here, no matter if there are complications beforehand, known or unknown, young or old, high or low risk, there is just no reason to ever, ever give birth by yourself, with no support available. I think Dr. Amy’s main point here is that *you don’t know* beforehand, whether you are high or low risk. You can be young, healthy, multiparous, whatever…you can go from low risk to high risk in an instant. You need to have help. That’s all.
Was Monica unassisted? That is indefensible no matter what happens to the baby.
IIRC she was, reading back over the original post it does not say that, but from what her “friends” were saying on another post I gathered that she was unassisted. Someone can correct me if that’s wrong…
There was a recent accident near here where a motorcylist died in an accident. He was driving down the interstate, texting, and not wearing a helmet.
Where he was driving, neither of those is technically against the law.
Now let’s say that while he was doing that, he was run over by an out-of-control semi driven by a drunk driver.
Does that make his choice of texting while driving a motorcycle without a helmet acceptable? Would anyone be defending his “choice”? “Oh, he would have died anyway.”
Folk who ride motos helmetless are rather a good parallel, because there’s a group that does indeed consider riding without a helmet empowering, and some try to make the case that it’s safer than riding with (“I can hear/see better!”). But the numbers don’t lie (starting with the classic Hurt report).
They also use the argument that “Riders die wearing helmets too!”
Bravo Dr. Amy for this. I am sure she would greatly prefer not to be posting personal information on the Internet at all – it has made me queasy from time to time myself. But that horrific colloquy with Rachel yesterday made clear that publicizing these stories is the only way to counter the crazy homebirth (and now unassisted birth) subculture on the Internet.
I think she does it to effectively give counterpoints to all of the home birth stories, they tend to be personal narratives that resonate more emotionally for many people compared to statistics. It’d be nice if she didn’t have to rely on anecdotes, but hearing about a family that lost a very wanted baby is more emotionally meaningful than hearing 5 in 1,000.
This may be off on a tangent, but it seems to me that the number of homebirth deaths which are put down to “multiple congenital anomalies” exceeds the percentage in the entire population of births, and I wonder why. In my career, I actually saw, both in hospital, and at home, relatively few instances of multiple congenital anomalies that would be so severe as to be incompatible with life. Is it because homebirth mothers routinely avoid ultrasounds? Some do, of course, but it seems that many do all the testing that the average pregnant woman does. So why do so many babies which are born at home have such a high degree of congenital abnormality?
Or is this merely a mistaken impression?
I don’t know if your observation is true, but I could definitely understand wanting to give birth at home, away from all the happy expectant families in the hospital, if a woman knew in advance that her baby had no chance of survival.
Mothers need the safety of hospitals, too.
In December, there was the case of a Texas woman who gave
birth at home. The baby was compromised and spent time in the NICU, but survived. The mother went into shock after the birth and was hospitalized; she died two days later. Her four children are now motherless.
Homebirth isn’t safe for anyone.
True, but homebirth is much more dangerous for the babies than it is for the mothers. I’m not sure I would see homebirthing such a baby as being different from choosing a C-section in this situation. Then again, I also don’t know what comfort measures would be available to a dying baby in the hospital that are missing at home.
If the baby is going to be alive for a period of time, then many hospitals (at least here) will let the parents take the baby home and provide some kind of end of life nursing care at home. For unexpected stillbirths or babies not expected to survive long then some hospitals are better than others. Some have private postnatal rooms, some have special bereavement suites or units, where the rooms are equipped with cold cots so the baby can stay with the parents as long as they want. Some hospitals hire specially trained bereavement midwives who work 1:1 with the family through the delivery and postnatally, and they help make memory boxes and take pictures (if the family wants that). Unfortunately, at least here in the UK, there’s not very good standardisation of care so your experience could vary hugely depending on where you live/give birth.
Hospitals can deal with stillbirths even if unanticipated. A postpartum mother can be moved to a private room on a different unit, and discharged early if she is OK. Some places [not a lot, I grant you] even have family suites for special situations.
In that scenario, it’s more of a hospice care situation. Some families may want a termination, some may do a hospital delivery after continuing the pregnancy as long as possible, some may want to suffer at home. As long as the mother understands the risks to her, I don’t see a reason to argue with her. Informed consent is all anyone can ask.
Average UCer will usually only have boutique scans if they have any scans at all. They even boast on their public pages about places where “no need for a doctor” ultrasounds can be bought:
very anecdotal, but my sister had a friend of a friend use a homebirth midwife and her ultrasound was at a one of those “for entertainment only” boutiques. She had conjoined twins and the ultrasound place didn’t even say “you should see a doctor”. I was horrified by that!
Those kind of boutique ultrasounds aren’t meant to be used for medical purposes. They are strictly for parents to get pictures. I’d be surprised if a radiologist looks at them at all.
Right, but I thought that maybe even an untrained lay person working there (or the mom herself) could see the babies on the ultrasound and based on their shape say “this doesn’t look quite right. You should see a doctor.” They did tell her the babies were both girls.
I’m not a doctor or close to it, so maybe I’m thinking that’s easier said than done.
The ones around here won’t do a scan unless you give them your doctor’s information to send the results to. They don’t want to be liable for a problem going unremarked on.
This policy is not universal, however.
I am a family doc, not a radiologist but I think ultrasounds are difficult to read. I mean I know enough to tell if a baby is vertex, find the spine and heart but that’s about it. Not sure how much training the techs at the boutique ultrasound places get.
I had to do a weekly antenatal clinic in a rural hospital as part of my OB rotation about 7 years ago. The scanner was older than I was, the size of a fridge with a six inch screen.
With THAT scanner, when patient’s asked if I could tell them the gender, I’m afraid my response was that I was just hoping to see a heart and a head and work out if baby was head up or head down.
It’s easier said than done. I’d guess those people are trained only to find a penis and take a picture with the full baby in it.
Just understanding what you are seeing on the screen is hard. When I do ultrasound on my patients, the techs helping me are looking at me like I’m making it all up as I go along. Despite me telling them and showing them what I am looking at.
I dunno exactly what the babies looked like. A trained professional would surely have seen this. Maybe it was really obvious and the person who did the US was really that bad. Maybe it was very hard to see. Maybe she didn’t actually do a full scan of the baby and missed it….
Do they intentionally not look? I just wonder if it’s a policy to Never Look Or Comment, for liability.
I’m going to regret asking but, at what point in this process did they realize she was pregnant with conjoined twins?
It was very sad… they realized it birth. Neither baby survived. Mom was transferred from home due to failure to progress. Just a horrible situation. and that’s the first thing that always comes to my mind when I hear about those non-medical ultrasound places.
That is horrifying.
Ouch! Imaging studies are tricky to perform and read, especially ultrasounds. I would not trust an ultrasound read by a
non-doctor,non-radiologist, a radiologist who didn’t have specific training in and many hours experience reading fetal ultrasounds.I still bristle at the assumption by patients that the quality of their care is directly proportionate to the quality of the interior decorating and the friendliness of the care provider. It’s the difference between being a salesperson and a professional. And to be honest, I’m friendly and well-liked, but I’m not playing nicey-nicey with you just so you’ll post better reviews of me – unlike the shiesters out there.
A doctor advised in the comments on a different post that congenital only means that it happened during birth – or maybe before birth? So, without seeing more detail, we don’t know if it means full-on encephalitis, or simply hypoxia. (Hope I used terms correctly – I am decidedly not a doctor, so don’t quote me!)
Con·gen·i·tal (kən-jĕn′ĭ-tl)
adj.
1. Existing at or before birth usually through heredity, as a disorder.
2. Acquired at birth or during uterine development, usually as a result of environmental influences.
From the American Heritage Medical Dictionary
It means “born with”.
It does mean “born with” but that does not mean that the anomaly did not exist prior to the onset of labor. Quite the opposite. It usually develops, or begins to develop, early in pregnancy because there is often a “glitch” in the embryonic development. Transposition of the Great Vessels; the Tetralogy of Fallot, for example — very severe cardiac anomalies, don’t appear overnight.
By no means are all congenital anomalies incompatible with life [it is true, however, that if there is one present, the chances are good that there are others]. Hypospadias and hare lip are congenital anomalies which can be well dealt with with surgery, but even if not corrected, are not fatal. Esophageal atresia, however, must be corrected by surgery or it can be fatal.
But, as Bofa writes, if a major anomaly is suspected, and the birth takes place in hospital, or even if it comes as a surprise, being in the place where the infant can be immediately given intensive care or surgery can, and does, mean the difference between life and death.
It doesn’t mean that anomaly didn’t exist before labor, but it also doesn’t mean that it did.
Damages from injuries that occur during labor, as long as the damage occurs before birth, are also congenital anomalies.
It is an interesting debate, but with very severe problems I can see how someone might prefer to labor at home and do not put the baby through the NICU-early surgery-life with dissabilities experience. I do not know if it was Monica’s choice or not, but with certain problems I can understand that choice.
I commented that multi-organ FAILURE happens with hypoxia, congenital anomalies are pre-existing. Given that the friends cite liver and renal abnormalities (which it would be hard to diagnose within 24 hours – and in 18 years I’ve never, ever seen a “congenital liver abnormality”), I suspect there is more to this story, but it’s impossible to know without an actual autopsy report.
Congenital liver problems have happened at least once. Our daughter’s liver was donated to a young toddler that was born with a bad liver and had lived in the hospital her whole life. She got to go home for the first time after recovering from the transplant.
Wow. What a generous donation by your family.
You make a good point – I should have been more clear: not that it *can’t* occur… but it’s exceedingly rare.
Exceedingly rare and possibly survivable if you aggressively manage it, get a transplant, and get lucky. The odds aren’t great before and during transplant, it is apparently a fussy surgery and life without a functional liver is an ongoing medical crisis, but they tend to do really well afterwards. The child who received our daughter’s donation is going to kindergarten this year.
I’m glad you know that story, and thanks for sharing it.
Firstly – Cobalt, even though I’ve seen your name in these comment threads many times, I had no idea you’d lost a child, and I’m so sorry.
But secondly – thank you, so very much, for choosing organ donation. That was the one thing that gave me comfort when we lost our son, that our loss could mean life for another child and joy for another family. And I’ve had several friends whose lives (or family member’s lives) were saved by organ donation. It’s a cause dear to my heart.
It was the right thing for us, certainly. It was all we had, really. Knowing that some child would survive got us off the ledge that night and more than once since. One less story ending like our daughter’s did. One more kid going home with their family. It helps.
I’m sorry you lost your son.
So sorry, Cobalt, but how wonderful to have chosen to save another life.
That infant who received your child’s liver must have had a miserable life, but it’s highly unlikely that any liver abnormality would kill a baby during birth.
That’s an extremely generous and kind way to look at what must have been a devastatingly emotional and sad day. Even if you didn’t get to take your kid home another family was. Takes a lot of strength to be happy about that instead of bitter that it wasn’t your child that got to go home. I’m glad you saw it as a way to spare another family similar grief.
The mother commented on Dr Amy’s Facebook page that she did have a 20 week anatomy scan as part of her OB care.
Multiple organ congenital defects, none present on a 20 week scan? That’s an interesting situation.
I wonder how often that that occurs? That doesn’t sound like something heredity, does it?
I’m no doctor or radiologist, but it does seem weird to me. At my child’s 20 week anatomy scan, they did a very thorough inventory of her organs. And we are acquainted with a couple whose baby was determined to have abnormalities at the 20 week scan, that were a lot more subtle than “every organ in the child’s body is deformed”.
Many things can be seen in a scan, but not everything. It will detect anomalies that cause changes is the structure of organs (shape, size, density. If the problem is at a cellular level or at a functionnal level, it could go unoticed.
It’s also possible that it was a developpement anomaly that appeared later in the pregnancy. Might also be secondary to an infection aquired later in the pregnancy.
It’s not impossible for this to have been unoticed. But we’ll probably never know for sure.
I wonder if it was a true “anatomy scan” and not just a u/s by an unskilled technician to determine sex/get cute pictures.
That’s what I’m wondering too.
I’ve had two home births and it’s quite normal to skip ultrasounds all together or just do the “boutique” ultrasound to determine gender. I skipped all ultrasounds with my last homebirth and regret it now (of course)…
It happened to a couple with a son next to my son’s incubator at the NICU. Their son was born with multiple defects that were not picked up during the uneventful pregnancy. He has a chromosomal abnormality. I do not want to give any more details in order to do not identify them but basic facts: healthy mom,healthy dad, uneventful pregnancy, other kids from the couple completely normal, standard prenatal care, at least three US during pregnancy.
And it happened. It happens.
My daughter was born with a serious heart defect and died. The defect (HLHS plus transposition of vessels and a large ventricular septal defect, complicated by pulmonary lymphangiectasia) wasn’t picked up by my obstetrician on any of the scans (and I had a number or them).
Two things though – firstly, this seems to be rare enough that most of the medical people I meet are incredulous that it wasn’t picked up, and secondly, the defect, while very severe, wasn’t an absolute guarantee of death. I know of children with similar defects who have, after successful surgery, grown up to live pretty normal lives. Perhaps things would have turned out differently had I done what I did in my subsequent pregnancy – much higher resolution scans by an MFM that indicated not only the heart but also the great vessels and the direction and volume of blood flow, repeated several times between 13 and 24 weeks, and a c-section birth in a hospital with a top quality NICU and a pediatric pulmonologist present at the birth.
I am so sorry about the loss of your daughter.
Just a query about terms, is the ‘anatomy scan’ what in the UK is called the ‘anomaly scan’ looking at bones, organs, size etc… that picks up (hopefully) any developmental or birth abnormalities?
Generally yes. It’s the standard 20-24 week scan where they check the baby’s anatomy for anomalies.
But because humans insist on making sharing a language complicated, they call it different things based on where you are.
Haha thanks 🙂 Yeh it does make international communication tricky, even when sharing the same language.
With grand multiparity as risk factor, adequate prenatal care where I live would have included MFM-equivalent consultation and a lot more than just a single US scan at 20 weeks.
Grand multiparty alone? Where I practice they are comanaged by CNMs and OBs. No extra testing. Of course it’s the rare grand multip who is not also AMA with other health problems common for older moms.
Yes. My OB, if I were to get pregnant as grand multipara would have to present my case and consult senior doctors in his hospital, or I would even be automatically redirected into care of a specialist or a higher level hospital, depending on other risks.
Depends on who examines the scan. At a conference some time ago, one of the leading doctors in this field in Israel showed us things that most doctors, unless they specialized in ultrasound interpretation, would probably miss. I can’t think that these “boutique ” scans are submitted to any but the most superficial scrutiny.
Yeh I agree, boutique scans are a little odd…I mean, you wouldn’t have boutique x-rays or boutique MRIs =/
Yeah, they do:
http://fullbodymriscan.com/about-us/
I was in the ER once getting my knee fixed (again!), and they guy in the next bay had come in (on a weekend) after having had one of these boutique MRIs. He had been told that “something” was found, and he should follow up with his PCP. So of course, he came right to the ER because he was terrified.
…
You know I’ve often compared our current times to being a repeat of the 1920s with the richer getting richer, the poor getting poorer, sensationalism abounding, people racing or fighting animals again (see Man vs Cheers and the attempted eaten alive by a boa bs), new technology being applied in ways it really shouldn’t with cavalier attitudes, snake oil abounding in the guise of homeopathy…
But dammit now we have this. Apparently we learned nothing from the Tricho hair removal system.
well that seems…expensive and unnecessary
Ha, when I saw Mattie’s comment, I thought – well, not boutique X-rays, there’s a genuine radiation hazard, but MRIs? Only a matter of time… Sigh.
Just when we were starting to reduce the overuse of CT scanning due to radiation risks, MRI jumped into the void. No radiation, but definite risks to health budget and wallet.
There are some benefits, tho, like MRI replacing diagnostic arthroscopy of knee, which commonly became “therapeutic arthroscopy”, with no evidence of benefit.
It’s not the technology that’s the problem, it;s illogical use of it. Both from risk-averse clinicians and a risk-averse population, who are more likely to criticise “missing something” than overdiagnosis.
Typical VOMIT- Victim Of Medical Imaging Technology.
Things we aren’t looking for show up all the time on scans. What we used to call “incidental findings” or “of doubtful clinical significance”.
Now, if you have a full body scan for no reason, it may well throw up something a bit odd.
You have the stress and anxiety while it is investigated.
The time, cost and potential risks of those other investigations.
Most likely, it is something that isn’t a problem and won’t ever be a problem, but you only know that after extensive investigation.
Personally I have a LOT of weird anatomical quirks and incidentalomas, which I have no interest in having investigated further. I have no symptoms, they are unlikely to cause me problems, why would I?
Of COURSE you should have tests to investigate symptoms, but it is a very bad idea for well adults with no symptoms to have whole body scans and every blood test available as a sort of fishing expedition.
Most people assume that the outcome will either be an all clear or early detection of an easily correctable problem.
Few consider that it might mean months of tests to get to the bottom of something that turns out to be irrelevant, a diagnosis they would much rather not have known about, or possibly side effects or damage from unnecessary treatment or tests.
Just had to go through this myself.
Presented at an Instacare with right should and side pain and I suspected a possible gallbladder attack. Instacare doctor prodded around and told me to go to the ER right now because he suspected appendicitis. So we go to the ER.
One ER trip and CT with contrast later I get the all clear on my gallbladder and appendix. But oh yeah, you have an 11 mm cyst in your right kidney you might want to get checked out. That kidney is the one that’s always throwing stones so I go home and read the imaging report. Something about being an irregular enhancing that. So I Google what that means and immediately go “Oh fuck.”
Hey that’s indicative of a renal carcinoma! YAY! My doc was a bit concerned about this as well so he ordered an ultrasound. So then I have to get an ultrasound. Inconclusive. Then it’s either wait six months to see if it gets bigger and then cut it out if it does or get an MRI contrast. I’m having a total stress meltdown and I’m not going to wait six months so I get the MRI.
MRI shows it’s likely not a renal carcinoma and probably just a really weird cyst. YAY! Oh by the way you also have some weird tumors in your liver. FUCK!
So I find out it’s less tumorS and more just A tumor that’s difficult to visualize on the image and rather small. Could be the result of long term oral contraceptives. Thanks, uterus, you bitch.
So after the cascade of imaging after imaging I had the kidney cyst scanned six months later and no growth. Now I just need to be checked by MRI every year for a few years (MRI so they can keep the radiation dose to the reproductive organs lower) and then one every few years after that until a) it goes away b) gets bigger and say goodbye to kidney or c) keep getting scanned if conditions a or b are not met.
I really am thankful for medical technology but sometimes it’s a lite too sensitive. I spent the better part of a month anxious on if I needed to apply for short term disability or not because of an incidental CT finding.
I still don’t know what caused that shoulder pain either.
The right shoulder pain could be a rotator cuff problem. My approach was NO IMAGING NO REFERRAL wait for it to get better – which it did.
Yeah that was the weird part. It wasn’t that either. Had all my range of motion with no pain.
It felt like someone had stabbed a knife into my ribcage underneath my right shoulder blade and no amount of repositioning or stretching made a difference. Had my husband help me stretch the joint out a bit in case i somehow pinched a nerve. It just got progressively worse before it just up and disappeared about a day later and its never happened again. It wasn’t muscle pain either which was weird. It felt exactly like the beginning of passing a kidney stone; that really deep and hard to explain pain that just makes you feel ill all over. But it was in the wrong spot. No flank pain at all, it was radiating from that spot under my shoulder blade down my right side to about even with my bellybutton but more towards the front of my body the lower it got than the back.
I stuck it out for about twenty four hours before the pain was unbearable. I’ve gone in to work while passing small kidney stones so it wasn’t normal pain for me. I came home and just fell on to the couch face first while my husband tried to convince me to go to Instacare and I continued to say no I’ll just go to the massage school the next day and have my shoulder worked on while I continued to lay face down a few hours until I realized how stupid I was being.
ER doc didn’t find anything pulled out of place and I followed up with the Spine and Pain clinic I work next to just to make sure I didn’t tweak a nerve in my neck or upper back somehow. Everything was clear there too.
So it’s kind of a big shrug and hell if we know type of thing.
VOMIT – I love it.
Overuse of imaging technology on low-risk populations leads to false positives and overdiagnosis, which can cause harm in and of itself.
Tests for logical purposes, though – like antenatal screening – much more rational and targetted.
Because they DIE from them. You aren’t counting the babies born in the hospital that had congenital defects but didn’t die.
As I mentioned the other day, there are more adults alive with congenital disorders than there are children. It’s because babies with “congenital disorders” who are BORN IN A HOSPITAL have a chance to live, and that chance keeps improving over the years.
A baby born at home with congenital disorders doesn’t have a chance at all. It’s a death sentence.
There are certainly babies who have defects so severe they cannot be saved. However, if you don’t go to the hospital, the ones that can be saved also don’t have a chance.
What saves the lives of babies with congenital disorders:
-prenatal care
-early detection
-in utero intervention
-birth in specialist hospitals
-access to treatment immediately after birth
as opposed to homebirth approach that can best be summed up as “Some babies (that cannot survive natural birth at home) were not meant to live.”
That thought occurred to me this morning, that this line of reasoning to explain this baby’s death is just another way of saying the usual “some babies just aren’t meant to live.”
In my health system, if a congenital anomaly is discovered on ultrasound the mother doesn’t deliver at our local hospital, but is referred to MFM and delivers at a hospital that has a NICU and the appropriate surgeons and neonatologists present at the time of delivery. While we do not know all the details of this case, I find it surprising that a 20 week anatomy scan was completely normal if that many severe congenital anomalies were present to be incompatible with life.
I’m curious if an ultrasound was done and what kind of ultrasound. Was it an actual anatomy scan done with a specialist – specifically checking everything out? Or just a boutique ultrasound to look at gender and listen to the heart beat?
I’m curious about the same thing. But we’ll probably never know.
Good question, Ashley.
Hmm…If you look in CDC Wonder, 2007-13, restricting to gestational age 37+ weeks, at least 2000 grams at least some prenatal care, and restrict cause of death to congential anomalies, the death rate is a little higher for hospital versus home birth (0.30 versus 0.24 per 1000), possibly due to women who know that they have a fetus with CA going to the hospital rather than sticking it out at home. However, the death rate for CA in hospital with a CNM (presumably low risk women who had an unexpected finding of CA in the baby) is 0.16 versus 0.30 for out of hospital other midwife. There are lots of ways to interpret this finding, but it sounds to me like women of comparable risk have more infant deaths due to CA out of hospital than in, maybe related to less available equipment and fewer skilled attendants being available, maybe related to less competent screening for CA prior to delivery leading to more unexpected CA being found.
Restricting to “Certain conditions arising in the perinatal period” (i.e. hypoxia), by the way, gives you 0.18/1000 for in hospital, 0.73 for out of hospital. When “other midwife” is the attendant, the rate is 0.75/1000, when “other” is the attendant the rate is 1.49. (Though that includes accidental unattended births, presumably.)
Facebook really changed the way normal human brains work. Amanda, Margo and the rest of them shrieking harridans either do not know Monica in real life, or are part of the cult – or paid “birth workers” with vested interest in howling “It’s safe!”- that assured her that homebirth was safe or safer than hospital birth. It isn’t and it wasn’t for Monica and her little boy. Moses might not have lived in hospital either but he wasn’t as safe as home, let alone safer.
Condolescences to the family.
And shame on you on Amanda the Tattler. I do not follow posts on Facebook but thanks to her, I now know the name of her “friend” and the name of her little boy, although I didn’t want to. I have no doubt I am not the only one.
I’d rather just go to the zoo or even watch National Georgraphic instead of having this mother and baby dangeled before me with their names because Amanda thought she had a point to make.
“If they disagree with us, they must be shills!”
Just because you’re paranoid doesn’t mean they’re not out to get you, eh? You guys are funny.
It’s funny you say that. Because “If they disagree with us, they must be shills!” is what homebirthers say ALL the time about anyone who doesn’t hate medical science. On the other hand, it’s really not what Amazed just said about anyone. I see you’re projecting.
I’m projecting? Please enlighten me as to what exactly I’m projecting.
Wow, literally nothing satisfies the vicious shrieking horde that make up Monica’s “friends.” I had “friends” like that once, and I’m eternally grateful that I chose to walk the fuck away from them.
It’s because it’s less about Monica and her tragedy than it is about the fact that Dr Amy is vilifying home birth and those who advocate it.
I am deeply sorry for Monica and her poor little boy. I hope she finds comfort and healing with those who truly love her, not these ‘friends’ who are screaming that her boy’s death had NOTHING to do with home birth and he would have died regardless. And yes, that’s likely the case.
But if it weren’t, if his congenital defects WEREN’T incompatible with life, then maybe the home birth was a contributing factor. There will never really be any way to truly know for sure.
(also a lot of her ‘friends’ are doulas and home birth assistants, so of COURSE it’s not like they have a vested interest or anything).
I was thinking of you yesterday, a loss mom sharing about how her midwife was manipulating her and something she said reminded me of things that you wrote about. I mentioned sth like…there is this woman who survived a cult …and it turns out that she knows who you are and has read your blog too. Your speaking out makes a difference, even for others who are still too broken to speak out about what “friends” like the ones surrounding Monica right now did to them.
Wow!
I’m glad to know, even if it makes me blush a bit
On Facebook, Monica graciously accepted my apology.
Of course she did. That’s because she’s an amazing, gentle woman. She never deserved your hate to begin with.
What Dr Amy said was NEVER said with hate. More sorrow than anything as she wrote a piece on 7 infant deaths in the past WEEK. And 6 of those 7 can be directly attributed to home birth, which is one of the main reason she writes this blog, to show that home birth is dangerous, and yes, in worst case scenario, deadly.
In Monica’s case, Dr Amy assumed that Moses died from complications in home birth (like the others in this cohort) as there were no further details on the original post.
She has since been corrected and as you can see she has been more than willing to apologize. There was NOTHING hateful in her intentions.
I’m one of the people who was there hearing that those homebirth deaths were happening day after day. I know not just the name of Monica’s baby Moses but names of those other babies and grief of their parents too.
Human filth commenting here today and claiming higher moral ground have managed to utter not a single word of empathy for any of them except to claim that these babies that died in homebirth and the grief of their parents are either not real or that their deaths “had nothing to do at all with homebirth you know”.
Such sick adherence to natural childbirth ideology is beyond reprehension. They are literally willing to walk over dead bodies to prove their points.
And they say that we’re disgusting because we’re sticking up for Dr Amy and her motives in writing this blog.
You know what’s disgusting? Cassie the Doula dragging the mom into online birth groups now while she is grieving in order to prove how Cassie is not a liar. And Cassie is a liar, because Cassie was claiming that there was an autopsy report three days ago, and that she is sharing information from it, when it turns out now that we were able to hear the mother that the family picked up this preliminary death certificate only yesterday. Cassie the Doula who runs unassisted childbirth groups online and claims to be “a friend” wasted no time and posted images of it to prove herself only hours after family got it.
The level of emotional manipulation on display is unbelievable. I hope this mom manages in time to find real support for her unfathomable loss among more decent people than the ones she is surrounded by now.
Don’t forget her ‘friend’ Amanda who was the first one to share the name of Monica’s baby, when Dr Amy never did.
She’s an amazing, gentle woman – how very different she is from her “friends.” Maybe you should take a page from her book.
I’ve never claimed to be amazing or gentle. Monica is a far better person than I. Which is why she doesn’t deserve this vitriol.
No one is saying anything about about Monica, actually. Plenty bad about you, and saying that Monica made poor choices, but there is no vitriol at all towards her. Grief, yes, that she lost her baby, and anger that it happened, but no vitriol.
You are exceptionally bad at actually reading for comprehension, you know.
Dr. Amy is not about hate. She’s against the lies spread by the natural childbirth advocates. All of us here mourn for this babies
Your behaviour during this tragedy has been appalling.
Yeah supporting my friend emotionally and financially is really horrible. Bad Amanda!
Yeah, and all your emotional and financial support costs her is your feeling of entitlement to share her last name and the name of her baby on the internet with strangers you seem to think are out to get her! With friends like you, who needs enemies?
o.O you totally found me out. How will I ever complete my evil master plan now???? Shucks.
What kind of person pumps herself up on the internet by telling strangers she’s giving her grieving friend money? Klassy.
Accusing other people of violating her privacy and then putting the full name of your friend and her late son on this site is disgusting. Bad Amanda doesn’t even come close.
I hardly consider this a sincere apology. It is written in a very tongue-in-cheek fashion and is ripe with snark and sarcasm. Good for you for following through on your word, but how low of you to use it as another chance to kick a grieving mother while she’s down. I just lost any and all respect I would have had for your opinion as an expert.
What about it is tongue in cheek? Dr Amy admits she didn’t have all the facts, that this death wasn’t DIRECTLY caused by home birth (but it may have been a factor) and that she is sorry for her loss.
And if you want to talk about kicking parents when they’re down, talk about the midwives who want to sweep bad outcomes of home birth under the rug and never speak of them again.
This is ridiculous home birth was never a factor in this. You people need to get over yourselves and realize that this beautiful baby boy spent every last minute he could with his parents enjoying him. Rather than waiting in agony for the day to come when he would be delivered. All of you guys are jerks for taking advantage of the tragic l9ss of a little boy to further your ridiculous cause
How do you know it was never a factor?
Because according to the autopsy and doctors Moses’ conditions were unfortunately incompatible with life.
Where is the autopsy, and had it been performed when you made that claim?
Yes it had
You didn’t answer the ‘where’ part.
The where part is that it is with Monica and she has shown it exclusively to compassionate loving people.
Preliminary death report has been posted all over the internet by these so called “friends” who are too busy defending homebirth to know the difference between that document and an autopsy report. Mom was clear that it will be weeks before they get definite answers and the autopsy report. And no, that preliminary death certificate does not say “it was 100% not in any way homebirth’s fault” like you obviously think it does.
With friends like that, I truly feel she should seek adequate grief support to get her through this because they are the ones parading the baby that she lost around as “proof” of their beliefs – same people who are unable to express any compassion towards all those other babies that died that same week in homebirth and are unable to say a single word about the grief of those mothers, except for when they say that these babies and the losses of their mothers are “hickups” that never even happened.
Listen monster, I would have told you to go crawling back under your rock but since I know your rock includes leading vulnerable women and babies – like Rachel from yesterday’s post – to their deaths lso you can line your greedy pockets or feed your fucking, twisted self-esteem, I’d rather have you here.
Hear me, Cassie, Amanda, Margo, Marie and the rest of you fucking heartless bitches? Please stay here. We can take you without anyone dying or being injured. Unlike you, we don’t consider our pockets or egos more important than people’s lives or deaths.
Please stay here.
We are not heartless, unlike all of the rest of you, many of us actually know Monica so we are the ones emotionally invested in yhis. We are the ones crying for this baby and their family. We are the ones supportibg the Dunn family in thier time of need. All of you people who have no knowledge of what actually happened or how this family really is, just needs to quit being so cold and cruel to a grieving family. Instead of spouting hate, and proving ignorance show some love and support to this family
You are also the beasts who think saving babies who – gasp! – die at alarmingly higher rate at homebirths is a “ridiculous cause”. I don’t know what you are – a homebirth midwife, a doula, someone who risked her own children’s lives just to get them out of her jay-jay and is all hurty feelings at being told that it was dangerous. And I don’t really care. But you are one of those things, else you would not have harped at the “ridiculous cause”. What does it hurt, Marie? Your purse or you ego?
You NCB nuts are very good at crying for someone online and then happily going to find the next victim you can cry for. Thanks for staying with us. That takes minutes away from hunting vulnerable women and cheering them on the way to riskier choices.
Dr Amy did apologize. That’s more than I can expect from someone like you who literally said that preventing deaths is a ridiculous cause.
Poor Monica. No one deserves “friends” like you.
Lol you are so funny. I never said your so called cause was ridiculous, I said this particular attack on Monica and the Dunn family is. Her sons death was not caused by a home birth. I am not a home birthing assistant in any way, but I have delivered a baby in an ambulance twice. Personally I have given birth medication free in a hospital 6 times. This has nothing to do with how I choose to birth my children. The Dunn family made the right decision for their family. Get over it and quit using their pain to further your cause. Show some damn compassion
What do you think our cause is? Thanks for following in Amanda’s footsteps, though. I didn’t know Monica’s name was Dunn. Thanks for exposing your friend like a freak show to people like me who would not have known this detail of her identity otherwise. Some friend you are. So compassionate.
You have given birth medication free 6 times! May I see your medal? Come on, you know you’re dying to show it to the world.
What’s our cause again? Cause pain to the Dunn family? We didn’t know they existed till last week. But being the mental giant you are, you couldn’t possibly grasp the discrepancy between this blog’s age and our realization that Monica, last name and baby’s name caringly provided by friends, existed. Earth to Marie: there were 6 OTHER babies dying in the same week Monica’s baby died. If you don’t think raising awareness of the dangers this mode of births holds, then you’re the same asshole as a human being than you are as a friend.
To the commenters here: I told you so. I told you she was someone who boasted with having kids coming out of her jay-jay. She even bragged about it to me, of all people.
I am really, really getting better at knowing her ilk.
Again: thanks for providing me with the information I didn’t want and didn’t need, Marie. Now, if someone decides to use it to harass Monica, how would you know it wasn’t someone like me who read it in your post? Some friend you are!
“Personally I have given birth medication free in a hospital 6 times.
This has nothing to do with how I choose to birth my children.”
Cognitive dissonance does not even begin to explain these two statements made one right after another. One must be suffering from complete cognitive detachment in order to be able to say it like that and think they’ve made a rational point.
I’ve long started to think that CD must be absolutely required for membership in the exclusive NCB Nut Club.
Are you sure? Didn’t. this medically compromised newborn spend his last moments of life apart from his mother, not in her loving arms… wasn’t he transferred to a hospital where dedicated medical professionals valiantly tried to rescue him?
I am positive. Moses came into the world in his fathers arms and left in his mothers. He was loved every single moment of his life both inside and outside of the womb
well?
Well I have been busy doing things that are very important, with loving compassionate people who know a grieving family deserves peace and not ridicule for thier decisions
My FIL used to say ‘For every accident there are a hundred near misses’. I wonder if that is true in the hazardous world of homebirth? For every perinatal mortality, are there a hundred avoidable cases of nonfatal perinatal morbidity? What do you think, Dr. Amy? Are there any stats on that?
http://www.skepticalob.com/2014/01/risk-of-anoxic-brain-injury-is-more-than-18-times-higher-at-homebirth.html
Ah, thanks for the link Ash, I had missed that one.
Good for you, Dr. Amy. I applaud you taking the high road -despite the nasty, abusive posts her friends subjected you (and your readers) to.
It was deserved. And this is hardly an apology.
She only had limited information when she was told about this baby. She has since received more information and amended her statement accordingly as well as issuing an apology.
No one deserves the kind of abuse she’s been subjected to and MOST of it was NOTHING to do with the woman and her baby, it was because she was (once again) vilifying home birth (with good cause) and the midwives were running scared.
If she wanted to avoid backlash and ridicule, she should have never written about it to begin with, without first having all of the facts and verifying their validity. Writing about it the first time was irresponsible and ignorant, and it should be called out for what it is.
Ridicule? By people like you? And she should care… why?
It’s a badge of honour, Lauren. Personally, I would have been insulted if someone like you and Monica’s other “friends” here thought me trustworthy. I suspect Dr Amy feels this way as well.
What’s your interest in this case? Are you a midwife? A doula? Someone who just wants to have her own choice mirrored back at her and cannot stand that someone writes about the risks people like her undertake with lives, brains, and overall health?
Your comeback is quite comical and makes absolutely no sense. You don’t know me at all, so to say “someone like you” is asinine. My one and only interest in this case is that my friend’s name was drug through the mud based on generalities and assumption, and it wasn’t right. Then to apologize in such a “ok I apologize, but I’m not at all sorry” kind of way only made it worse.I have absolutely no interest in expressing an opinion on the larger debate topic of the site.
My sole purpose in posting the remark that you replied to was to say that Dr. Whoever made a very reckless decision when she decided to write about someone and tout assumptions as truth before knowing the details of that particular circumstance. Like I said before, it was irresponsible and ignorant and should be recognized as the outright crappy journalism that it is.
My presence on this thread has absolutely nothing to do with hospital vs. homebirth or Dr. Vs midwife/doula/whatever! If you take your blinders off and read my previous comment again with a rational and logical mindframe, then you will see that I have no affiliation with either field of service.
Anyway, I’ve made my point and I am done here. So I will discuss it no further. Good luck arguing each other to death, ladies.
I did read your post, thnakyouverymuch. I strongly dislike people using their friends’ tragedies to position themselves as those noble protectors arguing the higher moral ground by inventing things like “bringing a mother down”. I suppose you did have Monica read here to show her just how noble you are? Showing how people brought her down but you defended her?
Monica did make the more dangerous choice and that’s a fact, with a healthy baby or without one. That’s a fact. If you dislike it, that’s your problem. Dr Amy wrote her second post with compassion – but I don’t think you have the capacity to understand it.
If someone did Monica a disservice, it was Amanda What Her Name was, by making Monica easier to look for. Supposedly, she’s also a friend of Monica’s, yet I didn’t see a single reproach here. That’s because you’re of the same ilk, aren’t you? The kind who feels good about themselves at their friends’ expense.
Since I dislike such behavior, I prefer to think you’re just an internet friend, if not someone who benefits directly by the NCB ideology. And no, your denial doesn’t mean anything to me. We’ve had concerned “friends” here after the wakes of other tragedies and they have turned to be midwives, doulas, and the likes. The people who were RL friends showed from a mile – and they weren’t anything like you.
No, it’s because we don’t appreciate our friend getting her name dragged through the mud and told that her baby died because of her birth choice when that wasn’t the case. I don’t personally care where someone chooses to birth, it’s their body and baby, so it’s their choice. I wouldn’t personally be comfortable with a home birth, but I don’t think it’s wrong for someone else to choose it.
Only Monica’s first name was used. A layperson visiting this blog would have had a hard time differentiating her from all the other Monicas on Facebook.
Her baby was never named until one of her so-called ‘friends’ did so here in the comments. And Dr Amy assumed that the circumstances of the birth played a part in the baby’s death. She has been corrected and amended her statement accordingly.
Why are you still jumping up and down and screaming in rage? Is an apology not enough?
Dr Amy is human. She made a mistake and has owned up to it. Which is more than a lot of these midwives have done.
How many babies have died in the last week during hospital births?
Around 0.7 per thousand, including those with congenital abnormalities.
The homebirth death rate, according to MANA’s own surveys, is 2.06 per thousand (with 22.5 per thousand for breech, 4.75 per thousand for HBAC).
Fussy correction, but for 2007-13, the mortality was 0.6 per 1000 with no restrictions except for age 39-41 weeks gestation. Remove even the simplest risk factors (very young age, no prenatal care, etc) and it goes down to 0.4/1000.
With 4 million births annually and 0.4 death rate that puts the number of babies born in hospitals in a week at abt 76 000 and the number of babies who died in hospitals the same like these homebirth seven at 30 dead babies in a week
Meanwhile, there is abt 40 000 homebirths per year and there were 7 dead babies among 769 homebirths that happen in USA in one week.
4 000 000 births – 30 dead babies in a week
40 000 homebirths – 7 dead babies in a week
As heartbreaking and as unbelievable as this one week’s homebirth death count looks, it’s merely a typical weekly toll according to what the data available on death rates from all the studies including MANA’s tells us (0.4 vs 2.06 per thousand). The only difference is that, this week, we heard about almost all of them as they happened.
Apologies are rare. I know I never received one for multiple things regarding my own homebirth.
Thank you for writing this. I know it isn’t easy.
My condolences to the family.
No-one on the “other side ” would have reassessed their position, nor made an apology. Well done.
It does seem unkind to blame home birth loss mothers for their losses but it is also important to place the blame where it belongs to discourage others from making the same mistakes. There is so much encouragement to have a home birth on the internet and so little discussion of the very real, potentially devastating risks. So I mean, I agree with the people who hate these posts, but I hate that they have to exist — I hate that these mothers took unnecessary risks with their babies’ lives and with their own.
Anyway, that said, does the autopsy report you saw provide any additional information — were these actually congenital anomalies that could not have been addressed in the hospital? Or were they anomalies that could have been dealt with under the right circumstances?
I’m not here very regularly, but I’ve never seen a lot of mother shaming. I’ve seen sadness for the losses, I’ve seen anger at the midwives. The mothers we usually understand are vulnerable and misled.
Until the post how awesome it is they had their homebirth and oh-by-the-way kid’s in the NICU, but hey, my lady bits are intact!
…then we get a bit miffed at the mothers.
What is wrong with you people? Do you really think this site is going to educate you about birth? Go read a textbook, Obstetrical or Midwifery based, I don’t care. Or better yet, read both, and then find out what you actually believe. I literally cannot comprehend how a person would think that Amy Tuteur is a good person to glean information from. These posts are so bankrupt of real information that it is just sad. Are all the people that read this brainwashed (or here to try and figure out WTF is wrong with the readers of this site)? Perhaps they’ve had bad outcomes at home (as if home is the only place bad outcomes happen)? What a sad statement about the state of the world if people really think this website, these articles, this woman, is worth reading. Why does anyone care what other women are doing? Do you think women who choose homebirth are stupid? The stupidity and vitriol I’ve seen here are disgusting. I hope you all find a way to rise above this nonsense and seek truth. It is fine to disagree about birth, safety of homebirth, etc. It is not OK to be a hateful, slanderous pig.
What is up with you idiots? Do you all have the same person coaching you how to write these comments? Because they all sound exactly the same. But I’ll bite, just a little.
Why does anyone care what other women are doing, you ask? Because they and their children die, or are severely harmed at homebirth, at a FAR FAR highter rate than in a hospital. Because homebirth providers have no accountability when their complete ineptitude hurts or kills a woman or a child. Because they perpetuate a cultlike mentality. Because they are extremely misogynist while pretending they’re feminist – because they reduce women down to their reproductive organs.
That’s why. Because it’s bullshit that people like this are allowed to practice on the most vulnerable patients.
Go read a textbook and make your own choices? Sure, how about you go read the Code of Federal Regulations and decide which drugs should be on the market? Maybe you can read a text book and cure cancer.
Can you read a text book and build a jet engine?
I don’t have a bad outcome at home. I was smart enough to know home was the last place I should be during birth. I was lucky, even at the hospital.
How about you go tell people in the home birth community to go to medical school? Or to stop minimizing risks? Or how AWESOME HIE must be since they all seem to not care about what happens to their children?
It’s not okay to be hateful, slanderous pigs, love. You might want to write that for yourself one hundred times. We’ll wait.
What’s wrong with me? Well for starters I really want a steak but I don’t have the energy to make one. I have a lot of credit card and student loan debt and it feels like it’s never going to get paid back. Other than that I’m okay, thanks for asking.
I don’t come to this blog to educate myself about birth, but I use the site UpToDate and other evidence-based resources to learn about birth. I come to this blog to talk about relevant evidence-based issues relating to birth, particularly as it applies to skepticism surrounding the cult of natural childbirth. I don’t think the average reader comes here to learn about birth. Just wanted to clear that up because you seemed confused about why we were here.
Except she provides links to studies, statistics and the like that PROVE home birth is risky and stupid. And she writes these posts to show the depravity of those that subscribe to the cult mind and believe that birth is a ‘natural’ and glorious process.
It’s natural, sure, but far from glorious. And it’s DANGEROUS. When things go wrong in labor they go wrong FAST and if you’re far from help, then you’re in trouble.
It’s not about shaming women for their choices. It’s about holding to account the midwives who LED them to believe that that choice was RIGHT and the ONLY choice, by minimizing the dangers (if not outright lying about/skipping over them) and scaring women into believing that if they go to hospital, they are going to be ‘raped’ by the doctors and not wind up having the ‘perfect’ birth experience.
Now correct me if I’m wrong, isn’t a perfect birth experience one where you wind up with a healthy LIVE baby?
So all these home births which your cult leader Ruth describes as ‘hickups [sic]’ are less than perfect. And probably needless deaths as there’s a pretty good chance that most, if not all, of these babies could have been saved if they had been delivered in a hospital.
Well, we get a bit grouchy when quacks lie to mothers to try to entice them into denying their babies medical care.
I wouldn’t call that wrong, though.
The safety of homebirth is not debatable. Study after study has shown AT LEAST a tripling of risk of death to the baby. Even the homebirth midwives’ own research showed that. You can disagree with that the same way you can disagree with the Earth being round.
So close to a bingo.
Is it too much to ask that you learn the difference between libel and slander?
Oh, who am I kidding.
Whoa, hold on here! Do you take advice from midwives? Because if you do, you’re just being a hypocrite. At least dr. Amy has a medical degree. She CHOOSES not to practice. But she’s stills doctor, albeit a non practicing one.
But seriously…if you need to file a lawsuit, do you go to the law library and “educate” yourself? Or how about going to a paralegal? No? Well why not? Maybe because….YOU WOULD LIKE TO WIN THE LAWSUIT. So you hire an attorney…you at a minimum get advice from one.
Your post basically says that anyone can educate themselves on anything, so why listen to experts? And that’s just…ludicrous.
As for why we care what others are doing…we don’t care what YOU are doing. We care what shoddy/unlicensed/barely licensed, etc midwives are doing! If homebirth were safer in the U.S., we’d care a lot less.
I read a lot of obstetrics reference works after my first baby was born, trying to understand whether more could have been done to spare him protracted fetal distress, Apgar scores, a traumatic forceps rotation which left one plate of his skull overlying another even after birth, and an absence of any suck reflex for 24 hours. What I learnt showed me that there was a lot that could have been done if the midwife had only called for medical help rather than trying to keep it all ‘natural’. I’ve been reading Dr Amy’s posts for a while now and never seen her post bad information about obstetrics.
Your post seems quite bizarre since it is in response to an apology.
You lost me at ‘believe’. The first one, there may well be more than one, since belief rather than knowledge seem to be a core tenet of the homebirth peddling industry.
Regardless of anyone’s belief, homebirth is far riskier for babies than hospital birth, and taking advice about how to manage pregnancy, labour and delivery from a high school graduate with a lust for birth is no substitute for seeking high quality medical care from a team of experts.
By the same token, why do *you* care what people are doing by reading this blog, and what gives you the moral high ground and the right to call these people stupid, brainwashed, nonsensical? Your post is full of colourful adjectives making it clear how much you detest Dr Amy and anyone who reads her blog, but then you go on to claim to be against vitriol and hate and somehow closer to the “truth”…
Why do NCB devotees care so much about how other women give birth? Why do they continue to vilify pain relief, medical intervention, c-sections, obstetricians (hatefully, slanderously so at times)? Why is it OK for some to be passionate, but not for others? You can’t have it both ways.
I am probably less educated in birth and pregnancy than most of the regulars here, and I have read UK midwifery textbooks (I still own one) and a small amount of the medical literature, as well as spending some time as a student on a UK maternity ward and with NHS midwives way back when I was a student nurse. I am still far less educated in the field than most regulars here.
Why would you come here believing you know more than both the blog owner (a former OB) and the regular commenters? Read a textbook? Some of these people work in the field day in and day out. Reading a textbook comes nowhere close to their knowledge base.
There is no question that home birth, particularly in the US, carries a greater risk than hospital birth. It’s not a matter of opinion, but fact.
I read a textbook on rockets once. I can totally work for NASA now, right?
Certified Professional Rocket Midwife sounds like a fun job…lots of shiny buttons, flashing lights, and you probably get to wear a cool hat. I can count backwards from ten, will you be my mentor during my online apprenticeship?
Yes! Now we just have to acquire liquid oxygen, hydrogen, and a extremely potent oxidizer as civilians without pinging an NSA watch list!
But we don’t have insurance so maybe we can fly under the radar.
Those sound like toxic chemicals…we should use all natural alternatives that will gently work with nature to achieve ecstatic launch. I have organic non-GMO vinegar and free range local baking soda in my kitchen, will those do?
But that produces carbon dioxide! I can’t leave a carbon footprint!
” Or better yet, read both, and then find out what you actually believe.”
This is not how science works.
” Or better yet, read both, and then find out what you actually believe.”
The last thing a grieving mother needs is a know it all like you shaming them. Leave these poor families alone. This just proves you jump to conclusions and don’t have an idea what you are talking about.
As far as I’m concerned, this is like a drunk driver getting into an accident on an icy road. The ice may have been a factor, but that doesn’t make drunk driving safe, does it?
It may be that Monica’s baby had no chance to survive, but if he had any chance, Monica took it away with her decision to have a homebirth.
Moreover, Monica’s story is a striking illustration of one of the main dangers of homebirth: life threatening complications occur without warning. This time it was congenital anomalies, but it just as easily could have been a potentially survivable abruption that the baby didn’t survive because he wasn’t at the hospital.
Monica’s friends seem to be far more concerned with the reputation of homebirth than with Monica. Homebirth kills babies; deal with it!
This is a crappy ‘apology’. You’re not sorry at all. The baby was born not breathing and the doctors said they couldn’t have saved him even if they were in the hospital. The congenital deformities were incompatible with life. Furthermore, there was no sign of this at the anatomy scan. I know Monica, and I am 100% sure that if she had known, she would have taken precautions and gone to either a birth center or hospital once she was in labor. She loves her children and she is an amazing mother. Shame on you for twisting her tragedy for your own selfish purposes.
“she would have taken precautions and gone to either a birth center”
Grand multipara with confirmed baby with such problems in a birth center? That’s not “taking precautions” and would be illegal for a licensed birth center to take any part in such high risk birth.
Ok. How should I know that? If they had told her they couldn’t take her, then I’m sure the hospital would’ve been the next option. The part you’re all missing here was that baby Moses was never going to make it. Regardless of where he was born. Medical professionals worked on him for an hour after they arrived at the hospital. He was also born sleeping. He had no chance. Where he was born is completely irrelevant and for ‘Dr’ Amy to try and make an example out of the Dunns for something they had absolutely no control over is disgusting. I feel sorry for all the people under her spell who lack the compassion to realize the extra damage they are causing to a wonderful family who are still grieving a loss they were unprepared for.
I really encourage you to remove identifying information from your post. The baby’s name and family’s name was not mentioned until you did so.
Her name and the name of her child has already been shared on public Facebook posts.
They weren’t shared on this website until you did so. Again, I urge you to remove them for your friend’s benefit.
I urge you to not tell me what to do. Thanks.
Okay, I get that she’s your friend, and you’re here to defend her, and that you feel that the homebirth vs. hospital thing is irrelevant in this case, etc. I do understand this. However, regardless of whether the names/personal info have been shared on a public FB page, I do feel that it does cross the line for you to be name-dropping on Dr. Amy’s blog. I’m not sure what is to be accomplished by disclosing names on here, but it doesn’t sit right with me, and I’m sure there are several folks on here that feel the same way.
Get over the fact that someone is telling you what to do, and pay attention to whether you are being a good friend to Monica or not. A good friend doesn’t put her full name or her baby’s name (much less both) on a public website. If a good friend has a lapse in judgment and does that, then a good friend soon comes to her senses and removes them.
Refusing to remove them because someone with better judgment told you to is just your ego talking. It’s not your heart. It’s not your conscience. It’s not friendship at all.
Yet we’re the meanies, right?
“Ok. How should I know that?”
Because you made that statement. You don’t know/have control over what you are saying or…?
Sorry, what’s this ‘born sleeping’? Is that some cute euphemism for stillborn? Stillborn, of course, is a cute euphemism for giving birth to a corpse.
But see…a lot of birth centers WOULD have taken her. That’s why we get so upset.
Show me a homebirth midwife who did a better job apologizing.
How exactly is that relevant here? You’ve dragged her name through the mud. Nobody needs to apologize about this but you. And you have done a horrible job.
Well, when a home birth midwife “apologizes” they blame the mother and said they were opposed.
Dr. Amy didn’t kill a child. She just reported on deaths.
Look, I don’t care about this whole hospital vs midwife war going on here. What I care about is my friend. ‘Dr’ Amy has ‘reported’ completely false information. Anyone with half a brain waits until they have all the information possible before making a judgment on what happened. She didn’t. She jumped to conclusions and it’s reprehensible.
And then she retracted it and apologized.
Like normal people do (and 100% of the news stations). Do you watch the news at all?
If you think what’s above is a decent apology, I feel sorry for your critical reading skills. Or lack thereof.
I think it’s much, much more than anything the homebirth community has ever given a mother who loss her child.
I’ve seen the indignities they heap on women who seek answers over what they were told was “safe” and “easy” and “natural”
I really don’t care about that. I’m not a home birth advocate. I’m not a hospital advocate. I’m just here to defend my friend.
And we all feel bad about what happened to your friend, whether you choose to believe us or not. And we want your friend’s child to not be forgotten.
I’m so sorry for your friend’s loss. It is heartbreaking.
You are confused if you think that the fact that the baby would have died anyway makes Monica’s choice defensible. It’s like the drunk driver who gets into an accident because of ice on the road. That doesn’t make drunk driving defensible.
I don’t think that. I think it was a tragedy that couldn’t have been prevented either way, and it’s done and over with, and badgering her about her choice now shows that you lack compassion.
Check out the not buried twice campaign. There is a lot more compassion here than you realize. Things can get a little snarky around here because of all of the loss/brain damage stories we come across. We mourn the babies. We mourn those losses. I am so sorry for your friends. I can’t even imagine the heartache.
I think too, Amanda, if that had been my friend I would be angry too. It really is hard enough to lose a baby never mind being accused of making a choice that lead to the death. It’s probably harder for the mothers who know that if they had chosen a hospital birth… the baby might be alive. As a labor nurse I see moms who have losses beat themselves for ridiculous things ( like a diet soda once) trying to understand why they lost the pregnancy or baby. I have always been uncomfortable with these online dissections of what happened from a post on the internet. I have noticed that often Dr. Amy really knows more about the case discussed than is publically available. But not this time. There is a danger in this as I have seen hospital cases analyzed similarly on the internet. Cases where I knew the facts and the posts had little to do with reality. People say awful things anonymously they would never say to a person’s face. Like me, for instance, saying “really???” when the post of a mom with a critically ill infant bragged about no tear with a 9lb baby. I would never say such a thing to a new mom. No matter how stupid the comment. Denial is there for a reason. I cringe that the mom could read our comments. Unless. maybe, it would stop her from doing it again. I don’t have any sense these homebirth midwives beat themselves up like doctors do. But the whole analyzing like we know what really happened has always made me uncomfortable. Sometimes I worry it’s all made up. Sometimes I think if we had all the real facts it would be different. Mostly because I have been on the other side. But, something came out today that the best way to change the mind of a vaccine denialist is to see the story and pictures of a baby with the disease the vaccine prevents. And I can say for sure, as a nurse, that death and loss becoming real to me changed my mind about homebirth ( I had one before I was a nurse). Holding a dead baby, crying with her family… the risk of that “experience” becomes real. Its not just a choice, its a choice with sort of rare but not sort of huge risks. Its very frustrating for doctors and nurses to try to break through with the facts about the risks. You mentioned your friend’s baby’s name. Look at Not Buried Twice. Read also about Gavin Michael. His story unfolded here, and though his midwife hasn’t really been held accountable, his mom came forward and the story of how she was betrayed by the homebirth community and her midwife is public and I am sure this grieving mom would have been completely gaslighted had it not been for Dr. Amy. She’s not the only mom. Dr. Amy gives a voice when these women are ostracized by their very insular and tight knit homebirth communities for questioning what happened at the birth and death of their babies. I am not really a big fan of dissecting posts by grieving moms who haven’t decided to tell their stories here. On the other hand, I am completely certain Dr. Amy does post about them because she is outraged by all the preventable death and disability. I really hope you read Not Buried Twice. Its a safer format, but it doesn’t get near the attention this blog does. This blog saves lives.
So you don’t care about hospital vs midwife yet somehow you know that a common insult from the NCB crowd is to put Dr Amy’s title in quotes? Hmm.
Hmm. Must be a conspiracy right?? FYI, I had my son in a hospital with a very welcomed epidural. I don’t plan on giving birth again so I have no dog in this fight. A respectable doctor would not draw conclusions without all information. Of course, there are many horrible doctors in America, so I’m not surprised at her lack of bedside manner.
And now you’re responding with ad hominem attacks. Just like the rest of the NCB crowd. What happened to your friend is a tragedy, no one is denying that, especially not Dr Amy, who has apologized because she did not have all the information, all she had to go on was what was in the original post.
Someone sent her the death certificate, and she has amended her stance accordingly.
How is that a lousy bedside manner? And how does it make the rest of her post invalid? Another SIX babies DIED. Your friend’s baby was only 1 of 7.
Dr Amy is entitled to write her opinion, especially when presented with so many reports of home birth gone wrong. She’s only human so like anyone she makes mistakes. She has apologized, which is more than any of the midwives in the NCB cult have ever done.
So what’s the issue? Also, Dr Amy hasn’t named your friend’s baby, or your friend, YOU have done that.
There was nothing ad hominem about it. Amy’s post says a lot about her personality and bedside manner. She has no compassion. I’m not pulling personal attacks out of thin air. I’m criticizing what I see here. Also I don’t get why you people keep bringing up that I named them. Their posts and information are already out there. They don’t mind. Does hearing his name bother you? Does it humanize him and his family? Does it make you realize that you people are attacking other people in their time of grief? His name was Moses and he mattered. He will always matter. He is not a pawn in your silly game.
Of course he mattered. All lives matter, which is why Dr. Amy reports on the homebirth deaths that are being covered up by the natural childbirth movement. However, I’m not convinced your friend actually matters to *you* since, unlike Dr. Amy, you have no compunctions about sharing her personal medical information and identifying information in a forum full of strangers.
People are bringing up that you identified the family because you keep saying that Dr. Amy “dragged her name through the mud.” Dr. Amy did not post her name or any identifying details, so she could not possibly have dragged her name through the mud. He does matter; his life and his death matter and I am very sorry about his death.
Writing a blog about preventable deaths is “bedside manner”? That’s nonsensical.
Oh yeah…totally jumped to confusions. ONE of SEVEN babies died due to congenital anomalies in a week. Or are you going to argue they probably had anomalies too? The likelihood is they didn’t. So I’d say she didn’t jump to a conclusion. It’s a BLOG. She wrote an OPINION piece based on information given. She doesn’t “report” anything. When told she didn’t have all the info, she asked for it. And honestly..,what she said is true. Her point is that sometimes anomalies DO happen unexpectedly. And if they aren’t incompatible with life…well…where would you rather be? Home or the hospital? When you choose to stay home, you ARE taking on a risk. There are absolutely cases like this where the baby would have died either way…but most homebirth deaths aren’t because of anomalies. So that’s a risk on its own… Because you simply can’t predict everything. She apologized…but her underlying point is valid.
Monica had a baby at a homebirth. That baby died. Dr. Tuteur assumed that the homebirth and the death were connected. They wound up probably not being connected.
That being said, homebirth is still an exceptionally stupid choice. The baby may have survived if born in a hospital- doctors often try to soften the blow by lying about survival chances to new loss mothers, though it’s certainly possible the baby wouldn’t have survived in a hospital either. But the only conclusion that Dr. Tuteur jumped to is that the death and the homebirth were intrinsically connected, and she retracted that statement. What more do you want?
I want to understand: Monica did not know, prior to labor and birth, that her baby had anomalies incompatible with life? Or she did know, but chose homebirth anyway?
I find it very difficult to believe that the routine 20 week organ screening, or a third trimester scan showed everything to be normal, but by birth there were multiple gross abnormalities.
No responsible midwife should encourage a woman with a baby suspected of ANY abnormality to deliver at home.
I reiterate, no one KNEW for certain who Monica was. Her surname was blurred out so if you went on facebook and searched for Monica you would’ve had a hard time finding her, particularly, if as you said, this was a friend’s only post and one of her friends forwarded the screen shot onto Dr Amy.
YOU Amanda were the one who put her last name AND the name of her baby (rest his soul) up in the comments for ALL to see. Up until then she was reasonably anonymous.
So if ANYONE dragged her name into the mud, it was YOU.
Some friend.
I will admit that I have real difficulties with those who choose to UC. When a woman is in a power differential with a care provider (like a midwife), it is very easy for me to see how she comes to trust that person. When you opt to do it on your own and pretty much give the finger to modern medicine, well, I just don’t understand that and I think the mother has a lot of culpability. I find it particularly galling that a number of the luminaries of the UC movement have dead children as a result of their actions, yet continue to advocate for this nonsense.
I don’t know the grieving family, but I agree with Amanda Wade. Most doctors really stink at apologizing, don’t they? I mean, I guess this is better than nothing, which admittedly is what you’re likely to get from a homebirth midwife who makes a bad judgement, but Dr Amy is still blaming the mother for the death of her baby. I’d have so much more respect for Dr Amy if this blog post had read something like “I don’t know the details about the congenital anomalies, and the hospital is still the safest place to give birth; but the evidence indicates that in this particular case the death was unrelated to the homebirth.”
Doctors and their insurers pay bigtime for their mistakes. And I don’t see much evidence of homebirth midwives ever admitting they made a mistake, even when these doctors-who you are very happy to rely on when what they say agrees with what you say-assert that a homebirth was a fatal choice.
In my experience, doctors very rarely admit their mistakes or apologize (I’m guessing because it’s a liability?). When they do apologize, it’s something like, “I’m sorry you feel that way, but I’m awesome and I made the right choices.” (kinda like Dr Amy’s apology above) I’m not saying homebirth midwives are any better, but I don’t have any experience with them.
Does the evidence indicate that, though? I’ve not seen it, of course, but based on what’s been mentioned so far, it’s a leap to assume that the baby couldn’t have been saved in a different setting.
Would he have been born “not breathing” if he had been born in a hospital with monitoring?
In this case, they were because there was no chance. However, there are currently more adults alive today with congenital defects than there are children, because hospitals have become better and better at saving the lives of those with defects.
Multiple organ hereditary “deformities” that didn’t show up at 20 weeks? I know that at 20 weeks they look at the organs to make sure they are normal. You would think that if they were so deformed, something would have shown up, wouldn’t you?
Of course, that is based on the premise that they are hereditary deformities, and not something acquired at birth.
Babies born not breathing happens frequently. We make them start. That’s kind of the point of neonatal resuscitation.
How sickening that this poor grieving mother had to take time away from those that love her to post a copy of the autopsy just to get people to quit bothering her and spreading rumors about such a horrible tragedy to benefit themselves. So disgusting.
and yet midwives could still take a lesson from this blog about how to respond to deaths. I’ve never seen a midwife apologize for their role in any death they have presided over. They deny what happened and move on, often smearing the loss family in the process.
Yep. In light of babies dying, the only thing you’ll get from homebirth midwives are:
-“It could have happened anywhere.”
-“Babies die in hospitals too.”
-“Some babies weren’t meant to live.”
-“Get your facts straight.” [And then we get nothing but crickets while we’re waiting for the “facts.”]
-DEAFENING SILENCE [or perhaps only the keyboard clicks of people getting deleted, banned, etc.]
But never an “I’m sorry. I was wrong. I didn’t know what I was doing, nor was I even remotely qualified to handle the situation.” Never THAT.
That is not a copy of the autopsy report. And it’s mother’s “friends” who are all apparently “birthworkers” who are keen on dragging her into all of this in order to prove that homebirth was/is infallible.
Disgusting indeed.
Really? I’ve seen a copy of the report in a group for cloth diapering
Except it wasn’t the mother, it was the mother’s friend. A doula by trade who is invested in the farce of natural birth advocacy.
A doula who ran her own unassisted birth group.
Condolences to this family in their time of grief.
Sincerest condolences to both parents and members of their family affected by this loss and to the all other parents and families who lost babies in homebirth during this week from hell who might be reading here because they are looking for answers. I’ll never forget how Gavin Michael’s grandfather came and posted a comment while the midwife who killed him was still busy lying online how she was not involved and how “that midwife was on top of everything”.
My prayers and condolences to the family of this baby as well. I am so sorry for your loss.
“Within the past hour, Monica’s friend Cassie Elizabeth forward the fetal death certificate that lists the cause of death as multiple congenital anomalies. It’s not an autopsy report, but it’s good enough for me. Of course it doesn’t tell us whether those anomalies were incompatible with life, but I didn’t stipulate that in my promise to apologize.
Therefore, I apologize to Monica for sharing her baby’s story in a way that implied that the baby’s death was a direct result of her decision to have a homebirth. Homebirth may have been a contributing factor, but the actual cause was the anomalies.”
Great gesture on your behalf.
My question would be this – without a full autopsy report detailing whether these congenital anomalies were genetic or a result of something else that happened during the birth, does this preliminary report completely exclude lack of adequate prenatal care and home as location of birth as contributing factors in this baby’s death? Because that is exactly what Cassie the Doula has been busy telling the internet, that this preliminary report “proves” how her friend’s baby’s death had nothing at all to do with homebirth.
You are a complete idiot. Go look up the word “congenital”!!!!!!!!!!!! Of course the anomalies were not a “result of something else that happened during the birth”. That is impossible based on the definition. No one has any right to be talking about these families, but especially not someone who doesn’t even know what the word congenital means. Are you psychotic? What on earth are you doing spouting your mouth about other peoples’ births???????????? WHAT DO YOU CARE?!
“Go look up the word “congenital”!!!!!!!!!!!! ”
Here is a comment left by an MD on this blog explaining some things that might help you understand who the real idiot in this conversation is:
“The term “congenital” only means “present at birth”. It does not necessarily mean that it was due to a chromosomal abnormality, or a genetic mutation, or a heritable trait, which are themselves 3 different phenomena. Congenital defects could also be due to an in utero event, such as infection, or amniotic banding, or placental abnormalities, or, as happens in many cases of
cerebral palsy, an ischemic injury at the time of birth. Hypoxia at birth certainly damages the brain, but it can damage every other organ in the body as well. Some organs are simply more resilient than others. Not only are patients not informed about these distinctions, it is often difficult for physicians to explain them in a way that people without a medical background can understand.”
^ Read that and then run your burn under cold water, Margo.
(I reserve this spot for Margo to come back with “Oops – I stuffed up. I’m really sorry, and I withdraw all thoose !!!!!!!!!!”)
My husband’s blindness is congenital. Rubella caused cataracts, and the surgery (Mid 70s) to remove those caused glaucoma.
What do you? Really, love, whiff on some lavender. Your blood pressure must be sky high.
Congenital means “present at birth.’ Congenital anomalies can be genetic, but are not necessarily so. They can be sustained during birth. Someone posted this information here the other day, and it sounded suspect, so I looked it up. Pity you didn’t do the same.
Yo, Margo, what do you think is the definition of congenital?
And perhaps those other six don’t have friends who fight to stay informed and involved. Mercy, benefit of the doubt, compassion. They all are called for when copy and pasting stuff you read on Facebook from people you’ve never even met.
What about the details shared on the other six were vague about homebirth being the cause of death? Healthy term babies don’t die for those reasons in the hospitals if the parents are consenting to standard care.
Oh please. I would love to know what you have said about my own homebirth story. Was I met with compassion? Mercy? Doubtful.
Who are you? I don’t think I’ve heard your homebirth story?
That might be because her son lived.
She did file a HIPAA complaint against her midwife for withholding her medical records.
I do hope her midwife didn’t suffer too much from that.
Not just for withholding medical records, I think, but also for discussing her birth on the internet… I think? Crowdsourcing ahead of time and then blaming mom and shittalking afterwards?
It’ll take you less than thirty seconds to google her name and “homebirth”. Go on.
Google is a powerful tool. So is social media. Look me up.
Just did. Don’t think I’ve ever said anything about your story. Who was your midwife? What is your grievance?
“What is your grievance?”
…
You can’t be serious.
I am. What is it? I’m assuming you filed a civil case?
I’m not Amanda. I’m the “troubled person in need of healing.”
Please try to keep up.
As I’m sure you know, Katie, home birth midwives in the US generally don’t carry liability insurance, and even some birth centers don’t carry it. That’s at least partly because they refuse to follow the risk-control procedures that an insurance company would require. And there are plenty of websites on which midwives advise each other to declare bankruptcy and/or move across state lines when things go wrong.
(I’m sure you know all that, since YOU are one of the midwives who moved across state lines when California convicted you of a FELONY.)
Anyway, that’s a long way of saying that it is pointless for most women to file civil lawsuits against home birth midwives. Unfortunately that means that when things go seriously wrong, the family ends up having to pay for things like baby funerals or a lifetime of care for handicapped babies, out of their own pockets. Here’s just one example:
http://www.bendbulletin.com/home/1897490-151/the-risk-of-being-born-at-home
statistically that’s pretty unlikely, but you would know that if you had looked at MANA’s own numbers instead of their press release.
Mercy, benefit of the doubt, and compassion are good things to give to the grieving parents. I’m less convinced that the doulas and midwives who attended the home births that ended in death should be treated with the same characteristics. Justice, inquiry, and determination to avoid future disasters would be more helpful characteristics to provide to the professionals who attended the births.
Bahahahaha that’s rich.
Fuck off, murderer.
I love you x a million.
I truly enjoy reading your blog, and I have learned a lot from you and this community over the years. It has greatly changed the way I view birth, and I value the connections I have made here. That being said, I feel like this post reads a “sorry, not sorry” kind of way. On the one hand, it’s great you followed through and publically apologized. On the other hand, I can’t imagine the pain that she is going through and there are parts of this that still seem a bit….knife twisty to me. I understand and applaud you for warning families about the issues with HB, and certainly after this week it is necessary now more than ever, however, if you are going to apologize just leave it as an apology and hope that they find peace.
A UC in a grand multipara….there are lots and lots of things that could have gone very wrong in that situation.
It’s not like homebirth is safer unless your baby has multiple abnormalities.