Yes the baby died, but my homebirth midwife was awesome

midwife listening at human belly

Another homebirth, another dead baby, another loss mother proclaiming that her midwife was really, really nice to her.

In this particular case it is not clear whether baby Sarah would have survived had the mother been under the care of an obstetrician, since the baby may or may not have had congenital anomalies; but there is no question that the baby would have had a much better chance of surviving if her mother had had appropriate care for a postdates pregnancy and an ultrasound that had revealed any potential problems that might have been addressed in a timely fashion.

Be that as it may, the story shares the defining characteristic of many homebirth loss stories; the mother defends the midwife. And the key point always seems to be that the midwife was really, really nice.

You know what? Hour long appointments are medically useless. They don’t prevent death or disability; they don’t improve recognition of deviations from normal; they don’t accomplish anything besides stroking the ego of the mother.

Reading between the lines, it seems likely that the midwife dismissed the value of the tests that she discussed. All prenatal tests are reliable. That’s why they are part of the standard of care in the first place. Are they accurate? Yes, they are quite accurate for what they are designed to do. Screening tests, like the serum AFP (alphafeto-protein) test are able to distinguish betweeen those babies at risk for a neural tube defect and those who are not at risk. Diagnostic tests like amniocentesis and ultrasound are highly accurate at diagnosing abnormalities. What decision would a mother be willing to make based on what she knew? Even women who would not terminate a pregnancy under any circumstances can obtain valuable information about the baby that may dramatically increase the baby’s chance of survival in the face of an abnormality.

It’s not merely “possible” that testing would have revealed anomalies; it’s virtually certain. Early tests and late tests would certainly have revealed spina bifida if Sarah did indeed have it. Screening ultrasound would have revealed any additional abnormalities. A routine non-stress test and biophysical profile at 41 weeks may have revealed that Sarah was dying and offered the opportunity to save her life.

If all this seems familiar, it is because it is. I’ve lost count of the many times I’ve written about babies who died completely preventable deaths because the homebirth midwives involved were grossly incompetent. Indeed, just this week I wrote about a woman whose midwife left her in active labor to go shopping (!), who returned to deliver a lifeless baby that nearly died during a shoulder dystocia, yet the mother was fulsome in her praise of the irresponsible and possibly incompetent midwife.

There are some who suggest that this is a form of Stockholm Syndrome, where an abused person becomes emotionally attached to the person who has kidnapped or otherwise harmed them. I suspect it is something different. Although it appears that the mother is defending the midwife, she is really defending herself and her choice of homebirth. To acknowledge that the midwife was irresponsible, undereducated or incompetent is to acknowledge that the mother, far from being “knowledgeable” about finding a competent provider, had actually been clueless when it came to determining the midwife’s skills. To acknowledge that the midwife failed to prevent or even contributed to the baby’s ultimate demise is to acknowledge that homebirth is just as dangerous as 99% of American women believe it to be.

The emphasis on how nice the midwife has been is no coincidence, either. Homebirth is about risking the baby’s life for the mother’s birth “experience” and that experience starts during pregnancy. Who wouldn’t enjoy a provider who repeatedly congratulated you on your “education,” your “strength” and your “inner wisdom”? Most people realize, however, that prenatal care is not about being patted on the head, but rather its purpose is to ensure a healthy baby and a healthy mother. A “nice” midwife might enhance a woman’s fragile self-esteem, but it won’t do anything to save a baby dying a preventable death.

That’s why I have the greatest respect for women who have endured the horrific experience of losing a child at homebirth who didn’t have to die and are able to take a clear eyed look at what and who led to the preventable death. Homebirth loss mothers who speak out about the incompetence of homebirth midwives face terrible treatment within the natural childbirth community and they are very brave to persevere in spite of that treatment. Yet they are braver still to be able to overcome a far higher hurdle: the acknowledgement that their choice (often made with the best of intentions) was wrong, that they were not “educated” and that their intuition let them down when they needed it most. These women are a small, but unfortunately growing, group. Instead of protecting themselves and their egos they are still mothering the child they lost by standing up for him or her, making sure that others do not forget, and alerting women to the very real dangers of homebirth.