Hideous death rate prompts temporary closure of Baby + Co birth center

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The latest scandal in American midwife attended birth out of hospital birth is occurring in Cary, NC. According to the The News & Observer:

Three-and-a-half years after its splashy debut in Cary, the Baby+Company natural birthing center has stopped delivering babies after the deaths of three newborns in the past six months.

The spa-like facility that enticed expectant moms with midwives and water-birth pools alerted its customers by email on Friday, March 16, that it would be sending all moms in labor to WakeMed Cary hospital, the birth center’s business partner, while it reviewed recent “incidents.” On Thursday, after inquiries from parents and The News & Observer, the center released the information about the newborn deaths.

The company said the Cary site has had a total of four deaths since it opened in October 2014. That compares to only one death at its other five centers in three states. According to Baby+Co, it has supported 1,200 pregnancies over its 3 1/2 years in business in Cary.

An additional baby is currently hospitalized in the NICU at Duke.

Four deaths in only 1,200 births is an extraordinarily high death rate of 3/1000. To put that in perspective, according to the CDC Wonder database, midwife attended hospital birth for low risk women has a death rate of 0.4/1000. The death rate at the Cary birth center is more than 600% higher than expected!

The death rate at the Cary, NC birth center is more than 600% higher than expected.

Is out of hospital birth safe?

I asked that question about homebirth in The New York Times back in 2016 and answered it.

[T]here are places in the world where home birth is relatively safe, like the Netherlands, where it is popular at 16 percent of births. And in Canada, where it appears safest of all, several studies have demonstrated that in carefully selected populations, there is no difference between the number of babies who die at home or in the hospital.

In contrast, home birth in the United States is dangerous. The best data on the practice comes from Oregon, which in 2012 started requiring that birth and death certificates include information on where the birth occurred and who attended it. The state’s figures show that that year, the death rate for babies in planned home births with a midwife was about seven times that of births at a hospital.

Many studies of American home birth show that planned home birth with a midwife has a perinatal death rate at least triple that of a comparable hospital birth …

Birth center birth is homebirth with a twist. The birth takes place outside a hospital but in a facility that has some safety standards and equipment.

Why is out of hospital birth in the US so deadly? There are a variety of reasons but one of the most important is the philosophy of “normal birth,” the self-serving idea promoted by midwives that the process of birth is somehow equally or more important than the outcome. It’s self-serving because “normal birth” is defined as what midwives can do autonomously, not by what is best for babies and mothers.

There’s a major problem with that definition: “normal birth” is inherently deadly. Since even apparently uncomplicated births in low risk women can naturally end in death for babies and mothers, birth outside the hospital is essentially a gamble. Women and the midwives who encourage them gamble that if complications occur (and some serious complications will inevitably occur), midwives can recognize them and transfer women to the hospital in time to prevent death.

But that can only happen if the midwives are proactive in making sure that women with risk factors are not allowed to give birth at the center, if complications are correctly identified and not dismissed at “variations of normal” and if complications are acted upon immediately before they become full blown disasters.

I’ve heard privately from a variety of people with knowledge of the Cary birth center situation who insist that this is just the tip of the iceberg. There have been serious safety concerns since shortly after the center opened, safety concerns that were not taken seriously.

The director of the center, Margaret Buxton, CNM was interviewd by a local TV station. You can listen here to her weasel words about a “cluster” of deaths and her false implication that this can happen in the hospital, too.

Buxton repeatedly reference to the “cluster” is both tasteless and misleading. A “cluster” did not die, four individual beloved babies are dead and at least on camera Buxton never offers her condolences. The deaths were almost certainly preventable. And while it is true that deaths can occur in a cluster, when those deaths are averaged over the number of patients delivered at the center, the death rate should be THE SAME as the death rate in the hospital, not 600% higher.

There should have been a maximum of 1 death among 1,200 patients. Once a second death occurred, it might have been reasonable to talk about a cluster and assume that the rate would average out over time. With a 3rd and 4th death, Buxton should not be talking about a cluster and in my view should be acknowledging a disaster.

Baby + Co is a birth center franchise. The News & Observer article claims that the other 5 birth centers have had lower death rates so the problem may be confined to the particular center and its staff. I wonder what kind of malpractice insurance Baby + Co carries. It looks like it may be needed.

  • Nick

    My wife and I had troubles with our delivery because of them. I am glad to see them closing their doors so that babies and mothers will be healthier during childbirth!

  • Guest

    I’m suspicious that this center may have had another death

  • Guest

    I’m wondering if this center had another death this month.
    December 2018.

  • Guest

    HIDEOUS is really the only word to describe these midwives ‘splaining away these infants’ deaths. Their patients die at an unacceptable rate in their facilities – but they’re worried about the ‘disservice to the birth center model of care.’?!

    They value their ideology over survival of their patients.

    Blog post:

    https://www.babyandcompany.com/babyco-response-north-carolina-dhhs/

    Letter to North Carolina DHHS:
    http://www.babyandcompany.com/wp-content/uploads/2018/06/BabyCoResponseToDHHS.pdf

  • AndreaRealMPH

    I tried to think objectively but hypothetically about homebirth with a non-nurse midwife and though this:
    Scenario: I’m 8 or 9 months pregnant and all the doctors in the US have been abducted by aliens. I must give birth at home. What do I do?
    A) Hire a Vagina Junkie hippie, pay her 4k in cash before the birth to have her tell me everything is fine, even if it isn’t.
    Or
    B) labor at home by myself and call the fire department if something seems wrong. If they send me a bill at all, it’ll probably be cheaper than a homebirth midwife and someone on the crew is probably experienced in CPR anyway…….
    I’ll take B any day!

    • Who?

      Plus you get a photo with a bunch of handsome firemen and you and the baby!

      In all those circumstances, I cannot see a downside to your plan.

  • Anonymous

    I have to disagree with one aspect of your article here:

    “Birth center birth is homebirth with a twist. The birth takes place
    outside a hospital but in a facility that has some safety standards and
    equipment.”

    Should probably read:

    “Birth center birth is homebirth with a twist. The birth takes place
    outside a hospital but in a facility that has some safety standards and
    equipment. Unfortunately for the mothers and babies, these safety standards are often inadequate or ignored.”

  • MWguest

    As part of my CNM training, (I’m embarrassed to admit this- but this all needs the light of day) I was required to take the American Association’s of Birth Center’s “How to Start A Birth Center” workshop. I was trained at Frontier. This was required for all CNM students.

    I found the workshop rather ill-informed on the risks of taking VBAC clients in out-of-hospital birth centers, instead the push from the AABC, as well as the CNM workshop leader was to advocate for VBAC in low-resource settings, such as their accredited birth centers. They support this under the guise of informed consent and shared decision-making.

    Accreditation of birth centers will do nothing to promote the safety of VBAC in birth centers, nor will the presence of a Master’s trained nurse-midwife.

    It appears that the birth center in Cary did not take on clients with prior cesareans, if that is to be believed, then they truly took low-risk clients into their service. That makes their neonatal death rate simply unconscionable.

    If these babies died after birth due to injuries they suffered during labor, there is some gross negligence in assessing the well-being of the client under their care.

    Low-risk women experiencing normal labor at term rarely lose newborns during labor under hospital-based care. This number is incredibly small in practice.

    It is offensive to suggest that ‘some babies just die’ and that there is nothing that could have been done about it. Especially considering the healthy, low-risk population the Cary birth center served.

    • BeatriceC

      I strongly suspect data torture is at play here.

      • mabelcruet

        From various other papers I’ve read from Hannah Dahlen, she should be arrested for systematically inflicting cruel and unusual punishment on data-its basically a hallmark of hers, how much can I twist this data to fit my pre-planned conclusions?

        • mabelcruet

          And also, Hannah Dahlen is an apologist for the murderous midwife Lisa Barrett, and claims that babies died not because Lisa Barrett was a dangerous halfwit with no skill and less insight, but because midwives were facing too much regulation and oversight. So quite frankly, nothing she says or writes can be taken seriously.

          • Ozlsn

            What really concerns me about this is that Dahlen teaches midwifery students. I really wonder what is being taught, and what attitudes are being propagated here because this will impact on care down the track.

    • maidmarian555

      I would still take my c-section babies being actually born alive with a higher risk of diabetes/obesity/asthma than I would them dying during birth all day every day. Period. (And that’s ignoring the specifics of whether they tortured the data to get these results- I still would rather a live baby with asthma than no baby all damn day even if this data is perfect and accurate). They need to start getting more honest about what they’re comparing CS babies against when they report this nonsense. You’re not comparing CS babies just against VB babies, you’re comparing them against the consequences of no CS. It’s so dishonest.

      • Merrie

        And then also look at whatever underlying issues might have fed into the c/s. A pregnancy where everything is ducky has a lower risk of complications as well as a lower risk of c/s to begin with vs one with GD, hypertension, pre-eclampsia, or whatever else.

        The discussion of induction is induction vs. expectant management at whatever gestation you’re looking at for whatever reason you’re looking at it. If you induce at 41 weeks, the proper comparator is expectant management at 41 weeks or even maybe induction at an earlier gestation, but not spontaneous labor at an earlier gestation because demonstrably that did not happen.

        • Amy Tuteur, MD

          “We were unable to control for confounding by indication since the underlying reasons for the provided medical and operative birth interventions were unknown.”

          In other words, the study is meaningless, just like most of the nonsense that comes from Hannah Dahlen and colleagues.

    • The Computer Ate My Nym

      Higher rates of diabetes in c-section babies…who are more likely to be macrosomic and born to mothers with gestational diabetes. Almost as though there’s a genetic component.

    • Anna

      I cracked the shits seeing this shared about. Pisses me off so much. Jaundice is pretty easy fixed! Obesity can be avoided! Death is very hard to reverse! Its at the point now where you can safely say anything out of Western Sydney Uni is going to have Hannah Dahlens stamp all over it. So interventions are bad mmkay. Midwives cam fix everything with their magic powers!

    • Ozlsn

      What is the actual paper they are referring to? I wish they would link to the actual article when they report – this sounds like reporting off a press release.

      • maidmarian555
        • swbarnes2

          Children born by emergency cesarean delivery showed the highest association for metabolic disorder, aOR 2.63 (95% CI 2.26-3.07).

          Okay, so what is the midwives’ plan for avoiding emergency C-sections? Having non-emergency ones before an emergency happens? Or just doing nothing when an emergency situation comes up?

  • Mel

    Maternal and neonatal survival during childbirth-gone-wrong is enhanced by rapid access to the right technologies and scads of people who are trained to use said technologies.

    When my son went into respiratory failure in the NICU, two neonatologists, at least two neonatal nurse practitioners, five respiratory technicians and no fewer than ten RNs were at the side of his isolette within 30 seconds. They joined his primary nurse, his backup nurse and the two other nurses in the ward who were working on him.

    Within arms’ reach, they had suction, oxygen, a NeoPuff, a ventilator, an entire bag of intubation supplies and pharmaceuticals to aid in reviving him. God only knows what they had available within the same wing.

    Spawn-baby was pink and squirming within a few minutes; they got him going again so quickly that he only had a single bradycardia event recorded during it.

    I aged a few years and got my money’s worth out of some therapy sessions from that day – but I’ve got a babbling, squealing little boy who army-crawls around the house, is learning signs, and is fascinated by shoes and semi-trucks. There was nothing boutique or artisanal or natural about Spawn’s first few months – but he’s alive and I’m so, so grateful for that.

    • Empress of the Iguana People

      I dunno, those kick butt costumes were fairly boutique. 🙂

      • Mel

        Ooh! Ooh! My brother got him a stuffed Baby Cthlulu along with the book “Good Night, Cthlulu” for Christmas. We also ordered the board book “C is for Cthulu” and a onesie that has an outline of a little Cthulu with the phase “I can has ur soul?” scrawled on it for his next set of doctor’s appointments.

        Watching other patients and doctors do double-takes is so worth it :-P.

        • Charybdis

          This author’s books are great light reading; it’s an interesting twist on Greek mythology and supernatural stuff (vampires, were-animals, etc). One of her most popular characters is Simi and The Simi has her own ABC book! It’s awesome, fun and sure to get a few sideways glances.

          https://www.amazon.com/Simis-ABCs-Adventures-Dark-Hunters/dp/1682615804

          Do the Deep Ones bring water from R’lyeh to mix Spawn’s formula? It is only fitting…..

        • Empress of the Iguana People

          That’s awesome! Girlbard has a shirt that says “I solemnly swear that I am up to no good.” Used to be Boybard’s too. His old yoda shirt, sadly, was cut up the center when he had to go to the ER.

  • DaisyGrrl

    After watching the video, I wonder if the affiliated hospital put their foot down and threatened to withdraw support (protestations in the text article notwithstanding). It sounds like there’s a business partnership there so the hospital might be concerned about becoming a party to a lawsuit.

    And honestly, if three deaths in six months wasn’t enough to prompt a longer shut-down, I don’t see why sending a baby to NICU would have changed anything (unless that incident prompted the complaint to the nursing board mentioned in the article linked below?).

    • J.B.

      Almost certainly. In NC midwives can only operate under supervision, and the medical board has put a lot of pressure on the one or two MDs supervising homebirths.

  • Amy Tuteur, MD
    • PeggySue

      Gosh, yeah, you’d hate for women to stop seeking care at birth centers…

    • mabelcruet

      Her excuse of ‘babies just die, they die in hospital too’ makes me very angry. It’s completely irrelevant to the investigation of how THOSE babies in THAT centre. Infant deaths in hospital are always investigated and discussed and analysed, and any learning is disseminated by the investigation panel. A hospital wouldn’t use the excuse of ‘well, babies die in birth centres’ to gloss over a death. If they want to be treated as professionals, they need to act professionally and not try to deflect blame.

      • Anna

        This a quadrillion percent! Its the go to argument of every OOH birth advocate and its utter shit. I’ve noticed it too – this “wah wah wah, why aren’t we taken seriously!?” – nek minnut “heres a link to some bullshit anti-Vit K propaganda” “heres a seminar on VBAC led by someone with zero clinical training or experience” “here’s an observational study of midwives feels that proves homebirth is safe!”. They want full autonomy, except for the responsibility part. If they can’t blame the system, they’ll blame the parents.

        • mabelcruet

          Or blame the baby. After all, everyone knows that ‘some babies are meant to die’, so those kiddos had a deathwish and it’s absolutely nothing to do with the midwife.

          • Zornorph

            They didn’t want to come earthside.

          • Tigger_the_Wing

            Oh, how I hate that phrase! As if women’s wombs are somehow magically in another dimension. Actually, I rather wish they were; I could have simply left mine there and only picked it up for pregnancies. No periods or period pain, no endometriosis, no prolapse, no surgery, no PPH, no hysterectomy.

  • MaineJen

    The phrase “birth center franchise” gives me the creeps.

    • Anna

      Yes!

  • Anj Fabian

    I’d have to verify this but the video made it sound like the center suspended activities and referred births to the hospital after EACH death.

    If so, it was a known thing. The staff had to know. The clients may have been aware that something happened. Why did these deaths keep happening?

    One unnamed midwife reportedly resigned.

  • lawyer jane

    It’s so sad that parents fall for marketing like this. You don’t want a “boutique” or “artisinal” experience in childbirth. You want the best f’in medical care you have access to.

    • Heather Hardy

      Amen….and amen.

  • Anj Fabian

    From the video

    “a cluster of difficult cases”

    “safety is at the heart of what we do”

    Clusters: “but it happens…”

    “clustering is challenging!”

    “Midwife community is concerned about an unfair portrayal”

    • Roadstergal

      “safety is at the heart of what we do”

      Nope. It’s not a Technology For Safety birthing center, it’s a Natural birthing center. Safety and nature have nothing fundamentally in common.

      • Box of Salt

        Safety and nature are frequently fundamentally in opposition.