Australian midwives boast about terrible homebirth death rate


Setting a new standard for cluelessness, Australian midwives are proudly presenting the results of a publicly funded homebirth program, a program that has a homebirth death rate 5X higher that of term hospital birth.

I received a iPhone photo of the poster that include this chart (sorry for the fuzziness):

Australian homebirth study

The accompanying message says it all:

I am attending the national PSANZ (Perinatal society of Australia and new Zealand) congress here in Adelaide and thought of you when I saw this poster

The authors seem to be blissfully unaware that their “rates” are anything but low given that this is a carefully selected low risk group at term. These deaths do not include those from rogue homebirth midwives such as LB nor freebirths. The publicly funded homebirth program has strict criteria including exclusion of women with any risk factors such as multiple births, preterm births, VBACS, breech. The births are managed by 2 properly trained midwives who also work in hospital and so quick referral and transfer is a given. !!!

Things that I noticed (I’m sure you will see more!!) are …

6 deaths in low risk pregnancies at term!!!!

0.7 % of IUGR missed

2.7% of the babies ended up in the nursery!!!!!! 9 babies had SIGNIFICANT morbidity

In the abstract they have the following conclusion further demonstrating their absolute ignorance:

“This study evaluates a substantial proportion of women choosing to have a publicly-funded homebirth in Australia. However, the sample size does not have sufficient power to determine safety. More research is needed on the safety of different birthplaces within Australia”

Interestingly they left this conclusion off the poster! Perhaps they didn’t want to embarrass themselves.

The poster is Publicly-funded Homebirth in Australia: outcomes after 5 years by Catling-Paull et. al. (Here’s the full size iPhone photo of the poster.)

According to the authors:

Homebirths account for a very small number of births in Australia. In 2010, only 0.5 per cent of all women … chose homebirth.

Currently, there are at least 15 publicly-funded homebirth programs [run by 13 directors] in Australia …

The programs accommodate women who are at low risk of medical or obstetric complications. Midwives are usually selected to work within the programs after … advanced obstetric emergency training, cannulation and suturing skills.

What did they find?

During the 5 years of the study, there were 1807 women who intended, at the start of labor, to give birth at home. 83% had a homebirth, 52% in water (I have no idea why they mention this except to check women’s performances against the midwifery ideal.) The transfer rate was 17%. The C-section rate was 5.4% and the neonatal death rate was 2.2/1000. That’s more than 5X the rate of 0.4/1000 found in a 2009 report on birth in South Australia.In addition, 2 babies suffered hypoxic ischemic encephalopathy (brain damage due to lack of oxygen).

And that probably undercounts the deaths and complications because reporting was voluntary and only 9 of 13 program directors responded. Nonetheless, the authors conclude:

There was a low rate of caesarean section, postpartum haemorrhage and third degree perinatal tears as well as low rates of stillbirth and early neonatal death in this sample of women and babies.

It’s absolutely mind boggling that Australian midwives appear to be completely unaware that the neonatal mortality rate for term births in Australia is approximately 0.4/1000. They are boasting about a death rate of 2.2/1000, nearly 5X higher than the expected death rate.

The findings of the study are not surprising. They confirm what we already know: homebirth increases the risk of neonatal death by a factor of 3 or more. The only surprising thing about the study is that the authors are cheerfully ignorant about the meaning of what they found.

Corrected to reflect the fact that I mixed up stillbirths and early neonatal deaths, thereby reporting the death rate at Australian homebirth as lower than it is.

145 Responses to “Australian midwives boast about terrible homebirth death rate”

  1. Kylie
    May 16, 2013 at 5:32 am #

    Interesting read.. I wonder.. where did these little babies die…. you mention a 17% transfer rate.. were the babies that died a part of this %… it is difficult to know the circumstances when you are just looking at numbers on a page..

  2. cate
    May 3, 2013 at 10:04 am #

    This article is completely wrong about the perinatal, neonatal and stillbirth death rates. See here for the Australian stats nationwide – Perinatal deaths are all fetal deaths (at least 20 weeks gestation or at least 400 grams birth weight or stillbirth) plus all neonatal deaths (death of a live born baby within 28 days of birth). The most recent reported Australian fetal death rate (2010) was 5.9 per 1000. Neonatal death rate was 2.8 per 1000 and perinatal death rate was 8.7 per 1000. This 8.7 figure compares to the reported 3.3 per 1000 for both stillibirth and neonatal death in the homebirth stats reported in the chart above.

    • Becky05
      May 3, 2013 at 10:16 am #

      Those are the stats for all gestational ages in all risk levels of pregnancy, while these homebirth stats are for low risk births at term. The numbers are very, very different.

  3. April 18, 2013 at 4:42 am #

    I’m a bit confused. With a mortality rate of almost 5x higher than hospital birth, this is not that far off the 6-8 times higher we saw for the Oregon data collection, even though the Oregon group almost surely had significantly fewer criteria for risking mothers out (no criteria in some places, I’m sure) as well as lower qualifications for the midwives as CPMs and DEMs. I would’ve thought that a low risk group affiliated with a hospital program could expect to see significantly lower mortality stats than a group where high-risk cases are being tackled by underqualified care providers.

    Additionally, this ( Australian study indicated a mortality rate 17 times higher than hospital. Why would we expect to see such variety in these outcomes? Even if SA midwives were taking on high-risk cases, that’s a significant increase over Oregon, where there would surely be considerable numbers of high-risk homebirths attempted.

    What might cause this sort of wide variation in the data?

    • Anne
      April 18, 2013 at 6:58 am #

      I wonder whether it has something to do with the rarity of homebirth in Australia.

      Unlike UK and the Netherlands, homebirth has never been common in Australia in the last 30 years, and as most MW have been trained as nurses first their natural tendency will be to stick with what they know and stay with hospital births.

      Only those with a fire in their belly about homebirth will get involved in such programs (auspiced by the government-run hospitals although they may be), with NBC ideology trumping responsibility to their “duty of care” as employees of the hospital (not the woman).

      Doesn’t take much of a slip down that slope from “the studies say this is as safe as hospital birth” via “the FHR always dips in second stage” to “OMFG, breathe baby!” while the doula calls an ambulance.

      • Becky05
        April 18, 2013 at 7:29 pm #

        Maybe distance from the hospital, too?

        • KarenJJ
          April 19, 2013 at 2:38 am #

          I don’t know that distance would be one of the big problems. The hospitals I know with homebirth programs are big tertiary hospitals in capital cities and they set an ‘intake’ area. You need to be within a certain range of the hospital or you can’t have a homebirth under their program. Where I live, they’ve set a 30 minute drive radius (possibly too far? but considering the state I live in is the same size as Western Europe it seems close..).

    • KarenJJ
      April 18, 2013 at 7:31 am #

      Also the small numbers mean that an extra one or two deaths in the small sample will make the rates look worse than they might look with a larger sample. I wonder if that’s what is seen in the 17 times higher statistic at least.

      It’s true that homebirth is not a very popular option here. Even when it’s free.

    • April 18, 2013 at 7:43 am #

      I think we are all confused. And maybe we can all just take the figures and use them to prove whatever it is we want to prove. For people like me, who cannot quite get their heads around confidence intervals and the like, you can look at them and think: that is not many dead babies, it won’t happen to me.

      One of the conclusions I draw is one I already believe – birth is unpredictable and potentially hazardous, and the skill of a single individual in the wrong place is not going to make a whole lot of difference to that. It probably won’t happen to you, but it is very unwise to gamble on it for the very dubious benefit of being in familiar surroundings.

      I find it very depressing that so many subscribe to the ludicrous House of Cards that is the ideal “birth experience”, in or out of hospital. If your sense of security, empowerment, pleasure, triumph, and your love for your child rests on such flimsy foundations how do you cope with real life? (Of course, people do – but in spite of, surely, not because of?)

    • auntbea
      April 18, 2013 at 9:54 am #

      To get a high-risk homebirth, two things have to happen: the midwife has to allow it and the mom has to want it. Even many homebirth advocates would not birth at home with twins or breech (even though stunt births loom large in the homebirth lore). So it is possible that there isn’t much additional effect from trained midwives and/or strict criteria at keeping out the high-risk population. This would, of course, mean that the fact that American widwives are not well trained is less important to the risk of homebirth than we think. Or it could mean that Australian midwives are only well trained and regulated on paper.

      Further research needed.

  4. Sue
    April 18, 2013 at 4:08 am #

    Cue a Hannah Dahlen article to follow it up – thanks for the heads up!

  5. Mary herrington
    April 17, 2013 at 11:40 pm #

    Calling all healthy birth outcome advocates!!! I am in a “hot” debate on the Feminist Breeders Facebook page on her ICAN post. Come to FB and support me/safe birth!!!

    • Awesomemom
      April 18, 2013 at 1:59 am #

      I would help you but I have been banned. I doubt you will last very long either since she is very fond of scrubbing out dissenters.

  6. notahomebirthlactivist
    April 17, 2013 at 7:55 pm #

    Wow this scares the shit out of me. I have many friends who birthed through this programme :/ I wonder if these facts will come to light. On another note.. im thrilled That I had my babies in the hospital!

  7. April 17, 2013 at 5:34 pm #

    It’s disgraceful. As an Australian, the impression I got was that because we don’t have a CPM equivalent, homebirth must be a reasonably safe option; why else would any ethical care provider promote a choice that had such a high risk attached? At least not without being extremely forward about those risks.

    Unfortunately, much of the same “Birth is as safe as life gets,”, “Your body won’t grow a baby that is too big,” woo is present here down under.

    These homebirth providers harp on ad nauseum about informed consent, but what hope do THEY give you to provide informed consent when everything they peddle is dripping with bias?

    • KarenJJ
      April 17, 2013 at 8:54 pm #

      They give confirmed consent but doctors play dead baby cards. It’s another thing I can’t get my head around. Has any midwife ever said ‘if we don’t act quickly and perform an intervention there is a higher risk that your baby could die’.

      • Karen in SC
        April 17, 2013 at 9:25 pm #

        No, they say “sometimes babies die.” And “at least you had a wonderful spontaneous homebirth.”

      • KarenJJ
        April 17, 2013 at 9:32 pm #

        oh dear “informed” consent, not “confirmed” consent. I really should blame auto-correct but I was typing on my laptop so have no excuse apart from being distracted by the rubbish truck arriving.

      • Phascogale
        April 26, 2013 at 7:55 pm #

        Actually lots of midwives say this…. but usually in the hospital setting. And it’s talking to the mum to explain what’s happening (and why) when everything is going on around her that she’s frightened and doesn’t understand (and the doctor has told her why but it didn’t sink in the first time).

    • Sue
      April 18, 2013 at 4:26 am #

      It’s because HB midwifery isn’t about safety, it’s about “rights” (of the mother and midwife) and not the health of the baby.

  8. mollyb
    April 17, 2013 at 4:26 pm #

    I find it somewhat interesting that even among the (one would imagine) ultra-crunchy set who chooses homebirth, nearly a third have stopped breastfeeding by 6 weeks.

    • auntbea
      April 17, 2013 at 4:32 pm #

      Those must be the people who transferred. They really just weren’t cut out for motherhood.

      • Guestll
        April 17, 2013 at 5:18 pm #

        Speaking of transfers, a 17% transfer rate is too low.

        • CSM
          April 17, 2013 at 5:31 pm #

          I wonder how Australian MWs work – are they hospital employees? Work in collectives? In Canada, you get hired by a practice, and if the head if the practice is on the fluffy side, you better have a low transfer rate and a high homebirth rate or else your contract won’t be renewed. I doubt you could get fired for having bad outcomes, though.

          • April 17, 2013 at 6:32 pm #

            They would be state government employees, operating under the auspices of a hospital.

          • CSM
            April 17, 2013 at 7:30 pm #

            So I guess it is a similar model. Here we are ‘independent contractors’ paid by the government, employed by self-organized and run midwifery practices. We have hospital privileges but aren’t hospital employees.

          • Renee Martin
            April 17, 2013 at 7:08 pm #

            Thats scary.

          • notahomebirthlactivist
            April 17, 2013 at 8:04 pm #

            Basically they have their own midwife practice, but they work with the hospital too. They are all proper nurses and I believe have to have a fair bit of experience. I have met a number of them and although they are a bit earth motherish.. they are not radical and they do sensible things like risk out and transfer a lot.. it sucks for them that they truly believe in the “natural birth at home is safe for most” thing.. when the stats obviously don’t support them.

          • CSM
            April 17, 2013 at 8:27 pm #

            So they aren’t direct-entry MWs like what we have here? I have faith, then. In theory, at least.

          • KarenJJ
            April 17, 2013 at 8:52 pm #

            I think there are a few direct entry courses at university now. It’s still a university degree, but doesn’t have the nursing degree first.

          • thepixiechick
            April 17, 2013 at 10:17 pm #

            These stats were prepared about the public hospital homebirth program. These are hospital employed midwives who attend homebirths for low-risk women with a stringent risking-out and transfer protocol and full hospital back up. There are also independent midwives, but they are very much a different kettle of fish – they run their own show in relation to risk and transfer and I don’t believe there are stats available for them (happy to see them though if someone knows of them).

            This is very interesting – as I thought this homebirth program was pretty circumspect, and to mangle a phrase from the crunchy mamas in my view ‘this is as safe as homebirth gets’. It seems that isn’t actually very safe at all.

          • CSM
            April 17, 2013 at 10:40 pm #

            Very interesting. So what is it about Canada and its comparable safety stats for home vs hospital, then? Sounds like Canadian MWs would be crunchier as a direct-entry group that self-regulates and doesn’t necessarily enjoy good hospital relationships so I’d expect to see a similar set of data, if not worse.

          • KarenJJ
            April 18, 2013 at 12:18 am #

            No, that’s what is so disconcerting about these figures. Independent midwives are not included in these stats and they seem to take on more riskier births. I’ve known one home VBAC through an independent midwife in Australia. That would not be allowed through these hospital-based homebirth programs.

            In Australia giving birth at a public hospital is free, as well as giving birth in a birth centre (I don’t know of any private birth centres) and so are the hospital based homebirth programs. To hire a private midwife for a homebirth will cost a few thousand dollars and so you really have to go out of your way to choose it.

          • thepixiechick
            April 18, 2013 at 10:03 pm #

            Sorry for double post – Disqus issues o_O

          • thepixiechick
            April 18, 2013 at 1:42 am #

            These would be hospital employed midwives as these stats are based on a public hospital homebirth program, consisting entirely of low risk mothers, with strict criteria for risking out, transfer and full hospital backup. There are also independent midwives, but they are a very different kettle of fish, and their attitude to risk and transfer varies widely. I am not aware of any stats that cover them, but would be interested to see them if anyone has them.
            This is very interesting as I always thought these hospital based homebirth programs were about ‘as safe as homebirth gets’. Turns out that actually isn’t very safe.

          • Sue
            April 18, 2013 at 4:32 am #

            HB is still very much fringe in Oz. Almost all MWs work in hospital and are specialist nurses, who do the job or both labor and delivery RNs and delivery atttendants. They work together with medical staff and call them in when required. Most repair vaginal tears according to severity.

            To work independently, any MW working under Australian law has to have a specific OB who has agreed in writing to be their go-to for oversight. This caused a lot of grief in the MW community, who saw it as one profession supervising another. The law currently stands, though. Many propsective “independents” say thay can’t find any OBs willing to buddy them. (That probably means something).

    • KarenJJ
      April 17, 2013 at 9:10 pm #

      I was interested in that too. Most of these women wouldn’t have returned to work by then. We have a years maternity leave and also 18 (?) weeks paid at minimum wage recently introduced (although prior to that there was also the ‘baby bonus’ of $5k). I doubt it is due to a return to work.

      I’d be curious at how they measured the breastfeeding rates – is it exclusive by six weeks. Does one bottle of formula strike you out or is breastfeeding taken as 80% breastmilk (or however they measured it).

    • Antigonos CNM
      April 18, 2013 at 10:05 pm #

      And a good many of them will try to pretend they still are for as long as they can…I’ve had mothers obviously giving formula who swear it’s pumped breast milk. Breast milk never looked so creamy…

  9. Who me?
    April 17, 2013 at 3:58 pm #

    “The only surprising thing about the study is that the authors are cheerfully ignorant about the meaning of what they found.”

    Is that really surprising? It’s clear to me after reading post after post here that all NCB advocates care about is promoting their beliefs. Has anyone been following this little gem on MDC? Even when confronted with all of the data, all they care about is trying to find their way out of it. They only want to talk about how the numbers must be wrong, and they do not want to try to find a way to improve outcomes. It’s not about the safety of the baby or the mother, but about their ideals.

  10. auntbea
    April 17, 2013 at 3:53 pm #

    According to the poster, the safety of homebirth is under debate in Australian. Those who speak English, American, Canadian or South African are apparently in agreement.

  11. Amy Tuteur, MD
    April 17, 2013 at 3:48 pm #

    Oops! I originally undercounted the deaths because I switched stillbirths (2) and early neonatal deaths (4). I’ve corrected it to show that the neonatal death rate in the study is 5X higher than term hospital birth!

  12. April 17, 2013 at 3:44 pm #

    Why on earth were there 10 vaginal breech deliveries? They should have been risked out.

    • CSM
      April 17, 2013 at 5:01 pm #

      That does seem like a lot.

    • Therese
      April 17, 2013 at 6:51 pm #

      Well, I have heard a couple of accounts of hospital births where it was discovered once the woman was already in labor that her baby was breech. So I guess we’d need to know how often that happens in the hospital to determine if the 10 vaginal breech rate is high.

      • Renee Martin
        April 17, 2013 at 7:08 pm #

        How ignorant do you have to be to not notice a breech baby until labor?
        Come on. They knew.

        • CSM
          April 17, 2013 at 7:35 pm #

          It does happen – not everyone is easily ‘palpable’, and since MWs are non-interventional, they would rather not use U/S or even a VE in order to rule out a breech baby – they would rely on palpation and fetoscopes. And then if you have a precipitous multip in labour – chances are, you aren’t going to catch that baby until the woman is fully dilated/ the bum is on the perineum.

          • KarenJJ
            April 17, 2013 at 8:49 pm #

            My obgyn got it wrong towards the end (not sure how he managed it, I was about 36 weeks and I’m not overweight and he’s a very busy and experienced obgyn) But then he turned on the ultrasound and found bub was head down after all.

          • CSM
            April 17, 2013 at 9:21 pm #

            What a jerk! doesn’t he know that ultrasound hurts babies???

          • Dr Kitty
            April 18, 2013 at 2:58 am #

            My OB thought my kiddo was breech when I was sure she was head down. I’m slim and she had a bony little bottom, which he mistook for her head. My guess was based on where the majority of the kicks were. But we did an US and found out for sure.

          • Sue
            April 18, 2013 at 4:24 am #

            It’s crazy not to make us of ultrasound when it is so available and easy to use. In my practice, there are so many procedures we once did “blindly” (by feel and anatomical landmarks) that we now use U/S for – so simple and much safer – from centrally-placed intravenous lines to nerve blocks. If you can see rather than doing things blind, why wouldn’t you?

          • Antigonos CNM
            April 18, 2013 at 10:02 pm #

            Vanity. Seems silly, but there it is.

          • auntbea
            April 18, 2013 at 9:57 am #

            I had three different doctors mistake mine’s (now very chubby) bum for a head. Every time I went in, the doctor was visibly annoyed that the previous doctor had clearly missed an obvious breech. And then did the sono and similarly declined to report breech in the chart.

          • Captain Obvious
            April 18, 2013 at 7:56 am #

            But he used the sono, so he wasn’t wrong in the end and you didn’t labor breech.

          • KarenJJ
            April 18, 2013 at 7:16 pm #

            Absolutely! Which is why I can imagine midwives are getting it wrong as well, but they are often not checking with ultrasound as well.

          • Captain Obvious
            April 18, 2013 at 7:55 am #

            That’s right, so many Homebirth midwives say cervical exams are useless, then they get an unplanned breech…that is malpractice.

          • fiftyfifty1
            April 18, 2013 at 8:43 am #

            But all 10 precipitous multips? I can see that happening to 1 or 2, but all of them? They either knew or should have known and should have transferred.

          • CSM
            April 18, 2013 at 10:01 am #

            Nah, not all of them, of course. Another possibility is when a MW wants to transfer but the client is so set on her vaginal breech that she simply won’t go. I haven’t experienced it myself (thank goodness!) but witnessed OB patients who come in with a breech diagnosed in labour and will NOT have a C-S until they’ve had a good trial of pushing. They cite the Term Breech Trial and feel very empowered while everyone else just facepalms and prays things go well.

          • The Bofa on the Sofa
            April 18, 2013 at 10:42 am #

            they would rather not use U/S or even a VE in order to rule out a breech baby – they would rely on palpation and fetoscopes.

            Which is why Captain Obvious characterized it as “almost malpractice…”

            That they “would rather not” do it doesn’t mean it’s not malpractice.

        • Captain Obvious
          April 18, 2013 at 7:53 am #

          Unrecognized breech is really almost malpractice nowadays.

        • Wren
          April 18, 2013 at 6:00 pm #

          My son flipped from head down to breech at at term. The following week a GP, two OBs and a midwife all missed it. A medical student didn’t, but was told he was wrong. He was found to be a footling breech after my water broke and I was in labour. Midwife said c-section and I went along with that no problem. I do know a breech position can be missed though.

  13. Karen in SC
    April 17, 2013 at 1:59 pm #

    Wouldn’t 6 (2+4) out of 1807 births be higher than 1.1/1000?

    • Aunti Po Dean
      April 17, 2013 at 2:53 pm #

      Yes its blurry but it says on the poster 3.3 per thousand

      • The Bofa on the Sofa
        April 17, 2013 at 3:08 pm #

        Yeah, 6/1807 is 0.33%

        I wonder about this part about ignoring those deaths with “congenital defects.” Do hospital stats include those or not?

        • Therese
          April 17, 2013 at 6:53 pm #

          If it’s low risk hospital birth then I am guessing they wouldn’t because wouldn’t that make someone high risk?

          • Renee Martin
            April 17, 2013 at 7:12 pm #

            No, you can have a baby w issues and not be high risk, depending on the issue.

        • Dr Kitty
          April 18, 2013 at 6:06 am #

          Ireland certainly DOES include those deaths in their statistics.

          With a policy of abortion being illegal for congenital abnormality Ireland has proportionally more cases of severe congenital and genetic abnormalities making it past 24 weeks than many other European countries, and that has a resulting impact on the perintal and neonatal mortality stats.

          I would imagine mos hospital stats include the expected deaths of very unwell babies.

          • The Bofa on the Sofa
            April 18, 2013 at 10:47 am #

            I don’t doubt you. Unlike midwives, hospitals aren’t all concerned about HIDING their outcomes to make them look better.

            I mean, we already pretty much hear midwives who claim that, if you ignore all the bad outcomes, then homebirth is perfectly safe.

    • Amy Tuteur, MD
      April 17, 2013 at 5:15 pm #

      I’m not sure how to handle the two stillbirths. According to the poster, all mothers were planning homebirth at the time that they started labor. If the babies died between the time that the midwife arrived and the baby was born, they are intrapartum deaths and should be added to the early neonatal deaths. However, if the babies died before the onset of labor, those deaths should not be added in.

      • April 17, 2013 at 6:00 pm #

        To me, it depends on whether they were stillbirths that COULD have been seen coming or not. Stillbirth is perhaps another one of those words/expressions that people assume have a precise meaning – like low risk – but don’t, always. 30 weeks? 42 weeks? My niece’s stillbirth was caused by a problem with the shape of her uterus, which in my ill-informed opinion should have been picked up. In her next two pregnancies, CS avoided any such complication.

        • Karen in SC
          April 17, 2013 at 6:10 pm #

          The euphemism “born sleeping” for stillbirth isn’t very precise either. Some babies do die before the onset of labor and a woman who wanted a homebirth may go ahead with that plan. I’m not sure when a late miscarriage is regarded as a stillbirth, or if the terms are interchangeable.

          • Elizabeth Abraham
            April 18, 2013 at 1:25 am #

            My understanding is that, at least in the U.S., after 20 weeks, it’s considered a stillbirth rather then a miscarriage (other places may use 24 weeks, my understanding is that the NHS in the UK considers 24 weeks the limit of viability and will not make efforts to save or treat babies delivered before that gestational age). The terms are not used interchangeably by medical professionals or public health statisticians.

          • Aunti Po Dean
            April 18, 2013 at 1:58 am #

            This is publically fuded homebirth which is only allowed for TERM pregnancies

          • Elizabeth Abraham
            April 18, 2013 at 3:01 am #

            In that case, no one should be referring to an intrapartum death as a miscarriage. (I was responding to a question about when a death counted as a stillbirth, and when it might be called something else.)

          • Karen in SC
            April 18, 2013 at 7:24 am #

            yes thanks for the reply.

          • Hannah
            April 18, 2013 at 2:57 am #

            Not strictly true. They would usually attempt to resuscitate over 24 weeks but might also try to resuscitate at 22 or 23 weeks depending on the condition of the baby and after discussion with the parents:


      • Disgusted
        April 17, 2013 at 8:16 pm #

        In Australia an intrapartum death falls under the classification stillbirth. It is frustratingly misleading. You will notice that the 2009 report you linked to in your post records only “stillbirth” or “neonatal death” no further information is provided.
        Hospital homebirth programs have extremely tight criteria. It is very unlikely that even an anticipated stillbirth would have been supported to homebirth on the program.
        It is quite safe to assume then that these “stillbirths” are infact intrapartum deaths.

  14. Hannah
    April 17, 2013 at 12:03 pm #

    Interesting, does it provide a breakdown of primp vs multip birth?

    • Hannah
      April 17, 2013 at 12:05 pm #

      That should, of course, read “primip”

  15. Eskimo
    April 17, 2013 at 11:13 am #

    I met a woman this weekend who told me she is a “homebirth midwife assistant.” She fully presents herself as knowledgable and experienced at first, but after talking to her for 20 minutes it turns out she took ONE ONLINE COURSE! ONE! Annnnndddd she said she watched youtube videos on how to perform newborn cpr. Youtube videos.

    She goes to the laboring mothers house, takes vitals, and then SHE determines if labor is along far enough to call the midwife in. She answers calls for her and gives out medical advice… and she does seem to come off half-intelligent but she literally knows NOTHING. Her last job was for a collection agency! She was joking about how this pays better than her old collections job. And of course – she spews off all the typical bullshit about homebirth – its safer – less inductions equal better outcomes – yadda, yadda…

    Can you imagine being TRICKED into trusting your babies life with this woman?

    Anyway, I told her to check out The Skeptical Ob! Ha! She said she never heard of it but I hope she comes here and reads this!!!

    • Susan
      April 17, 2013 at 11:19 am #

      That’s horrible and I think it’s also got to be illegal. It sounds like practicing nursing without a license or worse.

      • Eskimo
        April 17, 2013 at 11:27 am #

        I know! I kept think that this has to be illegal… it has really been bothering me.

        • The Bofa on the Sofa
          April 17, 2013 at 11:36 am #

          “There oughta be a law…..!”

          Jeez, I was puzzled yesterday when I had an appointment with the NP when the woman who took my vitals was a “Medical examiner” and not a nurse of some sort.

          • auntbea
            April 17, 2013 at 11:47 am #

            Presumably she found you had no pulse?

        • Renee Martin
          April 17, 2013 at 7:03 pm #

          I’m sure it is not illegal, as ling as she isn’t claiming to be a nurse or other protected title.

          • Bombshellrisa
            April 17, 2013 at 9:46 pm #

            It’s scary though, as this person is assessing a woman and using her “knowledge” to make a decision.

        • April 18, 2013 at 2:44 am #

          It is illegal in California, you have to be a licensed midwife to work as a montrice! Navelgazing Midwife worked as a montrice after she stopped working as a midwife. I would imagine its illegal in some other states.

          • Antigonos CNM
            April 18, 2013 at 9:34 pm #

            Yes, but California licenses CPMs, which is what NGM is. Granted, she gives every indication of being exceptionally intelligent and well trained, but licensure is only as good as the standards of education and practice which are required for it — and regrettably some states will license almost anyone.

      • Karen in SC
        April 17, 2013 at 12:11 pm #

        maybe she could be recruited for the PCM credential.

      • April 18, 2013 at 2:49 am #

        I looked at the website and this is a CPM offering montrice services.

    • Bombshellrisa
      April 17, 2013 at 12:28 pm #

      Sounds like a monitrice to me. It’s unsettling to think that there are women who are uneducated and caring for pregnant and laboring women….and depending on untrained assistants to relay information.

      • CSM
        April 17, 2013 at 4:56 pm #

        800 bucks for a VE and FHR auscultation every now and then? Holy crap, I could be rich.

        • Bombshellrisa
          April 17, 2013 at 7:34 pm #

          And if you can do a belly cast and take belly pics, you could charge even more!

          • Sue
            April 18, 2013 at 4:15 am #

            and don’t forget the placenta capsules

          • CSM
            April 18, 2013 at 9:37 am #

            Google “CTV placenta pills” – Disqus wouldn’t let me post the link for whatever reason. The ‘mother’ mentioned in the article is actually a uni-trained, fully licensed midwife who works in a large urban practice in Ontario. That’s creme de la creme, folks.

          • CSM
            April 18, 2013 at 9:42 am #

            I find it funny that “restoring levels of estrogen” from eating your placenta is a good thing and helps you make more milk, while taking a combined OCP is a no-no because it screwes up your milk supply. Why? The estrogen! But wait…

          • Antigonos CNM
            April 18, 2013 at 9:51 pm #

            But it’s NATURAL estrogen, doncha know?? NATURAL is GOOD.

      • April 18, 2013 at 2:41 am #

        A montrice is supposed to be a licensed midwife with formal training…

        • Bombshellrisa
          April 18, 2013 at 11:49 am #

          If only! Remember Trudy the doula, who insists that epidurals make women “give birth as paraplegics”? She is a doula/monitrice

          • Karen in SC
            April 18, 2013 at 12:12 pm #

            I remember! She never came back, did she? Wonder if she learned anything?

          • Bombshellrisa
            April 18, 2013 at 12:31 pm #

            I hope so-even if just to be less hostile about hospitals and medical professionals.

            Here is how doula and monitrice are defined per this practice. Only one CPM in the mix

      • Antigonos CNM
        April 18, 2013 at 9:50 pm #

        This is an unintended side effect of the whole “nurse practitioner” and “advanced practice nurse” phenomenon. Back when “physician’s assistants” came on the scene, I felt it was only a matter of time before diploma mills would begin churning out ersatz degrees that would give at least some PAs powers far in excess of their knowledge and abilities.
        Here in Israel I have trained girls doing National Service how to hook a woman up to a fetal monitor — it really isn’t difficult, with a bit of explanation, to show an 18year old how to find the fetal heart — but they MUST notify me they have a woman being monitored [outpatient clinic] so I can read the tracing. They obviously don’t know how to–that’s my job.

    • Pinky RNC
      April 17, 2013 at 1:00 pm #

      When I was a new L&D nurse, I took the NRP program twice and had an experienced nurse with me at each birth for approximately 2 years before I became comfortable enough to assume responsibility of a depressed newborn. I think it is psychotic to think you can resuscitate a newborn successfully by watching a few youtube videos!

    • Captain Obvious
      April 17, 2013 at 3:14 pm #

      I have a patient wanting to use a doula, fine. Then she tells me she wants the doula to come to her house when she is in early labor so the doula can tell her when to come to the hospital. I think I would rather have her call me, but fine. Then I google this doulas website and find out she writes, “Married with four adult children, she became interested in birth through her own four, very different birth experiences, including a Caesarean section, two VBACs and an unplanned home breech delivery”! So this doula had an unplanned home breech delivery and my patient wants her advice on when to come to the hospital?

      • The Bofa on the Sofa
        April 17, 2013 at 3:45 pm #

        Can you point that out to her?

        She’ll probably ignore you, but…

      • Renee Martin
        April 17, 2013 at 7:02 pm #

        Tell her she should call you, but to “trust her instincts”, not a doula. Its likely she will want to go in sooner, so this may help.

      • Squillo
        April 17, 2013 at 11:42 pm #

        My anecdote: Cousin wanted a VBAC, hired a doula. Doula kept telling cousin it was too early to go in, and that if she went in too early, she’d just be risking an unnecessarian. Cousin’s water broke and baby began crowning. Ambulance called, healthy baby delivered in ER corridor. Cousin & husband–who had no interest in a VBAC home birth–very unhappy with doula.

      • Aunti Po Dean
        April 18, 2013 at 1:53 pm #

        My guess is. She is planning a homebirth and will only come in if things get scary for her

      • April 30, 2013 at 9:23 am #

        Omg. I hired a doula too in hopes for her guidance on when to go to the hospital. She told me in labor that I should go ‘whenever I feel ready’. Some help! Good thing I ‘felt’ when to go, and got to the hospital just in time to push out my baby who stopped breathing and needed immeduate intubation!! Her life was saved just in time, no thanks to the doula!! To think these people come off like they can be of assistance just because they’ve given birth too. Disgusting fraud.

    • CSM
      April 17, 2013 at 4:53 pm #

      Yep. Appearing intelligent while producing BS is on the MW skill list. Some also are quite charming and well-spoken, making everything they say sound fully legit.

      • Sue
        April 18, 2013 at 4:13 am #

        “Charming and well-spoken” seems to be very convincing to some people – they love charming nonsense but resent knowledgeable snark because they want their own prejudices re-inforced and want to feel smart and special.

        I see this all the time on discussion sites about everything from diet to immunisation – people want respect for their nonsense and hate being corrected with bluntness. They fall for the charm every time.

        • The Bofa on the Sofa
          April 18, 2013 at 10:57 am #

          I have pointed out previously that snake oil salesmen, pretty much by definition, have to be slick and well-liked. If they weren’t, they couldn’t sell snake oil.

          You can’t prey on others if you look like a predator.

  16. PrecipMom
    April 17, 2013 at 11:07 am #

    I would really love it if there could be a blog post somewhere showing every study that has come up with the x3 risk. That information was not available when I was evaluating home birth safety, but this number has been coming up over and over in more recent studies and I think it is very difficult to rationalize away.

  17. Elle
    April 17, 2013 at 11:04 am #

    I hate it when my biased conclusions are ruined by things like “logic” and “facts.”

    • Susan
      April 17, 2013 at 11:15 am #

      Me too. Thats the difference between a true professional like Judith Rooks who faces a conclusion she doesn’t like and Bart Simpson “you can’t catch me” homebirth midwives.

  18. Eddie
    April 17, 2013 at 10:57 am #

    Again, a rough factor of three. This is remarkably consistent across different countries with different medical systems. The only requirement for this factor of three seems to be that the midwives are well-trained. (When they are not, it’s a much bigger difference, as we see in some parts of the United States.)

    • attitude devant
      April 17, 2013 at 12:46 pm #

      That “remarkably robust finding” (as I am wont to say) of the three-times increase in mortality at home birth….. Fascinating how it turns up over and over and over again!

      • auntbea
        April 17, 2013 at 1:02 pm #

        It’s almost like natures operates according to some set laws, or something.

        • CSM
          April 17, 2013 at 9:36 pm #

          That’s just crazy thinking, hon

    • Aunti Po Dean
      April 17, 2013 at 2:23 pm #

      Yes and the surprising lack of low Apgar is also remarkably consistent. The Apgar score at 5 minutes is a good indicator of neonatal condition and only 13 babies were found to be below 7, 9 of these would be the ones with SIGNIFICANT morbidity (HIE and respiratory distress pointed out above) leaving only 4 others, the 2 stillborn babies would have had apgars less than 7 Yet 48 were admitted to the special care nursery.

      • Captain Obvious
        April 17, 2013 at 3:18 pm #

        Remember, these are Homebirth midwives assigned Apgars.

        • attitude devant
          April 17, 2013 at 3:23 pm #


        • Renee Martin
          April 17, 2013 at 7:06 pm #

          “Grey, floppy, and not breathing? Thats an apgar of 9!”

          Might as well ignore any metric those idiots claim, if they can’t be verified.

          • CSM
            April 17, 2013 at 7:38 pm #

            It’s called “the baby is a little shocked, he’ll be fine!”

        • KarenJJ
          April 17, 2013 at 8:39 pm #

          These midwives are better educated than US homebirth midwives and have hospital training. THere are also two of them which should provide some checks and balances.

          I have a friend that is a manager at a home based nursing organisation and they have been introducing smart phones to enhance their medical records, recording photos of wound care etc.

          It might be interesting if this was used in the homebirth programs. Although I’m not sure that the subtleties of colour would be so visible…

          • Squillo
            April 17, 2013 at 11:31 pm #

            Is is two fully qualified midwives, or one fully qualified plus one apprentice/student, as seems to be the case most often with CPMs?

          • thepixiechick
            April 17, 2013 at 11:41 pm #

            I believe in this program it is two fully qualified midwives.

          • KarenJJ
            April 18, 2013 at 12:09 am #

            That’s as I understand it to be. The training as a student would have happened at the hospital. There might be a student there being used as a doula but that would be in addition to the two trained and registered midwives.

          • Sue
            April 18, 2013 at 4:20 am #

            “Pupil midwives” (as they are still called in Oz) are generally RNs who are starting their training in midwifery – they aren’t student nurses but novices in the midwifery specialty.m (The newer direct entry MW training may be different – but it is less common).

            It says a lot if HB with tight risk-outs, attended by competent hospital MWs still carries 3X mortality – that seems to be the best that can be achieved in the home setting, even in the best conditions. I wonder if those services are giving that warning to prospective families…

          • Phascogale
            April 26, 2013 at 7:48 pm #

            Direct entry midwives in Australia have done a 3 year (full time) university degree (which also includes a large number of nursing subjects that are part of the nursing degree). So much better trained than US ‘midwives’.

            Some women will just refuse to transfer to a hospital. I’ve seen some paperwork for people that sign up for the homebirth midwife program and there’s a pretty big clause about when you need to either transfer out of the program antenatally or during labour. But I’m not sure of the duty of care of the midwife if a women refuses to go to the hospital during labour. I think the midwife can leave her (something with the contract to allow her to do this) but can’t be sure.

      • April 17, 2013 at 3:42 pm #

        Without knowing why they were admitted and for how long, that figure doesn’t tell you much, does it? And brain bleeds, like some other things, are not always that noticeable if they are not severe and you are not specifically looking.

        These were all multips, presumably the lowest of low risk – in theory. Human nature to think: Well, not many died, not much of a risk Push it heavily and then what? Lovely, in theory, to go back to the Good Old Days when midwives ruled, and natural was the only thing on offer. Not so lovely if you get the statistics that went with it.

      • Sullivan ThePoop
        April 17, 2013 at 8:25 pm #

        Isn’t an inability to regulate body temperature a common reason for NICU admission and most often those infants have a high 5 min APGAR score.

        • Elizabeth Abraham
          April 18, 2013 at 1:33 am #

          Sullivan, my daughter had Apgar scores of 9 and 9 (as assigned by the neonatalogy team in the OR) and required immediate NICU admission for respiratory distress due to prematurity. She needed three doses of surfactant and CPAP assistance to get through her first 24 hours. She was pink, alert, and screaming, but she had sticky lungs and she needed help.

          I use this anecdote often, to illustrate that Apgars aren’t the be all and end all of newborn evaluation. A good apgar might quite reasonably be applied to an infant who nonetheless needs immediate, drastic assistance. That’s why you need to combine it with the NICU admission stats (among other things) to evaluate outcomes.

          • Antigonos CNM
            April 18, 2013 at 9:59 pm #

            Even Dr. Apgar herself said that there was no true 10 at one minute, and warned that her score was not meant to be some sort of “achievement” but only a guide. However, I’ve worked in delivery rooms where if the Apgar isn’t 9 at five minutes you’d better be able to explain why not, as if the baby has to pass some kind of test.

          • Sullivan ThePoop
            April 18, 2013 at 10:23 pm #

            I know what you mean. My son had a 5 and 9 and didn’t need NICU admission.

        • Phascogale
          April 26, 2013 at 7:52 pm #

          I’d like to see actual stats on the SCN admissions. I’ve also seen a lot of babies with good APGARS at 1 and 5 mins but end up in the SCN.

          How many were in for phototherapy to treat jaundice?

          Then there’s the undiagnosed GDM’s (ie fine GTT at 28weeks but would’ve been GDM at 32 or 34 weeks) that have trouble maintaining blood sugars.

          And a myriad of other reasons that are not necessarily related to labour and birth.

    • CSM
      April 17, 2013 at 4:57 pm #

      Could someone with more knowledge than myself look up Canadian stats?

    • Amazed
      April 17, 2013 at 8:47 pm #

      The only requirement for this factor of three seems to be that the
      midwives are well-trained. (When they are not, it’s a much bigger
      difference, as we see in some parts of the United States.)

      No, according to the thread in MDC that someone linked to, it isn’t. There was that one poster who made the same assumption and she got asked questions like, How do you know? Do you have quotes to support this claim?

      These women are immune to logic.

  19. April 17, 2013 at 10:14 am #

    Another case of the study not saying what the Homebirth advocate thinks it says. I guess reading comprehension (in addition to math and science) is also not a prerequisite to the study of midwifery.

    • KarenJJ
      April 17, 2013 at 10:36 am #

      Maybe it’s a nursing specialty? If you say it cheerfully enough, nobody will notice it hurts until too late.

      • Antigonos CNM
        April 18, 2013 at 9:55 pm #

        Quite a few years ago — when BSNs first became popular — creating meaningless, jargon-filled texts with sentences running on and on, and never a monosyllable when a polysyllable could be found, began to be produced by these degree grads who’d never even touched a patient but desperately needed to show their “erudition”. Never read so much garbage in my life, frankly.

    • Aunti Po Dean
      April 17, 2013 at 2:06 pm #

      Also they dont seem to understand sample size and power. They have conducted a study which took information from all of the centers which responded, pooled the data and had a look. Sample size doesnt come into it. Sample size would only be relevant it they were conducting a study such as a RCT or similar.
      I can’t quite believe this poster got through peer review to appear at this conference which is quite prestigious. MInd you we dont know what the reviewers might have been thinking.

      • FormerPhysicist
        April 17, 2013 at 2:22 pm #

        Well, the information is valuable. Even if presented wrongly. If I were a reviewer, I might approve it so that the data is out and published and couldn’t get hidden. Nasty politics, but better than MANA hiding the data.

      • CSM
        April 17, 2013 at 5:26 pm #

        It may have been peer reviewed by other MWs who are equally oblivious. It’s just like our guideline committee. One oblivious person writes the guideline, another one obliviously reviews and approves it.

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