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

Hello, Dr. Amy.

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

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

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

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

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

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

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

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

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

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

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

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

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

From,
Humbled about birth

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

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

According to an online legal dictionary:

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

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

My definition of involuntary babyslaughter is this:

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

And similar to manslaughter:

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

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

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

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

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

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

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

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

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

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

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

And, to my mind, most egregious of all:

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

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

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

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

1. No, your public blog is not private.

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

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

2. Copyright does not prevent quoting your blog.

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

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

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

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

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

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

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

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

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

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

To homebirth loss mothers I say this:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 

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

There are so many homebirth deaths occurring that I am having a hard time keeping up. I originally planned to blog today about the recent homebirth death in New Jersey attended by a CPM who had already had her license revoked. I’ll need to save that one for another day.

I came across the story of this homebirth death because of a post entitled, The MOTHER of all posts: IT’S NOT OUR FAULT.

Her heart rate was monitored closely with consistent reassuring heart tones the entire time. At the point when she was crowning … we were still getting a steady, consistent heartbeat. I pushed for a reasonably short amount of time and delivered her without the need of an episiotomy … and I only tore minimally not requiring stitches. She was born and had already passed, the cause of which we can only conclude was having suffered a cord accident in the last moments of birth. She received immediate emergency care but was unable to be revived.

The stories are sickeningly familiar. The blog detailing the mother’s commitment to unmedicated childbirth as “healthier”; the death that supposedly took place in the moments before birth; the clueless midwives who had no idea that the baby was dead; and the link to site where donations can be made to cover the cost of the funeral.

The mother is livid that someone chose to mention that it was her decision to have a homebirth that led to her daughter’s preventable death.

I received a comment on my blog yesterday. Completely, off the topic of the post it was attached to. Unrelated. Here is what it said:

Knowing that this was a “home birth” and that you have NOT once mentioned home birth in all the blog entries that you have written…I would like to just say one thing, that “women who give birth at home trade the “birth experience” for “safety”. There are “risks” with both home birth and hospital birth, but I can’t understand why anyone would want to sacrifice safety for experience…just saying!

… We are devastated by the tragic loss of our baby girl and this judgmental, hateful “anonymous” has the audacity to tell us it’s our fault…

If this person believes we are responsible that’s one thing, but to point their finger at grieving parents in the midst of our immeasurable pain, something this individual could NEVER understand, and try to shame us and blame us by telling us our child’s death is our own fault is disgusting. What type of human being could sink so low? How revolting can someone really be?

What type of human being? The type that cares that babies are dying unnecessarily.

One of the delicious little lies of the homebirth movement is that women who choose homebirth take responsibility for the outcome. The hell they do.

They blather on about being “educated,” about doing their “research,” about ignoring the advice of obstetricians, family members and friends. They insist they understand the risk that the baby might die … right up until the moment the baby dies.

Then they blame God, the universe, fate, anything else but themselves, the people actually responsible for making the choices that led directly to the death of their babies.

Hey life, universe, god or whomever it concerns,

I’ve got some questions for you.

I’m suppose to be celebrating the birth of my baby girl right now. Snuggling her, holding her and kissing her. Why am I planning a funeral?

She was healthy, strong and perfect, why couldn’t she survive the last moments of childbirth?? Why wasn’t my body perfect for her exit? I TRUSTED it. I trusted you.

No, you didn’t trust life, the universe or god. You trusted YOURSELF to know better than medical experts.

Who made the choice to deliver at home, far from emergency equipment and personnel? The homebirth mother. Who made the choice to hire a substandard practitioner? The homebirth mother. Who chose to ignore the medical advice of obstetricians? The homebirth mother. Therefore, who is responsible for the death of a baby that could have been prevented by obstetrical interventions provided by legitimate obstetrical providers in a hospital? Who else but the homebirth mother?

Saying that the homebirth mother bears responsibility for the death of her baby at homebirth is not incompatible with feeling sorry for her loss. It’s no different than grieving for a child who went through the windshield and died because her mother didn’t buckle her into a carseat. That mother is no doubt devastated, and no feeling person can failed to be moved by that devastation, but that doesn’t change the fact that the mother, through her action or inaction, is ultimately responsible for the death.

It is all so damned repetitive:

• The claim of being “educated”:

We researched for months, we read all the information we could find, we learned from every source out there. Our midwives educated us but never pressured us or even encouraged us to give birth at home.

• The claim that the midwives were not at fault.

Our midwives closely monitored the entire pregnancy… The attention, genuine concern and high quality care we received from these three amazing women (and EVERYONE who worked at the midwifery practice) was incredible…

Incredible? That’s not how I would characterize midwives who didn’t know that the baby was in distress until it dropped into their hands already dead.

• The pathetic assertion that the baby received the same resuscitative measures that would have been available in the hospital.

Could she have been revived if she were in a hospital? The same procedure that would have been made to attempt to resuscitate her in a hospital WAS MADE for Aisley.

No, the same resuscitative measures were not used. There was no expert resuscitation with intubation.

• The insistence that it is no one’s fault.

It was an accident that she died. Accidents occur in hospitals as well. The risk of infant death in a home birth is less than 1%. It was an unforeseeable tragic event. Would anyone blame a mother in a hospital for being responsible for her baby’s death? How dare anyone blame us!

How dare they blame you?

YOU are the one who chose to give birth far from emergency equipment and personnel. YOU are the one who insisted that you were “educated” about the risks of homebirth. YOU are the one who chose midwives who were so clueless that they didn’t even know that the baby died during your labor.

When a baby dies at homebirth, those who warned you are entitled to say “I told you so.” What happened to your daughter is precisely what those who warned you were afraid of. They did tell you so; you chose to ignore them. YOU were the one who made the decisions and therefore, YOU are the one who is responsible.

Homebirth advocacy websites are classic “rumor communities.”

What is a rumor community?

… Community members limit the scope of conflict by asserting authority to speak publicly and rejecting contributors with countering opinions as irrelevant. They sustain their threatened community by denying scientific evidence and demanding unattainable levels of scientific proof, and they socialize conflict by recruiting bystanders to enter the fray using appeals to wider social values.

That description applies to every homebirth website I’ve ever seen from Mothering.com to Lamaze’s Science and Sensibility to the personal websites of homebirth midwives and homebirth advocates:

Asserting authority to speak publicly ✓
Deleting other opinions as irrelevant unsupportive ✓
Denying scientific evidence ✓
Recruiting bystanders to the fray with talk of feminism and rights ✓

The quote above comes from a new paper, The Persistence of Rumor Communities: Public Resistance to Official Debunking in the Internet Age, recently presented to the American Political Science Association Annual Meeting by Jill A. Edy and Erin E. Baird of the University of Oklahoma. Edy and Baird discussed the anti-vax community, but their findings apply to the homebirth community as well.

Rumor communities use two distinct strategies to promote their views, one strategy for insiders and another for “bystanders.”

The insider strategy is obvious and the banning of outsiders is critical to that strategy. A rumor community is designed as an echo chamber where only approved views can be shared. Anyone who disagrees must be banned so that accurate scientific information will be suppressed. Of course homebirth advocates don’t acknowledge that the widespread banning occurs in an effort to suppress accurate information. Instead they claim that the rumor community is designed for “support” and that alternative viewpoints (or even additional information) is unsupportive.

The bystander strategy is more subtle. Edy and Baird believe that we need to change the way we view the propagation of conspiracy theories and rumors, both political and scientific to encompass these bystander stategy:

Current research on rumors, conspiracy theories, and other forms of political misperceptions favors a modernist perspective and a psychological research paradigm. The scholarship emphasizes the factual inaccuracies of individual beliefs and theorizes about how individuals came to hold or spread those beliefs, what sorts of messages might dispel them, and the impacts of inaccurate beliefs on political opinions. Communication is conceptualized as a means of transmitting inaccurate or accurate information, and public opinion is conceptualized as the aggregation of individual opinions.

This conception is inadequate because it ignores the social dimension:

… Generated and sustained by interest groups, political rumors, conspiracies, and misperceptions speak to fundamental elements of political culture. They survive because they are persuasive, not because they are true in any kind of modernist sense. These characteristics of rumors, conspiracy theories, and misperceptions are better understood with a cultural approach to communication and an understanding of public opinion grounded in group conflict.

The new paradigm they propose has its origin in political science:

E. E. Schattschneider offered a theoretical model for understanding political conflict that involves group conflict, describing a process of “socialization of conflict.” He observed that a party on the losing side of a political argument seeks to broaden the scope of conflict by recruiting allies who may come in on the losing side and turn the tide in their favor … Thus, we might expect that ardent believers in a debunked rumor might both resist changing their beliefs and seek to recruit additional supporters from amongst those Schattschneider referred to as “bystanders.” … Rumors may survive and thrive not because debunking messages fail but because rumor communities appeal to wider social values and broader audiences in order to sustain the political conflict they are losing.

The social value invoked by rumor communities is typically personal liberty:

… Many members of the anti-vaccine movement describe themselves as engaged in political action, resisting government and public health authorities. The rumor they believe has been debunked by scientific and public health experts, yet they continue to agitate against childhood vaccination. Political conflict over the rumor is both visible and archived in Internet coverage of the debunking and public responses to it. In responding directly to online news coverage and blog posts, the rumor community engages in public discussion that includes both believers and nonbelievers before an audience of interested citizens whose opinion may be affected by what it sees. According to Schattschneider’s model, the rumor community’s public discussion socializes conflict to the extent that it appeals to bystanders to enter the conflict on the side of the antivaccine advocates.

Sound familiar? It should because homebirth advocates make the same claims in an effort to engage bystanders.

Homebirth advocates routinely describe themselves as engaged in political action, resisting “Big” government, “Big” Pharma and “Big” Medicine. In this way they elide the fact that most of their claims are nonsensical (“homebirth is as safe as hospital birth”; “obstetricians don’t follow the scientific evidence”; “childbirth is only painful because women have been socialized to think it is painful”) and attempt to engage bystanders by appeals to freedom and rights. They solicit support from outsiders who reject the nonsensical claims by invoking claims of political liberty. The Human Rights in Childbirth Conference and the new movie Freedom for Birth are merely the latest and most explicit efforts along these lines.

Homebirth advocates love to claim that they have “educated” themselves by reading and participating in homebirth websites. It should be obvious, however, that you cannot educate yourself by participating in a rumor community. So how can the average person decide what it is a rumor community and what is a legitimate source of accurate information? That’s relatively easy. Any community that resorts to frequent banning of commentors with different opinions is a rumor community and, therefore, thoroughly unreliable.

In other words, virtually every homebirth and natural childbirth website is a rumor community and not a source of accurate information. It doesn’t matter whether the community is sponsored by Lamaze, by Mothering Magazine, by Ricki Lake, by The Feminist Breeder or any other of the myriad homebirth and natural childbirth bloggers. It’s a very simple rule of thumb:

If they ban dissenters, they are rumor communities. Websites that offer accurate scientific information don’t need to ban people who disagree.

Breech babies make up only 3-4% of all births, yet they represent a disproportionate share of homebirth deaths. Why? Because breech birth is dangerous.

I’ve written before that, contrary to the prattling of homebirth advocates, breech is not a variation of normal. I have also pointed out that homebirth advocates indicate their awareness of this when they brag about breech homebirths in which the baby did not die.

Homebirth advocates are fond of quoting the PREMODA study to support the decision for breech birth at home, conveniently ignoring the fact that the PREMODA study found that breech birth could be relatively safe in high resource settings, using extremely strict exclusion criteria, and attended by a very experienced obstetrician (though even then not as safe as C-section). Obviously, none of that applies at homebirth.

So what is the real risk of breech homebirth? I just came across a study about breech birth in low resource settings that put the risk of breech birth in perspective and the risk is huge.

As the name of the study, Neonatal Outcome of Term Breech Births: A 15-Year Review at the Yaoundé General Hospital, Cameroon, indicates, it looked at breech birth in a low resource setting, a hospital in the developing world. Like the PREMODA study the breech births took place in a hospital with access to emergency C-section, involved some exclusion criteria and were attended by obstetricians and midwives. Unlike the PREMODA study, however, the exclusion criteria were not extremely strict and births were attended by obstetricians and midwives, not necessarily those who had the most experience in breech birth.

What did the authors look at?

We conducted a cross-sectional analysis of data collected from March 1992 to March 2007 at the Yaoundé General Hospital, Cameroon…

From the birth registers and the neonatal discharge summaries we identified respectively all term singleton breech deliveries and all term breech delivered infants transferred to the neonatal unit. The mode of delivery, cesarean or vaginal was also noted. The exclusion criteria were multiple pregnancies, antenatal fetal death, and major fetal congenital malformation such as anencephaly and hydrocephaly… The sample size calculated using the incidence of breech delivery of 3% was 45 with a confidence interval of 95%.

Even in this low resource setting, elective C-section was performed nearly 30% of the time because breech vaginal birth was felt to be too dangerous.

… Of 249 term singleton infants in breech presentation, 73 (29.31%) were born by elective cesarean section and 176 (70.67%) were allowed for trial of vaginal delivery with 136 (54.61%) delivered vaginally and 40 (16.06%) delivered by intra-labor cesarean section.

What did the authors find?

… Compared to infants born by elective cesarean section, those delivered vaginally or by intra-labor cesarean section were more likely to have low 5-minute Apgar scores (4.1% vs. 17.77%; P <.001), require admission to neonatal unit (08.21.% vs. 13.63%;P <.001), and have an increased risk for perinatal mortality (0% vs. 05.68%; P < .001). Trial of vaginal delivery of term infants in breech presentation was associated with significantly increased risk of perinatal death and neonatal morbidity.

In other words, more than 1 of every 20 term breech babies died despite the fact that the delivery took place in a hospital with access to emergency C-section and despite the fact that more than 1 in 5 were ultimately born by C-section anyway. To put that into perspective, the Hannah trial, the study that found that breech vaginal birth increased the risk of perinatal death, found only a 1.3% rate of perinatal death at breech vaginal birth.

Homebirth is not a low resource setting; it is a no resource setting. There is no ability to perform an emergency C-section and most homebirth midwives have no exclusion criteria for breech homebirth. The perinatal death rate for breech homebirth is almost certainly much higher than 5.68%.

Why do so many breech babies die at homebirth? Because breech vaginal delivery is extremely dangerous.

Rather than boasting about breech homebirth, homebirth advocates should be ashamed of taking such a hideous risk with the lives of their breech babies.