Yesterday I drew an explicit parallel between the way that the fashion industry wields the body image issue to induce insecurity and thereby sell clothes, make up and diet aids and the way that the natural childbirth industry uses an idealized image of birth to induce insecurity and thereby sell midwife and doula services, homebirth and a myriad of books, tapes and DVDs.

Over the past few decades everyone from individual women, to physicians, to feminist scholars has come to grips with the fact that the fashion industry sells a view of the female body image that is unhealthy, unrealistic, and deeply toxic to women’s self-confidence. They sell the image that thin women are better, more popular, happier and an ideal to which all women should aspire.

Similarly, the natural childbirth industry sells a view that women who have an unmedicated vaginal birth are better women, better mothers, and an ideal to which all women should aspire. Now is the time for everyone from individual women, to physicians, to feminist scholars to come to grips with the fact that the natural childbirth industry sells a view of birth that is unhealthy, unrealistic and deeply toxic to women’s view of themselves and their confidence as mothers.

It has ever been thus in the natural childbirth industry. The philosophy of natural childbirth was created originally by old, white men to convince women that their primary function in life was to stay home and bear as many children as possible. It is perpetuated by women midwives, doulas, childbirth educators and lobbyists whose income depends entirely on convincing women to judge themselves by the function of their body, not the product of their minds or the content of their character.

The natural childbirth industry, like the fashion industry, situates a woman’s worth in her body. The natural childbirth industry, like the fashion industry, implies that women who meet the ideal (unmedicated vaginal birth or a size 2) are happier, better and widely admired. Women who don’t meet the ideal are unfeminine, unhappy, unadmired, and, in the case of the natural childbirth industry, bad mothers to boot.

But women who are a size 2 aren’t better, healthier or superior in any way to women who wear a different dress size. Similarly, unmedicated vaginal birth is not better, healthier or superior in any way to childbirth with pain relief, interventions and even C-sections.

The life blood of the natural childbirth industry, like the life blood of the fashion industry, is guilt and the inevitable by product of both is self-hatred. Women are convinced to buy fashionable clothing and expensive make up, to starve themselves and submit themselves to the ministrations of plastic surgeons in order to assuage the deliberately induced feelings of guilt and self-hatred.

Similarly, women are convinced to buy the services and accoutrements of natural childbirth, to endure agonizing pain, and submit themselves to the ministrations of poorly trained, deeply manipulative midwives, doulas and childbirth educators in order to assuage the deliberately induced feelings of guilt and self-hatred.

The image of the female body promoted by the fashion industry is manipulative, unhealthy and deeply anti-feminist. The image of childbirth promoted by the NCB industry is manipulative, unhealthy and deeply anti-feminist.

Women should reject both.

What would you say if your teenaged daughter confided that she was profoundly depressed because she did not look like a fashion model? Yes, she is thin (size 4), but not size 0 like all the actresses and models she sees in People Magazine. Yes, she is tall (5’9″), but not as tall as the women she sees in Vogue who are over 6′. Yes, she has a nice figure, but nothing like those models in the magazines.

What if she told you that her inability to look like those models made her hate herself? That being unable to look like those models is the worst thing she could possibly imagine happening to her? How about if she said that she could no longer spend time with her boyfriend because he deserved a thinner girlfriend? In fact, she couldn’t enjoy and didn’t deserve to enjoy any aspect of her life unless and until she could look exactly like those models she so admires.

I’m going to guess that you might point out to her that being a healthy weight for her height and body type is far more important than wearing a specific clothing size. That the models that she aspires to emulate differ markedly from real women and it makes no sense to try to emulate them. That they don’t even really look like they appear in magazines; they are airbrushed and Photoshopped to a perfection that is impossible to attain in real life.

I’m going to guess that you would take pains to explain how women have been exploited by the fashion industry into feeling inferior so they will buy more clothing, more make up, more diet aids in a futile and psychologically harmful attempt to replicate the arbitrary standards decreed by that industry. You might even point out that it is an industry that is profoundly anti-feminist, judging women for their bodies and not their minds.

In other words, if you are sad that you aren’t the ideal weight, height and proportions decreed by the fashion industry, blame the industry that set you up for disappointment.

Now imagine that you are profoundly depressed that you did not have a homebirth. Yes, you had a healthy baby, but you did not give birth vaginally. Yes, you survived the experience, but you “gave in” and got an epidural. Sure, your baby is breastfeeding fine, but you have a lot of nipple pain, and you’re sure it is because you weren’t able to do the breast crawl in the operating room.

The loss of your homebirth is the worst thing that has ever happened to you. You can’t enjoy your baby because you didn’t really “give birth” to her; she was surgically removed like a tumor. You can no longer enjoy and don’t deserve to enjoy any aspect of your life until you achieve your healing homebirth.

Imagine, in other words, that you are like this woman featured on the blog Homebirth Cesarean:

Losing the home birth was the scariest thing I could imagine. I had been preparing for this home birth the entire pregnancy. I did my prenatal yoga where I would hold incredibly uncomfortable poses for 60 seconds, breathing through them as if they were contractions and visualizing my body opening and my baby being closer to me. Then squatting at the end of the session envisioning my baby coming out and being lifted into my arms. Every single workout I would end in happy tears becuase I was practicing giving birth to my baby and soon she would be on my chest.

But she went postdates, her labor stalled, and her baby’s heartrate began to dip. She ended up with a C-section.

And this was my fault. My body so broken labor wouldn’t start, and now it was on the verge of suffocating Geneva. I had no choice but to give up my body for my baby. It was a moment of sacrifice: sacrifice of my dreams, of my body, of my future pregnancies and births and possibly even children…

She describes her C-section:

… Everyone milled around as if I wasn’t there, pulling and sucking and cutting as if I were a dead body. No one told me what was going on, truly treating me as if I were a dead body they had to remove Geneva from. They provided fundal pressure which feels like an elephant is sitting on your chest and I literally could not breathe, but had no way to communicate this. I thought I would pass out. When they pulled out Geneva I felt nothing but despair, and cried because I could not see her and she was surrounded by strangers. She needed me and instead the first woman to hold her was that hateful OB. I knew I should be happy and felt so guilty that I couldn’t be happy…

What would you tell her? Here’s what I would tell her:

Having a healthy baby is more important than having a vaginal birth.

The experience you aspired to differs markedly from what real women experience and it makes no sense, either physically or psychologically, to try to emulate those who have an idealized experience.

That the women who do have the idealized experience are lucky, not stronger, not better made, not more deserving.

I would tell her that she has been exploited by the natural childbirth industry, a multibillion dollar industry that sells childbirth “fashion,” attempting to convince women that they need midwives, doulas, childbirth educators, hypnotherapy tapes, books and DVDs in a futile and psychologically harmful effort to replicate an arbitrary standard decreed by an industry that makes money ONLY if you accept their arbitrary standard.

And I would emphasize that the natural childbirth industry is profoundly anti-feminist, judging women for the function of their bodies and not their minds.

In other words:

If you are sad that you didn’t have a homebirth or an unmedicated vaginal birth, blame the industry that set you up for disappointment, the natural childbirth industry.

How would you feel if you heard that a woman left her newborn home alone for several hours to get together with friends?

Shocked? Horrified? Worried for the safety of the baby? Bewildered at the terrible risk the mother is running merely for a few hours of enjoyment? Stunned that anyone could risk the life of their precious baby for an experience?

Why are most people horrified? Because it strikes them as gambling of the most indefensible sort: gambling that the baby will not encounter a life threatening event, like a fire, or choking, or someone invading the house and kidnapping the baby, while you are enjoying yourself.

But let’s be realistic here. What are the chances that your baby will die if you leave him or her for a few hours of adult entertainment? The chances are vanishingly small. How often does the house burn down? How often does a newborn choke in the middle of a nap? How often does someone invade a home to kidnap a child? Not very often at all, yet we still consider it incomprehensibly selfish to abandon a baby just to get out for a little while.

What’s the difference between leaving a newborn home alone for a few hours and choosing homebirth?

Leaving a newborn alone for a few hours is MUCH safer than homebirth. After all, the chance of a life threatening event occurring to a newborn in an average day is tiny. In contrast, the odds of a life threatening event occurring to a newborn during childbirth is orders of magnitude higher. A woman who chooses homebirth is basically gambling that such a life threatening event will not happen to her baby, because if it does, she’s deliberately left the baby alone without the people and equipment who could save him or her. From the medical point of view, the baby is home alone.

This is not merely a theoretical argument. In the past week alone, 3 infants sustained fatal injuries at homebirths (2 I have written about, 1 that I have not yet written about). Those babies would almost certainly be alive if their mothers hadn’t gambled their lives at homebirth.

Yes, gambled is the appropriate word. Their mothers gambled that a life threatening emergency wouldn’t happen during childbirth and they were wrong. They took a chance and their babies died as a result.

So much of homebirth advocacy is devoted to convincing women that the gamble is smaller than it really is:

“Women were designed to give birth.” But that doesn’t decrease the chances that the baby will die in the process.

Birth affirmations are quoted to convince women that they can decrease the risks if they just pretend hard enough.

“The hospital is only 10 minutes away.” Maybe, but then maybe the bar down the street is 10 minutes away, but if you are there partying while your baby is home alone, your baby will still die if he or she experiences a threat to its life while you are away.

Women who choose homebirth are gambling that their babies won’t experience life threatening emergencies during childbirth. Since there is no evidence that the rate of life threatening emergencies is any lower at home than the hospital, they are simply gambling that those life threatening emergencies will occur to someone else’s babies, not theirs. If they win the gamble, it’s awesome. If they lose the gamble, the baby is dead, and they are left with crushing guilt and grief for the rest of their lives.

The bottom line is that if you wouldn’t gamble your baby’s life by leaving him or her alone for a few hours to enjoy yourself, why would you gamble your baby’s life by abandoning him or her to a undereducated, undertrained lay person masquerading as a homebirth “midwife,” and trusting that nothing bad will happen?

The only substantive difference between the two situations is that leaving your newborn home for a few hours so you can go out and party is SAFER than choosing homebirth.

There is a group of women out there who proudly and unapologetically kill and injure babies.

They are birth bloggers and they are a plague on babies who want nothing more than to live and to live uninjured by preventable birth injuries. The babies’ biggest enemy is the dozens of stupid, self important women with no obstetric education or training who dispense medical advice about childbirth.

Don’t get me wrong; they don’t mean for babies to die. But if they do, they are just unavoidable collateral damage of their favorite hobby: pretending to be experts in childbirth without any actual expert qualifications.

People like Ricki Lake and Ina May Gaskin are basically drenched in blood. One is a talk show host and the other a lay person who let her own baby die. They have lots to say about what is right with homebirth, and wrong with hospital birth, but neither of them actually has a clue. They present themselves as authority figures, but authority figures who don’t deign to take responsibility for the death and injury they leave in their wake.

Ina May is a cult leader, and probably believes every piece of nonsense that comes out of her mouth. Ricki Lake, on the other hand, knows that she isn’t a medical professional, yet she is happy to make money giving what amounts to medical advice. No matter how insulated she is from reality, Lake has got to know by this point that babies have died because their mothers watched her movies. Does it bother her? Does she lose sleep at night over those dead and injured babies? Could she care less about what happens after she takes her money and her kudos and goes home?

There seems to be an endless parade of birth clowns, who think the fact that they gave birth vaginally, or took a 16 hour doula course, or got certified as a “childbirth” educator, makes them an authority on childbirth. Everyone from the self proclaimed “public health scholar” Gina Crosley-Corcoran (I wonder what her professors would think about her “scholar” status), to uber conspiracist Jennifer Margulis (everything causes autism!!!), to the doula behind My OB Said What??!! actually have the temerity to believe that, despite an utter lack of professional qualifications, their blitherings about childbirth are wisdom to be shared with the unwary.

Consider Rebecca Dekker, blogger at Evidence Based Birth. What are her qualifications for analyzing the childbirth literature and holding forth on her conclusions? She’s a cardiac nurse.

Would you take cardiology advice from your labor and delivery nurse? You’d be a fool if you did. You’d be just as big a fool as the women who take childbirth advice from a cardiac nurse, although not as big a fool as a cardiac nurse who thinks she is qualified to analyze the obstetric literature and share her insights with the wider world.

Dekker, like all birth bloggers, is aware that her knowledge is terribly deficient. That’s why she quickly bans anyone who uses scientific evidence to contradict her. Birth bloggers are apparently “strong mamas” when it comes to vaginal birth, but pitifully fragile flowers when it comes to scientific criticism, so sensitive that they must magically make the criticism disappear.

Dekker’s latest adventure is to produce a YouTube video disagreeing with the new ACOG position paper on waterbirth. What qualifications does Dekker have to disagree with the American Academy of Pediatrics Committee on the Fetus and Newborn? Does she have any neonatology training? Don’t be silly. She doesn’t need any actual training or experience in either obstetrics or neonatology to value her personal opinion above the experts in those disciplines.

So here’s what I want to ask Dekker:

If you make your little video and a baby dies as a result of his mother watching it, do you plan to take any responsibility for that baby’s death?

Or do you think that baby’s death has nothing to do with you?

Or, more likely, do simple fail to think at all about the outcomes that result when you share your “expertise”? I’m betting on this one.

Dekker, like most birth bloggers, is so full of herself, with outsize belief in her ability to “analyze” the obstetric literature, despite absolutely no qualifications to do so and no professional experience to draw upon, that she actually thinks she is doing a service for mothers. The reality is that she is morally culpable for spreading misinformation. She is also morally culpable for any deaths and disasters that result, whether she thinks about them or not.

Real medical professionals consider very, very carefully how they advise both patients and people who read their writings. You won’t find real medical professionals counseling people on areas outside their expertise. You won’t find them pretending that their expertise somehow magically extends beyond their actual education and training.

But then birth bloggers are not professionals. They are clowns and they would be funny except for the sad fact that babies die as a result … and birth bloggers simply go on their merry way spewing misinformation with nary a thought for the death left in their wake.

Thinking about homebirth? These mothers of these babies were, too. Their babies are dead as a result. In one case, the mother died.

James died after an abruption

Baby Girl in Portland taken home to die due to massive brain damage when she failed to breathe at birth.

“Thor” son of author Elizabeth Heineman died from lack of oxygen during labor.

Gavin Michael died of lack of oxygen when he was more than 2 weeks overdue.

Lloyd died of lack of oxygen during labor when 3 weeks overdue.

Baby girl died due to shoulder dystocia.

Baby girl died of viral infection contracted in birth pool water contaminated with diarrhea.

Baby died in Indiana when s/he failed to breathe at birth.

Mother hemorrhaged to death during transfer to the hospital after birth.

Aminah, a second twin, died after a cord prolapse.

Sam died of aspiration nearly 3 years after homebirth left him profoundly brain injured.

Utah baby died of lack of oxygen during labor while mother attempted a VBA3C.

Michigan second twin died while mother attempted a VBA2C.

Baby boy died after fetal distress during labor, hospital transfer and C-section.

Paityn died during labor.

Baby girl died of lack of oxygen during 4 day labor.

South Carolina baby died during labor at a freestanding birth center.

Natalie died of lack of oxygen while her mother pushed for 6 hours with meconium running down her leg.

Kaiya died of lack of oxygen during labor.

Michael died of meconium aspiration after his mother attempted a VBA2C.

New Jersey baby died during breech birth.

Baby girl died of Group B strep sepsis.

Aisley died of lack of oxygen during labor.

Oregon baby died of overwhelming infection.

Second twin died in Indiana after partial delivery, transfer and hospital C-section.

Baby boy died of cord prolapse.

Baby boy died of lack of oxygen during labor.

Gianni died after his mother hemorrhaged during labor.

Jude died at a freestanding birth center.

California baby boy died during prolonged labor with maternal fever.

Sunrise died after fetal distress during labor.

Baby girl died after fetal distress in labor.

Baby girl died of “complications” after homebirth.

Titus died of shoulder dystocia.

Baby girl had a cardio-respiratory arrest after birth.

Baby boy, second twin, when his head became trapped during breech delivery.

North Carolina baby died when s/he could not be resuscitated after birth.

Idaho baby girl died after fetal distress during labor.

Idaho baby boy died after fetal distress during labor.

Idaho baby died after fetal distress during labor.

These are 40 deaths that I wrote about in the past 2 years. And only the American homebirth deaths. And only the deaths that I heard about.

Homebirth represents approximately 1% of US births. When you look at term births of normal sized babies to white women, homebirth represents approximately 1.4% births. So if you are planning to tell me that “babies die in the hospital, too,” ask yourself if you’ve heard of nearly 3000 deaths of term babies in the hospital in the past 2 years.

Homebirth kills babies (and mothers) and the only people who appear to be unaware of that fact are homebirth advocates.

Thinking about homebirth? Maybe you should think about these babies (and mother) and think again.

If I had a nickel for every time a homebirth advocate claimed that a “risk” of hospital birth is a 1 in 3 chance of having a C-section, I’d be a very rich woman indeed.

What’s the real risk of having a C-section? A lot lower than you’ve been told.

I’ve written in the past that homebirth midwives have a one size fits all approach to childbirth. It makes no difference who you are, what your past medical history, what your test results in this pregnancy show, or what complications you’ve experience in this and previous pregnancies, all women are treated as if they are identical, and homebirth is nearly always prescribed as the correct course of action. That refusal to personalize care (the exact opposite of obstetric care) is used to scare women into believing that because the C-section rate is 32%, the average woman’s chance of having a C-section is 32%.

To understand why that is foolish, it helps to consider other examples, like lung cancer.

The lifetime risk of developing lung cancer is slightly less than 7%. Does that mean that YOUR chance of developing lung cancer is nearly 7%. No it does not. The lifetime risk of a specific individual developing lung cancer depends greatly on whether or not you have ever smoked or still do. The risk of developing lung cancer is more than 20 times higher for smokers as for non-smokers. So if you are a smoker, your lifetime risk of developing lung cancer is much higher than 7% and if you are a non-smoker, your lifetime risk of developing lung cancer is much less than 7%.

The same principle applies to C-sections. The personal risk of ending up with a C-section in any given pregnancy is dependent on your personal situation. For example, if complete placenta previa is diagnosed at term in your current pregnancy, you chance of having a C-section if you go to the hospital is not 32%, it is 100%. A C-section is always performed because attempted vaginal delivery through a complete placenta previa invariably leads to the death of the baby and mother.

As I discussed recently, the chance of having a C-section after a previous C-section is dependent on your personal situation. For the average woman with one previous C-section, the chance of a woman attempting a VBAC ending up with another is 39%. However, the chance of ending up with a C-section falls to only 10% if you’ve had a vaginal delivery since you’ve had the C-section.

So what is the real risk that someone contemplating homebirth would actually end up having a C-section if she went to the hospital instead.

No one should be having a homebirth after a previous C-section. The risk of a severe complication is simply too high. Therefore, any one who meets the low risk criteria for homebirth has never had a C-section in the past. For them, the risk of having a C-section in the current pregnancy is NOT the same as the total C-section rate. To determine that risk, we must look at the primary C-section rate.

According to the paper Primary Cesarean Delivery in the United States, the chance of having a primary C-section is 21.9%. Does that mean that a specific individual’s chance of having a C-section is 1 in 5? No, it does not, because the risk of a primary C-section is dependent in large part on whether you have given birth in the past. The primary C-section rate for women who have never given birth in the past is 30.8%, but the primary C-section rate for women who had given birth to at least one child was only 11.5%.

The typical woman who chooses homebirth has had at least one child in the past, so her actual risk of having a C-section if she has a hospital birth is NOT 1 in 3, but slightly higher than 1 in 10. That’s a very big difference.

How does that compare with the primary C-section rate at homebirth. According to the MANA study, the overall C-section rate was 5.2% and the primary C-section rate was 4.3%. Unfortunately, MANA did not break down the primary C-section rate by parity. Of the overall group of women attempting homebirth, we do know that 77.7% had given birth to at least one child. The primary C-section rate among parous women is likely to be lower than 4.3%. Nonetheless, for women who have given birth before, the risk of having a C-section after attempted homebirth is around 4%, while the risk of having a C-section in the hospital is 11.5%. At the same time, the risk of having a baby die at homebirth is dramatically higher than the risk of perinatal death in the hospital.

Most women who choose homebirth have had a baby in the past. Therefore, they are trading a small risk of having a C-section in the hospital (11.5%) for a dramatically increased risk of having a dead baby. Is that really worth it?

Gina Phillips, the homebirth midwife who was supposed to be at the labor of baby James‘ mother, but was home “resting” instead, will be the subject of a homebirth midwifery peer review next week.

It’s difficult to learn the details, because this process, which is supposed to be a form of accountability and a way to improve safety, is shrouded in secrecy by Texas homebirth midwives. But I’m going to go out on a limb and make a prediction. Despite alleged grievous negligence:

• she reportedly left a VBAC patient who had been labor more than 24 hours under the care of her student while she went home;
• the patient’s excessive bleeding was allegedly reported to her by phone, but she told her student it was normal;
• the patient allegedly experienced an abruption;
• transfer was delayed so long that the baby allegedly suffered a catastrophic brain injury and subsequently died;

I predict that the peer review will be a thorough whitewash, with minimal if any consequences for Phillips, and no new standards that will bind other homebirth midwives.

What is supposed to happen during clinical peer review?

According to Wikipedia:

… The primary purpose of peer review is to improve the quality and safety of care. Secondarily, it serves to reduce the organization’s vicarious malpractice liability and meet regulatory requirements… Peer review also supports the other processes that healthcare organizations have in place to assure that physicians are competent and practice within the boundaries of professionally-accepted norms.

Peer review is not a morbidity and mortality conference where anyone present can contribute to analysis of the case. Peer review is a formal process in which reviewers are carefully selected, documents and information are introduced and the person who is the subject of the review can explain why he or she chose a specific treatment course.

I have been told that the plan for the peer review of Gina Phillips is that she will be reviewed by other midwives who are there to have their own cases reviewed. If true, that would be horrifying. As mentioned above, I would like to obtain definitive, official information about the way that this review will be conducted, but there is no official information. The process appears to be entirely informal, random, and obviously biased.

It is, of course, rather difficult to hold a homebirth midwife to specific safety standards when their national organization, the Midwives Alliance of North America (MANA), rejects ANY safety standards, preferring to leave the determination of safety up to each individual midwife. Presumably that means that if a homebirth midwife thinks abandoning a VBAC patient during a prolonged labor to go home and “rest” is safe, then it is safe.

These stories of egregious practice by homebirth midwives are replayed again and again, and babies die as a result. Homebirth advocates like to pretend that such midwives are outliers and every profession has “bad apples.” I predict that this peer review is likely to reveal that there is no such thing as a “bad apple” in homebirth midwifery, that the real purpose of homebirth midwifery peer review is to exonerate the midwife in question, and that dead babies are merely excusable collateral damage.

If a homebirth midwife faces no consequences or minimal consequences for literally abandoning a high risk patient in labor, then there are no standards in homebirth midwifery at all.

Let me speak directly to those in charge of the Texas homebirth midwifery peer review, whomever they may be:

We will be watching the outcome of this peer review. I hope that you will prove me wrong and recommend major curtailment of practice or even surrender of license in this case. We want James to be #notburiedtwice, first by his parents, and then by the homebirth community, which typically acts as if dead babies are just an unavoidable cost of doing business and require no response beyond a slap on the homebirth midwife’s wrist, leaving her to go forth and preside over other homebirth disasters and deaths.

Don’t whitewash the death of baby James.

How many babies have to die before homebirth advocates acknowledge that it has become an act of selfishness? How about two babies a day?

Last Sunday, the same day that doula Nirvana “Harley” Jennette was taking hideous risks with the life of a baby in Georgia, two other midwives (one in Texas, and one in Oregon) tooks hideous risks with the lives of two additional babies and both babies sustained fatal injuries as a result. It seems that “trusting birth” is just a euphemism for “letting babies die preventable deaths.”

Let’s be honest here. Homebirth midwives are under tremendous pressure to keep their clients at home. If they have to transfer to the hospital during labor, it’s because they misjudged the situation. They may be exposed to disciplinary or even legal action. And the longer they wait to transfer, the more likely it will be that the baby suffers a fatal injury, so the more likely they are to face dire consequences for themselves. Paradoxically, the more dangerous the situation becomes (and, therefore, the more likely that the homebirth midwife will face scrutiny), the more pressure she feels to stay at home and just hope against hope for a happy outcome.

That’s how babies in Portland and in Dallas-Fort Worth sustained their fatal injuries.

The mother in Portland was expecting her first baby. Membranes had been ruptured for more than 40 hours. Labor was protracted but not out of the bounds expected for a first labor and the baby was delivered and did not breathe.

The midwives waited 15 minutes to call for assistance, and the baby did not reach the hospital for over an hour after her birth.

On admission to the hospital, she was profoundly acidotic, a sign of long term lack of oxygen. Despite cooling therapy, she had suffered a catastrophic brain injury, so severe that baby has been taken home to die.

Yet again, another utterly clueless midwife is shocked to catch a nearly dead baby. The time required for transfer should give pause to any homebirth advocate who thinks they can get to the hospital fast enough in an emergency. The baby needed the immediate attention of a neonatologist when she was born. Instead, she didn’t arrive at the hospital until over an hour later. And all that time even more of her brain cells were dying. The baby did not have to sustain a catastrophic brain injury. She was not “meant” to sustain a catastrophic brain injury. It happened because her mother gambled the baby’s life in exchange for a birth “experience” and the baby lost.

Baby James sustained his fatal birth injury while his mother was attempting a home VBAC. She had had a C-section in her first pregnancy, and a successful hospital VBAC in her second. She was an excellent candidate for a hospital VBAC. No one is ever a candidate for a home VBAC.

James died of an abruption that his mother’s student midwife failed to recognize despite heavy vaginal bleeding. Where was the actual midwife? Reportedly she was home resting because the mother’s labor was so long. That, of course, was the first sign of imminent disaster. A woman who has had a successful VBAC should not be experiencing a prolonged labor subsequently. Indeed, the prolonged labor, with the accompanying possibility that the baby did not fit, dramatically raised the risk of uterine rupture. An abruption during an attempted VBAC is often the result of rupture of the uterus, but I have not been able to ascertain whether James’ mother experienced a ruptured uterus as well as an abruption.

I did receive information that was reportedly posted by the student in a student homebirth midwifery group. According to that information, the student midwife called her preceptor at home to tell her about the excessive bleeding, and was reassured that it was fine. I was told that it was ultimately the father who called 911 because the student wouldn’t. Unfortunately, it was too late. An emergency C-section was performed, but James had sustained catastrophic brain damage and was removed from life support 18 hours later. James was not “meant” to suffer a catastrophic brain injury. It happened because his mother chose homebirth.

The poor baby’s obituary is appalling. Indeed it appears as if the student midwife wrote it:

When the time came for him, his mama labored mightily to bring him into this world and his daddy was so proud of his mama. He lived for 18 wonderful hours…

Wonderful hours? I doubt those hours were wonderful for either James or his parents.

Survivors: Mama and daddy; sisters; grandparents … and midwife Kaitlyn Wages loved this boy and his family more than words can say.

A baby is dead and the obituary talks about his mother’s “performance” in labor and how much the student midwife loved him?

The midwives have written extensively about the baby:

An extremely rare complication? No, abruption is a common complication, occuring in 0.4-1% of all pregnancies.

No questions?

I asked the midwives on their Facebook page why this baby died. Their response? To delete the question and ban me. I wonder if that had anything to do with concealing potential culpability from their other clients.

Why shouldn’t ask questions of people who are grieving?

It may not be the time to ask questions of the parents, but it is most certainly the time to ask questions of the midwives. This is the time for a full investigation into a neonatal death that appears to have been entirely preventable.

The sad fact is that these deaths are not remotely surprising. Giving birth at home is equivalent to leaving your infant at home alone. In both cases, the mother is “trusting” that the chance of anything going wrong is small enough that it’s okay if she puts her own experience first. In fact, leaving your infant home alone while you got out and party is probably safer than choosing homebirth. The odds that the baby will experience a life threatening complication while sleeping (or screaming and crying) at home is vanishingly small. The odds that your infant will experience a life threatening complication at homebirth is thousands of times higher. So if going out partying and leaving your infant behind is grossly irresponsible, that makes choosing a homebirth more irresponsible still.

The bottom line is that giving birth in a hospital is an act of love. With the mounting evidence that American homebirth is far more dangerous than we ever imagined, giving birth at home has become an act of selfishness.

Hi, folks Hypa (short for Hypatia) Crit, CPM here to introduce you to the wonders of childbirth without technology. So few people have seen a real natural childbirth that we thought it would be instructive to bring one to you on an IMAX screen so we can capture every detail

Before I introduce our birth goddess mama, and our (irrelevant now that he’s contributed his sperm) father, I want to take you through our simple preparations for technology free birth.

Let’s meet the people who will be helping us. That’s Lex over there behind our large format camera, and Steve and Mike are operating the secondary cameras that you can see in other parts of the room. Sandy is our birth photographer who will memorialize the event with 500 photos using her 42 megapixel Hasselblad camera. She’ll be arranging them into a fabulous automated slide show for your viewing pleasure.

Oops, almost tripped over the klieg lights on my way to introduce Kelly, mom’s friend from high school who will be live Tweeting the event and Margie who is live blogging for our viewers who want real time access instead of waiting for the IMAX movie or the YouTube video.

How about the preparations for birth?

The great thing about homebirth is that you don’t need any of those machines that go ping. Technology ruins the birth experience. For example, instead of the thoroughly unnatural epidural we have a plethora of options for pain relief in labor including acupuncture needles (that’s Neveah our acupuncturist), cranio-sacral therapy with our therapist Rolf, a Tens machine, and, best of all, a 5 foot diameter birth pool (filled with air by an electric pump) containing all natural water!

The mess? Don’t worry, there won’t be any mess. We have every surface covered with rubber sheets or fabric that is specially treated to be waterproof.

Let’s meet the birth team!

Childbirth is supposed to be an intimate experience, so there are only a few of us in addition to the videographers, photographer, live Tweeter and live blogger (plus the potentially 7 billion people watching around the world). Of course there’s me, Hypa Crit, the midwife and my midwife trainee Krystal. Here’s Sharon the doula and her assistant Maeve. And let’s not forget out hypnotherapist Donna who has brought her hypnotherapy tapes to help in labor. We’ll be listening to those tapes when we’re not listening to the custom designed birth mix playing on the Bluetooth enabled speakers.

What? You’re wondering who is that in the back of the room next to the high speed dehydrator. That Serena, our placenta encapsulation specialist, of course.

You have to admit: isn’t this a lot more homey than the hospital with all those machines that could save your baby’s life in the event of an emergency? Plus, there’s none of those annoying strangers like the neonatologist or the anesthesiologist who would destroy the intimacy of the birthing experience by interfering and saving someone’s life.

What’s that you say; what if there is an emergency?

First of all, in the unlikely event that we are not trusting birth enough, we have plans for unforeseen occurrances. In case of emergency I have both the hospital and the ambulance on speed dial on my iPhone. If the baby doesn’t breathe when she is born, we’ll just chant “Breathe, baby, breathe.” Babies know the sound of their mother’s voice and that usually does the trick. We’re even prepared for postpartum hemorrhage. We’ll rip off a piece of the raw placenta and force it under the unconscious mother’s tongue and that should fix everything in a jiffy!

Could someone die at a homebirth?

Duh, some babies aren’t meant to live so of course they will die. But don’t forget: there’s a silver lining to a homebirth death. No matter what happens, it is never, ever the homebirth midwife’s fault. Sure the baby died just like the obstetrician, in-laws and friends warned, but that was just an amazing coincidence.

Would technology have saved the baby’s life? Give me a break. Everyone knows that technology never works, and it just ruins the birth experience.

There is a disturbing homebirth photograph that is now circulating on the web.

You can find the photograph here.

Those posting and sharing the photo find it charming. I find it emblematic of so much that is wrong with homebirth.

What does the photo depict? It’s a picture of a young girl about four years old trying to provide counter pressure on her mother’s lower back during a contraction.

Why is it disturbing to me? Because it captures the overweening narcissism of homebirth, where the mother is the star of her little piece of performance art, everyone else (including the baby) is just a prop, and the mother is elevating her need for attention and validation above the needs of her own children (in this case the four year old).

Simply put, it is never appropriate for a small child to attend a homebirth. Childbirth belongs to the realm of experiences that are too intense and disturbing to be viewed by young children. Just as it is inappropriate for children witnessing their parents having sex, or scenes of graphic violence, and scenes of gore, it is inappropriate for a young child to witness a homebirth.

Moreover, it is never appropriate for a small child to provide care to a parent. It is not appropriate to ask a child to hold the basin when her mother vomits due to chemotherapy. It is not appropriate to ask a child to change her mother’s dressing after surgery. It is not appropriate for a child to console a mother in severe pain. It is the parent’s job to support the child, NOT vice versa.

All children, especially small children, need to feel that their parents are strong and can protect them. No child should be asked to witness a parent in severe pain or to provide the care that should be provided by another adult.

Rule of thumb: If your child will be disturbed by the movie Bambi, he or she should never be at a homebirth.

So why do women surround themselves with their older children at homebirth? Simple: to show off. This is Mom’s big moment. She’s the star and everyone should bend themselves to her need for attention, support and validation.

The truth is that it is an abrogation of parental responsibility to have a small child at a homebirth. It’s no different from asking your four year old to help you parse the details of your divorce or to confide the trauma of your sexual dysfunction to him or her.

Make no mistake: this has nothing to do with the inherent beauty of childbirth. And don’t bother to claim that small children witnessed birth in nature; they didn’t since most indigenous cultures segregate women in labor and do not allow men or children near them.

It is not charming for a little girl to support her mother through labor. It is developmentally inappropriate, and deeply, unforgivably selfish.