In a striking about face, Jennifer Margulis, wootastic journalist and homebirth advocate, has modified her stance that vaccines cause autism to embrace the idea that ultrasounds cause autism. It’s not surprising when you think about it because the vaccine autism claim has been thoroughly and exhaustively debunked vaccines and ultrasound are exactly alike: both are interventions and all homebirth advocates know that interventions are bad.

On her blog today, Margulis treats us to her special brand of smearing by insinuation “journalism” by posting her interview with Dr. Manuel Casanova, M.D., the Gottfried and Gisela Kolb Endowed Chair in Outpatient Psychiatry and a Professor of Anatomical Sciences and Neurobiology at the University of Louisville. As far as I can determine, Dr. Casanova’s theory is this: ultrasound can affect cells, the brain is made of cells, ultrasound may affect the brain. How does he get from that to autism?

Through this absurd bit of deduction:

Those were my initial thoughts about why ultrasound could be of significance in terms of autism. Then the more you examine ultrasound and its epidemiology, the more proof you can draw of the same as a risk factor for autism. Populations within the United States that don’t use as much ultrasound are at a lower risk, like the Amish. The Somalis, where autism is practically unknown in their native countries, when they migrate to developed countries, they acquire a higher risk. This is not a property of being in this country. Somalis also acquired a higher risk for autism if they move to other developed nations. Obviously, in these new surroundings, they are receiving more ultrasounds.

Many people believe that because having a child with autism confers a greater risk for having a sibling similarly diagnosed, that this is a genetic condition. However, this could also be explained by ultrasound, as the mothers tend to go to the same OB-GYN practitioners…

Sorry, Jennifer Margulis and Dr. Casanova, it’s pretty clear that ultrasound doesn’t cause autism, attachment parenting causes autism.

Let’s face it, the the more you examine attachment parenting and its epidemiology, the more proof you can draw of the same as a risk factor for autism. Populations within the United States that don’t practice attachment parenting are at a lower risk, like the Amish. The Somalis, where autism is practically unknown in their native countries, when they migrate to developed countries, they acquire a higher risk. This is not a property of being in this country. Somalis also acquired a higher risk for autism if they move to other developed nations. Obviously, in these new surroundings, they are exposed to attachment parenting.

Many people believe that because having a child with autism confers a greater risk of having a sibling similarly diagnosed, that this is a genetic condition. However, this could also be explained by attachment parenting, because mothers who practice attachment parenting with one child tend to do so with their other children.

Consider the following graph that demonstrates beyond a shadow of a doubt that attachment parenting causes autism by demonstrating the steep rise in autism prevalence that occurred following the publication of Dr. Sears’  exhortation to practice attachment parenting:

Need more proof? You can refer to my ground breaking post of November 2010 in which I first revealed that attachment parenting causes autism.

1. Both autism and attachment parenting have increased dramatically in the past two decades. The origin of the attachment parenting is credited to Dr. William Sears, who first mentioned it in his book in 1988. Studies show that in the VERY SAME YEAR, the incidence of autism began to rise dramatically. (Environ. Sci. Technol., 2010, 44 (6), pp 2112–2118).

2. Regardless of who practices attachment parenting or how they define it, no one can deny that the practice of attachment parenting ALWAYS precedes the diagnosis. There are no known cases in which attachment parenting practices began after autism was diagnosed.

3. The purported mechanism is thought to be the sensory deprivation caused by baby wearing and extended breastfeeding. During the critical early months and years, when babies should be learning about the world and making millions of neuronal connections, babies exposed to AP are deprived of contact with the outside world (many are constantly carried in a position where they can see nothing but the surface of the mother’s clothing) and their exposure to other individuals such as fathers, grandparents and childcare workers is severely limited.

4. No one has EVER shown that attachment parenting does not cause autism.

5. Even those who strongly reject the notion that attachment parenting causes autism acknowledge that there are MANY children raised with attachment parenting who are subsequently diagnosed with autism.

6. Many of those who deny a link between attachment parenting and autism stand to lose money if attachment parenting is shown to be harmful. Authors, lactation consultants, and sling manufacturers, among others, have a strong economic motivation for discouraging investigation of this link.

*****

Those who have read this far have probably figured out that this is a satire. I’m satirizing the “thinking” of wootastic “journalists” like Margulis. The purpose of the satire is to demonstrate that what seems to Margulis to be compelling “reasoning” is nothing more than nonsense, and logical fallacies.

I’ve tried to highlight the major rhetorical gambits of the claim that ultrasound causes autism. Number 1 is the claim that because both ultrasound use and autism have risen in recent decades, ultrasound must cause autism. That claim is foolish as can be seen when the same observation is made about attachment parenting and autism. Just because the incidence of two phenomena rise at the same time does not mean that one caused the other.

Number 2 is the temporal connection. Prenatal ultrasound precedes the observation of autistic symptoms, but a lot of things precede the observation of autistic symptoms. That’s because those symptoms typically do not appear until the early toddler years and anything that takes place earlier (like attachment parenting practices or prenatal ultrasound) will precede the observation of symptoms.

Number 3 invokes a spurious mechanism of action. It is certainly plausible, but no evidence is presented that it actually occurs.

Number 4 is the “argument from ignorance.” The argument from ignorance dares the opponent to prove a negative and when a negative cannot be proven (since that is a logical impossibility in most cases), the conclusion is proclaimed that this “shows” that ultrasound causes autism.

Number 5 is the “fallacy of the lonely fact.” Since some children have developed autism after their parents practiced attachment parenting, the conclusion is drawn that large numbers of children will develop autism after their parents practice attachment parenting.

Number 6 is the conspiracy theory that undergirds almost every attempt to defend vaccine rejectionism. But when the same “reasoning” is applied to attachment parenting, it is easy to see that the conspiracy theory does not have much explanatory power. There is ALWAYS someone who stands to benefit from any recommendation or practice. That does not mean that those who benefit are actively hiding information on harms and risks from everyone else.

True to the principles of wootastic “journalism”, Margulis concludes the post with the seemingly innocuous call for “more research.” But we cannot and should not waste time “researching” connections that have no basis in science. If we did, we could spend a lot of time “researching” whether the moon is made of green cheese or whether clouds are made of marshmallows. The call for “more research” is just away to add gravitas to what are often ridiculous claims. We do not need to “research” every wacky idea that vaccine rejectionists devise and our refusal to “research” those ideas without basis in science or logic is not a sign that someone is hiding something.

The key point is that what passes for “reasoning” among wootastic journalists like Margulis is not reasoning at all. It is nothing more than wild accusations, logical fallacies and conspiracy theories. There is no more reason to take seriously the idea that ultrasounds cause autism than there is to take seriously the idea that attachment parenting causes autism.

It’s almost as if homebirth advocates are trying to advertise their moral bankruptcy. They couldn’t care less how many babies die at homebirth, why they die at homebirth and who pretends to be a midwife.

I suppose I shouldn’t be surprised since this is a crowd that has spent years desperately hiding (or when exposed, ignoring) the hideous homebirth deaths rates in Oregon, Colorado and in MANA’s own database. Homebirth midwives have always valued their freedom to “practice” over the lives of innocent children, but this is a new low, even for them.

I’m referring of course to the case of Rowan Bailey. She allegedly represented herself as a licensed midwife even though she uncredentialed and unlicensed. She has been jailed for allegedly presiding over an intrapartum death at homebirth that occurred in July. *Initially it appeared that she allegedly presided over a second intrapartum death in February, but the newspaper has issued a correction stating that the death occurred in July and was reported to the police by the State Medical Board on February 7. In addition, she was arrested last month for prostitution. What are other homebirth midwives doing in response? They’re raising money to “free” her, of course.

Over they years I have written about dozens of preventable homebirth deaths involving mind boggling incompetence on the part of homebirth midwives. Inevitably homebirth advocates parachute in to the blog to insist that the midwife in question was a “rogue” midwife and not representative of homebirth midwives as a group. It appears that you cannot be more of a “rogue”than Rowan Bailey, yet I have seen no midwifery organization, no midwives and no “birth workers” of any kind calling for her to be investigated, and if warranted, held accountable for malpractice.

Quite the opposite, in fact. A fundraising campaign has been launched on her behalf:

Wednesday, March 27, 2013, a friend, teacher, mentor, and fellow midwife, Rowan Bailey, as we know and love her was arrested for murder in Asheville, NC. North Carolina prohibits the practice of midwifery by traditional community midwives and CPM’s

In case you were wondering, they couldn’t care less what she did, who was hurt, and whether her actions led to the deaths:

At this time, the details of the case are not available until we have more input from Rowan’s attorney.

It doesn’t matter what happened. All that matters is the issue of human rights:

The way we birth is a HUMAN RIGHTS issue and we must embrace it with compassion, love, and responsibility.

Wrong! The right  of a baby who begins labor alive to be born alive may be a human right. There is no human right to represent yourself as a midwife when you are uncredentialed and unlicensed. There is no human right to get your birth junkie fix while letting babies suffocate to death. There is no human right to escape accountability for actions that hurt others. It is morally grotesque to pretend that there are any such human rights.

Bailey has no shortage of supporters. Here’s a look at the Twitter feed soliciting support:

The behavior of these supporters is nothing short of disgusting. They’re raising money to “free” an uncredentialed, unlicensed “midwife” who is charged with misrepresenting her qualifications to parents, presiding over a homebirth death, and who was arrested for prostitution, without making an attempt at, indeed without even calling for an investigation of any kind. Why? Because they think their “freedom” to entertain themselves at births and get paid for it is more important than whether babies live or die.

We can thank these supporters for one thing, though. They have made it crystal clear that they are morally reprehensible in addition to being unfit to care for pregnant women. Rowan Bailey is an object lesson in why North Carolina should never license homebirth midwives. They are ignorant, dangerous and utterly unconcerned about whether babies live or die.

Bailey’s supporters should be ashamed of themselves, but that’s not likely. If you’re willing to ignore dead babies, then you’ve already broadcast the fact that you have no shame.

Poor Jennifer Margulis!

It’s getting tougher and tougher to be a homebirth blogger. It’s fine if you restrict the comments on your blog to only those who know as little about science, statistics and childbirth as you do. You can dazzle those people with any nonsense that you care to fabricate. But when you are hawking your book, you have to interact with the rest of the world. And the people in the rest of the world are so mean, so hateful, so lacking in basic decency that they have the unmitigated gall to demand … actual evidence.

What’s a homebirth blogger to do when confronted with evidence that doesn’t support her position? Standard operating procedure in the homebirth community, which Margulis faithfully followed, is to offer a stupid excuse, and she outdid herself by offering one of the stupidest. When confronted on her recent post (When Obstetricians Hate Homebirth Midwives, Birth Becomes Less Safe for Everyone) with the recent statistics from Oregon that planned homebirth with a licensed midwife has a death rate 9X higher than term hospital birth, Margulis responded with this gem:

Amy, Oregon has some of the safest best homebirth stats in the country IF YOU DON’T COUNT PORTLAND…

Having made a complete fool of herself, and completely incapable of rebutting my claims, Margulis has retreated to a pity party on her Facebook page:

I’m used to be flamed and hated, but some of these comments are so nasty and personal that I think they go too far. I need advice from more experienced bloggers: do I allow the hate comments to continue (that’s what I’m leaning towards) or do I turn the comments off?

What’s “hateful” about the comments? Apparently it’s “hateful” to demand that someone support her factual assertions with actual facts. Apparently it’s “hateful” to question a journalist with a PhD in literature on whether she has the qualifications to write about obstetrics, science and statistics. Apparently, for homebirth advocates, just like for junior high school girls, it is “hateful” to dare to disagree.

Here’s a little unsolicited advice for Margulis:

In the world of grown ups, it is not hateful to disagree with someone or to demand proof for their assertions. If you want to put yourself out there as a defender of the safety of homebirth, you damn well better be prepared to support your positions with actual facts. And if you can’t support your position (and you can’t), instead of whining, start questioning your beliefs.

Exactly how many babies have to die preventable deaths at homebirth, Jennifer Margulis, before you manage to wrap your head around the fact that you are wrong? Ten? A hundred? A thousand? Or is it more important to you to hold on to cherished beliefs than to care whether babies live or die?

Addendum (3/30/13): Apparently whining isn’t enough to prevent those “hateful” people from insisting that if you publish a book, you ought to be able to defend your claims.

Henceforth Margulis intends to employ the professional homebirth advocate’s most important tool, the ability to make dissent disappear by deleting or banning it.

“Any future comments on this thread that do not show respect towards myself and other commenters will be deleted, and the commenter will be blocked from commenting on this blog in the future.”

Why do professional homebirth advocates reflexively reach for the delete button, and, if available, the ban button, when confronted with dissent? I suspect there are three reasons:

1. It is vital for their advocacy (and I suspect for their fragile self-esteem) to create a space that doesn’t simply reinforce their beliefs, but makes it look like no one believes anything else. Dissent simply cannot be tolerated.

2. They are incapable of addressing the criticism.

Most professional homebirth advocates are aware at a certain level that they don’t have science on their side. They readily vomit up bibliography salad, but they don’t analyze (or, in many cases even read) the citations they offer.

Margulis could have acknowledged her mistakes and corrected them, but that would have required two things she apparently cannot tolerate: actual research into the topic she’s babbling about and intellectual honesty.

3. They are afraid of letting their readers think for themselves.

If they had even a fraction of confidence in their own claims and/or a modicum of respect for the fact that their readers are intellectually capable of drawing their own conclusions, they wouldn’t merely let dissent stand, they would welcome it. By defending their claims against those launched by critics, they could strengthen their case that homebirth is safe. But they are exquisitely aware that they lack the knowledge base and the intellectual ability to defend the safety of homebirth. Most importantly, they are well aware that the dissenters are often right and they are wrong.

Here’s the link for the full size printable version. Feel free to distribute it to friends and legislators.

https://dl.dropbox.com/u/27713670/Real%20midwives%20and%20homebirth%20midwives.jpg

Addendum: The original version had a typo (of course!) so I have replaced it with a corrected version.

Logic has never been the strong point of homebirth advocacy. That’s not surprising, since the central premise, that giving birth at home attended by a pretend “midwife” is as safe as giving birth in the hospital, defies both common sense and basic fact. Therefore, I’m used to goofy, illogical excuses from homebirth advocates confronted with appalling death rates.

Apparently desperate times call for desperate measures, however. Homebirth midwifery is entering a period of desperate times because homebirth midwives can no longer hide their hideous death rates. States are starting to collect the statistics on planned homebirth attended by licensed midwives and the results are nothing short of appalling. In Colorado, licensed homebirth midwives have a perinatal death rate more than double that of all hospital birth in the state (including premature babies). Most recently, the Oregon homebirth death rates have come to light. Planned homebirth with a licensed homebirth midwife in Oregon has a death rate 9X higher than term births in the hospital.

I brought up this point in a the comment section of the latest post by homebirth advocate Jennifer Margulis. The post is entitled When Obstetricians Hate Homebirth Midwives, Birth Becomes Less Safe For Everyone and it is the usual amalgam of mistruths, half truths and outright lies favored by all homebirth advocates. The fundamental problem with the post is that is has the cause and effect relationship entirely backward; obstetricians hate homebirth midwives (to the extent that they think of these fringe “providers” at all) because they are incompetent clowns who have horrifically high death rates.

The post itself is the worst kind of “journalism,” with its unsourced claims (“The government official (who spoke to me off the record)”), ignorance of childbirth (“Doctors in America are trained to believe that birth, even low-risk birth, is dangerous.” A glance at homebirth death rates confirms that even low risk birth IS dangerous), and outright lies (“Most American obstetricians have never even seen an unmedicated childbirth when they finish their residencies;”).

When I challenged Margulis to defend that lie, she could not. Then I moved on to the heart of the issue:

I’d also like to know why Ms. Margulis fails to acknowledge the hideous death rates at planned homebirth with licensed homebirth midwives in Colorado (4x term hospital birth) and Oregon (8x higher). No less an authority than Judith Rooks CNM MPH publicly testified that Oregon homebirth midwives are not safe providers.

And Margulis responded with the stupidest excuse for homebirth deaths I have ever heard:

Amy, Oregon has some of the safest best homebirth stats in the country IF YOU DON’T COUNT PORTLAND…

Duh. Homebirth is apparently very safe if you just remove the dead babies from your calculations. And what reason does Margulis provide for removing Portland from the calculations? None, of course. She hoping that homebirth advocates are stupid enough to be persuaded by that inane excuse, or, worse still, perhaps she actually believes that it is a valid excuse.

My response:

You’re joking, right? That has to be one of the most inane excuses I have ever heard. Of course Portland has most of the deaths; it has most of the homebirths. You can’t exclude it no matter how much you’d like to pretend that you can…

Homebirth midwives are not professionals. What kind of professionals, when confronted with an appalling death rate at their own hands, try to hide it and make absolutely no effort to improve their education and training? Homebirth midwives are lay birth junkies who lack the education and training of ALL other midwives in the first world. Their hideous deaths rates are evidence of their gross incompetence. Why are you defending them?

Margulis reponds with a nonsensical non-sequitur:

Good question. If you ask Marsden Wagner, MD, a perinatologist and perinatal epidemiologist from California and director of Women’s and Children’s Health in the World Health Organization for 15 years, he will tell you: Doctors.

And then goes on to share a McCarthy-esque claim

I have a binder of over 1,000 pages of evidence about the safety of out-of-hospital delivery in Oregon. I suspect you will discount this as evidence.

As if we should accept the blustering of “an award-winning travel, culture, and parenting writer” over the epidemiological analysis of Judith Rooks, CNM MPH.

She insists:

Dr. Melissa Cheyney is a careful and scrupulous researcher. I have a high regard for her work…

Melissa Cheyney has behaved with an appalling lack of ethics, professional or otherwise. She has known for YEARS that homebirth midwives in Oregon and across the US have horrific death rates and she has done everything in her power to hide that information.

Margulis concludes:

Let me try one more time: I would like for everyone who cares about birth in America, as you and I both do, to try to remember that we all want the same thing: the best possible outcome for mom and baby, a safe and happy birth, and a good start in life.

Actually, we don’t want the same things. Homebirth midwives and homebirth advocates couldn’t care less about the best possible outcome for mothers and babies. When babies die they ignore them, try desperately to hide the evidence, and make absolutely no effort to improve their education and training or hold responsible midwives accountable. When it comes to homebirth, midwives profit and babies pay the deadly price.

I am used to stupid excuses from homebirth advocates, but when confronted with the appalling death rate in Oregon, Jennifer Margulis offers the goofiest excuse yet. I had expected something more from Margulis than the intellectual equivalent of covering her eyes, putting her fingers in her ears and pretending that the deaths of these babies don’t count. My mistake.

Addendum: Surprise! Jennifer Margulis forgot to mention that her husband James di Properzio is a lay member of Oregon’s Board of Direct Entry Midwifery. Did she get her 1,000 pages of documents from him? Does this mean that she is publicly challenging the analysis of Judith Rooks, CNM MPH? I wonder what Rooks’ would say about Margulis’ pathetic attempt to excuse the hideous homebirth death rate in Oregon, and the blithe dismissal of Rooks’ conclusions.

One of the primary reasons that women give for deciding to breastfeed is the belief that it promotes mother-infant bonding. Breastfeeding advocates have emphasized this point for years. There’s just one problem. There’s no evidence that breastfeeding promotes bonding; it’s just another cruel deception advanced by those who adore competitive mothering.

In Breastfeeding and Maternal Mental and Physical Health, a chapter in the forthcoming book Women’s Health Psychology, Jennifer Hahn-Holbrook and colleagues supply an exhaustive review of the existing literature.

The authors appear to strongly favor breastfeeding, but even they have to admit:

Conventional wisdom holds that breastfeed- ing helps mothers bond with their babies. In fact, one of the most common reasons given by women for wanting to breastfeed is the opportunity to bond with their children. In the scientific literature as well, breastfeeding is often assumed to aid in maternal–infant attachment, without necessarily giving reference to direct evidence. Given this, it is surprising that only a few studies have actually tested this hypothesis in humans, and even fewer have found significant results. Here, we review the small literature on the impact of breastfeeding on the mother–child bond. Briefly, however, we found no studies with evidence that breastfed infants are more securely attached to their mothers than formula-fed infants.

So if there’s no evidence that breastfeeding promotes bonding, where did the idea come from? It came from the same place as most claims of attachment parenting advocates: they made it up. In the absence of any evidence to support the claim, why has it been promoted so vigorously and so widely? For a very simple reason: it raises the stakes in the ongoing battle of competitive mothering.

Competitive mothering, which reaches its apogee in the philosophy of attachment parenting, is all about investing relatively unimportant infant caring practices with major benefits, both real and fabricated, mostly fabricated. Why? Because parenting is hard, and pretending that there are only a few physical tasks that you must perform makes it much easier to feel good about your parenting. It’s hard to parent a child, involving years of caring, worrying, helping and standing by to pick up children when they fall. Even then, you will not find out how you’ve done for nearly two decades, when the child is finally grown, and you may find that your efforts have not produced the results that you would have desired.

How much easier then to pretend that a few relatively meaningless task of infant caring have outsize significance and can determine which mothers are the best mothers. That’s why many attachment parenting advocates cling desperately to attachment parenting behaviors whether they benefit a particular infant, whether they strain a marriage or whether a child has demonstrated that he or she no longer wants to be treated like an infant.

The bottom line is that there is no evidence that breastfeeding has any impact on maternal-child bonding. Despite the lack of evidence, attachment parenting advocates continue to promote this lie because it serves them well in their primary task: building their own self-esteem. Wait, what? You thought attachment parenting was about babies? Don’t be silly. This was never about babies, only about some mothers and their deep seated need to feel superior to other women.

Let’s make one thing clear: homebirth is an industry.

It’s an industry that involves providers charging large fees for services of dubious worth. If you have any doubt that it is an industry, consider the many groups devoted to lobbying on behalf of homebirth providers and the hundreds of thousands of dollars that are spent on lobbying on a variety of issues that always come back to the same thing: more opportunity for homebirth midwives to make more money.

Homebirth advocacy in the US is chiefly about the opportunities for homebirth midwives to profit. Contrary to the morally grotesque “human rights” argument advanced by homebirth advocates, every women in the US already has the right to have a homebirth and already has the right to be attended by anyone she chooses. Homebirth is completely legal and surrounding yourself with friends or even complete strangers of your choosing is also completely legal. The so called “right” to a homebirth is exclusively about the “right” of a layperson to pretend that she is a midwife, and most important of all, her “right” to charge for her services. In other words, homebirth advocacy is about the “right” of homebirth midwives to profit.

When viewed through the prism of profit, all major homebirth issues come into sharp focus.

The issue of licensing of homebirth midwives, which is currently playing out across the country, is at the heart of the drive to profit. The fundamental goal of the homebirth industry is to obtain access to insurance reimbursements. Insurance companies have deep pockets and access to reimbursement would allow homebirth midwives to collect the outrageous fees they already insist upon and to raise their prices even further.

There’s just a teensy, weensy little problem. Insurance companies will not reimburse providers who are not licensed. Therefore, homebirth midwives are seeking licensure, while desperately trying to avoid the standards and accountability that are always a part of licensing.

Licensing is designed to ensure public safety by standardizing education and training requirements, mandating malpractice insurance, mandating continuing education, and ensuring accountability for those who provide substandard care. That represents a serious problem for homebirth midwives who wish to be able to “practice” without any education and pathetically minimal training. Furthermore, the midwifery leadership has made it very clear that they reject the idea of ANY standards of any kind, and will almost never discipline members of their community regardless of how egregious the malpractice and regardless of how many babies die. And malpractice insurance is out of the question for two reasons; first, it cuts into the profits of homebirth midwives and second, malpractice insurers have standards that homebirth midwives have no intention of meeting.

The drive for profit stands behind homebirth midwives’ opposition any and all regulations of their practice standards and their scope of practice. Practice standards limit the number of laypeople who can pretend to be midwives, and therefore limit who can profit. Restrictions in scope of practice, designed to ensure patient safety, limit the pool of women from whom they can profit. Hence the inane insistence that a variety of high risk conditions (breech, twins, VBAC) are “variations of normal.” Acknowledging the greatly increased risk of these conditions would eliminate the possibility of profiting from them, and therefore is forbidden.

How about women and babies? Do they benefit in any way from homebirth midwifery? The answer is mixed. Women gain nothing directly homebirth midwifery that they didn’t already have. Women have the right to a homebirth regardless of the status of homebirth midwives. Women have the right to be attended by these women regardless of the status of homebirth midwives. What’s at stake is the right of these women to be paid and who will pay them. To the extent that licensing of homebirth midwives could lead to reimbursement, it might allow women to hire homebirth midwives without direct cost to themselves.

Who pays? That’s easy to answer. Women pay and babies pay.

Women pay because they are tricked into accepting substandard care from uneducated laypeople who they erroneously believe have been vetted by the state. They are tricked into paying women who call themselves midwives, but are just lay birth junkies who lack even basic knowledge about childbirth. Women risk complications such as hemorrhage and uterine rupture that threaten their own lives and have led to preventable maternal deaths at homebirth. They pay with months or years of bladder and bowel incontinence from unrecognized and unrepaired perineal tears. Women pay money, pain and suffering to finance the fantasies of a group of laypeople who misrepresent who they are and what they can do, with tragic results.

Of course no one pays as much as the babies. As the statistics from Oregon and elsewhere show, homebirth has a dramatically increased rate of preventable neonatal death. Extrapolating from the Oregon statistics leads to the horrific conclusion that nearly 90% of the babies who die at homebirth would have been saved in a hospital.

Homebirth is an industry. It’s an industry devoted to creating and expanding opportunities for lay birth junkies to profit from their fascination with birth. It is an industry that rejects regulations, standards, and malpractice insurance because all of them cut into the profits of homebirth midwives. And it is an industry built of deceiving women and letting babies come to harm.

The homebirth midwifery credential, the CPM, is a trick and it was designed to be a trick. By putting letters after their names, uneducated birth junkies dramatically increased their ability to fool women about their credentials while simultaneously rejecting the standards and accountability that credentialing implies. That’s why the CPM must be abolished and most surely will be abolished. The only open question is how many babies will die before the profits of these poseurs are eliminated.

Homebirth midwives, doulas and childbirth educators like to refer to themselves as “birth workers.” I find it an apt description that betrays the focus of their work and the massive gulf between them and obstetricians.

Obstetricians are health care providers. Specifically, they provide healthcare for women throughout the reproductive years, including, but not limited to: well woman care, contraception, sexually transmitted disease treatment and prevention, pregnancy care, childbirth care, care for pregnancy and childbirth complications, gyncologic cancer prevention, diagnosis and treatment, and care during menopause.

Most obstetricians, in keeping with the ethics of any profession, provide health care regardless of the beliefs of the patient. Moreover, professional ethics requires providing care in keeping with the patient’s needs and values, and disregards the provider’s values and philosophies.

Homebirth midwives, doulas and childbirth educators are not healthcare providers. They evince little or no interest in the health of mothers or babies. They typically provide no care outside of pregnancy, and very little care within pregnancy. Their purpose is to create a very specific type of birth experience, regardless of whether that experience is compatible with the health and safety of their clients. Their purpose is create a birth experience that the provider will enjoy and that will validate the provider’s needs and preferences.

They are the childbirth equivalent of wedding planners with one very important caveat. They will only plan the wedding of their dreams, not the wedding of your dreams.

If the childbirth experience of your dreams happens to coincide with the childbirth of their dreams, they’ll help you. Otherwise, tough luck; you’re on your own. They enter the relationship with primary purpose of entertaining and validating themselves. They are invariably “birth junkies,” women who enjoy the process of birth, and they are “workers” because they want you to pay them for entertaining them, and validating their personal choices. Indeed, some birth workers are quite candid about their lack of interest in the baby.

“Birth workers” ignore the responsibilities of real professionals. They don’t bother with a real education; self-study and a few seminars all the educational and financial investment they are willing to make in their training. They created credentials for themselves without the input of anyone else. They reject oversight of any kind. They reject regulation. They refuse to carry insurance. In short, they begrudge anything that might interfere with their ability to enjoy themselves and profit from the experience.

To give them their due, however, we should acknowledge that although they are ignorant of childbirth, science and statistics, they are brilliant at public relations. Like tobacco companies, they have managed to convince a segment of the public that paying them for their inferior and deadly products is a matter of “freedom” and “human rights.” And like tobacco companies, they are willing to lie and obfuscate in the effort to keep the profits flowing.

Birth workers are an industry, an industry devoted to their own profit and entertainment. They are not healthcare providers and they are not professionals. If you are worried about the health and safety of your baby and yourself, you would hire a healthcare professional, like an obstetrician or certified nurse midwife (CNM), who has years of specialized education and training, and is governed by state regulation and professional ethics that place your well-being above their profit and their preferences.

If, on the other hand, you care more about your experience than about the health of your baby or yourself, feel free to waste your hard earned money on a “birth worker.” She’ll enjoy the experience and hopefully you and your baby will survive it.

Another homebirth death …

From The Experience Project:

I lost my son … in Feb 2013 at 40 weeks 2 days during delivery, the last pushes killed him official cause was cord prolapse. The hospital staff tried everything possible to revive him for 26 minutes after his birth but he never came back to us. He was 8lb’s 6oz and absolutely perfectly beautiful. I miss him, my arms ache, my heart hurts, my breasts ache every time I am around a baby …

… with all the heartache, bewilderment and questioning that accompanies a homebirth loss:

I have gone through feelings of guilt I should have done something different … I do still blame the midwife as I do feel she was not monitoring him very well at all & was very against me going to the hospital & told my husband that all women say that they wanted to go & to ignore me until I insisted screaming for my husband to call 911 when she finally used the fetal doppler to check his heart rate & he was fading fast…

This was our first baby we had no way of knowing how things were supposed to be we were clueless thinking we were going to have this beautiful romantic home birth & instead we live in a nightmare…

The doctors and nurses struggled to save the baby:

His heart stopped almost as soon as I was transferred from the the stretcher to the hospital stretcher as they were trying to position him for an emergency C-section his heart stopped & the Dr said it was to late for a C-section he was wedged to far down in the birth canal. I pushed with everything I had & finally delivered him within minutes …

But it was too late:

He never took a breath I didn’t understand he was dead I didn’t believe them when they told me he was dead. I remember … thinking his little blue body was perfect & beautiful & thinking of course that is what he looked like. I petted his head as the Dr cut the cord & told him “Hello” then he was whisked away to a warming table set up in the room across from my bed & I watched as they were performing CPR the hospital staff did such a good job that he turned pink but his heart never beat on it’s own & he never took his first breath.

I kept saying they made a mistake as I cuddled his lil body I finally asked the Dr if there was a mistake & was he really dead & he told me with tears in his eyes that yes he was dead.

And the midwife?

She said her name was Sharon Kocher however we found out this was not her “real” name I think her “real” name is Victoria I don’t know her last name… I forgive her but I pray every night that God will block her from practicing again.

A bit of internet research revealed this:

Victoria Kocher helped bring tiny Ethan Criswell into the world in the home of his parents, William and Cheryl Criswell.

Despite Ethan’s diminutive size and physical ailments, Kocher said she saw no reason to call the hospital. “He looked tiny, but what’s my judgment of small?” she said. “He breathed good … I saw no risk.”

Ethan, who authorities said was delivered seven weeks premature, weighed less than 3 pounds and suffered from multiple birth defects, was born March 14. He died seven days later at an area hospital.

Ethan’s parents are charged with involuntary manslaughter. Kocher, who said she served as the family’s labor coach, is charged with child endangerment…

The Criswells, through their lawyer, tell a different story. “She represented herself as a licensed practicing midwife,” said attorney Lynn Johnson, who also accused Kocher of lying about her name. “The Criswells knew her as Sharon, not Victoria.” …

Kocher refused to comment on the allegation she used an alias. According to court documents, she has also used the names Sharon J. Kocher, Vicky J. Newman, Victoria J. King and Victoria J. Smith.

According to another news story:

Victoria Kocher later pleaded guilty to a charge of unauthorized practice of midwifery and was sentenced to five years probation.

The mother who posted her story on The Experience Project is left with empty arms and a broken heart:

I have felt that all this is a nightmare that I will wake up from since that day. I think about him everyday, I grieve everyday, I have returned to life in someways it does get easier to cope but I do not think I will ever stop grieving for him.

The Oregon homebirth midwifery statistics, described by Judith Rooks, CNM MPH as “the most complete, accurate data of any US state on outcomes of births planned to occur in the mother’s home or an out-of-hospital birth center,” show that planned homebirth with a licensed homebirth midwife has a mortality rate 800% higher than hospital birth at term. The Colorado statistics, which the licensed homebirth midwives have been desperately trying to hide, shows that planned homebirth with a licensed midwife has a perinatal mortality rate more than 300% higher than all births, including those that are premature. Six years in a row, the CDC statistics have shown that planned homebirth with a non-nurse midwife has a mortality rate 3-7.7X higher than hospital birth. And that number actually undercounts the carnage because babies who were transferred and died in the hospital aren’t included in the homebirth group.

Why is the death rate so appallingly high?

Because licensed American homebirth midwives have absolutely no idea what they are doing or even what they are talking about.

Consider this flourish of homebirth midwifery stupidity, What Makes Birth “Safe”? by Maryn Leister, CPM. I really appreciate the ironic use of scare quotes indicating that apparently even Maryn knows that homebirth at her hands isn’t actually safe; it’s “safe.” I wish I could reprint it all, because it is difficult to believe that anyone could stuff so much mind blowing nonsense into one blog post, so I strongly encourage everyone to read the entire piece. Unfortunately, I can only offer you excerpts.

Maryn starts with the typical brainlessness that passes as “wisdom” among homebirth advocates. In answer to the question what makes birth “safe,” she declares:

To me, it’s a trick question. Because nothing makes birth safer than it already is. In its truest form, of course. The delicate dance of mom and baby, to complete a sequence that is normal and physiological. It’s already “safe”; at least, as safe as anything else that our bodies are programmed to do. Eating, sleeping, eliminating. We don’t question that these processes are “safe” for the average person. They just are. We don’t ask “what” makes them what they are.

So homebirth in nature, with its inherent neonatal mortality rate of 7% and maternal mortality rate of 1%, is “safe” and it can’t get “safer.” But it is not safe (minus the scare quotes), and it only seems safe because modern American obstetrics lowered the neonatal mortality rate by 90% and the maternal mortality rate by 99%, saving the lives of nearly 200,000 babies and 40,000 women each and every year.

Not only is Maryn’s philosophy idiotic, it is ugly, including a large dollop of social Darwinism:

The problem is the thought that birth NEEDS to be made any safer than it already is. But it’s actually not “safe” that many people are after; it’s birth being infallible.

How is this possible? How can we erase the possibility of death from birth? We cannot. They are two sides of the same coin, but this is an uncomfortable subject and not addressed by those that think other humans or special machines can save every baby and every mama. That is not real, and that is not life, unfortunately. There is an element of risk in everything we do in life; whether it’s crossing the street, or driving our car. Birth is no different.

Some babies die and they’re meant to die. That’s why it’s okay that Maryn and the homebirth midwives who advance this philosophy apparently have no obligation to save them. Saving those babies and mothers would require Maryn and her fellow clowns to actually learn something and they don’t care to be bothered with knowledge. In fact, they don’t care to be bothered with standards at all. It’s not just Maryn and her colleagues who think so; the organization that represents them, the Midwives Alliance of North America has enshrined the “no standards” policy in their statement of values and ethics:

A. We value our right to practice the art of midwifery, an ancient vocation of women.

B. We value multiple routes of midwifery education and the essential importance of apprenticeship training.

C. We value the wisdom of midwifery, an expertise that incorporates theoretical and embodied knowledge, clinical skills, deep listening, intuitive judgment, spiritual awareness and personal experience…

It is hardly a coincidence that MANA gives pride of place to freedom of the midwife, and not safety of the mother and baby. In the entire document, they mention safety only once, only vaguely and only in connection with what homebirth midwives “value,” not in connection with any ethical obligation to patients:

We value the physical, psychosocial and spiritual health, well-being and safety of every mother and baby.

Back to Maryn and her nitwittery:

And as far as the WHO is “safe”; well, I don’t think it’s any of our business to determine this for ANY woman. There is no way to quantify risk …

Well, sure, for those who don’t know basic arithmetic there is no way to quantify risk, but people who can add, subtract, multiply and divide have no trouble doing so. In fact, not only is it the business of every healthcare provider to do so, they are REQUIRED to do, because they are required to obtain informed consent. That means that they are responsible for knowing exactly what the best estimates of risk are for any set of circumstances, and for accurately transmitting that information to women. No one can make an informed decision about homebirth if they don’t have information.

Maryn ends and she began, in a wave of blistering stupidity:

Walking with women is the TRUE job of a midwife. And this walk is done differently from midwife to midwife. Ideally, all midwives would be educated, compassionate, up on current research …

Wrong again, Maryn. It’s not the ideal. It’s REQUIRED.

It’s hardly surprising that babies, too many babies, are dying preventable deaths at the hands of these midwifery clowns. It is time to abolish the CPM credential and require anyone who wishes to call herself a midwife to meet that same educational and training standards (including a 4 year university degree in midwifery and extensive in hospital training) required of midwives in ALL other industrialized countries.

Of course, Maryn and her fellow clowns would no longer be able to call themselves midwives and would no longer be able to make money by offering their services. Don’t worry, though, I have a solution for Maryn and her compatriots. If all it takes to make homebirth safe is to pretend that it’s “safe,” all they need to do to make money is pretend that they are making “money.” That way homebirth midwives can make all the “money” that they want, while well educated, well trained healthcare providers can care for babies and mothers and keep them safe.