Is this pitiful response the best homebirth midwives could offer?


I’ve been waiting eagerly to see how CPMs (certified professional midwives) would respond to my piece in The New York Times Sunday Review Why is American Home Birth So Dangerous?

I made several points in the piece:

  • Homebirth is relatively safe in Canada and other countries.
  • The US homebirth death rate is 3-7X higher than comparable risk hospital birth.
  • Most US homebirths are attended by CPMs a second, poorly educated, poorly trained class of midwives that do not meet international midwifery standards.
  • If we want to ensure safe homebirth we should start by abolishing the CPM credential.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Abolishing the CPM and requiring all midwives to meet international standards is the first step to making US homebirth safe.[/pullquote]

The Midwives Alliance of North America (MANA), the organization that represents homebirth midwives has responded … sort of.

They wrote a lot of words, they raised a lot of irrelevant points and they did not address the central issue, the fact that CPMs don’t meet international midwifery standards.

MANA President Marinah Valenzuela Farrell wrote Women Are Choosing Home Birth: The Infant-Maternal Health Care System in the US Owes Them a Safe Option.

Yes, and a safe option would mean abolishing the CPM and requiring ALL midwives to meet international standards.

Ms. Farrell is a case in point. As far as I can determine [please correct me if I am wrong], she has no formal midwifery training of any kind, no midwifery school, no midwifery degree, no hospital training, nothing.

How does Ms. Farrell address my four points in her response. She can’t, so she doesn’t even bother.

1. How does Farrell address the disparity in homebirth outcomes between the US and other countries that have relatively safe homebirth?

She ignores it.

2. How does Farrell address the statistics and citations in my piece demonstrating the higher death rates at US homebirth?

She doesn’t.

Critics of home birth cite flawed birth certificate studies and highlight relative instead of absolute risk. The State of Oregon has recently made an important leap forward by creating a birth certificate that captures the intended place of birth as well as provider type.

That’s EXACTLY the birth certificate data used to compile the statistics that I quote from Oregon show that planned homebirth with a licensed CPM has a death rate 800% higher than comparable risk hospital birth.


The data was compiled by Judith Rooks, CNM MPH, a noted homebirth advocate. Rooks’ testimony before the Oregon Legislature is damning:

Many women have been told that OOH births are as safe or safer than births in hospitals…

But out-of-hospital births are not as safe as births in hospitals in Oregon, where many of them are attended by birth attendants who have not completed an educational curriculum designed to provide all the knowledge, skills and judgment needed by midwives who practice in any setting.

3. How does Farrell address the fact that CPMs don’t meet international standards for midwifery education and training and would not be considered midwives in Canada, the UK, the Netherlands, Australia or any other industrialized country?

She ignores this critical fact.

Farrell writes:

Families deserve the support of a provider that meets international standards.

But she neglects to mention that CPMs don’t meet those standards.

Judith Rooks, in a 2013 interview, asked pointed questions about the CPM:

The lingering questions then become why are the minimum standards so low, especially in comparison to counterparts around the world? Why is it acceptable for midwives to aim for the cheapest, quickest route instead of striving to be their best? Why are the “certifying” bodies (ie NARM/MANA) keeping the bar so low…as in only requiring a high school diploma as of 2012 instead of requiring a college level education to deliver our babies?

Why, indeed?

The answer is that there is a group of laypeople, Marinah Valenzuela Farrell among them, who can’t be bothered (or don’t have the academic ability) to get a real midwifery degree, so they practice without one … and the results are deadly.

I do agree with Valenzuela Farrell on one point, though.

The US healthcare system should do everything possible to ensure that American women who choose homebirth have access to the same level of safety as Canadian, Dutch, British and Australian women who choose homebirth.

That’s why we must abolish the CPM and require all midwives to meet international education and training standards.

It will put women like Marinah Valenzuela Farrell out of business and that can only be a good thing for American babies and mothers.