You can’t make this stuff up!

From Tribe de Mama:

Yoni. An all encompassing name for our sacred portal. Vagina, clit, labia, lips, g spot, womb…

A portal of power & wisdom. We are here to help one another birth a new way of being. A new way of honoring. We must take the time to honour our temples, our yoni’s, this sacred portal. A space from which we can tap into our innate power as women.

Really? Really??!!

I nominate this for most nonsense ever squeezed into the space of one paragraph:

[pullquote align=”right” color=”#A76678″]Embrace it, the hair, smell, touch, taste, all of it. Celebrate it in your own unique way![/pullquote]

When we honor our bodies & our wombs we attract lovers who honour us as well on this journey through our awakenings. May we be unafraid of our own power, our own bodies. May we bask in the radiance & pleasure that we so rightly deserve as women in this lifetime. May we heal it for ourselves, for our families, our partners, sisters, children, for the earth. Let us take back & realize our own power.

But what if you don’t feel comfortable with your yoni?

Are there past hurts that have happened? Have you not honoured your body the way you so rightly deserve? Allow the questions to come, allow the answers. Hold space for your own feelings & past experiences. Allow them to come up & know that you are safe.We must heal our womb to allow for the love to pour through us. It is there waiting to heal. Our yoni’s deserve our utmost respect, awe & admiration.

How should you honor your own yoni?

– Yoni Steams
– Giving your moon blood back to the earth
– Using cloths pads, organic cotton, or menstrual cups (Our yoni’s are so sensitive & need to be honoured by anything that touches them)
– Yoni egg
– Gentle & natural products when bathing.
– Not allowing entrance or penetration until you are fully aroused & engorged
– Yoni massage
– Place your hand lovingly there & just allow gratitude for it.
– Embrace it, the hair, smell, touch, taste, all of it. Celebrate it in your own unique way!

Thanks, but no thanks. I live in the 21 Century where a woman’s power is not located in her vagina, but in her mind, her character and her actions.

I wrote yesterday that Monica’s friends insisted that her baby, the 7th baby who died at homebirth last week, died of multiple congenital anomalies. I promised to publicly apologize to Monica if there truly was an autopsy report detailing the anomalies.

Within the past hour, Monica’s friend Cassie Elizabeth forward the fetal death certificate that lists the cause of death as multiple congenital anomalies. It’s not an autopsy report, but it’s good enough for me. Of course it doesn’t tell us whether those anomalies were incompatible with life, but I didn’t stipulate that in my promise to apologize.

Therefore, I apologize to Monica for sharing her baby’s story in a way that implied that the baby’s death was a direct result of her decision to have a homebirth. Homebirth may have been a contributing factor, but the actual cause was the anomalies.

I still consider Monica’s story a cautionary tale.

Congenital anomalies occur in hospital, too, but unless the defect is known to be incompatible with life, doctors don’t throw up their hands and deprive the baby of their best effort to ensure every possible chance at survival. Doctors are as committed to the wellbeing of disabled babies every bit as much as unimpaired babies.

Of course, even if we remove the death of Monica’s baby, that still leaves 6 deaths, hardly a cause for rejoicing.

Nonetheless I hope my apology helps lessen any distress that I may have caused Monica, her family and her friends.

Ruth Rodley feels sorry for herself.

In Saturday’s piece I quoted her brutal dismissal of the 7 babies who died at homebirth last week as “hickups.”

…she is so anti homebirth, that she will find ANY story about homebirth that may have had a little hickup [sic] and totally throw it out of proportion. There may have been a few deaths, BUT please be aware that we know even in the hospital that wouldn’t have been avoided. it was out of anyones control …

Ruth contacted me privately. I offered her the opportunity to write whatever she wanted in response and promised to post it unedited and in its entirety. Ruth declined, declaring that I would find her response in her Facebook group.

Here it is:

There is a lot of stuff going on about me right now so let me clear something up… I didn’t say that dead baby’s were hiccups, I meant that some of the home births just had a hiccup, everything was fine in the end. I also didn’t know this was for the whole country, I didn’t even know about these stories. Of course I don’t want babies dying, I also don’t force mums to have homebirths, I can’t make someone go to the hospital if they don’t want to.

[pullquote align=”right” color=”#43556d”]Just get out of the hospital… go for a walk hand in hand with your man… have a little kissy time.[/pullquote]

There are a few obvious discrepancies between the two posts:

• Ruth acknowledges that she didn’t know about the deaths; despite that she assured women that they were unavoidable.
• Ruth acknowledges that she didn’t know about the 7 deaths; despite that she assured women that there were only “a few.”
• I’ll let you decide for yourselves whether she referred to dead babies as “hickups.”

I want to draw your attention to this phrase:

I also don’t force mums to have homebirths, I can’t make someone go to the hospital if they don’t want to.

It is the all purpose excuse wielded by those who encourage women to risk their babies’ lives … and it’s a lie.

As a commentor on my Facebook page pointed out in regard to homebirth advocates:

Every time they’re cornered on the safety issue they immediately switch over to “it was their choice…”. Yeah, it was their choice – because you told them it was safe, dummy!”

Exactly!

For example, we can see how both Ruth Rodley and Meg Heket attempted to manipulate Rachel, a young woman at term planning a hospital VBAC, less than two weeks ago.

Rachel has been having contractions on and off for days. Heket instructs her:

So say it with me now “when I go to the dr tomorrow I will NOT NOT NOT have any VEs [vaginal exams].”

But Rachel wants to have a vaginal exam to determine her progress. No matter.

Ruth tells her:

well just remember… that even if you had one done and were told you were say 3-4cm… that could totally change by tomorrow. so my thoughts would be, why get one if it might make you feel self doubt, when BOOM you could suddenly be in full blown labour tomorrow of the next day

Rachel details her concerns over the next few days, but is repeatedly assured by members of the group that she should wait for labor to start.

Ultimately she goes to the hospital because of regular contractions and is told that she is 2 cm dilated, whereupon the group members tell her to leave the hospital.

But she doesn’t want to leave the hospital. She feels comfortable there and thinks that the staff is treating her wonderfully. She also loves her OB. No matter.

A fight breaks out in the group with some women insisting that Rachel should leave the hospital because she is increasing the risk of another C-section merely by being there and others saying that Rachel should do what she prefers.

Ruth weighs in with this gem:

ok, istead of going home, just get out of the hospital… go for a walk to help things along, just on’t stay there and keep their fingers OUT of your vagina. it’s only going to increase the chances of infection.. go for a walk hand in hand with your man… have a little kissy time xx

Fortunately Rachel ignored Rodley and stayed. The baby had a deep heart rate deceleration that eventually recovered, followed by no variability on the tracing and decreased fetal movement. Rachel’s doctor recommended a repeat C-section; she trusted him and agreed.

Fortunately.

She could have died. I listened to my heart and my gut and said yes to the section. And she was coated, plastered in meconium. Her lungs, her eyes, her mouth…

Had Rachel listened to Ruth and left the hospital, her baby may very well have died.

What would have happened then? Ruth would have whined that she “can’t make someone go to the hospital,” despite doing everything in her power to keep Rachel from going to the hospital in the first place and then encouraging her to leave when she got there.

Ruth is lying to herself and lying to her followers when she insists that she has nothing to do with the deaths that occur as a result of heeding her advice.

Ruth Rodley knows nothing. Meg Heket knows nothing. They are cuckoo clocks that reliably sound, “Don’t do what your doctor recommends!” at regular intervals despite having no idea of the facts of each individual case. Then when women follow that deadly advice, they blame the women for listening to them.

They have a name for this type of behavior: emotional abuse.

This isn’t about homebirth and it certainly isn’t about babies. It’s about women like Ruth and Meg being “queen bees” in their domain and it doesn’t matter who died as long as they maintain that status.

Rodley and Heket are not alone. There are many others who engage in the same form of deadly emotional abuse because they love the power they have over other women, literally the power of life and death.

They are ignorant, they are self-absorbed and they are not your friends no matter how often they tell you they are.

These women encourage co dependent relationships, defined as:

a type of dysfunctional helping relationship where one person supports or enables another person’s addiction, poor mental health, immaturity, irresponsibility, or under-achievement.

Rodley, Heket and their ilk support relationships that enable their followers’ immaturity, irresponsibility, and poor decision making.

They don’t support; they destroy babies and they destroy mothers’ lives.

And when disaster occurs, do they feel sorry for the women who listened to them?

Oh, no, they only feel sorry for themselves.

 

I have no words to truly capture the ugly narcissism of some homebirth advocates, but apparently they do.

Had this brave little chickie at home 6/1 … And didn’t go quite as planned. She was born unresponsive. No oxygen to her brain for unknown amount of time. Straight to the hospital (I was still naked in the ambulance!) then transferred an hour and half away where my fought [for] her life… Collapsed lung, spiration, heart problems, seizures, brain damage, low blood sugar … Just to name a few! Today she’s doing better than anyone said she would. She’s perfect… Currently only on feeding tube. And guess what… She was 9lbs, 90z and I didn’t tear!!!! And still, i’m glad I had her at home!

I thought that was perhaps the most horrifying thing I had read from a homebirth advocate, but it was immediately followed by this:

Congrats! We too had unexpected complications with one of our births, a severe placenta abruption. He suffered lack of oxygen for an extended period or time and was life flighted in where they cooled him for 5 days. He is now 2 1/2 and has severe spastic quad cp (cognitively unaffected) but we are so glad we had him at home too…

The callousness and self-absorption defies belief.

[pullquote align=”right” color=””]He is now 2 1/2 and has severe spastic quad cp but we are so glad we had him at home[/pullquote]

Meanwhile, some further fallout from my exposure of 7 homebirth deaths in the past week.

First, the moderators of one of the groups that encouraged these women are still flailing around trying to deny what happened.

Meg Heket is the sister of Janet Fraser, who you may remember, let her own daughter die at homebirth and then declared that her daughter’s death was less traumatic than the “birth rape” she supposedly endured during the birth of an older, healthy child.

When asked about the 7 deaths last week, Meg had this to say:

I don’t even know what babies she’s talking about, I’m sorry. She probably doesn’t know either. She just makes stuff up as she goes along. I genuinely think she’s quite unwell to behave in the callous way she does, it’s not normal. Lot’s of people don’t like homebirth, but they don’t use the deaths of babies to further their agenda. Nor do I use the deaths of women and babies in hospitals to further mine. I actually think women are smart enough to make savvy choices for themselves without me scaring the bejesus out of them.

Can you say “projection,” Meg?

Meg thinks women are smart enough to make choices for themselves ONLY when deprived of information about homebirth deaths and disasters. That’s why she and fellow moderators are ruthless in erasing deaths from their groups.

Second, friends of Monica, the mother whose quote I share when describing the 7th homebirth death have vociferously and repeatedly insisted on my Facebook page that the baby died of congenital anomalies, detailed in a autopsy supposedly completed less than 24 hours after the baby died.

That’s certainly a possibility, so I invited the friends to share the report (with names redacted, of course).

Curiously, after dozens of previous comments and insulting memes, every single friend promptly disappeared and has not returned since.

7 babies died at homebirth in one week and additional babies were injured. Each represents a tragedy, but collectively the stories of their deaths may do some good. They appear to have become a tipping point in the world of homebirth. It’s possible to deny the relationship of one homebirth death to the fact that it took place at home. It is impossible to deny that 7 homebirth deaths across the country in the space of only one week is very strong evidence that homebirth kills babies, babies who didn’t have to die.

It is sad that it has come to this.

Thinking about homebirth? Hopefully, the deaths of these 7 babies will make you think again.

Homebirth advocates are panicking. At least 7 babies have died at homebirth in the past weeks.

Although homebirth advocates are excellent at denial, even they are having a tough time explaining this away.

Consider Ruth Rodley, an administrator of one of the most dangerous and notorious homebirth Facebook groups. Here’s what Ruth had to say about the 7 deaths in one week:

…she is so anti homebirth, that she will find ANY story about homebirth that may have had a little hickup [sic] and totally throw it out of proportion. There may have been a few deaths, BUT please be aware that we know even in the hospital that wouldn’t have been avoided. it was out of anyones control …

Really, Ruth? A DEAD BABY is a “hickup” in your view? How can you be so utterly heartless?

[pullquote align=”right” color=””]Really, Ruth? A dead baby is a “hickup” in your view?[/pullquote]

Ruth’s ugly statement gives me an opportunity to expound on the difference between ignorant homebirth clowns like Rodley and real medical professionals.

1. Obstetrics is preventive care.

Just about every test, intervention and procedure is designed to prevent dead babies. We can argue about whether a particular test accurate, whether a specific intervention might be avoided in a specific case, or whether a particular procedure was require in the circumstances. We cannot and should not argue about the value of preventive care.

A woman has the right to forgo hospital birth, just like a woman has the right to ignore a doctor’s advice about smoking, drinking and obesity. But in both cases, what she’s really forgoing is preventive care. Claiming that a baby who dies at homebirth would have died in the hospital is like claiming that the 400 pound woman who smokes two packs of cigarettes a day currently residing in the ICU after her heart attack would have had a heart attack any way even if she hadn’t been an obese smoker. Sure both are theoretically possible, but unlikely.

When you forgo the preventive care that was designed SPECIFICALLY to prevent death during childbirth and then your baby dies, you can’t expect anyone to take you seriously when you claim it would have happened anyway even if you’d had preventive care.

2. Obstetrics is always trying to do better. Homebirth advocates never try to do better.

Doctors and real midwives take bad outcomes very seriously. They are crushed by deaths. They are always trying to do better; that’s why we collect childbirth mortality statistics in the first place. You will NEVER hear an obstetrician or real midwife dismiss a potentially preventable death as inevitable. At the very least, the obstetrics department of the hospital will review the case and offer suggestions for better managment. If the death is the result of a system wide failure, new policies will be put in place. If the death is the result of not acting fast enough, the entire obstetric department will drill on responding faster or a special emergency team might receive extra training as first responders.

Homebirth midwives automatically absolve themselves of responsibility for doing better by pretending that nothing could have been done to change the outcome. There will be no root cause analysis for fear that the root cause is the decision to give birth at home; better not to look than to find that out. There will be no hospital review. There will be no new safety policies because there are NO safety policies at all. No one will drill on preventing future disasters because that would mean that they might have prevented the present disaster.

3. Obstetricians take responsibility. Homebirth midwives and advocates do everything in their power to deny and avoid responsibility for their own actions.

Homebirth advocacy depends on the willful belief of several fundamental fictions: the fiction that childbirth is inherently safe; the fiction that the key to avoiding a bad outcome is “trusting birth”; the fiction that homebirth deaths are always unpreventable.

I wouldn’t want a pilot who refused to take responsibility for a crash; I wouldn’t want an architect who refused to take responsibility for a bridge collapse; I wouldn’t want a doctor who refused to take responsibility for a potentially preventable death. Why would anyone willingly choose a homebirth midwive who will never accept responsibility regardless of the type and magnitude of the disaster that occurred at her hands?

4. Obstetricians will fight fiercely to save your baby and you. Homebirth midwives and advocates will dismiss you and your dead baby as “hickups,” a nuisance to be casually dismissed while proceeding merrily on their way to self-actualization. An obstetrician cares profoundly whether you and your baby survive; a homebirth midwife or advocate couldn’t care less.

Ruth Rodley and her ilk are contemptible creatures whose self-esteem depends on hood-winking other women into risking their babies’ lives and then refusing to accept responsibility when those babies die.

To all those homebirth advocates parachuting in here and on Facebook in a desperate attempt to deny that homebirth isn’t merely deadly, it’s obviously deadly:

Don’t waste your time.

I’m as likely to believe you as I am to believe the 400 pound smoker in ICU who claims her heart attack was unavoidable.

To Ruth Rodley:

Do the babies of the world a favor and shut up! Stop luring women into risking their babies’ lives to boost your self-esteem. Find another hobby like gardening. That way if anything dies as a result of your advice, it will be an expendable plant, not another woman’s precious baby.

And if you have anything to say to or about me, come here and say it so I can publicly eviscerate your desperate lies.

The pace of homebirth deaths appears to be accelerating. When I first started the predecessor of this blog back in 2006, I heard about a few homebirth deaths a year and wrote about every death I heard about. Gradually the pace picked up to one or more a month. Earlier this year I acknowledged that there are so many homebirth deaths that I can no longer keep up with them. As recently as last month I reported on multiple homebirth deaths that took place in the space of 6 weeks (Latest homebirth harvest of death).

Now I’m horrified to report 5 6 7 homebirth deaths in the past WEEK! [Edited after readers of this post shared information about two additional deaths. See below.]And those are only the confirmed homebirth deaths; there may have been more. There were additional cases of injury as well.[pullquote align=”right” color=”#333333″]If 7 dead babies in one week is not enough to convince you homebirth is dangerous, I don’t know what is.[/pullquote]

Why the dramatic acceleration in homebirth deaths?

I suspect part of the increase may reflect the reported increase in homebirths. I am hoping, however, that the dramatic increase in deaths in partly a reflection of the fact that as this blog has become more popular, and as other homebirth safety groups have sprung up, I’m simply receiving more reports than I have received in the past.

In the past WEEK:

DEATHS

1. July 23 Baby Boy C.

Born in a CPM attended birth center. Birth announcement removed from the birth center’s page. Cause of death unknown.

2. July 24 Baby Boy C.

Everyone… Please pray for my friend L…she just delivered her first baby boy this morning and he started having trouble breathing…. they did CPR on him while waiting for the paramedics…. got baby to BGH and airflighted him to SHM NICU…. He’s struggling to survive… his body keeps overheating and he’s had 2 seizures.

Later that day:

PLEASE PRAY RIGHT NOW… He is fighting for his life…. on a cooling pad (bc his body keeps overheating which is causing seizures) and he is on a breathing machine but taking a breath here and there on his own…as well as being “hooked up” to many other things…

July 26th:

Baby C. has an MRI test to medically confirm any brain stem activity but it takes 48-72 hrs for him to go thru the warming and cooling process…. His heart is very strong but that seems to be the only part of his body working on its own…

July 29th (after warming completed)

Last night they received the MRI test results from their doctor. The MRI test confirmed with the other test results… This is very devastating and so very sad and we ask for you to pray for their Comfort…

Baby C. went home to be with Jesus at 11:30 last night.

3. July 25/26 Baby Boy

Unassisted pregnancy, unassisted birth after a previous premature birth at 30 weeks.

A friend:

Our best friend and his girlfriend lost their baby boy during home birth last night. This was their second child. With her first her water broke 10 weeks early and their daughter was a premie. This pregnancy had gone without event but also without any prenatal care. It is her belief that pregnancy is natural and requires no additional monitoring if everything goes well. This is not his belief, but he wasn’t able to convince her and decided to support her choice ultimately.

I do not know any more details at this time…

Another friend:

Prayer warriors, I’m upset by God’s tactics today and it’s really throwing me off. Maybe I just need to share this with you…

Our friends abruptly lost their infant son during labor and delivery this weekend. There are no words you can say when a parent must face the loss of a child. My most eloquent scripture and our entire ability to love seems utterly meaningless, right now. Their hearts have been on mine without wander today.

Our friend who lost her son, she made pregnancy her job. She did countless hours of research into understanding every facet of her job as a mother. I have watched her nurse a preemie to bounding health, their first daughter. She was born for this job, being a mother, and she’s GREAT at it. Why is she asked to shoulder this?

4. July 26 Baby Girl E.

Attempted unassisted homebirth. Stalled at 9 cm. Mother’s friend crowd sourced advice on Facebook. Ultimately transferred to the hospital with a live baby. Baby appears to have died during further labor.

5. July 27/28 Baby gender unknown

Grand multip attempting HBAC. She had had multiple previous successful VBACs. Transferred for abruption. Mother developed eclampsia with seizures. No fetal heartbeat on admission to the hospital. Emergency repeat C-section for a baby that appeared to have been dead for at least an hour.

6. July 26 Baby Girl A

Born at home before noon after what appears to have been an HBAC. Baby immediately transferred to the hospital “due to complications of labor.” Baby died before midnight.

The mother details the first time she was able to see the baby after her hospital transfer:

An eternity passed before I was able to see her, or at least that is how it felt. She had so many wires and tubes and pokes and pricks. I was able to touch her forehead and her hand. We were told she had a cooling cap on her head to cool down her brain. We were told to hope and pray for a seizure, because then we were know there was a least a little brain activity. This was the most absurd thing I have ever been told. I remember being so angry at the doctors for telling me to hope for such a horrible thing, but then it sank in how bad this really was. My daughter had NO brain activity, none. She had machines breathing for her, she would never do that on her own. She wasn’t clotting. She was anemic, acidotic and brain dead.

7. July 30 Baby Boy M

 

Today we delivered our M. He wasn’t breathing and never responded despite all attempts by us or the medical team after transfer. We lost him officially at 3:30…

In addition:

There are two other babies born at home/birth center who are currently fighting for their lives (one with group B strep pneumonia, another baby with a severe brain injury).

If 5 6 7 dead babies in one week is not enough to convince women that homebirth is extraordinarily dangerous, I don’t know what is.

Homebirth is often promoted as a way to save healthcare dollars. No hospital use, no medications, no doctor. Unmedicated homebirth costs a lot less than hospital birth (barring complications, of course). Treatment intensity is lower, interventions are fewer, and the mortality rate is only slightly higher.

In the same spirit of cost savings, I suggest unmedicated home vasectomy with licensed home vasectomists!

Think about it:

There are nearly 500,000 vasectomies performed in the US every year.

[pullquote align=”right” color=””]If women can be birth warriors, men can be incised scrotum warriors![/pullquote]

Is it really necessary to use hospitals, surgi-centers or doctors’ offices for a procedure that is nothing but a snip-snip?

Imagine how much money we could save by doing vasectomies at home!

Is it really necessary to use powerful pain medications and sedatives for something that takes 5 minutes? Pain medications are interventions and everyone knows that interventions are bad. Certainly if women are supposed to endure 24 hours of unmedicated labor at home, men can endure a few minutes of having their scrotums cut. If women can be birth warriors, men can be incised scrotum warriors.

Imagine how much money we could save if we just convince men that the pain of vasectomy is “good pain”!

Is it really necessary to have vasectomies done by urologists? Urologists are specialists in pathological urology conditions and men undergoing vasectomy have no urologic disease. Why not have certified lay people do the job? Vasectomies cost up to $2000. Surely certified vasectomists could do the job for $50 or less.

Imagine how much money we could save!

And what’s up with the extensive training demanded of urologists? Why bother when licensed home vasectomists can start on the job after observing 20 vasectomies performed at home on unmedicated men by other licensed home vasectomists? With such a low upfront investment in training, home vasectomists could make a good living charging only $50 per procedure.

Imagine how much money we could save!

Do we really need follow up sperm counts in order to ensure the procedure worked? A follow up sperm count is yet another intervention, and everyone knows interventions are bad. A follow up sperm count that is greater than zero will inevitably lead to a cascade of interventions to address the problem. Better not to know and just see what happens next.

Think of all the money we would save!

Wait, what?

You think it would be inhumane to snip two little cuts in a man’s scrotum without anesthesia? How can that be when a vasectomy is so much less painful than childbirth? Surely men could be taught to be empowered by the pain of vasectomy, just as women are taught to be empowered by the pain of childbirth.

You think it would be barbaric to entrust cutting into man’s scrotum to a lay person with minimal training? How can that be when vasectomy is so much simpler than childbirth and lots of people think that a lay person is an adequate attendant for birth?

You think it would be wrong to forgo a post op sperm count and risk an unwanted pregnancy? How can that be when an unwanted pregnancy is so much less serious than the death of a baby or mother in childbirth and homebirth advocates think those are acceptable since we are saving money?

Here’s what I want to know:

If no one would tolerate an unmedicated home vasectomy for men on the grounds of cost saving, why is anyone promoting unmedicated homebirth for women as a way to save money?

You may have read about a new Dutch study of homebirth that shows that homebirth increases the risk of neonatal death.

You may have also read the spin, that the risk of homebirth is confined to poor women. This piece in The Washington Post is typical:

The infant mortality rate is also higher in the Netherlands than in European countries with similar medical resources. But as more Dutch mothers have switched in recent years to delivering their babies in hospitals, rather than their homes, doctors have noticed a drop in newborn deaths.

So far, so good.

Researchers wanted to understand why, between 1980 and 2009, the country’s infant mortality rate fell from 4.25 deaths per 1,000 births to 2.42 deaths per thousand births. Over the same period, the share of deliveries in maternity wards swelled from about 61 percent to 73 percent. On the surface, it appeared the home method may simply be riskier for babies.

But the story isn’t that simple. What happened to the women during their home births depended a lot on their income, and relatedly, their access to routine medical care before and after pregnancy, according to a study published this month in the American Economic Journal: Applied Economics…

… [A] poorer woman who preferred a home birth was more likely to encounter tragedy. The 28-day infant mortality rate for them more than doubled, from about 2 deaths per 1,000 births to 5 deaths per 1,000 births.

[pullquote align=”right” color=”#66a018″]The rise in hospital births explains roughly 46–49% of the reduction in infant mortality in the Netherlands between 1980-2009.[/pullquote]

One possible interpretation of the findings of the study is that the danger of homebirth is restricted to poor women, but there is another, far more likely interpretation of the data: homebirth is safe ONLY when nothing goes wrong. Any unforeseen complications double the risk that the baby will die.

The paper Saving Lives at Birth: The Impact of Home Births on Infant Outcomes by Daysal, et al. was written by economists. The math in the paper is probably perfect; however, some of the medical assumptions are problematic.

The basic statistics are incontrovertible: homebirth increases the risk of neonatal death and the recent increase in hospital birth in The Netherlands has been associated with a fall in mortality rates.

According to Daysal, et al.:

Historical data show that 7-day (28-day) mortality declined from 4.25 (5.35) deaths per 1,000 births in 1980–1985 to 2.42 (3.18) deaths in 2005-2009, while the share of hospital births increased from 61.25 percent to 72.06 percent. In addition, using a decomposition … we find that most of the mortality decline between 2000–2008 comes from newborns over 2,500 grams, who are more likely to be low-risk and thus eligible for home births.

This is a critical point. Not only has the neonatal death rate decline in proportion to an increase in hospital birth, but that decline occurred in babies of normal size, suggesting that these were term babies.

Indeed:

Back-of-the-envelope calculations suggest that the rise in hospital births explains roughly 46– 49 percent of the reduction in infant mortality in the Netherlands between 1980 and 2009.

In this paper, the authors looked at all births in The Netherlands from 2000 to 2008. The key finding:

We find that giving birth in a hospital leads to substantial reductions in newborn mortality. We provide suggestive evidence that proximity to medical technologies may be an important channel contributing to these health gains.

That seems pretty definitive, so why is the mainstream media hedging about maternal income?

The study found that the increase in deaths was confined to postal codes with low median incomes. In other words, most of the deaths occurred in poor areas. But that DOESN’T mean that the proximate cause of those deaths is poverty.

In the first place, the authors looked only at addresses, not at actual maternal income. Second, maternal income is likely a proxy for the incidence of complications. It is well known that lower socio-economic status in pregnancy is associated with greater risk of complications. Therefore, a more realistic conclusion is not that homebirth is dangerous for poor women only, but rather that homebirth is dangerous if anything goes wrong. Homebirth is safe only if nothing goes wrong. Once a complication develops, the risk of neonatal death rises dramatically if the baby is anywhere but a hospital.

In fact:

The lack of an impact on the 5-minute Apgar score suggests that the general health of low-risk babies born in a hospital is similar to those born at home shortly after birth. Hence, any mortality reductions from a hospital birth are likely due to the medical care provided after delivery. A hospital birth may reduce infant mortality through various channels, such as the availability of better facilities and equipment, potentially better hygiene or the proximity to other medical services.

As I’ve written many times before, hospitals are like seatbelts; most of the time you don’t need them but wearing them all the time dramatically lowers the risk of death.

The take home message from this paper is NOT that homebirth is safe for wealthy women. The take home message is that homebirth is safe ONLY when nothing goes wrong.

Homebirth is gambling with your baby’s life. You’re gambling that there won’t be any unexpected complications. But if there are complications, your baby is more likely to pay for your gamble with his or her life.

Mariah Sixkiller claims she is a birth feminist.

Birth feminists simply believe in a woman’s right to make empowered choices about her birth experience. We believe a Mom should have evidence-based information about all her birth options, which all too often does not happen. We believe a Mom should be supported through her decision-making process and into the birth experience itself, which all too often does not happen. And we believe every Mom is entitled to her own choice, without judgment, whatever it may be, which all too often does not happen.

Natural childbirth advocates have hijacked “feminism” in the same way that political conservatives have hijacked the flag, and homophobes have hijacked “family.” None of them believe in choices; they believe in one correct choice. None of them believe in evidence; they misuse the term to promote a predetermined agenda. And none of them refrain from judging those who make anything other than pre-approved, officially sanctioned choices.

But I’m an actual feminist. That’s how I know that natural childbirth has nothing to do with feminism.

Sixkiller writes about her vaginal birth after cesarean (VBAC):

[pullquote align=”right” color=”#da0c0c”]I’m an actual feminist. That’s how I know that natural childbirth has nothing to do with feminism.[/pullquote]

When the time came, in February 2012, I labored for four days with no medicine. I have never worked harder or experienced a more unbelievable thrill than meeting my son that day. I felt relief, pride, strength, and elation. I felt empowered by the birth, and it changed my life for the better. My post-partum experience was amazingly positive—a sharp contrast with my first post-partum experience. And to this day, I look at my middle child with wonder and appreciation for the experience we had together—the time I gave him his life, and he gave me mine back.

I’m a feminist and that’s not feminism. That’s narcissism.

Sixkiller’s piece in The Daily Beast is publicity for Ricki Lake’s latest venture in promoting the subjugation of women to their biology, Mama Sherpas: Midwives Across America It’s yet another effort to extol the virtues of women’s pain, suffering, and ignorance of science.

As I wrote recently for Time.com regarding Lake’s effort to demonize the birth control pill:

She’s part of a natural parenting movement that is anti-hospital birth, anti-epidural and anti-formula — technological innovations that have made the legal, political and especially the economic liberation of women possible. Opposition to the Pill is the next logical step of that philosophy…

The technology of the 20th Century — hospital birth, epidurals, infant formula and especially the Pill — freed women from being slaves to their biology.

Opposition to the birth control pill is opposition to women’s emancipation.

I’m a feminist and I can tell you opposition to women’s emancipation is not, and can never be, feminist.

I’m a feminist. That’s why I spent years becoming an OB-GYN, so I could understand every aspect of childbirth and provide women with safe, satisfying births.

I’m a feminist. That’s why I object to the insistence of natural childbirth advocates to reducing birth to the ways that a mother uses her vagina, uterus and breasts.

For most of human history, women were reduced to only 3 body parts: vaginas, uteri and breasts. How they used them represented the sum total of their value to men. In contemporary natural childbirth advocacy, how women use their vaginas, uteri and breasts represent the sum total of their value as mothers.

I’m a feminist. That’s why I support the use of pain relief for the excruciating pain of childbirth.

I’m a feminist. That’s why I encourage women to get their medical information from medical experts, not from washed up talk show hosts.

I’m a feminist. That’s why I recognize that how you give birth to your child (or even IF you give birth to your child) has nothing to do with your love for that child.

I’m a proud, committed, enthusiastic feminist.

That’s why I recognize that natural childbirth has nothing to do with feminism … and everything to do with manipulating women into accepting the profoundly misogynistic notion that women’s worth is determined by their vaginas, uteri, and breasts, instead of their intellect or the content of their character.

To the Editors of the British Journal of Obstetrics and Gynecology,

Thank you so much for response to my tweets about the recent publication of Safe for Whom? by Melissa Cheyney et al. and your suggestion to submit a Letter to the Editor.

The format for Letters to the Editor is too restrictive, so I decided to share my concerns in this open letter.

Simply put, dear Editors, what were you thinking?

[pullquote align=”right” color=”#dd2332″]Melissa Cheyney has lied, denied, decried and defied efforts to inform the public of the hideous death toll at homebirth.[/pullquote]

Did you actually solicit an opinion piece from a LAY midwife, indeed the lay midwife who has single-handedly done more to hide the growing toll of tiny bodies of babies who succumb to American homebirth than anyone else? Melissa Cheyney has lied, denied, decried and defied efforts to inform the public of the hideous death toll at homebirth.

Did you know that Cheyney, like all American “certified professional midwives” (CPMs) is grossly undereducated, grossly undertrained and fails to meet the standards for ALL other midwives in the industrialized world?

Did you know that the CPM credential was fabricated from whole cloth by lay people who couldn’t be bothered to get a real midwifery degree, but wanted to hijack the excellent reputation of American certified nurse midwives by awarding themselves similar letters after their names?

It appears that you are unaware that Cheyney, in her role as the Chair of the Oregon Board of Direct Entry Midwifery, steadfastly REFUSED to release the homebirth mortality rates in her possession for fear that regulatory authorities might wish to investigate the death rate and discipline the midwives involved in the deaths:

Cheyney explained … due to some state regulatory boards having very hostile relationships with midwives, the quality and quantity of data submitted might be adversely affected if regulatory authorities were provided access.

The state of Oregon subsequently hired Judith Rooks, CNM, MPH, a known supporter of homebirth, to calculate the Oregon homebirth death rate in 2012. Rooks presented her findings in this chart:

Rooks regretfully acknowledged:

Note that the total mortality rate for births planned to be attended by direct-entry midwives is 6-8 times higher than the rate for births planned to be attended in hospitals. The data for hospitals does not exclude deaths caused by congenital abnormalities.

Many women have been told that OOH births are as safe or safer than births in hospitals…

But out-of-hospital births are not as safe as births in hospitals in Oregon, where many of them are attended by birth attendants who have not completed an educational curriculum designed to provide all the knowledge, skills and judgment needed by midwives who practice in any setting.

These were the statistics that Melissa Cheyney tried to hide.

Did you know that in her role at Director of Research for the Midwives Alliance of North America (MANA), the trade union that represents homebirth midwives, Cheyney REFUSED for 5 years to release the mortality rates from a MANA survey of nearly 20,000 homebirths from 2004-2009, hiding them until 2014 when the pressure became too great.

Undoubtedly you know that Cheyney ultimate published the results in Outcomes of Care for 16,924 Planned Home Births in the United States: The Midwives Alliance of North America Statistics Project, 2004 to 2009. Did you read the paper? If you had, you would have found that comparing Cheyney’s death rate at homebirth of 2.06/1000 with the CDC death rate for low risk white women (ages 20-44, at term, with babies that are not growth restricted) of 0.38, we find that homebirth has a death rate 5.5X higher than hospital birth. In other words, the death rate at homebirth is 450% higher than comparable risk hospital birth.

Moreover, the death rates in certain subgroups were astronomical:

(5 fetal/neonatal deaths in 222 breech presentations), TOLAC (5 out of 1052), multiple gestation (one out of 120), and maternal pregnancy-induced comorbidities (GDM: 2 out of 131;
preeclampsia: one out of 28

You can also be sure that the authors understood that their data showed that homebirth has a horrifically high death rate, because they try to hide the number of deaths for the past 5 years, released the data only under pressure, and then proceeded to draw a conclusion entirely at odds with what their own data showed. In addition, you can also conclude that homebirth is NEVER appropriate for breech, twins or VBAC. Finally, you come away from the paper with the horrifying realization that MANA has absolutely no idea what its own members are doing. There is no systematic attempt to determine if they are safe practitioners.

Is it any wonder then that Cheyney, who has spent years hiding the death toll at homebirth in her own state and across the country dismisses even the idea of homebirth safety by asking “safe for whom”?

And is it any wonder that Cheyney tries to reframe the conversation to ignore the death rate altogether:

Let us move beyond this polarising debate on whether homebirth is safe …

It was grossly inappropriate to solicit a commentary on homebirth safety from Melissa Cheyney, a lay midwife who has spent her career lying about the death toll of American homebirth.

BJOG should retract Cheyney’s latest effort at obfuscation and apologize to its readers for soliciting her opinion in the first place.

Sincerely,
Amy B. Tuteur, MD