A baby is dead and Hannah Dahlen thinks the problem is oppression of midwives

36247186 - creative on a theme of oppression, a pencil eraser and word oppression. vector illustration.

Homebirth midwives are nothing if not self-absorbed.

A baby is dead and Hannah Dahlen, a spokesperson for the Australian College of Midwives, has the unmitigated gall to use the preventable death as an opportunity to whine about the “oppression” of midwives.

Hannah Dahlen has never met a dead baby she couldn’t exploit for her own purposes.

According to ABC Australia:

The baby, referred to as “NA” by the New South Wales deputy coroner, died during a breech birth at a property near Nimbin in northern NSW in February last year.

The coroner found in September the parents of NA were clearly warned by their doctor of the dangers of a home birth because the baby was lying sideways…

There was no midwife or medically qualified person present during NA’s birth, in a practice often referred to as a “free birth”.

The parents were warned that the baby could die at homebirth and in an amazing coincidence — who could have seen that coming? — the baby died at an unassisted homebirth. Why was the birth unassisted? Because no doctor or midwife would attend a homebirth of such extraordinarily high risk.

This was a completely preventable death. For Hannah Dahlen, it was just another oppportunity to whine.

“I think there’s a few things driving this,” professor of midwifery at Western Sydney University, Helen [sic] Dahlen, said.

“One of them is the increasing over-regulation and oppression of midwives in this country …”

Say what?

Let me see if I get this straight. According to the Coroner’s Report, the parents were warned by doctors and midwives that the baby was transverse, that a transverse birth was far too dangerous to attempt at home and that no doctor or midwife would attend them if they chose to risk the baby’s life in that way.

… In my view both parents knew that they had been warned in general terms against proceeding with a home birth. Their pre-existing views made them wilfully blind to the level of risk involved. In my view it is established that they knew the foetus was lying sideways shortly before the due date. However they did not appear to properly understand or accept that they were heading into a potential catastrophe.

What does that have to do with the regulation of midwives? Not a damn thing.

But Dahlen has never met a dead baby she couldn’t exploit for her own purposes.

Dahlen made this horrifying claim in 2011 in the wake a multiple preventable homebirth deaths:

When health professionals, and in particular obstetricians, talk about safety in relation to homebirth, they usually are referring to perinatal mortality. While the birth of a live baby is of course a priority, perinatal mortality is in fact a very limited view of safety.

Really? On what planet would that be?

On Planet Midwifery where dead babies are a small price to pay for increased midwifery autonomy.

Dahlen’s claims in this case are even worse. This baby’s death had no more to do with midwifery regulation than it had to do with physician regulation. And regulation of midwifery is no more oppressive than regulation of physicians. The point of regulation is that safety standards matter more than the desires of individual practitioners. That’s a good thing, not a bad thing.

No matter. Dahlen exploited this baby as yet another opportunity for midwifery lobbying.

Dahlen’s claims are not simply an exercises in extreme callousness, they are a symptom of the ugly self-absorption that places the feelings and interests of midwives above everything else including the lives of babies.

  • Verboten

    Why should we have regulation of midwives? Women can kill their babies if they choose, let them bring them into the world however they please, fascists.

  • Hayley Pipkorn

    I would not want this woman within 10kms of me if i was having a baby! The woman is delusional!

  • maidmarian555

    The Spinning Babies website is one of the first hits you’ll get on a search for transverse babies: http://spinningbabies.com/learn-more/baby-positions/other-fetal-positions/sidewaystransverse/

    It would not surprise me if the parents had come across something like this and decided there was a strong chance that the baby could be persuaded to turn itself. FTA: “39 weeks: Why have a cesarean now? (Warning, opinion coming…) The reason may be for your surgical team’s convenience. Why should your baby miss a few brain cells for the ease of scheduling? If you are healthy in other ways, give your baby another week or two. There are risks in both choices, so choose carefully. Early surgery has unavoidable side effects that will happen, and waiting has theoretical side effects that may happen. Babies have been known to turn head down at 40 weeks with 5-7 forward-leaning inversions.”

    When I was pregnant my midwife thought my baby was transverse (a scan confirmed she’d confused his head with his feet and he was head down). When I was looking for information, I found more reputable sources such as the NHS website had very little information on this, and was horrified when I found this sort of advice easily available. This site was also recommended repeatedly on forum posts asking for information on transverse babies.

    • Azuran

      Again with that ‘surgical team convenience’ Man they really have a problem with that.
      F*** those surgeon for wanting you to have a well prepared, scheduled c-section during the day, in a well staffed hospital, with all personnel available in case of an emergency. And not a crash c-section, at 2am, with tired on call staff in an understaffed surgical and NICU ward.
      And the ‘brain cell’ thing is just horrible, where did they come up with that?

      • RudyTooty

        The blatant me-first privilege is displayed when she recommends to clients with a malpositioned baby to not to schedule a cesearean, but to wait for labor and go in and have a c-section…. you know, whenever,

        Because that’s what hospitals are for: Waiting for the privileged, pumpkin spice latte-slurping, yoga-pants-wearing set to walk in at any time of day for their cesarean section at *their* convenience. Which they’ve decided is a few hours since onset of *natural* labor because natural labor hormones are always good. Scheduling is bad. Accomodating anyone but themselves and their magical hormonal bodies is bad.

        Fucking privilege. All right there. The world revolves around me.

        • Azuran

          And then they complain that the recovery from their emergency c-section at 2 am after x hours of labour was hard. That everyone was in a hurry and that she wasn’t treated like a princess by the overworked staff.

        • TheArtistFormerlyKnownAsYoya

          Hey, I had a PSL in my yoga pants yesterday. But I scheduled my c section – alert doctors who aren’t rushed, yes please!

          I think the real goal here is to maximize women’s suffering. Oh, so you thought you could “get out” of the pain and suffering of labour? No fair! C sections after labour has started are so much harder on your body. I think that’s her real motive.

          • Heidi

            That PSL better have been organic, locally roasted coffee, used organic spices and contained actual organic pumpkin, which was gutted and roasted at the coffee house because cans are lined with BPA! And instead of milk, it better have been made with organic hemp “milk”!

          • TheArtistFormerlyKnownAsYoya

            No, alas, I got it at Starbucks. For shame!

          • Heidi

            Don’t tell but I just finished letting my baby eat a lunch of non-organic, microwaved frozen peas & carrots and cut up Gerber meat stix.

          • TheArtistFormerlyKnownAsYoya

            HORROR!! I just topped off my mostly-breastfed baby with formula. Sometimes, things just need to be easy.

    • Irène Delse

      “Why should your baby miss a few brain cells for the ease of scheduling?”

      Wait, what? Do these twits believe that a baby stops making brain cells when it’s out of the womb?? Oh, I get it: they didn’t think at all! (And missed the boat on decades of research showing that the child’s brain keeps growing into adolescence.)

      • Verboten

        I’m sure they know that. You are just trying to twist meanings to better fit your narrative.

        Pretty sure this is common knowledge, but you seem to be lacking:

        “At the same time, the cerebellum (motor control) is developing fast — faster now than any other area of the fetal brain (its surface area increases 30-fold in the last 16 weeks of pregnancy!).”

        http://www.whattoexpect.com/pregnancy/fetal-brain-nervous-system/

    • AnnaPDE

      “Why miss a few brain cells when you could have them grow, and then kill ’em off with loads of other ones when your stuck baby has no oxygen. So much less convenient for the surgical team, that’ll teach ’em!”

    • Amy

      Uh, because the risk of stillbirth is lower at 39 weeks than it is at 41 weeks?!?

      I will never understand these people.

  • Playing Possum

    It gets worse (I read the coronial report a few weeks ago).

    Mother was anaemic and Hepatitis C positive. She had already had one successful UC.

    Expert evidence was that if they had accepted obstetric care they might have had a successful vaginal delivery after version.

    The child protection team were notified prior to delivery but had no way of acting.

    The baby arrived at the hospital cold, unwrapped, blue, apneic,

    Because the local hospital had no way of knowing what would turn up, resuscitation was commenced but equipment wasn’t set up and the doctor had to be called from home.

    So basically all the things that home birth advocates insist are protective factors (“I can just go to the hospital”, “If it was really dangerous then child welfare would do force them to deliver in hospital”, “We can resuscitate a baby just fine until we get to the hospital”, “I’ve already had one normal birth”, “I’ll be forced into a CS if we accept conventional care”), were completely and utterly false.

    And to make matters worse, there has been an agreement in the last few weeks to extend the professional insurance exemption for private midwives doing home births until the end of 2019. Because the insurance companies have such high premiums (wonder why). There is so little incentive for improvement, because the only thing they can “lose” is their registration, and LB has had no problem continuing to attend births without registration, and the public health system will pick up the lifetime care tab for injured children.

    Midwives in Australia have very little to complain about.

    • Platos_Redhaired_Stepchild

      The parents of this child were deep into la la land.

      http://www.abc.net.au/news/2016-06-30/home-birth-mother-says-she-did-not-understand-the-risks/7556366

      “The desire when you have a baby is to have a safe environment – the hospital is full of sick people,” [mother] said.

      “People are not numbers … they are allowed to choose things that they want in their life”.

      She also told the court she trusted her husband, who had previously delivered five of his own children at home, and did not want a confrontation about where the baby would be born.

      Her husband said he did not agree with the doctor’s “point of view” regarding the hospital birth.

      “We didn’t feel any threat or danger,” [father] said.

      • Sue

        Actually, labor wards are generally full of healthy young women and babies, not “sick people”.

  • Ayr

    I’m sorry but shouldn’t a midwife be more concerned about safe, live deliveries than the right to do as they please. It seems all I hear about these days is midwives who are shirking their responsibilities for the sake of a glamorous home birth rather than a safe one.

  • yugaya

    Hannah Dahlen is the worst POS there is. She actively tried to coerce loss mothers to hide incriminating evidence against Lisa Barrett. “Let bygones be bygones”.

    The scum of the earth.

    • NinjaMama

      The fact that she is still employed by UWS enrages me. Just as it enrages me that last year’s Midwife Of The Year was bloody present at a home birth death. Disgusting.

      Between this and the endless horror stories I hear from friends and families giving birth in Australia’s midwife-led system (which I have bitched about on here for nearly 3 years), something needs to change in midwifery education in Australia if women like Dahlen are the teachers.

      • yugaya

        I hear that Lisa Barrett was reported to be attending births this year alongside a RM and that – nothing happened to either Lisa Barrett ot that RM. Hannah Dahlen, still the enabler supreme.

  • RudyTooty

    This:

    “On Planet Midwifery where dead babies are a small price to pay for increased midwifery autonomy.”

  • MaineJen

    I’m trying to wrap my head around this. What does a labor with a transverse lie look like? Does the woman’s body just labor and labor for days on end with no progress? Does the baby die of exhaustion eventually? Cord compression?

    And…at what point…after how many DAYS of no progress do these people finally throw in the towel and head to the hospital?

    • Without surgery they both die :/

    • Azuran

      Well, the baby is sideway and simply cannot fit. Any health care provider with half a brain would know to transfer ANY woman who has a transverse baby when labour starts. It’s never going to be born naturally.

      If they didn’t. you’d probably have contractions for hours (possibly days) but with totally unproductive labour. Eventually, the baby would die, either from the stress of the long labour, failing placenta or whatever.
      Eventually, if the mother doesn’t die of some complication from the very long labour (ruture, hemorrage, exhaustion etc) Labour will stop at some point (probably after days).
      The baby would then start decaying in the hours following it’s death. If infection sets in, the mother would die of septis after a few days.

      If infection doesn’t sets in and the mother doesn’t die some some sort of complication from all of this……..Well I’ve seen 1 case where this happened to a dog. The puppies basically went through some kind of aseptic necrosis/mummification/resorption process until all was left was hairy bones. When the uterus involution started, the bones tore through it and ended up loose in the abdomen. This caused massive sterile peritonitis that resulted in extremely severe adherence between all the abdominal organs and cause severe digestive problem. She had to be put down.

      • MaineJen

        Uuuuuugh oh my god. Do midwives know that this is what’s going to happen, or do they honestly think the magic sparkles are going to cause the baby to turn? (Rhetorical question, obviously…)

        • Azuran

          Even if it’s rhetorical: Yes they do.

      • Roadstergal

        That is horrible. 🙁 The poor dog.

      • guest

        Extremely rarely, you end up with a stone baby in the case of labor that just stops with the baby still in the uterus.

    • Ayr

      Any doctor worth their weight in salt won’t let it get that far. Granted they cannot prevent a patient from being stupid. They will try to turn the baby, if the baby cannot be turned they will encourage a c-section. But as I said they can’t force the patient to comply, and only an idiot or selfish POS would insist on trying to have a home birth with a breech baby of any kind.

  • namaste863

    Jesus, professional standards of practice and ethics are there for a reason! If practitioners are free to do whatever they damn well please, consumers get hurt!

    • Maud Pie

      Absolutely. Standards of care and the imposition of liability for breaching them were not established to frustrate those with an adventurous approach to health care.

    • Azuran

      and yet they are always the first one to accuse the doctors or nurses of anything that goes wrong. You can be sure that if that baby had died in the hands of a doctor, they would be screaming bloody murder because Golf game.

      • Roadstergal

        If she had been talked into a C-section and the baby had been born just fine, they’d be screaming bloody murder because golf game/dead baby card.

        • Azuran

          and unnecesarian of course. After all, baby is fine, so clearly it wasn’t needed.

          • kilda

            but of course. It’s very simple. If the baby lives, no C section was needed. If the baby dies, no hospital could have saved it. Hence, no C section is ever necessary.

  • mostlyclueless

    “…perinatal mortality is in fact a very limited view of safety.”

    I would agree if what she meant was that things like HIE and other birth injuries should be considered in the definition of safety (ie babies that survive but are seriously or permanently injured). Somehow I doubt that was her meaning though.

    • Sue

      Spot-on! So why do HB statistics only look at deaths an not morbidity?

      • Azuran

        Probably for the same reasons that we don’t have very helpful data on long term birth injuries even for hospital birth. We don’t really have good ways to measure if a baby is getting proper oxygenation through the birth. It can take years for the effect of lack of oxygen at birth to make themselves known. And by then, it’s very hard to know if it was really caused by the birth or not.

  • fiftyfifty1

    So Dahlen thinks that a midwife would have attended the birth if not for “over-regulation and oppression.” Ok then. So how, exactly, could that midwife have saved the baby? Because this baby needed a C-section. Is she suggesting that midwives should do home CS?

    • RudyTooty

      OK – reminded of the inane and insane indoctrination I endured for some time. And it’s subtle, and cunning: The way these midwives preach their doctrine.

      I kid you not:

      When I was I DOULA training, many, many years ago. I remember talking about *absolute contraindications to vaginal birth. And transverse lie was one that was mentioned. And we, the green, unwise doula trainees all pretty much nodded in agreement that that would be one situation where we, as doulas, would lovingly support a cesarean for our clients. But our souls trainer was also a CPM, and she set us straight! She spoke from such peaceful knowingness and authority and calmly mentioned that at midwife could just do a podalic version and deliver the baby breech.and she threw in something about physicians being unskilled and frightened to do such an “empowering” thing for women.

      I kid you not. I wish I was. Unfortunately we were all to young and green to call her on this fantastical bullshit.

      This comment – what would a MW do for this lady? – jogged my memory of this.

      • RudyTooty

        Argh – not a souls trainer!! A DOULA trainer!

        • fiftyfifty1

          The term “souls trainer” doesn’t seem any nuttier than “holding the space” or “coming earthside” or any number of other NCB terms.

          • Roadstergal

            I would 100% believe there’s a doula and/or CPM trainer out there who calls herself a ‘souls trainer.’

      • MaineJen

        As in…the midwife is supposed to reach in and grab the baby’s foot? …How often would that work out the way it’s supposed to, I wonder? :/

        • RudyTooty

          I don’t think the doula trainer’s objective was to give us any feasible information. It was to indoctrinate us to question ALL seeming “absolute” indications for a cesarean.

          So we would go forth and be minions to the NCB movement.

        • Mel

          Never.

          My mom had a total breech extraction for my Sis who was a transverse breech coming after vertex-positioned me. It took one anesthesiologist, two nurses to hold her legs in place, two “huge” (in my dad’s memory) guys to apply pressure to get Sis’s head and butt vertical from transverse and one OB to grab both her feet and deliver her.

          That’s six trained people with a patient with a fully dilated cervix that had just delivered a twin in a hospital with a neonatal resus team in the room.

          Mom says that with one midwife and no painkillers the mom would most likely kick and writhe so much that the maneuver would be impossible. For her, she did need people to pin her legs in place – she tried not to fight, but it hurt a lot and sometimes instincts kick in…..

          • Taysha

            My OB threatened me with this should my second twin be breech

            I have never been happier for a c-section (both kidlets are great)

          • Mel

            My mom was OK with the idea of a CS – but there was a weird series of events that lead to not having an operating theater available and a labor that went from “4 cm and progressing but slowly” to “Here’s Mel!” in 40 minutes.

            Not something Mom would recommend for anyone, but she was glad the OB knew how to get Sis out alive and well.

          • Kelly

            That is horrifying. This is why I would never try for a vaginal birth if I were carrying multiples.

          • Mel

            In all fairness to the OB and my mom, Mom had a slowly progressing premature labor at somewhere between 28-30 weeks with rupture of my membranes. The OB knew that we were vertex/transverse. The OB was trying to get her into an CS or OR room, but there was a major car accident that had all the ORs filled and CS were in progress in all of the CS rooms when Mom’s cervix decided it was time to dilate and efface.

            All of a sudden, I was crowning between contractions and slipped out at the beginning of the next contraction. Since it was 35 years ago, they weren’t sure how much placenta we were sharing so Sis had to come out right then.

            Mom said it was a really, really unpleasant 3 minutes of her life, but she’d do it again if it meant saving a baby’s life. She also points out that that’s why she’s massively in favor of moms getting an epidural. It’s much nicer if the docs can just dump a good dose of med in your spine than do the best they can with an inhaled drug.

          • Kelly

            Oh, I knew your mom didn’t plan on that. Situations happen but if I have a choice, I will not even think twice about going straight to a c-section. There are just too many risks for me to purposely go for a vaginal birth. I feel bad for your mom but glad that she was in a place where she could deliver you and your sister as safely as possible.

          • MaineJen

            …reminds me of *that* episode of ER… (shiver)

          • Daleth

            The more I read here, the madder I am that my MFM team (I had a team because mono-di twins are very high risk) kept trying to push me into attempting a vaginal birth, even though Baby B was breech or transverse at every ultrasound but one, and I was clear from about week 16 on that I absolutely wanted a c-section.

          • Kelly

            Why would they even consider it with that kind of presentation much less push it? That is insane.

          • Daleth

            Why would they even consider it with that kind of presentation much less push it? That is insane.

            I agree. I think there were two reasons:

            (1) the anti-CS brigade (Consumer Reports hospital ratings based solely on percentage of c-sections, etc.) has made them focus way too much on getting their c-section rate down, and

            (2) they were excellent doctors at an excellent, very high-resource maternity hospital (over 10,000 babies a year are born there, best NICU in the region, etc.), so they were confident that whatever happened, my babies and I would come out ok.

            But from my perspective, I didn’t just want us all to come out ok in the end. I also wanted to have the lowest-risk birth possible (a planned CS is drastically safer than an emergency one) and to spend as little time as possible scared about what was happening (that is, I didn’t want to spend 10 or 20 hours or however long in labor worrying about whether the babies would be ok, and I certainly didn’t want to spend any time in an actual emergency situation, panicking about a possible dire outcome that I couldn’t do anything about).

            In other words just like the hippy chicks I wanted a non-traumatic birth experience, and knowing myself–in particular, knowing how much I knew about labor complications, birth injuries, life as a handicapped person (my mom is handicapped), etc.–I knew that meant I wanted it to be over quickly (no time to worry) and done with as little risk as medically possible (no reason to worry).

            How is it not my absolute right to make that decision? It was pretty scary to discover that apparently, it’s not. Given how hard I had to fight to schedule a CS with my twins, I figure it must be all but impossible to get a MRCS at that hospital, or at least not with those doctors.

            Another reason I was so certain I wanted a CS was that since my mom is handicapped due in part to a forceps injury at her own birth (not to mention I knew that instrumental delivery dramatically increases the risk of pelvic floor damage), there was absolutely no way I would ever consent to forceps or even vacuum use (my babies were slightly premature and in such babies vacuum extraction has a risk of brain bleeds). I actually told my doctors, in a joking-not-joking way, “If anyone comes near me with forceps I will kick them in the teeth.” So if problems arose those solutions wouldn’t be available and it would be straight to a c-section anyway… so, logically, why not just go straight there to begin with and solve ALL the problems at once?

        • Azuran

          and in a transverse labour, I imagine that the cervix will often not dilate much, since it’s the pressure of the baby’s head against the cervix that causes a lot of the dilatation. So going in to get the baby must be excruciatingly painful.

          • Mel

            Plus, you could pull the feet down and create a prolapsed cord or have the head stuck behind an incompletely dilated cervix….yikes.

        • TwinMamaManly

          I had a birth like that – twin A normal, twin B came out footling breech – pulled out bruised, battered and not breathing. Both were raced off to NICU, blue and floppy. Spent a week in Level 1, a month there overall. I had a senior obstetrician who is the breech guru for NSW, an obstetrician, a midwife for me, and two Neo-Nate paediatric teams for my babies (along with assorted midwife and med students to observe). If I hadn’t been in the tertiary teaching hospital (Randwick Women’s) my babies could have died or been brain injured, and I probably would have sustained birth injuries. I regard that delivery as a successful birthing experience as we all survived it and came home healthy.

    • Sarah

      Yeah, she’s quite possibly right that a midwife would’ve attended if there were no regulation. It’s just not obvious why that would have helped in any way, not with a transverse lie. Not the most obvious of cases to be making that point with.

  • Dr Kitty

    What I think HD means is that Lisa Barrett wasn’t able to attend this birth, so the baby died in the absence of anyone who could gaslight the parents into believing that their baby would have died in the hospital.

    Maybe HD thinks that a MW present at the birth would have been able to persuade them into an intrapartum transfer, even if multiple doctors and MWs had been unable to persuade them to deliver in hospital?

    HD can’t think she has the skills to deliver a transverse baby at home, can she?
    That’s… a bold claim.

    • AirPlant

      Well obviously had a midwife been present the baby wouldn’t have been transverse. It would have sensed the magical aura of her sparkles and flipped vertex before flying out with the ease of a greased baby seal. The malpresentation can only be blamed on the intervention of the medical establishment that the mother actively rejected.

      • StephanieJR

        ‘greased baby seal’

        That is a very amusing image.

        • AirPlant

          my husband tells me I have a gift for hyperbole. 🙂

      • N

        “It would have sensed the magical aura of her sparkles…”
        only if the midwife had milk in her breasts. Without breastmilk, no magical aura with sparkles…. breastmilk-sparkles?

        • AirPlant

          Really, what kind of midwife isn’t actively lactating?

          • Mattie

            I did have a baby attempt to latch on to my boob while I was holding it, which was weird cause I had clothes on and also have never lactated (that I know of) lol

          • AirPlant

            Been there. Almost dropped the baby. Was not allowed to hold it again.

          • Roadstergal

            I’m beginning to think my strategy of ‘hold at arm’s length like a wet sack of flour’ strategy for when I’m handed a baby is a good one.

          • BeatriceC

            My youngest is 14 years old. To this day a hysterical newborn or intense nipple stimulation will still cause a letdown and a small amount of leakage . MrC found this out accidentally as I’d failed to warn him. That was really early on in our relationship and he still harasses me about it. I don’t even want to know what would happen if an actual baby tried to latch.

          • Dr Kitty

            Ehhh
            I went back to work six months post partum after both kids and very much still lactating.
            First time I was working in a paediatric ER, second time in GP (where I see a lot of small babies).

            Long story short, I have had A LOT of babies try to latch on to me while I examine them (because I usually put them on my shoulder while I listen to their backs, and then cradle them while I listen to their hearts).

          • corblimeybot

            Our kid tried to latch onto her male pediatrician through his shirt.

          • An Actual Attorney
          • Daleth

            That is SO CUTE!

      • mostlyclueless

        The midwife would have just asked the baby to turn. Obviously.

        • kilda

          exactly! and if she won’t turn then you have to respect the baby’s decision. I mean, it’s her journey.