Last week I wrote about two Idaho homebirth midwives, Colleen and Jerusha Goodwin, who lost their licenses after presiding over 3 homebirth deaths in less than a year.

Both midwives have had their licenses suspended. They deserve far worse. There is not a single mitigating factor in any of these 3 deaths. All three involved gross malpractice as well interfering with transport and lying by the midwives.

These women should be in jail. But, in the world of homebirth advocacy, a pile of dead bodies is nothing more than an inconvenience. Predictably, homebirth advocates are rallying in support of these midwives.

I thought that the situation was appalling. Now comes word that there was a FOURTH incident that occurred in 2008 and resulted in an infant with a profound brain injury due to lack of oxygen. The Goodwins have just settled the resulting lawsuit for $5 million.

According to OregonLive:

Two midwives have agreed to a $5 million settlement with a couple who sued them for medical malpractice after their baby suffered permanent brain damage, an attorney said Monday.

Coleen Goodwin and her daughter, Jerusha Goodwin, reached the agreement to avoid a jury trial, said Eric Rossman, attorney for Adam and Victoria Nielson. The trial had been set to begin on Monday in Boise.

The Goodwins, who own a birthing center in Meridian, Idaho, had their licenses to practice midwifery suspended last month after three babies died. The cases that led to their suspensions were separate from the Nielson’s claim.

The Nielsons said their daughter was born without oxygen at The Baby Place in June 2008, leading to permanent brain damage.

“If we had to go to jury trial today, I think a jury verdict would have reflected what they stipulated, if not more,” Rossman said shortly after the agreement was reached.

It’s unlikely that the parents will ever see any money from the settlement.

Rossman said it’s likely that the Goodwins will seek bankruptcy protection.

Whether or not they receive money, the Nielsons have accomplished something extremely important. They have succeeded in holding homebirth midwives accountable for their negligence. The have made sure that these birth criminals are not free to devastate other families. And they have alerted the public to the dangers of homebirth.

I’ve said it before, and I’ll say it again, the biggest mistake that homebirth midwives have made is their attempt to popularize homebirth. The true homebirth believers might be willing to tolerate dead and damaged babies, but average women lulled by lies about homebirth safety will not. They will file complaints; they will sue; they will organize; and ultimately, they will force state governments to respond by regulating these self proclaimed “midwives” out of existence.

I’m looking forward to reviewing the new natural childbirth book by Henci Goer and Amy Romano, CNM when it is release this summer. Thus far I only know the title, and I find it to be quite apt and unintentionally quite revealing.

The book appears to be the next iteration of Goer’s Thinking Women’s Guide to Childbirth. The philosophy behind that title was quite simple: flatter the gullible reader by implying that if you read the book you are “thinking,” as opposed to the rest of the uneducated sheeple who rely on the expertise of their doctors merely because obstetricians have 4 years of college, 4 years of medical school, 4 years of advanced training and thousands of deliveries to their credity. No, “thinking” women trust Henci who has no training in midwifery, no training in obstetrics, no training in statistics and no training in scientific research.

This time Henci has turned away from flattering the reader to conveying her thoughts about birth. The title of the book says is all, Optimal Care in Childbirth: The Case for the Physiological Approach. In one brief phrase, Goer and Romano have managed to convey everything that is wrong with the philosophy of natural childbirth: the fact that more importance is attached to process and the execrable idea that there is an “optimal” way to give birth.

The average reader is not likely to know about the origins of the current NCB catch words “optimal birth” and “physiological birth.” Their history is quite instructive.

As far as I can determine, the phrase “optimal birth” was first popularized by midwives Patricia Murphy and Judith Fullerton in their 2008 paper Development of the Optimality Index as a New Approach to Evaluating Outcomes of Maternity Care.

The optimality index reveals the obsession with process over outcome. As I wrote at the time the paper was published:

… [Murphy and Fullerton] prefer this approach because it deliberately incorporates specific beliefs about what constitutes optimal care. For example, traditional medical studies would consider the birth of a healthy baby to a healthy mother the optimal outcome; the Optimality Index would subtract points from a perfect score because, in their view, having an epidural is a non-optimal outcome.

The following will cause you to lose points on the “optimality index”:

• NST
• biophysical profile
• prescription medication of any kind
• induction
• augmentation
• any medication in labor
• epidural
• continuous fetal monitoring
• directed pushing
• less than 45° head elevation at birth
• perineal laceration

But that’s not even the worst part. The worst part is that any of these events are coded as equivalent to:

• cord prolapse
• severe pre-eclampsia
• eclampsia
• abruption
• shoulder dystocia
• intraventricular hemorrhage
• NEC
• pneumonia
• renal failure
• neonatal seizures
• perinatal death

So if you have an NST, biophysical profile, induction, any medication in labor, an epidural,continuous fetal monitoring, directed pushing, less than 45° head elevation at birth, a perineal laceration and a LIVE BABY your optimality index is 47.

If you have none of those things and a DEAD BABY, your optimality index is 56.

In other words, Murphy and Fullerton are biological essentialists:

The optimality index has two primary explicit motivations and one primary implicit motivation:

First, it is designed to give far MORE weight to process than to outcome; a perinatal death is equivalent to having an epidural.

Second, it is designed to measure how closely a birth adheres to the values of midwives.

Third, it implicitly dismisses the opinion of the mother by assigning it no value at all.

Ultimately, the optimality index tells us nothing about birth, but a great deal about the midwives who designed it and the midwifery organizations who support it: It does not matter very much to them whether the baby lives or dies. Conforming to the ideals of midwifery is very important to them. The mother’s opinion, needs and desires are meaningless.

The phrase “physiological birth” is similarly indicative of the biological essentialism valued by midwives. As Holly Powell Kennedy, president of the American College of Nurse Midwives explained:

I propose that “normal” is commonly used by midwives as a way to describe a process that counters the common and escalating interventions in many birth settings. A more fitting term might be “physiologic”— that which reflects the innate capacity of a woman’s body to reproduce without intervention—and which most women would be able to achieve when left alone to find their strength, and supported as needed in the process.

There you have it: everything that is wrong with the contemporary midwifery obsession with biological wrapped up in two somewhat clumsy sentences.

As I parsed in my analysis of Kennedy’s claim:

1. “commonly used by midwives”

The definition that counts is the one that midwives select. There are no objective criteria.

2. “counters”

The correct views of midwives are oppositional. Whatever is common in current obstetrical practice is to be opposed. Do common practices save lives? Who cares? It’s about the process, not the outcome.

3. “innate capacity”

What is that supposed to mean? Every woman has the “innate capacity” to get pregnant, but that doesn’t mean that she can. Every women has the “innate capacity” to carry a pregnancy to term but that doesn’t prevent miscarriage. Every woman has the “innate capacity” to have a vaginal delivery, but that doesn’t mean that the baby will fit or that the baby will live through the process.

4. “reproduce without intervention”

Ahh, there’s that obsession with process again. And what’s wrong with interventions anyway? It’s as if Kennedy and other midwives oppose any interventions on the principle that they are inherently bad. No attempt is made to discern if the interventions are helpful or even if they are requested by a woman herself.

5. “most woman would be able to achieve”

Would the baby be alive at the end of this achievement? Would the mother be alive? Kennedy doesn’t say. It’s the process that counts, not the outcome.

The title of Goer and Romano’s new book unwittingly reveals the profoundly unscientific, biased and self aggrandizing nature of contemporary natural childbirth advocacy. NCB is obsessed with labeling women, dividing them into those who give birth following the preapproved directives and those who do not. Natural childbirth advocates are obsessed with process; the outcome is virtually irrelevant.

Goer and Romano have written the perfect book for those who are more concerned with their “experience” than whether the baby lives or dies. No doubt those women will eagerly scoop up the book.

However, if your priority is whether your baby lives or dies, or if you reject the idea that women should be judged by the function of their reproductive organs, you should probably pass on this exercise in biological essentialism.

Be sure to check out the comments.

The British press is filled today with the latest installment of findings from the Birthplace Study, Cost effectiveness of alternative planned places of birth in woman at low risk of complications: evidence from the Birthplace in England national prospective cohort study published in today’s edition of the British Medical Journal. Although reporters are faithfully trumpeting the press release claims, the real findings are far more nuanced and far less definitive.

To understand why the Birthplace study does not and could not show that homebirth is more cost effective, it is helpful to look at the more detailed version of the findings available here. But first, we need to understand what “cost effectiveness” actually means.

Obviously any time you provide less care or lower quality care, the cost is going to be reduced. Therefore, homebirth is always going to cost less. The real issue is whether outcomes cost less, more or the same when you provide less care. But the study only looked at short term costs, and as the authors acknowledged, it is long term costs that are potentially enormous.

… With regards to the baby, a change from planned place of birth in an OU [obstetric unit] to a non-OU setting will generate lower costs, but this is accompanied by uncertainty surrounding effects on adverse perinatal outcomes…

That’s because:

The limited time horizon of the study meant that the follow up of outcomes for both mother and the baby did not extend beyond the time period of labour care, or higher level postnatal or neonatal care when this was received. Serious adverse outcomes can result in associated life-long health and societal costs, as shown by the size of damages paid in obstetric litigation cases, which represent a substantial cost to the NHS. Less serious, but more frequent, morbidities associated with labour and birth and its management affect women and babies. Follow up over weeks or longer to monitor recovery, or a future assessment of the outcomes for mothers and babies at a later date, would shed more light on long term cost- effectiveness.

In other words, the study CAN’T tell us about cost effectiveness since it does not take into account the largest costs, the costs of caring for a child injured during birth and the massive costs associated with legal settlements for babies who were injured or died.

There is an additional reason why the Birthplace study cannot tell us if homebirth is cost effective. The study population does not reflect the real world population of women who choose homebirth.

As I wrote back in December:

… The list of study exclusion criteria was far more restrictive than the actual exclusion criteria for homebirth in the UK. Therefore, a substantial proportion of the women who actually had a homebirth were excluded from the study even before it began. Of the 18,269 low risk women planning homebirth at the start of the study, 1346 (7.4%) were excluded from the study despite the fact that they went on to have a homebirth under the auspices of the National Health Service.

The bottom line is that the Birthplace study does NOT, indeed cannot, show that homebirth is more cost effective. All it shows it that among women who meet eligibilty criteria far more strict than the actual criteria for homebirth in the UK, homebirth is cost effective in the short term. Of course, the short term is irrelevant since it is in the long term that the true costs are incurred.

It is my impression that the authors of the Birthplace study really, really, really want to put the stamp of approval on a goverment policy to support homebirth that was approved before adequate safety data were available. In terms of cost effectiveness, however, the results are so restricted as to be virtually meaningless.

It’s difficult to imagine a more perfect example of the moral bankruptcy of professional homebirth advocates than their rush to “support” killer midwives.

In the wake of the preventable death of their son Magnus, Sarah and Jarad Snyder are suing The Greenhouse Birth Center.

You can read the story of Magnus’ birth and death at Hurt by Homebirth, and you can read about the lawsuit here.

As is inevitable in the aftermath of any death at the hands of homebirth midwives, no matter how egregious the malpractice, a Facebook group has been set up to support … no, not the parents who lost a precious infant … but the midwives responsible for the loss.

Among the homebirth celebrities lending their support is Ina May Gaskin. Magnus’ mother Sara has some questions for Gaskin:

Dear Ina May Gaskin:

Could you describe the role of a midwife in your own words, specifically during labor/birth?

How would you define the word “ethical”?

Do you believe that all doctors are ethical? Teachers? Religious Leaders?…Do you believe all midwives are ethical?

Do you believe midwives ever make mistakes?

What do you believe should happen when a midwife makes a mistake?…one that… costs someone his or her life?

What do you believe should happen when a doctor makes a mistake?…one that costs someone his or her life?

Do you believe that lying to cover up mistakes is ever appropriate?

What should happen when a midwife operates outside her scope of practice and purposefully takes on “high risk” birth without informing the parents she is doing so?

Why are families who share their less than perfect experiences demonized instead of helped, or God forbid, listened to in an effort to improve practice?

Do you know ANYTHING about the details of my labor and delivery? The care we did and did not receive? Have we ever corresponded?

Do you have any understanding at all of the confidence and trust we had in our midwives as competent caregivers before this preventable tragedy took place?

How would you define the word “betrayal”?

That’s what our midwives gave to us and that is what you too are doing in supporting them blindly. I am so disappointed, that you wouldn’t better know whom you are supporting and demand better as the leadership in this movement. The biggest regret of my life is ever having trusted a midwife with the well being of my child. How foolish am I to have thought you stood for something more honorable.

Most Sincerely,
Sara Snyder

Sara is much nicer than me. I have only one question for Gaskin:

How dare you reflexively support homebirth midwives without making any attempt to determine whether they are culpable for Magnus Snyder’s death?

I’d be happy to give her a forum on this blog to explain why anyone should take seriously those professional homebirth advocates who are so cynical and morally bankrupt that they think supporting negligent homebirth midwives is more important than whether babies live or die.

Lest you think that Gaskin is the only one, here’s a list of the other morally bankrupt professional homebirth advocates who don’t give a damn whether individual babies live or die:

Barabara Harper
Deborah Pascali-Bonaro
Jennifer Block
Pggy O’Mara
Geradine Simkins
and, of course, serial killer midwife Lisa Barrett.

I’m happy to extend my offer to them as well. How about it, ladies? Please explain to us why anyone should believe that professional homebirth advocates have any commitment to the safety and health of babies when you are so quick to support those who let babies die preventable deaths.

This is an object lesson in why the CPM should be abolished and why homebirth midwives should not be licensed. It makes no difference to them whether a baby lives or dies as long as their income stream is protected.

Lisa Barrett is getting a run for her money. Barrett, an Australian homebirth midwife, has presided over 5 preventable neonatal deaths in approximately 4 years. It only took Jerusha Goodwin and her colleagues at The Baby Place 10 months to rack up 3 entirely preventable neonatal deaths.

How do we know? Back in mid 2010 the state of Idaho decided to license homebirth midwives and creating a reporting process for bad outcome. No sooner did they create a reporting process than they started receiving reports of preventable neonatal deaths resulting from appalling negligence. The news story is here, but only the official documents can detail the true scope of the horror.

Death #1:

ii. On October ll, 2010, Respondent delivered N.H.‘s infant daughter, C.H., at The Baby Place…

iv. During the final stages of labor, C.H.’s fetal heart rate dropped significantly to 60 beats per minute.

v. Shortly after birth, Respondent failed to ensure that C.H.’s umbilical cord was clamped before a student midwife cut it. As a result, C.H. lost a significant amount of blood.

vi. The Baby Place‘s records documenting the birth of C.H. fail to state that C.H. was a nuchal cord delivery or that C.H.’s umbilical cord was not clamped before it was cut, which resulted in significant blood loss.

vii. On October 11, 2010, C.H. was transported by ambulance to the hospital. At the time of her admittance to the hospital. C.H. had “respiratory failure since birth” and “severe” hypoxic-ischemic encephalopathy. Additionally, C.H. had an initial pH of 6.5 with a base deficient of -30. C.H. died on October 25, 2010.

viii. Respondent failed to inform paramedics or physicians that C.H. was a nuchal cord delivery, that C.H.’s umbilical cord was cut before it was clamped, and that C.H. sustained significant blood loss as a result of the failure to clamp the umbilical cord. Additionally, Respondent failed to provide paramedics or physicians with relevant medical records or relevant details regarding the labor and delivery process.

Death #2:

ii. On August 9, 2011, Respondent delivered H.T.’s infant son, O.R., at The Baby Place.

iii. At the time of delivery, 0.R. was at least 42 weeks and one day in gestational age.

iv. Near the onset of labor, H.T. reported having “greenish” vaginal discharge. Additionally, when the spontaneous rupture of membranes occurred, there was meconium in the fluid and 0.R. was not born for another 19 hours.

v. H.T.’s labor was abnomrally protracted, as she was in active labor for approximately 48-and-a-half hours, the infant was at the plus 1 station for approximately nine hours, the pushing phase lasted approximately l0-and-a-half hours …

vi. During the afternoon of August 9, 2011, Respondent instructed H.T. and other midwives at The Baby Place to state that the pushing phase began at 3:00 p.m. despite the fact that H.T. actually started pushing at approximately 10:00 am. and continuously pushed until the time of birth
at 8:40 p.m.

vii. At the time of birth, O.R. was “limp, unresponsive and pale,” had meconium staining around the mouth, and had a heart rate of 80. Respondent then began resuscitation efforts but did so ineffectively, as O.R. was on a flat surface without the head tilted back and the mask was not properly sealed.

viii. The Baby Place waited approximately ll minutes after 0.R, was born to call paramedics.

ix. When paramedics anived at The Baby Place to transport O.R. to the hospital, they determined that he had an APGAR score of 2.

x. Respondent failed to provide a report of O.R.’s condition or progress to paramedics or hospital physicians. Respondent also failed to ensure that H.T. and 0.R.’s records from The Baby Place were transported to the hospital with O.R. Respondent first provided the hospital with the relevant medical records on August 12, 2011 at 4:32 p.m., which was three days alter O.R,’s birth and after O.R. died in the hospital.

xi. O.R. died at the hospital at approximately 3:41 p.m. on August 12, 2011. The autopsy stated that the cause of death was “anoxic brain injury secondary to prolonged vaginal birth complicated by meconium aspiration.”

Jerusha Goodwin’s mother Colleen, also a midwife, presided over death #3:

ii. R.R. is a Type 1 diabetic. Respondent provided care to R.R. without providing R.R. with written notice that she was required to obtain care from a physician for her diabetes as a condition to obtaining maternity care from Respondent. Additionally, Respondent did not obtain a signed acknowledgment fiom R.R. that she had received written notice of this condition for maternity care.

iii. On June 29, 2011, R.R. had flu-like symptoms and had been vomiting and had diarrhea throughout the day. These symptoms continued on June 30, 2011.

iv. During the labor process, the fetal heart rate frequently dropped to below-average levels and even dropped into the 80s. Respondent failed to document these below-average heart rates in The Baby Places’ records.

v. During the labor process, Respondent instructed R.R. to push when R.R. was not fully-dilated.

vi. During the labor process, Respondent provided R.R. with a one-page document explaining Group B Streptococcus (“GBS”), which recommended that “all women be tested for GBS at 35-37 weeks of pregnancy.” R.R. signed the form and waived the GBS test, but later stated that she “had no idea what [she] was signing,” as she was in a great deal of pain and was not provided with an adequate explanation of GBS.

vii. At 1:59 a.m. on June 30, 2011, Respondent called paramedics due to fetal heart rates that had decelerated to dangerous levels in the 80s. When the paramedics arrived at The Baby Place at 2:06 am., Respondent failed to ensure that R.R. was ready to be transported. Additionally, Respondent delayed paramedics from entering R.R.’s room for at least four minutes.

viii. Respondent failed to fully-cooperate with paramedics. She had to be asked questions multiple times before responding and would not provide adequate infomation regarding R.R’s condition. Moreover, Respondent initially failed to state why transport to the hospital was necessary. Additionally, Respondent failed to provide paramedics with R.R.’s medical records from The Baby Place…

xi. R.R. gave birth shortly after arriving at St. Luke’s Boise Medical Center. The infant was pronounced dead at approximately 3:03 a.m. on June 30, 2011.

xii. During the labor and delivery process, Respondent failed to keep complete and accurate records…

xiii. Approximately one year after R.R.’s pregnancy, Respondent asked another midwife to “re-do” R.R.’s labor charts. In or around June 2011, Respondent retrospectively created one page of chart notes from R.R.’s labor.

xiv. Respondent later stated that R.R. was uncooperative during labor and would not allow her to adequately monitor the fetal heart rates.

Both midwives have had their licenses suspended. They deserve far worse. There is not a single mitigating factor in any of these 3 deaths. All three involved gross malpractice as well interfering with transport and lying by the midwives.

These women should be in jail. But, in the world of homebirth advocacy, a pile of dead bodies is nothing more than an inconvenience. Predictably, homebirth advocates are rallying in support of these midwives:

Last night in the rain, about 30 parents of those children staged a rally of support here at KTVB studios. Many said they saw the report and felt compelled to share their positive experiences with The Baby Place.

Tracy Ryan told KTVB she came to the rally to speak for both women currently under investigation.

“This is a stand of support — a stand of support for two midwives in our community who have served these families, and now we are standing to serve them,” Ryan said.

I suppose that it’s fitting though: ignorant, immoral midwives supported by ignorant, immoral followers. That’s the world of homebirth advocacy.

From a letter sent to me by Mindy Wolfe, CPM. I found her commentary to be so powerful that I asked permission to reprint it:

In full disclosure, I was trained in the United States at a “college” of midwifery and then did nearly all of my clinical hours at a maternity clinic in the third world. I was not certified through the PEP process, but instead went from high school to a five month intensive course on basic health care and maternity care (everything from how to remove a tape worm to setting broken bones to suturing to resolving shoulder dystocia to manual removal of placentas to breastfeeding problems) and then spent one year at a charity maternity center in Davao City, Philippines. I then came back to the US and passed the NARM exam and the licensing exam in New Mexico.

Shortly after graduation, I moved back to Indiana, where CPMs are not licensed and midwifery is practicing medicine without a license and a felony. If for no other reason than that I have a young family, (although there are other reasons I’ll outline) the idea of being charged with a felony was enough such that I have never practiced in Indiana. I did, however, have opportunity to meet other women here in Indiana who do practice without a license. These encounters have opened my eyes to how poorly educated, dangerous and deceived most nearly everyone in the homebirth community truly is.

Some examples to further illustrate:

“What would you do in case of postpartum hemorrhage?”
“First, I would make sure the baby was breastfeeding well, then I would ask you to stop bleeding”

“You have a heart murmur and a strange heartbeat, but that’s not uncommon during pregnancy. You should be fine.”

“I prefer to use leeches for postpartum infections, I feel it’s a more natural approach”

“Twins that share the same placenta and same sac are just a variation of normal. It’s just that there are two babies”

I could go on but don’t suppose it’s necessary. For whatever underlying psychological reasons, these women are extremely dangerous practitioners who should be locked away. But, they continue on their sparkly path of destruction and misinformation. I wish it was as easy to call the police about a homebirth midwife as it is to call about the local drug dealer. Both should be out of business, for the sake of the well being of the community.

I did, for a time, work as an assistant to a CNM who provides homebirth services in Central Indiana, but actually ended up leaving, in part, because I feel that she is a reckless health care provider who has a martyr’s complex. Commonly accepted, mainstream medicine is all about the conspiracy, and every one is out to get her.

My last birth with her, the patient lived more than three hours from my house, and I was called to attend her birth alone because the two CNMs who were in the practice at the time were attending a disaster of a birth of mono/mono twins that was previously undiagnosed (the CNM did not require an ultrasound, even though the woman was measuring incredibly large for dates). The CNM’s protocol stated that the patient would not be further than 15 minutes from the hospital, but this woman lived in a very rural area at least 30 minutes from the nearest hospital. I handled her birth without any knowledge of her history (I had never even seen the chart), no medications at all, and an “assistant” who was a former vet’s assistant who had never seen a human birth in person. By grace we did not deserve, the woman’s labor and delivery were largely unremarkable and without incident, but after that point, I could not in good conscience work for this particular CNM any more.

After processing what has become something of an internal moral conflict, I have come to the belief that, with our system as it is, in Indiana, homebirth is not a safe option for anyone. Even the legal options are not well supervised, and any illegal option is the equivalent of Russian Roulette at best. From what I have seen and experienced, I believe that most birthing parents who pursue homebirth think they are doing the best for their families, and most homebirth midwives simply are not educated enough to know what they do not know. It’s dangerous, dangerous business; and if I had an effective platform for disseminating that information, I’d happily put my name on it.

My education, although more extensive than the PEP process that so many midwives use, was insufficient to the task of being an independent health care provider, and that being the case, I do not and will not practice, even if licensure was an option in Indiana. For whatever it’s worth, I took the Hippocratic Oath, too, and hang my hat on “do no harm”. I have come to accept that an extension of my promise to “do no harm” is to not remain silent.

It is axiomatic in homebirth circles that the Netherlands, the country with the highest rate of homebirth in the industrialized world, is a shining example of the safety and benefits of homebirth.

But it’s not and it hasn’t been for a number of years.

In the article Trouble in paradise, Hans Pols, senior lecturer in History and Philosophy of Science, University of Sydney, and a specialist in the study of Dutch birth practices, explains what happened:

It all started in 2003, when a major European study showed that perinatal mortality rates in the Netherlands were among the highest in Europe (10.5 per 1000 births …). After initial disbelief, denial … and criticism of the study’s methodology .., it was concluded that ‘the Netherlands has a problem’…

This startling realization prompted the government to sponsor a number of studies investigating the problem:

In the second quarter of 2010, the results of a large research project commissioned by the Ministry of Health were published. It concluded that the chances of an adverse outcome increase dramatically for women who were transferred to a hospital during delivery. In addition, the researchers noted that 25 per cent of risk factors had not been recognised by midwives, who are responsible for screening for them. Deficiencies in the organisation of care were thought to be responsible: in particular, the lack of communication, coordination and cooperation between midwives and obstetricians.

And:

Later that year, a study [Perinatal mortality and severe morbidity in low and high risk term pregnancies in the Netherlands: prospective cohort study] claimed that babies of women classified as low risk and starting care under the supervision of a midwife, had a higher rate of perinatal death and the same rate of admission to a neonatal intensive care unit when compared to babies of high risk women starting labour under the care of obstetricians. When a woman was transferred from home to the hospital during her delivery, perimortality rates increased almost fourfold…

Ironically, while American homebirth advocates have been (wrongly) touting the Netherlands as a homebirth paradise, Dutch women have reacted to the revelations that midwife care has a higher rate of perinatal death.

Giving birth at home appears to be falling out of favour in the Netherlands. The number of women opting for hospital births is increasing (from 70 per cent ten years ago to 75 per cent today), even though women classified as low-risk are required to pay additional fees…

And it is not just the issue of safety that is propelling them into hospitals:

The main reason is the extensive negative publicity related to homebirth and the availability of pain relief in hospitals. For a long time, both midwives and physicians discouraged pharmaceutical pain relief during labour. Dutch feminists have called for the right of women to pain relief, in particular epidurals, and questioned ‘the ideology of natural delivery and the positive meaning attached by midwives to women’s capacity to deal with pain without pharmacological support.’ Following a 2008 ministerial directive, women should receive pain relief on request …

Pols concludes:

… In the Netherlands, giving birth at home increasingly appears as an archaic procedure, once supported by an overly idealistic belief in the benign powers of nature. Although a great number of recommendations has been made and many plans developed, the amount of actual change thus far is disappointing. The Netherlands is the homebirth paradise no more and few international delegations will be visiting the Low Countries to see how delivery care is organised there.

Meet Abel, a gorgeous toddler who cannot walk, talk or sit unaided as a result of oxygen deprivation sustained at a birth supervised by homebirth midwives.

Abel’s parents believe that the midwives and the birth center at which they worked should be held accountable.

According to the Bend Bulletin

… Kristine and Greg Andrews — on behalf of their son — are suing the state of Oregon, Motherwise Community Birth Center, midwife Nicole Tucker, CPM and midwife Christyn King, CPM for the medical problems they say the baby faces as a result of oxygen starvation during birth.

The lawsuit asks for $25 million in noneconomic damages as well as $22.5 million in economic damages in the form of ongoing medical and therapeutic care and lost wages. It also asks for $3 million in noneconomic damages to Kristine Andrews for the experience she had with her son’s birth…

The lawsuit states no monitoring equipment was used to check the fetal heart rate. Nevertheless, “the fetal heart rate was noted to indicate periodic bradycardia (slow heart rate) and nonreassuring decelerations of the fetal heart rate.”

When born, the infant did not respond to stimulation and did not breathe on his own. He was taken to St. Charles Bend, and 10 days later was discharged with signs of brain damage caused by oxygen starvation from birth.

The baby suffered, among other things, significant brain damage and cerebral palsy.

Abel’s parents have not stopped there:

Finally, the lawsuit alleges the state was negligent.

The Oregon Administrative Rules have a list of “absolute risk factors” for birthing centers. When a risk factor is present, the regulations state a pregnant mother should be transferred to a higher level of care, like a hospital. One of the risk factors is hypertension. The state listed the threshold at a blood pressure of 150/100.

According to the lawsuit, that threshold was “inappropriate and not evidence based.”

The Andrewses allege the state was negligent for several reasons, most notably because of the blood pressure level it lists as a risk factor. The lawsuit also alleges the state didn’t require a mandatory disclosure form … and that it didn’t implement “evidence based standards for the protection of Oregon citizens.”

In my view, this lawsuit, and a similar suit filed in Michigan are just the first shots across the bow. I suspect that, ironically, the ongoing attempt to popularize homebirth and license homebirth midwives is going to end in the abolition of the homebirth midwifery credential, the CPM (certified professional midwife) and reverse the trend to license homebirth midwives.

Before Ricki Lake and The Business of Being Born, and before the Big Push, the national effort to license homebirth midwives, homebirth was a practice restricted to true believers. Sure homebirth dramatically increased the risk of perinatal death, but lawsuits rarely followed in the wake of those deaths. For the true believers, process is more important than outcome, and a few dead babies here or there did not weaken their commitment to privileging the process.

But homebirth midwives got greedy. They wanted access to insurance reimbursement and to more customers. The resulting effort to popularize homebirth has led to women choosing homebirth because they believed the propaganda. They thought homebirth was safe because that’s what homebirth advocacy organization claim, despite their own data that shows that homebirth increases the risk of neonatal death. Indeed, the Midwives Alliance of North America (MANA), the organization that represents homebirth midwives, refuses to release their own death rates.

Parents learned in the hardest way possible about the dangers of homebirth and that homebirth midwives are not honest about the real risks of childbirth, about the fact that the CPM is not accepted by any other country in the first world due to lack of education and training, and that being near a hospital is meaningless in the face of a life threatening emergency.

This new group of homebirth parents were never true believers and they see no reason to protect incompetent midwives and deceitful homebirth advocacy organizations. They intend to hold them accountable.

And that will hopefully mark the beginning of the end for the licensing of homebirth midwives.

Learn more about Abel and the foundation his family set up to support children with cerebral palsy and birth trauma at We Are Abel.

I read this paragraph last night and have been thinking about it ever since.

[They]have built an alternative world of internal legitimacy that mimics all the features of the mainstream research world — the journals, the conferences, the publications, the letters after the names — and some leaders have gained access to policy-making positions. Mixing an environmentally inflected critique of [obstetrics] and Big Pharma with a libertarian individualist account of health has been a resonant formulation for some years now, with support flowing in from both the Left and the Right.

This is a description of vaccine rejectionists, but it applies equally well to natural childbirth and homebirth advocates.

The paragraph appears in the paper The Legitimacy of Vaccine Critics: What Is Left after the Autism Hypothesis? by Anna Kirkland, published in Journal of Health Politics, Policy and Law in October 2011.

In both cases, vaccine rejection and NCB and homebirth advocacy, the paragraph provides a succinct explanation for how and why a movement based on pseudoscience has gained a hold on its followers and why those followers appear impervious to the massive amount of scientific evidence arrayed against their claims. What really resonated for me was the description of the alternate world, for it often seems that NCB and homebirth advocates do inhabit an alternate world that has nothing to do with obstetrics, science or statistics.

As I have written countless times, most of what homebirth advocates think they “know” is factually false, yet they don’t realize it. That’s because their alternate world mimics all the features of the mainstream scientific world.

Consider:

• Journals: The premier journal of the NCB and homebirth communities is Birth, published on behalf of Lamaze International. Although it is technically a peer review journal, it is made up in large part of papers written by editorial board, which includes such luminaries of the NCB and homebirth movements as Eugene Declercq, Marc J.N.C. Keirse, Michael Klein, and Marian F. MacDorman. Birth is where you send your paper if you can’t get it published in a real medical journal, and it carries little influence in the world of obstetrics, as its impact factor of 1.82 attests. For comparison, the impact factor of Obstetrics and Gynecology is 4.39.

  There is also a plethora of non-peer review journals including The Journal of Perinatal Education, another Lamaze production, and Midwifery Today, one of the many facets of the Ina May Gaskin empire.

• Conferences: NCB and homebirth advocates love conferences, ranging from meetings of professional organizations like the Midwives Alliance of North America, through single purpose conferences like The Homebirth Consensus Summit, to festivals of ignorance like the Trust Birth Conference. Unlike traditional scientific conferences where all viewpoints are heard on vigorous disagreements aired, NCB and homebirth conferences are heavily censored to remove dissenting views with the express purpose of creating an echo chamber for non-scientific claims.
• Letters after names: NCB and homebirth advocates try to confer legitimacy on themselves by adding letters after their names. The CPM (certified professional midwife) “credential” is the premier example of a made up designation meant to impress the faithful and to fool outsiders, but there are countless other combinations including LCCE – Lamaze Certified Childbirth Educator, CD(DONA)- certified doula (Doulas of North America), and my personal favorite, CHBE – Certified Happiest Baby Educators.
• Libertarian individualist account of health: Homebirth advocates like to invoke all sorts of made up rights, like the “birth as a human right,” and the “right” to be attended by the provider of one’s choice. Homebirth advocates decry government interference in birth choices, yet, ironically, spend a great deal of time lobbying for government involvement in paying for favored birth choices and providers.

As Kirkland explains about vaccine rejectionists:

[They] share an internally bounded world in which both individuals and ideas enjoy legitimacy, but undercut the groups’ external legitimacy … (emphasis in original)

NCB and homebirth advocates are shocked that their assertions about childbirth are greeted with disbelief and even contempt by mainstream medical practitioners. Their predilection for conspiracy theories leads them to envision a massive conspiracy among doctors and hospitals, and it simply never occurs to them that they exist in an echo chamber which mirrors their own nonsensical claims back to them.

Kirkland asks a question about vaccine rejectionists that can also be asked about NCB and homebirth advocates:

Under what conditions could we imagine leaders reporting back at a later conference that the right study had finally been done and proved them wrong?

When will we see Ina May Gaskin acknowledge that homebirth increases the risk of perinatal death?

When will we hear the leaders of Lamaze International acknowledge that the Fear-Tension-Pain cycle was made up Grantly Dick-Read and has little to no basis in science?

When will Marsden Wagner publicly acknowledge that there does not exist, nor did there ever exist, scientific data to support his assertion of an optimal C-section rate of 10-15%?

The answer to all three, of course, is never.

NCB and homebirth advocates occupy an alternate world of internal legitimacy, which means never having to face dissent, never having to respond to real scientific evidence, and never having to acknowledge that most of what they promote is factually false.