Two questions for Australian midwife Hannah Dahlen

Yesterday I wrote about the callous and clumsy attempt of national media spokesperson for the Australian College of Midwives, Hannah Dahlen, to change the subject from the fact that homebirth increases the risk of perinatal death to … well to anything else.

In Home births: it’s time to broaden the focus of the debate, Dahlen makes the bizarre and morally indefensible claim that preventable perinatal mortality is an acceptable component of safe homebirth.

When health professionals, and in particular obstetricians, talk about safety in relation to homebirth, they usually are referring to perinatal mortality. While the birth of a live baby is of course a priority, perinatal mortality is in fact a very limited view of safety.

In light of her self-serving, obfuscatory piece, I have two questions for Hannah Dahlen.

1. Why don’t you say what you really mean?

Instead of struggling mightily with bizarre formulations attempting to justify broadening the definition of “safety” to include unsafe practices, Dahlen should just come out with the truth:

Australian midwives know that homebirth increases the risk of perinatal death, but we like homebirths and we are going to keep doing them.

Dahlen is not the first to struggle to make an intellectually and morally indefensible claim palatable by wrapping it in nonsensical language. Including the nonrational is sensible midwifery, by Jenny A. Parratt, and Kathleen M. Fahy, published in the Australian midwifery journal Women and Birth is a masterpiece of the genre.

The paper also argues for “broadening” the definition of the safety to include irrational beliefs and actions.

…What is deemed as safe is aligned with what is rational and what is unsafe is aligned with what is irrational. As irrationality is not acceptable this essentially forces the definition of safety to be thought of as ‘true’ even though it may not fit with personal experience and all situations…

Yes, that’s a real problem with rationality. It blasts apart the irrational claims of homebirth midwives. And homebirth midwives love the irrational:

… During birth, making room for the nonrational broadens both midwives’ and women’s knowledge about trust, courage and their own intuitive abilities …

This is just another (particularly pathetic) attempt to “broaden” the definition of safety to include unsafe practices that Australian midwives like. They know that many of their homebirth beliefs and practices are irrational and (by definition) not supported by scientific evidence of any kind, but they like them and they are going to keep doing them.

2. Aren’t you embarrassed to ask whose fault it is that women fear mainstream care when it’s your fault?

So when these women seek care outside our mainstream system, whose fault is it really? …

… When a woman chooses to have a homebirth with risk factors present, the question we need to ask is not ‘what is wrong with her’ but rather ‘what is wrong with a maternity care system that provides such limited options and inspires such fear that she would take on the added risk’?

These women do not love their babies less, they fear mainstream care more and this is a terrible indictment of our care.

This is what is known as “chutzpah,” a Yiddish word whose definition is best explained by example. When a man who has murdered both his parents begs the judge for mercy because he is an orphan, that’s chutzpah.

When a midwife who has made a career of demonizing mainstream care asks “who’s fault is it that women fear mainstream care?”, that’s chutzpah.

Dahlen is on record promoting fear of mainstream care, including claims that:

obstetricians want to restrict women’s choices

Hannah Dahlen, of the Australian College of Midwives, says [Dr. Pieter Mourik’s] comments represent the latest salvo in a ”scaremongering campaign” by obstetricians determined to stymie efforts to give women greater choice.

obstetricians perform unnecessary surgery because they are surgeons

Part of the reason we have such a high intervention rate is because normal, low-risk women are being cared for by highly specialised surgeons trained in surgery.

obstetricians care more about money that about women

We have a very powerful medical lobby in this country. They are desperate not to lose their sizeable market share of births…there’s huge money to be made.

and, my personal favorite, maternity hospitals mix up babies

University of Western Sydney professor and ACM (Australian College of Midwives) spokesperson Hannah Dahlan said that baby mix ups are one of the common errors that occur in maternity units.

Whose fault is it that Australian women fear mainstream care? It is, in large part, the fault of Hannah Dahlen and her colleagues, who never miss an opportunity to portray obstetricians as money grubbing surgeons who delight in forcing unnecessary interventions on women in facilities that routinely mix up babies.

Let’s be honest, Ms. Dahlen. Homebirth midwives like homebirths because they are in charge and they are not constrained by any petty concerns like rationality or whether the baby lives or dies. Your piece about “broadening the home birth debate” is nothing more than a justification for midwives continuing to do what they like regardless of whether it comports with the scientific evidence and regardless of whether it kills babies.

At least have the intellectual honesty and moral fortitude to tell the truth, instead of hiding it in obfuscatory language: homebirth midwives will continue to encourage, promote and attend homebirths, and the dead babies be damned.

  • Juniper_Sprinkles

    Imagine, just imagine, if medical error in hospitals leading to death (one of Australia’s largest cause of death) was properly exposed to the public. Imagine.

  • Juniper_Sprinkles

    Oh dear God, woman. You are obviously working for the aggressive medical lobby. IF there is even one death during a homebirth, people like you make sure it is circulated on every newspaper headline for months on end. When people and babies die (as they do routinely, on a daily basis, as one of the leading causes of death) due to medical error in a hospital *crickets*. Move along folks, nothing to see here…

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  • Sophie

    Just.. Oh dear. You’re trapped in a system where artificial trappings are “needed” to keep women under their control of a mainly male medical profession. Home births and continuity of midwifery care is safe and often safer than hospital births for low risk women with high levels of unnecessary intervention. But God forbid if we say an induction, Caesar, or epidural or continual electronic foetal monitoring is unnecessary!
    The perinatal mortality rate in the late 1800’s began rising with the advent of doctor led and hospital birth- interesting, no?
    I was born at home, my son was born in a midwifery group practice’s birth centre. I was low risk. I am not a “hippy” by any means, but neither am I blindfolded by the medical profession.

    • Karen in SC


      Homebirths are *not* safer, even for low risk. Sorry to burst your bubble. Also, some mothers desire inductions, epidurals, and god forbid, even C-sections.

    • Squillo

      The perinatal mortality rate in the late 1800’s began rising with the advent of doctor led and hospital birth- interesting, no?

      Interesting, but totally irrelevant to any discussion of obstetrics in 2013. As is the point about the “male medical profession.” The current distribution of medical grads in the U.S. is closing in on 50% female, while the percentage of med school grads going into OB/gyn was 75.7 in 2007 (the last date for which I could find data quickly.)

      You may not be “blindfolded by the medical profession,” but you certainly have some blinders on when it comes to rational argument.

    • Young CC Prof

      Who are all these men in control of birthing? I didn’t see too many at the maternity ward!

      Do you have a source for that rise in perinatal mortality? More importantly, can you compare the current rate of perinatal mortality to the estimated rate from, say, 200 years ago?

    • Kumquatwriter

      “Mainly male medical profession.” Oh really?

      “In the US two decades ago, only 12.3% of
      ob/gyn residents were women; the percentage rose to 37.4% in 1999, and has risen
      steadily since then, they wrote. In 2007, the Israel Obstetrics and Gynecology
      Society had 1,198 members, 80% of them men, but among young residents studying
      the specialty, 54.3% were women. That statistic clearly shows where the future
      is going.”

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