The deadly failure of American homebirth midwifery

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It’s hard to become a real midwife.

American certified nurse midwives (CNMs) are the best educated, best trained midwives in the world. They have an undergraduate degree in nursing, a master’s degree in midwifery, and extensive hospital training in diagnosing and managing birth complications. European, Canadian and Australian midwives are also well educated and well trained; they have an undergraduate degree in midwifery and extensive hospital training in diagnosing and managing birth complications. In addition, American, European, Canadian and Australian midwives meet the International Confederation of Midwifery (ICM) Global Standards.

No one should be allowed to call herself a midwife unless she meets the International Confederation of Midwifery Global Standards.

But what if you couldn’t be bothered (or couldn’t handle) the necessary preparation to meet the ICM Global Standards but wanted to masquerade as a midwife anyway? You could take a correspondence course, attend a few dozen deliveries outside the hospital, pay money for an exam and you are a “certified professional midwife” (CPM). Actually, you don’t even have to complete even those minimal requirements. You can simply submit a “portfolio” of births that you have attended, pay the money and take the exam, and voila, you too are a CPM.

What would happen in a system where consumers couldn’t tell the difference between real midwives and lay people who awarded themselves the bogus CPM credential?

You don’t have to imagine. In a stunning journalistic review, Failure to Deliver, reporters Emily Le Coz, Josh Salman and Lucille Sherman, have produced a comprehensive look at the deadly failure of American homebirth midwifery.

The review is deep, wide ranging and involved dozens of professionals as well as grieving families and I encourage everyone to read every word. But, in truth, the entire review can be summed up in one sentence:

When you allow lay people who can’t meet the Global Standards of Midwifery to masquerade as midwives, babies and mothers die of medical neglect.

The stories are gut wrenching:

Baby Aquila never took a breath.

Her limp body slipped from between her mother’s legs in a river of blood during a Texas home birth in December 2009. The certified professional midwife, who missed a cascade of earlier indications of the baby’s distress, tried to save the girl. But she had locked her medical kit in the car and had to improvise…

Liz Paparella buried her daughter two days before Christmas.

And:

The laboring mom didn’t know her son was breech when she checked into Gentle Birth Options, a freestanding birth center in the Florida Panhandle community of Niceville. Riley trusted the midwife to guide her through the process.

But Cynthia Denbow, a certified nurse midwife and birth center owner, didn’t check the baby for more than an hour. By the time she discovered its bottom-first position, Riley was fully dilated and ready to push, according to Florida Department of Health records D…

Denbow called no physician. She encouraged Riley to stay at the birth center and push.

Riley did so for 22 minutes, as her unborn son went into distress and Denbow finally called 911. Doctors at Fort Walton Beach Medical Center delivered Baby Franklin by emergency C-section and rushed him to the neonatal intensive care unit for resuscitation. They couldn’t save him.

And:

…[Florida midwife Deborah Jacobs] Marin promised she would transfer Pino in case of emergency, as state regulations require.

Instead, the midwife let Pino actively labor for hours while her baby was stuck inside the birth canal, her head turtling in and out. The little girl suffered irreversible brain damage from a lack of blood and oxygen, court records show.

When Maddie finally emerged, she was covered in thick, pea soup meconium — the baby’s first stool — which stained her fingernails yellow, Pino recalled. She didn’t cry. She was purple and not breathing. Only then did Marin yell for someone to call 911.

The little girl lived in a semi-vegetative state until she died in February 2013, three days before her third birthday.

There are many more tragic stories in the piece, but all are eerily similar in their basic facts:

1. Failure to inform parents that CPMs don’t meet the Global Midwifery Standards.

These tragedies almost always start with a bait and switch. CPMs boast about the excellent out of hospital outcomes of Dutch, Canadian and Australian midwives without telling parents that they themselves wouldn’t be allowed to practice in those countries because of lack of education and training.

2. CPMs converting the liability of not being allowed to practice in any place with rigorous professional standards into the virtue of a homelike environment.

CPMs promote out of hospital birth because it is the ONLY way they can make money. Unlike ALL other midwives in the industrialized world, CPMs are alone in their inability to practice in hospitals and are therefore alone in their inability to manage their patients in both places. Therefore they have an incentive to ignore risk factors and avoid medically indicated transfers.

3. CPMs routinely violate the law.

Many CPMs practice illegally by ignoring state laws about who can be a midwife. In states that license CPMs, they also practice illegally by failing to meet even the minimal requirements promulgated specifically for CPMs including having a obstetrician to back up their practice, having a designated hospital to which they can transfer women experiencing complications, and by ignoring laws that bar them from overseeing high risk pregnancies and births.

4. Reckless disregard of the signs and symptoms of impending or ongoing life threatening complications.

If CPMs recognize complications (and many can’t), they have multiple incentives to ignore them. They lose control of patients they transfer. They are often practicing illegally and therefore need to hide their actions. They have represented themselves to their clients as knowledgeable but any transfer has the potential to reveal that they had no idea what they were doing.

Countries where homebirth is practiced routinely have strict criteria for transfer and high transfer rates. That’s why homebirth is relatively safe in those countries. Most CPMs have no transfer criteria and boast of low transfer rates. That’s why babies (and sometimes mothers) die.

5. Industry capture of regulatory bodies.

To the extent that CPMs are regulated, they are regulated by other CPMs, either those on state licensing boards or those who run CPM professional organizations. In other words, these regulatory bodies are captured by the industry they are designed to regulate. A medical equivalent might be if obstetricians served as the judge, lawyers and jury for obstetric malpractice cases AND believed that their primary purpose was to protect obstetricians, not patients.

Fortunately, the solution to these preventable tragedies is simple. All we have to do is what every other country in the industrialized world has already done: mandate that the ONLY people who can call themselves midwives are people who meet the Global Midwifery Standards. Contrary to the claims of homebirth advocates, this is NOT an issue of reproductive freedom or medical paternalism, it is an issue of truth in advertising.

We must abolish the CPM designation and make it illegal for these women to call themselves midwives. What should they call themselves instead? It doesn’t really matter so long as there is no possibility that mothers will confuse them will real midwives.

  • RudyTooty

    Related: The folks at Birth Monopoly are **just now** learning that homebirth loss families are shunned and shamed by their midwives and the natural childbirth community.

    That echo chamber is airtight. Geezus.

    Glad they’re starting to catch up. It’s past time to do so.

    http://birthmonopoly.com/out-of-hospital-birth/?fbclid=IwAR1fIkYsVr6RHO3Vh5L6LHePGQN0FzWcixanJGz3caPypS_FsFV0mIfIoi4

  • Lilly de Lure

    Slightly OT I know (apoligies) but a slight issue I did have with the Failure to Deliver article is that it was distinctly starry-eyed about the midwifery care on offer outside the US – concluding that foetal and maternal deaths weren’t a problem elsewhere as midwives were properly trained. I just thought that the below article that was published on the BBC website this morning might be a useful counterpoint to that:

    https://www.bbc.co.uk/news/uk-england-shropshire-46372355

    From the article:

    “It said the trust should also improve how it escalates cases of women at
    high risk at the midwifery-led unit or day assessment unit and review
    its policy on reduced foetal movements for midwives and sonographers.”

    In other words even the Internationally recognised training UK midwives have to obtain in order to practice in NHS hospitals did not stop staff at the midwifery unit attached to the hospital (an arrangement frequently sold as the “safe” option for mothers looking for a more homely setting for their births) from refusing to recognise and escalate cases that became high risk and from blithely ignoring mothers worried about lowered foetal movements. This lacksidaisical approach to the lives of babies is not a matter that adequate training can address on its own – its the ideology that needs to be tackled if we’re going to stop babies dying needlessly and that appears to be an international problem with midwifery right now.

  • Spamamander ctrl-alt-right-del

    A shout-out to the well-trained and awesome CNMs here. I was able to have a CNM for my first birth (2 and 3 were in the military hospital, and 3 was considered high risk as well). She was professional, warm, and capable. When I was exhausted after 14 hours of labor, and shyly asked for an epidural, she supported me 100% and tracked down the anesthesiologist to come to me first, as her other mom in labor hadn’t been so long and had a history of small babies. I had a birthing room at the hospital with family present. Thank you all for your skill and training.

    • MaineJen

      Second!! It was a CNM who convinced me I needed induction with my first baby, after my water had been broken all night and the next morning, I still wasn’t contracting or dilating. Thank you, CNMs who know what they are doing!!!

  • fiftyfifty1

    I started at 5 weeks myself, and my child is a healthy happy delight. In my case it did work wonders with the vomiting, but did nothing to touch the severe nausea. Some women it helps the nausea too, but not me. Good luck, I feel your pain.

  • mabelcruet

    That’s some scary reading-I knew some of the horror stories from various blog posts and articles over the years, but to read it all one section after another is frightening. I know the Royal College of Midwives in the UK have their own issues (and a comment in that review that ‘Midwives cover for other Midwives like you wouldn’t believe’ also holds very true for the UK) but at least if someone is struck off they can’t just wander over to the next town and set up shop there instead.

  • Amazed

    This series is amazing. Michelle Dew’s page? Also amazing, in a certain way. Now a whole bunch of them is crowing over their “birthworkers” or being “birthworkers”. If they were doctors or actual midwives, they would have said so.

    Masks are falling fast. And no one can convince me that these women aren’t aware of the risks. Refusing to acknowledge them isn’t “not knowing”. They simply don’t believe it can happen to their well-fed, waiting for ages to deliver the placenta, a bite of which will certainly stop their hemorrage and if not, the baby’s pull on mom’s Holy Breast will selves.

    Education is the key, they say. And they cite MANA’s stats. Oh the irony.

    • RudyTooty

      I’ve had lots of discussions about active third stage management – and yes, for everyone giving birth – with other CNMs. There is still this romanticized notion about birth and leaving it ‘untouched’ by any drugs….gah!…. but it doesn’t take much discussion – with any midwife who has experienced a torrential hemorrhage in any setting, in any role. We like keeping blood inside our patients. Keep it in. A NOT hemorrhage is so much better than a treated hemorrhage. So. Much. Better.

      A midwife like Michelle Dew will have the lowest possible rate of hemorrhage among her patients. I consider that a positive outcome.

      It’s hard, though, when patients accuse you of hurting them. Or of trying to hurt them.

      People come to CNMs for all the natural reasons – and I have to argue to get them to accept some basic interventions.

      “You’re a G10. I’d like you to have an IV locked during labor. So would the nursing staff. So would everyone in this hospital. If we need to give you drugs or fluids because of a PPH, this will make it much easier, and safer, for you.”

      Natural-minded patients don’t like hearing this. They’ll argue with me over this. It’s like I’m violating their religious beliefs.

      • Amazed

        I can see their attitude to CNMs like you at Michelle Dew’s page in all their ugliness. They really think they know better. They think golden olden days were better and bemoan progress-induced (pun intended) overmedication problems. Funny how they never bemoan the progress-induced problems of, say, having your joints wear out by typing on your tablet. Only childbirth is this sacred thing that should be preserved, otherwise they’ll miss on the chance to show us sheeple how educated they are!

        I wonder which insane natcherel/anti-vaxx group reposted her post to gather the loonies and send them into attack headfirst.

        OT: This time, my flu shot did not cause any swelling in my arm and this was supposedly the most potent one I’ve ever received. Conclusion: the more chemical ingredients, the fewer side effects! Sounds as reasonable as their penchant to swear in homebirth for everyone who isn’t, say, actively bleeding because hey, they did it and no one died!

      • fiftyfifty1

        “I’ve had lots of discussions about active third stage management-and yes, for everyone giving birth- with other CNMs.”

        How do you mean? Do you mean that it’s not yet standard of care where you practice, and that you and the other CNMs are still discussing it? I mean obviously a woman can still refuse, but where I trained it became part of standard procedure in 2002. Is this something that is still debated outside homebirth circles?

        • RudyTooty

          Sorry. Yes.

          Unfortunately.

          I wouldn’t say it’s “debated” because people are locked away in their echo chambers.

          The comments on Michelle Drew’s FB post reveal some of the backwards opinions on this.

          Sometimes from patients. Sometimes from CNMs.

          • fiftyfifty1

            So let’s say my sister were to get her care with a hospital CNM group, and her CNM was one who didn’t think active 3rd stage management was a good idea for uncomplicated pregnancies. Is my sister even going to be offered it as an option?

          • RudyTooty

            With that specific midwife? Probably not.

            It gets complicated because there’s an ideology around midwifery – which is the reason patients are choosing our practices – **specifically** because they believe we are providing this super-special natural birth thing – the institution doesn’t care about having us there, except that we are a marketable service. So we walk this line of acknowledging that patients are specifically coming into our practice for this type of natural birth service, but then recommending *standard obstetrical practice* and offending the patients who are coming for the *non-standard OB experience* At least that is where I’m at – and I’m always trying to do it in a way that doesn’t horrify and offend the patient and send them elsewhere. Because they’ll do that. If I piss off patients, and they leave our care, what am I there for?

            The problem is that we (the profession at large) frame too many interventions as “choices” – like active third stage management. And we don’t for others – like an an epidural. We moralize the choice to have an epidural. We call *optional* active third stage management ‘individualized care’.

            But I can’t say the issue of variation of care is a midwifery problem only – I work with a handful of backup OBGYNs – and each of them has their own tolerance and preference for a whole host of obstetric scenarios. If I’m on the day the more conservative backup OB is on, we’re having more c-sections. That’s just the way it is.

            Even among the OBGYNs I can’t say there is uniformity in care.

            But as far as active third stage management – it should be just standard. It should be. The standard of care should be offered first, and the patients can fight about it if they want to (and they have the right to) – but the midwifery model (ARGH) introduces the concept of ‘individualized care’ and ‘shared decision-making’ too often in arenas where it shouldn’t.

            “The clusters of practice combinations that emerged in this study suggest that there are extreme variations in clinician practices during management of the third stage of labor.”

            The major problem with this study is that they included CPMs in it – so OF COURSE there are extreme variations in 3rd stage management. But I think their conclusion is an accurate assessment. To answer your question again – you never know. There are still midwives (yes, CNMs, too) who ascribe to this type of superstition.

            And back to Michelle Drew – the CNM who went on a beautiful rant about this the other day. She was calling out this pseudo science – and not just to the lay midwives – I believe she was addressing the CNMs. And look at the pushback and wrath she got over it. Pfft. SMH.

            https://onlinelibrary.wiley.com/doi/pdf/10.1111/jmwh.12586

          • fiftyfifty1

            Wow, that is super depressing. To think that there is a simple procedure that is proven to work to the point of being standard of care, costs almost nothing, and is super safe, and some patients aren’t even getting TOLD about it because their CNMs don’t “believe” in it, or are too worried that they will lose customers.

          • RudyTooty

            It is depressing.

            I try not to blab too much on the internet about work specifics and patient specifics… and I don’t… but there is the surface of midwifery, and there’s the underbelly of midwifery….and I always seem to be uncovering more and more underbelly. Even with CNMs. Even hospital-based ones. I’m shocked at some of the shit they do. Of course they don’t advertise their incompetence/negligence… so I’m left to discover it when I receive a patient assignment … and sometimes I’m reviewing a chart thinking: W . . . . T . . . . F. . . . . .

            I don’t think I could bring myself to write as glowingly of CNMs as Dr Tuteur did in this very post.

            “American certified nurse midwives (CNMs) are the best educated, best
            trained midwives in the world. They have an undergraduate degree in
            nursing, a master’s degree in midwifery, and extensive hospital training
            in diagnosing and managing birth complications. European, Canadian and
            Australian midwives are also well educated and well trained; they have
            an undergraduate degree in midwifery and extensive hospital training in
            diagnosing and managing birth complications.”

            I mean, F***, we’re the best educated? Shit. What does that mean? I’d need to see a lot more competence and integrity in order to make a statement like that universally about CNMs. And I can’t. Ok. Among some CNMs… YES. Probably most. But others??? Good lawd. How do we weed these people out? Our education sure doesn’t do that.

            I mean, asking that the CNM/CM be the minimum standard for midwifery is really not asking all that much! It really isn’t!

          • Merrie

            I wasn’t offered active management as a matter of course in any of my births. I did get pit after my 2nd birth because I was bleeding a lot. By my 3rd birth, after I’d deconverted from the woo, I asked about it myself at a prenatal appointment and got a response from my CNM that seemed to boil down to “We think it’s best but most of our patients probably won’t want it, so we don’t even bother recommending it, but if it’s what you want we can do it”.

          • RudyTooty

            Thanks for sharing your experience, Merrie.

            That sounds like a scenario that could be extrapolated to quite a few midwifery practices.

            There is some faulty logic, I think, in your midwife’s statment
            – we think it’s best
            – the patients don’t want it
            – so we don’t offer it.

            If the practitioner thinks something is best practice – then it’s up to the practioner to convey that to the patient. They’re (WE’RE) failing at the starting blocks.

            How long ago was this? Was it recently?

          • Merrie

            It almost seems like “We think it’s best but it’s not *that* big of a deal, and we will do it if it’s really super necessary so we don’t need to try to convince everyone to do it in every birth.”

            I got the distinct sense that they would not have brought it up if I hadn’t, and I had my previous two births with the same group and I don’t remember talking about it (but I trended wooier then, and I could be mis-remembering as well).

            This was with my baby born in July 2017.

          • fiftyfifty1

            Hard to say whether Dr. Tuteur is writing glowingly. I think she’s just stating a fact. CNMs do have extensive training and education. What they choose to do with that education is, unfortunately, widely variable. Sounds like many of them throw it out the window.

          • A few years ago, I used to read the blog of a L&D RN who went on to complete a Masters’ level CNM course. She listed her courses, both to upgrade her associate degree to a BA in nursing, and then to continue. Most of it was really padding. “Identifying problem solving situations” was one that stuck in my mind, along with semester-long courses on how to establish a practice, among other things. I once asked her when she was actually going to begin studying MIDWIFERY, the “hard core” stuff like the anatomy and physiology of pregnancy and birth…

            Once she got her degree, she went to work in a medical practice and found she was largely doing gynecology — and stopped blogging.

            Given that UK and Netherlands’ “professional” midwives have also succumbed, at least in part, to woo, it’s possible that US CNMs ARE currently the best educated — there’s even talk of making it a PhD — but I’m not sure they are educated to provide the best care in all situations, because woo has permeated just about all aspects of maternity care these days. I’ve been retired for about 5 years, and frankly, I’m glad I am.

    • MANA’s stats are by now badly out of date.

      • RudyTooty

        Do you think more recent data from MANA will show anything different?

        • No. But quoting a MANA stat is really irrelevant. IIRC, the data was collected mainly in the 90s — indeed, it was out of date by the time MANA, kicking and screaming, was forced by intense pressure, to publish. It also was incomplete, as submission of data was voluntary. There is no legal requirement in the US, as there was [is?] in the UK, for ALL midwives, of whatever sort, to keep complete records of every labor and birth.

  • RudyTooty
    • RudyTooty

      This is what the former president of the ACNM says to someone (me, a CNM I might add) who said the following on her FB business page

      I said I thought the series on midwifery was excellent.

      I also said that I believe the minimum standard should be the CNM/CM.

      https://uploads.disquscdn.com/images/74956cfd0d0c7f0b7e60963b034f101b8147534e91fb9a62ad3e648df4642a10.jpg

      • Amazed

        Dear God. With leadership like this, in a few years the CNM credential might be the one abolished.

        She’s disgusting. Whatever CPMs are, most of them truly believe it’s never their fault. She should know better.

        • RudyTooty

          She should know better – but by the way she brings down the ban- hammer, she’s seems to to attempting to ensure that she hears nothing but her own delusions echoed back at her!

          And she had a PhD.

          She should know better.

      • I’ve been saying that for decades

        • RudyTooty

          How often do you get banned for saying this?

          Why is asking for CM/CNMs to support their *own standards * for education and certification so threatening?

          Because they don’t really believe in them???

          Because they don’t want to hurt the other midwives’ feelings?

      • fiftyfifty1

        I saw those comments you made, and they were as polite and measured as can be. She calls THAT being a troll? All for just saying that CPM standards are too low and that the reporting was excellent? Holy shit, it’s like she is running a cult.

        • RudyTooty

          Thank you.

          I thought it was very un-trolly myself. But there’s no evidence that I didn’t ALL CAPS FLAME HER since she deleted my comments.

          Thank you for recognizing my civility.

          If that’s what threatens CNMs ??? That?!?

          At least they can’t delete my comments in person. I do relish the face-to-face conversations.

          I need to find a way to cross paths with Breedlove.

          • fiftyfifty1

            I clicked on that thread last night and read all the comments, and just now went back to it, and she has deleted all but 10 adoring comments! She even deleted a comment that was nothing more than a request for a clarification/citation after somebody made the claim that the Failure to Deliver series didn’t “jive with studies.” I mean seriously? If I write “Studies show that x does y” and if you write “Can you direct me to those studies please?” that needs to be censored and banned? THAT is being a troll?

          • BeatriceC

            I’ve gotten in the habit of taking screen caps of anything I think may be deleted for exactly this reason. They may be able to delete comments, but screen caps live forever.

      • attitude devant

        For the life of me, I don’t get why CNMs are so quick to defend the CPMs. I mean, these crackpots are literally stealing and diluting your credential, and yet when someone tries to hold them to global standards they are silenced. What gives?

        • Amy Tuteur, MD

          They believe “the enemy of my enemy is my friend” and they see obstetricians as the enemy.

          • RudyTooty

            Explain Dr. Shah to me.
            Who is his enemy?

            How does he align with different factions in this mess?

            Note:
            OBGYNs do so much more for me and my patients – in terms of providing safe care – than any CPM. Even the meanest, crankiest OB. I’ll take a room full of cranky docs over sweet nice homebirth midwives ANY DAY.

          • attitude devant

            meh. I know several OBs just like Neel. He’s not dumb but he’s fallen for flattery from the midwives and repays it by not thinking critically about what they claim. It’s a pattern I see over and over—some male OB making this his calling card. They lend each other legitimacy is some weird co-dependent way. In reality, he hasn’t a clue what the CPMs are like. He lives in a setting with very highly-trained CNMs and doesn’t realize how ‘out there’ the CPMs are.

          • RudyTooty

            … falling for flattery ….

            Yes. This has been a suspicion of mine about some other OBs out there .. and yes, curiously, they’re nearly always male. It’s… curious.

          • Amazed

            I suspect his isn’t true ignorance but one that he has chosen. With all the CPM related scandals making it to the newspapers and various boards, he must be singing, “La-la-la, I can’t hear you” very loudly indeed.

            Studies are there. Publicity is there. It simply disturbs his neat little world, so he prefers not to think about it. Like that OB who also taught medical ethics – ETHICS – and chose to laud CPMs despite fully knowing about their trainwracks. His being cuddly with Missy Cheyney mattered more.

          • attitude devant

            You’re probably right, Amazed. Why do I persist in thinking the best of people?

            As for Paul Qualtere-Burcher, Missy’s devotee, go ahead and name him!

          • Amazed

            Oh, I would have named him if I had remembered his name. I only remembered the Paul part.

            I find it sweet that you still think the best of people. I suspect you do it for Shah because you haven’t had to deal with a victim of his the way you’ve had to deal with a homebirth mother after a CPM trainwreck.

          • Kq

            Sucks, being a genuinely good person. You end up blind to this shit

          • Amy Tuteur, MD

            I suspect that he is hoping to be the new Marsden Wagner with all the uncritical adulation of himself that implies.

          • attitude devant

            But, but, but….. We’re their goddam safety net! Without us being available in emergencies they couldn’t see their clients!

          • fiftyfifty1

            “I wanna bite the hand that feeds me, I wanna bite that hand so badly”
            Elvis Costello

          • Amazed

            But your very existence reminds clients that there are emergencies, you know.

            I’ve said it before but it bears repeating: doctors have patients. Midwives have clients. Yet somehow it’s doctors who only care about ’em bucks?

    • Amy Tuteur, MD

      Just another effort at obfuscation and — of course — the classic bait and switch.

      • RudyTooty

        I’ve said it before, I’ll say it again, Dr Tuteur:

        I have not always agreed with you over the years reading your blog. But you have **never ** deleted my comments and censored my words.

        I cannot say the same for the midwifery organizations where I have been a dues paying member. Or of people who have power or representation in those organizations.

        Ginger Breedlove is a former ACNM president – and her affinity for an echo chamber is alarming.

        Thank you – Dr Tuteur – for including my voice in these conversations – Gosh, that feels so silly to write! Don’t we, as Americans , value and cherish this fundamental right and freedom?

        The censorship among midwives and NCB advocates is probably the most maddening.

  • fiftyfifty1

    I am so pleased that these reporters dug so deep. They easily could have produced yet another lazy homebirth article “reporting the controversy”, focusing on the experiences of a few white women from Park Slope. Instead they gather info from all sorts of people: mothers, fathers, OBs, EMTs, judges, midwives, databanks. And not just white people either. They included black mothers and fathers, a black OB and a black midwife. This is especially important as CPMs have been exploiting outcome disparities to market themselves, claiming that out-of-hospital birth is the answer to racism within the healthcare system.

    • no longer drinking the koolaid

      When Michigan was debating the lay midwife licensing bill a Lansing e-zine contacted a midwife (CNM) who had sent a letter to the Michigan Senate opposing the bill, stating it should be much stronger. Her letter listed a mother and more than a dozen babies who had died at the hands of lay midwives during OOH births. Compelling stuff, but their false equivalency was to also contact a doula who responded that she was sure there was such a list of babies who died in hospital in obstetricians’ hands.

      • RudyTooty

        CNM opinion. Doula opinion.

        So that was considered getting “both sides” of the story?

        That’s the kind of journalism I’ve been used to when it comes to midwifery – that’s why I thought this most recent series was really, really good. What did you think of it?

        • no longer drinking the koolaid

          I thought it was excellent and based on the facts.

  • attitude devant

    The whole series of articles is just jaw-droppingly good. It’s such a complex topic and they really really got into the weeds on it. I’m impressed.

    • RudyTooty

      It’s very good. Speaking as a former insider to this crew of people (CPMs/lay midwives), they did a very good job of uncovering a lot of truth.

      Actually, I’m probably still an insider, I could get myself invited to a midwives’ herbal tea and moonblood worship drum circle next weekend if I wanted to…. I’ve chosen to avoid these folks. They’re still as unethical and dangerous as they’ve ever been.

      • attitude devant

        I’m always surprised at how unethical they are. It was amazing to have Leigh Fransen confirm what I’ve always suspected: that they’re slipping cytotec to their patients and stripping membranes. Amazing.

        (By the way, gotta love Leigh Fransen. That’s gotta take guts to say all that stuff.)

        • fiftyfifty1

          That part about the cytotec is enraging, because demonizing cytotec has been such a big part of how CPMs market themselves, “The doctors will induce you with CYTOTEC! a drug that causes ABORTIONS and UTERINE RUPTURES.” And then they do it themselves, illegally, without telling the woman, without any monitoring of the fetus! Holy shit.

          ETA: Yeah, hats off to Leigh Fransen. Way to bust it wide open. That took guts and honesty.

          • RudyTooty

            Isn’t there an account in this series about a midwife using RECTAL HOMEOPATHY for a laboring mother?

            That alone should be enough evidence that the midwife is a complete quack, and shouldn’t be trusted with anyone’s health or safety.

            Along with Leigh Fransen, Britt Hermes is another whistle blower that I admire – her field was not midwifery, but naturopathy – they are close cousins in woo-land.

    • RudyTooty

      What do you think are the most important things that were uncovered by this reporting that is commonly misunderstood by the public, and potential midwife clients?

      • attitude devant

        The lack of oversight, the very real risks, the differences between the credentials and the state laws around them and, most of all, the con games that people play. You?

        • RudyTooty

          THERE IS SO MUCH.

          They did a nice job of describing how the lack of accountability unfolds in homebirth midwifery cases – it’s not just one thing – it’s the lack of training, lack of standards of care, deceptiveness, incompetence, lack of malpractice insurance, and the ability for a midwife to declare bankruptcy to avoid paying damages – all of it!

          I think the parent interviews are very revealing of how seductive and appealing the midwifery model of care is – for various reasons – but now that these parents are on the other side where they were harmed – they’re seeing through this deception.

          [On re-reading, I’ve started to read the links to the requested documentation -from EMTs, from law enforcement, from regulatory bodies, deleted FB screencaps – such thorough reporting!]

          • attitude devant

            The documentation is VERY thorough. I loved how they just let Christy Collins blather on, and then would follow up with a sentence saying that her texts and emails from the events did not support her account of the events.

          • RudyTooty

            I’ve been having some FB exchanges with a few people who are protesting it by saying “THIS IS SO BIASED, I DIDN’T EVEN READ IT.”

            How can they tell it’s biased if they didn’t read it?

            How is *not reading something* doing your research?

            Have yer homebirth, then! But don’t say you know anything about anything!

          • KQ Not Signed IN

            That was my favorite part, too. Christy Collins – who had the *audacity* to say that her *career* suffered.

          • RudyTooty

            That was nauseating.

          • MaineJen

            The juxtaposition of her saying “I just had so much going on at the time!!!” i.e. newborn baby, autistic son…compared to Danielle Yeager and family devastated at losing their son. It’s quite damning.

          • Sarah

            Makes me wish I could play the violin, so I could get a very small one and play a tune on it for her.

  • fiftyfifty1

    “CPMs boast about the excellent out of hospital outcomes of Dutch, Canadian and Australian midwives without telling parents that they themselves wouldn’t be allowed to practice in those countries…”

    So really it’s a double lie, because I would hardly call out-of-hospital outcomes in those countries “excellent” in the first place. I would call them “good enough” maybe. If, and only if, the woman is very low risk to begin with.

    • Cristina

      I’m Canadian and I really don’t know how I feel about our midwives. I’ve also never used them, so I’m speaking as an observer, but I know a friend traveled 1.5 hours *in labour* to get to my town (where the midwives are) and the midwife didn’t even have time to get her gloves on before she delivered. There was a hospital in her town! Another friend’s sister-in-law had a homebirth and the midwives advised them to just toss pillows all over the floor when bedsharing so the baby could land on something soft (in case the baby rolled off the bed). Plus, another woman, an ex-coworker-turned-midwife, raged on about how terrible the Skeptical OB page once, then later mentioned attending her sister’s homebirth where she tragically had to have a C-section instead. My sister-in-law had a baby with a midwife (in hospital) and her baby (now turning 6) has cerebral palsy.

      • RudyTooty

        I’m American, and I don’t know how I feel about our midwives.

        And I’m a midwife. 😀

        What you’ve described is an ideology that puts people at risk of being harmed. And if midwives are promoting this ideology (“Come give birth with us! 1.5 hours away!” “Have a homebirth, it’s fine!” “Just put pillows on the floor in case your baby rolls of the bed! Co-sleeping, yay!”) – then they’re a problem.

        • Cristina

          I’m in northern BC and some places lack the doctors necessary to cover the entire population. The midwives aren’t necessarily present either (small intake at a single school that basically is at the US border), but I can see doctors recommending midwives simply to lift their patient burden as well.

  • QuantumMechanic

    Your second quote says: “But Cynthia Denbow, a certified **nurse** midwife and birth center owner…” (my emphasis).

    Is that correct or a typo. I ask because the rest of your blog post (rightfully) excoriates CPMs, so it seemed odd to see a CNM mentioned (not that they shouldn’t be called out when they mess up, too).

    • attitude devant

      She is a CNM. Yes, some CNMs are REALLY bad practitioners. It is really rare for anyone to admit this, but the financial incentive NOT to transport is huge for out-of-hospital midwives, and you don’t make money by telling someone they are too high-risk to deliver in your out-of-hospital practice, so some CNMs are doing really stupid things. I’m not saying they’re doing them for money, I’m just saying that the profit angle is concerning.

      • Amazed

        But somehow, it’s all greedy doctors’ fault.

        I’m currently on Michelle Dew’s facebook page. The Black Midwife Rant post. The comments are… I really want to reach out through the screen, grab some of these women by the neck and smash some common sense into them. I suspect most of them are either not educated in ANY field or have education in some very irrelevant area that has loose enough standards to let them fancy themselves smarter than they are. Many of them are CPMs and doulas and one shining example is a CPM student. ‘Nuff said.

        ETA: The “smash some common sense” wording is no typo. I don’t want to shake it into them. I want to smash it into the fucking face of every fucking bitch explaining that death is something normal and we shouldn’t be so wrung about it. Two of my friends would have died in pregnancy or childbirth – along with the babies – and yes, I would have been very high wrung about it. Bitches dare write that we’re too chicken? I’d like to have them say it to my face. I hope they know that knocked out teeth are also something normal. I’d hope that they’d go broke trying to get them replaced – from what I’ve heard, dentists in the US aren’t this cheaper than obstetricians.

        Yes, I know I’m savage. I don’t care. We’ve accommodated these loons long enough.

        • AirPlant

          oh my god, that thread. I am half way convinced that these women want more dead babies on their hands because their denial defies logic.

          • Amazed

            Same here. I’ve long stopped feeling sympathy for this particular brand of homebirthing mothers – that’s what I call “homebirthing bitches”. It isn’t enough that they had their own children at home, no, they have to push homebirth at everyone else’s face and declare that death isn’t this bad… other people’s death, of course.

          • AirPlant

            I am 13 weeks pregnant and did the thing where I joined a pregnant lady group (I have hyperemeis gravidarum and wanted a support group that wasn’t crackers and ginger) and I am endlessly aghast at the birth choices that these women are making and recommending.

            The one that jarred me the most was the homebirth that ended in a shoulder distocia and a baby not breathing described and jubilant and successful. Like the baby didn’t breath for five minutes and is in the NICU, that is not a success.

            Just last week a woman was complaining about her OB being alarmed when her blood pressure measured (and sustained) in the 180s which she was medicated. She was complaining that they wanted to take away her vaginal birth experience and I was just like they want your baby to not freaking die you nitwit.

            In both cases there were a dozen cheerleaders calling these idiots warrior mamas and I literally can’t even with this. We are all in this group because our bodies failed us. We are all reliant on medical intervention. How do you experience this and still want to roll the dice with your baby?

          • KQ Not Signed IN

            Oh you poor thing – HG is the worst. Just the worst. Have you been in to your doctor for anything? They ended up putting me on Phenegran, which took it down to “puke every few minutes” to “puke every hour or two.” I also had zero luck with crackers and ginger. I did do okay with sucking on Altoids to get through work – although they’re ruined for me forever now…

            Hang in there.

          • AirPlant

            I am managing ok now that I have unisom and zofran. I am actually really lucky because my situation is worst at night so I can still work and I can actually keep down water most days so I never had to do iv therapy. It is just that when the sickness started (at a glorious 4 weeks 1 day) it would wake me up around midnight and once I started vomiting it didn’t stop for literal hours. I would throw up and then gag until I got back my stomach acid and then throw that up sometimes with some esophagus blood in the mix and it would happen over and over with no breaks until morning. I broke down and started the drugs at five weeks and they got me sleeping through the night and during the day I just nauseous with maybe a couple rounds of throwing up. A few weeks ago the multiple times daily vomit was guaranteed but it has thinned out a bit so I am hoping that means I am the lucky 80% for who it isn’t the whole pregnancy.

            I am honestly so thankful for modern medicine through all of this and so grateful that it isn’t worse, I don’t know how I would have coped without the help, I barely feel like I am coping most days as is.

          • attitude devant

            I had it too! Worse yet, I was in residency! I was continually running out of the OR to vomit.

          • attitude devant

            ondansetron is really ok for 13 weekers…..

          • Amazed

            Good luck in your battle with HG, then! And try not to take their foolishness too hard. They’re all talk, mostly. Even the BP complainer DID agree to being medicated.

          • MaineJen

            Oh god, it’s not baby center, is it?? 😮

          • Madtowngirl

            “She was complaining that they wanted to take away her vaginal birth experience and I was just like they want your baby to not freaking die you nitwit.”

            This is the part I just can’t wrap my head around. Doctors arguably have an incentive for you and your baby NOT to die, yet they are so vilified for anything they do. I was at my daughter’s daycare “Thanksgiving feast” last week, and a mother there was going on and on about how she chose a midwife for her care (in my area, this most likely means CNM, since we have them integrated at our hospital now) because she “was less likely to have a C-section.” I just wanted to throttle her – of course you’re less likely to have a C-section with a midwife, because a competent one will risk you out if it’s likely you need one!

            You want a competent CNM for your care? Great! But stop buying into this garbage about doctors just wanting to cut you up so they can get to their golf game.

          • space_upstairs

            Actually, I was reading through the really old archives here the other day, and read that one of the biggest reasons doctors want to cut you up is because they’re afraid you’ll sue them if your “beautiful, natural” vaginal birth goes sideways! Doctors can’t win, can they?

          • RudyTooty

            I don’t think midwives (CNMs) really do anything to reduce the cesearean rate appreciably.

            We provide care to a low-risk population. And if they stay low-risk, and if the labor stays low-risk and progresses normally – voila = vaginal birth.

            This will be true with an obstetrican or a midwife.

            The problem is that midwifery is promoted by comparing the rate of low-risk women who have cesareans with a total cesarean rate … that’s a false comparison.

            Midwives aren’t taking care of the entire population (and we shouldn’t) and therefore midwives wouldn’t have a cesarean rate of near 30% (the national average).

      • The Bofa on the Sofa

        The common feature is not the cPm part, it is the willingness (or, moreso, motivation) to do births outside the hospital.

        Ideology.

        It’s what separates the good CNMs from the bad CNMs.

        • Anna

          Nailed it! This is why the reality of homebirth midwifery in Australia doesnt meet the advertised standard. Ideology and need to make money (and keep reputation of low transfer rate) keeps women that have no business being home in danger.

    • RudyTooty

      Because she was a CNM, there was probably more regulatory oversight and her license was suspended.

      https://www.nwfdailynews.com/news/20180221/niceville-midwife-disciplined-following-infant-death/1

      CPMs/LMs are licensed in states that explicitly permit reckless birth practices (VBAC, twins, breech, etc) – and when there is a bad outcome, there is no regulatory consequence, because they were acting within the scope defined by their licenses.

      The online database published by Gatehouse news did a pretty good job of describing what is actually legal for CPMs/LMs to do. Those details get lost often. People think licensing midwives means it’s safe – in fact, it can be the opposite.

      http://gatehousenews.com/failuretodeliver/explore-the-database/#states