Alternative health advocates, regardless of their specific beliefs, are all supremely confident about one thing. Whether they are vaccine rejectionists, natural childbirth advocates or aficionados of vitamins and supplements, they are absolutely sure that they are more “educated” than the rest of us. They are not “sheeple” who blindly follow whatever advice their doctor offers; they have done extensive “research” on the internet, and they know things that they did not know before, and that the rest of us do not know at all.

It is certainly true that advocates of alternative health have often done a great deal of reading. And it is true that they have learned lots of new things. But what they fail to understand is that they have acquired pseudo-knowledge. It has the appearance of real knowledge; it uses lots of big words, and it often includes a list of scientific citations. There’s just one teensy problem; it’s not true.

We are surrounded by pseudo-knowledge in everyday life and most of us understand that it isn’t true. Advertisements of all sorts of products, both legitimate and bogus, and filled with pseudo-knowledge. Most of us are quite familiar with the language of pseudo-knowledge:

“Studies show …”
“Doctors recommend …”
“Krystal S. from Little Rock lost 30 pounds in 30 days …”

In the era of patent medicine, claims like these were usually enough to sell a product. But consumers have become more jaded and the language of pseudo-knowledge has become more sophisticated as a result. Consider this explanation of the benefits of acai, the current favorite among the scourge of bogus nutritional claims. According to Dr. Perricone (a real doctor!):

The fatty acid content in açaí resembles that of olive oil, and is rich in monounsaturated oleic acid. Oleic acid is important for a number of reasons. It helps omega-3 fish oils penetrate the cell membrane; together they help make cell membranes more supple. By keeping the cell membrane supple, all hormones, neurotransmitter and insulin receptors function more efficiently. This is particularly important because high insulin levels create an inflammatory state, and we know, inflammation causes aging.

This exerpt is classic pseudo-knowledge. It contains big, scientific words and sounds impressive. It contains actual facts, although they are entirely unrelated to the benefit being touted. It contains completely fabricated claims that have no basis in reality (“they make the cell membrane more supple”) and which, not coincidentally trade on the gullibility of some lay people (if my skin is no longer supple, it must be because the membranes of the individual cells are not supple) and it asserts that “we know” things that are flat out false.

Acai has been little more than a giant credit card scam. After tricking people with such language, unscrupulous advertisers have offered to send a “free supply” in exchange for a credit card number. The acai may or may not show up, but the credit card is billed for a large amount regardless.

Vaccine rejectionists are being scammed in exactly the same way. They are proud that they are not pathetic “sheeple.” Just because their doctor tells them that vaccines are safe, effective and one of the greatest public health successes of all time doesn’t persuade them. They want to “educate” themselves to understand the issues involved.

What might you need to know to evaluate the safety and effectiveness of vaccination? Obviously, you need an understanding of immunology including an understanding of the difference between cellular and humoral immunity, and the formation of antibodies. You need a basic understanding of virology with emphasis on protein coats, and the difference between live, attenuated and fragmented viruses. And of course, you need an understanding of statistics as applied to large populations over long periods of time.

But wait! Science is hard and that’s unfair. Who has the time, the background or the ability to understand the fundamentals of immunology? Not vaccine rejectionists. Their knowledge of virology does not extend beyond a recognition that there are two kinds of “germs,” bacteria and viruses. And their knowledge of math often trails off at basic arithmetic, leaving them no way to understand statistics, even if they bothered to read the relevant texts.

So if they’re not reading about immunology, and if they’re not reading about virology, and if they’re not analyzing statistics, what exactly are they doing when they “educate” themselves? They are simply acquiring a large body of pseudo-knowledge.

Much of what they think they know is flat out false (“the incidence of vaccine preventable diseases was falling before vaccines were introduced”), is anecdotal information proving nothing about anything (“Jenny McCarthy cured her son of autism!”), or goofy conspiracy theories that are ludicrous on their face (the entire medical pharmaceutical complex is aware that vaccines are not safe and not effective but they’re giving them to their own children anyway.).

The natural childbirth crowd, is, if anything, even more aggressive in its ignorance. Vaccine rejection is touted by quacks and charlatans, Playboy bunnies and physicians who stand to profit from encouraging fear of vaccination (Dr. Andrew Wakefied, Dr. Bob Sears). No one in the medical profession takes them seriously; they are professional embarrassments. In contrast, the natural childbirth philosophy is part and parcel of midwifery. Both academic midwifery experts and celebrity midwives spew absolute nonsense and call it “knowledge”.

Barely a week passes on this blog without a lay person parachuting in to boast of all she has “learned” from the likes of Henci Goer, Amy Romano, Barbara Harper or Ina May Gaskin. And don’t even get me started on Ricki Lake; she just makes it all up as she goes along. Their assertions mark them just as effectively as if they had tattooed “gullible” on their forehead.”

“The US ranks poorly on infant mortality.” But that’s a measure of pediatric care, not obstetric care. Perinatal mortality is a measure of obstetric care and the US does very well on that measure.

“The majority of births in the Netherlands are homebirths and it ranks highly on measures of obstetric care.” Only 30% of births in the Netherlands are homebirths and the Netherlands has one of the highest perinatal mortality rate of any Western European country.

“Johnson and Daviss published a paper in the BMJ that showed that homebirth is safe.” The Johnson and Daviss paper is a bait and switch that shows exactly the opposite of what it claims.

“Homebirth is Canada is safe.” Canadian homebirth midwives have far more education, training, supervision and restrictions than American homebirth midwives.

When it comes to homebirth and natural childbirth advocates just about everything they think they “know” is factually false. The same is true for vaccine rejectionists and most other purveyors or advocates of alternative health.

The truth about health education is both simple and stark. You cannot be educated about any aspect of health without reading and understanding scientific textbooks and the scientific literature. Period!

Don’t waste your time perusing the internet. Unless you are willing to confirm what you read on the internet by reading the scientific literature, you can’t be sure you’ve learned anything.

Don’t bother to tell the rest of us that you are “educated” because you’ve demonstrated nothing more than your gullibility. You haven’t acquired knowledge, you’ve acquired pseudo-knowledge, and it marks you as a fool.

This piece first appeared in October 2010.

It’s all the rage on natural parenting websites and forums. Feeling guilty that you can’t provide enough breastmilk for your baby? Just get some from your friends on the Internet.

What could be more natural than sharing human milk?

According to Human Milk 4 Human Babies, a large internet milk sharing network:

Breastmilk, the biologically normal sustenance for humankind, is a free-flowing resource and mothers of the world are willing to share it. Milksharing is a vital tradition that has been taken from us, and it is crucial that we regain trust in ourselves, our neighbors, and in our fellow women…

To that end:

HM4HB has a presence in 52 countries around the world. There are 130 Facebook community pages and over 20,000 community page members. These virtual communities are run by 300 hardworking, multicultural administrators who lovingly and graciously volunteer their time to keep HM4HB continually focused on its mission, vision and values. Through our pages, hundreds of babies in need receive breastmilk every single day.

What could be more natural than sharing human milk?

How about sharing human disease?

The dirty little secret of peer-to-peer sharing of unpasteurized breastmilk is that a surprising amount of it is contaminated with dangerous viruses.

That’s what Cohen, et al. found in Retrospective review of serological testing of potential human milk donors.

Of 1091 potential donors, 3.3% were positive on screening serology, including 6 syphilis, 17 hepatitis B, 3 hepatitis C, 6 HTLV [human T cell lymphotropic virus] and 4 HIV.

The authors did not test random women off the street. They screened women who had volunteered to donate to Mothers’ Milk Bank of San Jose, California, USA, a not-far-profit member of the Human Milk Banking Association of North America who had already passed preliminary testing.

Potential milk donors consent to a multi-level screening process according to HMBANA guidelines and do not receive any payment for donating. In brief, this process begins with screening by their obstetricians for history or signs of significant illness, including hepatitis, syphilis and HIV. After being screened again with a questionnaire similar to that used by blood banks, remaining potential donors have blood samples drawn for serological testing for syphilis, HIV, HTLV-l and 2, hepatitis B and hepatitis C.

Nonetheless:

We found that 3.3% of the women who voluntarily sought to donate milk to our milk bank had positive serological screening tests for syphilis, HIV, HTLV-1 and 2, hepatitis B or hepatitis C.

That does not mean that fully 3.3% of the donor women had the disease. Viral screening tests have a significant false positive rate.

Potential donors to tissue banks in the USA were found to have a 3.16% prevalence of positive screening for the same viral agents, with 1.48% confirmed positive. This screening result is similar to what we report here. Although we do not have results of confirmatory testing, we would expect a similar rate of false positives for our screening.

The true incidence of virus bearing breastmilk would be approximately 1.6%. That’s a remarkably high level of exposure to deadly disease.

The conclusion is obvious:

The use of unpasteurised donor human milk from untested women may pose a significant health risk to exposed infants.

And:

There is a clear need to ensure the safety of all body fluids and tissues, including donor human milk, which may be donated from one person to another. In California, where our bank is located, milk banks are considered tissue banks, and therefore are licensed and regulated as such.

That’s why reputable breastmilk banks pasteurize donated milk. Just as you wouldn’t allow your infant to have a transfusion of blood contaminated with HIV, you shouldn’t allow your infant to have a bottle of breastmilk contaminated with HIV.

Who could disagree with that? You guessed it, certain lactation consultants, like Karleen D. Gribble, BRurSc, Ph.D,

… an Adjunct Fellow in the School of Nursing and Midwifery at the University of Western Sydney. Her research interests include adoptive breastfeeding, long-term breastfeeding, nonnutritional aspects of breastfeeding, child protection and breastfeeding, peer-to-peer milk sharing and models of care for traumatized children… Karleen is active in advocacy and teaching in the areas of infant feeding in emergencies and the marketing of infant formula. She is also an Australian Breastfeeding Association Community Educator.

In the article Milk sharing and formula feeding: Infant feeding risks in comparative perspective?, Gribble acknowledges that human breastmilk can carry deadly pathogens, but insists that efforts to regulate it are culturally driven

… [S]haring human milk between women and babies is perceived to be like sharing other bodily fluids or tissue. Because the practice of transfusion and of organ transplantation are heavily regulated by medicine (and for good reason), a culture that considers human milk to be another regulated bodily substance can only conceive of milk sharing as an activity that occurs rarely and under medical supervision.

But, but, but breastmilk is totally different. Yes, it is … it totally is.

… [H]uman milk is not a medicine and, while it is a bodily fluid, it is not like blood. Human milk is a substance created in one body that is excreted in order to be ingested by another body.

Ooh, ooh, ooh, I know another way it is totally different. It is white!

As such, human milk is sui generis, and it is in part because it is unique that there are such stringent cultural proscriptions on its articulations. Ultimately, the FDA, … and Health Canada seem to be operating under what philosopher Rhonda Shaw has identified as the “Yuk Factor”—responding to the dominant cultural meaning of milk sharing rather than the medical issues associated with milk sharing.

At this point, you are probably thinking that I am making this up. It is difficult to imagine anything  as moronic as insisting that efforts to remove HIV, hepatitis and syphilis from donor breastmilk is culturally driven.

Unfortunately, Gribble is spewing her stupidity to the general public as well as in esoteric journals. An article on the website Megaphone Oz, No use crying over shared milk, includes this:

The risks of milk sharing include the transmission of bacteria and viruses such as CMV, HTLV and HIV. But in Australia, these risks are incredibly rare says Dr Karleen Gribble from the University of Western Sydney’s School of Nursing and Midwifery…

“You’re really at a greater risk of being struck by lightning,” Gribble says.

Apparently Gribble has problems with basic arithmetic as well as basic logic. The risk of being struck by lightening is in the range of 1/1,000,000. The risk of unpasteurized donor breastmilk being contaminated with deadly pathogens is 1.6/100. Therefore, the risk of contaminated breastmilk is 1,000 times greater than the risk of being struck by lightening, but what’s a few zeros among friends.

Yes, sharing breastmilk is totally natural, but so is sharing deadly pathogens. It is only a matter of time before babies begin getting ill and dying from hepatitis and HIV contracted from peer-to-peer donated breastmilk.

After failing to kill her last child at an unassisted homebirth, Rixa Freeze has already begun boasting about taking risks with the life of her next child.

You remember Rixa. She’s a devotee of unassisted childbirth stuntbirth, the ultimate expression of the homebirth philosophy that the greater the risk you take with your baby’s life, the greater the “birth warrior” you are. Rixa, the purveyor of natural childbirth lies. Rixa, the woman who and helpfully posted the birth of Inga on YouTube to inadvertently illustrate exactly how babies die at homebirth.

The video includes the immediate aftermath of the birth when baby Inga became profoundly blue and lost all muscle tone due to lack of oxygen. Ultimately Rixa was forced to provide mouth to mouth resuscitation and fortunately, the baby responded. When I first watched it, I was so angry I was shaking, but then I realized that Rixa has done obstetricians a wonderful favor. She has inadvertently produced the ideal teaching video for demonstrating how and why babies die in increased numbers at homebirth.

Unassisted homebirth functions as a sort of pagan worship offering a human sacrifice to the goddess “Birth.”

“Birth,” like any goddess demands worship. Her power must be acknowledged and her essential goodness must be constantly praised through birth “affirmations.” “Birth” also demands constant evidence of belief. What could possibly be more demonstrative of true faith than the willingness to sacrifice your newborn child? …

You can demonstrate your trust in “Birth” by having a homebirth in a low risk situation, where an unpredictable emergency can kill or maim your child. But women who really trust “Birth” are those who choose homebirth when they are at high risk of killing their babies. That’s why the greatest praise and awe is reserved for women who insist on homebirth with twins, a breech baby or a previous C-section. The bigger the risk, the greater the faith, the higher the praise.

Of course:

It turns out that sacrificing your baby on the altar of “Birth” isn’t the highest form of devotion. That honor is reserved for deliberately placing your next child on the same altar and trusting that the goddess who killed your last baby won’t kill this one, too.

Which brings us to this pregnancy. Shortly after announcing the pregnancy, the boasting begins:

This pregnancy is funny–I really don’t know when to expect this baby! I’m either 16 weeks along or 12 weeks along. After my very early miscarriage, I thought I had another cycle…but it was really light and really short. Nothing like I’ve ever had before. I strongly suspect it wasn’t a cycle at all, but just some breakthrough spotting that happened to come right when I would have had a period…

But…I can only say I’m about 95% sure. There is still the possibility of my baby coming in late April rather than late March! This uncertainty doesn’t bother me at all. In fact, I like not really knowing and not really caring.

It would be easy enough to find out whether she is 12 weeks or 16 weeks along. She could have an ultrasound or even just a simple pelvic exam. But where’s the fun in that? Not knowing offers so many more opportunities to risk the baby’s life and isn’t that what it’s really about: risking the death of your child for bragging rights for yourself?

Think of the possibilities! She could have premature labor and not know it. Nothing increases your birth warrior cred like nearly killing your premature baby by giving birth at home. Or she could settle for the more mundane, but still high risk homebirth of a postdates baby. The very best part of these delicious possibilities? She won’t even know which high risk situation she has chosen until the baby appears!

Rixa’s choice is fundamentally unethical, but then unassisted childbirth is fundamentally unethical. It is a dangerous stunt whose only purpose is bragging rights for the mother. By definition, it involves deliberately risking the baby’s life and the greater the risk, the greater the glory.

I am profoundly grateful that Rixa didn’t kill her last baby and I hope that she won’t kill this one. But if so, it won’t be for lack of trying … and that is incredibly selfish, deeply unethical, and, above all else, appallingly stupid.

I receive many letters of support each week and I appreciate each and every one. This writer gave me permission to reprint her story of “recovery” from natural parenting ideology.

Hello, Dr. Amy.

I am a reader of your blog. I have been reading for 4 months now. I wanted to share a story that I was ashamed to write until now.  I gave birth 4 months ago and I believed in all this false ideology from the natural birth/attachment parenting groups.

When I got pregnant with my first child it was after infertility so I was very happy. I wanted to do the best I could for my child and I like to learn and read from the internet and other people’s experiences. I read about the attachment parenting community online and that led me to certain false beliefs. Like breast is always best and don’t let your baby cry.

I also came to believe natural birth was better in most cases. It didn’t help that I was deathly afraid of doctors and needles due to a past experience. It was on a credible mainstream birth board so I figured it was honest and true. I also asked several people about experiences and a lot of experienced moms I knew who even gave birth in a hospital fully endorsed my decisions and said “good for you” … .

I chose a birth center because they told me it was between a hospital and home and just as safe as the hospital.  I went to all the B.S. meetings and lactivist groups. There were flashes of intuition in my mind what I was doing wasn’t right like I wondered how a big baby would fit through my small pelvis, but, the midwives reassured me that there was no such problem. I also questioned what would happen to an overdue baby once again they said it was okay until 43 weeks.

I was 39 weeks when my labor pains started. I was relieved the labor started before 40 weeks. That night I called the midwife and she said wait for as long as possible at home. Things went bad from there!  I got intense pain. Pain so bad I couldn’t do anything. I called again the next morning at 2 am the midwife said you’re fine come in at 6 am. So I did and I was not dilated at all, yet I had an intense night, I had a feeling something was wrong.

Throughout the day I suffered. It kept getting worse, the pain was in my back and was excruciating, nothing like they had described at the birth center. The midwife kept reassuring me. It was nearing night 2 when they finally said come in at 4am. I came to the birth center they said I was 3 centimeters along. I freaked only 3 centimeters I was in labor over 24 hours; they calmed me and said I would be out by noon and to prepare the room and tub.

From 4 am to almost noon I screamed and fainted and puked in agony. No one should have to suffer the torture I went through. What made it worse was the midwife turned verbally abusive sensing her butt was on the line she lied to me and said pain was in my head and that she gave birth just fine… Then she said she had somewhere to go and I was taking too long.

I was about to drown myself in the tub when I had a revelation… [With] the midwife looking at me and saying, “You’re a coward and a bad mother if you give up on your birth experience. Do you want to go to a hospital and get a c section? Do ya? Huh? Do ya?” right in my face, I snapped. I realized … that I didn’t want to be here I was only here due to societal expectations. I am a spiritual person and in that moment I believe God saved my life and my baby’s.

So I looked at my husband, who was in favor of hospital birth and said quietly at first, “something’s wrong. I want to go to the hospital and get an epidural now.” Then I started screaming as I was led out. “I want an epidural! I want to go to the hospital! God save my baby!”

Long story short I made it. Turns out my baby was big for my pelvis. I had a delivery with the vacuum and even then he barely came out. I had an infection then and was in labor for 48 hours plus. Had I waited longer something might have happened like the women whose stories you tell on your blog. I had the courage to stand up in the moment in question and decide 48 hours was enough and that something wasn’t right… I’m glad my sense, with the help and intervention of God, came back just in time. My son was born healthy my hospital experience was amazing, nothing like they said it would be and I am grateful.

I am ashamed to tell this story because I fully take responsibility for my recklessness. I want others to be educated about my experience and that I would do it all differently if I had to do it over although I am kind of traumatized and am not sure I want to have any more kids. Thank you Dr. Amy as I found your blog while crying over what happened a day after and it simultaneously educated me and comforted me of my PTSD of that incident and to know I wasn’t alone in thinking natural birth was a sham and my pain was real. I lost a lot that day, the ability to enjoy my baby, loss of money, time, my trust in others and I would not recommend birth in a birth center to anyone. I would recommend trusting a good doctor and being prepared for any risks.

Since that day I have now debunked many other myths like only breastfeeding is good. (Due to pain from the birth I could not breastfeed, ironic, huh?) And that you have to cater to your baby’s every whim attachment parenting style. I have learned my lesson … I also fully believe God gave us modern medicine not the voodoo that comes from that movement.

So, I made it out safe and so did my baby but just because I did don’t mean I didn’t take a great risk. I share this story to you Dr. Amy and give you full permission to print it anywhere if you wish, just anonymously … I fully appreciate your efforts on your blog.

From,
Humbled about birth

I’d like to introduce a new term to the lexicon, because sometimes the old terms don’t really capture what I am trying to express. To “sanctimommy” and “quacktivist,” I’d like to add “babyslaughter.”

What is babyslaughter? Simply put, it is the newborn equivalent of manslaughter.

According to an online legal dictionary:

Manslaughter is a distinct crime and is not considered a lesser degree of murder. The essential distinction between the two offenses is that malice aforethought must be present for murder, whereas it must be absent for manslaughter. Manslaughter is not as serious a crime as murder. On the other hand, it is not a justifiable or excusable killing for which little or no punishment is imposed.

Indeed, a number of homebirth midwives have been arrested and charged with involuntary manslaughter in the past. I think it will have a lot more impact if we were more precise in naming it involuntary babyslaughter.

My definition of involuntary babyslaughter is this:

A newborn death resulting from taking of an unreasonable and high degree of risk should be considered criminally negligent babyslaughter.

And similar to manslaughter:

… The existence of a duty is essential. Since the law does not recognize that an ordinary person has a duty to aid or rescue another in distress, an ensuing death from failure to act would not be manslaughter. On the other hand, an omission in which one has a duty, such as the failure of a lifeguard to attempt to save a drowning person, might constitute the offense.

When the failure to act is reckless or negligent, and not intentional, it is usually manslaughter…

The analogy to a lifeguard is particularly apt since midwives are hired for the express purpose of keeping baby and mother safe.

There is no question in my mind that midwives like Lisa Barrett, Gloria Lemay, Karen Carr and Amy Medwin are guilty of babyslaughter. In each case, the midwife had a duty to aid the mother and baby. In each case the midwife took an unreasonable and high degree of risk. In each case the failure to act (or act differently) was reckless and negligent. In each case, the midwife did not intend for the baby to die.

Babyslaughter brings the full import of what these women have done into the light of day.

How about MANA (the Midwives Alliance of North America)? Their actions would never be considered manslaughter in law since they don’t have a legal obligation to individual mothers. However, in my judgment, they have a moral obligation and in that sense they are guilty of babyslaughter.

MANA consistently promotes the taking of an unreasonable and high degree of risk.

MANA consistently credentials women as “midwives” when they lack the education and training required of ALL other midwives in the first world.

MANA consistently opposes efforts to hold midwives accountable for their actions.

Though we might argue about the scientific evidence regarding the risk of homebirth in very low risk situations with highly educated attendants (such as in the Netherlands or the UK), there is no argument that homebirth of breech, twins, and VBAC has no supporting scientific evidence. Nonetheless, MANA consistently backs efforts to expand homebirth midwives’ scope of practice far beyond anything supported by scientific evidence.

MANA does not intend for babies to die at homebirth, but, like the lifeguard who sits idle as someone drowns, MANA makes no effort to prevent those deaths.

And, to my mind, most egregious of all:

MANA is actively engaged in hiding their own statistics that show, beyond any doubt, that homebirth dramatically increases the risk of perinatal death. MANA knows that homebirth kills babies; they are doing everything in their power to prevent women from finding out.

MANA has an ethical obligation to mothers to provide accurate information about the risks of homebirth and they are intentionally and negligently hiding that data, thereby allowing American women to inadvertently choose an unreasonable and high degree of risk to their babies by choosing homebirth.

I understand that legally MANA could never be charged with manslaughter. Ethical charges are another matter altogether and ethically MANA ought to be charged with involuntary babyslaughter, and there is a high degree of likelihood that they would be found guilty.

Homebirth deaths occur with depressing regularity, and I report on them with depressing regularity. The response of many of the loss mothers is also depressingly regular, so it seems necessary to explain some things about the internet.

1. No, your public blog is not private.

A personal blog is like a television channel. If you set up a personal television channel and only a few of your friends watched it, you might think that your channel is as good as private. It’s not; no channel on the regular dial is private. You would have no reason to complain if people other than your personal friends watch the channel. Similarly, you cannot complain when other people find your personal blog, either through Google or through others who have mentioned it.

There are many things you can do if you want your blog to remain private. You can password protect it, you can prevent Google from indexing it or you can host it on a secure server. Unless you do these things, your blog is public. Anyone can read it and anyone quote it.

2. Copyright does not prevent quoting your blog.

Copyright protects your work from someone trying to pass it off as her own or to profit from it. It does NOT prevent others from quoting your work if they attribute it to you and if they link back to you. There are, in fact, explicit protections for quoting work used in specific contexts such as parody and for educational purposes.

Fundamentally, The Skeptical OB exists to educate people, about the dangers of pseudoscience in general, and about the dangers of homebirth in particular. Quoting from homebirth blogs in order to illustrate various claims is well within the purview of an educational blog. It is not illegal to quote a public blog.

3. They call it the World Wide Web for a reason.

On of the most important characteristics of the web is that it is linked together. If you don’t want to be linked to the rest of the web, you can make your blog private (see above), but if it is not private, it will be linked and not just to other websites of which you approve.

4. This blog has a purpose and that purpose is to expose quackery in all its forms, with special emphasis on obstetric quackery.

Yes, I may use humor, and yes I write about scientific papers, news reports, homebirth celebrities, etc., but it is all for the larger purpose of educating the public. If I quote your or link to your blog it is because I feel it has an educational purpose. In that I am like most homebirth bloggers who create blogs to educate others about homebirth. If it turns out that your story actually educates people about the risks of homebirth instead of the benefits, so be it.

5. I am not unmindful of the suffering of homebirth loss mothers.

I don’t for a moment think that homebirth loss mothers suffer less because they decided to have a homebirth. However, I do think that the suffering of babies who are injured and die at homebirth is basically ignored within the homebirth community. There is a lot of pretending and denial surrounding homebirth deaths, from euphemisms like “born sleeping” (sounds a lot better than “born dead”), to “angel babies,” to absurd insistence that they don’t deserve our concern because they would have died anyway. That’s usually a self-serving lie.

I will continue to speak out on behalf of babies who are injured or die at homebirth, NOT because I think they are more important than their mothers, but because I think they are ignored within the homebirth community.

Perinatal death at homebirth is not rare; it is all too common. It may sometimes seem rare because homebirth is a fringe practice but as the practice attempts to enter the mainstream, the number of deaths is rising.

To homebirth loss mothers I say this:

I am very, very sorry that your baby was injured or died. So sorry, in fact, that I want to make sure that it doesn’t happen to anyone else. It is deeply unfortunate that your stories serve as object lessons of the dangers of homebirth, but, in my judgment, the loss is compounded if we refuse to learn from these deaths, if we refuse to acknowledge just how common they are, if we let substandard self-proclaimed “midwives” continue practicing, and if we allow organizations like MANA (the Midwives Alliance of North America) to get away with hiding serial “babyslaugher,” the newborn equivalent of unintentional manslaughter deaths.

Hi! My name is Ima Frawde and I am so glad that you have chosen me to be your guide during your climb of Everest.

The fact that you have chosen me indicates that you are well on your way to mastering the most important skill in climbing the mountain: Trust Everest.

And why shouldn’t you trust Everest? The mountain is totally natural; climbing is totally natural; reduced oxygen concentration at higher altitude is totally natural; and blizzards are totally natural. There’s never a need to fear anything natural.

Other people might choose professional guides to lead them, risking the chance that their climb will be marred by unnatural interventions, but by choosing me, you have demonstrated your faith in lay Everest guides. Lay Everest guides are the only ones specifically trained in low risk mountain climbing. Wait, what? Everest is not a low risk mountain? Don’t be silly. A high mountain like Everest is just a variation of normal.

Professional guides like the Sherpas have been socialized to believe that mountain climbing must involve all sorts of unnatural interventions like parkas filled with synthetic insulation, supplemental oxygen and GPS devices to map your route to the summit. Lay Everest guides understand that a truly empowering climb involves wearing only all natural vests knitted from free trade hemp, breathing only natural air and trusting that you will find your way to the top without a map.

How do I know this? From my training as a lay Everest guide. Before I received by credential (the CPG, certified professional guide) I had to watch 20 groups of people climb a mountain and then I had to climb 20 mountains. Since all mountains are the same, and Everest is just a variation of normal, I climbed a bunch of hills near my house and as we all know, hills are just short mountains.

Plus, since receiving my CPG I’ve led a million, trillion mountain expeditions from my hut at The Farm without a single death. Remarkable, I know! What? Of course I’ll be publishing that data in a peer reviewed mountain guide, just as soon as I find the time.

One of the best things about the Everest climbs that I lead is that they save so much money. We don’t need any of those fancy climbing shoes with crampons attached, no ice picks, and no rope. Sure the Sherpas insist that you need those things, but that’s because they make money by selling them to you.

How long will the climb take? I don’t set arbitrary time limits like those Sherpas who rush through climbs to get to their golf games. I’ve sent expeditions up the mountain (complete with my book Spiritual Mountain-climbing) that still haven’t come back after 5 years. I’m not worried about them because I trust Everest.

You need to prepare yourselves to withstand pressure brought by ignorant but well meaning relatives and friends who will beg you to hire those Sherpas and buy all that unnecessary gear. They may taunt you that you will change your mind about supplemental oxygen once you get to higher altitutes. That’s precisely why we don’t bring any supplemental oxygen so you won’t be tempted to use it and miss the empowering effects of hypoxia.

Don’t worry, though. Your mountain climbing doula will provide tons of support, encouraging you to get beyond the oxygen deprivation to your inner goddess.

I know that you’ve all heard stories of people who have died while climbing Everest. First of all, most of the people who have died DID have the Sherpas and the fancy gear; hardly anyone climbing Everest in hemp vests, without crampons, ice picks or ropes have died. Second, (let’s be honest here) most of the people who died on Everest weren’t meant to survive the climb. Some climbers just die and there is nothing anyone can do about it.

Are you ready? Great, let’s go. And keep in mind that if you survive this climb, next time you can climb Mount Everest unassisted!

Are homebirth deaths rare? It certainly doesn’t seem like it. We have been discussing the homebirth death of one baby  that occurred last month, but in the past few weeks 3 other homebirth deaths were being discussed, as well as a spectacular near miss.

1. A CPM practicing despite a revoked/suspended license presided over the death of a breech baby.
According to The Hudson Reporter:

The 31-year-old woman appeared in Central Judicial Processing court in Jersey City on Friday. She lives in Warren County, according to NJ.com.

According to the story, she was charged with being involved with the practice of medicine while her midwifery license was suspended or revoked.

It is not known for sure whether the child was stillborn or died after birth. An autopsy is being conducted.

The child was a breech birth, according to the story.

2. Another blogger takes responsibility for her decision but believes that group B strep sepsis is not to blame for her daughter’s death.

I still blame myself for the death of my baby. I can’t help but think back over all of the things I could have done differently. I think any parent would go through this but, with me, there ARE people who have blamed me and this makes it worse. My baby was born infected with Group B Strep (GBS). I planned to have her at home under the care of Certified Practicing Midwife (CPM). I also saw a family practice doc regularly for blood work, etc. I understand that having babies out- of- hospital is somewhat rare and controversial in the US but, for someone who is willing to take responsibility for her health and well- being and is willing to educate herself and find a qualified and competent midwife, the outcome is actually as good- if not better than- an in- hospital birth. I must emphasize that one’s midwife MUST be qualified and competent (more on this in another post). She didn’t die from GBS, though, no one knows why she died. She should have recovered from GBS- the doctors expected that she would- but she didn’t. Her newborn metabolic screen came back wacky and she had severe kidney and a heart issue. No one knew why- it was a mystery…

To the mother, those issues may seem unrelated but sepsis can result in shut down of organs like the kidneys and heart.

3. A 38 week stillbirth occurred which may or may not be related to the prenatal care provided by a homebirth midwife.

4. An obstetrician realizes just how incredibly close his newborn daughter came to death at homebirth.

I found the post because the author, Alaska obstetrician Glen Elrod, mentioned me:

…. Yes, I had read the Wax study about homebirth and ACOGs stance on homebirth and the Skeptical OB’s blog trashing homebirth, but I had read countless articles that picked apart the Wax data and called into question the methods and results, showing the flaws and pointing to that homebirth truly was safe…

His daughter was born safely at home, but after the birth, Elrod realized that they had barely dodged disaster and death.

… HOLY SHIT!!! I was mortified to say the least. The placenta! OMG, the placenta. It was the scariest looking placenta I ever remember seeing.

Velamentous insertion. The vessels of the cord start dividing in the membranes. Big, honking vessels unprotected and vulnerable. Plus, a vessel running through the membranes. Anything could have happened…

Anything, meaning unexpected catastrophic hemorrhage and death of the baby in short order, long before there is time for an ambulance to arrive, let alone transfer the mother to the hospital. I wonder if Dr. Elrod is quite so enamored of homebirth now, knowing how close he came to losing his own child.

These 4 cases, plus that of baby Aisley that I posted on Friday demonstrate why homebirth increases the risk of perinatal death. In all 5 cases, the mother was low risk. Yet one had midwives who failed to recognize that the baby died during labor; another lost a breech baby presumably to a trapped head; a third lost a baby to group B strep sepsis; a fourth had an unexplained stillbirth, and a fifth had a rare placental condition (vasa previa) that could easily have led to the death of the baby.

Nearly every study ever done on homebirth actually shows that it increases the risk of perinatal death, and that’s typically homebirth involving only very low risk women. In actual practice, homebirth has hideous perinatal mortality rates as the experience of Colorado, Oregon, and North Carolina midwives shows.

Even MANA (the Midwives Alliance of North America) is hiding their own death rates because they are so high. In addition, they appear to believe that their own followers are gullible enough to be tricked with the same pathetic excuses over and over again.

As recently as yesterday, when I asked on Twitter why MANA is hiding their death rates, they replied with the perpetual inane excuse that they will be publishing it in a peer reviewed journal in mid-2013. As I recall, they have made that promise before. First they were going to publish the death rates in 2009 when the MANA statistics results had been analyzed. Then they stopped mentioning it altogether. When pressed, primarily by me, they announced that they were never going to publish the death rates since it would make midwives look bad, but would share them with “approved” researchers. Now, in response to increasing pressure, they claim that they will publish them next year. You’d have to be a fool to believe that this was anything other than their typical stalling tactics.

Homebirth increases the risk of perinatal death. Even MANA knows it and the seemingly endless parade of homebirth deaths reported on the Web or in news accounts merely confirms it.

Every time I think MANA can sink no lower in its willingness to hide and otherwise ignore the many homebirth deaths that occur at the hands of CPMs, they surprise me and sink lower still. From the Sept 2012 MANA Newsletter:

Michigan midwives have been bearing the brunt of a difficult series of articles and editorials in the state capital’s Lansing Journal. On the heels of that, this new and terrible proposed legislation seemingly has come as a knee-jerk reaction to an unfortunate birth outcome. Long without licensure or legal status on which to rely, Michigan midwives are facing fundamental challenges that demand enormous energy and coordination.

No, it’s not an “unfortunate birth outcome.” The death of Magnus Snyder is a horrific and utterly preventable tragedy. I suppose it stands to reason that an organization that hides its own perinatal death rates would also refuse to accord Magnus the respect of mentioning his name and possibly even pretending to regret the fact that he lost his life.

No, that’s apparently too much to expect from a group of birth junkies who made up a pretend midwifery credential and awarded it to themselves, who reject any form of regulation and who seek licensure for no other reason than to be able to bill insurance companies.

The birth junkies of MANA are currently holding their annual meeting in California. I wasn’t invited to address them personally (surprise!) so I will take this opportunity to address them in writing.

To all the women of MANA, from the cluless individual practitioners on up to the self-serving, immoral leadership, I have this to say:

I sincerely hope that 2012 will be the year that will be remembered as the beginning of the end for MANA and the second class of grossly undereducated and grossly undertrained “midwives” that it represents.

We have a long way to go in following Canada’s example of abolishing the CPM credential as inadequate, but we have made a good start.

Magnus Snyder’s parents filed a multimillion dollar lawsuit in the wake of his death and as a result, the Greenhouse Birth Center is closing and the midwives are filing for personal bankruptcy.

Abel Anderson’s parents included the State of Oregon in the multimillion dollar suit they filed after their son suffered a serious brain injury. That has drawn the attention of Oregon officials who are finding out that homebirth midwives are a major liability.

Michelle Goldberg wrote a widely read, powerful piece in The Daily Beast exposing the dangers of homebirth, the very dangers that MANA is trying so desperately to hide. The response by homebirth advocate Jennifer Block was pathetic in the extreme and utterly dismantled by Goldberg in a follow up article.

An Idaho birth center was slapped with a $5 million verdict and the midwives involved lost their licenses.

The newspapers have carried many stories of homebirth deaths, the most recent only last week when a NJ homebirth midwife presided over a homebirth death despite the fact that her license had been revoked.

Despite desperate efforts on the part of Colorado midwives to hide their hideous death rates, the data was obtained through the Colorado Open Records Act and showed an appalling death rate nearly triple that of the state as a whole.

There are other things that didn’t happen, and will almost certainly come back to haunt CPMs. There were ZERO efforts by CPMs to investigate any of the many homebirth deaths; instead, in some of the more egregious cases, homebirth midwives held rallies to support colleagues who had been arrested, who had presided over multiple deaths, and who had already pled guilty to felonies.

In the 6 years that I have written about homebirth I have never been more optimistic about the prospect of legislating the criminally inadequate CPM credential out of existence. I have never been more optimistic that homebirth midwives will be held responsible for the preventable deaths that occur over and over and over again at their hands. I have never been more optimistic that homebirth midwives will incur massive financial penalties for their horrific incompetence.

Ironically, it is their desire to make more money by popularizing homebirth that will do them in. They were safe so long as they cared only for true believers, but now that homebirth is chosen by ordinary women, it is getting harder and harder to hide the deaths. There are more of them and the parents are not content to pretend that “some babies die.”

Of course, success at holding homebirth midwives accountable won’t bring Magnus back and won’t heal the hole in his parents’ hearts. It is beyond anyone’s power to do that, but as long as I can write I will do my level best to make sure that the babies who are victims of these tragedies will not be reduced to “unfortunate birth outcomes.” They are people; they died unnecessarily, and the incompetent self-proclaimed “midwives” who are responsible for these tragedies must be held accountable.

 

Addendum:Let MANA members know how you feel about homebirth deaths. Use Twitter to demand that these deaths be investigated;  you can remember individual babies by name. Be sure to include #MANA12 in your tweet and it will automatically be added to the Twitter feed created by MANA conference participants.