No, homebirth studies have NOT shown that there is no increased risk of death


Homebirth advocates in general, and the Midwives Alliance of North America in particular, love the “big lie.” They have no intellectual respect for each other and operate on the assumption that homebirth advocates will believe anything, no matter how ridiculous or outrageous, if you just say it loud enough and long enough.

For example, MANA executive Wendy Gordon CPM (and placenta encapsulation specialist!), writing in the comment section of her Science and Sensibility piece, which has been ripped to shreds. is still telling lies as fast as she can make them up.

But what seems to be clear, time and time again in the most rigorous studies on homebirth safety, is that for women with healthy low-risk pregnancies, there is no increased risk of death (however that is defined in those studies) …

That, like most of what comes from Wendy Gordon and MANA is bullshit!

Why? For a very simple reason.

Prior to the recent Grunebaum paper showing that homebirth increases the risk of an Apgar score of 0 by nearly 1000%: THERE HAS NOT BEEN A SINGLE HIGH QUALITY STUDY OF NON-NURSE MIDWIFE ATTENDED HOMEBIRTH IN THE PAST 8 YEARS!

In fact, the has only ever been ONE STUDY that specifically addressed non-nurse midwife attended homebirth, the Johnson and Daviss study, which claimed to show that homebirth with a certified professional midwife (CPM) in 2000 were as safe as hospital birth. There’s just one teensy problem. The authors didn’t compare homebirth in 2000 with low risk hospital birth in 2000 because that would have shown that homebirth with a CPM had a death rate nearly 3X higher. In order to hide that fact, Johnson, the former Director of Research for the Midwives Alliance of North America, and Daviss, his wife and a homebirth midwife, compared CPM attended homebirth in 2000 with a bunch of out of date papers extending back to 1969 when (conveniently) the perinatal death rate was much higher than 2000.

All the other homebirth papers that Wendy Gordon and MANA like to quote come from different countries where there are NO CPMs because CPMs are considered to have too little education and training to qualify for licensure in the Netherlands, the UK, and Asutralia. As it happens, those studies from the Netherlands, the UK and Australia ALSO show that homebirth increases the perinatal/neonatal death rate, too. There have been several studies of homebirth in Canada that showed that — with strict eligibility criteria, and a massively high transfer rate — deaths as homebirth could be avoided. There were no CPMs in that study, either, as Canada, which used to recognize the CPM, abolished it several years ago on the grounds of inadequate education and training of CPMs.

Of course, that doesn’t mean there has been no data on non-nurse midwife attended homebirth in the US. The CDC has noted both place of birth and attendant since 2003. They looked at birth certificates signed by non-nurse midwives certifying that they were the attendant who delivered the baby. That means they looked only at PLANNED homebirths and they found, in each and every year, that homebirth had a neonatal mortality rate from 3-7X HIGHER than comparable risk hospital birth. You can see a chart of the results below:


Moreover, the state of Oregon collected their 2012 data of planned homebirths attended by licensed midwives and had it analyzed by Judith Rooks, CNM. It showed that homebirth has a mortality rate than is 9X higher than comparable risk hospital birth.

There is ANOTHER source of data for the death rates of homebirth attended by non-nurse midwives. That’s the database of approximately 27,000+ planned homebirths assembled from 2001-2009 by MANA itself. What’s the death rate for those births? MANA REFUSES TO RELEASE THE DEATH RATE!

At this point, EVERYONE understands that the MANA death rates are hideous, even homebirth supporters. They spend their time spinning absurd reasons why MANA should release the hideous death rates, claiming that they must be “flawed” in some unspecified way that justifies hiding them.

So let’s review why Wendy Gordon’s claim that studies have shown that homebirth is as safe as hospital birth is nothing but a bald faced lie:

1. There have been NO high quality studies of non-nurse midwife attended American hospital birth in the past 8 years.

2. The ONLY study of CPM attended homebirth shows a mortality rate nearly 3X higher than comparable risk hospital birth in the same year.

3. Studies from other countries are not applicable since their midwives are far more highly trained.

4. The CDC data shows that homebirth, in every year from 2003-2008, had a neonatal death rate at least 3-7X higher than comparable risk hospital birth.

5. The Oregon data fro 2012 shows that planned homebirth with a licensed non-nurse midwife has a mortality rate 9X higher than comparable risk hospital birth.

The recently published Grunebaum study merely confirms what we (and MANA) already know: homebirth dramatically increases the risk of perinatal death.

The data is pretty clear and the MANA statistics would merely provide the coup de grace. That’s why it is important for MANA to release their own death rate.

Nearly 300 people have signed the petition to MANA demanding the release of the death rate. Please sign the petition now and urge your friends (real and virtual) to sign, too.

Let MANA know that the time for lying and hiding has passed. American women deserve to know what MANA executives know: how many of the babies in their 27,000+ database died at the hands of homebirth midwives?

81 Responses to “No, homebirth studies have NOT shown that there is no increased risk of death”

  1. Daleth
    April 17, 2015 at 11:23 am #

    Does anyone know how Grunebaum et al. defined “midwife” in their home birth studies, and where they got information on the home birth attendants? I’m just trying to answer someone’s claim that the studies were flawed because they didn’t distinguish between lay midwives and CNM’s attending home births.

  2. Dora g
    October 4, 2013 at 5:06 pm #

    Just an aside, Dr. Grunebaum delivered my daughter by c-section nearly 4 years ago. Nearly 24 hours after my water broke, and after 8 or so hours of pitocin, I was still at a 1/2 cm. Grunebaum was the OB on call. I never felt pressured to agree to a c-section. I asked his opinion, and he gave it. He told me that if I wanted to wait, my daughter was being monitored, and it would be okay. But he anticipated another 24 hours or so for me to fully dilate, and considering my narrow anatomy (which I was aware of thanks to the multitude of vaginal ultrasounds while TTC), I would likely need a c-section anyway. I said, then let’s meet my daughter tonight. The delivery was free of complications, and my daughter was in my arms within 5 minutes of her first cry, while Dr. Grunebaum and others in the OR gushed about how beautiful she was. We were in recovery and nursing in about a half hour. It was lovely.

  3. araikwao
    October 3, 2013 at 5:44 pm #

    Always the fewest comments on posts like these. And no parachuters. Wish they would educate themselves on this, rather than in the rainbows&affirmation-filled echo chambers..

    • Bombshellrisa
      October 3, 2013 at 6:36 pm #

      It’s the math part. The birth affirmation crowd tends to shy away from actual facts and figures.

    • Burgundy
      October 3, 2013 at 7:27 pm #

      I was secretively hoping the lady (can’t remember her screen name) who can’t tell the difference between rates and absolute numbers would jump in and defend NCB…..

      • Karen in SC
        October 4, 2013 at 7:40 am #

        Kelley, Eager Hands. She never did come back with any sources.

        • araikwao
          October 4, 2013 at 6:33 pm #

          Can’t those eager hands do some more Googling? 😉

    • Lisa from NY
      October 3, 2013 at 11:09 am #

      Study she quotes was not scientific at all.

      • EllenL
        October 3, 2013 at 3:35 pm #

        And she never pointed out this from the study:

        “All trials included licensed midwives, and none included lay or traditional midwives. No trial included models of care that offered out of hospital birth.”

        To sum up, birth with a licensed Nurse Midwife, IN A HOSPITAL with physician supervision, is a reasonable choice for some women. I wish that was the point she had chosen to make.

        • Lisa from NY
          October 4, 2013 at 12:59 am #

          Thanks. I missed that point.

  4. almostfearless
    October 3, 2013 at 2:08 am #

    Shared on my FB page although I know I will get slack for it. We should all push as hard as possible on this petition. Don’t be shy. Don’t worry. Don’t question if you should ruffle the feathers of your crunchy friends. Protect babies. Do the right thing. If everyone on this site made this a priority we’d hit 10K in no time. Let’s go!

  5. Playing Possum
    October 2, 2013 at 10:15 pm #

    Totally OT but very scary:

    • Sue
      October 3, 2013 at 12:54 am #

      Yep – but no insurance, so the family misses out.

    • Lisa from NY
      October 3, 2013 at 6:17 am #

      Quote from article: The 68-year-old’s website states that she is no longer practising.
      However in a separate section she spruiks her readiness to make herself available to expat couples who ‘‘want to have their baby at home but live in countries where this birth choice is not provided for’’.

      If the police want to catch her, all they need to do is pose as a family in desperate need of a midwife. Does anyone know how to contact the police in Sydney, Australia?

      • PJ
        October 3, 2013 at 4:22 pm #

        That is pretty funny–does she really think she can just nip off to some foreign country, practice as a midwife for a few weeks, then go back home? Doesn’t quite work like that.

  6. lucy logan
    October 2, 2013 at 9:21 pm #

    i would like to repost the petition without giving the site access to all my fb info or my gmail contacts.. is there a permalink?

  7. Amy Tuteur, MD
    October 2, 2013 at 9:05 pm #

    The state of Oregon has issued it’s report on homebirth deaths in 2012. It DOESN”T EVEN MENTION the 800% increased death rate at homebirth!! It’s a total whitewash. My post about it will appear in the morning.

    • Young CC Prof
      October 3, 2013 at 9:05 am #

      I was rather interested to see that the CNM-attended home births actually had a 40% transfer rate, much higher than the CPM transfer rate. Is that what actual knowledge and some measure of prudence gets you? (Obviously, the numbers are too small to see if that changed the death rate, but it’s still notable.)

      • October 3, 2013 at 11:56 am #

        That sounds entirely consistent with the Canadian transfer rate…

  8. the wingless one
    October 2, 2013 at 7:47 pm #

    Sorry OT but at my son’s preemie developmental clinic follow up today the NP mentioned how scary it must have been that he had DIC during his NICU stay. I didn’t even realize that was in his charts until she said it and am frankly kind of glad I didn’t. I’ve only ever heard of it on this site and only in relation to severe PPH so I’m not sure how it applied in his case? I knew he had extremely low platelet counts for several weeks after birth and had multiple platelet transfusions as well as ivig and plasma one or two times. He did get one blood transfusion but they said that was only because they had taken so much blood from him to try to figure out what was wrong. I’m going to ask his pedi next week but was wondering if anyone here might have any thoughts to how he had DIC when as far as I know he never actually had any bleeds? Or is that just the diagnosis when platelets are so low that the patient is unable to clot? I guess I’m just confused because the only context I’ve ever heard of it in are the pph cases discussed here and it doesn’t quite seem to fit in his case. Thanks!

    • jenny
      October 2, 2013 at 9:05 pm #

      DIC can have multiple causes, and blood loss is only one. Also babies have very little blood to begin with. Low platelets are thrombocytopenia and that is different than DIC but the two can be related. My daughter’s doctor told me that DIC is exhaustion of a clotting factor and platelets, caused my many small clots all over the body. In turn that causes many small bleeds all over the body. It’s a dysfunction of the clotting…. cascade? From what I understand it is a lot more complicated than that but he was trying to explain it to me in a way I could understand. I hope you get the answers you want when you talk to your son’s doctor.

      • the wingless one
        October 2, 2013 at 10:51 pm #

        Thanks for the reply! That makes more sense than how I was thinking of it.

        • Sue
          October 3, 2013 at 2:01 am #

          DIC – disseminated intra-vascular coagulation – is also known as a consumptive coagulopathy – in that there is widespread clotting, resulting in the clotting factors being used up, and therefore risk of bleeding.

          It is sometimes seen in severe infection – such as septicaemia with organisms like meningococcus. The clotting in small peripheral blood vessels can lead to poor circulation in the extremities, and the bleeding tendency can lead to tiny haemorrhages under the skin (”petechiae”).

          The treatment is aimed at stopping the main disease process, then replacement if required.

          So glad your baby got through all this!

          • the wingless one
            October 3, 2013 at 5:28 pm #

            Thank you Sue! He did have a lot of petechiae all over his body so I guess in that sense he did have hemorrhages but just luckily not a massive one.

            It was definitely a scary time and I feel so lucky he made it through and seems to be totally fine now. I guess I feel even luckier now knowing what I know. They were never able to fully figure out what happened, their best guess was that he had macrophage activation syndrome from my lupus antibodies but they said that was just their best theory given that they could find no other cases. He’s recovered fully now it seems so in that sense we also got lucky since they more commonly find heart issues with babies affected by maternal antibodies.

            Just one of the many reasons I love this site – all the knowledgeable commenters such as you and Jenny!

  9. EllenL
    October 2, 2013 at 7:13 pm #

    OT (but not really).

    Do you all remember homebirth midwife Valerie El Halta, who
    faced criminal charges in Utah? The Salt Lake Tribune has updates.

    A recap of the El Halta case, and her background:

    El Halta’s plea deal (*head to desk*):

    Dr. Amy covered the original story here:

    • Guesteleh
      October 2, 2013 at 9:45 pm #

      From the comments: How to begin? How about I start with my financial interests? Most of these discussions begin with the contention that obstetricians are biased toward hospital deliveries, because that’s where the money is. Well, I get paid to care for sick babies. When home deliveries go bad, we care for the victims. It happens at least a few times a year. A few go home healthy. Many die in hospital or are discharged home with severe brain damage. Virtually all spend a substantial time in the newborn intensive care unit under our care. I hope never to see another baby injured or killed by a home delivery.

      Utah is blessed/cursed by a coterie of well meaning, inadequately trained, inadequately equipped lay-midwives. Attending one home delivery that resulted in a bad outcome was the lay-midwife and one of our hospital kitchen staff who was learning the trade. Hardly the background of professional education you would look for to manage a life or death situation.

      Well motivated advocates of home births point to a history of good results. Part of the success of home deliveries is good results from countries with professionally trained midwives. Also the odds are that deliveries without definable risks are usually uncomplicated for both mother and baby. Taxi drivers have a great record of success in back seat deliveries. If a lay-midwife understands the myriad risks for problems in labor or delivery (diabetic moms, first pregnancies, previous caesarian section, etc.) and refers those moms for hospital deliveries, she may go a long time before encountering an emergency in labor, delivery, or problems with baby’s condition after birth. Sooner or later, unfortunately, the odds are likely to catch up with her. When they do, she is stuck in a house without the immediate access to special help (anesthesia, caesarian delivery, trained personnel for neonatal resuscitation and assessment) that can make the difference between an asphyxiated or dead baby and a healthy newborn. That help is rarely needed, but when it is, you had better be in a hospital where it is available immediately

      We shouldn’t blame the parents who choose home delivery with a lay-midwife.
      They have neither the education nor the training to adequately evaluate the information provided by home delivery advocates, information that is often wrong. Essentially they are placing a bet that all will go well, and likely they will win that bet. If they lose, they lose big. The midwife loses nothing.

      Ms El Halta has apparently found a way to worsen these odds. She deliberately chooses to deliver women at high risk of major complications at home. Her “gift” is “birthing hands”. She writes articles and books about it and seems to have gotten away with high risk deliveries fairly often. However, it would appear that her arrogance and ignorance have resulted in at least two deaths. She plans to keep at it. I am angry, but not surprised. I have met physicians with a similar lack of insight.

      Good obstetricians or nurse-midwives are trained to manage pregnancy, assess risks and provide appropriate decisions to effect a good result from labor and delivery. Good hospitals are capable of providing a positive, patient centered birth experience. A patient centered approach means that parents have the right to make key decisions about the birth process to ensure an experience that fits their needs and desires. Hospitals also have the resources to deal with complications during labor and delivery. They have highly trained pediatricians on staff to assess and manage problems with newborns. Good prenatal care and excellent care in hospitals during labor and delivery reduce the number of babies that we care for in NICUs. I hope never to see another sick, brain damaged or dead baby from a home delivery gone wrong.

      Parents making plans for a home delivery by a lay midwife are making a bet that she can adequately assess risks and that labor and delivery will proceed without complications. They will likely win that bet. Going to Wendover with those odds would make you rich, but every now and then you would lose a little. Lose the home delivery bet, and you lose everything.

      To quote a bumper sticker on the wall of the late Dr. August (Larry) Jung’s office, HOME DELIVERIES ARE FOR PIZZAS.

      • Lisa from NY
        October 3, 2013 at 6:09 am #

        “I hope never to see another sick, brain damaged or dead baby from a home delivery gone wrong.”

        I read this before I went to sleep. Big mistake.

  10. Lisa from NY
    October 2, 2013 at 5:30 pm #

    Please rephrase the petition next time to say “Please help publicize the great success rates of midwives so more insurances will cover their services”

  11. October 2, 2013 at 4:50 pm #

    The thing about birth and risk associated with birth – is you often do not know your risk status prospectively. Even the most fit, most healthy woman can transition from “low risk” to “high risk” while in labour and rather quickly – and a lot of current practices are the equivalent of burying your head in the sand in that regard.
    It’s like saying those who avoid car crashes with drunk drivers are more likely to make it home alive – or seatbelts are only needed if you are in a car crash – you only know you’ve avoided the crash once you are safely home. Yet, I don’t see any widespread campaigns against the unneccessary use of seatbelts…

    • The Bofa on the Sofa
      October 2, 2013 at 9:03 pm #

      Risk only refers to the prospective question of how likely you are to experience something. And the probability question is about groups, not about individuals. This retrospective assessment you are talking about is not risk, it is outcomes. Risk refers to the probability of experiencing that outcome.

      Talking about it retrospectively is worthless.

      Low-risk and high-risk are terms with real meanings.

      • October 3, 2013 at 11:56 am #

        Bofa – you are right. Sometimes the coffee just doesn’t hit until its too late. My point being that it seems as though many of the studies assign risk retrospectively – after they know the outcome…

  12. Elisabeth Fiona
    October 2, 2013 at 2:45 pm #

    Are there any American studies showing the death rate at homebirths attended by CNMs?

    • The Bofa on the Sofa
      October 2, 2013 at 2:57 pm #

      Probably not possible. Not enough CNMs are doing HBs to make a meaningful dataset. There are exceptions, of course, but for the most part, CNMs know better.

      • Mishimoo
        October 2, 2013 at 7:10 pm #

        As my wonderfully sarcastic CNM said: “Nothing ever goes wrong at homebirths because everyone is so peaceful, right?” *derisive snort*

      • MaineJen
        October 3, 2013 at 1:44 pm #

        I wish…I know a CNM who had her baby at home…with a CPM in attendance. Yikes. I have no explanation.

  13. Mel
    October 2, 2013 at 2:19 pm #

    Obviously, there is no difference in the outcome between planned homebirths and hospital births. Some babies are just meant to die.
    – MANA’s real motto

  14. Elle
    October 2, 2013 at 1:40 pm #

    Thanks for summing this up so well. There is so much information about studies, numbers, data, etc. that it’s easy to forget where I can find a quick breakdown of where things stand – I’ll keep this post around as a reference!

  15. GuestB
    October 2, 2013 at 1:34 pm #

    Wendy Gordon CPM (and placenta encapsulation specialist!)
    Makes me laugh every time.

    • araikwao
      October 2, 2013 at 5:54 pm #

      Because you wouldn’t want an amateur encapsulating your placenta, now, would you? (but apparently it’s ok to have one deliver your baby)

  16. auntbea
    October 2, 2013 at 12:52 pm #

    Grunebaum show that homebirths are significantly more likely to be older than 35, to go seriously post-dates, and to be macrosomic. For some unknown reason, they don’t run the multivariate regression to control for that. Certainly, it’s part of the problem that midwives are allowing these high risk patients to go forward with homebirth, but what are the comparisons when we limit to women under 35, less than 42 weeks, and less than 4000g?

    I can’t do it myself because the CDC is shut down.

    • The Bofa on the Sofa
      October 2, 2013 at 1:13 pm #

      I don’t think you can dismiss that part of the problem so easily. If it is true that “low risk pregnancies” are just as safe at home, but midwives are doing non-low-risk pregnancies, then that is a huge problem.

      Fixable, yes, but still a big problem.

      • Amazed
        October 2, 2013 at 1:17 pm #

        I’ll say it again: they can’t have it both ways. They either cannot screen women out properly and are therefore incompetent, or they fail at attending low-risk women properly and are therefore incompetent, We cannot use proper comparisons when they don’t use proper measures to exclude improper patients,

        They can’t have it both ways.

        • EmbraceYourInnerCrone
          October 2, 2013 at 4:17 pm #

          Would proper risk out criteria include risking out of home birth all first time mothers? And if so, how many CPM’s actual do that?

          • Amazed
            October 2, 2013 at 7:27 pm #

            They’ll probably use the Birthplace stidy to convince first time mothers that homebirth was as safe or safer. The part of the Birthplace study they like, of course. Just like some mothers here were convinced by the conventient part of Johnson and Daviss study being paraded in front of them.

      • auntbea
        October 2, 2013 at 1:21 pm #

        I’m not dismissing it. I just want to know the independent effect of actually being at home versus simply being in a higher risk category. If midwives are as incompetent as we have been claiming, we should see a negative effect even in comparable populations. The two populations shown above are not comparable on three major risk factors.

        To put it another way, the chart above shows that MDs have higher death rates than CNMs. We know that this doesn’t mean that doctors are less competent than CNM’s, just that they are taking on higher risk patients. The provider effect and the risk profile of the patients are different things.

        • theadequatemother
          October 2, 2013 at 2:15 pm #

          I think there is more value in determining the risk elevation for homebirth as it is practiced. Sure you could control for this that and the other in a study of CPM managed homebirth but what is that really going to tell you of importance? What is the death rate and comparative risk given how they actually practice? In my mind that’s the important question. You can leave it to the big studies in the uk Netherlands and Australia that compare like populations at home and hospital to see the effect of home… And as Amy points out even with actual strict risk out criteria and trained providers death at home is more common.

          I did not think, as an aside that either the BC or ON study was large enough to look at perinatal mortality…am I missing a cdn study of note?

          • auntbea
            October 2, 2013 at 2:31 pm #

            It would tell me the independent impact of place of birth. I find that interesting. More importantly, it would prevent people from saying, well HB is only dangerous if you go post-dates, have a big baby, etc.

          • attitude devant
            October 2, 2013 at 3:24 pm #

            auntbea, look at Dr. Amy’s November 25, 2011 piece on the Birthplace Study. I think you’ll find that answers your questions.

          • auntbea
            October 2, 2013 at 3:32 pm #

            Except that the independent effect of an American CPM should be higher, since they are less well trained.

          • attitude devant
            October 2, 2013 at 3:33 pm #


          • theadequatemother
            October 2, 2013 at 3:41 pm #

            Okay but unless you are going to let CPMs have hosp priv how are you going to get out that independent effect of home birth with a CPM? Otherwise the risk is polluted by different provider type. The risk of homebirth is well delineated by the birthplace study and the Netherlands study where midwives at home were compared to midwives at hospital.

          • auntbea
            October 2, 2013 at 4:47 pm #

            One category: Low-risk (on observables) with CPM at home. Second category: similarly low-risk (on observables) with a doctor in hospital. In the US.

            I am confused why people are arguing with me. I am just interested to see the numbers because I am…just interested. It seems relevant. I’m not trying to challenge the finding that homebirth is dangerous, because, duh.

          • fiftyfifty1
            October 2, 2013 at 11:40 pm #

            So is your question how much of the CPMs’ bad numbers can be attributed to the following issues?:
            1. Not having enough training (e.g. doesn’t know how to fix shoulder dystocia, hasn’t practiced enough neonatal CPR, lacks knowledge about gestational diabetes)
            2. Having a High Risk population.
            3. Not having access to certain tools that can be found only in hospitals (e.g. antibiotics, induction meds, blood transfusions, continuous monitors, ORs, ultrasounds)
            These are interesting and complicated questions. Especially because #1 can bleed over into #2. You gave the examples of advanced maternal age, macrosomia and postdates. Maternal age is not modifiable, but macrosomia is partially preventable and going past 42 weeks is 100% preventable (if you have the training and tools)
            I think the best substitute comparison group for CPMs’ low risk patients would be CNM low risk hospital births. But what would you consider the correct comparison group for their high risk patients? Should we compare homebirth breech outcomes to hospital vaginal breech outcomes or to hospital breech C-section outcomes?
            Or is your real question “How bad would it be if CPMs would restrict themselves to only low risk births?”. To that I say “who cares!” because they have made it clear they will refuse all attempts to restrict their scope of practice.

          • auntbea
            October 3, 2013 at 9:02 am #

            I actually think #1 and #3 are largely inseperable, because if you in situation #3, in the US, you are very likely assisted by someone with insufficient training, because most CNM’s and all (?) MD’s work in a hospital setting.

            But here is the setting. Let’s say there are two mothers, both planning homebirths, one of whom is more realistic than the other. They are both 37, have hit 42 weeks and have babies measuring large. One of them realizes the increased risk and goes to the hospital, one decides to stay home. Both of them have their babies within the next 24 hours. Is the second one at greater risk of losing her baby? I have no doubt the answer is yes, but I would like to see the numbers, because I think in numbers.

            With sufficiently detailed data, we would be able to match on multiple measures of risk, and get the impact at both high AND low risk of CPM/home vs. MD/hospital. That would make a nice little table.

          • fiftyfifty1
            October 3, 2013 at 10:40 am #

            So basically you are interested in only deaths due to problems during labor and delivery? This was something addressed in the Oregon study when Judith Rooks CNM commented on the large number of intrapartum deaths in the homebirth group and reminded everyone that intrapartum deaths are vanishingly rare in hospitals.
            But the risk of going past due is not mainly intrapartum death (at least in a fully-monitored setting), it is PRE-labor IUFD (intra-uterine fetal demise).
            To me, your example of the two 37 year old moms is asking the question: “How much of the risk of prenatal mismanagement can be removed if a mom transfers care on the last day of her pregnancy?” The answer is that if this mom transfers to the hospital before labor begin, she has a basically 100% chance of coming home with a living baby. But we are assuming she hasn’t had an IUFD already, and that’s not a safe bet. It’s also not a safe bet that her midwife has noticed that baby is big.
            I know you would like to have all these variables separated and laid out on a grid. But they are not independent variables at all. Doctors work hard to PREVENT situations where they would be faced with the risky task of delivering a post-dates, macrosomic, advanced maternal age nullip.

          • fiftyfifty1
            October 3, 2013 at 10:43 am #

            ” The answer is that if this mom transfers to the hospital before labor begin, she has a basically 100% chance of coming home with a living baby.”
            ETA: unless she goes to the hospital and does something like insist on no monitoring and no C-section etc.

          • auntbea
            October 3, 2013 at 10:59 am #

            Don’t judge me and my love of grids.

          • Bombshellrisa
            October 2, 2013 at 5:38 pm #

            CPMs in Washington state either have or are attempting to get a bill passed that would enable CPMs to apply for hospital privileges. They are so completely unaware of how out of their league they are, but it would be hysterically funny to see these “midwives” try and do their particular brand of voodoo in a hospital setting (because you know there is accountability there, along with real professionals who will not put up with their nonsense).

          • Antigonos CNM
            October 3, 2013 at 12:45 am #

            I doubt that, even if it were legally possible, many hospitals would be interested in having CPMs on staff. Their insurance rates would skyrocket.

          • Bombshellrisa
            October 3, 2013 at 1:36 pm #

            They just want admitting privileges and to be able to be the primary caregiver once a patient is transferred. The ones who are behind the bill actually have med mal insurance, but they are still lacking any real skill as medical professionals.

          • Antigonos CNM
            October 3, 2013 at 11:13 pm #

            I think it is just a ploy to gain legitimation: see, I’m on the staff of X Medical Center, so I am doubtless a “professional”.

          • Bombshellrisa
            October 4, 2013 at 2:25 am #


          • amazonmom
            October 3, 2013 at 8:57 am #

            I could see a CPM try and wave off the NICU team and subsequently be eaten for lunch. It would be entertaining.

          • Bombshellrisa
            October 3, 2013 at 1:38 pm #

            I would actually like that. I just wonder what all they think that they can do for a patient by simply transferring to the hospital. If they still don’t want to use pitocin or talk the patient out of pain control, then what? Sit in the chair by the bedside and knit?

          • amazonmom
            October 3, 2013 at 7:02 pm #

            Maybe I am wrong but I thought someone became a CPM to avoid the hospital and the medical model of doing things. Why do CPM want hospital privileges? So they can admit their own transfers? Are they suddenly going to behave like traditional medical providers?

          • Bombshellrisa
            October 4, 2013 at 2:27 am #

            I just had this awful thought it was to make sure that they make their extra $1000 fee. The one that they usually charge to accompany the woman during transfer. They can bill for an “emergency transfer” plus the delivery.

          • NCBer No More
            October 2, 2013 at 2:59 pm #

            It’s important to know the risk of homebirth as it’s actually practiced AND to know the risks of independent factors. Then CPMs can tackle those weaknesses one-by-one, knowing which are most deadly to babies. That is, if they have any interest in facing facts to improve the care they provide.

          • Happy Sheep
            October 2, 2013 at 5:01 pm #

            They don’t. They will not be tackling any issues. If we control for the higher risk clients they take on, hopefully their death rate goes down with such controls, but HBer will then use it to say “look its not as bad as you thought!”
            Wendy Gordon acknowledged a 2-3 times higher risk with HB and basically said that it wasn’t all that bad, since the actual rates were so small.

        • Antigonos CNM
          October 3, 2013 at 12:43 am #

          This is an excellent point. The home births I attended were all within a very strict set of parameters — and not just for the pregnant woman but for her home and certain social conditions as well because the governing body for midwifery in the UK has stringent regulations. In the US today, just about “anything goes”. That’s why the MANA stats are so important. Of their 27,000 births it ought to be possible to determine how many were to women who, prior to the onset of labor at any case, were truly “low risk”.

  17. The Bofa on the Sofa
    October 2, 2013 at 12:20 pm #

    time and time again in the most rigorous studies on homebirth safety, is that for women with healthy low-risk pregnancies, there is no increased risk of death

    This is a curious comment. Even if it is true, then it begs the question, if there is no increased risk of death for women with healthy, low-risk pregnancies, why are midwives having such awful death rates?

    Apparently they are doing a terrible job being able to identify healthy, low-risk pregnancies. How is that any consolation? “Homebirth is safe if you are healthy and low-risk. Of course, midwives can’t tell the difference between low-risk and not-low-risk, but hey, if you are one of the low risk ones, then it will come out ok.”

    And that is the conclusion ASSUMING WHAT SHE SAYS IS TRUE!

    You can talk about all the studies you want, but the outcomes are what matter. And in the end, babies are dying with midwives at scarily high rates. That’s a problem.

    • Burgundy
      October 2, 2013 at 12:50 pm #

      Of course all home birth are low-risk, it is just variation of norm. Therefore, high-risk pregnancies are just lies and scar tactics from the evil OBs. (I am so going to hell)…..

      • Lisa from NY
        October 2, 2013 at 1:24 pm #

        I like the Freudian slip, “SCAR tactics”

        ( C is for … )

    • rh1985
      October 2, 2013 at 4:11 pm #

      Not to mention all the pregnancies that had zero risk factors that anyone could have found prior to labor starting, yet something goes horibly wrong during birth.

    • Happy Sheep
      October 2, 2013 at 4:55 pm #

      They don’t find what they’re not looking for. If you’re not testing for GD, GBS or blood pressure, you can pretend none of your clients ever have these issues because of your special diet or supplement or whatever, or because those things aren’t real anyway. Then they handwave away any complications as not meant to live, or mom must have done something wrong.
      Breech and twins are variations of normal, HBAC has no extra risk, therefore pretty much everyone is low risk. Until they’re not.

  18. Karen in SC
    October 2, 2013 at 11:42 am #

    Great summary! What would make it even better is to append the original sources that you reference.

    Unfortunately that is the modus operandi of NCBers. What Dr. Amy says can’t be true since she doesn’t have any sources – she must have just made it all up!

    (Cuz that’s what they do with “bibliography salad.”)

    • Lisa from NY
      October 2, 2013 at 12:45 pm #

      Dr. Amy is known as “he-who-must-not-be-named” in the NCB world, because hard evidence is a dirty word.

      Hearsay evidence is much prettier.

      The NCB community would prefer to emphasize pretty things like “think positive” and ” a midwife will hold your hand”

      • Petanque
        October 2, 2013 at 7:26 pm #

        Yes those pretty things are much more comfortable for ladies, especially pregnant ones. Our minds just don’t deal very well with nasty science-type facts!

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