Idaho homebirth disasters not about tension, but inadequacy of certified professional midwives (CPMs)

Colleen and Jerusha Goodwin have hit the big time; they’ve made the national news. Today’s Washington Post carries an Associated Press article entitled, Case of suspended Idaho midwives show ongoing tension between home-birth industry, hospitals.

Unfortunately, the article confuses the main point. Any tension between homebirth midwives and other providers is the result, not the cause of the real problem: the grossly inadequate training of certified professional midwives (CPMs).

The Goodwins managed to preside over 3 neonatal deaths in a ten month period. Most obstetricians won’t have that many neonatal deaths in an entire career. There was a fourth incident that occurred in 2008 and resulted in an infant with a profound brain injury due to lack of oxygen. The Goodwins have just settled the resulting lawsuit for $5 million, although it is unlikely they will ever pay a dime since they did not carry malpractice insurance.

Both midwives have had their licenses suspended. They deserve far worse. There is not a single mitigating factor in any of these 4 tragedies. All four involved gross malpractice as well interfering with transport and lying by the midwives.

According to the Post article:

A former employee who trained at The Baby Place said hostility the Goodwins developed for doctors ultimately led to delays in emergency transports to hospitals.

Dani Kennedy told The Associated Press this antagonism caused them to make decisions against the best interests of mothers and babies, broadening the historic midwife-doctor divide to a wide gulf — with tragic consequences.

Coleen Goodwin “did hesitate to transport, and that was really upsetting to me,” said Kennedy, who trained at The Baby Place between 2007 and 2010. She left to open a practice in Hawaii, in part over these concerns.

Homebirth advocates are fond of claiming that the licensing of homebirth midwives will eliminate such tension, but the Goodwins were licensed. Therefore, the failure to transfer for complications was not because they feared being prosecuted for practicing midwifery illegally. Rather they apparently either failed to recognize the seriousness of the major complications that developed or they feared that their incompetence in improperly addressing the major complications would be exposed.

Far better for homebirth advocates, though, to portray this as a turf issue rather than a competence issue:

… [R]emedying feuds like the one Kennedy said influenced the Goodwins’ decision-making is growing more important, said Oregon State University professor Melissa Cheyney, a medical anthropologist and certified midwife.

Midwives often feel disrespected by the medical establishment, Cheyney said, while doctors’ objections to out-of-hospital births may harden with every traumatic transport.

This comes on top of the already-existing divide between the two views of childbirth, with midwives emphasizing the safety of natural births in a familiar, comfortable setting, while the American Medical Association contends women are best off in a hospital, where life-saving technology is nearby if something goes awry.

“You’re having this compulsory interaction between two value systems,” Cheyney said. “A transport means these two systems have to come together — and work together.”

Midwives feel disrespected by the medical establishment? They ARE disrespected by the medical establishment, but not because of their philosophy. They are unworthy of professional respect because they lack the education and training of ALL other midwives in the industrialized world.

As I have repeatedly pointed out, CPMs are not real midwives. They awarded themselves a pretend “credential” to disguise from lay people and legislators the fact that they have less education and training than midwives in Europe, Canada and Australia. The CPM is not recognized and is not eligible for licensure in the UK, the Netherlands, Australia. It used to be accepted in Canada, but they have abolished the CPM on the grounds that it fails to meet minimal standards for midwifery training, which include a college level degree.

The results of homebirth midwifery practice in Idaho (as well as every other state that has collected statistics) have been tragic:

Objective measures of Idaho’s midwife-doctor relationships — and their impacts on babies — are difficult to come by, because the state doesn’t keep comprehensive records of the outcomes of midwife-assisted births requiring hospital transports.

A private effort, the Idaho Perinatal Project run by St. Luke’s, documented 138 instances between 2005 and 2011 where mothers who planned a home birth were transported to a hospital.

Though its records are also incomplete — reporting is voluntary; there are no reports for 2012 — they do point to the trauma that accompanies a planned out-of-hospital birth where something goes wrong. There were at least nine cases where infants died at or before arriving at the hospital and several instances of birth asphyxia, fractures, post-partum hemorrhage and unexpected twins. (my emphasis)

These families have experienced unimaginable anguish because CPMs care more about being able to practice and make money than they care about whether babies live or die. Hopefully, these deaths will lead to stricter standards.

In my judgment, the biggest mistakes that homebirth midwives have made are the attempt to popularize homebirth and to license CPMs. Bereaved parents now have a mechanism to file complaints and states are now totting up the extraordinary number of deaths at the hands of CPMs. State governments will be forced to respond by regulating these self proclaimed “midwives” out of existence.

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