Homebirth in The Boston Globe

It has been quite a week for homebirth stories in the mainstream media. There have been three major stories including a long piece in The Boston Globe Sunday Magazine entitled Her home-birth battle. It tells the story of Jenifer Holloman, a woman who had had a C-section 24 years ago, who chose homebirth with lay midwife Deborah Allen for her second child for the usual reasons:

She was studying to be a midwife, she wanted to maximize her chances for having a vaginal birth this time around, and she believed maternal care in the United States had become overmedicalized. Still, there was another, even more important reason Holloman says she and her husband, a carpenter, were interested in home birth. They didn’t have insurance, couldn’t afford the $179 monthly premiums for Commonwealth Care …

Holloman ruptured her membranes on February 7, 2009, and didn’t begin labor until February 10 at 1:45 AM. By waiting longer than 24 hours for her labor to begin after memebranes ruptured, Holloman and her midwife chose to accept a dramatically increased risk that the baby would develop a serious infection.

Holloman abandoned herself to her contractions and recalls that through the lens of her single-minded focus, time seemed all but suspended. But not for Beetz [her husband]. “As the day wore on, I got more and more concerned,” he says. “On numerous occasions I asked Deb, ‘Is this normal?’ She’d say, ‘Yeah, it’s normal.’ I started getting texts and calls. People were starting to worry. I was starting to worry.”

By late afternoon on the 10th, Holloman entered the final phase of labor. Each time she pushed, Beetz says, he thought he was about to meet his baby. But each time, there was nothing. “At 5:30, I was nervous,” he says. “At 7:30, I was really nervous. At 8, I was terrified, and I didn’t know what to do.”

Then they could no longer hear the baby’s heartbeat.

… Allen moved her and tried to find the heartbeat again. The medical charting all but stops by this point, but according to what Holloman and Beetz recall, Allen told them that the monitor must not be working. She reached in her bag for new batteries and changed them. Still no heartbeat. Allen picked up the phone and called the hospital…

Nonetheless, they didn’t actually leave the house for at least an hour, according to Holloman and Beetz, and they drove themselves to the hospital… Holloman says Allen first suggested they take a car instead of an ambulance, and then that they stay home. “I remember looking at her and saying, ‘Deb, I want a full medical intervention,'” Holloman says… “I picked up the telephone and called Cape Cod Hospital myself. I said: ‘My name is Jenifer Holloman. I am having an obstetrical emergency. I’m coming in.'”

By that point, the baby had been dead for hours.

At her request, Holloman was put under general anesthesia so she wouldn’t be awake when the baby was pulled from her via C-section. When she awoke, she found out she had had a boy. They named him Emmet… After Holloman awoke, she pulled up the list [of family and friends] on her laptop and sent out an e-mail announcing the death of their son.

… When Holloman was released from the hospital, she and her husband went home to the place their baby had died. “Everywhere I looked, all I could see was that I didn’t have my son,” says Beetz. Still, they rarely left the house, because venturing out was just as painful. Everywhere they went people asked for the baby. The lady at the bank, the people in the supermarket, visitors at the farm. They started doing their shopping a half an hour from home, where no one knew them.

“It was the longest, saddest year of my life,” recalls Holloman.

The official cause of Emmet’s death was infection with group B strep (GBS). Obstetricians routinely test women for the presence of GBS because it is the leading infectious cause of death of newborns. Women who are found to be positive for group B strep are routinely treated with antibiotics in labor, and, not surprisingly, cannot be allowed to wait hours after rupturing membranes for labor to start, since that further increases the risk that a deadly infection will develop.

Homebirth midwife Deborah Allen never did a test for group B strep, failed to recommend hospital care when membranes had been ruptured more than 24 hours and ignored Holloman’s low grade fever and chills.

In the wake of her baby’s death, Holloman evinces a touching faith that things would have been different had Deborah Allen been a licensed certified professional midwife (CPM). If only homebirth midwives were legal and regulated in Massachusetts, everything would have been different.

“A better-trained midwife would never have allowed what happened to transpire,” Holloman says. She and Beetz wanted their case to be investigated by an entity that could, if appropriate, sanction Allen and prevent her from delivering more babies. Holloman went to the police, the district attorney, the attorney general, the Department of Public Health, the Board of Nursing, and the Board of Medicine. “No one could do anything. They told us she’s neither fish nor fowl in the eyes of the law,” Holloman says. Last year, she and Beetz filed a lawsuit in Superior Court against Allen alleging negligence. “We didn’t want to sue anyone,” Holloman says. “This is the last house on the left for us.”

Her faith is entirely unjustified. Within the past several months alone, two certified professional midwives in two different states presided over homebirth deaths. Rather than an investigation by local CPMs, both midwives were treated to fundraisers by their peers to pay the legal costs incurred by their arrests.

Holloman has testified at the State House in support of the bill [that would license homebirth midwives] and has lobbied representatives directly. Two weeks after Holloman made one of these visits in late 2009, her neighbors … brought her some sad news. Their niece, who also resides in Massachusetts, had just lost her baby in a home birth. She had also been attended by a lay midwife.

Holloman might be even less optimistic if she learned that the Midwives Alliance of North America the organization that represents CPMs KNOWS that homebirth with a CPM leads to preventable neonatal deaths. They have refused to release the death rates of the 23,000 planned homebirths in their database. Rather than investigating substandard care, they are actively hiding it.

Holloman clings to the notion that it was not homebirth but rather the homebirth midwife that deserves the blame for Emmet’s death.

… She says she asks herself whether she isn’t telling herself some sort of vital lie, but does not believe she is; she doesn’t think home birth caused her son to die, but rather the care she received from Allen…

There is no doubt that Holloman received substandard care, but substandard care is standard for homebirth midwives. Homebirth midwives (CPMs) should not be licensed; they should be abolished. That’s what Canada has done, putting it in line with all other countries in the industrialized world.

And nothing changes the fact that homebirth increases the risk of neonatal death. All the existing scientific evidence says so and all the state and national statistics confirm it. The only people who appear to be unaware of the dangers of homebirth are homebirth advocates themselves.