Midwives: Ignore homebirth deaths

Homebirth midwives are worried. I keep posting accounts of homebirth deaths. Now you might think they were worried about the number of homebirth deaths, but you’d be wrong. Apparently homebirth midwives Janelle Wahlman of Birthsense and Kitty Ernst are worried that women might be influenced by these accounts. Therefore, they’ve set out to try to neutralize them.

Janelle is shocked, shocked that I might use accounts of homebirth deaths to illustrate the dangers of homebirth. After all, that’s the favored tactic of homebirth advocates to support homebirth. Every homebirth advocacy website and publication is chock to the brim with birth stories about wonderful, “empowering” homebirths. Evidently homebirth midwives want women to read only the stories with good outcomes; the many stories of homebirth death shouldn’t be published at all.

Too late for that. I already posted the story. The only thing left to do is to try to undermine the points that I have made. Unforuntely, it attempting to do so, Wahlman trots out many of the inane logical fallacies that characterize homebirth advocacy. Janelle starts by quoting me:

I understand that a tragic story is a more powerful way to convey risk than any set of statistics will ever be. That’s why I post stories of homebirth deaths, to illustrate that childbirth is inherently dangerous, that childbirth emergencies occur in low risk situations, and that being close to a hospital is often not close enough to matter.

She continues:

Let’s dissect Dr. Amy’s rationale for posting stories of homebirth deaths:

1. To illustrate that childbirth is inherently dangerous. I disagree with this point of view. Certainly, childbirth carries the potential for danger, but when birth is supported in such a way that interventions are avoided unless they are clearly beneficial, birth occurs safely the majority of the time…

She disagrees. She disagrees? Funny, but it isn’t a matter of opinion; it is an empirical fact. The idea that disagreeing means we can discard facts we don’t like is an immature error of cognitive reasoning favored by all believers in pseudoscience.

Second, the fact that childbirth “occurs safely the majority of time” is one of those meaningless truisms favored by homebirth advocates. Driving drunk “occurs safely the majority of time,” too. That doesn’t mean that driving drunk is safe.

2 Childbirth emergencies occur in low-risk situations. True enough. However, if this were really a primary concern of obstetricians, why would they not be present in the hospital, at the bedside of their patients, for the duration of every low-risk labor? …

The “but he did it” defense is well known to mothers everywhere. When confronted with an episode of wrongdoing, many young (and not so young) children attempt to defend themselves by accusing a sibling of doing something similar. Homebirth advocates further embellish this childish “defense” by insisting that no difference exists between home and hospital, since an obstetrician is definitely not present at home and might not be present at the hospital. That conveniently elides the fact that nurses, anesthesiologists and other obstetricians ARE present at the hospital and emergencies can be handles by doctors other than the patient’s personal physician.

3. Being close to a hospital is often not close enough to matter.

Sometimes babies die. Sometimes there are deaths that cannot be prevented, no matter where we give birth. Sometimes there are deaths due to negligence on the part of the midwife or doctor, no matter where the birth occurs.

This is probably the stupidest of the many stupid arguments advanced in support of homebirth. The fact that some babies die is NEVER a justification for the death of a specific infant. The key point about homebirth is that MORE babies die at homebirth than in the hospital. In fact, homebirth TRIPLES the risk of neonatal death. No amount of bleating that “sometimes babies die” justifies increasing the risk of preventable neonatal death.

Kitty Ernst wrote:

As always, [Amy’s blog post] points to the urgent need to get the “teams” working together, assure that who is with the mother is competent and working within a system of care – and stop arguing about the place of birth – AND collect and publish on-going, real-time data on what we all are doing! Once we do that the place of birth will become a non-issue.

No, there’s no need for “teams.” We already know that American homebirth midwives do not meet the most basic standards of education and training. We already know that homebirth with an American homebirth midwife TRIPLES the risk of neonatal death. We already know that homebirth with a CNM DOUBLES the risk of neonatal death. And we already know that MANA (the Midwives Alliance of North America)is withholding their own safety data that almost certainly shows that homebirth dramatically increases the risk of neonatal death.

Here’s what we do need:

We should ban direct entry midwifery.
We must counsel women that homebirth increases the risk of neonatal death.
We should force MANA to reveal their data to the American public.

If American women still want to choose homebirth after that, it’s their right to do so. But hiding homebirth deaths, dismissing homebirth deaths and attempting to justify homebirth deaths as Wahlman has tried to do, is precisely what we DON’T need.

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