Standards? Oregon homebirth midwives don’t need no stinking standards!

Standards stamp with binder in the office

You might think that Oregon homebirth midwives would be shocked into action by their hideous death rates.

You would be wrong.

Who cares about dead babies? Not Oregon homebirth midwives.

In August 2010, Melissa Cheyney, then Director of Research for the Midwives Alliance of North America (MANA) and also the head of the Oregon Board of Direct Entry Midwifery, rejected a call by the state for access to the MANA homebirth death rates for Oregon. As a result, the State decided to collect the statistics themselves. They turned to Judith Rooks, a certified nurse midwife and midwifery researcher who was known to be a supporter of direct entry midwifery, to analyze the Oregon homebirth statistics for 2012.

In March 2013 presented the data using this chart:

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Rooks regretfully acknowledged:

Note that the total mortality rate for births planned to be attended by direct-entry midwives is 6-8 times higher than the rate for births planned to be attended in hospitals. The data for hospitals does not exclude deaths caused by congenital abnormalities.

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

Who cares about dead babies? Not Oregon homebirth midwives.

Since then, as far as I can determine, no similar analysis of homebirth safety has been undertaken and homebirth midwives have dragged their feat in implementing higher standards.

Finally, the Oregon Board of Direct Entry Midwifery has proposed new standards to enhance safety and Oregon homebirth midwives are incensed. They have directed their clients and supporters to bombard the Board with a form letter that summarizes their objections. Thus far 86 people have sent the form letter as originally written, and additional people have submitted it with modifications.

Here are the objections as stated in the letters:

The proposed rules that I do not agree with are:

  • Requiring midwife to terminate midwifery care when an indication to transfer presents
  • Requiring midwife to immediately transfer care to the hospita] when a transfer of care indication arises in labor.
  • Transferring care in labor for two blood pressures over 140/90
  • Transferring care in labor for inability to hear fetal heart tones
  • Transferring care in labor for outbreak of genital herpes
  • Transferring care in labor for thick meconium-stained amniotic fluid when birth is not imminent
  • Transferring care postpartum for retained placenta
  • Transferring care postpartum for a client with postpartum depression or mood disorders with suspicion or possible endangerment of self or others
  • Transferring care postpartum for high blood pressure
  • Transferring care for the newborn with high respirations
  • Transferring care for the newborn with temperature below 97 degrees
  • Having to consult in pregnancy for someone taking any medication
  • Having to consult in pregnancy for all VBAC clients
  • Having to consult in labor for someone who has one high blood pressure (140/90)
  • Having to consult in labor for a surprise breech
  • Having to consult in the postpartum period about any evident or suspected infection
  • Requirement that each time fetal heart tones are taken they be assessed continuously during and after contractions
  • Removing twin home births from LDMs scope of practice.

These higher standards are in no way unusual. Nearly all the proposed changes reflect compliance with standards in countries like the UK, Canada and the Netherlands, where homebirth is much more highly regulated and, in consequence, much safer than in Oregon.

Who cares about international standards? Not Oregon homebirth midwives.

Every single one of these situations is a risk factor for death of the baby, the mother or both. It is only reasonable that homebirth midwives should do everything in their power to prevent dead babies and dead mothers.

But there’s an additional risk; its a risk to the midwives themselves. It’s the risk of losing money. That risk to their wallets is apparently more important to Oregon homebirth midwives than the risk that babies or mothers might die preventable deaths.

Of course, there’s yet another possible reason for midwives to oppose these standards and it’s even more appalling than the financial conflict of interest. Homebirth midwives are so poorly educated and so poorly trained that many may not understand the significance of these risk factors. Indeed they might not recognize them as risk factors at all, euphemizing them as “variations of normal.”

Here’s a tip for them: if it substantially increases the risks of death, it’s not a variation of normal.

For example, the Oregon Health Evidence Review Commission informed the Board:

We have highlighted two key areas in which the proposed rules conflict with the updated evidence review related to recent evidence of infant harms…

• Vaginal Birth After Cesarean (VBAC) -up to 4 prior cesarean sections, or 3 without a previous successful vaginal delivery
• Breech presentation

… A 2014 study by Cheyney included in the 2015 Coverage Guidance found that breech position increased the intrapartum fetal death rate by 13.51/1000 v. 1.09/1000 vertex (p<0.01) – a 12-fold increase in death rate. This study included 16,924 planned home births with 222 breech presentations and 5 perinatal deaths…

VBAC updated evidence

The updated HERC evidence review found 2 new comparative U.S. studies that provide additional information about the harms to neonates in women with prior cesarean planning an out-of-hospital birth.

Who cares about scientific evidence? Not Oregon homebirth midwives.

Standards? Oregon homebirth midwives don’t need no stinking standards!

  • EMT2014

    I live in Oregon and this is one of the many reasons I delivered in the shiny new hospital near my house and never for a second considered a home birth.

  • Sue

    They don’t want to transfer care for “a client with postpartum depression or mood disorders WITH SUSPISION OF POSSIBLE ENDANGERMENT OF SELF OR OTHERS”???

  • Sara

    Jeez, they don’t even want laws that protect them from disaster, lawsuits, etc.

  • fiftyfifty1

    Why do they even care?
    Transfer for elevated blood pressure? Just measure it wrong!
    Thick mec? Oh don’t worry that’s just, um…medium mec!
    Twin pregnancy? What twin pregnancy? Oh surprise!!!!
    Herpes? Who’s to say those aren’t just razor bumps!
    etc. etc.

    • Anna

      Works in Australia! 43 weeks? We’ll just go by your original LMP, that makes you 41+5! Suspected breech? So we didn’t palp this week because you refused it right? Gestational Diabetes? You know that glucose drink is toxic right and you don’t need it. Twins? Ultrasounds have never been proven to be safe – do you really want to risk that?

  • RudyTooty

    THIS —————> “Homebirth midwives are so poorly educated and so poorly trained that many may not understand the significance of these risk factors.”

  • MaineJen

    They STILL want to deliver twins at home, even after that horrific Canadian study. (Anyone remember when that study came out? The one that showed vag breech birth had a ridiculous death rate).

  • Sassafras

    I’ll give birth in an operating room where I know they do aseptic practices, instead of my contaminated house!

    • andrea

      I know, right? I would never let a midwife into my house to judge not only my body and birth….but my kitchen floor and tub? No way.

      • Allie

        OMG, my GP came to the house when I was in labour to check me (it was part of the pre-natal birth program we participated in – minimal woo involved). Anyway, I didn’t realize it at the time, but I was actually pretty far along and having strong contractions that were getting difficult to breathe through without help. Meanwhile, hubs is running around the house cleaning up because the doctor was on the way. I finally lost it and yelled at him that if he cleaned another goddam f—ing thing I would beat him to death with a shovel! Pretty sure she didn’t even notice the house, especially after she realized I was 8 cm and 15 minutes from the hospital. All she said was “get the car!”

        • andrea

          Eeeeek!
          I was actually thinking more of prenatal visits long before labor starts. It’s great your GP didn’t care!

  • PeggySue

    Thick meconium with birth not imminent? What could possibly be good and benign about this situation? In what universe would it be sensible to continue at home?

    • PeggySue

      Same for so many of these!!! Outbreak of genital herpes????? Inability to hear fetal heart tones?????? (that’s the one that has me goggling at the screen) Retained placenta?????????????????????? I guess it’s all fine if you consider maternal death and fetal death a variation of normal.

      • KQ Not Signed In

        “I guess it’s all fine if you consider maternal death and fetal death a variation of normal.”

        That’s the thing. They do.

  • andrea

    This needs to be sent to all pregnant folks desiring home birth in Oregon . Even the dimmest bulbs in the box could get scared that they may not be transferred for surprise breech or not hearing heart tones.

    • rational thinker

      These assholes enjoy those extra risks. If they have a breech birth at home or any other problem on that list and give birth at home anyway then they have “bragging rights” and as long as they get that then the baby being alive or dead isnt of much importance.

      • andrea

        Unfortunately, there are people like that. I suppose I’m hoping to catch a subgroup of performance art birthers; who, while unconcerned about their babies, might value their uteri, continence, or sexual function enough to back off homebirth if they find a condition closer to the due date.

        • rational thinker

          They will often go to the hospital if they are worried their own life is in danger, but they wont go if just the baby is in danger of dying. We see those cases here with some regularity and its disgusting.

          • andrea

            Yep. I hate those articles, but it’s needed to out the hypocrisy.

      • Anna

        The midwives also desperately want a breech or twin birth on their record so they will encourage women to go for it. They become more sought after if they’ve done twins and breech or VBAMC.

    • Cristina B

      I think surprise should be in quotes. I think a big reason why they refuse the ultrasounds during pregnancy is to avoid knowing and being risked out beforehand. I’ve had 2 babies, with the second being breech, and I was pretty sure going into the ultrasound that he was, simply because of how uncomfortable and different it felt.

      • GeorgiaPeach23

        Omg my breech baby was so uncomfortable. I could not sit upright comfortably (which made driving really very awful). The c/s and recovery were a joy, frankly, because the constant source of pain was finally removed. Love you babe but damn.