No one seems to learn anything from the endless parade of preventable homebirth deaths.
There’s been another:
My beautiful son R Was born on May 9th. He only lived 31 hours…
It happened “suddenly.”
I was in labor for about 35 hours and pushed for about 6… My midwife checked the heartbeat after every time I pushed and the baby sounded happy and healthy. Until he didn’t. All of a sudden the heartbeat sounded off so she called the paramedics… I ended up giving birth in the ambulance … R. was not breathing and he didn’t have a heartbeat. They started to resuscitate him in the trauma room. He needed to be put on machines to breathe … But his condition got worse and worse. They told u s that he had no chance of survival and there was no brain function. So we let him go …
R’s mother is reeling:
…This was my first pregnancy and I had so many high hopes for a home birth. I had no fear. No doubt in my mind that everything was going to be perfect… I felt him moving until the very end. What happened? Also, apparently my placenta had a huge blood clot … could that have something to do with him passing.
Why does it sound so familiar, practically a routine homebirth outcome?
Maybe it’s because it sounds exactly like this homebirth disaster, But the baby’s heartrate was fine right before it dropped nearly dead into the homebirth midwife’s hands.
Or these: So many homebirth deaths I can barely keep track.
Or these: Homebirth death watch.
Maybe these: Homebirth hell, 5, no 6 dead babies in one WEEK!
Perhaps these: The cult of homebirth kills babies; 5 deaths in the last few weeks.
Why did this happen? It happened because R’s mother chose homebirth with undereducated, undertrained, ideologically brainwashed midwives.
It happened because magical thinking — positive affirmations, having no fear — has NO impact on the incidence of complications and death.
It happened because intermittent Doppler monitoring is not as accurate as electronic fetal monitoring.
For example, this tracing shows a baby in serious trouble:
Surprised? You might be if you thought that a fetal heart rate tracing supplied the same information as intermittent auscultation (listening) with a doppler. But electronic fetal monitoring provides a wealth of information that cannot be obtained by listening, and that allows for a more comprehensive view of fetal well being.
This is a tracing with limited beat to beat variability and subtle late decelerations.
Notice what you don’t see:
You don’t see a bradycardia, a sustained period of abnormally low heart rate. That’s because bradycardia is often a terminal event. Most babies can tolerate long periods of significant oxygen deprivation before they die, and they may not have any bradycardias until immediately before death. On this tracing, there is never a single moment when the heart rate is outside of the normal range, but the baby is nonetheless suffering from serious oxygen deprivation.
This is almost certainly what is happening in hours before a dead or nearly dead baby drops into a homebirth midwife’s hands. The midwife may be intermittently listening to the baby’s heart rate, but unless she is listening for long enough AND frequently enough AND exactly at the right times AND can distinguish subtle changes in heart rate, she will be blissfully unaware that a baby is dying right in front of her.
Homebirth advocates and their midwives who insist that the baby’s heart rate was “fine” until just before delivery are almost always completely wrong. The baby’s heart rate was not fine; they just couldn’t tell what was happening because they only listened intermittently.
And because they couldn’t tell, the baby died.
Most of all, these entirely preventable homebirth deaths keep happening because homebirth advocates construct a wall of denial around every death, insisting that even though their family, friends, and doctors warned them that EXACTLY THIS TRAGEDY was more likely to happen at homebirth, the fact that it happened is just an amazing coincidence!
Like this one:
…My story is similar to your. We heard a healthy heartbeat shortly before birth and baby was making strong movements an hour before. My sweet E was born sleeping at home with no warning that anything was wrong.
Or this one:
I attended a birth where the baby passed in labour, (their first baby), it was terrible and shocking! … Life has some really tough lessons. We can grow and learn and use these experiences for positive change.
Apparently not.
No one seems to learn anything from the endless parade of preventable homebirth deaths.
I had a great home birth experience with both of my kids. Here is a study that looked at the stats of home birth. It’s best to use facts and not anecdotes when considering home birth. http://onlinelibrary.wiley.com/doi/10.1111/jmwh.12172/full
The facts are, as are often repeated on this blog, that home birth is more hazardous for both mother and baby. I’m glad you and your kids were fine, but it’s playing roulette, not scrabble. One has very little control over any number of a lot of things that may be disastrous.
I did plan on a hospital birth with my first baby. Hospital protocols deterred me and I felt I had no choice but to have a home birth.
That seems highly unlikely
Hospital protocols are there for your safety, still consent is always required, it is still far safer to give birth in a hospital refusing whatever protocol you disagree with, then to give birth outside of a hospital.
It’s kind of ironic that you preceded your statement that facts are preferable to anecdotes with an anecdote.
You don’t seem to have read it. It shows that homebirth with a CPM has an increased risk of death. More recent statistics from the same authors show these hideous death rates:
https://uploads.disquscdn.com/images/9f1257136fe5029abd8c6c9bc7498ee4577b21f6e6e44a5e3db9d79484fee59a.jpg
If you were actually “the” Doctor, you would have cited the research article instead of a meme.
The Doctor is a 900 year old man in a blue box armed with a screwdriver.
Yes, that’s my opinion of a lot of doctors too.
I guess you missed the fine print on that one: 44 dead babies, out of a cohort of 17,000 term births, mostly low-risk. 15% of the mothers hemorrhaged, too.
0.44, 0.77, 0.85 per 1000 in this home birth study and literature review. The only physician delivered mortality stat I could find was 0.96 per 1000. Maybe you have additional studies that have physician birth mortality stats with better outcomes. I look forward to reading them.
What literature review? If you mean the study you linked above, those numbers aren’t even in it. Neonatal deaths are 1.3 per 1000 and intrapartum deaths are 1.3 per 1000 in the MANA records. (Intrapartum death of a healthy term fetus is considered a never-ever event in US hospitals, that is, each one that happens triggers an investigation.)
And what mortality stat are you talking about? Intrapartum death, neonatal death, or perinatal death? All babies, or only term babies?
The neonatal mortality rate (first 30 days) among all term babies delivered by physicians in hospitals in the USA over the last several years is about 0.6 per 1000. The mortality rate for babies delivered by midwives in hospitals (low-risk mothers) is 0.35. This isn’t from a study, this is from CDC records of all births and infant deaths.
The rate for babies delivered by midwives at home is much higher (1.1), and it is an undercount because it doesn’t include babies transferred to the hospital too late.
The study cited intrapartum death ar 0.85 after breach, multiparous and pre eclampsia were removed. The study also cited early neonatal at 0.41/1000 mortality.
I didn’t see your citation showing physicians have a better than 0.96/1000 mortality.
I am waiting for you to cite neonatal and intapartum hospital physician stats.
The CDC’s records are publicly accessible. Go here: https://wonder.cdc.gov/lbd-current.html and dig up any statistics you want. Remember, early neonatal is birth to 6 days, late neonatal is days 7-27.
Intrapartum death statistics are not currently published, although available data suggests a MUCH smaller rate than that. This study from 1988! finds a rate of 0.3 per 1000, on all babies except micropreemies, and the rate today is probably much lower. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1112673/
Also, do you realize just how much you are comparing apples and oranges right now? You’re comparing home birth results with all the high risk cases pulled out, and low risk home birth mothers tend to be the lowest risk women of all at the beginning of pregnancy, to hospital physicians who deliver all pregnancies, including women who have terrible complications.
It’s great everything went well for you. Lucky too.
Others aren’t so fortunate, and because they are in the care of people who can’t recognise trouble, or who believe they can ‘fix’ anything, mothers and babies are injured and killed.
Here’s what this study really says.
http://www.skepticalob.com/2014/01/homebirth-midwives-reveal-death-rate-450-higher-than-hospital-birth-announce-that-it-shows-homebirth-is-safe.html
You thought we didn’t know about Missy Cheyney’s attempt to make midwives look good? That you’re the first one to show us this paper? It shows how dangerous homebirth is – after trying to obfuscate its own results.
Facts are a good thing but if you had homebirths because this “study” (in fact, a self-selected survey with less than one third of homebirth midwives participating and these being under NO obligation to disclose outcomes that they don’t want to disclose) claims to show, you were not leaning on facts. And while I’m glad everything went well fot you, your ANECDOTE could be Liz Paparella’s. Only, Liz later then chose a third homebirth and her daughter died a preventable death.
Your “facts” are no facts at all.
She’s just demonstrating Pablo’s First Law of Internet Discussion: Regardless the topic, assume someone participating knows more about it than you do
You cite a biased blog. Why don’t you cite a study showing dangerous stats on home births instead. I will be happy to read it.
That photo reminds me of Regina Kay Walters, her killer forced her to cut her dark hair short, wear a black dress and heels and took a last photo of her. Her hands are up in that position. I bet the picture of Walters was what made them dress and pose it that way, not necessarily intentionally. The killer was Robert Ben Rhoades, aka the Truck Stop Killer. I’m not linking the photo because it’s on some sites with names that could be triggering but you can easily see it if you search for it. This article about a woman who was nearly killed by him is worth reading http://www.gq.com/story/truck-stop-killer-gq-november-2012
“No warning that anything was wrong”
The reality is that nobody understood the signs that things were going wrong – or even looked for them.
I haven’t been here in a while because midwifery (home/birth center practice) is no longer part of my life, but I stopped by today and the first thing I saw was this story.
The mothers that used to be my patients are still confused about why I quit practicing. The reason I gave, and still give, is that birth OOH is too dangerous. Most of my former patients considered me a safe midwife because I had no qualms about calling an ambulance at the smallest thing outside of completely normal. However, when the epiphany occurred I realized that I wasn’t a “safe” midwife, I had only gotten lucky and I can tell you every single time I came close to having a disaster occur.
There were times when I had a mother bleeding badly and I was doing everything I could to make it stop and it wasn’t enough, but we had to wait for the ambulance to arrive and to transport. Or, the baby who had a really, really tight cord that wasn’t a problem until that last inch before birth. Or, the mom whose labor was going long and we decided to transport, but during the transport by ambulance to a hospital 15 minutes away the baby’s heart rate tanked and mom had a stat C/S when she got to the hospital. Baby almost died and spent several days in NICU.
The moms tell me they were grateful for the “great” care I provided, not understanding that great care would have been me not being complicit in them having an OOH birth. When I tell them birth OOH is not safe and why, some have still chosen home birth, but I am no longer complicit in making that an easy choice.
I no longer have to live with the cognitive dissonance of knowing I was risking someone else’s life.
hugs
My newly minted CNM friend is advocating a local ppd group being run by a homebirth association for me. It was hard to find the words in a delicate enough way (I do like her even if i think she’s swallowed far too much woo) that I do not want anything to do with that group. Finally, I was able to point out that I don’t want to make anyone else’s depression worse because my filter isn’t working enough to not show my opinion of home birth.
I don’t blame you for not wanting to get involved with them. There will no doubt be a lot of talk about herbs and supplements, and a lot of woo about how you wouldn’t have PPD if your provider or the hospital had done things in an “evidence based” way. That last parts is in quotes because most OOH advocates wouldn’t know evidence based if it was chewing their leg off.
Love the no filter! I might need to lose mine more often. Or not, but you know sometimes you want to. I have a family member who had a birthing center birth a while back and is probably planning another one or homebirth this time around. In Oregon. I really want to ask them how they can be comfortable with that and the horrible stats for planned OOH births in OR.
I trained as a teacher. We’re sort of obliged to develop a decent filter. Especially when your mentor teacher is arguing with you when you say humans come from the Great Rift Valley in Africa and she says we come from the Garden of Eden.
I don’t have a filter either. I find it’s a waste of time.
Thank you for sharing your insights – it takes both courage and maturity to re-think our previous positions.
I’ve been shamelessly indulging myself in homebirth nonsense today.
This article featuring Missy Cheyney: https://www.momsrising.org/blog/safe-for-whom-understanding-how-risk-factors-impact-birth-safety-at-home-and-birth-centers
First: AAAAAARRRRRRRRRGGGGGGHHHHHHH
Second: anyone else notice that they’ve changed from calling it ‘out of hospital’ birth to ‘community’ birth now?
You should look up transcripts from Oregon midwifery/DOH board meetings – she kept gaslighting them through multiple sessions with …blah blah blah MANA stats blah blah …and they ignored her and mandated all reporting independently. During one session she flounced out of a teleconference call when they did not buy her crap anymore and basically told them to “do their own research” and stop asking her for stats and purchase them from MANA.
I’ll do this next time I’m wandering around the internet looking to be enraged. 😛
“However, there is actually very little agreement on what constitutes “low-risk.”
Too high risk in UK, The Netherlands and for ACOG: twins, breech, HBAC, preterm, post term.
Where’s that disagreement about these basic, fundamental risking out criteria besides in Cheyney’s head and in MANA mission statements?
I have nothing nice to say. GAH. AAAAAAAAAHHHHH.
I have a lot of questions about that latest study of hers. First of all – cherry picking the data – there’s a huge gap and 3.0 cohort missing, and for the period for which Cheyney had previously boasted they gathered the most records. It was that bad, huh?
I’m certain it was that bad. Won’t stop her from trying to spin it in favor of a reckless ideology.
I see that she’s giving a webinar on Wednesday regarding this study. I’m toying with the idea of attending. Because I’m not enraged enough already.
I’m scared to read the link. :p But that quote makes me think – “…so it behooves us to be as conservative as possible when it comes to risking out.” I have a hunch I don’t come to the same conclusion as she does.
Those of us who are trying to warn unsuspecting well meaning parents away from these predatory midwives are fighting a battle where the goal post keeps being changed in size, color and location. When the benign term”community” is repurposed for home birth/ free standing birth centers we end up sounding uninitiated because we are not speaking their new language and therefore they can not hear us. We are mocked for being Peter crying Wolf when in reality we are legitimately screaming “WOLF”
They seem to be using the term “community” to mean “non-hospital” – ie both home and birthing centers.
Interesing to see that she identifies the factors that lead to poorer outcomes, but expresses it as “very little additional risk relative to our comparison group”. Very little? But what was the nature of the risk, and exactly how much? Didn’t they do the numbers?
Sounds very evasive to me.
“Yeah – a few extra babies died, but not many, and we didn;t count how many were injured. So, yeah, whatever.”
I can’t access the full article, which is (surprise!) published in the Lamaze journal Birth: http://onlinelibrary.wiley.com/doi/10.1111/birt.12288/full
The results section in the abstract says:
“The independent contributions of maternal age and obesity were quite modest, with adjusted odds ratios (AOR) less than 2.0 for all outcomes: hospital transfer, cesarean, perineal trauma, postpartum hemorrhage, low/very-low Apgar, maternal or neonatal hospitalization, NICU admission, and fetal/neonatal death. Breech was strongly associated with morbidity and fetal/neonatal mortality (AOR 8.2, 95% CI, 3.7-18.4). Women with a history of both cesarean and vaginal birth fared better than primiparas across all outcomes; however, women with a history of cesarean but no prior vaginal births had poor outcomes, most notably fetal/neonatal demise (AOR 10.4, 95% CI, 4.8-22.6). Cesarean births were most common in the breech (44.7%), preeclampsia (30.6%), history of cesarean without vaginal birth (22.1%), and primipara (11.0%) groups.”
(Note the not-so-subtle blaming of previous medical care for the outcomes).
These are VERY significant results, even if they don’t say what “less than 2.o” means. Is it 1.9, or 1.8. That’s a very big increase for a catastrophic event.
In the real, professional health care world, people would be scrambling to reduce this risk, not to dismiss it.
Found the full paper, with the actual results table.For risk factor ‘primipara’, intrapartum of neonatal death rate of 3.0, with 95% CI of 1.8 – 5.2).
Yep.
Just as bad as previously thought.
From the results table:
Risk factors and adjusted odds rations for various outcomes (95% CIs omitted here)
Primipara:
2.2 neonatal transfer
2.4 Neonatal hospitalisation
2.3 NICU
3.0 intrapartum death
Breech:
4.0 nenonatal transfer
5.4 5 min APGAR < 4
8.2 intrapartum death!!
Pre-eclampsia:
10.5 intrapartum death!!
12.5 eaarly APGAR <4
How can that woman justify saying "very little additional risk"?
This paper and Cheyney's fudging is worth a Dr Amy post of its own.
I wrote about the paper back in March:
http://www.skepticalob.com/2017/03/melissa-cheyney-and-the-midwives-alliance-of-north-america-finally-acknowledge-their-hideous-death-rates.html
Pity the interviewer hadn’t read your article. It could have gone like this:
Cheyney: “we found very little additional risk”.
Interviewer: “ARE YOU SERIOUSLY CALLING 3x DEATH RATE ‘VERY LITTLE ADDITIONAL RISK? Are you SERIOUS?!”
I suppose to imply that doctors and nurses are not part of the community, but are outside interlopers. And you don’t listen to outsiders, right?
Masters in Education?
Education majors are not actually known for great intellect, nor for being particularly good at spelling.
I think she was just trying to say she has a Master’s degree (so a “Master’s” education), not a Master’s *in* education – but I could be wrong.
Shoddy is a type of inferior cloth or yarn made from the shredded fibers of reclaimed or waste woolen cloth. It wasn’t durable or long-wearing at all. Used a lot by the poor and those in the South during the Civil War.
OT: for a non-native speaker like myself this blog is a gift that keeps on giving.
Hell, I’m a native speaker and didn’t know that datum. Good stuff.
Even in the North, for a little while, until the soldiers and their families got pissed off enough. People were making lots of money off really bad uniforms (and other supplies) Capitalism at it’s finest!
So can a competent practitioner detect the same non-reassuring rates with a Doppler as compared to EFM?
Nevermind, just found the very informative discussion on this below!
Let’s talk about the maternal deaths in hospital or the many injuries that women and babies obtain from Doctors. Any Tuteur will never support homebirthing because it takes money out of her pocket.
Sure thing, let’s talk about that. Also, we can talk about the actions taken against said doctors and the malpractice lawyers that will take your case.
How about we talk about how these women with CPMs have no recourse? How about we talk about sisters in chains? How about we talk about ALL the constructive changes CPMs have made stemming from these sad events? (Tip: the answer is none. No changes. ever)
The shill fallacy is old and overused. If you have no arguments, at least own it.
Absolutely, let’s talk about it! Maternal or neonatal deaths in the hospital are horrific. However, they’re much rarer than deaths in home births or birthing-center births. That’s why Dr. Tuteur is not in favor of home birth: because it kills people.
And doctors who commit medical errors can be disciplined or lose their license, and can be sued. Not the case with home-birth midwives. It’s extremely rare for a homebirth midwife to get anything more than a slap on the wrist, and they don’t have liability insurance either, so you effectively can’t sue them.
FYI, Dr. Tuteur is retired, so she has zero financial incentive to promote hospital birth. Home-birthing midwives, however, typically get thousands of bucks for “caring” for their patients. Hmm.
First I’d encourage you to *do your research* on death and injury in the hospital under the care of physicians, then compare this to death and injury that occurs in a low-resource setting with underskilled providers – such as lay midwives and CPMs – and then you’ll understand why Dr Tuteur does not support homebirthing.
Here’s a hint: why don’t you read some of the posts on this blog about maternal deaths before you start running your mouth?
I agree, let’s talk about the rate of maternal and neonatal death and injury at home vs at the hospital. You have that information at hand, yes?
Have you heard of apples and oranges? If not, you should look into them. They are both fruit but they are different kinds of fruit. Some people like apples, some people like oranges, and some people like both!
Now that you’ve been introduced to apples and oranges, let’s use them as an analogy for what you just said.
home birth is the apple and hospital birth is the orange. If I get one bad apple, it doesn’t mean that the orange is ALSO going to be bad. Similarly, I might pick up a bad orange, but the apple will still be fine.
OR I MIGHT GET BOTH A BAD APPLE AND A BAD ORANGE!
Do you see? Just because we are discussing a bad few bad apples in this article doesn’t mean that there aren’t also some bad oranges.
THEY HAVE NOTHING TO DO WITH ONE ANOTHER! Dr. Amy has no patience for hospital malpractice, either.
The facts are, however, that home birth is statistically FAR MORE DANGEROUS than hospital birth. Doesn’t mean that hospital births always turn out fine. Statistically they are much safer, but bad things can, and do, happen in hospitals.
Find a better talking point, because saying “bad things happen in hospitals too!” has NOTHING to do with whether home birth is safe.
They are completely different issues, and both need to be addressed- in DIFFERENT ways.
And if you want to talk about that (which is a long discussion in itself), we can talk about how when a doctor screws up, the patient can make a REAL complaint to a REAL licensing entity, and there will be a REAL investigation with REAL consequences. And there is REAL insurance available for compensation.
When a midwife (who isn’t a CNM – they are a totally different breed than the basic midwife) screws up, she is protected by her midwife friends, she carries no insurance to cover her patients, shen probably won’t lose her license, etc.
Shall we keep going?
Says “This comment was deleted.” Someone didn’t appreciative the feedback?
She tried to call our bluff, and discovered we weren’t bluffing. Turns out, she was.
Of course you’d want to run and hide at that point.
Now she’s (assume she?) going to run to her online friends and say “OMG DR. AMY’S MINIONS ARE MEAAAAAAAAANNNNNN!!!”
I should probably not be so sarcastic and condescending but I can’t take the stupidity…
If I remember correctly, this question came from a male-typed name: Bob or Rick or Mike or Joe.
Do you remember what they said, at all?
I haven’t – in recent years – been paying attention to CPM licensing laws in the US. But did a little digging around yesterday as I was reflecting on why it is that American women trust undertrained, incompetent midwives who consistently demonstrate an increased perinatal risk for their babies.
Gee, could it be that the push to license CPMs shows no sign of relenting? South Dakota just passed a licensing law for CPMs – now authorizing them to practice their dangerous and shoddy care. This is state-sanctioned incompetence. But if a state licenses these “professionals” – doesn’t that confer some sort of competence? I can see why women believe they are making a safe choice.
http://pushformidwives.nationbuilder.com/cpms_legal_status_by_state
So here’s a little criticism lobbied at all of you (us) here who understand the dangerousness of CPMs: WE CLEARLY ARE NOT DOING ENOUGH TO GET THE MESSAGE OUT. We aren’t.
This whole ruse and debacle of midwifery became plain to me nearly 10 years ago. Since then, MANA has released their horrid stats. We have story after story after story published on the web and social media of home births gone wrong. But states still enact licensing for these sub-standard unprofessional midwives.
We gotta work on the message. It’s failing miserably.
Somehow in my mind I’d convinced myself that others were seeing the light about midwives – but you know, the reality check that an increasing number of states are enacting licensing laws for CPMs kind of brought me back to reality. This trend is showing no signs of letting up, either.
Thoughts?
“We gotta work on the message. It’s failing miserably.” The message is not failing – legislators, lobbyists and above everyone else ACNM is failing miserably. Their refusal to sign up with ACOG on blasting all CPMs as substandard care providers and insisting on ICM standards as minimum of education and training is the main obstacle in stopping states from licensing the CPM quacks. Cheyney’s crap has been run out of town in Oregon – with mandatory reporting, mandatory Medicaid risking out criteria and fully transparent disciplinary records. Why the other states are not taking that lead and are instead introducing more of these killers into insurance reinbursements and legitimizing them with licenses can only be explained by lack of united, no nonsense ACOG/ACNM aka all qualified birth care providers front.
(my two cents)
Eh, I’ll take this on myself and saying as one who has woken up to this issue: *I’m* failing miserably.
The march is on to license CPMs state by state by state, I don’t see this letting up.
ACNM is interested in complicity and playing nice in the sandbox.
I don’t know what’s going to change this momentum – and the momentum is to license CPMs with very few requirements and meager oversight. MERA does NOT go far enough. Not. Even. Close. Maybe it will take more state-sanctioned infant deaths at the hands of an incompetent midwifery system – and no recourse for parents harmed by this.
I don’t know what is going to turn the tide. Those of us who understand the risks of hiring grossly incompetent midwives to attend one’s birth aren’t doing enough. My opinion. And I’m holding myself accountable, too.
“I don’t know what is going to turn the tide.”
We know what the first step is – mandatory reporting of all outcomes independent of midwifery boards ( foxes watching the hens usually) and full public disclosure. That was the game changer in Oregon, in Cheyney’s own back yard.
Is this changing the practice of midwifery in OR?
I’m not intimately familiar with OR midwifery laws – is it still a voluntary licensure state? Are midwives practicing differently? Are parents choosing differently? Has the public perception of the safety … ehrm or “safety” of midwifery changed?
I hope it has. I still think of Oregon as the mecca for unregulated midwifery.
Yes it already has – worst killers have been driven out of town and forced to close their practices, and worst killer midwives operating for decades are finally being stripped of their licenses.
There have also been a couple of peculiar sudden and early retirements from practicing midwifery of even Cheyney’s closest confidants.
https://www.thelundreport.org/content/state-imposed-obstacles-medicaid-payment-shutters-two-birth-centers
You can look up what kind of fuckery Colebrook got away with in the past on fully public disciplinary records page: https://www.oregon.gov/oha/hlo/Pages/Disciplinary-Actions.aspx
HBAC in 12th pregnancy of a woman of an advanced maternal age ( 40) with history of PPH, 4 previous preterm births, never had a term birth and other risk factors? It was “healthy low risk” according to this CPM. Preclampsia and eclampsia were ignored prior to labour and during the labour according to findings of the investigation.
During hospital transfer CS it was discovered that the patient also had vasa previa. Everyone survived luckily.
http://www.oregon.gov/oha/hlo/DisciplinaryActionDocs/AUGUSTINE_COLEBROOK_11-6616_FINAL_ORDER.pdf
well, that was a horrifying read. She saw a patient with hypertension, a headache, proteinuria and pitting edema and charted “no signs of pre-eclampsia”?
And now she’s traveling the country teaching other midwives.
http://www.augustinecolebrook.com/ap-workshops.html
How I wish I was kidding!
Wanna know something else? Such sudden urge to travel usually coincides with becoming a completely illegal traveling midwife. And those are the worst. If she accepted the aforementioned victim as low risk in a state where she was licensed and regulated, imagine the type of disasters she would take on as clients while operating with zero oversight.
The only reason I’m familiar with her name is because some midwives here were sanctioned by our state for shoddy practices and were required to partake in “continuing education” and the continuing education that allowed them to fully re-instate their licenses was taught by none other than the illustruous midwife, Augustine Colebook.
Sweet.
Oh, and go figure, she’s talking about the ProPublica story, too.
https://uploads.disquscdn.com/images/e4ded81199c3b7a2d958489162674b475a41df7105ceeafbdc241ade4cb0d394.jpg
I would send her disciplinary records to your state board and legislators.
That’s not a bad idea. Though I’m fairly certain the provision of remediary CEUs for licensed professionals currently has zero regulations.
Though, perhaps, the ACNM would be interested in this. Maybe they would stop with their assinine complicity of promoting CPM/LM laws which allow flagrant negligent practice of midwifery.
Perhaps because she was nearing eclampsia? Dear God….
Well….It’s not pre-eclampsia if it’s full blown eclampsia
“.. worst killers have been driven out of town and forced to close their practices, and worst killer midwives operating for decades are finally being stripped of their licenses.”
Good. That’s a start.
I’m still worried about the normal, usual CPMs – because they’re pretty scary, too.
Yeah. Show me a CPM who adheres to ACOG/Dutch/Oregon risking out criteria and I’ll stop saying how they ALL need to be outlawed.
Jeebus. I am a complete and total layperson, but that doesn’t sound like any low-risk scenario I’ve ever heard of!
“Life has some really tough lessons.” NO. F you, lady. This kind of thing *does not happen* in the hospital where the baby is properly monitored. And if it does, there is hell to pay for everyone involved. There is no reason for this.
The tough lesson is “you chose wrong when it came to giving birth, and because of that, your beautiful son died.”
Dr Amy, you are still so very hard to read, and so damn useful, oh goodness.
I am so much like this mom in the post was; first pregnancy, all bliss, everything fine, preparing for a home birth with good faith. The difference between us was only one thing: the care we received; that is, the level of education and experience of our midwives, and the system of care (or lack thereof) those midwives were working in. My story, too, begins with “I was in labor for… ” but continues with “… then got told to go to the hospital” (in Canada) where my midwife would continue my care, but using continuous monitoring and everything else my baby and I had ended up needing at that point.
Every time I read such stories, I am wrestling with the conflicting thoughts – from one side, it could have been me, from the other side, it could never have been me, however, NOT because of my own good faith but because of the knowledge and skills of my midwives I had decided to listen to, and the system of care that ensured a quality of education and a safe protocol.
Happy Mother’s Day to you, and to everyone here, and especially to those who save babies through informing and supporting their mothers and fathers.
I am very glad everything worked out for your baby and you! Dr. Tuteur has written about how much safer Canadian homebirth is than American homebirth, precisely because the midwives are actual medical professionals who know when to transfer.
My understanding is in Canada there is no down side for a midwife to transfer care to a Hospital . The laboring mother is still the midwife’s patient, the hospital has a working legitimate professional relationship with the midwife and everybody still gets paid. Here in the USA if a midwife has the foresight to transfer care she looses her “street cred” in the crunchy-sphere. The midwife also cuts off her stream of income because more often than not, she has no relationship with a hospital.
This sounds more like an issue with prenatal care than home birth.
How to you figure this is a prenatal care problem?????
There is no mention anywhere that the baby had a medical condition that was missed during prenatal check-up
However, the mother was allowed to labour for too long and push for an even more ridiculous period of time.
This baby almost certainly died due to complication that happened DURING the labour because the midwife was grossly incompetent.
It is absolutely an issue with home birth.
Ya think? The fake CPM midwife who presided over this senseless, completely preventable intrapartum loss conducts her prenatal appointments on a public beach. Because that’s how “awesome” she is.
Really, in what way was this a prenatal care issue?
Given that the antenatal care was provided by these apparently negligent CPMs, it is possible they missed an obvious risk factor. Probably not though.
This seems like an obvious PPP issue (power, passenger, passageway). Which is very common in first labours.
Either the baby was malpostioned causing ineffective cervical dilation, the contractions were dysfunctional or the pelvis wasn’t allowing descent and the cervix wasn’t dilating.
Do you know how this labour would have gone in hospital?
After recognising that nothing was happening fast, AROM and some pitocin would have been offered, with CEFM.
Either L&D would have sped up without incident or CEFM would have indicated that baby was in trouble.
Baby would have been delivered, either vaginally or by CS, depending on circumstances, and would probably have been fine.
This probably *wasn’t* predictable.
Most dysfunctional labours aren’t.
In hospitals, there are strict protocols for when to intervene of things look like they are going wrong.
6 hours of pushing after 30hrs of labour (even assuming only 18hrs were active labour) is WELL outside any accepted norm.
My mother trained as a Dr in Zimbabwe in the 1970s, where partograms were basically invented.
Do you know WHY they were invented?
Because almost all the African women gave birth at home, hours from hospital, with traditional birth attendants and minimal technology.
Partograms were developed as an early warning system, so the TBAs knew when it was time to transfer, before it was too late to transfer.
Not only did partograms save the lives of women and their babies, they decreased the CS rate. They only women who transferred were the ones who really needed to, and with enough time that intervention could still affect outcome.
CPMs are literally giving their clients less good care than many women in the developing world are currently getting.
TBAs in the developing world know birth is potentially deadly, fill out partograms properly and transfer at the first sign of trouble.
CPMs in the USA, as shown by homebirth tragedy, after tragedy, after tragedy, AREN’T doing that.
I don’t consider that a safe, professional service.
I wouldn’t pay money for it.
Why do you think anyone ought to?
I had about that 30 hours in labor if you include the day+ of disorganized early labor. The medical professionals didn’t consider that to “count” as labor but since it’s really hard to sleep with contractions every 4 to 15 minutes and back again I was exhausted. I have absolutely no idea how anyone pushes for more than an hour without some kind of intervention!
Nope.
Wish I saw as much crucifxion of the many shotty OB’s and their mistakes as I do underqualitfied midwives. Gotta love some good ol’ fear mongering.
If you, or anyone you know, has had a bad experience with an OB or think she was the victim of a medical mistake, They can make a complaint. That’s what professional orders are for. To protect the public.
If an OB had taken care of this woman the way this incompetent midwife did, he/she could be sued for a very substantial amount as well as face sanction from both the hospital and the professional order. And eventually lose their license if they didn’t improve themselves quickly or make repeated mistakes, making it impossible for them to practice anywhere in the world.
Tell me, what are the options of this mother? She can’t sue, CPM don’t have insurance and don’t have money. There is no professional order. At worst, IF the CPM works in a state where she needs a licence, she could lose it…..and move to another state to keep practicing.
You are the one fear mongering when you badmouth OBs
God bless my Dr. E and his colleagues! My bp had been fantastic for all 9 months of my pregnancy, and into the first 4 hours of labor. Then it hit the roof. I could have stroked out if some homebirth midwife had decided things were progressing really slowly (they were, I wasn’t even having contractions yet, just the broken water) and went to take a nap or something.
The only OB’s I’ve ever bad mouthed are ones who have abused patients before my eyes and threated to cytotec a unstable patient so she could crash section her before her her on call shift was over. Both calls to risk management were well deserved and well disciplined.
Well disciplined. See the difference? “Midwives” are not disciplined, they’re protected, including by you.
Why do you insist in taking cases in which the system works to whine that when a system doesn’t work, the person who points it out is a hater?
I am sick and tired with RNs who cannot simply appreciate their own profession but need to rage at OBs simply because they were unable to become doctors.
By the way, what hospitals have you worked at? You have ONE obstetrician and when they leave, there is no one to take a shift? Because that’s the only way someone would want to bother with a c-section, instead of leaving the patient to the next shift. Or were they just a c-section fanatics and feared that the OB on the next shift would let the mother have a vaginal birth?
So, you saw an OB doing bad things, you made a complain, he was disciplined. As it should be.
Why are you not holding midwives to the same standard?
Ah the OB golf myth. You know, besides being a logical fallacy of false equation, what you are doing by bringing that crap on a post about baby killed by fake CPM midwives and their utter and complete negligence is a major hypocrisy. This mother lost her baby but yeah, “at least” no one abused her with an “unnecessary” CS and everyone sat around and waited until her baby died.
You really get the sense from these CPM types that a dead baby delivered vaginally is preferable to a live baby born by C/S.
yep. Just like a dead baby with a virgin gut is better than a live formula fed one.
Bullshit. Never happened.
“…so she could crash section her before her on call shift was over.” I’m sure that’s the part Kwill made up in her own head. I mean, there would be no other possible reason to do a crash section on an unstable patient, would there?
There’s no valid reason to want to do a C-section on a mom who’s been laboring for a long time before the weekend light shift comes on.
Funny you should say that. Recent press releases are talking about how bad maternal mortality is in the US, with severe crucifixion of medical personnel.
This is on the mainstream press, not merely someone’s Facebook page
Difference is that a horrific story of bad midwifery care in a homebirth setting creates a nasty stigma for all midwives – even amazing CNMs. A bad outcome with a thoroughly trained OB reflects mainly on that person’s practice. As a LDRP RN I dont advocate for homebirth, but Im sick and tired of OB’s with God complexes who can’t see a balance.
Why does one bad case of midwifery care reflect on the whole profession? Because the standards for training and practice of CPMs are so low that it doesn’t prevent poor midwifery care, and one example quickly becomes many. And the neonatal death rate with CPMs reflects this.
And yes, some people will confuse all “midwives” with CNMs. But I can’t use that as an excuse to not speak out about the negligent and reckless behaviors that go on at homebirths with Licensed and Certified midwives. Distinctions need to be made.
The high quality and safe care provided by the overwhelming majority of CNMs in this country creates the illusion of safety with all other licensed and “certified” midwives. This is a bigger problem, I think, than the ‘stigma’ of bad care. People are duped into believing there is little to no difference between midwives – and that CPMs are just as skilled and safe as CNMs.
Sorry, this makes no sense. It rightly creates a nasty stigma for all those people who think that since they are privileged enough to do things “right”, they won’t need 21st century medical help. That’s not how a CNM operating under an OB’s supervision in a hospital is likely to practice.
What “balance” do you thinks should be sought here? Doctors want babies and mothers to come out alive and healthy. You think that should be “balanced” by the need to stroke a mom’s ego, by telling her she is superior to the bad luck that ordinary women, women who don’t eat organically, don’t pay for reiki, and who plan to buy some plastic toys for their kids, are subject to?
Doctors do interventions when they think the alternative is worse for the welfare of mother and baby. You want to “balance” that with what, exactly? A birth that a mother can brag about, since she used no icky technology?
” even amazing CNMs.”
Find me a homebirth CNM in USA who adheres fully and without exceptions to Oregon Medicaid risking out criteria., or whose freestanding birth center does not have in their client testimonials a birth just like this one. Latest example are See baby rogues practicing with dr Bootstaylor, who had full hospital privileges and didn’t flinch at a 41 weeks breech/breech birth that is against hospital protocols and all safe care guidelines (twin A was a footling breech).
With ACNM refusing to stand their own professional ground and joining ACOG in their policy statements against CPMs as substandard, unacceptable care providers and on homebrth, the sad truth is that all homebirth midwifery in USA is just “variants of completely fucked up”.
We had a CNM who used to do homebirths here, No longer crunching, I think. She was conservative. She transferred and all else. And she wrote here how she had recently reviewed a file of a mother who gave birth at home with her and there was a complication. The mother raved about her care. NLC could only think, What the hell was I thinking? What if it had ended differently?
Here, we have an example of a conscientious CNM who took a risk because it didn’t look so big – and later, she was terrified by herself. What about the vast majority of the tiny minority that are homebirth CNMs? I wouldn’t call them amazing.
Uh what? I’m also an L&D RN and I don’t agree at all. Do I like every OB I work with? No. Have any of them ever caused a baby’s death due to extreme negligence? Nope. I’ll take an OB with a ‘god complex’ over a midwife any day, even a CNM.
Midwives in the US need to retake their brand.
Since I’m here, doesn’t ‘nasty’ need a rest for anything to do with women-and most midwives, real or ersatz, are women-for a while?
Protecting the professional title of midwife would be the first step, to keep it reserved only for ICM standards educated and trained birth attendants in any setting, but that cannot be done without ACNM stepping up to demand those using it without adequate qualifications be prosecuted same as con artists pretending to be nurses or doctors.
The nasty stigma is created by the midwives who, instead of admitting the problem, rush to defend the incompetence.
When an OB messes up, everyone questions it, and calls it what it is. When a midwife messes up, the Sisters in Chains run to their defense.
That’s why it turns into an indictment of the profession. Not because mistakes are made, but because they refuse to acknowledge it.
The nasty stigma is created by the midwives who, instead of admitting the problem, rush to defend the incompetence.
And it’s also created by the people who speak of “midwives” as if all midwives are equally qualified, instead of telling the truth: that in the US there are two kinds of people who practice midwifery. (1) Real midwives with qualifications and experience you can have confidence in, i.e., CNMs; and (2) fake midwives — CPMs, which I see as standing for Certified Pretend Midwives — who have none of that.
Most CNMs in the US won’t do homebirths, period.
I’m sick and tired of LCs with God complexes
There are none so blind as those who will not see.
word
word
It’s “shoddy”, not “shotty”.
It is not fearmongering to point out that homebirth and the abysmal CPM “credential” is nowhere near competency. You cannot guarantee that anyone is going to have an easy, problem free birth. Midwives will tell you what you WANT to hear while OB’s will tell you what you NEED to hear. The OB’s are the ones who have to clean up after the midwives dump a laboring mother in the ER with no information. Is the mother GBS positive? What’s the baby’s heart rate? (note: “Strong heart tones” means nothing) How long has the mother been in labor/when did her water break? Was there meconium in the amniotic fluid? Who is her doctor? First baby? How far is she dilated?
Why don’t the midwives themselves want to be safer? Why do they resist instituting educational standards (real ones, a HS diploma is not enough), safety protocols and strict risking out criteria? Why do they continue to insist that NCB and home birth is easier and safer? It is clearly not, but they continue to insist that it IS, DAMMIT, and we just need to “trust birth” more.
I thought it was a typo for ‘shitty’.
Maybe working with vulgar morons is beginning to rub off on me.
either way, someone is not paying attention to their spelling
I thought it was a portmanteau for shoddy and shitty. Such words are sometimes delightful: I particularly like insinuendo, and (a word my daughter may have invented) trajesty – from tragedy and travesty.
One I’ve been using for years (after I made it up) is “pathetiful” . Pathetic + pitiful = pathetiful.
Portmanteaus are fun!
If an OB does something shoddy, there’s recourse and action. An OB can quickly kiss their career goodbye if they let tragedies like this happen. They are still going to have to pay for medical school even if they lose their license. The reason we especially need to point out CPMs is because there is no real recourse when tragedies like this occur (and occur much more often than with CNMs and OBs in the hospital). It’s not fear mongering to point out CPMs are “under-qualified.” I would say they’re wholly unqualified.
There’s actually a system to crucify shoddy doctors. There next to nothing for homebirth midwives in the United States.
Are ads for wearing seat belts fear mongering? I’m old enough that seat belts and car seats were not manditory when I was small. We always had them because my father was a firefighter and an EMT. Sure, I haven’t yet been in any accidents that were severe enough to be thankful for my seat belt, so that means the fear mongering is just silly, right?
I was in a minor fender bender when I was hit while parked. I had a small bruise on my collar bone from the seatbelt and a sore neck. I likely would have had only the sore neck had I removed my seatbelt. Seatbelts are bad. /end sarcasm.
If a seatbelt touch my naked skin, like when I wear only a T-shirt or similar, I get really itchy there. Some kind of allergy? Let’s forbid seatbelts as they can cause allergic reactions. After all, we grew up without them and are totally fine aren’t we?
The “don’t do X because some people are allergic” argument cracks me up.
Some people are certainly allergic to peanuts. Why is that an argument why I should not have rhem?
My allergy works better on a lot of this crowd. I’m allergic to marijuana, that sacred herb.
You CAN’T be! It’s natural and a panacea for whatever ails you, don’t ‘cha know! /s
yep. it’s right up there with breast milk as a magical substance that heals all ills.
The baby of a mom who is smoking pot and breastfeeding is the healthiest baby there is. Just don’t feed it gluten. #PortlandFacts
Which is worse: gluten or vaccinations? How about gluten IN vaccinations?
Oooh. I am going to market a line of gluten -free organic vaccines!! It’ll be the regular vaccines, because they’re gluten free and have carbon, but it’ll sell like gangbusters!
You def should do that. I read this article that people who do gluten-free are more likely to be anti-vax.
http://www.livescience.com/
ME TOO! People never believe me…but I swear, that stuff is wretched! It GAVE me muscle spasms (one of the things I was trying to STOP!).
I have trouble breathing, and that’s from a tiny amount in a lotion the local yarn shop sells.
I know you’re joking, but there’s a way to fix your issue.
You can actually sew a sleeve to fit around the seatbelt where it hits your skin. It’s easy enough with some jersey knit fabric and velcro, you can even use fabric glue instead of sewing.
Or buy your own, look up seat belt cover or seat belt pad and tons of options come up. They run from 10-20 dollars, from Amazon to Etsy.
Thanks for the idea of sewing a sleeve. This could work. Sometimes solutions are so easy, yet you have to think about them.
Hi Katelyn,
I used to work with CPMs and had that dreamlike “calling”‘ to become one myself. I now work in hospitals with people who are trained: RNs, CNMs, family practice physicians and OB/GYNs.
This isn’t about OBs or fear-mongering. BTW the shoddiest of OBs generally do a much better job of keeping their patients alive than run of the mill CPMs do.
This is about birth being as safe as it can be. Homebirth midwives have faulty perceptions of their skills, the risks their clients take, and their ability to accurately assess and manage labor. (I’m speaking from first-hand ignorant experience, here. I’m describing what I used to be.)
A successful homebirth is due to luck, and little else. Most of the time this works. But when it doesn’t, someone loses A CHILD.
This is a steep, and cruel, price to pay for ideology.
“This is a steep, and cruel, price to pay for ideology.”
Yeah, that’s the part that I can’t get over. There is no justice. Baby R was 100% innocent, and yet he paid the ultimate price. Mother certainly carries blame, she chose to defy medical advice and common sense. But the death of her child? Nobody deserves that. And then we have the “midwife”. She and her ilk are the ones spreading this vile ideology. She was 100% negligent. And her punishment? None. She’ll probably turn this into some midwifery seminar where she’ll charge money to blather about this being a great example of the beautiful “circle of life” .
The mother, the parents, the family, will suffer the consequences of this birth – and death – for the rest of their lives, and my heart goes out to them. That is punishment enough. And no one deserved it.
Midwives, and the certifying organizations that certify them, and the states that license them, and the healthcare professionals who are complicit by collaborating with these midwives should not be selling this dangerous product in the first place.
Innocent people are being harmed by the legal provision of a dangerous product: homebirth midwifery. I have no idea which state this occurred in, but I have no reason to believe this didn’t occur in a state with a legal, licensed midwife.
The blame, from me, will always fall squarely on the so-called PROFESSIONALS and authorities that allow this to happen.
I would like to think so, but I am not convinced. There are absolutely those who are so caught up in the ideology that this will not affect them as it should. It would be a case of another baby sacrificed at the altar of homebirth.
I hope that she becomes a voice of reason and doesn’t accept the apologetics. Her baby deserves that.
My heart aches for this unfortunate mother. She placed her trust and her life in the hands of a person she had hired to be a professional level health care provider. What these parents did not know was that the “midwife” they hired probably had no professional relationship with a local hospital or ob/gyn. So when this mother’s labor failed to progress normally the midwife stalled and wasted precious time hoping that ” trusting birth” would kick in and all would be fine. So is this infant’s death an indictment of homebirth or homebirth midwives? What difference does that make. Here in the United States of America homebirth Midwifes are free range predators.
At least with shotty OB’s they have other doctors and nurses who can get help for the mom and baby. With a underqualified midwives, they have no one to answer to and no one to make sure they are doing what they are supposed to. Also, in a hospital setting, if an OB caused a Mom or baby to die, there would be an investigation. There are no such investigations for underqualified midwives.
You’ve used the word twice now – what is “shotty”???
Pointing out people’s misspellings just makes you a jerk. Obviously she meant shoddy.
I don’t think that applies here. I assumed she had a typo and meant shitty. Shoddy didn’t enter my head as a possibility, so I can understand why someone is asking what shotty means.
I first read snotty, but i figured that was unlikely, 😉
“A baby died, but I am super concerned with how meen you are being.”
One thing I have concluded, following this thread and your examples within, is that you consider a C-section leading to a live baby to be as bad, if not worse, than a dead baby delivered at home, vaginally. That’s a hell of a way to run a railroad.
Funn. You must have gotten that from what oyhers have said. Not me. People jump to conclusions and love to fight and make themselves look big. I agree with most facts stated on this thread. My heart broke when my best friend chose homebirth. I really only meant that I wish we talked evenly and honestly about the issues and were not afraid to confront OB’s publicly like I have seen done with midwives. I shouldnt have to fear my job when reporting a doc, but I do. I love midwifery – educated, competent, skilled midwifery. I also love my OB who is also educated competent and skilled- in many aspects more so. Im grateful for both, and love the discussion and respect able to be had between the two. Im weary of badmouthing all of midwifery because of lay women who give it a bad name. I realize I’m partially at fault by the “fear mongering” comment. True or not, it implied unnessesary spite, which I did not intend. I dont agree with the entire tone of the article that does imply ill of midwifery and makes no good distinction between quality midwifery care and women who love birth and think that makes them qualified. Glad we can all comment and post our opinions!
This is a place I can post without having my comments deleted.
Can’t say that for MANA, BabyCenter, Evidence Based Birth.
I … hm… didn’t always appreciate the tone here at first either, but I DO appreciate that people, for the most part, are willing to engage in dialog and that my comments aren’t deleted. I also enjoy it when new folks show up with different perspectives, because the conversation is more lively that way.
How do you feel about UK midwifery, then? We’ve seen a number of reports of well-trained, high-skilled midwives who have refused to transfer care of patients, and who have had women and babies die because of it. The NHS is looking into it now, but it’s part of the same trend of valuing process (vaginal delivery without pain relief) over outcome (healthy mother, healthy baby).
Most midwives, especially CNMs, are people who want to do the right thing and are trained professionals. Midwifery as a profession has a serious problem, and it’s getting worse. Bad midwives aren’t disciplined, bad outcomes aren’t investigated, and bad processes aren’t changed. It’s poisoning the profession. At this point in time, I wouldn’t trust any midwife, because I don’t know and have no way of knowing if she’s one of the good ones or not. With an OBGYN, if I get a bad one, I know who to complain to, and I have a reasonable expectation that they will be disciplined, and I can sue for malpractice. None of those things are true of a midwife. You and your profession have the obligation to fix that.
Who is bad-mouthing “all of midwifery”? Except to say “Why aren’t the good midwives demanding that the bad ones get out of the profession?” I don’t think anyone here has any problem with midwives working under the supervision of an OB in a hospital, which is how most midwives in the US operate.
” the article that does imply ill of midwifery and makes no good distinction between quality midwifery care”
Bullshit. From this article: “Why did this happen? It happened because R’s mother chose homebirth with
undereducated, undertrained, ideologically brainwashed midwives.”
“Funn”
But it’s not, not at all. I’ve seen in my peers – very well-educated women – a swallowing of this ‘natural is better’ BS. I’ve seen women I know personally going post-dates, refusing induction, patting themselves on the back for going through the agony and danger of an ‘enforced natural’ birth – all with the support of midwives, often the ‘highly trained,’ ‘good’ midwives in the US and UK system. They have been lucky so far, and this woman was unlucky. It’s a killer attitude, literally.
Midwives everywhere are supporting these bad apples, closing ranks, minimizing the risk and the damage. The degree to which the UK midwifery leadership is doing so is breathtaking, and the ACNM is not taking a strong stance here in the US.
The phrase isn’t “One bad apple is no big deal.” It’s “One bad apple spoils the bunch.” Midwives need to call out and cast out the bad apples. This isn’t happening nearly enough.
Dr T has called out bad OBs and offered her support when legal action is called for. Women here have supported other women in reporting bad hospital care and persisting in order to effect change. This is not a ‘hospital uber alles’ site. This is a ‘we like living babies that grow up to be healthy adults’ site.
There isn’t as much public confrontation about OB mainly because of patient confidentiality and basic professionalism.
OBs don’t take part in facebook groups, discussing their patients and the births they attended.
They don’t crowd source for help on facebook when they face a complication.
When complications happen, it is handled professionally. OBs are not allowed to talk about it publicly or on social media
And if a baby died in the same way under the care of an OB, absolutely no one here would be defending him.
Academic question here: is it even possible through auscultation to hear and perceive a late subtle decel of 15 beats? I’m a pretty experienced doc and at a rate of 160, not sure I could on a *chest* tell the difference between 160 and 145 – can it be done on a fetoscope?
Not to mention I’ve never heard of anyone teaching listening to fetal recordings on Doppler or fetoscopes to hear variability or other patterns… Anyone with older ob or CNM training want to weigh in? Is it even possible to hear patterns without a visual strip? Sorry if this is a dumb question, or I am too young to know this, but I think it might not be -like, how would someone even learn to monitor heart tones without a strip?
I can’t speak to medical training for this, but I’m sure some musicians can. “Tainted love” is 143 bpm, “Happy” is 160; they each sound off to me if I sing the wrong tempo, and I’m not at anywhere near a professional level.
Yeah, my Demodocus had fun during my pregnancies guessing the baby’s bpm whenever Dr. E turned the sound on. He was usually pretty close, but we like precision here.
Remember when they changed the guidelines on CPR to use “Stayin’ Alive” to time the compressions? There was a Simpsons episode shortly after when Bart was giving CPR and started singing “How Deep Is Your Love.” I fell off of the couch laughing.
As an educator, I love that message. Do CPR by performing chest compressions to the beat of “Staying Alive.”
It’s simple, it’s memorable, once you’ve heard it, it’s unforgettable, and hopefully, even for laypeople with one CPR course, the knowledge will be readily available if ever needed. A brilliant idea, whoever realized that.
And am I correct in thinking that even an untrained person following that advice has a good chance of being helpful?
I am by no means an experienced clinician, just a learner, but I was once able to detect a late on intermittent auscultation (it’s with Doppler, not foetoscope.) Our intermittent auscultation procedure was 1 full minute before a contraction, during the contraction, plus at least one full minute after a contraction every fifteen minutes. I was palpating the contraction with one hand whilst listening using the Doppler. I felt the contraction start to ease under my hand and about ten seconds later heard the foetal heart slow considerably. It was very clearly after the peak of the contraction and was quite obvious at a decrease of about 20bpm. Hooked mum up to EFM just in case, and baby was in fact having lates.
It was only after this event that I realized that you should just use the EFM machine in the room for your IA instead of a portable Doppler, so that you can assess variability and you can get a strip.
Thanks, Puffin, that is exactly what I was asking. If never been trained in anything but a strip.
We were told that we should definitely NOT use a CTG machine for IA, because it would give you a useless printout, and if you were at all concerned then you needed to start a ‘proper’ trace.
Interesting. Correct me if I am wrong but by your post and your conversation with the rest I was left with the impression that EFM was an improvement over the techniques of the time (which is only natural as science develops) but for some reason some providers are not willing to part with it simply because they’re used to it, it sounds more natural and so on. AFAIK, hospital midwives can actually read a strip so it isn’t about offering what they can’t do and demeaning what they can. It’s really about “old ways are the best ways because – well, because”.
I am now retired, but my career began in 1967, before fetal monitoring and ultrasound, and ended in 2012. AFAIK, it simply is not possible to determine with any accuracy Beat-to-beat variability, or even to hear the FHR at the height of a contraction, with either a Leffscope or Pinard fetoscope. It might be possible tohearthe FHR during a contraction with a Doppler, but that depends on the baby’s position.
Who lets a primip push for 6 hours? By the time a Doppler, post-contraction, will pick up decels, they are severe and very prolonged. Itsounds to me like there was a concealed partial abruption. Had the mother been in hospital, even with intermittent EFM, there’s every chance the baby would have been saved.
It may well be very difficult/impossible with a fetoscope, but it is possible with CORRECT auscultation with a doppler. That’s frequently enough, and for long enough, and anything slightly ‘off’ would be an indication for EFM. Qualified midwives would have been taught how to correctly monitor with intermittent doppler monitoring (and use a partogram) but then they also wouldn’t be letting a primip push for 6 hours so…
Gah. Six hours, and no epidural. That must have been agony, in itself.
Nothing compared to the agony that this baby went through. 🙁
Or the agony the mother and family will endure for the rest of their lives.
Yes, there is a procedure for IA which is used at our hospital. It is endorsed by the national OB/Gyn society of Canada; It involves listening for a full minute starting at the end of a contraction, dividing into 6-second segments (done every 15 minutes during active labour, every 5 minutes during the second stage). Beats per 6-second segment are counted and recorded. A questionable pattern of subtle increase (suggesting late deceleration) or brady/tachy is an indication to do cEFM. Pushing longer than 3 hours is an indication for cEFM. With this protocol for low risk women there is no increase in long-term outcomes and a drastically lower rate of interventions… BUT a small increase is short term risk of neonatal seizures (but no increase in cerebral palsy). I discuss this with my patients and suggest that I like IA for low risk women but I also like/offer a 20-minute segment of continuous EFM intermittently.
Exactly.
But a stop watch, graph paper and a Doppler don’t really encourage positive energy, and are much less natural and in touch with the sacred birthing power of our foremothers than a quick listen every so often with an all natural wooden Pinard stethoscope.
Want to bet that IA in this case didn’t follow this protocol, or indeed any other recognised one?
Or that a partogram even crossed the threshold of the house?
Really interesting. With informed consent, I would likely chose EFM over the small increase in seizure risk, although I can imagine other women would reasonably chose otherwise. Also IA sounds incredibly labor intensive and dependent on really good training… I can see how EFM would end up being used instead where resources and reliability are a concern.
You are 100% correct…. I only trust IA done by our most OCD nurses… and I only trust it so much.
Frankly, my personal opinion is that it’s not very good at picking up late decelerations at all, and the reason why it’s associated with good outcomes in general is that it’s done on women who are extremely low risk. Also, patterns of subtle late decelerations generally turn into more obvious patterns of bad decelerations as labour progresses, which are more obvious to pick up on IA.
A late deceleration can be decrease less than 15 bpm from baseline and be concerning. A late deceleration can dip a mere 5 bpm from baseline – and no, I could not hear that with a doppler or a fetoscope.
Or, if I’m being honest (oh heck, WHY NOT?), I could envision myself telling myself that I my counting was off if I really heard a ‘slight’ deceleration after a contraction.
Well – any deceleration is an indication for EFM – because it is so hard to discern the type of deceleration – and no, there is no reliable way to hear variability of the FHR with listening alone.
What can be accurately heard with IA:
– baseline rate
– any accelerations from baseline
– any decelerations from baseline
Variability is quite valuable – and though I’ve heard many-a-midwife and natural birth promoter wax poetic about the non-superiority of continuous EFM – I looooooooooooove being able to see variability of the FHR.
One of the most depressed babies I ever saw born had NO decelerations prior to birth, but NO variability either.
No midwife – no intermittent auscultator of any stripe – would have EVER picked that up.
I am a lay person and even I know what those numbers mean. 35 hours of labor and six hours of pushing? Even if I had planned a home birth, I would have insisted on transferring after that much time. Wonder what the midwives were telling the mom about that kind of labor.
The length of this unfortunate women’s labor jumped out at me too. In a hospital, these parents would have been advised to allow technology to help their obviously struggling to be born baby make it out safe and alive. And another thing, when statistics are calculated does this tragedy get counted as a “babies die in hospitals too” event?
Probably.
Probably the same fearmongering bullshit they always say;
“As soon as you get to the hospital they start the clock and once x amount of time has passed that’s when they get out the knives and demand you go for a c-section. So you’ll feel rushed the whole time you’re there plus you’ll probably be subjected to a cascade of interventions which you probably DON’T want but won’t be able to refuse cos the doctors will insist they know best. Labor takes TIME it’s NOT an emergency, your body knows when it’s ready to deliver so just trust it and power through you awesome warrior mama!”
Or some variation thereof.
I wonder if the mom was too out of it to notice how much time had passed?? My first was unmedicated, 27 hours labor and 2 hours pushing. I lost all perception of time, since I was completely focused on managing the pain.
I was very out of it during my labor, but to me it seemed like I was in labor for 24 hours, but it was only about eight!
This is why it’s a cult. All cults demand a sacrifice and putting this birth ideology first results in many sacrifices of new babies deprived of 21st century medicine, to, instead, appease the “mother goddess.”
This baby did not have to die.
I was 39W6D and was not feeling my daughter move, and I went to my OB’s office. I was not in any way in labor. My blood pressure was elevated, but her heart beat was 150 BPM. She said that was good, but wanted me to go to the hospital for monitoring. That fetal tracing above at the hospital looked very nearly like my daughter’s tracing, although there were no decelerations.
The on call OB recommended an immediate c section and I consented right away as they explained why her tracing was so ominous. Within a half hour my daughter was born and received immediate resuscitation and support. She had unfortunately suffered diffuse damage to her brain but because they were alert to her dire condition, she was not put through labor and received immediate and appropriate treatment. She has mild CP, but it’s virtually unnoticeable other than sloppy handwriting and an aversion to climbing tall things. She is a smart, beautiful and funny little first grader now.
I was kind of that way. I bet she drops things a lot and can’t walk a straight line cold sober. No biggie; it just makes life entertaining! (But keep all your water bottles plastic!) She picked great parents!
Your daughter is so lucky to have you as a mother and not one of these NCB nutbags. I can definitely imagine people refusing the “unnecessarean” because oh, doctors just want to cut you, and, well, how well would that have turned out?
Good on you for picking up decreased movement, and good on your doctors for acting.
OT:
https://www.theguardian.com/lifeandstyle/2017/may/13/hadley-freeman-miscarriage-silence-around-it
If you haven’t seen this already, it is Hadley Freeman’s most recent opinion piece about collecting the ashes of her very recently miscarried baby.
The last line is searing:
“I picked up the bag – full of birth and death, love and fire, all the stuff of life – and went home.”
Oh, hell. And now I’m sobbing. That was beautiful. I had a set of twins and a singleton pregnancy end in second trimester loss, and the babies were considered medical waste and disposed of accordingly. That’s just what they did 20 years ago. I pretty much lost it at this point:
“Was I supposed to tell her the name I’d picked out for the baby? “It… wasn’t a real baby,” I said, feeling like a massive fraud.
“Of course it was, dear,” she said, handing me a small bag. “Baby Freeman” was written on the packet inside. I’d have made time for you, I thought.”
I know.
Our losses were early, and our sadness was very private. Even though I am not so much unobservant as blindly neglectful, I found comfort in a prayer for miscarriage I found on ritualwell.
I know you, personally, aren’t religious Beatrice, and although I am replying to your comment I’m not at all implying that you would find that helpful and I hope you won’t take offence, I’m just saying what helped me.
I do not begrudge other people’s rights at all to derive comfort from their religious beliefs (up until the point where they start hurting other people). Even in my secular, science based PPD support group the rule isn’t “no religion” it’s “don’t offer religious type comfort unless the OP asks for it”. You’ve never been anything but respectful of my choice to have no religious beliefs, so I have no reason to suspect you’d start now. 🙂
*hugs*
i have no idea what the did with Mom’s 3 stillborn daughters, nor what names they’d been considering. They may’ve only had one picked out since they were not expecting my sister to be triplets, but Mom’s 1st was 8 months along.
“Of course it was, dear,” she said
Wonderful wonderful woman.
Definite fear mongering. Well trained midwives know the baby isnt supoosed to be in the birth canal for longer than 1-2 hours after ruptuted membranes…. This home birth death wasnt due only to the fact it wasnt in a hopsital. This was a home birth death due to negligence of the attending midwife who failed to recognize the need for hospital care when it arose…. People and babies die in the hospital and outside it during childbirth in rare cases…. Its simply recognizing when someone needs medical care and when the natural way is a-ok that society needs to start distinguishing between.
” in rare cases…”
Fuck you. Go and count how many dead babies from stories same as this one are on the links in this blog. There’s what, 1% of births in USA happening outside of hospitals, all of them supposedly low risk? There’s losses as preventable as this one at the hands of fake CPM midwives happening all the time.
Really?https://uploads.disquscdn.com/images/9f1257136fe5029abd8c6c9bc7498ee4577b21f6e6e44a5e3db9d79484fee59a.jpg
In rare cases? Without mentioning that at home it’s at least 3 times less rare? Biased much?
And how, pray tell, are expectant mothers expected to tell well-trained from not so well-trained midwives when they’re all midwives and their governing body persists in keeping no standards existing and no midwives accountable, ever?
No, “society” doesn’t need to do anything. Laypeople do not need to do this. It is the job of those who claim to be professionals.
Hey asshole, why don’t you reply the posts here OR at Dr Amy’s facebook page? Why dodge the issue?
Scratch this, I know the answer. Because you’re a heartless, lying cult members who only cares to make midwives look good.
wow. you’re certifiably insane. it’s called some of us don’t get on disqus every day.
And when such failure of recognition becomes a recurring pattern, that’s a problem with midwifery in general.
It’s not fear mongering when the MAJORITY of homebirth midwives ARE NOT well trained and are killing babies everywhere with their lies and incompetence.
I agree with this. It’s sheer ignorance everywhere: the mother never knew enough to understand the risks, the midwives undoubtedly did not inform her or treat her appropriately because they most likely were themselves ignorant of obstetrics, and the “supportive” commenters are just as dim as everyone else.
Even highly educated women, not super-crunchy, are easily led astray. This last week, a friend of my daughter’s brought her son and new baby over to play with my grandchildren. In the space of three hours she nursed the three-week old three times. She had successfully nursed her first child for nine months, and felt pretty confident of her abilities. I gently suggested that it can be different with a preschooler to care for (and a lot of stress with a dying grandfather as well) and supplemental feeding might be of benefit. She agreed, a bit reluctantly, and after the baby wolfed down 60 cc and fell asleep, was astonished. She thought that because she had let-down whenever the baby cried that she was producing gallons of milk. Such a simple thing. I told her to offer supplements, if the baby didn’t want it, he was satisfied with breast milk, but if he did, it was a sign that, at least temporarily, (I wanted to salve her ego) she was not producing enough to meet his demands.
Just common sense!
Yes. Thank you for being there for her, and I’m so glad you got through to her. It can be really hard to be logical with so much going on.
*In the US*
“People and babies die in the hospital and outside it during childbirth in rare cases”
Babies die with and without antibiotics, but they die more often without them. Which do you want for your child?
Babies die with and without vaccines, but they die more often without them. Which do you want for your child?
Babies die with and without clean drinking water, but they die more often without it. Which do you want for your child?
Babies die in hospitals and at homebirth, but they die more often at homebirth. Which do you want for your child?
I can imagine the revisionist history the midwives in question will tell in the retelling of this homebirth death…” the mother refused to transfer and we respected her choices”
But the mother also chose attendants who would not/could not detect a need for hospital care. Her vanity led her to make that choice.
Most babies in who die in hospitals die because they just aren’t healthy, either because they aren’t developed enough, or for some other reason. Healthy term babies almost never die in hospitals. This mother chose to be far away from the care that could have saved her child. She chose that because she was vain. She surely has some idea that, during the long centuries when there was no modern medical care, babies died. She knew that, and thought she would do better with the same kind of care, because she was smarter, and doing things “right”, unlike all those poor women and children who suffer and die today in desperately poor places across the world.
Hopefully now, she can see that she is no better than all those women who eat non-organic food, get prompt epidurals, and come home from the hospital with healthy babies.
One of the things that jumped out at me was that she was _only_ 5 minutes from the hospital.
Even being 5 seconds from the hospital doesn’t help if you don’t transfer in time (that is: before the baby is deathbound).
I was only across the hall from the OR when my daughter’s dangerous decels were detected. Even so, the surgical team moved with urgency, and one of them was angry at how tangled up all my tubes and wires were because they delayed transfer to the OR. (I don’t even know what all I was hooked up to, but definitely pulse-ox, two fetal heart rate monitors, epidural, magnesium, IV antibiotics, and pitocin for sure, and somehow they were very tangled indeed). I’m not sure exactly how much time passed from getting my consent to getting her out, but it seemed like no time at all – it was probably at least five minutes, though. And less than a minute between the first and second twin!
I have felt *too far* from the OR when I’ve been *in* the OR with a patient.
Yes, this is kind of absurd, but it also conveys how quickly we want a baby born who’s in trouble. When it’s a STAT situation, it’s never fast enough.
Also, because she delivered in the ambulance, the ER docs were able to get to work on the baby immediately. If the baby was still in her, they would have first assessed her, and THEN gone to work on getting the baby out. So the mom still doesn’t realize that her fetus was more than “5 minutes” away from hospital care.
It’s unfair and very unkind to assume that it was “vanity” that made this mother choose unqualified attendants. The usual explanation is a combination of fear (hospitals scary!), unicorns-and-rainbows optimism (beautiful way to welcome baby into world!), and BEING LIED TO by midwives when you ask them anything about safety or risk.
was it vanity or a problem with our healthcare system and the lack of options covered by insurance ? The World will never cease to assume but will never know.
Nowadays, for as long as the ACA is law at least, maternity care is absolutely covered by insurance. So that definitely isn’t it. And if insurance refuses to cover homebirths, it’s because things like this happen there– the actuaries have determined that homebirth isn’t a safe option so of course the insurance company won’t pay for it.
Lady, you’ve pissed me off, because you have put me in the position of defending the health insurance companies and I do not like them. I think that they are immoral, greedy corporations who make money by denying people care. But in this case, they’re also right to not offer coverage to subpar medical options.
It is specifically because it was out of a hospital that this baby died. This kind of neglect wouldn’t happen in a hospital because because they wouldn’t allow a labor like that to happen.
When babies (or mothers) die in hospital, it is in spite of the safety mechanisms that hospitals, clinicians, governments and private organizations have tried to put into place to prevent accident or negligence. When they die in homebirth in the U.S., it is because those safety mechanisms don’t exist–because homebirth midwives don’t want them.
Great! You recognize that this baby died due to an incompetent provider in a low-resource setting.
Does being a CPM assure competency?
How do we know if a midwife is “well-trained?”
Is intermittent auscultation of the fetal heart rate in labor sufficient to detect fetal hypoxia?
Is a low-resource setting without medical equipment and personnel appropriate for a first time mom with a prolonged 2nd stage?
How does a low-resource setting with underskilled providers protect the safety of mother and baby during labor and birth?
But there is a pattern of this happening over, and over, and over at homebirth. Almost always with a CPM in charge. Is it ‘fear mongering’ to point that out?
SIX FUCKING HOURS.
I posted this on SOB facebook, too https://www.youtube.com/watch?v=CRhkZKUNyMY
This is why I talk up the WHO partograms, especially when an expectant father (or other relative) is nervous but can’t talk the mother out of home birth, a partogram and a clock really can prevent a lot of tragedies. 6 hours of pushing and 35 hours of labor, seriously? How can that possibly be normal?
(You can’t prevent all tragedies with a partogram, babies with placental dysfunction can go into distress with the very first real contraction, but they’re a sight better than trusting birth indefinitely.)
If you define “normal” as something that happens fairly frequently and people do sometimes survive, well then…
/sarcasm, in case that wasn’t obvious
6 hours pushing is totally NUTS, 35 hours of labour depends when they started counting :/ 35 hours active labour is nuts. But many people start counting from first regular contraction, or even first contraction that didn’t stop/start, she got to pushing so there was progress, but not much descent it seems.
I can’t imagine pushing for 6 hours, that is completely nuts. I have a friend who pushed for 3 hours with her first (after a long induction and a few different problems) and ended up with a c/s, and that sounds miserable enough.
I pushed for 1h30 before I had my c-section, and my mom was mad they let it go that long without any progress, she would have called the OB a lot sooner.
OK, that’s it. That’s the moment I knew would come. For the first time, I feel more angry at a homebirth loss mother than sorry for her.
Excuse me. Her tribe? Her TRIBE? Why didn’t you go in the forest and took just two furs to dress yourself with, you idiot? Your TRIBE? ALL your closest female friends? How many of these do you have? ClosEST? Are they all fools like you? Because I get the vibes that she summoned all the members of her cult to give birth through substitute, aka her. The information was fucking there. It was there! And she chose to lap at the bullshit her “midwives” were spewing instead.
When I see words like “my tribe”, I want to smack the privileged fool soundly. It’s a disservice to real tribes. It’s also a disservice to her own baby. Her tribe, gathered there to make video documents, no doubt.
Her language is very telling. High hopes for a homebirth. Dear God. Not high hopes for a healthy baby. The healthy baby is a given in this tribeswoman’s head, despite the fact that the merest Google search would have told her otherwise.
No wonder fake midwives keep flourishing businesses. When mothers don’t want to know and law doesn’t care, what do we expect?
I’m still inclined to lean towards the mother being brainwashed into a cult-like environment. It is now the in vogue thing for white women to appropriate the language of indigenous/tribal cultures, because that somehow makes them more “earthy”, or something. I don’t know. It’s disgusting, but she’s just repeating the words that have beens spoken to her.
Oh, I believe in the cult mentality as well. I also believe all those “closest friends” of hers have been acquired through the cult. I just don’t consider it any kind of excuse. I am not saying that she should have known better. I am not appealing to common sense. I am appealing to her very eyes. The information is there, easy to find.
It’s hard to cut the line between a cult victim and abuser. Yes, I believe this mother is a cult victim but had her homebirth been successful, she would have encouraged other women into it… and someone else would have been the victim.
Somewhere along the way, some personal responsibility is needed. Which is not to say that “midwives” are not more to blame.
I agree with you, but for a first time mom, I’m a little bit more inclined to be generous, because they’re trusting the so-called professionals. She seems genuinely shocked. And yes, the information is there, but it’s painted as fear mongering. The dark side of that community isn’t always obvious, and they can be very, very convincing in how they portray our discussions as bullying, fear-mongering, and just outright wrong.
I’m not saying any adult in these situations are blame free, just saying it’s way more complex than simple explanations.
She is a FTM but she is also someone who has “attended” unassisted childbirths and is completely immersed in all that deadly crap. That’s why she is so lost now – the ideology of the natural childbirth cult says if you do everything right nothing bad happens. She did everything right. It’s a long way from where she is now to understanding why and how her fake midwives killed her baby through negligence.
I used to be more generous to homebirth loss moms. No more. The only thing distinguishing them from the other cult members is that they drew the short stick and their baby died. That’s it. Otherwise, they would have kept luring other expectant mothers into their cult.
A cult member is a cult member and should bear some responsibility *not because their baby died* but because they placed them in this situation in the first place. Mothers who were lucky as well as loss moms. I am sorry but I am no longer inclined to pat them on the head because fear mongering. The information about just how professional their so-called professionals are is easy to find as well. When you choose to deprive yourself and your baby from what common norms in your society recommend, it’s up to you to find enough information, not only the touchy-feely bits.
Cult members are cult members, no matter if their baby died. These babies don’t die because their moms somehow “deserved” it. It’s just bad luck. That’s why normal people go to the hospital in the first place.
Good people can be brainwashed into doing terrible things. Coming out of that cult does involve taking a good amount of personal responsibility, but it also involves some compassion from the rest of the world in acknowledging that they didn’t go into this saying “hey, I want to kill my baby!”. They NCB crowd can be very convincing. I’d still prefer to attack the system, the leaders of the system, and the midwives that dupe women into believing the lies first and foremost. Also, I’ll repeat what I said to Dr. Kitty, I didn’t realized she attended births until yugaya said something, which does make me feel somewhat less charitable towards her. That makes her more a part of the system and less a victim of it.
They certainly can. Yet we don’t regard them solely as victims. I doubt anyone thinks these women go into this saying, “hey, I want to kill my baby!” but too many of those who entered the cult turn out to be the same women who turn blind eye to other women’s babies dying. The only reason we’re even discussing being charitable towards them is because it’s their baby who died. They are no doubt deserving of sympathy. They are loss mothers. But charity? Not from me. A woman is no more deserving to be viewed charitably because she drew the short stick in her idiotic choice than another who didn’t, although she made the same idiotic choice. No matter that the second one will probably beat herself in the chest how superior she is.
Nowhere did I say midwives and the cult leaders were not the ones who deserve more blame.
I think we may be saying similar things through opposite angles. I’m not saying let mom off scott free either. I’m just inclined to be a little bit more gentle with first time moms who’ve been well and truly duped.
And, as yugaya pointed out, that’s not the case with this particular mom, so my compassion dialed back quite a bit.
As a former actual cult member – I agree. I did some dumb, hurtful and dangerous shit while I was brainwashed. But I DID THEM. Although my state of mind at the time does matter, it doesn’t magically erase my own responsibility for the choices I made at the time.
She pushed for six hours.
Six.
There is a reason why anything over 3 in a primip without an epidural is generally considered problematic.
If her midwives had stuck to the accepted standard of care used by systems where homebirths are supervised by properly trained midwives with strict protocols for when to transfer, and called an ambulance 2 or 3 hours earlier, perhaps things might have been different.
Things WERE going wrong.
First stage of labour shouldn’t last 19 hours.
Second stage shouldn’t last 6 hours.
Everyone was ignoring that.
The signs were there, and no one was willing to admit it.
Everything was not perfect- the people who she had paid to tell her when it was time to go to the hospital failed in their duty of care.
I know that. You know that. I just give the first time moms a little leeway for being duped by the cult. But I didn’t realize, as yugaya pointed out to me below, that she’d attended unassisted births prior to her own birth. That makes it a little bit different. At any rate, there’s certainly a whole lot of blame to go around.
I really don’t actually think it does make a lot of difference, because after 30-odd hours of labour and hours of pushing, it is unreasonable to put the responsibility for making a decision to transfer onto the exhausted woman in agonising pain.
That is *why* birth attendants exist- because women are rarely in good shape to weigh up options and balance choices in an unmedicated labour.
They need people to take care of them when they are in a very vulnerable state.
Even if she had been saying “no, no, just give me more time” someone ELSE should have been calling the paramedics.
If these people are accepting money, then that is their job, they have a duty of care, and “the customer is always right” is not something that applies well in healthcare.
That’s the part where I’m not blaming the mother. The part where I think the mother bears some culpability, and where I have some compassion for her, is that she put her trust in this midwife who clearly did not act until it was too late. The part where I did lose some of my compassion when I realized she’d attended several births is that she wasn’t a complete novice with birth and yet she still chose this inadequate attendant for her own birth. I think I may be failing to express my thoughts adequately here. I apologize for confusion.
It works both ways, though. If she only saw “the beauty and power of birth”, she would have been even more sucked into trusting these attendants. Basically, that’s what I’m talking about in reverse. Things don’t stop with cult members’ own babies. They progress to other women, other babies.
But 30 hours into labor isn’t the part where mom is responsible. Her choices before that are on her though.
I didn’t mean the 30 hours of labour. I mean that after having witnessed “beautiful, empowering births”, she would have been more inclined to enter birth with complete trust in her attendants. Hence her choices before.
And yet they do. When they preside over these obviously abnormal labors that end in catastrophe, often they throw the decision not to transfer back on the mother, no matter how many false reassurances they offered.
If a medical professional says, “This is bad and we really really need to do X because of Y,” and the patient clearly and coherently rejects treatment, that’s one thing, that’s the patient exercising bodily autonomy. But if the professional never says anything, or says it in a very vague way, he or she has failed.
The most digusting part is when it’s too late, and when they KNOW it’s too late, these fake CPM midwives will act all of a sudden like they “tried everything” and brainwash mother into believing how ” there was nothing anyone could have done”. Her sadist hack midwives let this woman’s baby suffer through six hours of pushing without saying or noticing anything. And then it was OMG emergency and they were “game on” I bet.
And yet in my case that is exactly what happened. It was entirely on me, a primip who’d been in labor for over 50 hours, to make the decision to transfer while in agonizing pain and not having slept in over two days. At least I wasn’t pushing; never got to pushing because I never dilated past 4. No recommendation, or suggestion, or even hint of transfer, was ever suggested by the CPM attending my birth. I decided to transfer completely on my own, while my husband, who had also completely drank the kool-aid, cried while rhapsodizing his vision of our perfect, gentle homebirth. This was after my CPM’s CNM backup had come and AROM’d me without my consent and lied about it to my face (because as much lip service as homebirth midwives pay to informed consent, they don’t seem to actually know what it means or care about it–the goal is just for a woman to push a baby out of her vag in her living room and ethical concerns, and even outcomes, are secondary). The hospital we transferred to hated us all (and I don’t completely blame them), partly because they’d experienced a homebirth death the week before.
But yeah, the transfer decision was all me. After the CNM broke my waters and told us they were “lightly” mec stained, that was it for me. Sad that I made a better decision while in active labor and on zero sleep than my supposedly “Professional” midwife did.
I still take responsibility for the overall very bad decision to attempt a homebirth. I would never do it again and I am very lucky that my baby and I were ok. Our transfer was not treated as an emergency and my son was doing well according to the EFM when we got to the hospital. I was given an epidural and allowed to labor for two more hours before I had a c-section.
After being in active labor for two hours, I was not in my right mind. I couldn’t even spell my daughter’s name to the nurse, I had to get my husband to do it. I could not imagine what this lady was going through and how all her mental resources were exhausted. These midwives will use this to be able retell a different story to the Mom and quite possible the Dad. I feel for the parents and hope they learn from this dreadful experience.
I’m kind of leaning your way, because I’d run across none of Dr. Kitty’s info before, though I did have sense enough to go to and listen to obstetricians.
As I wrote on my Facebook page, I analogize these situations to children who get ejected through windshields because they weren’t in car seats. Of course the mothers of those children did not intend for them to die and they grieve their deaths. But if one of those mothers then insisted that the fact that her child wasn’t in a car seat had nothing to do with the child’s death, I would be equally appalled.
I don’t think that’s quite the same because there’s not this massive, very convincing movement that’s indoctrinating women to believe that car seats are dangerous and holding their babies is “at least as safe” as using car seats, and that if people tell you to use car seats because of the risks of death in an accident they’re just fear mongering.
The NCB community can be very, very convincing, not just of their own agenda, but in vilifying those of us on this side of the fence, so that women are primed to automatically disbelieve anything we say to begin with. For a first time mother, not otherwise involved in the birth industry, that’s a lot to overcome.
As I’ve stated, my compassion is mostly reserved for first time mothers. I didn’t immediately realize the mother here had been involved in childbirth activities prior to her own first pregnancy. That makes her more a part of the system and less a victim of it, and reduces my compassion significantly. Additionally, as I’ve clarified, I’m not saying this is a “get out of responsibility free” card. I’m just saying that I’m a little bit more generous with compassion and gentleness with those that as see at least partially as victims of the NCB ideology.
But again, I was corrected that this mother wasn’t the standard first time mom, so I’m somewhat less compassionate. If she’s attended several births, she’s at least seen some minor complications and knows that things can go wrong, and had the opportunity to begin to wonder if perhaps all the stories of catastrophic complications weren’t exaggerated. She didn’t, so my compassion is somewhat reduced.
All that said, I still lean towards a certain amount of compassion towards people who have suffered that great of a loss, regardless of circumstances. It doesn’t take away personal responsibly, but I can still have compassion for them. I suppose having grown up in a fundamentalist Catholic home and gradually figuring out there was this big wide world out there, and that things were not anything like I had been taught, I can understand a little bit of the though process that goes on when a person is indoctrinated into that sort of ideology. What got me to really start evaluating the beliefs I’d been taught was a combination of being horribly mistreated by the church community (because I chose to get my tubes tied after a series of pregnancies that got progressively more complicated and more dangerous), and one very patient, very compassionate liberal woman who debated with me point my point, calmly, respectfully, and most importantly, gently, letting me realize for myself how horrible some of the beliefs I held really were. While I don’t think I ever caused anybody direct harm, I do have to admit to, and own that I harbored hateful attitudes in my teens and early 20’s, and if it weren’t for that one compassionate woman, who knows where I might be today.
And finally, I will say that I think if we’re going to make inroads in this battle to make things safer for women and babies during pregnancy, childbirth, and infant feeding, we need a variety of approaches. We need your direct, no-nonsense approach to call people out. We need people who are gentle and compassionate. We need people who are somewhat in between. Not every person responds to the same approach, so we can’t fight the battle with a single approach either. I truly appreciate what you do. I can’t handle the kind of confrontation you regularly engage in, and I’m awfully glad you’re around, because little bit by little bit, your willingness to do so is causing positive changes.
Having been part of the NCB community, it really is a cult. Of course, I still think I bear some responsibility for my poor decisions. Had the birth gone smoothly, I may never have woken up. But it is a cult. You don’t know what you don’t know, and you are not encouraged to explore beyond the confines of accepted opinion. Any information suggesting anything other than “OOH birth is as safe or safer than hospital birth” is attributed to the “evil ‘Dr.’ Amy” or her “minions.” She must never be linked to, even in criticism, lest she be benefitted by the extra clicks. It’s nuts. I still have many friends in the NCB community and am pretty much still in the closet; I have only outed myself to a few that I consider myself a former NCBer and I think home birth is dangerous.
Sigh. My own English-Yankee ethnic group have done many bonehead things, to say the least, but for heaven’s sake, my “tribe” are the Yankees, it’s my culture and that doesn’t mean its automatically so much worse than being Luo, Lao, or Navaho. All cultures have their pluses and minuses, and being a wannabe is pretty much always seen as a minus.
She is voicing the same sentiments as those who do not vaccinate. An unwavering belief that absolutely nothing will go wrong. Bad things don’t happen to good people and people who make poor choices (like smoke or eat crappy food) deserve their fate (lung cancer, heart attack, etc). She did EVERYTHING right. And now she’s asking why everything went wrong.
Yes. Ironically, that’s the difference between us and those self-proclaimed loving everyone people. WE don’t think this or that homebirth baby died as a punishment because his mother was an asshole. We say, “the baby died AND the mother was an asshole”. They’re so smug in believing that whatever happens to us, it happens because we didn’t do something right but of course, they’re better. Superior.
Weird, I wrote about this just before I saw your post.
Hmm, I was wondering how big the step to bad things happening only to badly behaving people is. I might have mentioned a discussion I had with my dad a few years back. He was wondering why the hell the state should pay for in vitro procedures when some women brought it upon themselves by leading a careless sexual life. I suggested that we send policemen to investigate every woman applying for state assistance in this issue to make sure she was a good girl. Ah, and diabetics who eat a bar of chocolate should be refused state-funded treatment as well. Not to mention smokers, drinkers and so on. I didn’t need to make the list longer for him to realize what a foolish notion he had just voiced. Later, he told me he didn’t mean it like “well, why should everyone pay to remedy the punishment of those who brought it upon themselves by being bad girls?”. I asked what the hell he meant. Some months later, he defended my views in a company (giving me the credit) but the fact that someone who traveled on his own expenses just in case a neighbour needed a blood transfusion (our blood donation system leaves much to be desired) could express such notions is very disturbing. Mind you, that was the neighbour whose teenage son tried to molest me, so my father didn’t feel warmly towards them at all. He still did it. And he still expressed notions that were highly problematic.
I guess the desire to believe it won’t happen to us because we’re good people is quite strong.
Meanwhile, many minorities consider “tribe” to be a rude word to refer to an ethnic group.
I consider it a gross cultural appropriation that’s disgustingly disrespectful to tribal peoples throughout the world.
That too.
Maybe focus less on the stylistic and cultural differences (“tribe,” so what–lots of people refer to their friends as their tribe), and remember that it’s absolutely not true that “the merest Google search” would have told her home birth was a bad idea. There are countless websites claiming that home birth is safe.
This woman got brainwashed. She sounds heartbroken. For the sake of her future children, she needs support from rational people, because the “support” she gets from her “tribe” is likely to NOT make her realize that having babies this way is dangerous.
And by support, I don’t mean a bunch of fond platitudes. I mean sympathizing with her loss AND helping make her aware that the reason it happened is because her midwives were wrong — literally dead wrong — and cannot be trusted.
If you actually want to stop this kind of death from happening, or reduce it, that’s what you need to do. Vilifying the mother, insulting her and blaming her and letting your own prejudices against her linguistic and cultural quirks get in the way… that’s not going to help.
And repeating that she’s a good girl who did nothing wrong and every good mother would have done the same is going to help?
Somehow, a good percent of women end up not seeing themselves as proud “tribeswomen”. I’ve thought about the reasons why some women are more vulnerable to this bullshit. But no matter what, everyone should bear some personal responsibility for making a choice that endangered someone else. What I see on this site (and I used to participate in it) is the distinction between cult members and loss mothers. Do you think that becoming a loss mother somehow erases her earlier identity of a cult member who urged others to risk their babies’ lives? How does that work?
And repeating that she’s a good girl who did nothing wrong and every good mother would have done the same is going to help? …she couldn’t help but be lied to, that every other mother in her place would have chosen home and midwives?
Where are you getting that? Because nothing I said suggested at all that that should be the message. I think you are too angry about what happened (and understandably so) to hear what I’m saying, or indeed to hear any message but “this woman is an evil evil human being.”
So let me spell it out.
We’re trying to convince pregnant women not to choose home birth, right? Because it’s exponentially more likely to kill or permanently injure their baby? Ok. So we’re agreed. And on the other side, the home-birth promoters are shouting about “choice” and “freedom” and “naturalness,” etc., and sometimes “feminism,” and so forth. And they’re lobbying loudly and coherently enough that in the past year two more states have passed laws licensing CPMs to practice.
That being the case, what do you think is the MOST EFFECTIVE argument against CPMs and home birth? In other words, who are legislators and pregnant women going to listen to and remember the most?
The answer is, moms who have lost babies this way. Moms whose babies have cerebral palsy or severe brain damage or some other major injury from home birth. You can spout statistics all you want, and you can be provably correct, but nothing convinces people like a sympathetic person saying, “This happened to me, please don’t let it happen to anyone else.” That is the only thing that makes people who are resistant to an idea realize that the tragedy in question could happen to THEM. Numbers don’t do it for most people; they just don’t. They’re too abstract.
So what happens if you demonize home birthers? They stick together and stick up for themselves even harder. And what happens if you demonize a woman whose baby just died? The same thing, squared, plus you just made yourself look like a heartless a-hole. Is that a good move? Is that going to actually help reduce home births in America?
No.
If you want to reduce home births in America, quit seizing on tragedies to vent your personal feelings of rage, grief, etc., and start doing something that works.
I agree – we need to hold those accountable who are responsible for the is proliferation of incompetent and negligent care.
That would be
– the certified professional midwives themselves who hold themselves to idealistic and pathetic standards.
– the midwifery professional organizations that explicitly promote out of hospital birth: MANA, NARM, NACPM
– the midwifery professional organizations that ‘play nice’ with the other organizations – because they believe that to discredit a certain type of midwife is harmful to all midwives – ACNM, MERA
– the states that have enacted legislation that licenses and permits the practice of midwifery by these incompetent individuals, allows them to bill insurance (creating another layer of legitimacy), and often explicitly does NOT require any professional liability insurance coverage (creating a further lack of accountability), and further conflates trained skilled midwives with certified professional childbirth hobbiests. 30 odd states and counting.
http://pushformidwives.nationbuilder.com/cpms_legal_status_by_state
I’m so sorry for that mother’s loss.
“We can grow and learn and use these experiences for positive change.”. Not if you don’t understand what caused an untoward outcome in the first place. People don’t understand just what the strip means, but even after being away from tocometers for almost 30 years I could see how bad it was. This is like ausculatating cardiac sounds for a suspected MI rather than running a rhythm strip. People just don’t understand the difference between a single episode as opposed to a trend that can be clearly seen on a strip.
“”We can grow and learn and use these experiences for positive change.”.”
She talking about the positive changes, spiritual growth and maturity that comes from accepting death … even preventable death.
When I lost my son in 2013 and my daughter in 2014 (first was placental abruption 2nd was cervical incompetence), the absolute WORST thing that was said to me was “you can always have another baby” “at least you know you can get pregnant” or “you’re young so you can always have another”. They were the most ignorant, rude and dismissive remarks. My heart aches for this woman to have to be told that.
I’m so sorry.
I’m so sorry. It’s terrible.
I’m so sorry.
Oh my God, how did you not strike more people? I’m so sorry for your double loss.
My parents got some of this when my older sister was stillborn, too. We humans are stupid on a regular basis. 🙁
Believe me, I wanted to punch them lol but my fiance (my family calls him the lion tamer because of how good he can calm me down lol) was able to stop me from having no impulse control.
Oh god. That poor little boy.
After giving birth to my first baby this January, I’ll never understand the problem people have with fetal heart monitors. Yes, I was “hooked up to machines”, but it meant that I could constantly see how my baby was doing. It was incredibly informative and reassuring. Before I had my daughter, I thought I empathized with those that didn’t want an “over-medicalized” birth, but not anymore. I would have been terrified out of my mind if I had to labor at home.
Exactly! I loved the monitors. They weren’t super comfortable but good lord, nothing is comfortable at that stage of pregnancy, and they weren’t particularly uncomfortable either. I would’ve endured a whole lot worse to have the constant reassurance of their (twins) heartbeats.
A woman after my own heart – it can be difficult and uncomfortable to be hooked up but my god its great to see your baby’s trace and know that he’s OK in there!
I had several late 1st trimester / early 2nd trimester miscarriages. Those you can’t know until there is no heartbeat or you just start bleeding. I used to snitch the fetal heart monitor (or the portable ultrasound) at work so I could reassure myself that the current pregnancy was at least still viable. I always was thrilled at quickening since I was able to tell kiddo was “alive and kicking”, so to speak. Monitoring to me is very reassuring.
I’m sorry for your losses.
I spent a month in the hospital before my twins were born. I had to undergo NSTs at least once a day as well as another check up in the evening and the night. It sucked. It’s very hard to do an NST on 24-28 week old babies, much less doing two at the same time. There were days that I spent hours on my back with those damn elastic bands strapped to me while a nurse pushed on my stomach, or worse, my bladder. But you know what? I would do it again to have my babies safe. I would have done it every day for another three months if it would have meant my girls could have been full term. Anyone who whines about having to use fetal monitors during labor can f*ck off.
Yeah, I had twins and pre-e and lots of monitoring. No option for wireless monitoring, and to top it off, I developed contact dermatitis from the monitor straps. It was torture, but I still did it.
I do wish someone would look into more comfortable strap material, though.
Monitoring made me feel more comfortable, too. Between the IVF and the awareness of my mother’s losses (8 at least, 3 late enough to be stillborn) and the fact that kicks often felt like gas or muscle twitches, only ultrasound left me reasured.
I absolutely love the sound of the babies heart beats.
The first SS shows her saying that she has so many questions. She’s not going to get the truth in those groups. I really hope someone can message her or something and link her to the homebirth loss and trauma group run by Ashley, or the hummingbird network or even the evidence based vbac Group where she will be respected, showed sympathy and empathy and told the truth at the same time as reassuring her that she’s not at fault and did nothing wrong. These midwives are horribly incompetent. They don’t know what they don’t know and refuse to admit that
Right! I am so freaking grateful that I didn’t have a bad outcome with my first at a freestanding birth center, because it’s pure luck – but I had no idea what could have gone wrong until I found this site while pregnant with my second. Even though nothing horrible happened in my case, I still have to reassure myself with the fact that I was being lied to and brainwashed, for their profits’ sake. The guilt I would have felt had there been a bad outcome and then I found the truth? It’d be hard not to commit actual violence against that midwife.
And then, you’d be tried as if you attacked a human being. I am increasingly convinced that midwives and yes, many in the cult are not this. Actually saying that if a baby cannot breastfeed, it’s better to let the soul pass peacefully? It’s interesting, though, how they’re always so quick to point out that hospital is just 5 minutes away. Looks like they aren’t going to let their own soul pass peacefully. Instead, they’ll ride there to summon their servants… err, the medical staff, to work their miracle and save them/the baby.
Human beings? As if!
A journalist I run across in Facebook groups, who’s normally pretty good, wrote a piece a couple years ago promoting passage of a midwifery bill. She talked up how homebirth would be so great for rural women, since they’re hours away from hospitals with good obstetric departments. I composed a biting letter to the editor, only to find that they require publishing personal information with any letters, and I actually fear the NCB crowd. Sadly, they’re also all up in the liberal groups in my conservative state, and it’s so hard to deal with that.
Christ, what will it take for these stupid fucking imbeciles to connect the dots? They won’t even listen when their own experiences prove that everything they think they know is entirely fucking wrong.
The baby was “making strong movements”-struggling. Her baby was distressed. It’s also telling that the midwives were letting a primip push for six hours.
My first was born by C-section as he did not turn head down. My second, my daughter did turn her head down, so I was allowed to try a VB. I was at the hospital as soon as I had some contractions and my waters broke. So I felt save. I felt my baby “making strong movements” too! Until the midwife told me, that according to my contractions I should have an opening of 8cm at least, and instead I had no opening at all. She called the gyn. He performed a c-section to get daughter out. Until the moment I was in the operation room I felt her “making strong movements. And yet, she would not have come out vaginally. For how long would I have felt her making strong movements at home and feeling save because of it? Until suddenly there wouldn’t have been strong movements anymore? So I know first hand, that yes strong movements are good – baby is still alive, but it is NOT a sign, that everything is ok. After the birth I thought that her movements were struggling to find the right way out without any success. AND: she was so tired after birth that she slept for 48 hours, with an occasional waking up to drink at the breast and go on sleeping. So for baby making strong movements for hours and hours is tiring and stressful.
God, poor kid.
Another example why I probably should *not* go to that homebirth alliance’s PPD group, because I am no ally.
This mom is lost. She did everything right. Now she has a dead baby. And the fuck ups in that unassisted group are telling her that her perfect baby boy dying is nothing – she can have another baby.
They are all ill. I hope someone from her family manages to find their way to dr Tuteur and that they file a lawsuit against the hacks who presided over this preventable loss.
One instance of the baby’s name was not removed from the screenshot.
Thanks. I fixed it.