Homebirth is a business

business red word and dollar on magnifying glass

In today’s NYTimes, pediatrician Aaron Carroll wonders How to Make Home birth a Safer Option.

Noting that a recent study in the New England Journal of Medicine showed out of hospital birth in Oregon doubles the risk of perinatal death, Dr. Carroll makes it clear that he and his wife did not think that homebirth was safe enough for their babies:

I and my wife, feared the deaths of our babies during delivery so much that we chose in-hospital births. Our zeal to minimize that specific risk outweighed any other considerations. If faced with the decision again, I don’t doubt we’d choose the same…

The overwhelming majority of American women (nearly 99%) feel exactly the same way. Homebirth is a fringe practice. The pressure to support homebirth is not being driven by women. It is being driven by midwives and the rest of the natural childbirth industry (doulas, childbirth educators, natural childbirth lobbying organizations). Why? Because homebirth is a business.

The push for homebirth is not being driven by women. It is being driven by midwives.

Homebirth represents 100% of the income of American homebirth midwives, and it represents professional autonomy and a lack of professional scrutiny for others.

Dr. Carroll cites the UK experience with midwifery and efforts to lower treatment intensity. But the UK experience has hardly been encouraging. There, too, midwives have been aggressively clawing for market share both in and out of hospitals and the results have been ugly.

1. At Morecambe Bay:

Frontline staff were responsible for “inappropriate and unsafe care” and the response to potentially fatal incidents by the trust hierarchy was “grossly deficient, with repeated failure to investigate properly and learn lessons”.

Kirkup [the author of the report] said this “lethal mix” of factors had led to 20 instances of significant or major failures of care at Furness general hospital, associated with three maternal deaths and the deaths of 16 babies at or shortly after birth.

2. At Royal Oldham/Greater Manchester:

Seven babies and three mums have died in two Greater Manchester maternity units in the space of just eight months – sparking an independent investigation.

3. At Milton Keynes:

History is repeating itself with the deaths of FIVE more newborn babies following staff failures at the hospital maternity unit…

Milton Keynes has now seen at least eight such deaths in two separate periods over the last eight years.
The latest five deaths happened over eight months between 2013 and 2014…

Most of the deaths involved staff failing to recognise or act upon warning signs of foetal distress.
All the babies were full term and previously healthy, and in each case parents claim speedier medical intervention could have saved their lives.

This is not an isolated problem. Liability payments for dead and injured babies now represent fully 20% of the NHS maternity budget.

That’s what happens when health systems employ midwives to lower treatment intensity.

The question we ought to be asking is not how to make homebirth safer (although that is a worthy goal); the question we should be addressing is: why do midwives promote homebirth as safe when it manifestly increases the risk of death?

Midwives are infatuated with homebirth for a number of reasons:

1. It is the natural end point of their love affair with promoting what they can do and demonizing what they cannot. They’ve gone from favoring the employment of midwives in maternity units, to midwife led units and birth centers. Homebirth is the logical next step, freeing them from any scrutiny by other health professionals.

2. It reflects the intellectually and morally suspect philosophy that the “best” birth is NOT the safest birth, but the birth with the least interventions.

3. It ensures that women cannot get effective pain relief.

4. It is a midwife full-employment plan. In contrast to a hospital based unit where one midwife can care for multiple women at a time, homebirth (in many countries) requires two midwives to care for one woman.

Women (and their physicians) have very different priorities. Homebirth is not popular and will never be popular among pregnant women. Most women have no interest in anything that raises the risk of perinatal death. Homebirth is deeply unpopular among obstetricians; most of us abhor anything that increases the risk of perinatal death. Homebirth is anathema among neonatologists for the same reason.

Follow the money! Homebirth is a business. It isn’t about women or babies or birth; it’s about midwives … and women contemplating homebirth (and the doctors who care for them) need to understand both the risks of homebirth and the self-serving motivations of those who promote it.

  • AA

    I guffawed at this letter in response to a NYTimes article about crisis pregnancy centers.

    http://www.nytimes.com/2016/02/22/opinion/crisis-pregnancy-clinics.html?

    “Such clinics do not typically empower pregnant women by giving them
    information about the potential for medically unnecessary cesarean
    surgery”

    Must use every opportunity possible to discuss the dreaded unnecessarean!

  • itry2brational

    “Homebirth is a business”
    So are obstetrics and gynecology, else the govt wouldn’t allow my OB/GYN wife to incorporate. The AMA operates very much like a trade union. Thinking your cherished profession is above the influence of money would be naive.

  • SageThinker

    Read the front and back cover of Ina May Gaskin’s book. http://www.amazon.com/Ina-Mays-Guide-Childbirth-Gaskin/dp/0553381156/ref=asap_bc?ie=UTF8

  • SageThinker

    It’s not a “fringe practice” — define “fringe” here, please. It’s a sound practice. It’s driven by women, *not* by midwives — not by the “Big Midwifery” industry. This is a polemic, and the “follow the money” call is way way way off. Midwives don’t make big bucks, and many offer sliding scale with many even attending some births for free because they care about it. But that’s too much for you to understand.

    • toofargone

      The income of a homebirth midwife relies solely on homebirth services. Losing a few patients could have a serious effect on her financially. An OB or CNM can offer a greater breadth of services than a homebirth midwife and they will not suffer from the loss of a few patients. An OB can prescribe/administer contraception, provide medication for PCOS, and can diagnose and treat a multitude of other women’s health issues. A homebirth midwife’s income is solely dependent upon the client supporting all things “natural” in regards to childbirth (with a few exceptions like the midwives that are allowed to use Pitocin for PPH or that are able to obtain labs and such). A mom wants medical pain management, no homebirth. A mom want IV antibiotics for GBS, very few homebirth midwives support and can do this (maybe CNMs at home). A mom wants the OR down the hall for her VBAC just in case of a rupture, no homebirth. But in the latter case, homebirth midwives irresponsibly support HBAC because “it is what the mother wants,” when the ethical thing to do as a professional, as a health care professional, would be to advise against an HBAC. Even MANAs results show terrible outcomes for HBACs. They are “Big Midwifery” because they support reckless choices because their livelihood depends upon it.

  • Anna

    Every pregnant woman who considers homebirth should read this whole blog first.Perinatal death is one of a worst things that can happened to a family,I thank God that I have never known such devastation but I had this fear during my pregnancies,the last two of which were medically complicated by partial placental abruptions.I really think that some level of fear is unavoidable and can be beneficial during pregnancy as logically it should urge women to make safe choices for their unborn babies.Exemples include : not smoking for fear of miscarriage,not drinking alcool to prevent damage…and giving birth in a hospital to avoid the majored risk of stillbirth.

    • yentavegan

      and not falling for the unscientific propaganda of the Natural birth industry. Such as” Babies are not library books..there is no such thing as a due date..the baby will be born when s/he is good and ready” POST DATES are DANGEROUS for the baby! Also labor that lasts and lasts for hours/days without progress are NOT HEALTHY for the baby. If the doctor says it is time for a c/section now before the baby is actually is in crisis..why fight them on this? It is far better to intervene while the baby is still thriving than wait for the baby to be severely oxygen deprived.

  • SF Mom & Psychologist

    OT: Update on my new nephew… Apparently his airway was blocked by meconium, which led to the O2 deprivation. He’s been dx’d with mild-to-moderate HIE, and is on a 72-hour cooling treatment. We’re hoping he masters the suck/swallow skill sooner than later. My heart aches for my sister-in-law and her husband.

    Because I know I can safely vent about this her, I’ll just say that I am HORRIFIED by this. Why the heck didn’t she have a c-section?!?? I’m told by her mother that the new parents are not really discussing that. And that the narrative of “Mom was a total hero, pushing for 6 hours, and the doula saved the day when she had mom get on all fours to push” is the dominant story. They honestly think this doula did them a bunch of favors. Never mind that my sister-in-law was so exhausted and doped on morphine, and the baby was so covered in mec that she couldn’t even see or touch him after he was born, and now he’s cooling in the NICU so she can’t hold or nurse him. Great birth story my ass. I wasn’t there, but it seems like all of this could have been avoided.

    Thanks to all of you who responded with support and strong hopes for his recovery.

    • demodocus

      poor kid. here’s hoping he’s got as mild a case as possible

  • Amazed

    OK, is this my favourite male OBgyn? (Sorry, Dr Biter, I don’t go for huggers) in the comment section of the article?

    Amosg: “The issue is not to make a home birth “safer”. It is to make it safe, so
    no more babies have to die because of the place where they were born.
    Home birth can never be made as safe as a hospital birth because of the
    location and the midwife not being able to provide the services a
    hospital can provide. Telling women considering a home birth is
    misleading them.”

    Love you, Dr. G., if that’s you. And even if it isn’t, I still want to marry the poster’s opinion.

  • mythsayer

    My friend had her baby a couple weeks ago…3 weeks early. She had her first at UCSD’s midwife unit (CNM’s, attached to the hospital). With her first birth, she tried to go “natural” and ended up screaming for an epi and it was too late so she ended up with no pain relief and was apparently screaming at everyone the whole time. She tore and they didn’t tell her she should have chosen stitches so she ended up healing down there a little weird. All told, she was so traumatized, she waited three years to get pregnant again. But she was still telling me homebirth isn’t THAT unsafe…she is semi woo, but not bad. Bad enough to want CNM’s but smart enough to ONLY want CNM’s. If she’d had the choice of a CNM at home I’ve wondered if she’d have tried it.

    Anyway, fast forward to now. Her insurance changed so she couldn’t go back to ucsd. She chooses another hospital in San Diego, THANK GOD. She forgot how traumatized she was…actually, she FORGOT her fist labor entirely. She decides she’s going to try natural again and her husband (who was actually my friend from college, so I’ve known him longer than her) intervened (and this is the most passive guy ever so him intervening is huge) and told her she hated the first labor and needed the epi. So she gets one (and loved it).

    But the REAL story is that she was being monitored constantly. Remember I said the bay was three weeks early? It turns out that he’s wrapped the cord around his neck, arm, and leg and had started to pull the placenta away from the wall of the uterus. That started labor and the pain was so bad, she was screaming for the epi the second they arrived. And just before he was born, his stats dropped dramatically and she had to push him out ASAP. They are both fine…because of the monitoring.

    If she’d been at home…or maybe even the midwife unit if they don’t use EFM there…this could have gone so bad. The minor abruption could have turned into a major emergency and she knows it. She’s grateful for the monitoring.

    I just wish the ncb crowd understood that these things aren’t rare. Something that was minor in the hospital would have likely turned into a horrible emergency somewhere else. I just thank god she was smart enough to know that the risks weren’t worth it (and that her husband wasn’t going to let her try natural again, which therefore required a hospital anyway).

  • Dr Kitty

    Ok…
    Let’s say, for the sake of argument, that homebirth is acceptably safe IF you accept a 30% transfer rate.
    Let’s say half of those transfers are by ambulance.

    If 50% of women choose to birth at home, 7.5% of all births will require an ambulance transfer.

    Inevitably, unless EMS services are massively improved and invested in, any increase in HB will lead to a pay off somewhere else.

    Susie might get her lovely peaceful homebirth, Joe might die from his heart attack because the EMS couldn’t get to him in time, because they were transferring Annie and her baby to hospital.

    It might take a while for the statistical analysis and audits to confirm it, but would we really support more homebirth if it led to worse outcomes, not just for the people who choose it, but for EVERYONE who needs an ambulance that day?

    You have to look at health systems as the very, very complex systems they are. Big picture stuff.

    • yugaya

      Unsafe birth promoters in UK that run local VBAC groups are already boasting about the fact that HBAC is an awesome choice against medical advice because “you get your own ambulance on standby”. So yes, their carelessness about loss of lives associated with homebirth extends to include dead babies and neighbours as well.

      • AirPlant

        The ambulance on standby thing actually breaks my brain. How does that work for the EMTs? Do you just peacefully park in front of the house for two days just in case? How do these people not get completely laughed out of the room? Like sure, we will totally give a skip to the car accidents and seizures and just chill here waiting for you to knowingly give birth in a medically subpar environment. Trauma victims can wait, you need to give birth with tea lights.

      • Linden

        They say, “You have your own ambulance on standby.”
        I hear, “We are disasters waiting to happen.”
        How on earth anyone would not be put off by that comment, I don’t know. I would be running for the hills.

        • The Bofa on the Sofa

          They say, “You have your own ambulance on standby.”

          I hear, “We are disasters waiting to happen.”

          In contrast, I hear “Look how special I am!”

          It’s all about me.

          • Charybdis

            I hear that too. Another way to one-up the other homebirthers. “I had an ambulance on standby in the driveway the ENTIRE time I was in labor!! Aren’t I SPESHUL!!??!”

          • Amazed

            In the viper nest, one birther even bragged that should something happen, they’d get to bump another emergency since evil hospitals sort women depending on the urgency of the c-section they need. But when Her Homebirthing Highness calls from the Chamber of Serenity to notify her servants that she’d need their services, they’d postpone any potential c-section that isn’t crash to wait for her and see if she’d need to be urgently waited on, aka being served the Dish of C-section. Purely elective C-sections? Sorry, Mom, I know you’re ready and so on and we might have even given you the anestesia but you’ll have to wait.

          • Dr Kitty

            I was second on the elective list for my son’s birth. So we were expecting to go into theatre at about 9:30. There were emergencies, so we ended up going in at 10:30, and #2 was born at 11:00. I was reading my kindle, and my husband went and got a coffee, so it wasn’t exactly a big deal.

            But still… The entitlement bugs me.

          • Amazed

            Oh it isn’t the emergencies I have something against! They happen. It’s the entitlement, as you say. The happy expectation that they’d get to bump someone else seeing nothing wrong with it when they could have been in the hospital in the first place and had the problem discovered and addressed instead of making everyone wait for them just in case.

            My own buddy bumped the elective c-section of her hospital roommate. A placental abruption. What more reason would you need to bump someone? Not the same as making someone wait because of you just in case and brag about it.

          • Gene

            When I had my first, the staff forgot about me in triage for two hours. Women were screaming and laboring and all but delivering in the halls. My water had broken, but no labor. When the staff remember us, they kept apologizing. Umm, screaming pushing women take priority over stable term ROM. It’s called triage.

          • Amazed

            Yeah, the whole point of going to the hospital is to be treated if there is, you know, an emergency. Non-emergencies get bumped. Still, decent people will apoligize if they just forget about someone. Like my dentist. When I have to wait for my appointment, she apologizes. It’s nice but not really needed. I’m a big girl and I know that sometimes, she cannot wave her wand and magick the emergency patient’s problem away in a timely manner.

        • Dr Kitty

          Idiots.
          Belfast, where I live, population 400,000, has 10 paramedic ambulances capable of transporting patients and several one-man emergency response vehicles and non-paramedic ambulances.

          How monumentally selfish do you have to be to decide that 35,000 people effectively don’t need an ambulance, so you can give birth at home (VBAC being fully supported in UK hospitals)?

          The last time I called an ambulance for a major “lights and sirens” life or death scenario, it took almost 20 minutes to get to me as it is…

          You want an ambulance on standby, may I suggest you pay for a private one, the kind that attend sporting events. That way no-one else has to suffer for your choices.

          • Roadstergal

            That sounds reasonable. Part of the cost of attending a trackday event is paying for the ambulance and EMTs on standby. We’re taking on a known risk, we pay for the extra medical help.

      • Daleth

        Do they really have an ambulance on standby? That’s so unfair to everyone else in town.

        • yugaya

          Yes, I’ve read several birth care protocols from different trusts in UK that state how when a woman signs that she is going against medical advice and wants a homebirth the hospital is obliged to hold extra emergency people on staff and ambulance service on hold and await pending disaster transfer.

    • KeeperOfTheBooks

      And I can’t speak to the UK, but in many parts of the US, we have problems with underserved communities in both very rural areas and even urban ones when it comes to emergency services.
      If my diabetic father, who has also had multiple “cardiac episodes,” calls 911, he can reasonably expect 30+ minutes to go by before the volunteer EMTs–not paramedics, EMTS–can get their stuff together and get out there. This is not a knock on the volunteers, who do a very hard job in addition to their day jobs: they cover an area of dozens of square miles, and calls can, of course, come anytime, including when they’re in the middle of picking up a load of hay/getting the animals vetted/whatever. Dad lives four miles from the nearest town–population 1,000–and about thirty from the nearest hospital equipped to handle cardiac stuff. Backup of the sort they have in the UK is absolutely impossible in those communities, and there are a lot of them in the US.
      I, on the other hand, have lived in major cities ever since I became an adult. I have on several occasions had to call 911 for situations involving someone either getting quite ill (suspected heart attack at my place of work, for instance–“I feel just like I did when I had my last heart attack,”) or someone becoming violent/threatening violence. In each case, the wait–and I repeat, this is in a very large city indeed–was about 10 minutes because emergency resources are so understaffed. I can only imagine what it would be like with half the laboring women in the city expecting ambulances on standby.

    • ukdoc

      Dr kitty, you are spot on with this but it is typical small picture thinking of NHS systems, they also don’t factor in the 2 midwives for a home birth, so taking them away from labour ward, which may be dangerously understaffed. It’s so selfish to expect scarce public emergency resources to be at your beck and call apart from the fact the ambulance response time may be 20 minutes plus even for a 999 call. We just don’t have adequately funded maternity services to look after those in hospital without spreading them even thinner. But the people in charge seen to think it’s better to pay out millions in damages than hire more midwives and doctors to look after women properly, and encourage home birth lunacy as it is ‘cheaper’! U.K. Maternity is a mad mixture of NCB ideology and penny pinching which is starting to unravel…. The people working in the system are working flat out and generally provide great care but they are too thinly stretched and postnatal support etc is non existent in many hospitals

      • Sarah

        They also don’t appear to factor in that homebirthing women, as a population, still require there to be CLUs, emergency facilities etc. So each homebirthing/FMLU woman still also contributes to the cost of needing to maintain a system for EMCS etc.

  • fiftyfifty1

    Dr. Carroll, in his NYTimes piece, badly misuses the zebra/horse medical metaphor. The adage is supposed to go like this: When you hear hoofbeats, think of horses before zebras. This is to remind students that when a patient has symptoms of something going wrong, the problem is more likely to turn out to be a common ailment than a rare ailment. So when a young man has right lower quadrant abdominal pain, think appendicitis before postulating that he is an undiagnosed hermaphrodite with ovarian torsion. When an elderly person has progressive memory problems, think Alzheimer’s before Creutzfeldt-Jakob. But here’s the thing: just because something is a common “horse” diagnosis, doesn’t mean that it is safe or healthy. Horses will trample and kill you just as readily as zebras.

    Dr. Carroll seems to ignore this. In his opinion, we shouldn’t think too much about the risks of homebirth because homebirth deaths are statistical “zebras” compared to homebirth “horse” outcomes where everybody ends up alive. But that’s never how the adage was intended to be used.

    In truth, the things that kill babies at home are usually “horses”. They are the same damn old run-of-the-mill problems that commonly killed babies before modern medicine: infections, asphyxia, meconium aspirations, entrapment. And the thing that kills moms at home is a “horse” too: bleeding to death postpartum.

    The problem comes down to this: When homebirth midwives hear hoofbeats, too often they don’t think zebras OR horses. They ignore the sound completely. And opinion pieces like Dr. Carroll’s are complicit.

    • Amazed

      The rub is, he happily admits homebirth can NEVER be made safe enough for his own babies. But yeah, for the rest of us it can do.
      I ALWAYS listen to what people say. I never look at what they do.
      It’s just like some homebirth loss mothers. They keep singing the prayers of homebirth and insist that it had nothing to do with their tragic outcome… but they quietly march off to have their next baby at the hospital. At least they have a real incentive – not toeing the party line would ostracize them from the birth cult, err, community that many of them had spent the last years into. What’s Dr Carroll’s incentive? I thought pediatricians didn’t suffer any lack of patients? Is he a NICU doctor who’s bored with all those empty places there?

    • Who?

      His article is disingenuous. His central thesis is that the death of a child is an equivalent risk to the risk of cs, other interventions or a nicu stay. The giveaway is this line:

      ‘It’s perfectly rational for parents to accept a statistically
      significant, but relatively rarer, higher risk of one bad outcome to
      avoid another.’

      That, and the second last para which is such a monster of nonsense I won’t copy and paste it in case my laptop explodes.

      No doubt it is true that a nicu stay is less likely for a homebirth baby, and the
      level of interventions is lower for mothers when giving birth at home: neither is available at home, after all. But that doesn’t mean that either mother or baby would not have been more well, or comfortable, or alive, if they had been available.

      Perhaps he was constrained by a word limit. In which case he needs a good editor to help him say what he means within the word limit. Or perhaps he is just as shallow and callous as he comes across.

      • OttawaAlison

        Csections are not bad outcomes, they’re a tool to get the baby out. I’ve had a csection and a dead baby (who was born via vbac though she died before labour), my csection baby is happy and healthy. My body healed. My daughter who died makes my heart ache and yearn every single day. They’re in no way comparable.

        • Who?

          I’m so sorry. Your earlier post talking about your daughter who died touched me deeply.

    • Sue

      Well put – thanks.

      HBMWs are not health care workers – they don’t understand the diagnostic methodology that looks at the risks that are inherent to the patient, the risks of the situation, and the symptoms and signs. Diagnosis inherently involves the classification of risk. Horses, top of the list, zebras low down. The most efficient way of sequentially eliminating possibilities (differential diagnosis) is by confirming or ruling out the most likely answer first, then going down the list in order of likelihood (in this particular person, today, presenting like this).

      I expect a competent Pediatrician would also work that way (one hopes) – perhaps he hasn’t sorted out the concept properly in his mind.

      • fiftyfifty1

        “The most efficient way of sequentially eliminating possibilities (differential diagnosis) is by confirming or ruling out the most likely answer first, then going down the list in order of likelihood ”

        That may be the most efficient way, but that’s not the right way. You have to prioritize the list based not only on what is most common, but also on what is potentially most deadly. It’s a complex balance.

        • FEDUP MD

          Yeah, I imagine during his pediatric training he learned once or twice that this time the fever wasn’t viral, but was sepsis, or leukemia, or JRA, or Kawasaki, etc etc even though 98% of the time he saw a kid with fever it was just fever phobia with a viral syndrome. If he ignored the zebras he will have had a small graveyard following him around.

    • mythsayer

      I hate the horse/zebra thing. Doctors are willfully blind to zebras, IMO. I have all the symptoms of connective tissue disease but not the blood tests (a 1:160 ana is all I ever have but its permanently that high). But I had a nuclear bone scan that showed symmetric polyarthritis of all my small joints. I have documented nerve damage on nerve conduction studies AND sensory evoked potentials. The hose would be its my spine. But mri’s prove its not.

      So five years later I now have a hole in my nasal septum. A HUGE hole and my nose is fully ulcerated around that hole and it has been a year and it won’t heal. Despite that, my ENT refused to think it was related. But I NEED him to say it is, because my diagnosis is so tenuous (to the point that my rheumy wants to take it back…the nuclear come scan might’ve been a false positive..:despite he fact that my FIRST symptom was joint pain in my fingers and I went to EVERY DOCTOR complaining of extreme morning stiffness…BEFORE the bone scan. But sure…it was a false positive…yeah right).

      But now, with my nose refusing to heal, my ENT is finally considering connective tissue. Because short of cancer, which we’ve checked multiple times, it is pretty the ONLY answer. With all my symptoms, it’s clear I’m not healthy and at this point connective tissue issues is the Occam’s razor answer. But despite years of bizarre test results, all they care about is the blood test. Except that things like sjogrens and psoriatic arthritis are usually seronegative.

      I’m SO sick of being treated like a horse when I am clearly a zebra (I met a third year medical student and showed him all my stuff and he was horrified…he said “something is seriously wrong with you” but he can’t do anything to help since he’s, you know, not a doctor yet).

      I know being a doctor is hard. But some of them are doing swipes damage by refusing to believe In zebras at all.

      • Medwife

        A zebra is rare but it’s not a unicorn.

    • Daleth

      PLEASE go post that comment on the NY Times piece, if you haven’t already. It’s so important.

  • Allie

    There are a lot of trolls posting in the comments these days. Would it maybe be better not to engage with them quite so much, since it hijacks the conversation into just one direction, precluding other, more interesting conversations? Just a thought.

    • Who?

      Ultimately, it isn’t about what he thinks, it’s about exposing those positions and putting responses up there that might (though probably won’t) interest or influence him, but that might give pause for thought to a lurker wondering about homebirth, perhaps having some doubts about what her ‘midwife’ has told her.

      There are posters on here who say they came to mock and ended up having a complete change of mind-I think these discussions show both sides in a way that really isn’t possible otherwise.

      • crazy grad mama

        Agreed. It’s important for the lurkers and for the people reading these posts in the future that the troll nonsense not be allowed to stand unchallenged.

    • Kq

      Amen to that. I can’t even read the comments anymore.

  • RBC4
    • Who?

      All the more reason for American women to not choose homebirth, surely?

      • RBC4

        Or to work to improve the situation… my whole damn point all along. Because there clearly is a model of healthcare where home-birth is safe.

        • Amazed

          Oh don’t play the victim card! Improving the situation can only be achieved by flushing out the demons, aka Certified Pretended Midwives (CPM) while your whole damn point all along was keeping them and making them good.

          The thing is, they cannot be made good. They can choose to become real midwives (CNM). No one is stopping them. They don’t want to and you rush to whiteknight them.

          Pathetic. Especially with this rusty sword and the fact that you never took a single damned fencing lesson.

        • Who?

          But why? The people who attend home births in the US are high school graduates with very few deliveries under their belts; they require cash payment up front and leave the washing and cleaning up to the family; they say doctors are evil and add nothing but that they are okay in an emergency; they crowdsource labour management advice on facebook.

          They blame mothers when babies die on their watch.

          Why would they change? They are on a nice little earner, get to play with pregnant women and babies and be the ‘good guy’ in a bad world.

          The only thing that stops them studying to become a nurse midwife is that it will interfere with their lifestyle.

          • RBC4

            Fair enough. This is clearly a very different situation than the one we’re dealing with up here. Registered nurse midwives study for 4 years in medical school, with what amount to residencies. I wouldn’t want an uneducated person at my birth either. When I think of midwife, I clearly have a Canadian midwife in my mind. They’re amazing by the way. Really.

          • Who?

            Sure. The American ones are a nightmare.

            I could not care less where anyone chooses to give birth, but they should know the facts. American homebirth midwives are incompetent, egocentric and most importantly entirely ill-equipped to safely care for pregnant and labouring women.

            The facts are available, and if someone, knowing those facts, chooses to birth at home, fine by me. They’d likely be safer freebirthing ie with no attendant, as at least then it would be cheaper and there would be no one telling them not to call for help.

            I’m glad your family’s homebirths went well, and I’m sorry you’ve had some sadness too.

          • The Bofa on the Sofa

            So you agree with Dr Tuteur that US homebirth midwives are unqualified to have anything to do with childbirth?

            But I am confused, why are you just realizing that now? I thought your were educated and all that shit?

          • RBC4

            I agree with Dr Tuteur that home-births in Canada can be safe, I cannot speak to the system in the U.S. (never did except to say it needs changing).

          • Who?

            See, as I read your remarks below, you assumed midwives everywhere were like Canadian midwives.

            This is a common fallacy we all fall into, assuming our world is the whole world.

            Then you thought that it was doctors stopping these birth hobbyists (my personal handle for US (and Australian and NZ) homebirth midwives) who were persecuted by the evil hospital doctor system, oppressed and kept down by the machine.

            When in fact they are a bunch of lazy, greedy dilletantes who leave chaos and death behind them. They could enhance their skills, but that would involve learning maths and chemistry and being tested and graded.

            And now, you know better. Which is great.

          • RBC4

            I think this kind of vilification does no one any good…
            And now you know that home-birth can be safe when an appropriate model is put in place. What a wonderful thing conversation can be.

          • Who?

            Are you sure?

            I don’t think there is a single untrue word in my posts.

            Read ‘Hurt by Homebirth’ in the sidebar, then come back and tell me I’m villifying anyone.

          • fiftyfifty1

            “I think this kind of vilification does no one any good…”

            Actually, it’s just the sort of vilification that has left Canada much better off than the US! Canada used to have the exact same problem with lay midwives that the US has. But then, in one fell swoop, it outlawed all of those untrained, dillettante, incompetents. And Canada’s homebirth death rate improved!

          • RBC4

            That sounds like a really good idea.

          • fiftyfifty1

            So you support the outlawing of the CMP “credential” then?

          • RBC4

            I can’t speak to it because I have no idea what that means… I admit my ignorance to the American system. I’d love to see a system adopted in the states that allowed safe midwifery care to exist as an alternative to women, as it does here in my neck of the woods.

          • fiftyfifty1

            So you think that it’s “a really good idea” that Canada outlawed all midwives except University trained 4 year midwives. Yet you have “no idea” about what the US should do with its own lay midwife problem? That’s weird. Why all of a sudden so reticent and measured? You never previously were reluctant to spout your mouth off when you had no idea what you were talking about.

          • Who?

            ‘Dilletante’ is a word that doesn’t get used enough.

          • AllieFoyle

            Vilification? Pointing out the negatives and offering examples of poor care is hardly vilification. Homebirth can be safe, sure — it’s safe when nothing goes wrong. It’s very much like saying that russian roulette is safe except for the times when there is a bullet in the chamber.

          • demodocus

            And this guy was calling *me* arrogant.

          • Who?

            I thought he was going to come out okay there, briefly, but he was
            really affronted/challenged by the reports yuyuga posted for him, which
            seemed to completely tip him over the edge to irretrievably crazy angry guy. It’s
            hard to hear things that challenge your world view, and hard to come
            back from the very confident remarks he made.

            You look after yourself.

          • fiftyfifty1

            “Registered nurse midwives study for 4 years in medical school, with what amount to residencies.”

            Canadian registered midwives are certainly better trained than American CPMs (lay midwives who have awarded themselves bogus credentials), but they have less required training than American CNMs (certified nurse midwives) and they have WAY less training than an OB from ANY country. And there is no country in which midwives attend medical school or do a residency.

          • RBC4

            Assistant Dean of the Midwifery education program at McMaster University is Eileen Hutton http://obgyn.mcmaster.ca/faculty_member_hutton/
            She is an obgyn.
            The program is integrated into the faculty of health sciences, the same department that churns out physicians http://fhs.mcmaster.ca/main/welcome.html

          • Who?

            All of which is great, none of which makes fiftyfifty1 wrong.

            Around here, the faculty of health sciences educates doctors, nurses, physios, OTs, speechies and ambulance officers.

            They have different programs, some faculty members work across the programs. It’s administratively and practically convenient, doesn’t mean they all get the same training.

          • RBC4

            http://midwifery.ubc.ca/
            Part of the faculty of medicine at UBC

          • Who?

            Great!

            Are you hoping to make a point other than the one we’re all violently agreeing with, which is that homebirth in Canada is safer than in the US?

          • RBC4

            Nope

          • Haelmoon

            Its not med school though, it falls under the administrative umbrella, but it is not medical school. Midwifery students don’t get an MD when they graduate.

          • RBC4

            So they’re qualified or not to deliver babies in your opinion?

          • Haelmoon

            Yes, midwives in Canada are qualified to delivery babies from low risk pregnancies and low risk mothers. Where the difference comes in is about the consent process. I am very up fron with patients that I can’t predict out comes and I involve them in the decision making, although I will readily provide my opinion. Sometimes I see midwives not wanting violate patient autonomy, to the point that they will support unsafe decisions to accomodate patient choice. Patient autonomy is important, but sometimes you just have to tell the patient that they are making a poor or dangerous choice. They may still choose the same thing, but at least they are closure to truly informed consent.
            I don’t like homebirth, but I would never want to restrict a choice. I am uncomfortable with midwives trying to encourage women to have homebirths, rather than supporting just those that want them. I disagree that women should be encourage to birth at home. I disagree that a 50% intrapartum transfer risk is not a big deal. Most are by private car, but many use ambulance. Not at communities are well staffed from an ambulance standpoint, so transfers are not always as quick and easy as we would like.
            I agree that we are not perfect in the hospital, and some babies and moms will die despite our best efforts. However, I have never seen a baby die in hospital who would have been better off deliverying at home.
            Midwives in Canada are well trained primary maternity care providers. When things deviate from normal, they are well incorporated to the systems. However, I can do things that a midwife can’t, yet there is nothing in the labour/delivery room that I (including my nursing team, because we are a team) can’t do.

          • The Bofa on the Sofa

            When my wife was in vet school, one of her instructors from the College of Vet Med was a biochemist and did not have a veterinary degree at all.

            You don’t know what you are talking about.

          • fiftyfifty1

            Yes, and I’m a physician who is a community faculty preceptor for 2 different Nurse Practitioner programs. I flatter myself that I help turn out some pretty darn good Nurse Practitioners. That still doesn’t mean the students I supervise are in “medical school” or that they do “residencies” or anything like them.

          • BeatriceC

            I don’t think you understand how this works. The credentials of the teacher or the department in which the program is run doesn’t determine what type of program it is. That is determined by the curriculum. CNM students are studying a different curriculum than medical school students, regardless of which department oversees the implementation and who they stick in front of the classroom.

          • RBC4

            So, still not up to your standards to have an OBGYN as an assistant dean then. You are clearly a difficult person to please. You’ll be glad to know NO ONE IS FORCING YOU TO HAVE A MIDWIFE

          • Who?

            A nurse training program won’t be the same as a doctor training program, because the professions are different.

            It’s great high quality people are involved in nurse training. Doesn’t make the people they train as nurses into doctors. It would be a failure if it did.

          • FEDUP MD

            Yeah, I know next to nothing about nursing. If nurses all magically disappeared from the hospital there would be a ton of deaths, because we doctors are not nurses and have no idea how to be a nurse. I remember meeting with a compliance officer in our office who was telling us the order sets all had to have drip rates, concentrations, etc in them and we all looked helplessly because we had no idea what she was talking about- then the nurse manager jumped up and and said she would make all of those out for us because they were in the nursing scope of practice, not ours. It’s not a lesser profession. It is as vital but just very different. Just review nursing notes to see. We are focused on diagnosis and treatment. They are focussed on solving problems and patient education. Both vital, but different.

          • Taysha

            Uh, no, by your model (and the UK model) women are being forced to deliver with midwives.

          • BeatriceC

            This isn’t about being difficult to please. It’s about accepting reality. The CNM curriculum is different from the medical school curriculum regardless of who teaches it. By your logic all my 7th graders should have been given college algebra credit simply because I also taught at a college. I’m sure they’d be pleased to hear that.

          • Haelmoon

            No, Eileen is a midwife. She is a doctor because of academic credentials, not because of medical credentials. I know her peronally, she is not an OBGYN.
            I teach midwivery students from UBC. There are still some gaps in their training. There is also some creep of “natural practices” and biases in their preceptors which often leads to some poor patient choices. OBs and MFMs like myself are happy to be involved in their teaching, but they are really only trained to care for low risk women. A common mistake I see is that because something is common (ie obesity or advanced maternal age) is is low risk. The reality is, in most areas, only 1/3 of women are actually low risk, the other 2/3s have varying degrees of risk factors.
            I like the midwives I work with, but I don’t like homebirth. Not all midwives like homebirth. However, there are many patients that want homebirth without proper screening for risk factors. Putting your head in the sand does not make the risks go away. Plus, some of the so called risks of hospital deliveries (increased inductions and epidurals) are actually driven by patient choice. Not all women consider an induction or an epidural a bad this.
            So yes, midwives are well trained in Canada, but it is far from a perfect system yet.
            (edited for typos, I am sure there are more)

          • Haelmoon

            Not all members of the OBGYN department need to be MDs. Just like the SOGC – Society of Ob/Gynes of Canada – has none OB/GYN members (GPs) and non-physician members (nurses and midwives). We are on the same team, but are not the same thing.

          • Bombshellrisa

            http://www.birthtakesavillage.com/registered-midwives-traditional-birth-attendants/
            I understand that only registered midwives can call themselves “midwife” in Canada. There are still what are called “traditional birth attendants” who do what US CPMs do (with the same type of training) that attend births for a fee. Moreka Jolar and Gloria LeMay are two well known ones.

          • HappyMom

            I know 2 Canadian midwives, neither attended the Certified Nurse Midwife program. Umm, and it is not Medical School! What? I looked into it when I was in Secondary School. No. Untrue. Each of these women did a midwifery training in third world countries, and UK to get their “hands-on”. And never attended the degree program. But my Midwife’s backup did, she was every bit as silly as the midwife I unfortunately had. They were greatly influenced by the movement in Midwifery Today (trust birth). I remember telling her my sister was an Oncology nurse, she said that she used to be also. To which I asked if she had gone to the Midwife program, she said no, and suggested she tried to forget what they learned as nurses. Ugh!

          • attitude devant

            ahem. Actually the requirement for a high school diploma is a rather recent change. There is a CPM where I live who does not have a high school diploma.

          • RBC4

            this is obviously terrifying, and speaks more to my point that you need to look beyond your borders for a viable solution.

          • Who?

            The need is for the truth to be told about birth hobbyists, so people can make a truly informed decision.

          • Who?

            That’s depressing beyond belief.

        • swbarnes2

          Okay, work how, exactly? Do you have a policy recommendation that doesn’t require the whole lot of them to get get years and years of training? Or that doesn’t result in homebirthing midwives saying “No homebirth for you” a lot more often? I think these women want the rush of being the hero of baby birthing, but do not want all the years of schooling that it takes to be employed in places where childbirth is SAFEST, namely hospitals. When half of primips wanting a home birth end up at the hospital anyway, the logical conclusion is that they should ALL start there. How do midwives make a living with their client base so drastically cut?

          • RBC4

            All this day confirms is that I remain thankful to live in a country with a single payer heath care system. Midwives here are paid regardless of “risk-out” (called transfer of care here).

          • swbarnes2

            One more time…is your ideal standard of midwifery going to include HALF of primips being transferred to the hospital WHILE IN LABOR? Don’t you have to conclude that even very well trained midwives are crap at determining which primips are actually able to birth at home, and therefore, the safest policy is not to try to make that determination at all, but have everyone at the hospital?

          • RBC4

            Very trained midwives (in Canada, jeeze, do I still have to say this) are just that, very trained, and able to assess risk adequately, as the studies show. Studies supported by Canadian OBGYNs.

          • fiftyfifty1

            “and able to assess risk adequately, as the studies show.”

            So with first time mothers it’s 50/50. So basically, they are as well trained as a coin?

          • RBC4

            But there is no increased risk in transfer of care either… its not entirely about predicting the outcome, which even the best obgyn will tell you is impossible, its about knowing when to cut bait and get to the hospital. Canadian midwives clearly do know this. An ambulance ride, or a ride in a car, or whatever, does not increase risk factors for birth significantly, as the study shows. Studies supported by Canadian obgyns

          • yugaya

            “Canadian midwives clearly do know this.” Not in Ontario:

            “Because there was a previous history of placenta accreta/previa, a midwife-attended hospital birth had been planned for this birth with immediate IV setup on admission and a plan to manage the third stage of labour with oxytocin. This is not what transpired in the event. According to the midwife’s notes she recorded a gestational age of 36 weeks (37 weeks by ultrasound dating) and yet advised the mother to come to the clinic. If the gestational age were 36 weeks, this was a preterm, premature rupture of membranes with a gush – a situation requiring timely assessment.

            When you add the past history of precipitate labour at 38 + weeks and placenta accreta/previa, the location for that timely assessment should be the hospital. Despite the midwife’s advice, there is no record of an assessment by the midwife in her clinic or in the woman’s home. It is unclear whether the mother elected to go to hospital on her own or at the instruction of midwife”.

          • RBC4

            Wow, you found 1 case (which you failed to cite, but I’ll take your word for it that its legit). Any cases of OB’s making a bad decision? They’re infallible right. Good grief the lengths some people go to. Mistakes are indeed made. If you are out to villify, you will succeed, always. If you are out to educate yourself, I’ve provided some information for some of you. Good luck in the future.

          • Who?

            You need to read the whole report. Case after case, and likely a drop in the ocean.

            It’s horrifying.

          • Amazed

            You think you can educate us after literally everyone, from humble yours truly to Haelmoon who’s a high risk OB has literally handed you your ass on a platter about one fact or another?

            Try to enroll into a midwifery program. There are male midwives. With a hubris like yours, you’ll fit right in with the midwives from the report yugaya has so kindly and repeatedly pointed out to you and you pointedly ignored.

          • yugaya

            Wow. All of the reports are posted in the comments under the SOB blog you cited. And you just hit the level of “disgusting beyond all means” with that “you found one case haha it proves nothing”.

            Here’s more:
            2006, #8 term stillbirth, the case of “brownish-green fluid” meconium present at rupture of membranes turning clear when homebirth midwife assesses the woman 12 hours later:

            “On Aug. 25 at approximately 1030 hours, she reported ruptured membranes and contacted her midwife. Early on the morning of Aug. 26, the patient
            started having contractions. At that time, a brownish-green fluid was reported. The midwife assessed her at approximately 1000 hours. Since
            her contractions were irregular, the midwife determined that the mother was not in established labour. Membranes were confirmed as ruptured and
            the midwife’s notes indicate that the fluid seen at the time was clear, the cervix was 1-2 cm dilated, posterior, 25% effaced and spines -2 to -3. The midwife also noted the presence of some meconium or possibly dried blood.

            The midwife arranged for an obstetrical consultation
            because labour had slowed down. The obstetrician saw the patient at approximately 1430 hours. The consultation report indicates that he reviewed the history and relied upon the vaginal examination as
            documented by the midwife.

            It appears there was no clear communication between the consulting obstetrician and the midwife about the care of the patient, the issue of monitoring and the question ofin-patient versus outpatient care. As the obstetrician was consulted about the potential for intervention and the management of the
            pregnancy, however,it should be expected that these parameters would be dealt with both verbally and in writing.

            While the cause of death was most likely hypoxemia, at autopsy there were no significant neurological changes apart from moderate congestion in both cerebral hemispheres. There was staining consistent with meconium aspiration in the terminal airways.”

            The obstetrician consulted relied on midwife’s notes, and the midwife did not understand that the recommendation was for hospital. Once back in hospital it was too late and this baby was lost.

          • Who?

            If we were playing homebirth bingo, this one would have all the ‘what’s a few dead babies’ squares marked.

          • Amazed

            Haha, so funny, right? Nothing this bad, just a preventable death due to horrifying negligence. Big man RBC4 little joke!

          • Taysha

            You know, being snarky with people who know more than you doesn’t help your case.

            It’s legit. There are dozens. Hundreds.

            I take it you’re the kind to be understanding with murderers, pedophiles and robbers? I mean, vilifying is so mean.

          • RBC4

            HUNDREDS!!??? My goodness, by all means, lets see the proof of hundreds.

          • Taysha

            By all means, let’s see the proof homebirth is AS SAFE AS THE HOSPITAL.

            Risk for risk. Identical numbers.

            AND GO!

          • yugaya

            Taysha this is not the first time I’ve seen that level of pathological response when you confront these zealots with real, documented deaths at the hands of those that they idolise.

          • Taysha

            I like it when they belittle us and then we’re bully and vilifying them.

            Or, you know, they’re dumb and flounder when out of their comfort zone of woo.

          • yugaya

            2006, #21 neonatal death in “low risk” homebirth:

            “This 38-year-old G2P1 sought midwifery care on Dec. 14, 2005, with an expected due date of July 15, 2006. Her previous delivery was a 16-hour home birth, and it appeared that the baby required some resuscitation atdelivery.

            “The patient took five hours to dilate from 9 cm to 10 cm; the Society of Obstetricians and Gynaecologists of Canada guidelines for a multiparous woman
            is 1 cm per hour. The fetal heart was recorded every two to three minutes. The notes did not explain why the heart rate was being recorded so frequently. The recommendation for intermittent auscultation
            requires the fetal heart to be listened to ever y 15 minutes for one minute throughout active labour and the presence of periodic changes no ted. In the absence of reassuring findings, continuous electronic monitoring should be commenced.

            The entire labour has only one acceleration of the fetal heart noted at 1005 hours. It was appropriate
            to use intermittent auscultation during labour, as long as the care providers were reassured of fetal wellbeing. There is no obvious indication that the midwives were concerned about the baby even with the presence of only one acceleration throughout labour, which was not reassuring.

            The fact that an IV was commenced indicates there was some concern, as usually IV is only started at home where there is a need for Group B Streptococcus prophylaxis, dehydration, postpartum
            hemorrhage or in preparation for an emergency transfer to hospital. The documentation during this labour is inadequate and confusing, and the chart is not appropriately filled in. There is no signature
            corresponding with the initial record. Midwifery notes should have a signature sheet along with the midwives’ registration numbers.

            The use of castor oil when the cervix is 9 cm dilated is questionable. Thisproduct is used at times to try and assist a post-term woman get into labour, not to augment desultory labour at 9-cm dilation.

            At 1926 hours, the infant was born with no tone or respiratory effort and the heart rate was 146 bpm. The ambulance was called immediately and arrived
            at 1930 hours. The Apgars of the infant were 1 and 5 at 1 and 5 minutes. Several efforts were made to intubate the baby, but they were unsuccessful,
            so the baby was transferred to the nearest hospital where the initial pH obtained was 6.85. The infant was transferred to The Hospital for Sick Children and was treated in the neonatal ICU. The infant died there 17 days later from profound effects of perinatal asphyxia and hypoxic ischemic encephalopathy. “

          • RBC4

            2006, 2009, I mean, this is clearly a problem since you have 3 cases in 10 years as evidence… It’s darn near an epidemic.
            I’m not going to bother, but if you think I can’t find cases of OB’s making mistakes, you’re kidding yourself.

          • RBC4

            The proof is in the paper as they say. You can vilify if you want, and you will succeed as I said, but it’s ridiculous to assume this is the norm.

          • Who?

            Would you expect doctors to not be disciplined over failures like these?

            None of these midwives were.

          • yugaya

            This is from the first Ontario homebirth outcomes study 2003-2006 – first column is OOH births, second column is hospital births. That study is available here: http://www.aom.on.ca/files/Communications/Reports_and_Studies/Birth_Ontario_Home_Birth_Hutton_Sept_09.pdf

            That’s the study that first claimed that homebirth with Ontario midwives is AS SAFE AS HOSPITAL. Notice the carefully designed equal number of deaths in both groups. Read the cases documented in the coroner reports. Note down how many of those deaths fit the exclusion criteria for this study and are among the over 400 outcomes that were removed from the final toll. Even one would have been enough to show the truth – homebirth is never, under any circumstances as safe as hospital birth. Not even in Ontario.

            (For the second study the authors went to more extreme lengths and removed the outcomes of basically all complications that they could think of. Still a number of dead babies had to be manually removed via the same mechanism of *coding errors*.)

          • swbarnes2

            Right, it’s a little hard to see exactly how big the groups they are talking about are, but in the right-hand column of page 7, under “Meta analysis”, they claim stillbirth and neonatal death rates to be about 1.15 per 1000. If you assume they are talking about the largest possible groups, that’s 36,000 women, for about 40 baby deaths. But they eliminated a lot of deaths off the top, including 189 that maybe should still be included, and a few dozen reports that are contradictory…but the coronor reports would seem to indicate that a lot of homebirth deaths include suspicious paperwork, so likely at least some of those confusing reports are likely homebirth deaths, and with at most 40 deaths (and some of the tables seem to be talking about smaller groups with fewer deaths) omitting a dozen deaths could really swing the analysis. As a side note, I’m not seeing the 45% transfer rate that Dr. Tetuer quotes for primips (just 25% overall transfer), maybe she’s remembering that figure from a paper on British home births?

          • yugaya

            It could be from the follow up study for the period 2006-2009, but the link to it is now dead: ( if anyone can find it, please post).

          • yugaya

            Do you understand how every single one death like the ones I posted being excluded from the studies you keep bringing up on the grounds of missing documentation/coding errors changes the mortality rate comparison that is the golden argument of those like yourself clinging to the idea of safety of homebirth in Ontario?

            Do you not understand that these are only the cases that we know about thanks to external, non-midwife influenced review of a selected number of cases? No? Mkay.

            My mistake. I should have figured out I was talking to stupid long time ago.

          • Charybdis

            Noone is saying that OB’s don’t make mistakes. It happens, However, they are held accountable for their errors, it is reviewed by their peers/medical board. It can result in a reprimand or loss of their license to practice medicine, if the error is bad enough. Plus, they have things like malpractice insurance. CPM’s here have none of that, so they can continue to lie, cheat, steal, and misrepresent themselves to other unsuspecting pregnant women who have “done their research”.

          • yugaya

            “but if you think I can’t find cases of OB’s making mistakes”

            No one is saying that OBs don’t make mistakes. But when OBs make mistakes there are consequences and ways for families to obtain justice and compensation.

            Currently only homebirth midwives in Florida are made to carry malpractice insurance and parents often don’t even have the ability to file complaints to medical boards or with the police because CPMs in their state are *alegal* and not subject of any professional or legal consequences of their actions.

            Image and stats are from USA study that reviewed over 800 obstetrical malpractice cases for the period indicated. When OBs make mistakes there is a system in place that protects those harmed. When homebirth midwives make mistakes, they usually just file for bancrupcy and move to another state and carry on killing just the same.

          • swbarnes2

            I take it that the super frequent monitoring indicated that the midwives knew something was going wrong, but they didn’t call the ambulance and really had no tools to deal with whatever was wrong except whatever they could push through the IV?

          • yugaya

            Yes, major red flag that is picked up in the coroner review:”The fetal heart was recorded every two to three minutes. The notes did not explain why the heart rate was being recorded so frequently.”

          • yugaya

            Case:2011‐S‐3
            OCC File:2009‐705 The midwife dispensed an unqualified, unlicensed “support person” to attend a woman with high risk pregnancy in an emergency situation at 36 weeks 2 days gestation:

            “In this case, the role of the support helper/attendant was to provide assistance to the registered midwife for the birth. It was not the
            appropriate course of action for the midwife to contact/deploy a support person who was not a registered health care provider for a patient
            that was G11P6 at less that 36 weeks gestation, with frank bleeding and a history of prenatal bleeding and prior retained placentae, who was in labour.

            This infant was stillborn as a result of placental abruption at 36 weeks gestation. Delays in getting to the hospital appear to be primarily a function
            of the rural setting where the patient lived and possibly the weather at the time. It cannot be determined from this review whether earlier transportation to the hospital would have resulted in a more positive outcome.

            However, upon being notified of the vaginal bleeding, and realizing the environmental challenges of the family transporting the woman to hospital,
            the midwife should have immediately contacted the local Emergency Medical Services(EMS).”

          • yugaya

            2009-N-12 – records “unclear” for a planned homebirth (must be “coding errors”), one GBS culture got “lost”, so second one was ordered without any explanation:

            “GBS culture on August 18 at 36 weeks was not reported. The GBS culture repeated on August 28 2008 at 37 weeks 4 days was negative. A home birth with midwives was planned…Post mortem examination revealed severe diffuse acute bronchopneumonia in both lungs. Cultures from
            cord blood, cardiac blood and the lungs grew beta-hemolytic Streptococcus group B. The cause of death was prolonged rupture of membranes with ascending infection, acute chorioamnionitis and foetal sepsis. This infant died from Group B Streptococcus sepsis. Prolonged rupture of membranes (>18 hours) is a significant risk factor for chorioamnionitis and neonatal sepsis. In this case, membranes had ruptured approximately 33.5 hours prior to delivery.”

          • Who?

            Was this the flounce?

            He’s failed to stick the flounce before…

          • yugaya

            And one of the most horrific cases of unethical conduct I have ever seen anywhere:

            2009-S-9. High risk mother and horror high risk home stillbirth at almost 42 weeks in October 2006.

            “The midwife engaged in an argument with the EMS crews about where to transfer the patient and child. There was significant discussion about seeking authority to cease resuscitative efforts on the baby once it was learned how long the infant had actually been without signs of life. The midwife was demanding that the ambulance transfer the patients to Hospital A, while the EMS crews were being directed by a doctor to transport the patients to Hospital B. The EMS crew was given permission
            to cease resuscitation efforts on the infant and the mother and stillborn were transported to Hospital B at 1230 hours.

            .In this case, contrary to the guideline, the mother was advised to drink juice, lie down and call back if no movement was detected. The first midwife
            had many opportunities and clinical reasons to call an ambulance (e.g. no foetal heart detected, no second midwife at birth, baby not responsive at birth and inability to set up bag and mask for neonatal
            resuscitation). The second midwife also chose not to call an ambulance immediately upon her arrival at the scene 30 minutes after the birth. She waited another 30 minutes (now one hour after actual birth), to call the EMS

            The resuscitation performed by the attending midwife appears to be totally inadequate. The record indicates that the midwife unwrapped the nuchal cord that was void of blood. She then suctioned, although there was no notation of how the suctioning was done. The record indicates that the midwife did one minute of cardiac compressions, then“quit”. The midwife was obligated to perform neonatal resuscitation until the EMS arrived
            to assist and transport to a hospital. The midwife was certified to provide neonatal resuscitation and did not in any way offer the accepted resuscitative efforts for which she was trained.

            There was no notation on the record of the parents ever asking the midwife to cease attempts at resuscitation. Upon arrival of the EMS crews one hour after the birth, the parents gave permission for resuscitative efforts to be performed. The midwife did not communicate with the EMS that the infant had been deceased for almost an hour. ”

            Full case report detailing the horror is available here: http://www.mcscs.jus.gov.on.ca/stellent/groups/public/@mcscs/@www/@com/documents/webasset/ec083752.pdf .Keep in mind that no disciplinary hearing was held even over this death or any other case that is documented in the coroner reports between 2004-2011. So excuse me if I don’t think that these studies you keep bringing up prove anything other than the lengths to which homebirth apologists will go in order to keep these deaths deliberately hidden from the public view.

          • DaisyGrrl

            I suspect that case report relates to an Ontario midwife whose license was finally revoked for incompetence in 2014. I can’t find the full decision document right now, but I remember reading there were three perinatal deaths in her practice during the period reviewed in disciplinary proceedings (she was usually conveniently late to the scene…). Meanwhile, she was allowed to practice for nearly five years while the disciplinary process wound its way through the college of midwives process.

          • yugaya

            According to this document from 2014 that promises more transparency: http://cmo.on.ca/wp-content/uploads/2015/06/CMO-Transparency-Report-Nov-26-20141.pdf, all disciplinary hearings and actions are to be available to the public on their website. There is one license revoked in 2014, but that midwife is already eligible to be reinstated because her license was revoked for a period of one year, and the proceedings against her started in 2012: http://cmo.on.ca/wp-content/uploads/2015/07/Discipline-Hearing-Summary.pdf

            The coroner review report from which I quoted the case details was published in September 2010.

          • DaisyGrrl

            I may email them and ask for the document. It was something like 100 pages of inexcusable act after inexcusable act. The disciplinary hearing covered the period from 2006-2009, if I remember, and took 3 years to get to a hearing because they reviewed every…single…birth she presided over as practice lead. I’m reasonably sure that the death mentioned in the coroner’s review was one covered in this midwife’s disciplinary hearing.

            Some of the highlights of what I remember reading include:
            – many missed births (some became unattended, others had a new midwife who was left alone with the mother, against standard of care) because she wasn’t in the area when she was on-call.
            – at least three deaths, two of which may have been preventable (including the shit show you quoted above)
            – inviting a new member of her practice to “catch the baby” in a hospital where the new midwife had yet to receive privileges
            – repeatedly stating during the hearing that no one knew at the time (mid-2000’s) that maternal obesity was a risk factor for poor outcomes
            – accepting a patient with Graves disease. She looked the condition up on Wikipedia(!) and decided she could provide prenatal care.

            She was reported to the college by a neighbouring practice, who I imagine was sick of cleaning up after her, and a couple of her former employees.

            I doubt she’ll get reinstated quickly or easily. I get the impression that the college wanted to make it as hard as possible for her to overcome the findings and get reinstated.

            As a final note, this midwife has a high rating on ratemds.com (over 4.5/5). Her patients loved her.

          • OttawaAlison

            See that’s a big issue, these midwives are nice, the women trust them with everything and when shit hits the fan it protects the midwife. In one of the harrowing cases I know about (won’t discuss details), she fully believes the midwives were blameless even though they went against known guidelines and recommendations.

          • KeeperOfTheBooks

            Here in the US, a (now former) friend persuaded her daughter-in-law to use a CPM for a homebirth rather than having an OB at a hospital birth because everyone knows that Homebirths Are Better. This was DIL’s first baby.
            The midwife never showed up. She sent a student to check mom, who was laboring in a tub but really uncomfortable and scared. Student decided that mom was nowhere near delivery and left. Mom ended up with an unassisted-except-by-terrified-dad homebirth with plenty of accompanying tearing, then later had what I can only describe as the worst breastfeeding story I ever heard, and I’ve heard some doozies, but heaven forbid she quit just because her nipple was partly detached…
            Mother-in-law’s biggest worry was that this might mean that future babies wouldn’t be born via homebirth, and that the mom and dad might hold this against the midwife, who, after all, knew what she was doing since she’d attended hundreds or thousands of births. MIL was even networking with another midwife who was a friend to try to sit down with the couple and explain that future births wouldn’t be so bad and they should just trust birth and CPMs.
            The mind boggles.

          • DaisyGrrl

            I wanted to add that if it had only been that death, I doubt the midwife would have been disciplined. It was the consistent pattern of behavior that showed she was a danger to her patients that got her license yanked. Had she bowed her head and promised to do better and said she’d learned her lesson (and that was the only incident)? I bet she’d still be practicing…

          • CognitiveDissonaceHurts

            Back in my crunchy granola days, before midwifery was legislated in Ontario, I actually interviewed, as a possible midwife candidate for my home birth, an Ontario midwife who later had her license revoked for negligence…

            She was very warm and I liked her, but decided to go with a British-trained midwife instead of a lay midwife.

            History shows that I made the right choice.

          • yugaya

            “Mistakes are indeed made.”

            No. Several reviews asked for the conduct of midwives to be examined by their professional oversight authority.

            Not a single disciplinary hearing happened over any of these cases. So – if the “Mistakes are indeed made.” by the midwives like you say, how come there is zero responsibility?

          • KeeperOfTheBooks

            No human being’s infallible, but some are held to account. OBs are. If that stunt happened in a hospital, that OB would be up before a review committee before you could say “review committee.” Midwives, however, don’t like to be so mean and unsupportive as to question a decision made by a colleague.

          • Who?

            ‘…does not increase risk factors for birth significantly…’

            What’s a few dead babies, right?

          • RBC4

            Babies die, obgyns and midwives know this. Neither can prevent it. Neither is any better at preventing this, as the research shows, research supported by Canadian obgyns. I’m obviously talking to various forms of brick walls. If you think having an OBGYN makes you immune to a negative outcome, you are wrong. Read the article from one of our most respected news organizations, then the paper from the University of McMaster. I’ll leave you all to debate the data. It’s there for you to either educate yourself, or ignore at your choosing, nothing I say will change your mind clearly. Bye for now.

          • Who?

            So is this the flounce?

          • Taysha

            I had an OBGYN. Hell, I had an MFM.

            He told me the risks up front.

            Bet you don’t see midwives do that.

            You’re beyond pathetic at this point. It’s even worse because you can’t suffer a midwife yourself.

          • Who?

            This is the key-informed choice.

            Know the facts, and make a decision.

            RBC4 either really believes all midwives are safer than all doctors and hospitals, or doesn’t care whether they are or not, and just likes homebirth, and thinks that any risks-which mostly fall on the baby-are worth taking.

            Let’s hope he’d allow any woman in his life to be fully informed and make her own choice, not force her to rely on his judgement.

          • Amazed

            Neither is any better? Fuck you, scum. Obstetricians are better and that’s a FACT. Another fact that can’t make it through this thick thing you’re carrying around calling it your head.

            Do you know what’s gonna happen if people decide not to pursue higher, OB education? The plummeting of death rates will be reversed, you freaking idiot.

          • Amy Tuteur, MD

            Babies die? Not if obstetricians can help it, they don’t. Some midwives and people such as yourself display an ugly, callous fatalism toward these deaths.

            Modern obstetrics has lowered the neonatal mortality rate 90% in the past 100 years. Midwives haven’t done a damn thing to lower neonatal mortality. Perhaps it’s because of that ugly fatalism.

          • FEDUP MD

            Babies do die. As physicians we hate it, and spend our lives trying to avoid it, and even in cases where it turns out with current technology we couldn’t have done anything different, we research to try to advance the technology so that these things can be prevented in the future. My dream as a pediatric subspecialist seeing very sick kids is that someday I will be put out of business by medical advances.

          • OttawaAlison

            Withoit modern science many preemies, babies with parents with incompatible blood times, moms with pre-eclampsia would’ve dead. No one accepts those deaths as “it just happens” in 2016 since there are ways now to prevent this. Science says moms who have had a previous section do better in hospital, just like moms who would vaginally like to push out a Breech baby.

            Likewise while some stillbirth death at this point in time are unpreventable, did you know obgyns and research scientists aren’t sitting on their asses and shrugging their shoulders? That there is actual research happening at this point in time to prevent death’s like my daughter’s. You know what too, eventually when the causes are known, chances are more screening will happen. When tools are advanced enough to measure oxygen inside an at-risk mom’s babies, there will be more screenings done (and this would probably be aimed at every mom above the age of 35, regardless on how healthy the mom is).

            Here’s my big beef – a lot of midwives, even in Ontario (where I’m assuming you’re from, just like I am), have accepted a little technology but are always hesitant to add new technology because they feel the whole birthing process is pretty much perfect as it is, especially if we trust our bodies. Every screening, test becomes an open ended “it’s up to you”, while with my obgyn it’s more of “we recommend you do this” and you know what, with their years and years of experience I’ll take it.

            Birth has a huge waste rate, heck so does pregnancy especially in the early stages. The screenings that are done are not completed to fund obgyn’s beach houses, they’re done so the obgyn can routinely assess your risk factors. The other thing is, obgyns really don’t like to see babies die. Hell my tough as nails, stoic obgyn had tears in her eyes when she was telling me my daughter died. I got tested out the ying yang to see if I had blood disorders, liver or kidney issues or high blood sugar. The likely culprit was the placenta or maybe the cord but we do not know why, but my obgyn just didn’t say “oh well some babies just die”, which is something I often see in the natural birthing communities.

            I like to tell people my daughter’s death wasn’t preventable…yet, but I hold hope for the future. I lost my daughter almost 14 months ago and it is something that still consumes me so much even though I’m still able to work, volunteer, parent and function. I had a dream last night I had another stillbirth, it was a freaking nightmare last night and it is still a nightmare that I’m still in shock that it actually happen. The thing is, even though it was my worst nightmare to lose a child after a full-term pregnancy, I literally could not fathom the day to day living with such deep grief, that’s the thing, when it comes to life and death matters it is really hard to fully fathom what dealing with such a close death is like, so when people are saying “well I’m making an informed choice to not take the strep B or have a vbac at home” even though the stats are on your side, I often think really comprehending what you’re actually risking is very difficult, because it’s an abstract until it actually happens.

          • Chi

            I’m so sorry for your loss.

          • KeeperOfTheBooks

            I am so very sorry for your loss. I can’t imagine what you feel every day. I had a very early miscarriage, which was the worst emotional pain I’ve ever had (still hurts just thinking about it, and if I could check out of the month that baby was due entirely, I would), but I know it would have been orders of magnitudes worse later on. I wish I could say something that would help, but all I can offer are my sincere wishes for healing and peace.

          • Azuran

            But if you have a serious life threatening emergency, like massive post partum hemorrage or placental abruption, then yes, the ambulance ride might make the difference between life and death.

          • HappyMom

            Don’t you mean McMaster University? Are you really from
            Ontario?

          • niteseer

            Except for severe shoulder dystocia. That is a bummer during a transfer. Oh, and severe postpartum hemorrhage; and, undiagnosed congenital anomaly of the baby. Or severe weather conditions, like heavy snow and ice. The list goes on.

          • KeeperOfTheBooks

            “Or severe weather conditions, like heavy snow and ice.” Which, I’m sure, never occur in Canada, right? Oh, wait…

          • DaisyGrrl

            That’s when we bring out the dog sled ambulances.

          • KeeperOfTheBooks

            Two phrases I never, ever want to hear in combination and in relation to me are “labor” and “dog sled ambulance.”

          • CognitiveDissonaceHurts

            Baby #4: homebirth on the worst day of the winter. Ice storm all night shut down the roads. Our “we’re only 10 minutes to the hospital” would not have worked out so well if there had been an emergency.

          • Megan

            Or placental abruption, or amniotic fluid embolism, or entrapment…

            This is why I will never understand the mental gymnastics it takes to believe homebirth is as safe as hospital birth. It simply CANNOT be, no matter how much the system changes, credentials change, etc. if moms want to take on that risk for themselves and their babies after truly informed consent they are welcome to do that. But to say it’s as safe as hospital birth just is not and can not be true.

          • Who?

            So does this mean they assume-based on experience-that 50% of first timers will need a transfer? And they factor that in?

            In that case the only reason you would start at home is ignorance of how much labour hurts and how little you’re going to feel like climbing into an ambulance half way through.

          • yugaya

            Studies from which two midwives, based on their own self-appointed criteria, excluded as many fudged records and bad outcomes as possible.

            For the third time: have you read the Maternal and Perinatal Mortality Review reports for Ontario for the period covered by those studies or compared those cases to the exclusion criteria utilized in those studies? If not, please stop citing them as proof of safety or awesomeness of Ontario midwives.

            To me the worst revelation about the state of midwifery in Ontario, after reading through all of the cases that were picked up by coroner review process ( so nowhere near all the cases) was when I learned that not a single midwife in Ontario was subject of any disciplinary action over any of these deaths.

          • Amy M

            I have an online friend in (Manitoba?–not Ontario Canada, somewhere farther west) who wanted a homebirth with her (only) child. She had 2 midwives, it was all integrated into the hospital system. Either right before, or during labor, the midwives palpated her belly and said something like “Huh, this baby’s got its arm over it’s head.” At some point during labor, she experienced excruciating pain and insisted on getting to the hospital, which the midwives took her, in their car. At the hospital, it was determined that the baby was footling breech—my friend had a Csection, and all was well.

            I didn’t think this spoke well of the midwives who decided the baby’s leg was her arm over her head and that the baby “must have flipped” in labor. I’m just glad my friend wasn’t so hung up on homebirth.

          • HappyMom

            Like the “study” that supposedly shows breech birth is safer than a cesarean I heard about all last year? 😉 Good Canadian study, supported by the Society of Obstetricians and Gynecologists? So just a question, this is a response to women who are staying away from hospital care because they want to avoid cesareans. So why does the new policy need to be a situation, where they are experimenting on women who have chose the hospital and medical model of care? Why, are their bad choices, changing policies for everybody? In Canada! And no, my midwife in Ontario did not get paid if she didn’t deliver my baby, and I was risked out because of GBS. So she advised me to refuse the GBS test. She scared me out of it.

          • Amazed

            A Michigan mom, Sara Snyder, lost her baby because the midwives at her birth centre had attended a breech birth conference (or workshop) in Canada, had watched a breech birth video and told her about this study, neglected to mention that breech births were only recommended to be given a try at hospitals. Instead, as Sara said, midwives tried to do it at home, just not Sara’s home but someone else’s. The result was disastrous, the midwives claimed bankrupt and promptly opened another birth centre while Sara and her husband were left with the cold comfort of being confirmed to have been wronged by the court.

            All hail the breech birth study!

          • Sue

            We know about the outcomes of HB in countries with nationalised health care systems.

            In the UK, the Birthplace Study showed that, despite a well-integrated system, tight risk-outs and 40% transfer rate, 3 X more babies of first-timers DIED at home. They don’t even report injury or disability.

            Same in Aus – a review of the publicly-funded HB system also showed approx 3X excess mortality at home.

            There are many advantages to nationalised health care systems, but they can;t transform the home into a hospital unit with a health care team at the ready.

          • yugaya

            In Australia homebirth death rate which is low risk term pregnancies is the same as that for all hospital births, and all hospital births include all the severely premature losses and highest risk pregnancies.

          • Who?

            We also have some rugged individualists who head out to the badlands of birth hobbyism for their deliveries-their outcomes are the subject of coroner’s inquests, particularly in South Australia where this seems to to be particularly prevalent.

          • KeeperOfTheBooks

            There’s also a lot of fear-mongering in a lot of NCB circles.
            A friend of mine is working on becoming a CPM. We don’t talk about it because I think she’s a nice person, if uneducated and misguided, and I hate conflict. (I do post rebuttals to her inaccurate NCB screeds on FB, which has led to her not posting that stuff anymore.) She grew up in a crazy family, was never educated, and honestly seems to believe that if you go in for a hospital birth, there’s a good chance that the OB is going to tie you to a table, perform a C-section against your will, and probably sterilize you for good measure, too. It’s insane. She is utterly terrified of the whole hospital system and is totally scientifically illiterate, to boot, but after a few dozen births she’ll be able to hang out her shingle. Horrible.

        • Taysha

          It’s so sweet of you to think about us poor womin. Because we certainly have no idea how to proceed in this and try to improve our birth and the health of our children.

          I mean, we don’t even have a female OB to take on the predatorial CPMs that make it impossible to regulate homebirth…..wait…..

        • Charybdis

          Uh, no. There is no model where home birth is as safe as hospital birth. Can it get close, if the planets are aligned correctly (roomy pelvis, not-too big baby, uneventful labor, minimal pushing, little to no tearing, etc)? It can, but it is still not as safe as hospital birth. If the parents are informed of the risks of both types of birth and agree that they will place their eggs in the “homebirth” basket for whatever reason, then fine. But to be deliberately mislead by a CPM who has very little education and training and is preying on their fears/reservations about giving birth in a hospital is another thing entirely.
          What exactly is the siren song of home birth, anyway? No other procedure, no matter how minor, has a “home” option. Surgeons don’t make house calls, emergency medicine doctors don’t make house calls, follow ups after surgery don’t happen at home, etc. Things can happen that need to be addressed my a medical person in a medical setting, where all the resources (meds, bandages, radiology, oxygen, IV’s, etc) are located.
          You can’t have a non-interventioned birth until after it is over, You can opt for a scheduled CS or you can have a trial of labor. It is called a TRIAL for a reason and only in hindsight can one say they had straightforward vaginal birth.

          • rox123

            I can think of a few places where it’s safer at home. In my country, one baby fell of the delivery table after being given birth to last year, another one has died after his mum was made to walk between hospital wards while labouring, and if I remember correctly about ten babies died about 5 years ago when a neonato ward caught on fire due to hospital rules not being respected and hospital budget tight (shortage of staff). I think depending on the country, poverty and corruption, in certain situations, it might be safer to deliver at home.

          • yugaya

            No, even in worst of circumstances in the developing world the difference between timely access to obstetrical care and lack of it is the difference between life and death.

            The only situation I can think of when home was truly safer than hospital for giving birth is when the world was trying to bomb to death the dictator of my country while he was sleeping, and the supposedly smart bombs ended up landing in the maternity ward of the nearby hospital.

          • Amazed

            About 15 years ago, we had 2 babies DIE in a maternity ward here because of real, God’s true, horrible hospital-inquired infection. I don’t remember what happened to the staff but I remember the ward was closed for quite a long time until they truly and fully cleaned their fucking shit. The uproar was enormous. People were indignant – and they were right.
            Homebirth deaths here? As early as the first one (that we heard about) we were treated to the whole program: doctors only want to scare you, your baby doesn’t have bradycardia, your body knows how to birth your child… Next thing you know, a floppy blue baby is delivered at the end of a skype-commented labour, mum rushes to the hospital with cord still intact… and the entire fiasco gets deleted from the net as they howl how it was her choice and babies died in hospitals, too, and what terrible people we were for questioning her sacred Choice.
            As I have mentioned, that was the case that sent me curious to check if homebirth was truly safe in the USA as they screeched. After a few minutes in the web, I was questioning my own sanity since all I could find was praises. And then – bingo! Janet Fraser. Dr Amy commenting on her. Amazed clicks the skepticalobblogspot.com to see just how distorted the JF thing is here since NO ONE can be more traumatized by a c-section than baby death, and the rest is history.

          • yugaya

            Well, we have dr Geréb Ágnes, much loved by midwives in USA. Too bad that her fangirls over there never bothered to learn exactly how many babies died completely preventable deaths at her hands. I typed it up once, I’ll add it here when I find it:

          • Amazed

            About ten years ago, we had a woman going in coma after an elective C-section. I don’t remember who had fucked up but I think someone had. Bad things do happen in hospitals since they’re staffed by people and people, sadly but not forgivably, fuck up. Well, this story is still remembered and used like a cautionary tale against all C-sections (that was the same hospital that saved my friend’s baby after a placental abruption 5 months ago. You know just how they achieved it.) We also have at least 2 homebirth deaths that I can think of right now in a sample of about 100 homebirths – but warning against it is a fucking fear-mongering.

          • yugaya

            In Hungary, after homebirth was legalised, first intrapartum deaths occurred within months. Our first certified homebirth midwife – who had to get additional clinical training on top of ICM standard midwifery education – was seen in the press saying ” I have no idea how this happened”.

          • Amazed

            She must have traded notes with the leaders of Australian midwifery. That’s what they said after poor Caroline Lovell died.

          • Amazed

            They’re such charmers, aren’t they? They never have any idea but they do have a devoted following.

            A friend of mine, not quite sure that her first C-section was needed, never had the slightest desire to try for a VBAC, very down-to-earth, the hospital kind of girl to the boot, asked me about my other friend, one with the abruption, “Isn’t she afraid to go to that hospital?” The hospital where 10 years ago, someone failed the poor woman who went into a coma. 10 years of good and safe outcomes but people still remember and at least doubt. They want safety.

            I cannot fathom how people can choose midwives who they know have been personally involved in newborns’ deaths but they do. No one rallied behind that hospital – why should they? Why on earth people rally behind murderer midwives, Christy Collins and Agnes Gereb?

          • CognitiveDissonaceHurts

            Amazed, are you in Ontario? I had a friend who also was in a coma after her C-section, and it actually did confirm to our crunchy group about the evils of that procedure.

          • Amazed

            No, I am in Eastern Europe. I don’t know about your case there but here, the hospital did try to cover it which, of course, infuriated everyone, myself included. Homebirth deaths, though… we’re expected to shut up and believe whatever garbage they’re telling us, not the deadly internet advise they wrote before tragedy struck.

        • HappyMom

          Please read my comment above, I entered it to the wrong person. I hope it shows what the silly pressure from midwives States-side is doing here in Canada. I have given birth in Ontario (homebirth) and in Alberta (hospital).

          • Amazed

            No, you addressed it to the right person. It’s always helpful to know the truth behind the stats. I gather you were one of the “successful” homebirths with extensively filled documentation saying just how thoroughly informed you have been and how you, after fully accessing the risks, decided against testing and for midwives?
            Happy that you and your children didn’t make it into those averse outcomes yugaya cites, the ones that would have gotten buried and out of the stats.

    • Amazed

      Hi big man!
      Have you made it past the Facebook shotscreens of those beautiful human being aka midwives that I so helpfully pointed you at?

      • HappyMom

        Well, I nearly bled to death at my homebirth in Ontario, Canada in 2004. My midwife even though I was a grandmultip arrived quite a while after we called her and just in time for me to push. So my child had no monitoring whatsoever to determine how he was tolerating labour. I remember worrying about that, and trying to feel kicks and movements between Cx just to reassure myself. And my bleed was extreme, she held up the blood clots in her two hands, they were absolutely full. There was so much besides that. She called it 500ml, I now know it was a lot more than that, I felt horrible afterwards. Was pale and exhausted, I should have gone to hospital, she advised me not to. She advised me against a gbs test, because it could “risk me out” of my homebirth. She only gave me photocopies (which I was required to return to her upon my next visit) of the articles based on “studies” that advised me against taking ABx during labour, saying that would more likely result in an antibiotic resistant infection in my newborn. She taught me to be afraid of the hospital, that my doctor didn’t know what he was doing, that his care would endanger me. I was more afraid to go to the hospital, I only trusted her. I called her the next day, worried about how much I had bled and was continuing, she told me not to worry and I was “all good”. I reassured myself, we lived in town, we were ten minutes from the hospital, but, that wasn’t really true either.
        When I wanted to have my next baby with her, I lived 30min outside of the city. I was a grandmultip having another baby just 7mo after my big loss of blood. I asked her if I was a good candidate, thinking she would advise me to go to hospital, but she smiled and said I was good to go to have my baby at home. Trouble was I didn’t know that my blood work showed I was seriously anemic from the birth of my last baby. Trouble was neither did she, because they just hadn’t gotten the paperwork from my family doctor and by then I was 8mo along. Good thing I moved four provinces away, got under the care of an OB, who checked my paperwork from my blood work, and discovered the truth about my situation. I often wondered if I would have bled to death had I stayed in Ontario…. I guess we will never know. I’m glad to not know.
        Last year I fought my hospital, so I could have a cesarean at 37weeks to deliver identical twins (mo/di) who had an obvious size difference. I was going for NST at my own insistence because I could hardly feel them move. I sat in the triage, listening to women sign themselves out of the hospital AMA whose waters had been broken more than 24hrs, who were dead set on eating their placentas, who were refusing inductions, etc…… I just desperately wanted both of my babies to survive. Had nurses lecturing me how breech birth for my twins was safer than a cesarean. When I checked in for my “maternal request” cesarean, there was angry nurse who had lectured me during my NST. Happily, my OB supported me, knew my reasons and was the only champion for me. But I remember his physician’s assistant asking him, when they were beginning the operation, “why is she having a cesarean?” He politely told her that it was best for the babies at that point. My Baby B who was the bigger baby, was transverse up under my lungs, and he had a difficult time “finding” her. I am glad not to know what could have happened if I had listened to the Woo, and tried for the magical twin vaginal birth, along with the bragging rights. Well, I am glad I don’t know. Instead I have healthy, beautiful twin daughters. And I didn’t pass the risk on to them. I kept it on me. After all, I decided to become a Mom.

        • HappyMom

          Oh, and I didn’t breastfeed them either. 🙂

        • yugaya

          I’m so glad you and your babies are here safely. And yes, many women have shared just like you did their own experiences with recklessness of midwives in Ontario and the pressure to have homebirth or to forego important screenings or going to hospital.

        • Taysha

          My MFM once told me there are three scenarios that warrant a c-section with twins, no questions asked:

          – Baby A anything other than vertex
          – Baby A smaller than baby B
          – disparity of size in mo/di or mo/mo twins

          I had di/di twins, breech and transverse, so it wasn’t even considered maternal request, it’s just the way it was going to be. I’m glad your OB was on your side.

    • yugaya

      Did you read the Maternal and Perinatal Mortality Review reports posted in the comments? Any thoughts on the hideous cases that were quoted from them? There’s more – a lot more cases in all of these reports. In fact there are so many that they amount to a systematic pattern of recklessness and failure to practice within the scope and risking out criteria.

      Unlike you, regulars on this blog have gone through these reports, and when the midwives of Ontario in their studies exclude outcomes based on supposed *coding errors* we know exactly which horrible malpractice deaths those excluded homebirths include.

  • RBC4
    • RBC4

      Bye bye everybody.

    • Taysha

      “Researchers found that 75 per cent of women who planned a home birth were able to deliver at home, while 97 per cent of those who chose to go to hospital gave birth in that environment as planned; emergency medical services were required for 8 per cent of the women delivering at home — either before or after the birth — versus about 2 per cent in the hospital delivery group.”

      Some people don’t know what “as safe as” means. 2 to 8 = 400% increase

      • Inmara

        “97 per cent of those who chose to go to hospital gave birth in that environment as planned” – what happened to those 3 percent?

        • Taysha

          Planned vaginal delivery and planned c-section vs. emergent c-section?

          the other possibility would be late miscarriage, which I think would be more likely.

        • Amy M

          Side of the road/in car-in transit births?

          • Taysha

            ^ that. Or precipitous birth at home?

      • MaineJen

        Geez, I’d consider any incident that ended with emergency services being called to NOT be a roaring success. But what do I know? I’m just a typical American.

        • OttawaAlison

          See and that’s what has always bothered me. “Well we can always call an ambulance”, well calling an ambulance is a big deal, it means another emergency has been created, one where 2 lives may be on the line. In the hospital, while an OR might have to be prepped super quickly, if they needed to they can get the baby out really quickly, with an ambulance you’ll probably have an extra 15 minutes added on which can mean life or death.

          • Who?

            And the ambos are awesome, hats off to them, but they are not experts in either birth or neonatology(sp?) and nor do they have a hospital full of gear on board.

          • BeatriceC

            “with an ambulance you’ll probably have an extra 15 minutes added on which can mean life or death.”

            Let me tell you how scary those 15 minutes can be. I have a severe food allergy which results in almost instant anaphylaxis. I carry two Epi-Pens because that’s what it takes to keep me breathing long enough to get rescue to me. I started doing that after I did stop breathing after just one injection. The person that was with me called rescue the second she saw the pen come out of my purse. Response time from the start of the 911 call to when paramedics arrived was under 5 minutes, but they still arrived to find me in respiratory arrest. I know what it feels like to be deprived of oxygen and waiting for help. I know what it feels like to be struggling to breath, even with paramedics on site, while they wait for the doctor at the hospital to respond with orders (they have “standing orders”, but anything beyond that requires a doctor to approve.) Every second feels like an eternity. You honestly don’t know if you’re going to live or die. You start thinking about all the people you love and if you’re ever going to see them again. You worry that the phone call you ignored that morning will cause your friend to think you’re a bad person, and now you’ll never get a chance to call her back. Beyond that, the pain is like nothing I can describe. Every cell of your body is screaming for oxygen. You fight and struggle to draw air into your lungs, making your diaphragm work harder than it ever has before, but all to no avail. Even five minutes is intolerable. Fifteen minutes is pure torture. The aftermath isn’t much more pleasant. It takes days to recover from even a “minor” (by my standards) reaction. I feel like I’ve been hit by a freight train. I’ve been lucky. Medical assistance has always been “close enough” to save my life, but there have been innumerable ER visits, many inpatient stays and a couple ICU stays to keep me alive.

            This is what women are willing to force their babies to endure when they decide that calling an ambulance is a good option. I wouldn’t wish that on my worst enemy, let alone an innocent baby.

            *Note: I’m replying to you not because I misread and think you think this way, but because I was quoting you and wanted to add to what you said.

          • Bugsy

            More than two lives can be on the line. My father was diagnosed with epilepsy two years ago, and yes, if he has a seizure even despite treatment, needs to be rushed to the ER. Yes, I would be ticked if no ambulance is available for my father because someone else made the _choice_ to have a home birth. While it’s probably not a likely scenario, his life could be on the line in it. That’s not fair.

          • Megan

            In my town it’d be at least 45 minutes from phone call to hospital door. And that’s under the best circumstances.

  • SF Mom & Psychologist

    OT: Not a homebirth story, but seemingly a childbirth nightmare – all in the name of a vaginal delivery.

    My sister-in-law and her newborn baby boy were just transferred to a hospital with a higher-level NICU due to his failed neurological test and swallowing meconium. She had a vaginal childbirth (with a bit of pitocin and apparently morphine, but NO epidural!) after laboring for 50+ hours and pushing for about 6 hours this past weekend. Her labor started Friday evening (it was steady but took her forever to dilate), and her baby was finally born at 5am Monday morning. I’m sure she feels like she was run over by a truck, and now she has to go to another city (Oakland, about 40 minutes away) and deal with a potentially very scary NICU situation.

    I can’t help but wonder if she was so determined (or convinced by her doula) to birth vaginally and avoid an epidural and/or c-section, that she and her doctor(s) allowed labor and pushing to go on for too long, which led to these complications. Let’s hope that the little guy recovers and all is OK.

    • demodocus

      Jeez, good luck to them both.

    • Amazed

      Good luck to the little one!
      Fuck vaginal birth, long live safe birth.
      Fuck Nature as well. Bitch has been trying to kill us since forever, just like she finished her beloved children dinosaurs off.

    • attitude devant

      Six hours of pushing? That NEVER turns out well…..

      • mostlyclueless

        Never say never. I pushed for six hours before the OB called for a c-section. We were both monitored the whole time and there was no evidence that my baby was ever in distress. Everyone is fine now and my daughter is a healthy and happy 2.5 year old.

        • attitude devant

          I should have been clearer: vaginal birth after six hours of pushing does not turn out well, because the baby simply wasn’t fitting. There is usually trauma (e.g., to mom’s pelvis or baby’s brachial plexus).

          • mostlyclueless

            Unless the delay was because baby was malpositioned, and eventually rotates to a more favorable position.

          • Medwife

            Baby might well be fine but good luck to mom’s pelvic floor.

        • Linden

          You’re made of sterner stuff. They let me push for an hour (with glorious epidural!) before I got a episiotomy and delivery with forceps. My waters had broken more than 24 hours before, and they were getting twitchy.
          I was fit (I ran a marathon and two half marathons while pregnant). I could have pushed longer. But there was absolutely no way I could have managed 6 hours. No way. It was exhausting. Baby could have been fine, but I wouldn’t be!

    • BeatriceC

      I hope the little one recovers quickly! Too bad he had to suffer in the name of a ridiculous ideology. My heart breaks for him and his family.

    • Roadstergal

      The childbirth/breast/antivax woo is _so_ bad here in the bay area. It’s pretty much mainstream. 🙁

  • RBC4

    Also this… http://data.worldbank.org/indicator/SH.DYN.NMRT

    Now, I’m no doctor, but 2 is lower than 4 right? Those are the #’s per 1000 NEONATAL deaths in the Netherlands (where you yourself said the rate of midwifery attended births is the highest in the world) and The U.S. respectively.
    But who can trust those hippies at the World Bank anyways.
    Educate yourselves please. Midwives are professionals. In Canada they study for 4 years in a medical college, with some of that time spent along side OB’s, involved in the delivery of approx.100 babies during that time. OB’s are wealth’s of knowledge, no doubt, and absolutely a necessary part of a healthy childbirth in some cases. Midwives and OB’s work together in Canada to ensure the health of mom and baby. It’s a model that has only positives and no negatives. Cooperation (as opposed to opposition) often has that effect.

    • Young CC Prof

      And the stillbirth rate in the Netherlands is higher than in the USA. Your point?

      • RBC4

        Cite your work please

        • Young CC Prof

          http://apps.who.int/iris/bitstream/10665/43444/1/9241563206_eng.pdf

          You can look at stillbirth rates for many countries, and see that the USA’s is actually among the lowest.

          • RBC4

            Wow, so, Netherlands is twice as successful with overall neonatal data, but 12.5% worse when it comes to specifically perinatal deaths… And this is your resounding evidence that midwifery is a scourge? Not particularly convincing if you ask me… but then again, I’m from Canada where we tend to look at both sides of an argument before making up our minds… BTW Canada is better still than both.

          • OttawaAlison

            Canada also risks out women from homebirth left, right and centre. That’s why we’re lower. That said, running in stillbirth circles some situations you hear about under midwives can make your eyes bulge out.

          • RBC4

            I can assure you the same stories occur for OB attended births.

          • OttawaAlison

            Are you in the stillbirth community? You get to hear the some details that go against standards of practice. Most stillbirths are like mine though, happen before labour for unknown reasons.

          • OttawaAlison

            Let’s just say if and when my eldest has a child in 20 years or so, unless things are vastly different I’ll encourage her to go to an obgyn in a hospital.

          • RBC4

            That’s up to you. It doesn’t change the fact that in our country, it’s just as safe to have a midwife, and the data proves it.

          • OttawaAlison

            Meh, losing a baby is a horror no one should ever go through. I want any future kids I may have to have the best hands on deck. I’ll encourage the same for my child(ren if I have any more). I won’t desert her if she chooses to have a home birth and would support her in any way she would want me to (because I am her mom)but I wouldn’t be dancing in the streets about it.

          • RBC4

            I just attended a still birth, 27 weeks. It’s a horrible experience. The midwives were fantastic and professional through the process. Stillbirths happen. No OB or midwife can stop them.

          • Amazed

            You attended a birth? But you say you aren’t a doctor. I’ll bet you aren’t a sane midwife either, else you wouldn’t be so quick to hug demon “midwives”.

            What are you? A midwife who hates them evil interventions, sings kimbaya and would love to jump in the jacuzzi with the fools from Midwifery Today, or a doula of the natcherel variety?

          • RBC4

            Aw, so cute when they’re angry. Remember folks, co-operation is possible. Midwives are beautiful people who only want what’s best for mom and baby. They would not let anyone put mom or baby in danger. (Note: I am not a doctor, or a midwife, so you can try to figure out for yourselves why I might have been at a stillbirth). Come on America. Be better, everyone. We are your friends and we want what’s best for you too. Good luck!

          • Taysha

            “Midwives are beautiful people who only want what’s best for mom and baby.”

            I have a few words for you:

            Christie Collins
            Jan Tritten
            Melissa Cheney

          • moto_librarian

            “Aw, so cute when they’re angry.”

            You make me ill. This isn’t some kind of joke to most of us. I gave birth to both of my children with CNMs in the United States. What I cannot, and will not, condone is this obsession with valuing the process over the outcome. I’m glad you’re not a midwife. You shouldn’t be one if this is the best that you can muster.

          • RBC4

            I am sorry that American midwives have to fight against this much bully culture. All I’ve asked is that people educate themselves on the facts. It’s all I continue to ask for. You may choose whatever method you like, but options are good. Options that have been proven to be safe and reasonable. I realize I’ve said some things I maybe shouldn’t have. I apologize. I really don’t like to offend, and I probably did in this case. Please be kind and decent and engage in conversation whenever you can. Ask questions, read data, read studies, clinical non partisan studies by universities and colleges are best. Don’t pick on and bully people. Your choice is yours to make, but please don’t judge others for the choices they make (its really not very Christian). Good luck, and God Bless.

          • moto_librarian

            Do us all a favor and save your sorrow for the women who are left childless because of unprofessional and incompetent midwives. We have a very good grasp of the data, both in the US and abroad. You are the one who is lacking evidence here. It’s also amusing to hear you complaining about bullying after coming in here and acting like a total jerk.

          • RBC4

            I am truly sorry if you were offended. I hope you will accept my apology.

          • prudentplanner

            Clearly, everyone here is better ‘educated’ and better prepared to discuss the facts than you are. This group does read studies, this group does ask questions.

            When confronted with the facts, which group avoids the data & says their mantra even louder? the unqualified ‘midwives’ of America.

          • demodocus

            truly, i’m not. i just trust my doctors over random parents on the internet. That and i’ve noticed all the babies and mothers who died just after birth in history books about the good old days.

          • LaMont

            Um… you may be under the wrong impression about “typical Americans” but some of us particularly wonky pro-science types aren’t necessarily interested in being “very Christian” anyway, or in our online opponents calling down God’s blessings on us either.

          • lilin

            “Don’t pick on and bully people. Your choice is yours to make, but please don’t judge others for the choices they make.”

            I sure as hell am going to bully and pick on people who charge for medical care they are not qualified to provide.

            I’d expect you to understand that, but then, looking up your other comments on this blog, it’s clear that you have no idea about statistics, midwifery in the US, or anything else you’re blathering on about.

          • Taysha

            “Midwives are beautiful people who only want what’s best for mom and baby.”

            Aw, look. RBC4 is living up to her words.

          • Erin

            Excuse me whilst I throw up. A midwife, one of these trained professionals (not American) you keep talking about said to me in the aftermath of my son’s “interesting” arrival that… “Had I not had unprocessed issues with being raped, he would have descended” and followed it up with the wonderfully empathetic “shouldn’t have got pregnant if you weren’t over being raped”. Does that sound like a statement made by someone who had mine or my son’s best interests at heart? About 2 hours later I had my first postpartum suicide attempt which was prevented by someone who surprise surprise was not a Midwife. A more honest statement would be: Midwives are people [which means some of them are lovely and some of them are malicious and disgusting excuses for human beings].

          • Gatita

            This is the current state of midwifery in the U.S. We all saw this unfold in real time on Facebook as the baby died: http://www.psmag.com/health-and-behavior/when-home-birth-goes-wrong

          • yugaya

            I’m thinking some sort of quackster chiro or naturopath.In any case, someone who is paid for the deadly birth bullshit that they sell.

          • Young CC Prof

            “Stillbirths happen. No OB or midwife can stop them.”

            A 27-week stillbirth is a tragedy that almost certainly could not have been prevented. Stillbirths at or near term, or during labor, often can be prevented.

          • moto_librarian

            OttawaAllison had one. You might not be so fucking cavalier about it.

          • Amazed

            She can’t. She’s either a natcherel midwife, of those Guestll had who almost killed her baby, or a doula of the natcherel cohort.
            Neither of those can stop being cavalier.

          • RBC4

            Sorry, what part of “horrible experience” is cavalier exactly?

          • moto_librarian

            “Stillbirths happen. No OB or midwife can stop them.”

            Extremely preterm labor is hardly the same thing as a full-term stillbirth. The obsession with allowing women to go past their due date can indeed cause still births. So can foregoing routine testing. You also were focused on the the staff rather than the mother. Shall I go on?

          • RBC4

            Sorry, did I not go into enough detail on this very personal and terrible experience to satisfy you? I am not a health professional, I was not their working. Lets say I’m “related” to the deceased…. I mean really, this is just getting ridiculous. I can see what the midwives in your country are up against now anyways. Sad, really.

          • moto_librarian

            Midwives in our country have only themselves to blame. CPMs and DEMs don’t want to do the work required to become real midwives – CNMs. If those two credentials are abolished, many of our problems would disappear.

          • Taysha

            You mean the highschool graduates who hang around birthing mothers and eat all their food, right? the CPMs.

            You know, I thought you were just annoying. But you are truly disgusting.

          • yugaya

            “attended” implies you are qualified to attend births.

            Reaching for some borrowed authority there aren’t we?

          • RBC4

            Sorry, the word was in my mind and I used it in appropriately. You’re right, I should have used a different word. I was their is all I meant, not in any professional capacity, but as support, again, I don’t really want to get into the details because it was a very difficult experience, suffice to say, the midwives, and all the hospital staff were amazing.

          • yugaya

            I’m sure that word was “in your mind” – that would be the same place where you are more qualified to weigh in on safety of homebirth than MD OB/GYN who writes this blog.

          • Taysha

            I smell a backpedaaaaaaaal

            Also – “there” “on my mind” “inappropriately”

            And your grammar hurts my eyes.

          • RBC4

            sorry, corrected

          • moto_librarian

            And I think it’s safe to say that everyone here is extremely sorry to hear about any baby dying. If this was your own child, please accept my condolences. I’m very touchy about this subject because OttawaAlison is a friend of mine and I have felt such helpless sorrow watching her grieve her daughter.

          • prudentplanner

            Stillbirth is a horrible experience. There are more stillbirths:1,000 babies born at home with a CPM then at a high risk hospital with an OB.

            One of these things is objectively better (OB/CNM in-hospital care) and the other is objectively worse (higher stillbirth rate with CPM’s).

          • OttawaAlison

            I had one at 37 weeks, I am very sensitive about the subject.

          • RBC4

            I am very sorry for your loss. Im also sorry if any of my comments caused you undo grief. I would never intend harm. Please accept my apologies if anything I’ve said offended you. I can assure you I was not addressing your specific situation. I cannot imagine or understand how horrible it must have been for you I am truly sorry.

          • fiftyfifty1

            “Stillbirths happen. No OB or midwife can stop them.”

            Stillbirths happen. But 50% of them are preventable with good obstetric care.

          • Amazed

            Dumbass, perinatal mortality rate is the CORRECT measure for reflecting mortality rates that are birth-related.

          • RBC4

            Well, coming from a civilized individual such as yourself, I can only assume this is correct. Also, I can only assume you’re moving to Canada soon where the perinatal rates are lower than in the U.S.

          • Amazed

            Sweet. Actually, I’m living somewhere where the perinatal rate is worse than the US but the outcomes following a hospital prenatal care (the lack of which makes the rate too high) are quite good. That’s why I’ll stick to the hospital.

            And you’re still a dumbass for attending births and pretending knowledge without knowing the most basic fact about measuring safety.

          • moto_librarian

            Do you also know that the States does not have universal health care? The ACA (a.k.a., “Obamacare”) is a tiny step in the right direction, but it’s nothing like what you have in Canada. That alone would preclude a system for home birth like the one that you have.

          • fiftyfifty1

            “so, Netherlands is twice as successful with overall neonatal data, but 12.5% worse when it comes to specifically perinatal deaths”

            “Overall neonatal deaths” isn’t what you think it means. The neonatal death rate isn’t an “overall” chance of your baby dying, it’s a measure of a very specific kind of death: The chance of a baby dying within 30 days *that was deemed alive* at birth. So if your baby dies in utero at 38 weeks gestation because nobody noticed you weren’t growing properly? Not counted. If you go into labor but your baby dies during labor because you weren’t monitored closely? Not counted. And then there is the whole problem with a baby that is “deemed alive”. In the Netherlands, babies born before 24 weeks aren’t counted, even if they are born alive, kicking and crying. In the US, babies born all the way down to 20 weeks are counted. Some states even lower. Babies born before 24 weeks have a *very* high mortality rate. As others point out to you, a good third of the US mortality statistics are from deaths in these ultra-preemies. But the Netherlands is only too glad to pretend they don’t exist at all.

            The short version? A woman who gets pregnant in the US has a better chance of ending up with a living baby than that same woman with the same pregnancy in the Netherlands.

    • manabanana

      “Midwives are professionals.”
      Except when they’re not.

      “Midwives and OB’s work together in Canada to ensure the health of mom and baby.”
      But they don’t in the US. Not when we’re talking about CPMs and midwives who attend OOH births. The model that exists in Canada is replicated in very, very few OOH practices in the US. I would bet less than 1%.

      • RBC4

        All the more reason to adopt a Canadian model! The best of all worlds! Choices for moms! Safety for Moms and babies! Hooray for society! You can do it America, I believe you can beat us. But you won’t do it if you aren’t willing to change.

        • manabanana

          Talk to the CPMs. Talk to NARM. Talk to MANA. Talk to NACPM.

          The perpetrators are the ones that don’t want to change. Not the folks here.

          • Amy M

            Well, most American women really don’t want a homebirth, so they aren’t interested in adopting a system like Canada’s. To make it as safe as possible/as Canada’s would probably cost way more than anyone is willing to pay, considering our current system of hospital birth is pretty safe. I’m sure there are things about hospital birth, at least in specific hospitals, that should be improved, but adopting a home birth system won’t fix that. Of course, if we had a home birth system like Canada’s, maybe more Americans would choose homebirth, but I suspect they would still be a significant minority.

          • manabanana

            I agree, I think homebirth will continue to serve a minority of birthing women. My point was that it’s the MIDWIVES who are standing in the way of creating a model like Canada’s.

            CPMs do NOT want additional training, they do NOT want to require a college degree and they do NOT want increased professionalism and accountability. All those things would come with a Canadian-like model of care. They need to stop pointing their fingers at physicians, THEY are the problem. No one is stopping NARM or MANA or CPMs from adopting more stringent standards but themselves.

          • Amy M

            Oh absolutely! So since the CPMs don’t want change and the American women (as a group) don’t really either, it is not very likely.

          • RBC4

            The only question I have is, could Dr. Tuteur come to Canada, see our model, read the data, and say to a group of midwives here “we are equals”. Bit of a white coat complex there if you ask me. If Dr. Tuteur is serious about improving midwifery care in the U.S., she should advocate for change, rather than demonize, which only serves the status quo.

          • moto_librarian

            Because you are not equals. Colleagues, yes. But at the end of the day, when labor starts going wrong, care is to be transferred to the most qualified person: the OB.

          • Amazed

            It’s interesting how obsessed they are with being “equals”. She screeches for a white-coat complex but many midwives seem to have a huge inferiority complex. Look at how they bristle at being called midlevel providers.

          • Taysha

            ’cause she couldn’t cut it in Med School.

            White coat envy, more like it.

          • yugaya

            Your data is hideous, and your RM in Ontario have as much blood on their hands as the worst of CPMs in USA. And they are as morally filthy as MANA in the way they fudge the numbers in their own studies – when they exclude all of the homebirths for which the records that would risk women out are conveniently missing, and the ones where women who were documented to be too high risk were still having dangerous homebirths with outcomes excluded because those were *coding errors* – of course their mortality rates look awesome!

            But to know that one would have to read those studies you posted carefully, instead of just copy/pasting crap like you do.

          • RBC4

            I think there’s lots of blame to go around on both sides. But demonizing isn’t really helpful if you’re really concerned about making things better.

          • Amazed

            Demonizing it? Haha!

            I’ve got an idea! Why don’t you take the CPMs Dr Tuteur supposedly has “a white coat complex” against and return them to Americans changed and bettered?

            Demonizing fake midwives? Woman, they ARE demons. They drink newborns’ blood. And mothers’ blood, just ask Caroline Lovell if you can find someone who can talk to the dead.

            Show us your amazing success in bettering your very own Gloria Lemay and then take the fake midwives we’re discussing and turn them into safer professionals. THEN, you can ride your high horse and proselytize.

            Asshole.

          • RBC4

            Wow, so these are the people that frequent this site. Okay, you’re clearly all in good company then. On that note. Good luck to you all.

          • Amazed

            I cannot return the notion. Good luck in convincing people that you know what you’re talking about? When you are clearly in position to be believed that you have knowledge? You attend births and you don’t know what the best measure for birth and pregnancy related mortality is.

            Good luck to all the victims, err, clients or patients who might come your way.

          • manabanana

            I don’t think I demonized anyone. The CPMs don’t want change. That’s the truth. They provide shoddy care and their outcomes demonstrate this. They see no reason to change.

            I’m not going to repeat myself – see above comment. The CPMs are perpetuating these outcomes and this poor system of care.

        • AllieFoyle

          …and you think that believing everyone should do things the way you like them is a typical american thing? I’m starting to wonder if it might be a Canadian trait as well. Nah, it’s silly to assume everyone in a large, diverse country conforms to my negative stereotypes….

    • MaineJen

      What about perinatal death rates?

      *crickets*

      • RBC4

        which can be cited where?

        • moto_librarian

          Oh, I don’t know. Try searching this blog.

    • demodocus

      I don’t live in Canada, i live in the US and unless the culture of midwifery changes within the next 5 months (especially with the half-trained kind of midwife who do most of the homebirths), I’m going to the freaking hospital, with an OB on duty, when I have my baby. I will pass 3 hospitals on the way that don’t have an ob on duty. ‘Cause lifeflighting in case my baby goes into distress would freakin’ suck. Besides, my endorphins must be broken. THey never kick in when I exercise or breastfeed and they sure as hell didn’t modify my pain when I was in labor last time. 1 epidural please!

      • RBC4

        Typical American. “What I want is what everyone should want. Why isn’t everyone just more like me! Then we wouldn’t have these problems of people wanting different experiences. We’d all just shop at Wal-mart, eat Mcdonalds, etc.” No one is saying you can’t go to the hospital, no one is saying you can’t have an OB, no one is saying you can’t get an epidural (midwives can oversee epidurals here in Canada)… You get to still have your thing. Other people just want their thing too.

        • demodocus

          Bless your heart. 1% of us have a homebirth. Which means that for once, I’m actually in the majority. A nurse-midwife actually delivered my first child, but the ob was there to sew up the giant hole the kid’s giant head gave me.

          • RBC4

            Midwives in Canada sew up those holes every day.

          • demodocus

            That’s nice for you guys.

          • demodocus

            Still isn’t going to do me any good when I have my baby this spring. You can’t change a culture that fast.

          • Bugsy

            How’s the pregnancy going, demodocus? Do you know the gender (or will it be a surprise?)? Hope all is well!

          • demodocus

            She’s a girl, and unlike her brother’s totally uncomplicated gestation… Stupid cold, on the positive side, i’m so miserable that i can’t dwell on the stuff that exacerbates my depression, on the negative side, i had to change my socks after a sneezing attack, among other garments. And my primary care doc wants me to have an echocardiogram because i’ve been short of breath since i got pregnant. I walk up this hill 300+ times a year and i’ve been panting going up it since October. I’m not *that* fat and unfit.

          • Bugsy

            Congrats on the girl, although I’m sorry to hear that the pregnancy is a bit rougher. 🙁 My two pregnancies – both boys – were completely different from one another as well, although in my case it was the first one that was a nightmare. Couldn’t the shortness of breath be normal in pregnancy? It was for me…but I guess it was more the third trimester. Going up the stairs made me exhausted, never mind trying to do anything that involved some sort of lifting/climbing. Anyway, congrats again!!

          • demodocus

            Hoping, but between my past history of asthma, my father’s recent death due to heart failure, and my well padded, “elderly” form, Dr. A wants to check stuff out.

          • Bugsy

            Hugs and best wishes.

          • demodocus

            Thank you.

          • moto_librarian

            Really? I sure as hell hope they aren’t suturing more than a second degree tear. I’m glad that I had an attending OB to stitch my cervical laceration up.

          • Haelmoon

            Midwives in Canada repair first and second degree tears. Third and fourth all go to OBs, even if it means a postpartum transfer. We are often call for complicated second degree tears too. If it is a small simple tear, anyone can fix it. If it is complicated or involves the rectum, you want a surgeon to fix it. Otherwise, they will just come see us later to fix the repair.

        • Taysha

          Wait, this is too rich.

          Typical American for shunning homebirth because it is UNSAFE in the US. Typical American should embrace homebirth because it’s supposedly safe in Canada.

          Unless she’s moving to Canada, I don’t see how her decision is anything but perfectly logical.

          “We’d all just shop at Wal-mart, eat Mcdonalds, etc.” Oh honey, stop. Really. Stop. Your projection is showing. Typical American is not really a thing. Typical Midwife, however, is pretty proven by your comments.

          • demodocus

            Haven’t even seen a Walmart in years. And we average Mickey Deaths about twice a year.

          • RBC4

            No one said the decision wasn’t logical. Not everyone wants to make that same decision is all. It not unsafe. Also, for clarification, I am not a midwife, nor am I a health professional of any kind. Some of these comments are getting hate filled. I only said typical american in the sense of, well no one should be able to think different from me… which is where you’re all going with all your comments. I on the other hand, am simply welcoming choices. You get to have your choices, I am not judging them, and think they are perfectly logical.

          • Taysha

            You are being recalcitrant about exhorting how marvelous homebirth is in canada and how people should give it a go, and take a look, and try, and they are being “Typical Americans” if they don’t.

            You’re an idiot. You are judging. You are implying you know better than everyone. You also have a significantly impaired situational awareness.

          • RBC4

            No no no. I am saying that they are pushing their anti-home-birth american values when they need not. They still get to have their baby in a hospital. The beauty of options. Really, no judging at all… promise. I respect that decision whole heartedly. I might even make it myself in certain situations.

          • Taysha

            You are saying midwives are amazing, people need to adopt midwives and midwives are great and wonderful.

            We are telling you that is not the case in the US.

            By that same token, because water is clean in Canada you’d encourage India to use it from the tap.

          • BeatriceC

            “By that same token, because water is clean in Canada you’d encourage India to use it from the tap.”

            Or the people from Flint, MI. That’s closer to Canada and a more apt comparison.

          • momofone

            But you’re also saying they’re equal choices, and at least in the US, they aren’t.

          • Bugsy

            Heh, this applies to me. I’m an American who moved to Canada a few years ago. HB may be marginally safer here than in the states, but I still went for a hospital birth for the 10-week-old snuggled in my arms. Not intending to have any others, but if I did, they’d also be in a hospital. Any increase in risk is too much for me.

          • Taysha

            sniff his head for me (her?). Because – baby =)

          • Bugsy

            🙂 Just sniffed his head for you but will stay clear of sniffing the other end. Kiddo is going for the continual diaper blow-out method this morning!

          • demodocus

            mine, too, and he’s 2. Sigh. He just figured out how to open the fridge door and he’s continually after the apples.

          • RBC4

            That is absolutely your choice, and a good and logical one.

          • swbarnes2

            You surely observed that part of the reason it’s safer in Canada is because they turn more people away…more patients told “You are too risky, no home birth for you” and at least twice the transfer rate during labor when things start to go badly. Canadian “homebirth” is safer because fewer homebirth candidates actually give birth at home. This is hardly a ringing endorsement for home birth.

          • Taysha

            Personally, having to do laundry after giving birth puts me off homebirth FOREVER.

            But yes, with a well-regulated system, well-educated midwives and good protocols, a large number of women would risk out.

          • RBC4

            This is exactly my point. Thank you Taysha. You were able to articulate what I could not. Midwives actually want you to risk-out (it’s the first time I’ve heard this term, so I’m sorry if I’m using it inappropriately, but I think it means, too risky for home birth, lets get you to the hospital) if things aren’t going smoothly. No one wants a bad outcome.

          • Young CC Prof

            That’s how it should be, but in practice, too many midwives bend the rules or find reasons NOT to risk out.

          • RBC4

            Ya, more evidence that the system needs an overhaul to provide standards and practices for midwives like we have up here. I hope you’ll achieve that one day.

          • Young CC Prof

            Actually, I was referring to Ontario midwives.

          • Amazed

            Do they?

            Read the Facebook thread (since the white-coat complex you invented and your distrust of all things American obstetrical undoubtedly won’t let you make it past Dr Amy’s first post in the wake of the tragedy). Read the thread and come tell me again how midwives want to risk patients out.

            http://www.skepticalob.com/2014/02/the-internet-never-forgets.html

          • Taysha

            No, honey, you are not articulating anything. Homebirth is not safe. Homebirth is so unsafe only a minute fraction of candidates can, potentially, undergo it. Minute fraction of which a large part of them get sent back to the hospital half-way through it.

            You’re saying that Canada is awesome and everyone should try homebirth. You’re saying it’s as safe or safer than a hospital birth. If it were, women would not get risked-out. They’d be shoved into homebirth by the hospitals.

            When a hospital sends a patient to birth at home because it’ll be safer is when I’ll believe homebirth is safe.

          • RBC4

            For the last time, I never said everyone should try it. I thought you were reasonable, but you are not. I will not respond to you anymore. Sorry.

          • Taysha

            You are mocking and harrassing people, and calling for them to “come see the awesome system in Canada to change your mind!”. And you’ve accused people of being “typical americans” wanting what everyone wants.

            So yeah, you are. Again. When hospitals send laboring mothers home for their safety I’ll believe in the safety of homebirth.

            good luck with that, sweets.

          • OttawaAlison

            I’m not American and a Canadian, but it pisses me off when people dismiss Americans as “typical American”. There isn’t a typical American, yes there are Americans that anger me like Donald Trump and the Bundys (Clive, Ammen and of course the unrelated Ted), but most are good, loving people even if I don’t agree with all the viewpoints, but neither do all Americans..

          • demodocus

            We do have half a dozen major subcultures (not counting assorted native groups and newcomers) that’ve been developing for centuries.

          • Amazed

            You barged in here on your high horse insulting people and whining for poor pretended midwives before showing just how ill-informed you were. You aren’t sorry for being an ass. You’re only sorry that people here know enough not to fall for the mantras you pull out of your you know what.

          • Taysha

            She’s not talking to me now. Cause I was supposed to be “reasonable”

            Concern troll is concerned she got caught backpedaling.

          • Amazed

            She says he’s a he and he’s passionate about midwifery because his own child (or children) was born at home with great midwives.

            Personally, I am not getting passionate how men should march through kidney stones without relief but that’s just me.

          • Taysha

            I like the bit where you told us to educate ourselves, paraded the supposed stats of how awesome HB is in Canada and how much better than hospital birth it is.

            also the bits where you mocked us for being angry. Who’s getting angry now, love?

          • swbarnes2

            Midwives don’t get paid by clients they refuse to treat, so there is definite incentive NOT to risk out. And again, homebirth stats are improved in countries where midwives are more likely to say “no homebirth for you”, either by risking out, OR by transferring low risk women who spontaneously develop problems. The conclusion is pretty obvious. The safest % of homebirths is zero. You saw the paper about how babies born away from hospitals have far higher chances of having an Apgar score of 0 at 5 minutes, right? Those 45% of Canadian primips who transfer would have had far better outcomes if they’d been in a hospital the whole time, instead of being moved by ambulance with a baby halfway in, half way out.

            http://www.ncbi.nlm.nih.gov/pubmed/23791692

          • Taysha

            It was interesting i just read an account from a physician regarding homebirth in rural areas during bad weather. Since the risk by driving is so high, they encourage homebirth during dangerous weather. (Hospital about 60+ miles out)

            But the physician and two nurses drove TO the laboring mother and stayed for 24+hrs. so as i said, interesting and thankfully very rare.

            Wasn’t there a paper some time ago that said HB midwives did not know how estimate Apgars and that’s why apgars in HB were so high?

          • yugaya
        • Megan

          If being a typical American means a hospital birth for me and my daughter in March and safer outcomes compared to the current alternatives, then for once, I am very happy to be a typical American.

        • yugaya

          I get accused of being American all the time. Usually I consider it a compliment on the grounds of being a non-native speaker and living on the other side of the planet. In this case – not so much.

        • monojo

          You really should act like a “typical Canadian” and apologize for that statement.

          * I don’t actually believe that any individual person can be solely defined by their nationality. I am snarkily responding to the fact that you think they can. Especially when you are woefully uninformed about the state of homebirth midwifery in the US.

          • fiftyfifty1

            “You really should act like a “typical Canadian” and apologize for that statement.”

            Come on, RBC4. Say that you’re “sore-y”.

    • yugaya

      It seems you need to get educated on that too – from OECD stats, definition on how perinatal, neonatal and fetal mortality rates are reported and calculated in the Netherlands ( you can pull the info for USA and compare the criteria on your own I assume):

      “Netherlands
      Source: Eurostat database. Data extracted in June 2015 (extracted on June 10th, 2015).
      Methodology: Data come from the Causes of death statistics, based on the obligatory registration in the population
      register. Stillbirths are obligatory registered with a minimum threshold of 24 weeks (and before 1991, 28 weeks);
      children who die within 7 days after birth are also included.
      Further information: http://ec.europa.eu/eurostat/data/database > Population and social conditions > Demography and migration (pop) > Mortality (demo_mor) > Infant mortality rates (demo_minfind).

      Minimum threshold of 22 weeks:
      Source: The Netherlands Perinatal Registry (PRN). Data are derived from the linkage of PRN-data and Population Register (PR).
      Methodology:
      – In the Netherlands it is not obligatory to report to the authorities a stillborn child with a gestational period of 22-23 weeks.
      – The perinatal registry includes 4 registers (midwives, bstetricians + gynaecologists, GPs and paediatricians/neonatologists) and uses the minimum threshold of 22 weeks.”

      http://webcache.googleusercontent.com/search?q=cache:ztH__gklTU8J:stats.oecd.org/fileview2.aspx%3FIDFile%3D255bc14f-cf40-4fed-9e00-f09c0faa5d08+&cd=2&hl=en&ct=clnk&gl=hu

      • Taysha

        *fangirls*

        • yugaya

          Yeah, now all we have to do is to sit and wait for our dear birth *atendant* guest to do her own *research* and enlighten us on how this much difference in mandatory reporting of fetal deaths between the Netherlands and USA computes into her conclusion that ” 2 is lower than 4 right?”:

          ” In the United States, State laws require the reporting of fetal deaths, and Federal law mandates national collection and publication of fetal death data. Most states report fetal deaths of 20 weeks of gestation or more and/or 350 grams birthweight. However, a few states report fetal deaths for all periods of gestation.”

          http://www.cdc.gov/nchs/fetal_death.htm

          • RBC4

            20 weeks, vs. 22 weeks is not an enormously different number that can account for a doubling of a stat. In some cases, some states count miscarriages as perinatal deaths.
            All of which misses the point, or doesn’t change the fact. Midwives, when regulated and allowed to practice alongside health practitioners are just as safe as OB’s. It’s not rocket surgery as they say.

            In closing.
            A) I’m a man.
            B) I work for a utility company. I have the day off and got sucked into a conversation that I am passionate about because of my experiences with midwives (my baby boy was born at home, with 2 lovely midwives in attendance, with luckily/thankfully, no complications. I’ll never forget it. I have one other experience that I’m not going to go into details about, but the midwives were amazing then too). I know it’s not for everyone and none of my comments have been intended to convince anyone to have a home birth, as that would be an uneducated decision for me to make. You, your family, and your health professional should make that decision whether it would be safe for you or not. It isn’t always.
            C) What the heck holy cow why do you all hate midwives so much?

            There is a conversation here for those willing to have it. For the rest, who are only interested in imposing their own point of view on the rest of the world. We will not be deterred by bullies. We will continue to let the world know there are safe alternatives. Safe alternatives is all. No one is forcing you to have a home birth, or a midwife.

          • demodocus

            Homebirth midwives in the U.S. are *not* as well trained as Canadian, Dutch, or British midwives. Not by a long shot. A friend who sits next to me in choir will shortly be a CNM. She babysits for us. And if your partner’s midwives saw me, and if they are as sensible as my fellow alto, they’ll refer my “elderly” butt to the hospital.

          • yugaya

            “20 weeks, vs. 22 weeks is not an enormously different number”

            Except it’s four weeks of mandatory data difference because ” In the Netherlands it is not obligatory to report to the authorities a stillborn child with a gestational period of 22-23 weeks.”

            While in the USA: “In 2013, about one-third (34%) of all fetal deaths at 20 weeks of gestation or more occurred at 20–23 weeks of gestation”. http://www.cdc.gov/nchs/data/nvsr/nvsr64/nvsr64_08.pdf

            Yeah I know, according to you, that bears no impact on mortality rates AT ALL.

            *at this point I’m tempted to start praying to the Gods of the Internet to please be merciful and once upon a time send us that one non-idiot NCB zealot that I believe with all my heart is real, is out there and exists*

          • Taysha

            “We will not be deterred by bullies. We will continue to let the world know there are safe alternatives. ”

            Let me know when you find those safe alternatives.

          • Taysha

            PS – As a man, I wish you kidney stones.

            And make sure you take no pain relief.

          • moto_librarian

            The last thing that we need is to have someone drop in here an mansplain to us. You don’t know a damned thing about home birth in the United States, are completely unaware of some of the problematic aspects of Canadian midwifery, and generally behaved like an ass. Does that explain it clearly enough for you?

          • Erin

            Despite my own dubious experiences with midwives, I fully believe that women should be given all the facts surrounding birth and should be legally allowed to try and give birth wherever they want. My Grandmother had all but one of hers on the kitchen table, in fact she “free birthed” most of them (not through choice I hasten to add and no it wasn’t an amazing beautiful experience) and she and they survived just fine. It’s not my cup of tea but I support it. What I don’t support though is the lies women are told surrounding it.

            However by the sound of it, I (with my limited experience of delivering a couple of foals and a handful of sheep as a teenager) could have delivered your son as there were no complications. Show me a pph or a stuck baby or any of the other potential complications and other than yelling for the nearest Doctor my input would be limited and I suspect from my own experiences and those of other women I know that’s exactly what a midwife would do too so I’d rather cut out the middle “snake oil salesman” (My husband’s words and yep, he’s rather bitter on the topic of midwives.. ) and go straight for the Doctors or at least the same building as them, near the blood banks, the NICU and operating theaters.. you know, the stuff which comes in useful when your coin toss comes up tails.

          • The Bofa on the Sofa

            I fully believe that women should be given all the facts surrounding
            birth and should be legally allowed to try and give birth wherever they
            want.

            Erin- of course, that is the only way it CAN be. You can’t force anyone to go to the hospital to give birth. How could you? Shoot, plenty of people who plan to give birth in the hospital still don’t make it. You can’t control that.

            And not too many people think you should even try. What you CAN control, however, is whether incompetent bumblers can pass themselves off as professionals, when they don’t adhere to professional standards. In fact, we do that all the time. We don’t let just anyone hang a medical certification on the wall and claim to be qualified to practice medicine. That’s what CPMs are doing. They claim to be midwives, but don’t have the training or skills that would qualify them to be midwives in any other country, or even match up to CNMs in this country. And yet, many states allow them to practice, despite their inadequacies.

          • Erin

            The point I was trying (obviously badly) to make was that how many women given all the non biased information would actively choose to birth at home. Yes accidents happen, one of my friends gave birth in a lay-by on the side of a dual carriageway for example but I think too many of the women of my acquaintance who pursue waterbirths/homebirths are doing it because of the misinformation they are fed by the media and our “professional and educated midwives”. One of whom told me I was an ideal candidate for home birth 12 hours into a PROM as a first timer in back to back labour with a baby pushing against something which had my legs buckling under me with every contraction and who was only partially on the cervix. When I repeated that conversation to the Doctor who retrieved my son from my uterus 69 hours later he said something along the lines of “please tell me she was joking”. It doesn’t matter how trained and “professional” you are when your training is to push women into unsafe choices based around a fantasy (the experience) and a desire to cut costs.

          • Who?

            Exactly-this is all about informed consent and accurate information.

            Birth hobbyists don’t seek the former or supply the latter, perhaps out of ignorance, perhaps out of greed.

          • monojo

            Homebirth in the US is not safe. It is homebirth midwives who resist efforts to make it safer. I’m happy for your positive experiences, but they don’t change the facts.

    • SarahSD

      Hi RBC4.

      Regular readers here are annoyed with you because you mistakenly assume they know nothing about the differences between midwifery across health systems. We know about the Canadian system, Dr Amy has even made a post about it recently:

      http://www.skepticalob.com/2015/12/why-is-canadian-homebirth-safe-but-american-homebirth-dangerous.html

      Today’s post was not about the Canadian system, which is clearly safer than the state of homebirth midwifery in the US. Many readers here would strongly support a professional and integrated collaborative system. Many other readers would never choose a homebirth even within a “safer” system because things can go badly quickly.

      One of the things I love about the discussions here is the way Dr. Amy and this community of readers shed light not only on the science and the statistics, but also on the intertwined culture of natural childbirth advocacy (and natural-everything-advocacy). Several readers are Canadian, myself included. The anti-intervention, pro-“natural”, “everything is a variation of normal” culture that permeates American homebirth is also present in Canadian midwifery culture. This ideology is able to do more damage in the US because there are fewer regulations, standards and restrictions on midwives here. In Canada, as we’ve seen in the UK, if midwifery becomes even more widespread as a cost-cutting measure, and the anti-medicine, valorizing and “trusting” natural/vaginal birth-at-all-costs ideology continues to grow among them unchecked, more babies will die and be injured in birth.

      • OttawaAlison

        Kind of my big fear, especially as a lot of midwives are moving away from hospitals to stand-alone birth centres. If they keep up with the proper screening and all that and risk out (for out of hospital births) things like vbacs, maybe it would be fine, but since they do happen right now out of hospital against the advice of the SOGC and other sketchy stuff, it makes me wary.

        • SarahSD

          Yeah. I’ve already heard enough enabling/encouraging of risky choices to make me nervous. I would hope that they are at least collecting better data on outcomes than what we have seen in the US.

  • RBC4
    • Taysha

      I always love when people ask me to get “educated” and provide links to their team, instead of independent study.

      You seem to be taking this very personally. Considering the horror stories we have seen you’re going to have a hard time convincing anyone that midwives are the bees knees.
      We’ve seen differently.

    • OttawaAlison

      I may have been in the hospital control for that study. I was classically low-risk with a very normal pregnancy. Though I hope my csection wasn’t considered a bad outcome (at 41.5 weeks to boot), she’s a very healthy 9 year old now and was born healthy (almost 9lbs, alert, in great health right away).

    • yugaya

      You are bringing up Ontario midwives as proof of what? That they practice recklessly and without any shred of professional consequences for any of the homebirth disasters that they presided over during the period that those studies cover?

      Here, get educated but beyond the auto-dictated glossy abstracts, all the links are in the comments: http://www.skepticalob.com/2015/12/why-is-canadian-homebirth-safe-but-american-homebirth-dangerous.html

    • Amazed

      Aww, dumbass doesn’t know how an MD is earned and maintained.
      Is there something dumbass knows at all?

      • yugaya

        Apparently the dumbass does not know the Maternal and Perinatal Mortality Reviews for Ontario at all.

        • Amazed

          Well, why should she? She only cares about perinatal mortality. Stillbirths happen. Neither midwives or OBs can prevent them.

      • Taysha

        She also thinks 4 years of schooling and 100 births make them comparable to OBs

        • RBC4

          Actually, it makes them able to run the obstetrics department of a hospital… see Markham-Stoufville hospital where the head of obstetrics is, ‘gasp’, a midwife.

          • Taysha

            Not the head. The CEO. The Chief of Staff is an MD.

            but you don’t understand what that means, now do you?

          • lilin

            ZING!

          • lilin

            Wow. You really don’t know anything about the subject you’re defending, do you? Not *anything*.

    • crazy grad mama

      Aw, you have to love* comments that start with “get educated.” Possible variants include “educate yourself” and “do your research.”

      *And by “love,” I mean “roll your eyes because the commenter has a degree from Dr. Google and has clearly not bothered to read anything else on the site.”

      • demodocus

        Shades of anti-vaxers.

  • Madtowngirl

    I’m very disturbed that the same people who cry that birth is a business for hospitals and doctors, don’t see that homebirth is a business. I mean, how can you justify paying hundreds for a doula, midwife, etc, when insurance pays most of your hospital costs? I paid $1500 total for my daughter’s birth. If I hadn’t needed a c-section, I probably wouldn’t have paid anything. “Free” and safe vs. expensive and dangerous. I’ll take hospital birth, please. I realize it’s not this way for everyone, and that I had amazing insurance. But I’d take safe and expensive, too.

    • LaMont

      I think that it’s the “compelled” nature of it. Set foot in a hospital, and you *must* pay that money (or insurance has to). At home, you could just have a kid and not pay a cent, but you can choose to make it “nice” for yourself by having cheerleaders/a pool/whatever. But no one is going to make you do or pay anything. I think that might be it? Besides, regardless of cost, any homebirth advocate is going to see your hospital c-section as a failure of care anyway, because in their book, cheerleading is a pure good while telling someone “you *need* a surgery” is always a self-serving lie. Just a lot of reality-defiance, basically.

      • AirPlant

        So it is lottery logic. You ignore the risk of the negative outcome and choose to believe that you will win.

      • EmbraceYourInnerCrone

        Renting a birthing pool costs money. Many CPMs require that the pregnant woman purchase a lot of the disposable items need for the birth themselves. (Many CPMs leave the clean up and washing soiled linens, draining and cleaning the pool, etc, to the woman and her family)

        Most CPM midwives charge thousands of dollars, which must be paid upfront, BEFORE you deliver. Also most CPMs in many states are not required to have malpractice insurance, so if something happens and your baby is for instance, severely brain damaged due to a birth accident, you will not be able to sue for help with the child’s future care.

        Additionally a CPM is NOT a pediatrician, newborns can have serious health problems that only have subtle signs until they become emergencies, do you want to risk your baby’s life/health by just assuming they are healthy?

  • demodocus

    it is far more important to me that my little daughter thrives and that i’m around with her and her brother than all the comfy pillows and lavender oil and midwives knitting in my rocking chair in the world.. ‘Though if my sister is there again, she can bring her knitting 😉

  • AirPlant

    George Takai shared this and I was so disappointed. Why is it that people are so OK with making sacrifices on the heath of women and babies? Every time this shit gets a little more mainstream support it scares me a little bit more. Complications are not particuclarly rare and they have real consequences and George Takai is not going to be the one holding the bag if things go south.

    • demodocus

      A gay male actor is not necessarily the best person to listen to about childbirth. Hopefully, some of his nieces or his sister tell him off. You’d think he’d actually know people who had a baby out of the hospital (other than in the camp.)

      • Young CC Prof

        To quote a young gay man who had a baby with a surrogate: “She says her water broke! What does that mean?”

        • demodocus

          Clearly didn’t read the James Herriot vet books

    • Madtowngirl

      I was pretty disappointed in his post, but I was even more disappointed in the comments. “Homebirth is totally safe! If something goes wrong, you’ll just be transferred.” “Homebirth is great! No doctors to control me!” “I’m going to make my wife have a homebirth.” “Homebirth is a great way to save money and so relaxing!” “CPMs are highly trained!”

      I was sad for the L&D nurse who commented. She urged people not to have a homebirth, since she’d seen the result of many gone wrong. She got ripped apart. :/

      • AirPlant

        You made it farther than I did, I stopped reading after the first couple comments for the sake of my mental health. I have been chanting “Loudest doesn’t equal Majority” to try to calm down

        • Madtowngirl

          I really need to stop reading the comments. Although, it’s about the only thing that gets my heart rate up nowadays!

          • AirPlant

            I can’t say that I am able to stop myself from reading the comments, but I am getting better at knowing when to stop.
            On that note though a highschool friend of mine had a homebirth recently and the absolute worst comment was her mother in law writing on the facebook birth post “Congratulation on making the absolute best choice for my grandchild! If you had tried giving birth in the germy hospital I might have had to kidnap you and that baby!”

          • Young CC Prof

            Because nothing says feminist liberation like your MIL controlling your body and your children.

    • attitude devant

      I have suspicions that he’s not running his own FB page at the moment. He IS very busy with other projects.

  • Manabanana

    http://onlinelibrary.wiley.com/doi/10.1111/jmwh.12394/abstract

    I know it’s hard to keep up with all the nonsense that comes from MANA. Have you any interest in addressing this rubbish?

    • yugaya

      It’s always entertaining to see the number gymnastics they employ.

    • yugaya

      “By comparison, neonates in the intended waterbirth group experienced more negative outcomes than the non waterbirth group” and “waterbirth may be associated with increased risk of genital tract trauma for women”.

      I think aliens have hijacked Melissa Cheyney and replaced her with a clone that has some basic morals.

      • demodocus

        no we haven’t. It was the trolls under the Golden Gate Bridge.

      • The Bofa on the Sofa

        I’ll tell you, it has been my impression that Missy has actually toned down significantly. It appears that the outcomes they have been finding have been so bad that she can’t deny it. Now, being a salesman, she’ll continue to try to market what she can, but there has been a lot of concession on her part regarding safety. “Yeah, it’s not as safe, but hey, there are all these great benefits….”

        • yugaya

          There’s that second cohort since 2009 that we are all waiting to see the results of – I’m sure Missy would have done so long time ago if it could be made to appear good.

      • Dr Kitty

        So…
        The only benefit of water birth is a slight reduction in labour pain, and you’re trading that for a worse outcome for your baby and an increase in the risk of a (painful) perineal tear which might cause long term dyspareunia and incontinence, and raises the risk of a PPH being missed…

        Water birth, if honestly represented, is a really hard sell.
        “Here, sit in some lukewarm, faecally contaminated water, your pain may reduce from 10/10 to 9/10, but the risk of bad things happening increases”.

        Which is why it is sold as “lovely” and “peaceful” and “spiritual” instead.

        The only mammals that birth in water are whales and dolphins.
        Last time I checked, no blowhole.

    • manabanana

      Gymnastics? Didn’t the WHOLE DANG SAMPLE show poorer outcomes? These are MANAstats for crying out loud.

      Drives me nuts.

      • yugaya

        They are always comparing one subset of their poor outcomes with the rest/total of their poor outcomes and trying to come up with numbers that seem legit and not really bad at all. Compared to non-MANA outcomes of low risk hospital births – all of MANA results are equally hideous.

    • Young CC Prof

      The data presentation is a little confusing, I’d have done the percentages the other way, and I’d have used “intended waterbirth” to describe all mothers that planned a water birth rather than just those that were unsuccessful.

      I really can’t take much of anything away from this study, to be honest. What seriously bothers me, however, is that there were 8 intrapartum deaths, and the study doesn’t say anything about what group they were in or how they occurred. It also doesn’t say anything about the 2,949 intrapartum transfers, what their outcomes were or whether they planned waterbirth. It’s like a student with good computer skills did the data analysis, it’s answering all the wrong questions.

      The study from January 2014, I believe that one was deliberately written to try to hide bad outcomes, this one is just… meh.

      • Young CC Prof

        Or were those 2,949 intrapartum transfers? I can’t even tell. I’d love to review this study, but I can’t comprehend it.

      • Manabanana

        The 8 intrapartum deaths – that were excluded from this “study” – are troubling. To say the least.

        “Whoops ! 8 babies died after labor started, but before birth – we’ve got to just throw that data out.”

        Who reviews submissions for the JMWH? And WTH are they thinking?

        Thanks for confirming that this study is outright CONFUSING.

        Notice how many planned breech, twins and VBACs were included. And that none of these risk factors are considered contraindications to waterbirth?

        SIGH