Is there medical professional more devoid of ethics, morality and simple human compassion than a midwife who ignores dead babies?

I doubt it, but Ginger Breedlove, CNM, former president of the American College of Nurse Midwives, appears willing to ignore all three when her profits and those of other birth workers are at stake.

Breedlove has produced what she imagines is a riposte to Gatehouse Media’s incredible expose of American homebirth midwives (CPMs, LMs), Failure to Deliver. Instead she confirms what seems to me to be its central contention: babies are dying as a result of substandard midwifery care and the midwifery leadership can’t be bothered to give a damn.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Breedlove tries to bury dead babies twice, first in tiny coffins and then by refusing to acknowledge that they lived and died.[/pullquote]

The central characters in Failure to Deliver are the babies who died. Their lives and preventable deaths are engraved on the hearts of their bereaved parents. In a 600 word rant, Breedlove doesn’t mention the babies even once! Instead, like many homebirth advocates and midwifery leaders Breedlove attempts to bury dead babies twice, first in tiny coffins and then by trying to expunge their existence from public consciousness.

Yesterday, in writing about Failure to Deliver, I identified some of the tactics homebirth midwives use to mislead consumers. Today, Breedlove demonstrates them.

She starts with the bait and switch:

I submit we would NOT see this type of clear attack on midwives and birth centers in ANY other high-income country where midwives have worked for decades, in all settings, with far better outcomes while delivering far more babies than their OB counterparts.

Duh! The most important revelation in Failure to Deliver is that homebirth midwives (CPMs, LMs) don’t meet the standards of midwives in ANY other high income country, but try to trade on the achievements of those other midwives. Homebirth midwives seek to confuse consumers about this second, substandard class of midwives, and Breedlove continues the deliberate deception.

She includes the classic midwifery red herrings:

WHY NOW? When we are battling the highest rate of maternal mortality in over 20 years, untenable inequities for black and brown communities in receipt of comprehensive maternity care, the battle over respectful maternity care and realities of consumer choice?

Maternal mortality has risen because women are dying for LACK of high tech interventions, the very interventions that midwives don’t provide. Untenable inequities for black and brown communities? Indeed, the number of black and brown midwives is tiny. Perhaps midwives ought to look to their own glass house before throwing stones.

Breedlove rails against fear:

ANY news that begins with emergency 911 recordings is intentionally designed to evoke fear in the readership. For me, it leads with an intentional set up as a page turner that keeps you on the edge of your seat, and ends with provoking the same reader emotions – FEAR.

But why shouldn’t we fear the preventable deaths of babies? Oh, right, because it would hurt the incomes of midwives and what’s a few dead babies compared to midwife profit?

Again and again Breedlove ignores the dead babies to focus on midwives:

As we work at #GrowMidwives to advance the Midwifery profession among many stakeholders including hospitals, physicians, midwives and consumers, it is quite frustrating to have to sort out fact from fiction, misuse of titles, and a void of comparison to hospital birth with similar populations including relative risk data.

I can’t begin to imagine how Breedlove believes her “frustration” is more important than the preventable deaths of babies and the shattered lives of their parents, but apparently she does.

She has papers!

We have numerous studies to counter some of the cited associations made in the article about home birth and birth center birth.

So what! The tobacco companies had numerous studies to counter the association between tobacco and lung cancer. That didn’t make them true.

There is absolutely no question that CPMs and LMs have neonatal death rates triple (or more) death rates from comparable risk hospital birth. What does Breedlove plan to do about that? Absolutely nothing!

Ethical medical professionals put the wellbeing of their patients first. Not Breedlove:

And, #GrowMidwives will continue to help #GrowConsumers and others who see the value in full integration of Midwives in this country.

In the meantime, the rest of us will continue to work tirelessly to see the value in live, healthy babies and mothers. And we will continue to marvel and mourn the fact that enablers like Breedlove don’t give a damn and keep burying dead babies twice.

Breedlove should be ashamed of herself, but that would require both ethics and insight and apparently she has neither.

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.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]No one should be allowed to call herself a midwife unless she meets the International Confederation of Midwifery Global Standards.[/pullquote]

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.

In 2018 there is reality and what certain segments of society prefer to believe.

Reality is that immigrants enrich our country, take jobs that no one else wants, and are no more likely to come to our border than they ever were. In the overheated imaginations of our president’s followers, immigrants steal from our country, take all the desirable jobs, and have begun coming to our border in massive numbers.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Brooks’ New York Times piece is inaccurate, disorganized and based on personal beliefs not supported by facts.[/pullquote]

Why the discrepancy? Because cognitive dissonance won’t allow blue collar white workers to blame the real authors of their misery: the Republicans who promote the interests of the rich over the needs of the working poor.

In 2018 there is the reality of maternal mortality and what certain segments of society prefer to believe. This includes Kim Brooks, the author of America Is Blaming Pregnant Women for Their Own Deaths, an opinion piece in the NYTimes.

Reality is that maternal mortality is disproportionately a problem of black women, that the leading causes of death are heart disease and pre-existing chronic medical considitions, and that women are dying from LACK of high tech interventions not too many interventions. In the overheated imagination of Kim Brooks, an individual with no professional education or training in obstetric issues, the problem is that doctors are mean to women.

Brooks’ piece is inaccurate, disorganized and based on personal beliefs that are not supported by the facts.

This appears to be the key sentence:

For experts studying the United States’ maternal mortality and injury rates — which are estimated to far surpass those in other developed countries — and for women in labor, the failure to treat mothers as people is neither antiquated nor dystopian, but absolutely pressing.

That’s is sheer, unadulterated bullshit, the intellectual equivalent of claiming that immigrants are ruining our country. Reality is very different.

Reality #1: Women of African descent die at much higher rates than women of other ethnicities.
Reality #2: Maternal mortality rates are a function of “whiteness” of the country.
Reality #3: The leading causes of maternal death are cardiac disease and pre-existing medical conditions
Reality #4: Women are dying in the days, weeks and months before and after childbirth, NOT in labor.
Reality #5: Women are dying because of lack of access to high tech interventions.
Reality #6: Maternal mortality is a social problem as much as it is a medical problem.

I could write reams about these issues but a few graphs and charts make reality quite clear.

1. This graph shows the stark difference between maternal mortality rates for black women and all other women:

2. This disaparity is true for all industrialized countries and in some it is even larger. As a result, the “whitest” countries have the lowest maternal mortality rates and international comparisons that don’t account for ethnic composition within nations are meaningless.

3. Why do women die in pregnancy, childbirth and the year afterward?

The most important message in this graph is that fully 41% of US maternal deaths are caused by cardiovascular (including cardiomyopathy) and non cardiovascular diseases. And that reflects the fact that pregnant women are now older, more obese and suffering from more chronic diseases than ever before.

4. In her piece Brooks refers repeatedly to dying in childbirth, but as Neel Shah, MD notes, more than 80% of maternal deaths don’t occur on the day of delivery and more than 60% aren’t even within a week of delivery.

5. Brooks, like most people imagines that maternal mortality is a problem of too many interventions and unnecessary interventions (“too much, too soon”) when in reality it is a problem of LACK of interventions (“too little, too late”).

Brooks approvingly quotes an executive of the California Health Care Foundation:

“Women know what they want when it comes to labor and delivery, and it turns out the things they want (midwives, doulas, fewer unnecessary interventions and cesarean sections) are less expensive and produce better outcomes.” The problem is not that pregnant women are uneducated or uninformed; the problem is that those in charge aren’t listening to them.

There is precisely ZERO evidence that midwives, doulas, fewer interventions and fewer C-sections could reduce maternal mortality. Indeed, just this month the New England Journal of Medicine published What We Can Do about Maternal Mortality — And How to Do It Quickly recommends four strategies to reduce maternal deaths:

• Best practice bundles for common obstetrical emergencies
• Enhanced preparedness for complications
• Drilling for emergencies
• Timely transfer to high resource hospitals

6. Pointing out that maternal mortality is in large part a social, not a medical problem is not blaming pregnant women for their own deaths anymore than pointing out that drug abuse is primarily a social problem not a medical one.

The leading causes of maternal death are cardiac disease and pre-existing medical conditions; that’s because maternal age is increasing, obesity is increasing and therefore the prevalence of chronic medical conditions is increasing. No one is to blame for that and refusing to acknowledge it is a lazy attempt to protect women’s feelings at the expense of their lives.

The bottom line is that America is NOT blaming women for their own deaths. Claiming that midwives, doulas and fewer interventions will prevent maternal mortality is like claiming that a border wall will protect blue collar workers from economic harm. Some people may prefer to believe it, but it’s not reality.

There’s ongoing controversy in the lactation profession about where infants ought to sleep.

Although considerable data shows that co-sleeping is a major risk factor for sudden infant death, breastfeeding professionals have tried to argue that since co-sleeping purportedly improves breastfeeding rates, and breastfeeding proportedly improves infant health, the benefits of breastfeeding outweigh the risks of co-sleeping. That’s untrue.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Breastfeeding, co-sleeping and room sharing lead to poorer quantity and quality of infants’ and mothers’ sleep. [/pullquote]

In an effort to reduce the risk of co-sleeping while maintaining mother-infant proximity, the American Academy of Pediatrics recommends room sharing until age one. There’s very little evidence that room sharing has any benefit, but no matter. It seems to be a good compromise.

What impact does co-sleeping and room sharing have on maternal and infant sleep?

Lactation professionals seem to think that co-sleeping improves the quality and quantity of maternal sleep. Room sharing advocates have not really addressed the issue.

The scientific evidence shows that mothers and babies who co-sleep or room share get LESS sleep and poorer quality (more fragmented) sleep.

For example, Mother-Infant Room-Sharing and Sleep Outcomes in the INSIGHT Study was published in Pediatrics in 2017.

The authors note the importance of sleep to both babies and mothers:

The importance of getting an adequate night’s sleep has been increasingly recognized by professional societies including the American Academy of Pediatrics‍ (AAP) and the American Academy of Sleep Medicine.‍ Inadequate sleep has been associated with poorer cognitive, psychomotor, physical, and socioemotional development, which includes emotion regulation, mood, and behavior in infancy and childhood.‍..[I]nfant sleep has a bidirectional relationship with parent outcomes as demonstrated by associations between infant sleep and parental sleep, maternal sensitivity, relationship quality, parental emotional health, and parenting practices.‍

They note:

The desire to optimize infant sleep duration and consolidation, however, must be balanced with safe infant sleep, a fact reinforced by the 3500 infants who tragically die of sudden infant death syndrome (SIDS) or other sleep-related deaths annually.‍ According to the Eunice Kennedy Shriver National Institute of Child Health and Human Development’s “Safe to Sleep” campaign, most SIDS deaths occur when infants are 1 to 4 months old, 90% occurring before the age of 6 months.‍ Despite these figures, the recently published AAP Policy Statement, SIDS and Other Sleep-Related Infant Deaths, recommended that infants sleep in their parents’room on a separate surface, ideally for the entire first year but at least for the first 6 months.‍
The 1-year recommendation has questionable congruence with the epidemiology of SIDS (as risk is far lower after 6 months), and it runs counter to the common clinical advice parents receive. Based on evidence of improved infant sleep, clinicians may encourage parents to establish independent sleep environments (ie, in a separate room from parents) during the middle of the first year to promote healthy and sustainable sleep patterns before the typical onset of separation anxiety later in the first year.‍

The authors compared room sharing and independent sleeping to determine both sleep quantity and quality.

They found:

At 4 months, reported overnight sleep duration was similar between groups, but compared with room-sharers, early independent sleepers had better sleep consolidation (longest stretch: 46 more minutes, P = .02). At 9 months, early independent sleepers slept 40 more minutes nightly than room-sharers and 26 more minutes than later independent sleepers (P = .008). The longest stretch for early independent sleepers was 100 and 45 minutes more than room-sharers and later independent sleepers, respectively (P = .01). At 30 months, infants sleeping independently by 9 months slept >45 more minutes nightly than those room-sharing at 9 months (P = .004). Room-sharers had 4 times the odds of transitioning to bed-sharing overnight at both 4 and 9 months (P < .01 for both).

They concluded:

Room-sharing at ages 4 and 9 months is associated with less nighttime sleep in both the short and long-term, reduced sleep consolidation, and unsafe sleep practices.

That’s room sharing, but what about co-sleeping?

Sleep patterns of co-sleeping and solitary sleeping infants and mothers: a longitudinal study was published in Sleep Medicine in 2015.

Controversies exist regarding the impact of co-sleeping on infant sleep quality. In this context, the current study examined: (a) the differences in objective and subjective sleep patterns between co-sleeping (mostly room-sharing) and solitary sleeping mother-infant dyads; (b) the predictive links between maternal sleep during pregnancy and postnatal sleeping arrangement; (c) the bi-directional prospective associations between sleeping arrangement and infant/maternal sleep quality at 3 and 6 months postpartum.

They found:

 Co-sleeping infants had more reported night-wakings than solitary sleeping infants.
 Co-sleeping was not related to objective infant sleep quality.
 Co-sleeping mothers had more fragmented sleep than solitary sleeping mothers.
 Poorer maternal sleep at pregnancy and at 3 months predicted co-sleeping at 6 months.
 Breastfeeding was related to poorer maternal/infant sleep and to co-sleeping.

They concluded:

Mothers of co-sleeping infants report more infant night-wakings, and experience poorer sleep than mothers of solitary sleeping infants. The quality of maternal sleep should be taken into clinical consideration when parents consult about co-sleeping.

Breastfeeding is another factor associated with poor infant and maternal sleep.

According to the 2017 paper Exclusive breastfeeding at three months and infant sleep-wake behaviors at two weeks, three and six months:

…At three months, exclusively breastfed infants had a shorter of the longest sleep period at night than exclusively formula fed infants. At six months, exclusively breastfed infants at three months spent more hours awake at night than partially breastfed infants, awake more at night than exclusively formula fed infants, and had a shorter sleep period at night than partially breastfed and exclusively formula fed infants. This study showed differences in sleep-wake behaviors at two weeks, three and six months, when exclusively breastfed infants are compared with partially breastfed and exclusively formula fed infants at three months, while no effects were found for sleep arrangements, depression or anxiety.

Similarly, Sleep Patterns As A function of Breastfeeding: From Infancy to Childhood, published in 2018, showed:

There was a significant interaction between breastfeeding status at 6 months and age, on the longest consecutive sleep period (p<0.001). At 6 and 12 months, breastfed infants had a shorter longest consecutive sleep period than non-breastfed infants, (6:15 ± 2:49 vs 7:56 ± 2:49, p <0.001; 7:26 ± 3:16 vs 8:51 ± 2:52, p <0.001), with no difference at 24 and 36 months (p>0.05). There was no interaction between breastfeeding and age on total nocturnal sleep duration (p>0.05).

It’s long been known that exclusive breastfeeding leads to more fragmented infant sleep and therefore poorer quality sleep for mothers. Co-sleeping and room sharing, far from ameliorating the problem, actually make it worse.

Every women should decide for herself how she will feed her infant and where her baby will sleep, but new mothers deserve to know that breastfeeding, co-sleeping and room sharing lead to poorer quantity and quality of their sleep.

They say a picture is worth a thousand words and the image below is quite impressive. It’s the rate of autism over time compared to the rate of breastfeeding over time:

Over the past 4 decades, there has been a shocking rise in the prevalence of autism. Antivax activists have pointed out that there has been an increase in the number of vaccines that infants receive and conclude that vaccines cause autism. But as this graph shows there has also been a dramatic increase in breastfeeding rates. Indeed the two seem to rise in concert over time demonstrating a link between breastfeeding and autism.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]It is grossly irresponsible for any medical professional or organization to announce a link based on a temporal association.[/pullquote]

Obviously more research is needed. We should be urgently investigating whether breastfeeding causes autism. We should reconsider recommendations designed to encourage breastfeeding and ask if we are ignoring the harmful effects. In the meantime, we should direct lactation consultants, La Leche League and the Baby Friendly Hospital Initiative to inform new mothers of the very clear association between breastfeeding and autism. How can women make an informed decision about breastfeeding if they don’t know about the link?

If you read this far you’re probably asking yourself what has happened to my reasoning abilities. Just because two phenomena rise in concert doesn’t make them linked. Sure, it raises the possibility, but it is grossly irresponsible for any medical professional or organization to announce a link based merely on a temporal association. I must be joking, right?

Yes, I am joking but the folks at Baby Friendly UK are not. Here’s a tweet they published this morning:

Links also found between induction of labor and autism but more research needed #bfconf

The hashtag refers to the UNICEF/Baby Friendly Hospital Initiative conference now under way in Liverpool.

Correlation is not causation, though. Rising autism rates are correlated with rising induction rates AND rising breastfeeding rates. Unless the folks at the BFHI are willing to suggest that autism is linked with breastfeeding, they shouldn’t be suggesting that autism is linked with induction.

The above tweet was part of a series reporting on a lecture by lactation professional Karin Cadwell that demonized oxytocin and suggested that it interferes with breastfeeding.

Wait, what? A natural hormone produced in part to promote breastfeeding interferes with it? Well, sure, if you put it in an IV! Apparently the oxytocin knows where it came from no matter that it is chemically identical to the oxytocin produced by the mother’s body.

If the webpage is any indication, the lecture is an amalgam of the naturalistic fallacy (if it’s natural it must be good; if it’s technological it must be bad), the Panglossian paradigm (nothing can improve upon nature), and utter nonsense like this:

Then, one of our local hospitals hired a full time OB anesthesiologist and epidurals began. The nurses reported an immediate outbreak in flat nipples and babies who had trouble latching. One of the nurses told me that it was almost as though the baby didn’t know that the breast was there! Now, epidurals, labor induction and augmentation with synthetic oxytocin, operative deliveries and elective cesarean births are widespread with ubiquitous breastfeeding problems.

Prof. Cadwell appears to think this is what passes for “reasoning”:

I ask myself almost every day, how can something that is so fundamental to good health, in fact our survival as a species, be so difficult? How can it be that babies fail to latch when the characteristics of their mother’s Montgomery gland secretions are analogous to their unique amniotic fluid flavor? What has happened to otherwise healthy, full term babies in the process of being born that they would deny themselves the ultimate pleasure nursing?

It’s analogous to the “argument” that anti-vaxxers make about vaccines: Immunity is fundamental to good health and our survival as a species. Unvaccinated is the biological norm. Therefore, vaccines are unnecessary and possibly harmful.

It’s a ridiculous “argument” when made by anti-vaxxers and equally ridiculous when made by lactation professionals.

Unvaccinated may be the biological norm for infants and children but deaths from vaccine preventable diseases are also the biological norm. Natural immunity is indeed the product of hundreds of millions of years of evolution, but that didn’t make it perfect or even close to perfect.

Just because breastfeeding is the biological norm does NOT mean that all women produce enough breastmilk, that some women don’t have flat nipples, that some babies can’t latch. But, but, but if those things occurred in nature lots of babies would die! That’s right and until very recently, lots of babies DID die for precisely that reason. Human existence is perfectly compatible with massive rates of infant mortality.

So if correlation does not equal causation and natural is not necessarily best, how do we figure out if breastfeeding or induction causes autism.

To determine if Event A caused Disease B, we need to investigate whether it satisfies Hill’s Criteria. These are nine criteria, most of which much be satisfied before we can conclude that Event A is not merely correlated with Disease B, but Event A actually causes Disease B.

I’m not going to review all nine criteria here. I’ll highlight two that are most important in this setting.

Consistency: Have the findings that purport to show a relationship been replicated by other scientists, in other populations and at other times? If studies fail to consistently show the relationship, causation is very unlikely.

This is a critical point. One experiment or even a few studies is NOT enough to determine causation. A large number of studies that consistently show the same result is required.

And:

Consideration of alternative explanations: In the case of breastfeeding (or vaccines) and autism, there is a very simple alternative explanation. Autism cannot be diagnosed before the age of 2 and breastfeeding (and most vaccines) are given before the age of 2.

Similarly, as autism is almost certainly genetic, there may be differences in the pregnancies or fetuses affected by autism that lead to a need for oxytocin induction or augmentation in labor. For example, there is some evidence that autism leads to larger head size. Larger head size leads to greater need for interventions in labor. Therefore any association between oxytocin administration and autism may be a consequence not a cause.

The correlation between induction and autism is probably weaker than the correlation between breastfeeding and autism. Unless and until the folks at Baby Friendly are willing to suggest that breastfeeding causes autism, they have no business suggesting induction does.

Most women love their children desperately and want to be good mothers. Unfortunately that leaves them vulnerable to experts, real and self-proclaimed, who insist they know what is “best” for babies. But what women (and experts) often fail to realize is that what is best is often determined by socio-cultural factors that are left unexamined.

For example, parenting experts of the early 20th Century, embedded in a culture that highly valued both technology and conformity, thought that what was “best” for babies was formula, rigid schedules and limited displays of affection so as to prevent becoming spoiled. In contrast, most experts of the early 21st Century, embedded in a culture that highly values nature, experience and maternal self-sacrifice, claim that what is best for both babies and mothers is natural childbirth, breastfeeding and attachment parenting.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Good mothers don’t trust parenting experts; they trust themselves.[/pullquote]

It seems never to occur to experts that mothers themselves might actually know best. After all, mothers (and fathers) love their children more than anyone else, are more attuned to their needs and cues, are responsible for balancing the needs of multiple children within a family, and are best acquainted with the personal, cultural and religious needs of the family as a whole. Simply put, good mothers know what is right for them and their children. And good mothers know that expert advice is often flat out wrong.

Keep in mind that I’m not talking about scientific evidence. Doctors and scientists are experts in what the science shows. I’m referring to advice about what constitutes good parenting for a specific mother and child pair.

Experts may insist that unmedicated vaginal birth is best because it’s it natural. But good mothers know that their own needs in childbirth are also important. Good mothers often consider the health of the baby paramount, but recognize that their own needs in childbirth (safety, pain relief, and preserving future continence and sexual function) matter a great deal. It is not selfish to consider them; indeed ignoring them is paramount to erasing women from childbirth.

Experts claim that breast is best, but good mothers know that ensuring babies are fully fed, content and growing matter far more. The benefits of breastfeeding in industrialized countries are trivial and there are real risks to underfeeding babies. That doesn’t even take into account the suffering of a baby who isn’t getting enough food because his mother isn’t producing enough or because he isn’t able to remove it from the breast. Good mothers know that being fed is far, far more important than being breastfed.

Attachment parenting experts claim (with no evidence) that babies have a need for perpetual maternal proximity that exceeds any need a mother has for sleep. They recommend that babies sleep in bed with mothers because it’s natural, because it facilitates breastfeeding (natural!) and promotes infant security and self-confidence (they just made that up). In contrast, good mothers know that their own needs for sleep, privacy and partner intimacy are also critically important. Indeed, sleep deprivation can contribute to maternal postpartum depression, a condition that is bad for both babies and mothers. Moreover, good mothers know that bed sharing is a safety issue because it increases the risk of sudden infant death syndrome.

You may have noticed a theme. Good mothers know that though babies require maternal sacrifice, they don’t need and don’t benefit from maternal self-erasure.

We should be looking carefully at the socio-cultural factors that have led to a philosophy of mothering that demands total self-abnegation. While experts may claim that such a philosophy is best for babies or that it must be correct because it is natural, the truth is as old as recorded history if not older. It’s about controlling women through the love they have for their children.

Contemporary parenting philosophy is based on prejudices about women, where they belong and what they can be allowed to do. Specifically, contemporary parenting philosophy is built on the belief that women belong at home, with no personal identity or needs, and that anything they do for themselves — whether as mundane as getting adequate sleep or as phenomenal as winning a Nobel prize — necessarily comes at the expense of their primary purpose: bearing and raising children.

But good mothers know that maternal needs and children’s needs dovetail most of the time. Children don’t need a mother who is a doormat; they only need a mother who loves them. And good mothers know that love has nothing to do with childbirth, breastfeeding or attachment parenting.

Good mothers don’t trust parenting experts; they trust themselves.

I’m going into the birth keeper business!

I’ve decided to start my own school for homebirth and freebirth. I’m concerned that birth has strayed far from what nature intended and part of the reason is that women have forgotten the deeply spiritual aspects of birth. Dr. Amy’s College of Raw, Orgasmic, Totally Crunchy Homebirth (CROTCH) promises to train a new generation of birth workers with greater respect for the animal process of birth than most freebirth advocates do.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]The birth keeper holds the space in the mother’s bank account previously held by her money.[/pullquote]

The motto at Dr. Amy’s CROTCH is nothing so banal as “trust birth.” Our motto is “Worship Birth … or your baby will get autism” and we do that by faithfully imitating the other members of the animal kingdom.

In the first place, the term “homebirth” merely represents the fact that it takes place outside the hospital. Obviously it does not take place at home. Our animal sisters give birth in dens and under dense foliage; therefore, a CROTCH birth takes place in a burrow excavated from dirt by the mother in the days leading up to the birth.

In addition:

At CROTCH, we teach that birth is not simply orgasmic; it is multi-orgasmic. Study of the female orgasm demonstrates that it is typically accompanied by uterine contractions. Therefore, it only stands to reason that birth as nature intended involves an orgasm with every contraction. We feel sorry for those women who merely have an orgasm at the moment of birth. If they had truly worshiped birth, they would have had hundreds of orgasms.

Obviously, clothes are not natural. In addition to prohibiting hats or clothing of any kind on babies, we at CROTCH impress upon midwives, doulas and other birth workers the need for THEM to be naked at birth. Clothes interfere with their healing auras.

Privacy, of course, is critical. That’s why the mother must be unattended in her burrow. The naked midwife/doula/birth keeper and the mother’s naked partner must always remain downwind of the birthing mother to prevent her labor from stalling by interference with birthy smells. They cannot approach any closer than 100 yards, regardless of how much the mother screams and begs.

If the birth keeper can’t approach the mother, how can she monitor the labor? She can’t, and she shouldn’t. Monitoring and vaginal exams are evil. They are based on the hegemonic, patriarchal medical model of birth that presumes all mothers and babies have a right to live. Any birth worker with even minimal training knows that some babies aren’t meant to live and that mothers die in the hospital, too.

Prenatal care is totally unnecessary. Do animals have prenatal care? No, they don’t, and if prenatal care were necessary, they wouldn’t be here now.

The moments after birth are critical for the mother and baby to imprint upon each other. That’s why at CROTCH we teach birth keepers that mothers must lick their babies clean, and birth keepers must lick the mother’s perineum clean (unless, of course, she is a contortionist and she can lick her own perineum).

The cord must not be severed. The placenta must be left attached until the cord starts to shrivel. Then the mother must eat the entire placenta and cord just like the Khaleesi in Game of Thrones ate the horse heart. At CROTCH we recognize that dehydrating and encapsulating the placenta destroys the very hormones that prevent postpartum depression. All those placenta encapsulation specialists are pathologizing the placenta and stealing the money of unwitting mothers for doing so.

Immediately after birth, the mother must place the baby at her breast … and leave it there for the next 7 years.

At CROTCH we also recognize that not all babies were meant to live. It’s the birth performance that counts, not the baby. And to faithfully recapitulate birth in the animal kingdom, we suggest that the mother eat her young if they do not survive.

At CROTCH, we know that the key to an empowering, spiritual birth is the Holy Trinity. No, not the Father, the Son and the Holy Spirit, silly; the Mother, the Baby, and the Birth Keeper, or as we prefer to call it: the motherbabybirthkeeper triad. The mother’s body nurtures the baby; the baby knows how to be born; and the birth keeper holds the space in the mother’s bank account previously held by her money.

The best part is that CROTCH is totally free for a one time, non-refundable admission fee of $699 payable in 12 monthly installments of only $99. It’s a bargain at twice the price!

Look for Dr. Amy’s CROTCH, coming to a website near you, and prepare for an empowering birth (raw, orgasmic and totally crunchy) just as nature intended!

Adapted from a satire that first appeared in July 2013.

Freebirth, childbirth without medical assistance of any kind, is a stunt, a piece of performance art. As such, the baby is merely a prop and an expendable prop at that.

Don’t believe me? Believe Desirea Miller, leader of a freebirth group, discussing the idea of opting to get checked by medical personnel in the midst of a freebirth.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Freebirth is an extreme sport where the performance is the point.[/pullquote]

A live baby is usually the goal. Not everybody has that same goal but if that’s your goal, there’s no shame in going to get checked.

https://youtu.be/Zmik-Q_U_JA

Who is Desirea Miller?

Among other things, she’s the co-creator at Holistically Empowered Rebel Birth Keepers Academy of Learning (HERBAL), which has the best logo ever!!

Kudos to Desirea for having the courage to say what many freebirthers already believe. Freebirth is not about reproductive freedom and it’s certainly not about babies. It’s a form of extreme sport where the performance is the point.

What are extreme sports? A 2004 study offered this definition:

‘true’ extreme sports [are] a leisure or recreation activity where the most likely outcome of a mismanaged accident or mistake was death.

According to David Le Breton, Playing Symbolically with Death in Extreme Sports:

Many amateur sportsmen in the West, have today started undertaking long and intensive ordeals where their personal capacity to withstand increasing suffering is the prime objective… [P]eople without any particular ability are not pitting themselves against others but are committed to testing their own capacity to withstand increasing pain… Going right on to the end of a self-imposed ordeal gives a legitimacy to life and provides a symbolic plank that supports them…

In Death, danger and the selling of risk in adventure sports, a chapter in the book, Understanding Lifestyle Sport: Consumption, Identity and Difference by Belinda Wheaton, Catherine Palmer notes:

…[This] conceptual collapse between risk and mainstream … creates the impression that anyone can partake in these kinds of activities. The fact that inexperienced actors can leap from a plane or bungy jump creates the illustion that no expertise is needed to engage in extreme sports. In other words, these made-for-media versions of extreme sports are short-lived imitations of risk, rather than serious sporting … in which physicial fitness and technical knowledge are of paramount importance… [This] mediated normalisation of risk taking in particularly problematic in that it gives the impression that nothing goes wrong in extreme sports. In popular packaging, those activities … are presented as being entirely without risk or danger.

… The selling of risk is a careful exercise in discursive manipulation … [and] particularly tragic consequences … have accompanied this selling of risk …

Although freebirth is legal as a matter of reproductive freedom, freebirth itself is not really about reproductive freedom but rather about risking death, withstand pain and empowerment through a self-imposed ordeal that requires neither physical fitness nor technical skill. The beauty of freebirth is that the death being risked is that of the baby; the risk to the mother is much smaller. This feature explains that refusal of freebirthers to seek medical care to save the life of the baby (it is just a prop) while simultaneously seeking out medical care to save their own lives.

To paraphrase Wheaton and Palmer, freebirth isn’t the equivalent of jumping from a plane or bungy jumping, it’s the equivalent of throwing your baby from a plane or attaching a bungy cord to a baby and flinging it off a cliff. All the excitement, but none of the danger. It isn’t playing symbolically with one’s death; it is actively risking the death of another.

Seeking advice for no better reason that to save the life of your baby is frowned upon and often deleted. As Desirea explains:

Reaching out and asking for advice during labor while free birthing is extremely harmful. Freebirth is to be intuition led, not suggestion led. When a mama opens up her mind to other suggestions, thoughts, energies, and opinions, she is skewing her intuition…

If anyone is seen partaking in this kind of dangerous act within the group during labor, their comments/posts will be removed… We’d love to hear how you rocked your birth, but we aren’t here for suggestions during labor…

So giving birth without medical care of any kind is safe, but seeking advice is dangerous? Those claims only make sense if a live baby is not everybody’s goal. The performance, and the associated bragging rights, is everybody’s goal. Getting help of any kind, including help to save the baby’s life, ruins the performance.

Fortunately for freebirthers, getting help to save your own life is just fine. Otherwise how would you go on to have a healing freebirth of your rainbow baby next time?

Australian midwife Martina Görner boasted on Facebook:

What a homebirth full of unexpected surprises , literally one after the other!! ‍♀️ Mum gave birth to her sweet little baby boy in water and then we thought the placenta was about to come… But as it turned out, there was another baby boy about to make his entrance into the world!! What a super hero mum Brooke is. What an amazing birth!! ✨ The twins are identical twins and were born this morning ☀️ @ 08.03 & 08.07 weighing 2350 and 2200gr. Mum ‍♀️ and babies are doing really well. Big congratulations to everyone!! #homebirth #waterbirth #midwife #melbourne #naturalbirth #twins #tenmoons #twinhomebirth @ Melbourne, Victoria, Australia

Amended post:

An Ambulance was called following the birth of the twins to transfer to hospital. The twins arrived premature (at 35 weeks). One of the twins experience respiratory difficulties. Both twins were transferred by Ambulance to hospital.

A competent practitioner would never have boasted about such a massive screw-up but it’s par for the course in the world of homebirth. The midwife violated standards of her profession and no one died. She thinks that makes her amazing.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]If you wish to hold a license from a professional board, you must follow the rules.[/pullquote]

Her professional board [Australian Health Practitioner Regulation Agency] suspects — not surprisingly — it makes her incompetent and has suspended her practice pending investigation.

According to the Melbourne Homebirth Association:

Recently, Martina Görner from Ten Moons Midwifery in Melbourne attended an accidental twin homebirth, the story of which has been circulated on social media in the last couple of weeks. The mother and the babies were happy and well, however after the mother took the babies in to the hospital for a check up, Martina was reported to AHPRA by the hospital staff.

On 29/10 Martina’s offices were visited by “AHPRA investigations and security personnel, who wanted to immediately collect medical files, clinic computer and clinic mobiles” in relation to the birth.
Martina’s experience is not uncommon. Almost half of Australia’s privately practicing midwives have been reported to AHPRA, and the vast majority of notifications come from hospital staff, not from their clients. AHPRA, NMBA and most hospitals continue to struggle to understand that birthing women retain the rights to make choices in relation to their own care, even where those choices fall outside the guidelines.
Martina has a hearing before AHPRA / NMBA at 1pm on Wednesday 7th November, to determine whether she will have her registration suspended, and she has been required to give an undertaking that she will not practice as a midwife ahead of this hearing.

A petition organised by Bridget Muhrer of the Ten Moons Mothers Group has received over 10k signatures in less than 24 hours. The group is organising a flash mob protest outside AHPRA …

In other words, despite the fact that Görner violated multiple practice standards, homebirth advocates are supporting her.

Görner‘s registration has indeed been suspended and her supporters are furious. They seem to think this is an issue of reproductive freedom. It’s not; it’s an issue of professional competence. If you wish to hold a license from a professional board, you must follow the rules.

In and of itself, failure to diagnose twins is not malpractice. Prior to the advent of ultrasound, unexpected twins occurred in almost 30% of twin births. It is, however, malpractice to deliver a premature baby at home and that’s what Görner did. It’s not her only violation of professional standards.

Görner‘s boasts about her own practice indicate additional failures.

91% of patients declined the glucose tolerance test.

99% declined group B strep testing.

87.5% declined Rhogam during pregnancy

85% declined neonatal Vitamin K

Even though these are foolish, potentially deadly choices, women have the right to make these choices … but ONLY if they are properly informed since these are violations of professional standards. The fact that Görner is boasting about these statistics suggests that she doesn’t see these choices as risky and potentially deadly, but it is NOT up to a provider to decide whether or not she likes practice standards.

Moreover, if the provider doesn’t know the scientific facts about these choices, she can’t possibly be providing informed consent. It doesn’t matter whether or not she and her patients share the same mistaken beliefs about these interventions. Counseling a patient in a healthcare setting mandates providing them with accurate information and making sure they understand it. That requires counseling by someone who is conversant with the scientific rationale behind each recommendation. Failure to provide such counseling is malpractice.

Professional standards are guard rails on professional practice. They are not discretionary. Patients can refuse them but providers can’t tell patients they aren’t necessary if that’s not what the science shows. If you want to carry a license, you must follow the rules for licensure whether you like them or not. There’s a reason for that: public safety. A midwife who routinely violates the standards of her profession puts the public at risk.

A number of recent deaths in the freebirth community have been publicized by Katie Paulson in a series of Patheos columns.

“Lisa,” a member of a Facebook freebirth group for women who refuse any medical care for childbirth told the group:

My water broke the evening of the 4th and was discolored. Since I was 42 weeks I thought it was normal. But as the days went by it got more foul smelling and turned a sick poop color which was constantly leaking and the baby stopped moving on the 6th.

I woke on the 7th with so much pain and pouring meconium that Chris and I agreed it was time to transfer.

The baby was already dead. According to Lisa, the baby died of a massive infection.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Freebirth is NOT a reproductive right.[/pullquote]

The mainstream media have picked up the story and have expressed sympathy for freebirthers in general and “Lisa” in particular. They’ve been swayed by claims that freebirth is an issue of reproductive freedom.

Beth Greenfield of Yahoo Lifestyle wrote:

The baby’s death, then, and resulting fiery discourse, has for many been a line in the sand — with those on one side seeing freebirthing as a reckless choice that selfishly flouts the standards of modern medicine, and those on the other seeing it as the powerful epitome of a woman’s right to choose. The argument is strikingly similar in tone to that of this country’s abortion debate, with one question at the center of it all: How freely should a woman be to choose her childbirth experience?

I would argue that abortion is the wrong frame for this analysis since freebirth is not a reproductive right. Reproductive rights involve women’s right to control whether and when to reproduce; they encompass contraception and pregnancy termination. Reproductive rights are positive rights, requiring as they do both availability and access to birth control and abortion.

Freebirth is an issue of refusal of medical care, a negative right, a right to be left alone.

Indeed, reproductive rights advocates acknowledge this in an article written by Emily Shugerman of The Daily Beast.

According to [reproductive rights attorney Farah] Diaz-Tello, laws governing childbirth generally apply to providers, not to birthing mothers. The reasoning: Any U.S. resident has the right to refuse medical treatment, regardless of whether it is in their best interest. To prosecute a freebirthing mother, she said, the state would have to prove its own interest superseded that right.

“That would be a pretty remarkable thing to say,” Diaz-Tello said. “If you don’t go to the hospital when something’s going wrong, we’re going to what, seize your body and make you do it?”

Freebirth is akin not to abortion but to vaccine refusal.

Make no mistake, every pregnant woman has the legal right to refuse medical care even if that refusal will result in the death of the baby.

A mother’s legal obligation to the baby do not begin until the baby is born and separate from her. The baby does acquire a legal right to healthcare at the moment of birth. In practical terms that means that a woman has no legal obligation to seek medical care for an unborn child. If that child is born dead, no laws have been violated. In contrast, the mother does NOT have the right to refuse lifesaving medical care for a baby born alive. Had Lisa’s baby been born alive at home, she would have been legally obligated to call for medical assistance if the child showed signs of poor health.

Similarly a mother has a right to refuse vaccines for her child. The government and the medical profession cannot vaccinate a child without a parent’s consent.

In either case, the right to refuse care does not imply a right to be free of criticism for that refusal. Had Lisa’s baby been born alive and subsequently died of whooping cough after not being vaccinated, there would be nothing wrong with people pointing out that the baby died BECAUSE OF Lisa’s refusal of vaccines, that she bore responsibility for that death, and that it was ignorance of immunology, science and statistics that led her to make a terrible, deadly decision.

Similarly, there is nothing wrong with people pointing out that Lisa’s baby died in utero BECAUSE OF Lisa’s refusal of childbirth medical care, that she bears moral responsibility for that preventable death, and that it was ignorance of childbirth and its inherent dangers that led her to make a terrible, deadly choice.

In my view, NO ONE should have written to her personally, but there’s nothing wrong with reporting on the deadly results of such faulty reasoning. It’s like the decision to refuse to put a baby in a car seat. Were the baby to die from being ejected through the window in a crash, no one should write to the mother personally, but there’s nothing wrong with reporting on the deadly results of such faulty reasoning.

Publicizing freebirth tragedies does not compromise reproductive rights, because freebirth is not a reproductive right. It’s the same as the right to refuse any lifesaving medical treatment, no more and no less.