Hi. My name is Ima Frawde, CPM. The initials after my name stand for “certified professional mammarist.” I am an expert in normal breasts.

I don’t know about you, but I am sick and tired of the hegemonic, patriarchal, male medical system that is constantly telling women that their breasts are “broken” and need to be scanned regularly to detect breast cancer. Breasts are designed perfectly.

Are we suppose to believe we’re inferior to squirrels, cows, rabbits and elephants? We have about 5000 species of mammal and we’re encouraged to believe that we’re the only one that needs routine mammograms. How did we managed to get along for thousands of years before mammography? If breast cancer were really that dangerous, we wouldn’t be here as a species.

It’s not a coincidence that my comments sound similar to those made by Ina May Gaskin on Feministing. Ina May is my hero. Everything she says goes double for me (heh, heh, heh, just a little breast humor).

Why should you listen to me? As a CPM (certified professional mammarist), I am an expert in normal breasts. In fact, certified professional mammarists are trained specifically to manage breast health at home. In order to obtain my certification, I had to meet rigorous standards; I was required to submit a portfolio of 20 breasts examined within the home (right and left breasts are each counted separately). Plus I had to observe examination of an additional 20 breasts done by my preceptor. That means I had contact with 20 separate women before I began practicing on my own!

How did routine mammography become so popular? As my friend Ina May says, it’s all the hegemonic, patriarchal medical system “which views women’s bodies as defective designs and allows for profit to be made from women’s fears of their own bodies.”

In fact, it is fear that causes breast cancer. How do we know? Primitive women don’t get breast cancer. Think about it. All those charities in Africa are soliciting money for malnutrition, infant mortality, maternal mortality, and obstetric fistulas. Have you seen even one commercial for an African breast cancer charity? That proves it.

What? You don’t believe that fear causes breast cancer? You mean you deny that there is a mind-body connection?

Once you understand that fear causes breast cancer, you can see why trusting breasts is the best way to ensure good outcomes. Having a routine mammogram in unnecessary when you trust breasts. Mammography has a high false positive rate, and those false positives lead to a cascade of unnecessary interventions like breast ultrasounds and breast biopsies, not to mention undermining women’s faith in their own bodies.

But you shouldn’t think that certified professional mammarists reject technology. Far from it. If we feel a breast mass and it gets bigger despite breast affirmations, cranio-sacral adjustment, blue and black cohosh, garlic and Hibiclens, we refer women to breast cancer specialists. Since breast cancer is very, very rare, particularly in low risk women, we have very low referral rates.

Are we always correct? Unfortunately, no, but some women are just meant to die from breast cancer. They probably would have eventually died in the hospital anyway (it might have been 10 or 20 years later, but the principle holds true).

We’re also working on developing our own technology for identifying early breast cancer. We are creating our own mammography equipment. Even as we speak, several groups of women are currently fabricating mammography machines to our own specifications; they are knitting them from steel wool!

Our machines will have two major advantages over conventional, Western, allopathic mammography machines. First, they won’t involve painfully compressing women’s breasts, and second, they don’t use ANY radiation at all. As soon as the mammography machines are fully knitted, we plan large qualitative studies comparing the experience of having a mammogram with a knitted machine vs. a conventional machine.

You might be wondering why we are bothering with mammography machines at all. In answer, I will paraphrase anthropologist and midwife Melissa Cheyney:

The rituals of home breast care are not simply about assuring personal transformation via the transmission of counter hegemonic–empowering value —although many women certainly described their experiences this way. Home breast care rituals, are also self-consciously political in their intent. As the popular bumper sticker “Mammarists: Changing the World One Breast at a Time” suggests, home breast care is a performative medium for the promotion of social change.

This piece is satire.

The Feminist Breeder (Gina Crosley-Corcoran) is upset. Here she was, thoughtfully contracting with a sponsor to video blog every moment of “her” home VBAC live and no one is grateful.

You may recall me writing about the pathetic narcissism of live blogging a homebirth:

Silly me. I though birth was about having a baby. Evidently not. Gina’s baby is not mentioned even once. It’s about Gina and her willingness to graciously educate YOU, show YOU that birth doesn’t have to be perfect, and because YOU are so excited that you can’t imagine anything better to do with your time than follow every moment of stranger’s labor.

Evidently Gina can’t tolerate anyone who is not overwhelmed with gratitude for her self-absorbed-less effort to “educate” the rest of us with audio of her grunts of pain, pictures of vomit during transition and actual video of fecal contamination of the birth pool.

Now Gina is claiming, of course, that she is a victim. And how was she victimized? Apparently my failure to appreciate the sacred nature of her publicity stunt is cyber-bullying.

Here’s what Gina wailed in the comment section of a piece on Feministing about Ina May Gaskin. Her comment is a classic in the annals of self-absorbed, self-promoting, insecure NCB advocates who desperately seek validation for their “achievement” of pushing a baby through a vagina. I have helpfully annotated it (for your education).

Of course this article attracted the infamous, vile “Dr.” Amy (who isn’t even a practicing physician and NOT a member of the ACOG anymore.) [When a woman doesn’t agree with you, put her professional title in quotes. It is helpful to imply that “real” obstetricians (apparently those who belong to ACOG) think differently, even though everyone knows that the overwhelming majority of obstetricians consider homebirth to be dangerous and would be just as underwhelmed about Gina’s publicity stunt as I was (had they bothered to pay any attention to her).]

She and her unstable little cronies attacked, tortured, and cyberbullied me throughout my entire 9 month pregnancy – WHY? [Histrionic much? Hmmm, the entire 9 month pregnancy? Contrary to Gina’s belief that I am so interested in her that I followed her pregnancy from conception onward, my first post about her occurred when she was 7 months pregnant, and in response to her announcement that she would be live-blogging the birth.]

Because I chose to have a homebirth after two intensely traumatic hospital births. Anyone who’s reading her site and listening to it needs to check their head. That lady PUBLICLY wished that my baby would die. IN PUBLIC. ON HER NUTTY BLOG. [An example of the utter disrespect for the truth that is characteristic of natural childbirth advocacy. No one ever wished her baby would die, but, hey, it sounds so much more dramatic to pretend that it happened.]

As for whether birth and our reproductive autonomy is a feminist issue, HELL YES it is. The maternal mortality rate in this country is the WORST of any industrialized nation. [It isn’t, but when you are trying to make a point a lie is often far better than the truth].

Is that because a few women are birthing at home? NOPE! It’s because our cesarean rate is 32%, and our rates of intervention are nearly 100% in some hospitals. [Another lie that is ever so much better than the truth (see above).]

That’s not because those interventions are necessary, unless you believe that women are born fundamentally broken. We are NOT broken. [I never said or implied that Gina was “broken.” Ignorant, self-absorbed and desperately insecure, yes, but not broken.]

As Ina May says, “Your body is not a lemon.” We’ve internalized this misogyny for too long. Yes, some women need modern science for birth. MOST women do not. I’ve had the cesarean that nearly killed my spirit. [Oh, the tragedy. Her spirit was almost killed!]

I had the vaginal birth in the hospital that I practically needed lawyers at my bedside for. And I had the beautiful, swift, safe, practically PAINLESS homebirth that made me feel more connected to my body and baby than I ever thought possible. [And it needed to be video taped and live blogged because?]

Dr. Amy’s “science” is junk. It’s embarrassing to other physicians. And she’s just a plain horrible human being.

Here’s a few helpful hints, Gina (in the interests of education, of course).

• Writing satisfying lies does not make them true.
• Pushing a baby through a vagina is not an “achievement” and certainly not a feminist achievement. It’s what is known as biological essentialism, in short, the belief that women can and should be defined by their reproductive organs.
• Cyber-bullying is a serious problem and its significance should not be demeaned by wailing “cyber-bully” at anyone who doesn’t praise the ignorant and self-promoting gibberish you publicly post on the internet.

Finally, and most importantly, refusing to cater to your insatiable need for praise and recognition does not make other people horrible.

I am extremely grateful to the readers, and especially the commentors, who made 2011 the best year ever for the Skeptical OB. There were more than 650,000 visits to the blog and over 58,000 comments! Thank you for a very good year.

It is axiomatic among natural childbirth advocates and homebirth advocates that an unmedicated childbirth is an empowering experience. I would like to make three claims about this. First, by definition, it is impossible to be empowered by a normal bodily function. Second, that the use of empowered in this setting bears no relationship to the actual meaning of the word, and third, that “empowered” is simply a code word for “better than other women”.

According to the American Heritage Dictionary, empower means:

To invest with power, especially legal power or official authority. See Synonyms at authorize. Usage Note: Although it is a contemporary buzzword, the word empower is not new, having arisen in the mid-17th century with the legalistic meaning “to invest with authority, authorize.” Shortly thereafter it began to be used with an infinitive in a more general way meaning “to enable or permit.” Both of these uses survive today but have been overpowered by the word’s use in politics and pop psychology… The Usage Panel has some misgivings about this recent broadening of usage… and frown[s] on … psychological empowering because it resonates of the self-help movement, which is notorious for trendy coinages.

So there are a variety of accepted usages for the word “empowered” all relating to investing an individual with power or authority. Its pop psychology usage is even more popular; in that setting, it means to be in control of one’s destiny.

Regardless of which usage is employed, it is simply not possible to be “empowered” by a normal bodily function. Normal bodily function extends to all people indiscriminately. It has nothing to do with whether those people have either power or authority. When used outside the realm of childbirth, this is quite obvious. Could people be empowered by digesting their own food? No. Are women empowered by enduring painful menstrual cramps without medication? No. Are people who don’t need glasses more empowered than people who do? Certainly not.

Similarly, unmedicated childbirth is the default mode. Virtually every mother who ever lived had unmedicated childbirth (or died trying), and most women around the world have unmedicated childbirth each and every day. Does this make them more powerful than they would be otherwise? Of course not. By the same token, it is not going to make Western, white, relatively well off, and relatively well educated women any more powerful, regardless of what they would like to pretend.

So what do “natural” childbirth advocates mean when they claim that unmedicated childbirth is “empowering”? What they mean is that it makes them feel better about themselves in relation to their peers. The desire for unmedicated childbirth is a fad, no different than the fad for fancy handbags, or fast cars. Owning a fancy handbag or a fast car does not make one person superior to another, except for those who believe in the value of the fad object. There is nothing intrinsically better about fancy handbags, and there is nothing intrinsically better about unmedicated childbirth. However, for those who move in a particular milieu, a fancy handbag is a sign of status. For those in the “natural” childbirth community, being able to boast about an unmedicated childbirth is a sign of status.

Women who proclaim unmedicated childbirth to be “empowering” are slaves to the ideology of the group, not independent actors taking control of their own lives. No one can be empowered by a normal bodily function that is the default mode. They simply mistake their unmerited feelings of superiority for empowerment.

This piece first appeared on Homebirth Debate in May 2008.

Natural childbirth advocates often appear to be nothing more than a bunch of parrots. One of them makes up something and the rest of them mindlessly repeat it.

Consider the issue of maternal mortality. Fittingly, Ina May Gaskin, the biggest fraud in the world of NCB advocacy, misconstrued the most basic information (possibly deliberately) and fashioned the biggest lie. And once she made it up, Ina May played it for all it was worth.

In creating and promoting this lie, Gaskin harkens to a classic technique in pseudoscience. As described by Paul Wolpe in The Holistic Heresy: Strategies of Ideological Challenge in the Medical Profession an attack by purveyors of “alternative” medicine on an established discipline in medicine includes specific elements. The first is that the critic:

must portray the discourse as in crisis, must provide an alternative ideology to rescue the discourse, must legitimize their ideology through appeal to a reframed historical myth, and must portray the orthodoxy as a betrayer of the discourse.

According to Gaskin, rising US maternal mortality is an indication that contemporary obstetrics is in crisis. There’s just one problem: US maternal mortality is not rising.

In 1999 and again in 2003, the standard birth certificate was redesigned to capture all maternal deaths by expanding the maternal mortality criteria. Not surprisingly, maternal mortality appeared to rise as a result. There is no evidence that it actually rose (indeed the CDC has established that it did not rise) but that didn’t matter to Gaskin. She grabbed the issue and exploited it to promote homebirth midwifery. In a public relations master stroke, she even created a quilt (consciously modeled on the AIDS Quilt) to foster the illusion that the maternal mortality rate was rising and that modern obstetrics was the cause.

In May, Amy Romano, CNM of the Childbirth Connection parroted this falsehood in honor of Mother’s Day. Now Kimmelin Hull of Lamaze has jumped on the bandwagon. Hull, who (as she never tires of telling us) is working on an master’s in public health, ought to know better. However, the opportunity to criticize contemporary obstetrics is just too tempting, facts be damned.

Hull begins by parroting the lie that US maternal mortality has been rising. Hull quotes the WHO, the CDC, Amnesty International, and (of course) Gaskin, but she neglects to quote the specific studies that show that the apparent increase in maternal mortality is due to the birth certificate revisions.

From Deaths: Final Data for 2008:

Research done on this issue indicates that this increase represents an improvement in identifying maternal deaths. For example, a study in Maryland that used multiple data sources as the standard showed an improvement (from 62 percent to 98 percent) in identifying maternal deaths after adoption of a pregnancy checkbox item consistent with the 2003 standard certificate.

And Changes in Pregnancy Mortality Ascertainment: United States, 1999–2005:

The maternal mortality ratio increased significantly from 11.6 in 1995–1997 to 13.1 for 1999–2002 and 15.3 in 2003–2005 … Vital statistics identified significantly more indirect maternal deaths in 2002–2005 than in 1999–2002. Between 2002 and 2005, mortality ratios increased significantly among 19 states using the revised death certificate with a pregnancy checkbox; ratios did not increase in states without a checkbox. (my emphasis)

Having parroted the lie, Hull then proceeds to parrot the claim that contemporary obstetrics is in crisis:

… Perhaps then, the simplistic question to ask is, “If we are spending so much money each year on maternity care, why is the maternal death rate in our country climbing when expenditures—estimated to be in the hundreds of billions of dollars—on other health conditions, such as cardiovascular disease, are resulting in declining death rates?”

Then, nonsensically, Hull parrots the assertion that midwifery theory is the answer:

… By encouraging the perspective that pregnancy and birth are inherently normal, healthy processes (as opposed to disease/disease states) the eventual clinician is more likely to approach patients with a sense of trust in the germane mechanics associated with pregnancy and birth as opposed to a pessimistic assumption that each pregnant patient is a “ticking time bomb” to be weary of.

What? The solution to an increase in maternal mortality is to trust birth? That makes no sense. But making sense, like the truth itself, is irrelevant to the NCB parrots.

Sadly, 2011 ended with an appalling 5th confirmed homebirth death in North Carolina. The fourth homebirth death had actually occurred several days later. The death was, as is typically the case with homebirth deaths, needless, senseless, utterly predictable, and totally preventable.

The mother is a doula and had a waterbirth. The baby was a breech with a trapped head. The mother transferred to the hospital with the breech suspended from her vagina. By the time doctors could extricate the baby, she was dead.

This brings the confirmed homebirth death rate in North Carolina in 2011 to an extraordinary 12X times the expected death rate for comparable risk hospital birth (0.4/1000), and proves, yet again, that breech is NOT a variation of normal.

How many babies have to die before homebirth advocates realize that “trusting” birth is a recipe for disaster?

On Wednesday I reviewed the homebirth deaths that appeared on this blog in the past year. Today, we’ll take a look at the state, national and international homebirth statistics I wrote about in 2011 as well as scientific papers that looked at the safety of homebirth.

1. Western Australia: 20 fold increase in hypoxic deaths at homebirth

From The 13th Report of the Perinatal and Infant Mortality Committee of Western Australia for Deaths in the Triennium 2005–07 full report (here). The results are truly appalling AND entirely consistent with the terrible homebirth death rate in the US. The major finding is that homebirth QUADRUPLED the risk of perinatal death compared to hospital birth. Indeed, homebirth dramatically increased the risk of death at every level, from stillbirth to infant death.

2.South Australia: Homebirth death rate 17 times higher than comparable risk hospital birth

The state of South Australia, which includes the city of Adelaide, has published it’s perinatal mortality rates. The data shows that planned homebirth has a perinatal mortality rate more than 17X higher than comparable risk hospital birth.

The report, Pregnancy Outcome in South Australia 2009, is a dry recitation of birth statistics without editorial comment. The statistics are analyzed in every possible way to give a vivid picture of birth in the state. Among the ways the data is analyzed is according to place of birth and the results are surprising and distressing.

3. Missouri: homebirth has a 20 fold increase in intrapartum death

From Birth outcomes of planned home births in Missouri: a population-based study by Chang and Macones published in the American Journal of Perinatology in August 2011:

… We observed that planned home births attended by non-CNMs remained positively associated with odds of newborn seizures after controlling for confounders. Specifically, the adjusted OR of newborn seizure among births delivered by non-CNMs was more than 5 times as much as the odds in hospital/birthing center births delivered by physicians/CNMs … For intrapartum fetal death, planned home births attended by non-CNMs and physicians/CNM yielded adjusted ORs of 11.24 and 20.33 respectively relative to hospital/birthing center births attended by physicians/CNMs …

4. New Dutch study raises troubling questions about the safety of homebirth

Planned Home Compared With Planned Hospital Births in The Netherlands by van der Kooy et al. is large, comprehensive and raises troubling questions about the safety of homebirth.

The large amount of data is analyzed in a bewildering number of ways, but the bottom line is that homebirth is safe when nothing goes wrong; in the presence of life threatening problems, homebirth increases the risk of death. Moreover, while homebirth with a Dutch midwife in the absence of complications is nearly as safe as hospital birth with a Dutch midwife, the perinatal mortality rate in both groups is 33% higher than comparable risk women delivered in hospitals by obstetricians just across the border in Flanders.

5. How many babies died at the hands of Colorado homebirth midwives this year?

Drum roll please …

The death toll of planned homebirths attended by licensed Colorado hoomebirth midwives in the last reported year is so high that the midwives, in violation of Colorado law, refuse to relase them!

Let me repeat that. After 4 years of high, rising, and nothing short of appalling death rates, Colorado homebirth midwives are now refusing to report how many babies are dying at their hands. They published an annual report. as they always do, but they left out the homebirth deaths.

6. How many babies died at the hands of Oregon homebirth midwives?

A new website, Oregon Homebirth Midwife Info, has compiled a Midwife Directory that makes for stomach-churning reading. The directory lists midwives by name and includes reports of deaths as well as other major morbidity and actions taken against the midwives.

It is an incomplete list; not all Oregon midwives are included and there may have been additional deaths that are not recorded. Nonetheless, the statistics are no less than horrifying.

In the past decade, no less than 19 babies have died at the hands of Oregon homebirth midwives.

To put that in perspective, consider that there are approximately 1000 homebirths per year in Oregon and that the neonatal death rate for low risk women in a hospital setting is 4/10,000 (0.4/1000). That means that you would expect approximately 4 homebirth deaths per decade. Instead there were at least 19 deaths, for a rate more than 4X higher (375%) than expected.

7. NZ study tries to bury increased homebirth death rate

From Planned Place of Birth in New Zealand: Does it Affect Mode of Birth and Intervention Rates Among Low-Risk Women?

the homebirth group had lower rates of major interventions and the homebirth group had lower rates of minor interventions. How about deaths?

Well, funny you should mention that. There was a little bit of a problem there and the authors made a valiant attempt to hide it.

A total of six neonatal deaths (a death occurring up to 27 days after birth) occurred in the sample, two (0.11%) from women planning a home birth and four (0.15%) from women planning to give birth in the tertiary hospital. No intrapartum, intrauterine deaths were reported.

Hey, the death rates are exactly the same! Wait, what? The authors deliberately used the wrong denominator for calculating the hospital birth death rate?

Indeed they did. They compared the death rate at homebirth with the death rate in tertiary [high risk] facilities, but that’s not what we want to know. We want to know how the death rate at homebirth compares with the death rate at all hospital births, not the death rate at tertiary facilities.

What the authors should have told us was that there were two neonatal deaths (0.11%) among women planning a home birth and four (0.03%) from women planning to give birth in the hospital. In other words, the homebirth death rate was more than triple that of the hospital birth death rate. Oops!

8. The Birthplace Study

The Birthplace Study is the most important homebirth study published this year, and it is one of the most important homebirth studies ever published. In involved a large multi-year study, was designed to address the safety of place of birth by controlling for the many factors that had not been handled properly in other studies. The study looked at intended place of birth to rule out improperly assigning transferred patients to the hospital group, and included only the lowest possible risk women. The study was conducted by The National Perinatal Epidemiology Unit in the United Kingdom.

What did it show?

Homebirth increases the risk of perinatal death and brain damage in the lowest risk women receiving care from highly trained midwives (often two) and liberal access to transfer.

Homebirth increases the risk of perinatal death and brain damage even when, at the start of labor, breech, twins, VBAC. positive GBS status, gestational diabetes and obesity were excluded. All routinely occur at homebirths in the US, the UK and Australia.

And how about the purported “risks” of interventions that homebirth advocates are always taking about?

Homebirth increases the risk of perinatal death and brain damage even though the incidence of epidural use was 5 times higher in the hospital group.

Homebirth increases the risk of perinatal death and brain damage even though the incidence of pitocin augmentation was 5 times higher in the hospital group.

Homebirth increases the risk of perinatal death and brain damage even though the incidence of operative vaginal delivery was 3-4 times higher in the hospital group.

Homebirth increases the risk of perinatal death and brain damage even though the C-section rate was 4 times higher in the hospital group.

In other words, any way you choose to look at it, no matter how carefully you slice and dice the data, there is simply no getting around the fact that homebirth increases the risk of perinatal death and brain damage.

9. Latest CDC data: Homebirth killing more babies than ever

American homebirth with a homebirth (non-CNM) midwife had a neonatal mortality rate 7.7 times higher than comparable risk hospital birth!

The table shows that the neonatal mortality rate for homebirths attended by an American homebirth midwives (CPM, LM) is 7.7 time higher than comparable risk hospital birth attended by a CNM (certified nurse midwife). This extraordinarily high death rate is all the more remarkable because it actually under-counts the homebirth death rate. That’s because homebirth transfers ended up in the hospital MD group and were not counted in the homebirth group. The real number of homebirth deaths is almost certainly significantly higher.

*****

It’s a pretty damning collection of evidence. In every state, province and country where the issue of homebirth safety was examined, homebirth increased the risk of newborn death and serious injury.

There is, of course, one set of statistics that is missing. That would be the safety data compiled by MANA (Midwives Alliance of North America) on the 24,000 homebirths in its database. MANA explicitly refuses to release the death rates to the American public. The executives of MANA know that homebirth increases the risk of neonatal death; they just don’t want American women to find out.

As the year 2011 draws to an end, I’d like to review the year in homebirth. In this post, I review the homebirth deaths that I wrote about in the past year. In future posts, I’ll address the state and national statistics released this year as well as the homebirth studies that were published in 2011.

First, the homebirth deaths:

1. Attempted VBA3C

Initially reported on a message board:

A girl who I went to college with had a baby around 10 last night & both are in critical condition. This is her 4th baby. She had 3 previous c-sections & was trying for a VBAC homebirth. Her uterus ruptured in several places & she lost a lot of blood. She is intubated & had 2 blood transfusions. She isn’t out of the woods yet, by any means. The baby was born blue & unresponsive, was resusitated, but showing signs of possible brain damage. She was flown to a different hospital than her mom. The baby is being kept in some sort of induced unconscious state currently. Please keep Lori & baby Vera in your thoughts & prayers!! Thanks.

From the blog of a family member:

Update (2/3/11): According to the neonatalogists “…the MRI showed that a large amount of fluid had collected (hydrocephalus) and was putting pressure on parts of the brain, actually moving sections into different areas (herniation). The EEG showed minimal electrical activity from the cerebral hemispheres. The neurologist stated that there is some brain swelling as well as significant brain damage in a large part of her brain, but she is NOT brain dead. Vera still has some reflexes. What they believe Vera has is HIE, Hypoxic Ischemic Encephalopathy.”

Update (2/12/11): Vera died last night.

2.Arrest of midwife Amy Medwin

You might think that this would be an opportunity for soul searching in the North Carolina homebirth community, but you’d be wrong. The North Carolina Friends of Midwives and the Charlotte chapter of the International Cesarean Awareness Network (ICAN) view this as an oppportunity to promote the interests of CPMs.

The latest news reports indicate that Medwin’s current arrest was prompted by TWO bad outcomes in one month. The first case was an intrapartum death in which Medwin attended the labor but claims she left before the birth of the dead baby. The second is the case discussed above in which the baby is still hospitalized and fighting for its life.

3. Joseph

Alicia’s son Joseph died in the aftermath of a homebirth. Writing on Mothering.com, Alicia explains:

One month ago I gave birth at home to a beautiful 9lb 9oz baby boy named Joseph Phoenix, but he decided that he did not need to stay long in this world and he died the next day…

He decided? Not exactly.

According to a memorial on Flicker:

[The baby] was born at 10:05 AM on February 13, 2011. He was not breathing when he was born because his arm had pinched off his umbilical cord as he descended. The hospital re-started his heart but he was already gone, as later tests showed no brain activity…

He did not “decide” to die. He died because of profound hypoxia during labor that went unnoticed and untreated.

4. Midwife Karen Carr

Carr’s guilty plea to felony charges came in the wake of presiding over the death of a breech baby who’s head became stuck for more than 10 minutes before Carr even bothered to call 911.

The baby’s position wasn’t the problem, Carr said; the problem was that the baby’s head became stuck.

That is the obstetric equivalent of insisting that ‘it wasn’t the fact that I pushed him off a ten story building that killed him; the problem was that he hit the ground.”

5. Complaining that doctors play the “dead baby card“

After that experience and the regret of not trusting my instinct, I told DH that we’d be having no more babies unless I was able to plan a homebirth for the next one. I’m full-term with baby #3 and hoping to have an awesome HBA2C story in the next month! No matter how the birth turns out, I appreciate having a care provider who understands that each pregnant mother is an individual who is capable of researching and making her own decisions about “HER” body and child…

The mother began labor spontaneously at 41 1/2 weeks, labored for 24 hours and apparently delivered vaginally the day before yesterday.. The baby was born not breathing. Subsequent evaluation revealed meconium aspiration and catastrophic brain damage due to lack of oxygen. The decision was made to take the baby off life support.

The baby is dead.

6. Birth center death

The mother claims:

I don’t ever want anyone to fear a VBAC, or to fear going over their due date, or to fear having their baby in a birthing center because of our situation. Those things had nothing to do with what happened to our little angel, and there isn’t anything that could have been done to prevent it either.

Not exactly. Had the mother had an elective repeat C-section at term, the baby would definitely be alive today. Had the mother had continuous electronic fetal monitoring, the baby would almost certainly be alive today. Had the mother given birth in a hospital, the baby would likely be alive today.

7. Another HBAC: another rupture, another hemorrhage, another baby dies

Let’s see: a homebirth, 2 previous C-sections, a macrosomic baby, and undiagnosed pre-eclampsia. The perfect homebirth candidate!

And look how well it went. The uterus ruptured, the placenta tore away from the uterine wall and he baby died long before she ever got to a hospital. Way to trust birth!

As a bonus, the mother had a massive hemorrhage, extensive abdominal surgery and will be unable to bear any children in the future. Hey, ICAN, are you going to feature this story?

8. Prominent midwife retires after homebirth death

Back in April Brynne Potter, CPM, in her role as a board member of NARM (North American Registry of Midwives) appeared on the Kojo Nnmadi radio show to defend Karen Carr, the midwife who pled guilty to felony charges in connection with the homebirth death of a breech baby. What Potter neglected to mention is that she was on leave from her practice for recently presiding over — you guessed it — the homebirth death of a breech baby.

In the wake of that death, Potter is giving up the practice of midwifery.

9. Third North Carolina homebirth death

The mother is a diabetic (not gestational) who labored at home and ultimately transferred to the hospital after pushing for many hours. The baby was born by C-section, asphyxiated and brain dead, as well as suffering from overwhelming group B strep sepsis. The baby was taken off life support the next day.

10. Mother of 6 dies in the wake of attempted homebirth

The mother posted on homebirth websites and reported that she had already had one successful homebirth after 2 previous C-sections.

In the wake of her death, a friend began soliciting breast milk for her baby:

A beautiful, wonderful, amazing friend of mine passed away on Monday (08/22/11) after giving birth to her sixth child just a day before. She never got to meet her son, as she had lost so much blood by the time he was taken via emergency cesarean section. She tried so hard for this last pregnancy, and continued to nurse her second youngest (nearly 2 now) through it. She was a beautiful, WONDERFUL soul…

Her doula Michelle Fonte had posted a prayer request on August 21:

PLEASE. energy. thoughts. prayers for a very special mama of mine. in the hospital. who needs all of our help. she needs you. really. really.

Unfortunately, she died the next day.

11. Another needless, senseless, utterly predictable, totally preventable homebirth death

The latest needless, senseless, utterly predictable and totally preventable homebirth death is currently being discussed on the Birth Without Fear Facebook Page, which links to the original story and a picture of a beautiful baby who looks to be sleeping but who is actually dead.

I had the most simplest pregnancy, and the healthiest baby boy, decided at 8 months to ditch my OBGYN and go with a midwife and home birth to welcome my son into this world as calming and peacefully as I could. I did chose to go with an unlicensed midwife, as licensing is not required in the state of Oregon, but the greatest mistake of all was not seeing the warning signs for myself. his being my first born I put all my trust and faith into two midwives, who in the end made some bad decisions and proved to be quite negligent. After a full 8 days of labor I delivered my son at home with no heart beat. After all I had done to prepare him for his peaceful arrival, instead of living he rests peacefully….

12. Author of “Perfect Birth Experience” has a dead baby

Canadian homebirth celebrity Annie Bourgault had a twin homebirth. One of them lived and one of them died.

Bourgault describes herself as:

… a reporter who finds evidence based information about birthing. She interviews health professionals, leading experts in childbirth and parents whose work help women feel empowered and fulfilled during pregnancy, birth and motherhood. Sign up for her free report: 7 Steps To The Perfect Birth Experience.

Bourgault was expecting twins, and her “perfect birth experience” did not involve being “fearful of the birth process.”

Pushing Max who was breech was amazing. I could even say it was easy-ish. Even if it wasn’t that easy. It felt like it. When I held him in my arms I kept thinking: “What was the big deal? Why did the hospital refused to let me birth you the way I wanted? Without drugs? Without a c-section? I knew we could do it.”

Then Sam… came out 45 minutes after his little brother. He was in a perfect position: head down. We heard his little heart beating 10 minutes before he came out…everything was fine…seemed fine. While I was pushing him out I heard my midwife say: Oh no! It’s the placenta!” She came in front of me and said: “push your baby out right now!”

… I pushed a baby and a double placenta at the same time…

… I kept saying his name over and over..like a song. I thought if he had a name he couldn’t die. ” … I kissed him, massaged him, loved him with all I had. I believed he was going to be OK.

He wasn’t. He never took a breath.

13. Postdates + long labor + CPM = dead baby

The whole “trust birth” thing continues to work out very poorly for homebirth midwives, the mothers they serve, and most of all the babies who die preventable deaths because of their lack of education and training. Consider the homebirth death that occurred in the Santa Cruz area under the care of “Rebecca, CPM.”

At some point during the 54 hours of labor, the baby stopped getting adequate oxygen. The baby expelled meconium repeatedly, suggesting that she suffered for hours. An electronic fetal monitor would have made it clear that the baby was oxygen deprived, but they didn’t want that, because they were trusting birth. As is all too common at homebirth, the baby died after a long struggle and the CPM not only had no idea that the baby was struggling, but she had no idea that the baby was dead.

To summarize, a postdates mother was allowed to labor for 54 hours with grossly inadequate monitoring of the baby and the baby died a completely preventable death. Why? Because the parents trusted a CPM, an ignorant, undereducated, undertrained, self proclaimed “midwife” who blithely sat by completely clueless while a baby’s life ebbed away.

14. Lisa Barrett presided over a 5th homebirth death

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

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

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

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

15. Kim Mosny presides over homebirth tragedy

Kim wants you to believe that there was no way this could have been prevented.

… Midwives care only for low-risk women, who have healthy life-styles; who do not smoke, drink alcohol, or abuse drugs, and who’s medical status is determined to be healthy, without medical conditions or diseases that would risk them out of care. Thus, there were no other risks that could be determined as causal for this client’s placental abruption. As a result of the abruption, the baby was very quickly deprived of oxygen and he died. He felt no pain. Thankfully, the mother remained stable and did not suffer medical complications herself.

Technically speaking, everything that Mosny wrote may be true. However, she left out some critical details that cast a very different light on the tragedy.

The patient was 42 weeks and 1 day when this stillbirth happened. While the actual precipitating event that led to the baby’s death may not have been preventable, the death itself may have been preventable. The stillbirth rate rises steadily at the end of pregnancy, and 42 weeks is considered the outermost cut-off for induction and delivery of the baby. Had this patient been induced in the hospital before 42 weeks, the outcome would likely have been a healthy baby.

16. Severe IUGR and stillbirth

She planned a homebirth with the same CPM despite her history of a previous C-section, a macrosomic baby, an occult cord prolapse and a postpartum hemorrhage.

At 41 weeks, her daughter died in utero on Thanksgiving day. She was delivered later that evening in the hospital. The baby weighed 5 lbs. 15 oz, suggesting that she had been suffering from intrauterine growth retardation likely due to placental insufficiency.

17. 4th North Carolina homebirth death

The latest homebirth death in NC occurred on December 16. According to the Charlotte Observer:

Just before 8 p.m. Dec. 16, police and paramedics were called to a home on Seamill Road, in a neighborhood near the Catawba River. They discovered the newborn unresponsive.

Charlotte-Mecklenburg police said it appeared complications had occurred after the baby’s mother participated in a water birth – a method of giving birth in a tub of warm water.

Paramedics performed CPR and then took the baby to Carolinas Medical Center, but the infant soon died.

Homicide detectives, who respond to all infant deaths, said they began investigating and determined that two women were in the home at the time of the birth. Police said they were practicing midwifery but did not have the proper license required by state law. Police arrested Mary Stewart Barhite, 43, of Charlotte, and Jacqueline Lynn Proffit, 45, of Indian Trail, on Friday. They are charged with practicing midwifery without a license – a misdemeanor.

*****

These 17 deaths are just the ones that I could confirm; there have been others.

Of note, 13 of these deaths occurred at the hands of American lay midwives and CPMs. There are approximately 10,000 American births attended by non-nurse midwives each year. The death rate for comparable risk hospital birth is 0.4/1000, which means that there should be approximately 4 deaths each year. Instead there have been 13 deaths that I have heard about and confirmed for a death rate that is more than 3X higher than comparable risk hospital birth. The real death rate for homebirths attended by CPMs and other lay midwives is undoubtedly much higher. (Addendum: One death is is a stillbirth, so there were 12 neonatal deaths for a rate 3X higher than comparable risk hospital birth.)

Homebirth with a CPM kills babies. There is no doubt about it. All the state and national statistics confirm this. MANA (Midwives Alliance of North America) is hiding its own death rates because they confirm this. The homebirth deaths of 2011 are yet further confirmation.

How many babies have to die preventable deaths at homebirth before homebirth advocates acknowledge the obvious?

You have to give homebirth advocates credit for intellectual honesty. It doesn’t matter to them whether babies live or die and they don’t care who knows it. Apparently, babies who die are just collateral damage in the fight for every woman to put her birth experience ahead of her baby’s very life.

How else to explain the grotesque nomination of Australian midwife Lisa Barrett as a “National Birth Hero” on a major homebirth advocacy website, One World Birth? It’s as if the AMA nominated Michael Jackson’s doctor, Conrad Murray, as physician of the year.

Indeed, the parallels between Dr. Murray and Ms. Barrett are striking. Both ignored the law to follow their patients wishes, both violated basic standards of practice and both accepted large sums of money for doing so. But Conrad Murrary is facing several years of jail time for letting one patient die a preventable death, while Lisa Barrett is nominated as a “hero” having presided over FIVE preventable deaths. The medical community is disgusted by Murray’s behavior. The homebirth community is impressed with Barrett’s.

Barrett is a one woman crime wave, presiding over no less than 5 preventable deaths in the past 5 years, as well as practicing midwifery without a license and taking her claim that a baby who born only barely alive as a result of her negligence should be ignored as not a person all the way to the Australian High Court (and losing).

You might think that homebirth advocates, who prate endlessly and falsely, that homebirth is as safe as hospital birth might consider Barrett a liability. You might think that homebirth advocates who are careful in most public pronouncements to declare that homebirth is appropriate only for low risk women might disavow a midwife who deliberately takes on very high risk patients. You might think that homebirth advocates would prefer to ignore Barrett, not honor her. But, of course, you’d be wrong on all three counts.

Lisa Barrett is not a birth hero, she is a birth criminal.

What is a birth criminal? A birth criminal is a midwife who ignores the growing pile of tiny bodies, babies who died preventable deaths as a result of her direct or indirect professional actions. Lisa Barrett is hardly the only birth criminal, and hardly the only birth criminal lauded for her despicable actions.

Melissa Cheyney is a birth criminal for fighting every effort at homebirth safety regulation at the state and nation level. She presides over the Board of Direct Entry Midwifery of a state with a neonatal death rate FOUR times the rate of comparable risk hospital birth. She, who is in charge of midwifery licensure, opposes mandatory licensure. In her role as Director of Research of MANA (Midwives Alliance of North America) she heads a vigorous effort to hide the appallingly high death rate of the 24,000 planned homebirths in MANA’s own database.

Other birth criminals include:

Janet Fraser (let her own baby die)
Laura Shanley (let her own baby die)
Amy Medwin (pleaded guity to charges in a homebirth death)
Karen Carr (pleaded guilty to felony charges in a homebirth death)
Russ Fawcett and the North Carolina Friends of Midwives (who held a rally on behalf of Amy Medwin)

The list goes on and on and is far too long for one blog post. But the biggest birth criminal of them all is the oldest and best known among them, Ina May Gaskin. Gaskin is the Jim Jones of homebirth midwifery. She created the contemporary cult of homebirth, brews the kool-aid and accepts no responsibility, indeed refuses to acknowledge, the many babies who have died as a result of her bizarre and proudly irrational beliefs. I suppose it is hardly surprisingly that she accepts no responsibility for the many unknown babies who died as a result of her preaching about the purported virtues of homebirth; she accepts no responsibility for the death of her OWN child who died as a result of her refusal to seek obstetric care.

I used to think that there was nothing more disgusting than homebirth advocates who ignore the rising toll of homebirth deaths, but One World Birth has showed me that I was wrong. There is something more disgusting than ignoring the deaths: honoring those who cause them.

Why are these women smiling?

Shouldn’t self-proclaimed “midwives” Mary Barhite and Jacqueline Proffit look even a tiny bit remorseful or at least sad in the wake of presiding over yet another homebirth death in the state of North Carolina?

Maybe they are smiling because they know it doesn’t matter how many babies die at the hands of self-proclaimed homebirth midwives. Other homebirth midwives and homebirth advocates will support them (possibly even pay their bail and any fines they incur), and no one in the homebirth community will even bother to investigate. That’s what they did for the previous 3 confirmed homebirth deaths that have occurred in North Carolina in this year alone.

That’s right. This is the 4th confirmed homebirth death in NC this year for a rate that is a whopping TEN times higher than the rate of death for comparable risk hospital birth. And that’s only the confirmed cases. I have seen information that there have been as many as three other deaths this year, including one at the hands of the wife of Russ Fawcett, the president of NC Friends of Midwives (the group that held a rally for infamous midwife Amy Medwin, who pleaded guilty to felony charges).

It appears that North Carolina is vying with Oregon, Colorado and Missouri to prove that certified professional midwives (CPMs) the second, inferior class of midwife that exists in no other first world country, should be banned due to the extraordinary number of deaths that have occurred at their hands.

The high and rising homebirth death rate in Colorado is so appalling that homebirth midwives have actually refused to release their death rates for the past year. Evidently, they are taking a page out of the playbook of the Midwives Alliance of North America (MANA), the organization that represents homebirth midwives, who conducted a publicly announced collection of safety data from 24,000 planned homebirths and now are hiding how many deaths occurred at the hands of homebirth midwives.

It is critical to understand that CPMs are a second, inferior class of midwife, ineligible for licensure in ANY other first world country. They lack the education and training required of EVERY other midwife in the industrialized world. Indeed, they don’t even have college degrees. They have a post-high school “certificate.” Many have earned this certificate by correspondence course and even more have earned it without any contact with an educational institution, merely by submitting a “portfolio” of births they have already attended. Simply put, these women are self-described “birth junkies” who couldn’t be bothered to obtain a real midwifery degree.

The latest homebirth death in NC occurred on December 16. According to the Charlotte Observer:

Just before 8 p.m. Dec. 16, police and paramedics were called to a home on Seamill Road, in a neighborhood near the Catawba River. They discovered the newborn unresponsive.

Charlotte-Mecklenburg police said it appeared complications had occurred after the baby’s mother participated in a water birth – a method of giving birth in a tub of warm water.

Paramedics performed CPR and then took the baby to Carolinas Medical Center, but the infant soon died.

Homicide detectives, who respond to all infant deaths, said they began investigating and determined that two women were in the home at the time of the birth. Police said they were practicing midwifery but did not have the proper license required by state law. Police arrested Mary Stewart Barhite, 43, of Charlotte, and Jacqueline Lynn Proffit, 45, of Indian Trail, on Friday. They are charged with practicing midwifery without a license – a misdemeanor.

How many babies have to die before homebirth advocates understand that homebirth increases the risk of perinatal death?

How many babies have to die before state officials institute large fines and jail terms for self-proclaimed “midwives” who preside over homebirth deaths, often in direct violation of state law?

How many babies have to die before the Midwives Alliance of North America is forced to publicly acknowledge that they KNOW that homebirth at the hands of a CPM dramatically increases the rate of perinatal death?

Most importantly, how many babies have to die before the American public demands the abolition of the CPM “credential” as grossly inadequate for the safe care of pregnant women and their newborns?

Evidently quite a few. The tiny bodies are piling up in states like North Carolina, Oregon, Missouri and Colorado, and no one seems to care, least of all homebirth midwives and their supporters.