I have received information that Lisa Barrett presided over a 5th homebirth death. The baby boy was born on May 31, 2009 and died due to brain damage on June 2, 2009. This was the mother’s second homebirth with Lisa Barrett. According to the mother:

Sunday at about 8:40 pm our son Ian was born at home. He didn’t breathe at birth despite our midwives’ best efforts. We went to hospital with him where he was put on a ventilator to help him breathe while they worked out what was wrong with him. Long story short, he had severe brain damage and other problems that the doctors reckon happened weeks or months ago, or even at conception. It’s just one of those things that’s out of our hands. He died this afternoon (Tuesday) at about 2:00 in my arms at Flinders medical centre with Darrin & Caleb in attendance as well.

Several days before the birth, the mother, Melissa, had posted that the baby was breech:

… Mine’s breech at the moment, I’m sure he/she will turn anyway, but even if that doesn’t happen, breech babies still come out in one piece most of the time. And my midwife is a big believer in that too, babies come out whatever way they’re positioned and there’s usually a good reason they chose an ‘unfavourable’ one if it turns out that way.

Barrett presided over the homebirth of the mother’s first child (story on Barrett’s website).

The mother continues to support unrestricted access to homebirth. Only 3 months after burying her baby, she attended a pro-homebirth march protesting proposed regulations for homebirth:

And the legislation, if/when it goes through, will NOT stop me birthing at home next time. Yeah there’s a few publicly funded home birth programs, but I wouldn’t qualify for them now because one of my babies died. Never mind that Ian was damaged long before his birth, and in the unlikely event I had another baby with the same issues, there’s nothing the almighty ‘they’ could do about it anyway…

Of note, Barrett presided over this homebirth tragedy, an apparent breech birth, only a month after the death of Jahli Jean Hobbs, a breech baby who also didn’t breathe at birth and died shortly thereafter.

Lisa Barrett’s ears must be burning. They’re talking about her in the Australian Parliament:

South Australian Deputy Coroner Anthony Schapel recently completed an inquiry into the deaths of two babies in separate incidents in 2007 and 2009.

Former midwife Lisa Barrett attended both births.

South Australian Health Minister John Hill told state parliament on Tuesday he had been advised that Ms Barrett was associated with two other incidents involving home births.

On October 7 this year, a twin died, with the Women’s and Children’s Health Network advising the state coroner of the death.

And on October 12, a woman presented at an Adelaide hospital in established labour.

A baby was born safely, but Mr Hill said the mother then took the newborn home, against medical advice.

The minister said the mother subsequently returned to get medical treatment for the infant, accompanied by Ms Barrett.

Mr Hill said he was also advised that Ms Barrett was involved in a coronial investigation in Western Australia relating to the death of a twin during another home delivery.

But Lisa Barrett has done more than recklessly put at risk and then lose the lives of four babies. She has betrayed the ideals of midwifery itself.

Everyone knows that midwife is the person (usually female) who assists women with childbirth. Where did the word “midwife” come from? According to the Free Dictionary:

… Wife in its earlier history meant “woman,” as it still did when the compound midwife was formed in Middle English (first recorded around 1300). Mid is probably a preposition, meaning “together with.” Thus a midwife was literally a “with woman” or “a woman who assists other women in childbirth.” …

Why would women need assistance with a perfectly natural function like childbirth? Childbirth is inherently fraught with life threatening dangers and having an assistant is known to improve the chances that both baby and mother will survive. A more complete definition of “midwife” would be “a person who provides life saving assistance to women during childbirth.”

Note that the definition is not “a person who helps mothers self-actualize by having the birth of their dreams.” Yet midwives like Lisa Barrett, who repeatedly preside over preventable neonatal deaths, have implicitly rejected the traditional lifesaving purpose of midwifery in exchange for a role as new-age life coach, exhorting women to self actualize through giving birth in a non-traditional setting while defying any notion of safety.

To understand just how much someone like Lisa Barrett betrays the heritage of midwifery, it helps to imagine how an African-American midwife of the 1920’s, or a European midwife of the 1500’s or even an aboriginal midwife of the Neolithic period would have greeted the notion that her job was to facilitate self-actualization through birth. They would have been utterly incredulous, assuming that they even understood the concept of self-actualization as opposed to mere survival.

How did some midwives go so wrong? It’s all about market share.

Midwives had the job description “a person who provides life saving assistance to women during childbirth” to themselves until relatively recently. In the past 100 years, though, it has become apparent that obstetricians can fulfill the primary purpose of keeping mother and baby alive well, and in many situations better than midwives themselves. To retain or gain market share, some midwives chose to diversify by redefining midwifery itself.

Instead of striving to give a healthy baby to a healthy mother, these midwives re-purposed birth as an exercise in self-actualization. They turned birth into an extreme sport whereby women are supposed to derive a sense of power and mastery by completing a self imposed task in the face of tremendous physical exertion or pain. It is a deft bit of marketing; the reality is that, in contrast to completing a marathon or climbing a mountain, any woman can have a baby without pain relief and in defiance of safety precautions and most mothers who have ever existed have already done it (or died trying). No matter; these midwives portray unmedicated birth as a rare accomplishment. The midwife’s role is not to prevent death, but to coach women in this effort to self-actualize.

Looked on from that point of view, the inexplicable becomes understandable. The claim that “a live baby is not the most important thing” is impossible to square with the midwife’s traditional role to prevent neonatal and maternal mortality, but it makes sense if the midwife believes her role is to facilitate maternal self-actualization.

The reckless encouragement to “trust birth” in the face of even the most serious complications makes no sense for the midwife who views her purpose as preventing death, but it makes perfect sense if she think that increased difficulty and risk (higher mountain, longer distance) equals greater accomplishment.

And it also explains the obsessive invocation of “choice” whenever the issue of safety comes up. The African-American midwife of the 1920’s, European midwife of the 1500’s and the aboriginal midwife of the Neolithic period privileged safety over “choice” whereas the midwife/facilitator privileges choice above all else.

Lisa Barrett may be a particularly egregious case of the betrayal of midwifery, but she is far from alone. Contemporary midwifery theorists, particularly those in Australia and the UK have provided the philosophical rationale for abandoning the traditional role of the midwife in preventing neonatal and maternal death for the more appealing (to them) role of midwife as facilitator of self-actualization. The emphasis on “normal birth” as a goal in itself, the rejection of rationalism for “other ways of knowing,” and the insistence that “a healthy baby is not the most important thing” represent a betrayal of the essence of traditional midwifery in which the health and safety of baby and mother is paramount.

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Earlier this week I wrote about how Navelgazing Midwife has come to accept some basic realities about pregnancy and childbirth that many homebirth midwives reject. It has been a long time coming.

I first wrote about Barb Herrera, Navelgazing Midwife, almost exactly 4 years ago when she transferred a patient to the hospital so someone more experienced could suture a tear. She acknowledged that she really didn’t have enough experience to suture a tear or insert an IV.

A few months later Barb described her experiences with two births, one a face presentation where the baby would have died without a C-section, the other a serious shoulder dystocia that could have led to the death of the baby. Then she offered surprisingly harsh criticism for another homebirth advocate who questioned the judgment of a provider:

In ignorance, for there is no other way to say it but this, [she] says that whenever a doctor or midwife speaks about induction because the baby is getting large, that that is a threat. Only someone who hasn’t struggled with a shoulder dystocia – either in her own vagina OR with one in her hands as a midwife – would say something so amazingly dangerous…

Once again, she acknowledged that experience had taught her many valuable lessons.

… [W]hen women came to me and said, “I don’t want you to do anything but sit in another room,” I used to obsequiously tell them I would. It is the woman’s birth, after all, right?

Then, with more experience, I woke up and figured out I couldn’t help if I didn’t monitor the mom and baby. It’s not like I’ll do vaginal exams that aren’t warranted or intrude in women’s space, but there are minimums that I feel are necessary for competent care and I no longer will compromise on that belief…

In fact, she went so far as to declare that the reason to hire a birth attendant is because of her experience:

When I am hired to be someone’s midwife, I am being hired as a consultant. I am being asked to share my experience and knowledge, to utilize my skills – the ones that can save a life…

Over the intervening years, NGM has gained more experience and has changed her views based on that experience. That is what a good practitioner does. In fact, she has come to believe that the experience required for certification or licensing as a homebirth midwife is so deficient that homebirth midwives are not safe practitioner. She has put her money where her mouth is, suspending her practice as a homebirth midwife until such time as she has greater education and experience. She deserves kudos for that decision and for having the wisdom and humility to publicly acknowledge her evolving views.

Yet there is a deeper issue here, one that I would like to ask Barb about. There are people out there who have the requisite experience that Barb knows she lacks. We call them certified nurse midwives. And there are people out there who come out of their training with even more experience than that. We call them obstetricians. Those CNMs and obstetricians could have (and probably did) point out to Barb that she did not have enough experience to be a safe practitioner and she blithely ignored them.

In other words, Barb demonstrated the Dunning-Kruger effect. She had so little knowledge on the topic that she couldn’t fathom how little knowledge she had. She had a dramatically over inflated view of her own education and experience. Simply put, she didn’t know what she didn’t know.

It is a problem endemic to homebirth midwifery and is probably inherent to homebirth midwifery. Homebirth midwives disparage experience because they have so little of it. To acknowledge the value of experience would mean acknowledging their woeful inadequacy as practitioners. So here’s my question for Barb:

Was there anything that anyone could have said to you at the time you embarked on your career that would have brought home to you the absolute necessity of copious experience in becoming a safe practitioner? Put another way: Is there anything anyone could have told you to convince you that you didn’t know nearly enough?

If I had to guess, the answer would be “no” because the philosophy of homebirth midwifery disparages the value of experience. And that’s why the homebirth midwifery credential (certified professional midwife) must be abolished. It was created for, designed by, and administered under the auspices of a group of women who have so little clinical experience that they don’t understand the value of clinical experience.

The CPM is a pretend credential for women who want to call themselves midwives but can’t be bothered to (or don’t have the academic skills to) obtain a college level degree in midwifery. It is a pretend credential for women who don’t want to spend the time and energy necessary to acquire the experience that is mandated for all other midwives in the industrialized world.

But maybe Navelgazing Midwife would disagree. Barb, is there anything we could say to homebirth midwives to wake them up to the fact that their education and training is deficient? Is there any way we could convince them of the value of experience?

Since the subtext of the natural childbirth and attachment parenting movements is the notion of the good mother, it’s worth asking what makes a good mother. My whole approach to writing about childbirth and mothering choices is based my rejection of currently popular beliefs about good mothering. Simply put, I believe that good mothering is about choosing mothering and not about mothering choices.

What does choosing mothering mean? It means actively embracing the role of caretaker, confidante, educator and moral guide that mothering entails. It means worrying, planning, consulting, advising and ultimately letting go. Should he be the youngest in kindergarten or wait a year and be the oldest? How should she handle the playground teasing? Am I expecting too much from him or does he have a learning disability? Should I let her go to the dance with the older boy or is she still too vulnerable?

It is kissing the boo-boos, helping them face the fears, stepping aside and allowing them to talk to the doctor in private when they are old enough. It is piano lessons, orthodontia, religious services, holiday celebrations. It is not responding when she says “I hate you” and never failing to respond when you see him teasing another child. It is hard, damn hard, with weeks or months that leave you exhausted or emotionally drained. Yet it is also rewarding at the deepest level, forging a bond to last a lifetime, launching a happy young adult into the world.

It is NOT about specific mothering choices. Breast or bottle? That’s the mother’s choice and nobody else’s business. Natural childbirth? Irrelevant. Baby wearing? It depends on the baby and on the mother. Extended breastfeeding? Meaningless in the long run (and often in the short run, too).

How do we know a woman is a good mother? We know because she cares; she cares about her children and cares about the impact that she is having on those children. To love a child is to choose mothering. In contrast, specific mothering choices have nothing to do with love, because there is not only one way to express love.

My fundamental objection to the philosophies of natural childbirth and attachment parenting is not the emphasis that they place on mothering; I object to the fact that they privilege specific mothering choices over others. In other words, adherents believe their own mothering choices proclaim their “goodness” and that different choices on the part of other mothers identify them as bad mothers.

Instead of viewing mothering as a service they willingly give their children, they view it as a social identity that they construct for themselves, boosting their own egos in the process. That’s why discussions about NCB, breastfeeding and attachment parenting are such a source of discord between women. None of those discussions are about the best way to mother a baby; they’re all about who is the best mother. It may seem like a trivial difference, but it is an immense difference and most women recognize it as such.

The most critical ingredient of good mothering is love. A child who is loved has the advantage over any other child, regardless of the specific parenting choices his mother made. It’s time to acknowledge and value the power of choosing motherhood and stop judging other women based on mothering choices.

This piece first appeared in June 2010.

Time.com has inaugurated a new section called Ideas, and I contributed a piece:

Myths of Natural Childbirth

Barb Herrera, Navelgazing Midwife, has written a series of posts (starting here) on choosing a competent homebirth midwife. In reading the posts, I am struck by how much of what Barb writes comports with what I have written over the years.

I’ve written that homebirth midwives claiming to be “experts in normal birth” is worse than useless. It’s like a meteorologist claiming to be an expert in good weather. If nothing goes wrong, there’s no need for an attendant of any kind. The entire purpose of a birth attendant is to prevent, anticipate, diagnose and manage birth complications.

Barb writes:

But, whomever you’re hiring, it is someone to, ultimately, save the life of you or your baby if a tragic emergency occurs. When a complication occurs in the hospital, there is a team of folks to do the various parts of the job in keeping someone alive. If there are mistakes being made, there is almost always another person there to see it and fix the mistake. In a homebirth setting, you have one, usually two and sometimes three people to save the life/lives. If each person isn’t meticulous in their abilities, there is no back-up team to take over or even witness the mistake/s. This is why choosing the right homebirth midwife is so important.

I have written repeatedly that there are unanticipated life threatening emergencies that can and do happen at homebirth. If a baby needs an immediate C-section or if a baby is born requiring an expert resuscitation including intubation, the baby will simply die at home. The baby will be long dead before the mother and/or baby can be transferred to a hospital.

Barb writes:

It is vital for women and their families to understand that … there are also emergencies that happen in the home that would be able to be handled better and safer if mom and/or baby were in the hospital. If a massive hemorrhage occurs, there are no blood products in the home, nor are there the plethora of means to control bleeding like they have in the hospital. Also, if a baby needs more than minimal resuscitation, the hospital is the place to be for their teams of personnel trained to attend to such emergencies…

I have written that, contrary to the fantasy of the informed homebirth advocate, it is absurd to place responsibility for assuring the competence of a homebirth midwife on the mother herself.

Barb apparently agrees heartily:

… But, how is the client supposed to learn how to be a midwife and be able to gauge whether the interviewees are wise enough to fulfill their promises during their pregnancy – all the while getting care from these midwives? It’s absurd to expect a woman hiring a midwife to know more than the midwife herself. This is where a standardized education and skills system being in place can not only save the pregnant woman time and energy, but perhaps also her life or that of her baby.

Barb moves on to specific questions to ask a homebirth midwife. The questions appear to be designed to differentiate between midwives who follow scientific evidence and midwives who ignore scientific evidence. Although Barb is careful to state that the mother has a right to choose midwives who ignore scientific evidence, it is pretty clear that she does not think much of such midwives.

For example:

I have written repeatedly about the penchant for evidence-indifferent homebirth midwives to insist that any complication is a variation of normal, when it is not. Breech is not a variation of normal, neither is twins.

Barb writes:

Does she say a breech or twin birth is a “variation of normal”? This lets you know she’s on the liberal side of midwives, more amenable to delivering breeches and twins at home. If she is on this side of the spectrum, you might ask these next questions.

* “What is your experience seeing breeches and twins born?” …
* “Have you ever been the primary with them? How many and what were the outcomes?”
* “How did you learn your breech and twin skills?” …

Pre-eclampsia is a potentially life threatening condition for both baby and mother.

Barb points out:

… If you are looking for a conservative midwife, it’s important to know the standard of care is to transfer a woman if her blood pressure is 130/90 or 30/15 above her normal blood pressures. (If your blood pressure is usually 90/56, by the time your BP is 130/90, you could be having a stroke!) If you’re looking for a more liberal midwife, one who doesn’t stick to the rules of what most (medical folks) would consider safe, then knowing her answers will help you here as well. How she answers gives you pieces of the total picture of the type of midwife she is and a decent guideline-roadmap for a normal and inching-out-of-normal pregnancy and birth.

And pre-eclampsia cannot be prevented or treated with diet:

… I guess if you want to know if she’s still of the belief that the Brewer Diet can help a woman avoid or if she has preeclampsia already, the Diet can relieve the condition, that would be good to know, demonstrating she is not an evidenced-based midwife (some of the links have been locked for privacy), despite her possibly saying she is.

Barb is quite clear that, as I have pointed out in the past, friendship has nothing to do with safe midwifery:

… Choosing a midwife is not just about personality meshes. It definitely has elements of that, but it is not crucial to become friends with your midwife. In fact, I’ve found (through my own many mistakes) that not being friends keeps the boundaries clear and allows for decisions to be made autonomously by both provider and client…

In summary, Barb Herrera, Navelgazing Midwife, acknowledges that

• Homebirth has a very real risk of death.
• if certain life threatening emergencies occur at home the baby will simply die.
• The purpose of a birth attendant is to deal with emergencies.
• Midwives ought to be licensed and meet certain minimum standards.
• Breeches and twins are not variations of normal.
• “Liberal” homebirth midwives are indifferent to scientific evidence or ignore it.
• Friendship has nothing to do with safe homebirth midwifery.

In other words, Barb agrees with me.

There is something perverse and dysfunctional about a philosophy that leads a new mother to react with disappointment to the serendipitous rescue of her baby from certain death.

…I dont feel like I gave birth, I feel like he was taken from me…stolen…I dont feel like a mom yet and when Im not holding him I feel like I should still be pregnant.

According to her post on Mothering.com, that’s how Jasper’s mom feels after the emergency C-section that was necessary to save his life.

What happened?

So, last Friday (the 7th) was my 40 week OB appointment, I went in and got settled in for an NST like usual and Jasper ended up having some heart-rate decelerations which concerned my OB …

I got over there and they hooked me up for the NST for about an hour and Jasper had 9 decels, it was terrifying, at one point his heart rate dropped into the 50s.

At that point I was pretty re-signed to an induction, they took me back to a labor room and my OB came in and started the c-section spiel….

During this time my doula showed up and she was shocked too but she also saw the NST results and was very adamant that a c-section looked like the best option …

Did it turn out, in retrospect, to be a necessary C-section? It certainly did. The next day:

Then they told me he had pneumonia….

Turns out he had aspirated some of the meconium and was having some respiratory distress….they were transferring him to the local childrens hospital later that evening and starting antibiotics.

At the children’s hospital on Sunday:

His doctor came in (way young, way cute and way nice!!) and told us what was going on, he was still on dextrose for his sugars but they were weaning him off of that and onto tube feedings.

He was also on oxygen but NOT on a ventilator so that was a good thing, function wise his lungs were a- OK when it came to that.

His respiratory rate was not OK though due to the fluid in there causing him to have to work harder, they had started antibiotics the night before and expected to continue them for AT LEAST 3 more days, possibly up to 5 depending on what his labs look like tomorrow.

Let’s review:

Jasper, for no obvious or anticipated reason, was profoundly oxygen deprived and on his way to certain death (stillbirth).

Through an incredibly fortunate coincidence, his mother had an OB appointment while he was struggling for life.

The obstetrician noted evidence of fetal compromise, carefully evaluated Jasper with an NST and found that he was losing his battle, even before the stress of labor started.

There is absolutely no possible way that Jasper would have been born alive if labor had been allowed to start and continue naturally.

Jasper’s mother clearly understands all of this. She knows that she came within a hair’s breadth of losing Jasper. And yet:

I don’t know how to explain how I feel in regards to the c-section, I dont feel traumatized really…I know it was medically needed for him and it scares me to think what would have happened to him if I had been more stubborn about trying to induce first.

But I don’t feel like I gave birth, I feel like he was taken from me…stolen…I don’t feel like a mom yet and when Im not holding him I feel like I should still be pregnant.

I’m not sure I’m truly depressed at this point but I am frustrated and sad and feeling defeated and helpless.

Only someone thoroughly indoctrinated in the NCB philosophy that privileges process over outcome would have ever contemplated, let alone concluded, that she had not given birth as if giving birth was synonymous with passing through a vagina.

The reality is that this woman hit the jackpot. Despite having a placenta that could not adequately support Jasper, he didn’t die. Through an amazing stroke of good fortune, while Jasper was in the process of dying, he happened to be monitored. Because of that monitoring, his life was saved. It was an incredibly close call. He was so close to death that he aspirated meconium and would have died anyway after the C-section if it were not for the availability of NICU care.

The NCB emphasis on process as opposed to outcome perverts maternal bonding. Instead of enjoying her new baby and basking in her good fortune, this poor woman is reduced to concluding that she hasn’t given birth, and that she should be upset about it.

In my judgment, the essence of mothering is about providing for your child’s needs to the best of your ability. NCB is perverse to insist that good mothering means following a specific performance that ignores the needs of the individual child.

Jasper “told” his mother in the only way he could that a vaginal birth would kill him. Why should his mother feel bad for responding to his plea to protect him from certain death?

I thought Lisa Barrett was demonstrating contempt when she publicly tweeted during the recently completed Coroner’s Inquest convened to examine her role in two homebirth deaths but that pales in comparison to this.

According to a source, Barrett spent Friday evening at a twin homebirth that resulted in one healthy baby and a second on life support and declared brain dead.

I have asked Barrett to comment but have received no response.

addendum 10/14/11: Yes, Lisa Barrett did preside over another homebirth death. The story has just appeared on Adelaide now, aptly titled Inquest midwife Lisa Barrett helped deliver twins, one which later died:

The State Coroner was notified of the death last week of a newborn twin treated at the Women’s and Children’s Hospital.

The Advertiser has learned that birthing advocate Lisa Barrett presented to the WCH with the child’s mother in a taxi.

She had been assisting the mother with a homebirth when complications arose following the delivery of the first child, after which a taxi was called.

Ms Barrett is already at the centre of a coronial inquest into the deaths of Tate Spencer-Koch and Jahli Jean Hobbs during homebirths in 2007 and 2009 respectively.

Closing submissions in the inquest were heard last month and Deputy State Coroner Anthony Schapel has reserved his findings.

During the inquest the court also heard that a coronial investigation was under way in Western Australia regarding the death of one twin during a home delivery in July this year.

The court heard Ms Barrett attended that birth as a doula, not a midwife, and provided a statement to police.

So Lisa Barrett has presided over at least 4 deaths in the past 4 years!

I’ve been writing for years that homebirth is viewed by a homebirth advocate as a piece of performance art with herself as the star. Everyone, midwives, her partner, even the baby are nothing more than bit players in “her” birth. That’s certainly what Marni Kotak thinks.

Eat your heart out Feminist Breeder. Sure you broadcast your homebirth to the world, and you got a corporate sponsor. Nancy Salguiero has gotten lots more attention because she hired a publicist to promote her homebirth. But now poor Nancy, who hasn’t even had her baby yet, has already been eclipsed by Marni Kotak.

… Enter the very pregnant performance artist Marni Kotak, who is transforming the Microscope Gallery into a home-birth center where she will turn the birth of her baby into a work of art… Starting Saturday, she’ll be making the gallery home as she waits for the contractions to start … Then, she’ll have her baby right there with the assistance of a midwife and a doula…

According to Marni:

… I will be completely engrossed in the act of giving birth before a live audience. I will be focused on delivering my child into the world in the healthiest manner possible, rather than on how I look or what the audience may think. Everything I have learned about the birth process is that the more you surrender your mind and don’t try to control the event, but let your body do what it naturally knows how to do, the better your labor progresses. This, to me, provides for the most authentic performance art situation. And the ultimate creation of this life performance will be a living being!

And if that’s not selfish enough:

… her long-term project “Raising Baby X,” … will document her child’s upbringing “from birth through attending college and developing an independent life,” according to her website.

The child psychiatrists out there are already salivating over the patient Baby X will become. Just imagine the therapy sessions:

X (no longer a baby): It seems like my mother doesn’t care about me as a person. She sees me as nothing more than an extension of herself whom she can manipulate for her own ends.

Child Psychiatrist: It’s hard to argue with that assessment since she has used your for her own self aggrandizement from the moment of your birth, deprived you of privacy, and seen you as little more than an art project.

Marni actually claims:

I am driven to hold onto an authentic personal experience in a world that has essentially become consumed by an unreal hyper-reality.

Riiiight, because pushing out a baby in an art gallery in front of a live audience is the authentic experience of indigenous women in all times and cultures ….NOT!

Marni is ever so superior to those women who are immersed in our media driven culture:

… I do feel that people today are desperately seeking a sense of meaning in their lives. Facebook is feeding into that and providing — what I see as an ultimately empty — solution for a hyper-mediated world… Sadly, the more time that people spend on social networking sites and the less time they spend engaging in authentic experiences with friends and family in the real world — and yes, I do still think there is a real world — the more they are denying the significance of their own human experience. This in turn leads to a greater sense of desperation to find meaning in their lives, more wasted hours on Facebook …

Or perhaps to a desire to give birth in an art gallery in front of a live audience.

… And in giving birth in front of the audience, I am showing them, as in my previous performances, that real life is the best performance art, and that, if our eyes can be opened to it, all of the meaning that we seek is right there in our everyday lives.

Or maybe, like many homebirth advocates, she’s just an attention seeking narcissist.