MANA’s shocking indifference to homebirth deaths


After my talk at ACOG’s Maui conference, I was approached by quite a few obstetricians who wanted to share their stories of homebirth transfers that they couldn’t save. It seemed that even years after the fact, many doctors were haunted by what might have been: if only the homebirth midwife had understood that the baby was breech; if only she had recognized fetal distress; if only the patient had transferred to the hospital sooner. And it struck me quite forcibly that these supposedly heartless obstetricians mourn the deaths of homebirth babies far more than the midwives who presided over their deaths.

Nowhere is that more evident than in the shocking indifference of the Midwives Alliance of North America (MANA) to the deaths at the hands of their members. To say they couldn’t care less is an understatement. They don’t even bother to pretend for public relations purposes. Imagine that real medical providers such as hospitals, physician organizations or state medical societies were presented with evidence that a higher proportion of patients than expected died under their care. Whether they truly intended to do anything or not, we would expect expressions of concern, promises to investigate, committees to study the problem, etc.

MANA can’t even muster false concern. Instead, every new report of the dramatically increased death rate at homebirth attended by non-nurse midwives is met by a wall of defiance. MANA lies about what the study shows; MANA lies about previous research, MANA adjusts the comment policy on it’s blog to create a “safe space” (i.e. a truth-free zone) where supporters of homebirth can discuss it without the pesky interference of tiny dead bodies.

MANA doesn’t promise to investigate reports of the increased risk of perinatal death at homebirth. Why would they? They know from their own data that homebirth increases the risk of perinatal death.

MANA doesn’t promise to create committees to study the problem. They have no interest in solving the problem, so why would they study it?

MANA never claims to reassess the scope of practice of homebirth midwives. They are publicly on record as supporting each midwife setting her own (!) standards as if standards were personal opinions and not professional guidelines.

MANA no longer even bothers to deny the increased risk of death at homebirth. Their new approach could be summed up as “Sure more babies die at homebirth, but the absolute risk is low” as if that excuses those preventable deaths.

MANA’s indifference to these dead babies is more than shocking to me. It is downright chilling. I haven’t practiced obstetrics for many years, but I still remember the deaths of babies who we expected to live. In most cases we had already applied every piece of technology at our disposal and every bit of obstetric knowledge we had to save them, so there were no personal recriminations about not doing more. Nonetheless, I and the other physicians were profoundly moved, questioned everything we had done, and publicly presented the case to the other obstetricians and midwives in the department to be sure we had done everything we could.

No doctor or certified nurse midwife ever dared suggest that some babies aren’t meant to live, or tried to console us by pointing out that our absolute death rates were small. Had they done so, I suspect the head of the department would have fired them on the spot. Every baby counted for us and, honestly, I cannot fathom why every baby does not count for the women of MANA.

I suppose I could be grateful for MANA’s chilling indifference to the increased risk of perinatal death at homebirth. It certainly makes my job of pointing out the deficiencies of homebirth midwifery even easier than it already is. Sure, I can tell people that homebirth midwives are just laypeople masquerading as midwives, that they lack the education and training of all other midwives in the first world, that they are ineligible for licensure in any other industrialized country. But, at bottom, the most powerful demonstration that homebirth midwives aren’t healthcare providers is their casual indifference to homebirth deaths.

Actually, their reaction is worse than casual. Instead of calling for an investigation, instead of waiting for peer review of the midwife’s actions, instead of withholding judgment until all the facts are in, homebirth midwives call for a rally, raise money and wail that any attempt to hold homebirth midwives accountable for homebirth deaths is persecution and a violation of human rights.

By their actions and their words, homebirth midwives in general and MANA in particular, demonstrate their shocking indifference to the preventable deaths of babies at homebirth. I suspect that their reaction elicits a more powerful response of distrust and disgust than anything I could ever write about homebirth.

So thank you, MANA, I guess, for making my task easier. While you are cheerfully hiding the deaths of babies at homebirth, the public is recoiling in horror.

81 Responses to “MANA’s shocking indifference to homebirth deaths”

  1. Guest
    October 8, 2013 at 8:32 pm #

    Anyone have the link where MANA admits to homebirth causing more deaths? That could be really helpful.

  2. CDNGuest
    October 8, 2013 at 12:58 pm #

    OT: Interesting video presenting the recent study by the CDC. National morning show here in Canada. Obviously for a Canadian audience (no CPM), given the emphasis on the location of birth, not the birth attendee.

  3. Deena Chamlee
    October 8, 2013 at 7:03 am #

    The truth must be looked at fearlessly because of public health policy and without our protective mask of denial because it may warrant graduate prepared education after it is all said and done.

    No one should be integrated into the healthcare system in the United States without properly being prepared. And we need to be leading the way for the rest of the world.

    Refer to my prior post: how Ina May Gaskin became a midwife. A revered leader in midwifery globally. Have we all been swooned by her personality, thus, leaving us without the ability to see? I must say the book spiritual midwifery that I partially read when I was 18 was highly offensive in many inappropriate ways; language and nudity. Seems to me, however, her leadership with MANA has impeded our growth since the very beginning.

    Because of her lack of formal educational preparation in the profession of midwifery; we have poorly educated individuals, many lack any secondary education as required by the ICM only recently in 2012 did MANA change that requirement, using the title midwife delivering high risk obstetrics OOH and leaving dead babies and grieving families in their wake. All along denying the occurrences or threatening suit if any regulatory board or University based hospital attempts to address the atrocities.

    Is that really the type of individuals that we need to be signing on board with those in the midwifery community? After all the work we passionately undertook to change Oregon, two CNMs who worked with the legislative work group were revered as nobodies. The arrogance of it all and disrespect of two highly regarded dietetic prepared, one a fellow in the College and published, midwives and the legislatures ignored their recommendations.

    And the ones without any formal educational training in midwifery were revered as experts. Hence, birth attendants in the home continued on their path of destruction without any thought of how this would affect the public. High risk obstetrics remained in the hands of those uneducated and in a higher risk environment,thus, in 2012: 8 more babies lost their lives because of it all in Oregon. There had already been 19 deaths in three years documented on in Oregon.

    Nothing was accomplished actually after an emergency legislative session occurred. Why in the world was it an emergency? Unfathomable!

    Everyone is people pleasing and in denial of what is in front of their face. The misuse of the title midwife and the practice of midwifery by high school drop outs, high school educated in some instances individuals.

    People with English majors, people with MPH degrees and PhD in humanities in order to give prestige to the title DEM but most without any formal didactic training in midwifery.

    And we wonder why they refuse to change. They refuse to change because they are not health care providers. Otherwise, I cant bring meaning to why all the deaths have continued to occur year after year without any remorse, without any insight into self and without any amends to those whom have been harmed.

  4. almostfearless
    October 7, 2013 at 11:42 pm #

    The biggest thing for me coming out of this website and Dr. Amy’s work is the distinction between the CPM and a CNM. This is a really helpful tool to explain to anyone who is a homebirth advocate (who isn’t crazy). I just had a long conversation with my Aunt who had six homebirths and is big in herbal remedies and such. Even she, when I explained the CPM education levels was surprised and agreed that it’s no good. The message has to be that a low risk homebirth with a CNM, that is what is safe, the CPM homebirth is like hiring a doula — basically a support person — to manage your medical care and it’s super risky. It’s not just deaths either, things like being able to risk out patients appropriately… for example my pre-e was ignored by my CPM midwife, when I should have been referred to an OB. Then there are birth injuries that don’t result in death, for both the baby (brain damage) and mother (bits of retained placenta being untreated, pelvic floor damage that doesn’t get repaired, bad advice about breastfeeding when the infant is losing weight, which can actually result in having to go completely to formula because the situation gets too exteme and all the unnecessary pain that women endure because they think that epidurals hurt the baby, bonding or breast feeding, when otherwise, if correctly informed they might choose otherwise).It’s truly barbaric what women have suffered at the hands of these lay midwives, it’s a dark period for women that this group has convinced even a small segment of the population.

    • thepragmatist
      October 8, 2013 at 5:57 am #

      I am not pleased when my friends have homebirths, but with a very high transfer rate and a good care between home and hospital, I am not usually afraid for their lives. There are few midwives I would not want anywhere NEAR anyone I love, but mostly, I know that the worst that will probably happen is that mom is disappointed, suffers needless pain, and then beats herself up for it for months or becomes angry at our hospital/the OB/GYN on call.

    • Felicitasz
      October 8, 2013 at 10:23 pm #

      I had no idea about the different credentials either before having moved to the US from Canada and having started to read this site regularly.

  5. TwinMom
    October 7, 2013 at 9:19 pm #

    OT: I’m very surprised CNMs are performing homebirths, especially in sue-happy California. At least they will risk out for twins, breech, etc. But still:

    • Antigonos CNM
      October 8, 2013 at 4:00 am #

      Alas, just as there are MDs whose practices are questionable, there are CNMs who are deeply infected with various ideologies. Fortunately, not many.

      It’s not JUST about the CPM/CNM educational conflict. If a midwife is not legally supervised and restricted to act only within certain parameters, she can be a loose cannon. This is why, in countries like the UK, those midwives who work outside of hospitals are still connected to them, and to the national board which sets the standards for midwifery and has the power to sanction a midwife or remove her license. In the US, no such framework exists.

  6. Gretta
    October 7, 2013 at 7:21 pm #

    Meh. If all these members of ACOG have seen the horrors of this fiasco of unregulated home births then why don’t they get together and make a strong statement against it and make some noise for change? Instead they made that silly “if you must have a homebirth then….” statement that every uneducated flufferhead has used as proof that even the ACOG thinks homebirths are a-ok….

    • DaisyGrrl
      October 7, 2013 at 7:59 pm #

      One problem is the lack of hard data showing that these yahoos are insanely dangerous. Homebirth is not an insane choice when a woman is truly low-risk, has a skilled attendant and gives informed consent (I wouldn’t choose it but it’s within the realm of reasonable decision-making where I live). Many of the higher-quality studies are based on women being rigorously screened for risk and using skilled midwives who are well-integrated into the existing healthcare infrastructure. Studies from Canada, the Netherlands, and the UK are just not translatable to the US reality.

      If you’re an OB and you see a few homebirth disasters, it can be hard to judge the scale of the disaster the CPM community has brought upon mothers and babies. Someone skilled at crunching numbers could probably figure out the likelihood of an individual OB running into huge numbers of homebirth trainwrecks (and it probably varies tremendously by geography), but given the previously available data I don’t think many people were terribly bothered by women choosing to have babies at home. It seems to be only in the last year that the 8-10x higher death rate has started becoming clear (despite MANA’s best efforts to the contrary).

      The other thing to remember is that OBs have to be very careful in how they frame the message that CPMs are dangerous. MANA and the NCB community have done a great job at painting OBs as surgeons who don’t care about women’s autonomy, are only in it for the money, and are scared of losing market share. Warning women not to trust CPMs will just play into this dialogue.

      • Tim
        October 7, 2013 at 8:22 pm #

        You’d want stories from the Neonatologists and NICU nurses from the Level 3’s in any particular city as well, since they would have even more info than the OB’s. Plus the patient surge gets funneled to them (at least the babies that survive long enough) since there may be 20 hospitals with OB’s taking in transfers in a city, and just a small handful of Level 3 NICU’s.
        TBH I don’t know how anyone does these jobs – I was utterly heartbroken the whole time we were there. I’m so glad the world is full of people who are stronger than me.

      • Deena Chamlee
        October 8, 2013 at 9:25 am #

        that is just not true. this blog. There is ample data to write a publishable paper that could drive policy change.

    • fiftyfifty1
      October 7, 2013 at 9:40 pm #

      A strong statement coming from ACOG is likely to backfire. It’s CNMs who should be making the strong statement denouncing these idiots who are stealing and ruining their good name. “CMP” is a lie through and through. They are certified only because they banded together and decided to confer on themselves a made-up certification. They are the opposite of professional. They are not midwives, they are lay people.

      • guest
        October 10, 2013 at 8:08 am #

        Its also that, at the end of the day, a woman has a CHOICE to give birth at home, even with a CPM. even if its proven more dangerous. making a blanket statement demonising them or advising against it doesn’t take patient autonomy into account. the problem is all the lies and misinformation – often women are so decieved and the death rate etc so well masked by these monsters that there is NO informed consent. and that’s so very very wrong. If a well informed woman who understands all the evidence still wants to birth at home – well, thats her right and ACOG would be pretty shitty to advise against it. unfortuantley thats NOT the situation we have at the moment anyway.

        • KarenJJ
          October 10, 2013 at 8:33 am #

          They don’t have the choice to give birth with CPMs where I live, because there is no such thing as CPMs. They can do whatever the heck they want with whatever kind of charismatic, dreadlocked, coroner-court-tweeting nutter they want. Doesn’t mean our nutter gets to call herself a midwife, and if they get the laws right, it doesn’t mean that you can act as a midwife even if you call yourself otherwise.

  7. Deena Chamlee
    October 7, 2013 at 5:10 pm #

    How did you become a midwife?

    ina may gaskin: My first birth took place in 1966, and I was very surprised to find out that as a first-time mother, my obstetrician was unwilling to allow my baby to be born without medication. This was because he intended to use forceps (whether they were truly necessary or not), because most US obstetricians then believed that this was safer for mother and baby than allowing the normal birth process to take place. This idea was obviously revised a few years later, but I had no choice in the matter for this particular birth. Because I was a graduate student in English literature, I was aware that many women and babies had been injured during forceps deliveries. Besides, I was sure that women’s bodies could function better than my obstetrician had been taught they could. That whole experience really opened my eyes to how little scientific evidence underlay the obstetrical beliefs and procedures that were commonly used.

    Around that time, I heard a few women tell their home birth stories. Invariably, these were empowering stories. I was awed by these women who found ways to give birth at home — most of them pressured a friend, who happened to be a labor and delivery nurse, to sit with them during labor. After hearing a couple of women’s stories, I knew that I wanted a home birth myself and that if there were any way for me to become a midwife, I would like to be one.

    It wasn’t long before I had a chance to observe my first birth. The woman refused to go to a hospital and wanted me to stay with her. Her husband was prepared to catch the baby. I was lucky enough to see what seemed to me to be a short, relatively easy labor that ended with a perfectly healthy baby. There was no time to be worried during labor because it went so quickly.

    There were several other women who were aware of this birth, and when it was finished, it seemed that they were ready to regard me as a midwife. So, one by one, these women gave birth, and after the birth of the third baby, I was offered a seminar in emergency childbirth by a generous obstetrician. That seminar prepared me for the birth of the fourth baby, who needed resuscitation at birth and his mother, whose bleeding had to be stopped just after birth.

    source link

    MANA says three articles regarding MANASTATS outcomes including morbidity and mortality is in the process of peer review and will be published soon:

    Are we surprised that there are no uniform data sets in states that require mandatory reporting regarding direct entry midwifery or non nurse midwives out of hospital birth?

    Do we really think that an Organization who’s leader stated the above entry has the ability to analysis and correlate birth outcomes?

    And what defines peer review?

    How do we allow this to continue with what we know is occurring within the profession of midwifery?

    Cannot everyone see?

    Absolutely difficult to understand and or accept!

    • BeatlesFan
      October 7, 2013 at 5:22 pm #

      ” Because I was a graduate student in English literature, I was aware that many women and babies had been injured during forceps deliveries. ”

      Am I the only one who went “Huh?” at this part? WTF does English lit have to do with forceps deliveries?

      • wookie130
        October 7, 2013 at 6:35 pm #

        I absolutely thought the same thing when I read that. What the hell does being a grad student in English Lit have to do with ANYTHING with babies being injured with forceps? Once again, proving that Gaskin is a total wingnut, I suppose.

        • KarenJJ
          October 7, 2013 at 7:30 pm #

          It means that she is ‘really educated’, I suppose.

        • October 7, 2013 at 11:05 pm #

          There does seem to be a disproportionate number of people with postgraduate humanities degrees at the helm of the NCB movement.
          Off the top of my head: Inna May, Janet Fraser (history), Melissa Cheyney
          I’m not sure of the causation – it might simply be because they’re more articulate than their peers, or perhaps that they’re more ‘right brained’, more prone to gaslighting the past, overconfidence etc

          • Young CC Prof
            October 7, 2013 at 11:55 pm #

            Could be the relativism inherent in the humanities. Anything you believe is right for you. In some areas of life, it makes sense, in others… yeah.

            Then again, one of my colleagues who teaches PHYSICS has some truly bizarre unscientific notions. Of course, she’s Russian and was educated in the waning days of the USSR, so it’s not as strange as it might be.

          • AmyP
            October 8, 2013 at 12:59 am #

            No, that’s not unusual at all. I had a good friend who was Russian and a physics teacher and very smart, and she was involved in all manner of woo. She even did a stint as a faith healer, in fact.

          • Young CC Prof
            October 8, 2013 at 1:49 am #

            It’s amazing that the Soviets managed to match the West in the hard sciences, and yet so much of their medical science came out of the bottom of a cracker jack box. (Then again, they were spending just about everything they had on those hard sciences, to the detriment of many other areas of life.)

      • Certified Hamster Midwife
        October 7, 2013 at 7:41 pm #

        No, it makes sense – if she was reading books and stories written since forceps came in common use, characters in fiction would be born/give birth using them. So, unlike other 24-year-old hippies, she had at least heard the word “forceps” before.

        • BeatlesFan
          October 7, 2013 at 9:13 pm #

          I guess she missed all the stories where women and babies died in childbirth… and I didn’t think an English Lit education covered reading medical studies and journals. If it didn’t, she was using fictional stories involving forceps as a reason to mistrust them. How does anyone take this nut seriously?

          • Certified Hamster Midwife
            October 8, 2013 at 3:53 pm #

            This is one of those cases where someone has just enough knowledge to be dangerous. She knew that forceps exist and that babies haven’t always been extracted from their mothers with vacuums under twilight sleep. And the hygiene and nutrition hypotheses should cover why women and babies used to die but don’t anymore.

        • Antigonos CNM
          October 8, 2013 at 12:38 pm #

          About as much as Hollywood depictions of labor and birth have to do with the real thing. I am sure that, for primips anyway, most of them have no realistic idea of what labor is really like, just what they’ve seen on TV or movies, where the immaculately-coiffed and made-up mother accepts congratulations from family and friends while the baby snuggles. Maybe the mother is a little wan, to indicate that she “suffered”, but that’s about it. Even in “realistic” shows, where we see a disheveled woman pushing, she only pushes once or twice and it’s all over; there’s no sense of the hours and hours involved.

    • Lisa from NY
      October 8, 2013 at 12:42 am #

      They’ll disguise the death rate in a way to make it look low compared to car accidents on public highways.

  8. October 7, 2013 at 3:38 pm #

    Its so hard to get midwives to do anything about problems in their own community. I’ve shared about the sexually inappropriate conduct of a midwife here before, and its been hell to get anything done about it. The birth center refused to do anything. They lied about the licensing status of the midwife so I couldn’t report her.

    I had to publicly share what had happened to me online and start a petition to get the midwives college to evaluate its relationship with the birth center (because they send students there). Its been weeks and they haven’t managed to get two volunteers together to get the process going. They don’t care about any of the things they claim to. It makes me sick.

    I know my pain isn’t anything compared to a woman who has lost a child, but its illustrative of how little they care about anything except their money.

    I’m working on my small claims paperwork right now because its all I can really do. At least the maximum in the state of utah for small claims is 10,000$.

  9. AL
    October 7, 2013 at 2:23 pm #

    I feel that unless a celebrity has a failed homebirth story where a baby actually dies, the general public really won’t be made aware of how horrific this all is.

  10. AL
    October 7, 2013 at 2:23 pm #

    I feel that unless a celebrity has a failed homebirth story where a baby actually dies, the general public really won’t be made aware of how horrific this all is.

  11. Squillo
    October 7, 2013 at 1:21 pm #

    Ironically, they bleat that anyone questioning the state of homebirth midwifery in the U.S. is trying to deprive women of choice.

    What kind of choices do families who want homebirth have when they’re denied information and when the vast majority of providers are undereducated, underskilled, and whose professional organizations patently have no interest in improving things?

  12. bedorah
    October 7, 2013 at 1:05 pm #

    Almost all OB’s will have a failed homebirth horror story. We can’t share them in any public forum because of patient confidentiality laws. We shouldn’t even be sharing them in private (as Dr. Amy refers to above) but we can’t help ourselves!!! So unless the patient, or a friend or relative, shares the story, you won’t be hearing about it.

    • Alenushka
      October 7, 2013 at 1:35 pm #

      There are ways to share wihout disclosing PHI. Pt X. No city, not age, not unmber of kdis, marriage status, languges etc. Just lcinical info.

      • fiftyfifty1
        October 7, 2013 at 9:46 pm #

        Absolutely. HIPAA laws are there to protect patients’ identities, not to muzzle physician speech or prevent the sharing of case studies that can help us learn from one another.

  13. Deena Chamlee
    October 7, 2013 at 12:54 pm #

    I take breaks from this utterly heartbreaking mess from time to time. Then, every time I begin to get emerged again I can’t help but feel totally helpless in regards to driving change.

    I honestly feel the issues at hand have reached a point to be considered a public health crisis. And until there can be a consensus within the midwifery community in regards to standardization of : practice and educational standards and a governing body that sets national regulatory standards for all titled midwife, across all three settings, in all fifty states; midwifery led services by non nurse midwives should be banned until extensive scrutiny of mortality rates in each state are peer reviewed.

    Ethically, we have a responsibility to protect the public before any other entity, inclusive of profession. And God help us in making the non regulation of midwifery in the US cease.

    Because it seems no one can penetrate the protective mask of denial that so many in midwifery wear.

    • fiftyfifty1
      October 7, 2013 at 9:51 pm #

      ” And until there can be a consensus within the midwifery community”
      There’s the problem right there. CNMs have allowed a group of false midwives to have membership in their community. The consensus you hope for is never going to happen because the CPMs are never going to agree to standards. Boot these fakers out!

      • Deena Chamlee
        October 7, 2013 at 11:03 pm #

        hey there fiftyfifty long time no see.

        I know it will be interesting to see if any of the global standards for midwifery will ever be implemented within this country. Mana says its up to the states to protect the public; Ms. Gordon said this in a recent MANA Blog post. It’s never their responsibility.

        I don’t know what it’s going to take, except a very well written paper addressing outcomes of mortality and morbidity in all the various states.

        • Amazed
          October 8, 2013 at 7:13 am #

          Hey Deena, I think I have the answer: the states can protect the public by supervising MANA.

          Anyone willing to bet that Wendy Gordon won’t jump at this chance to protect the public?

          The hypocrisy of these women!

          Oh,and I have studied humanities. History and Theory of Culture is the subject I have a bachelor degree at in this field. You know what? I know the difference between fiction and fact. Amazing, huh? And I knew it before I entered elementary school, let alone the university. What on earth is wrong with Ina May?

        • fiftyfifty1
          October 8, 2013 at 9:51 am #

          I hate to be dense, but I still can’t understand why you put up with it. It seems that CNMs are enmeshed with CPMs. Why passively wait for a “very well written paper” to come along and save the day? Why not start speaking out now? Why do CNMs stay silent?

          • Deena Chamlee
            October 8, 2013 at 10:09 am #

            hey fifty do you really think me as passive?

          • fiftyfifty1
            October 8, 2013 at 8:29 pm #

            I’m not sure. It’s like patients who complain to me that their dead-beat, pot-head, mostly-uninvited sister has been camping out on their couch and eating all the food in their fridge for months now. I ask why they don’t just boot her out and change the locks. “It’s complicated” they tell me. Ok fine, but I still don’t get it.

        • Bambi Chapman
          October 10, 2013 at 7:46 am #

          Deena, would you be up for doing a guest post on my blog about your thoughts on all of this??

  14. Karen in SC
    October 7, 2013 at 12:32 pm #

    Irony alert: The report of a single vaccination injury (absolute rate is low, too) leads most of these nuts to refuse vaccinations. The report of a 3-8x rate of intrapartum death – don’t care, doesn’t matter…

    • Courtney84
      October 7, 2013 at 4:16 pm #

      I never understand the process by which the “natural” parents pick and choose. I recognize no one lives in a vacuum and that many (all?) parenting decisions and are multivariate and complex. A less impactful conundrum to me is always that a single ounce of formula will ruin your baby’s gut, IQ and attachment BUT anyone who points out the dangers of co sleeping is fear mongering. The AAP says exclusively breastfeed for 6 months and room share, but don’t bed share. What causes them to latch onto one recommendation over the other?

      *i recognize there are many reasons why breastfeeding isn’t the appropriate choice for some families, just like I recognize that there will always be families for who bed sharing works for better than sleep deprivation. No one parents in a vacuum.

      • ratiomom
        October 7, 2013 at 4:27 pm #

        The criterium is how difficult something is for the mother. Homebirth without pain relief, breastfeeding at any cost, co-sleeping, babywearing, cloth diapers/EC, …all have in common that they are harder, more painful/dangerous or more time consuming than the alternative. Martyrdom is what distinguishes a good mother from the bad ones. These women are in it for the bragging rights.

      • Ceridwen
        October 7, 2013 at 7:57 pm #

        In some cases it is that they are actually choose whatever is the opposite of what the AAP or their doctor suggest. For example, in general, the natural parenting types love vitamins. They’ll give their kids massive doses of vitamin C for a cold and that sort of thing. But if a vitamin is specifically recommended by their doctor based on sound evidence they are quick to reject it. The best examples of this are vitamin K (parents declining the shot in the hospital) and vitamin D (parents refusing to supplement after baby comes home). Doctors are also apparently fear mongering when they suggest starting to give baby iron around 6 months old (even if through dietary sources!).

  15. Lisa from NY
    October 7, 2013 at 12:09 pm #

    Dr. Amy, maybe we can make an addition to your Hurt by Homebirth site and have videos of doctors telling their horror stories.

    • Renee Martin
      October 7, 2013 at 12:15 pm #

      That’s a GREAT idea!!!

      • Elle
        October 7, 2013 at 12:43 pm #

        And shining a light on how preventable some of these deaths are would certainly throw cold water on the whole “babies die in hospitals too” line.

        • Young CC Prof
          October 7, 2013 at 6:42 pm #

          Definitely. Rather than just deaths, it would be really good if we could sort out deaths from specific causes, and show that certain specific issues like, I don’t know, cord prolapse or shoulder dystocia, kill babies with distressing frequency at home, but almost never in the hospital.

    • Gene
      October 7, 2013 at 12:49 pm #

      The problem with that would be (in the US, at least) violating of patient privacy laws.

      • Dr Kitty
        October 7, 2013 at 1:03 pm #

        Unfortunately true.
        Although every OB who had a HB transfer disaster story could simply say “I’m an OB and in my career I have seen X babies die in HB disasters. In my entire career I have lost Y term, healthy babies”.

        Which gives no PII and would allow HB advocates to see how rare an event it actually is, and how much more common HB makes it,

      • Guest
        October 7, 2013 at 1:48 pm #

        I’m always so interested at the people who say, “Our OB assured us this would have happened in the hospital.” They can say anything they want to about what the OB said. The OB can’t respond. But after a year of reading this blog I am sure that a lot of OBs shed a lot of tears over babies they had a fighting chance at saving in the hospital.

        Someone posted a while back an article about an OB and how she told the patient it was not her fault because the truth was too awful and she knew it would take the mother years to be willing to face it, if ever. Anyone remember that piece? Have a link?

        • Allie P
          October 7, 2013 at 4:11 pm #

          I think it was on that michigan midwives site. About what OBs mean when they say comforting stuff like that.

        • amazonmom
          October 7, 2013 at 4:37 pm #

          Almost no doctor wants to tell a grieving parent that “No, this wouldn’t have happened at the hospital”. No doctor I know wants to rub salt in a grieving parent’s wound at that time.

          • BeatlesFan
            October 7, 2013 at 5:38 pm #

            I can completely understand that, but do the OBs not realize that, by not wanting to hurt an already grieving parent, they might be inadvertently causing more harm later on? I get the reasoning, but telling HB loss parents (untruthfully) that nothing would have saved their baby has the risk of just reinforcing the parents’ belief that HB is totally safe. They then tell everyone who hears their loss story that HB is totally safe… and the secondary take-away message from their story is that hospitals aren’t actually as life-saving as they are said to be, which again promotes HB.

            To be fair, I’m not a doctor and I’ve never been in this situation. I have to wonder, though- is telling parents that their baby might have lived somehow worse than having to tell them their baby died in the first place?

          • amazonmom
            October 7, 2013 at 6:49 pm #

            Yup, that is the problem. During one especially gory resuscitation in my career the neonatologist started ranting that “the idiot midwife killed this baby! She didn’t even have the G D guts to give a history to EMS! Why does this baby have DIC?” , he didn’t realize the father was coming down the hall and could hear him. The dad said the doula had told them she could deliver the HBAC at home. That his wife was bleeding with a sharp pain in her uterus for the 5 hours she was pushing. That the OB said she was only at 5 cm and had a uterine rupture so bad that the OB had estimated an 8 hour repair. I’m leaving out details here, but we lost the baby to uncontrollable DIC. Mom survived to give birth via c/s years later. Boy we wish Dad could have learned the truth in an easier way. We still feel awful that we didn’t sit down calmly and explain in a better way…

          • Anj Fabian
            October 7, 2013 at 7:17 pm #

            delivering an HBAC?

            Of all the ignorant, stupid, criminally reckless things to do….

          • amazonmom
            October 7, 2013 at 7:31 pm #

            She claimed to be a CPM. Long story.

          • KarenJJ
            October 7, 2013 at 7:38 pm #


            The CNMs have a problem of people confusing them with CPMs and now the CPMs have a problem of people confusing them with doulas.

          • amazonmom
            October 7, 2013 at 7:44 pm #

            The parents had been told the person was only a doula. The CPM that referred them to her said it was a way around the fact that the CPM would get in trouble for doing VBAC at a center. The parents were told to lie in case anything happened.

          • DaisyGrrl
            October 7, 2013 at 8:03 pm #

            That’s horrendous. I don’t even have words for how awful that story is. I’m sorry you had to witness such a terrible outcome and am so thankful that you’re there for the poor little ones who need your skills.

          • amazonmom
            October 7, 2013 at 8:20 pm #

            Thanks. This event led me to start researching the homebirth industry in general.

          • KarenJJ
            October 7, 2013 at 8:42 pm #


          • The Bofa on the Sofa
            October 8, 2013 at 11:36 am #

            I know that we all like to call the parents the victims, but come on. When people are telling you to lie to protect them from trouble, and you voluntarily agree to participate, you aren’t a mere victim, you are part of the lie.

            Wouldn’t you be wondering why a CPM would be getting into trouble for doing a VBAC at the center?

            You really have to buy into the conspiracy to fall for that.

          • amazonmom
            October 8, 2013 at 4:32 pm #

            That’s why I resent the homebirth movement so much. They portray the hospital as a bunch of greedy liars who want to take away your good time. Patients usually gravitate towards whoever tells them what they want to hear, and the industry takes advantage of them leaving dead and injured people in their wake.

          • fiftyfifty1
            October 7, 2013 at 9:56 pm #

            Yep. I can understand why doulas get mistaken for CPMs. I mean why not? All that differentiates a Doula from a CPM is a correspondence course, an easily falsifiable “skills checklist” and a test any idiot can pass.
            Now what I *can’t* understand is why the CNMs put up with CPMs calling themselves “midwives”. Actually they more than put up with it. They seem to actively invite these fakers into their fold. Why??!!!

          • Antigonos CNM
            October 8, 2013 at 4:09 am #

            CNMs have no power to stop anyone calling themselves anything, and the “CPM” was obviously a deliberate attempt by that sort of birth attendant to trade on the acronym for certified nurse midwives. The only thing a CNM could do would be to protest if someone used CNM fraudently [i.e. did not have the certification or degree]

          • fiftyfifty1
            October 8, 2013 at 9:44 am #

            No, there’s lots they could do if they wanted to:

            1. Publicity pushes/information campaigns along the lines of “Make sure your midwife is genuine”.
            2. When CPMs are trying to get insurance coverage in a new state, lobby against them.

            3. Refuse to work alongside them in practices.

            4. Insist that web sites like etc stop listing CPMs right alongside CNMs when patients do provider web searches.

            But apparently CNMs don’t want to do this. Instead they have seemingly rolled out the welcome mat for these fakers. They actually even hold professional conferences together. As an example of how enmeshed they are, read Deena Chamlee’s comments above. Literally years after she realized there was a safety problem she is still hoping someone can create “consensus” among all the types of midwives and that CPMs will voluntarily adopt stricter training and risk-out standards. CNMs as a group are too enamored with the romantic image they have of themselves as being spiritual heirs to the “granny midwives” to rock the boat.

          • October 8, 2013 at 10:35 am #

            I wonder if it’s possible to make “midwife” a legally protected term.
            It would immediately invalidate the “CPM” designation and reduce the risk of confusion.

          • Amy Tuteur, MD
            October 8, 2013 at 10:38 am #

            That’s what they did in Canada.

          • areawomanpdx
            October 7, 2013 at 10:59 pm #

            I have read numerous mainstream news stories that equate “doula” with “midwife.” So many people have no idea what the differences are.

          • Antigonos CNM
            October 8, 2013 at 4:07 am #

            I never even heard the term “doula” until I was in the US in 1999 and then someone had to tell me what it meant.

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