Whose fault is it that homebirth is not safe?

who is to blame question

Imagine if smokers blamed cancer and emphysema deaths on pulmonologists. If only those lung doctors would invent a safer tobacco cigarette many fewer people would die of lung cancer, right?

Imagine if vaccine rejectionists blamed the pertussis deaths in children who are unvaccinated on pediatricians who won’t treat unvaccinated patients. If only the parents could have taken their coughing, vomiting, whooping baby to the local pediatrician instead of the hospital ER, the chances of the baby surviving might have been increased, right?

Imagine if the survivors of people who shun conventional cancer treatments claimed that oncologists were responsible for the deaths of those who chose alternative treatments. After all, if oncologists had created chemotherapy that was gentler, the person who refused chemotherapy might have accepted it, right?

We recoil from those claims for very good reasons:

Pulmonologists have no responsibility for improving the safety of cigarettes. The people who bear the ultimate responsibility for tobacco caused lung cancer are the people who choose to smoke.

It’s not the job of pediatricians to improve the safety of vaccine refusal. The people who bear the ultimate responsibility for a vaccine preventable death are those who refused vaccines.

It is not the job of oncologists to make chemotherapy as pleasant as alternative “treatments” (although they are indeed trying to do so). The people who bear ultimate responsibility for dying a chemotherapy preventable death are the people who refuse chemotherapy.

Now tell me: whose fault is it that homebirth is not safe?

Yesterday I wrote about Elizabeth Heineman, currently publicizing a book long apologia on her son’s death at homebirth. Where does Heineman place the blame? On everyone but herself. Indeed, in an especially creative attempt to avoid responsibility for choosing homebirth, Heineman actually blames “politics.”

I believe that after decades of successful practice and no bad outcomes, Deirdre made the wrong judgment call in not referring me to a doctor once I was a week postdate. I believe that judgment call resulted in Thor’s death.

I believe the likelihood of her making the wrong judgment call was heightened by the fact that she felt under siege. I believe the warfare between the medical profession and out-of-hospital midwives made her reluctant to refer a low-risk pregnancy with no sign of trouble to a doctor …

It’s those obstetricians! They are responsible for her baby Thor’s death because they refuse to collaborate with homebirth midwives.

No, they’re not responsible for Thor’s death any more than pulmonologists are responsible for tobacco related deaths, or pediatricians are responsible for vaccine-preventable deaths or oncologists are responsible for the deaths of those who refuse chemotherapy. They are not responsible because they offer a safer alternative to the unsafe choices that people make. They are under no moral obligation to mitigate the danger of unsafer choices, beyond counseling against them.

Homebirth is the same. If you choose homebirth and your baby dies as a result, you bear responsibility.

You are not the only one who bears responsibility; there is an entire industry of natural childbirth and homebirth “professionals” feeding you lies about homebirth safety and they should be held accountable, too. But there is not a homebirth advocate alive who does not recognize that her choice is a rejection of conventional medical advice and a transgressive choice. Indeed many homebirth mothers choose homebirth precisely BECAUSE it is a rejection of conventional medical advice and a transgressive choice.

To the extent that homebirth midwives attempt to obtain informed consent, they almost always declare that in the event of disaster, they are not responsible. The consent forms often require the mothers to specifically accept responsibility for any bad outcomes. And indeed, when the inevitable tragedies occur, they turn in anger toward homebirth loss mothers who dare to expect accountability of homebirth midwives. The was NEVER part of the plan. The mother always knew that she was rejecting conventional medical advice and she is supposed to shoulder the responsibility for that decision, not those selfless “birth workers” who were merely giving her what she asked for.

When it comes to responsibility, homebirth is a game of musical chairs. There are lots of people and chairs at the beginning of the game: the midwife, the doula, the cranio-sacral therapist, all the providers of homebirth services start out with chairs. The minute a woman starts labor at home, the homebirth midwives and mothers pull out all the chairs, but one, the obstetrician’s chair. You remember the obstetrician. He or she is the one the mother ignored as not evidenced based, profit hungry, and driven to perform unnecessary C-sections just to get to his golf game. THAT obstetrician, the one the mother didn’t trust, it the ONE person she expects will save her baby and her if anything goes wrong.

The ultimate problem, though, is that American homebirth is not and can never be as safe as hospital birth. It is simply impossible because it is the hospital and the expert personnel and safety equipment that makes hospital birth safe. When you reject the safest choice, doctors are not ethically obligated to make your preferred unsafe choice safer.

When a person dies of a tobacco related illness, he or she is ultimately responsible, not the doctors who didn’t make cigarettes safer.

When a baby dies of a vaccine preventable illness after a parent rejects vaccines, the parent is responsible, not the pediatrician who advised against it and refused to care for the child thereafter.

When a person dies of cancer after refusing cancer treatment, he or she is responsible, not the oncologist who advised against it and refused to administer the alternative “treatment.”

And when a baby dies at homebirth, the mother is responsible, not the obstetrician who advised against it and refused to collaborate with a midwife he did not trust.

Homebirth mothers are very happy to claim credit when they dodge a bullet by refusing conventional care. If they are willing to claim credit, they are responsible when things go wrong. Homebirth is INHERENTLY unsafe and American homebirth will NEVER be as safe as hospital birth. Obstetricians are not responsible for making unsafe choices safer. Mothers are responsible for making unsafe choices.

Heineman’s midwife deliberately chose to ignore standard obstetrical practice, not because she didn’t know any better, but because she thought she could get away with it. After all, she had gotten away with it in the past.

Politics did not kill baby Thor. His mother’s decision led to his death. Had she chosen to accept conventional obstetrical care, Thor would almost certainly be alive to day. Heineman bears the ultimate responsibility, and her efforts to avoid that responsibility, while understandable, are shameful nonetheless.