I’ve written a great deal about midwives’ reflexive demonization of C-sections, but even I didn’t think they’d stoop to this.
Ginger Breedlove, CNM, former President of the American College of Nurse Midwives, and current Senior Vice President of Clinical Operations at Baby+Company, a birth center consortium, posted this tweet on Feb. 9.
We lost a highly admired Certified Nurse-Midwife to complications post c-section last night, never able to meet her first child. Explain how we are losing SO MANY WOMEN post C-Section in the 21st CENTURY! In 1978 when I worked L/D 9.6/100,000. Today 26.4!
Based on her tweet you might think that her midwifery colleague died as a direct result of an unnecessary C-section. But that’s not what happened.
[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]What could midwifery care have done to save the life of the midwife who recently died? Not a damn thing.[/pullquote]
According to a fundraising page set up by midwives who chose to help, not exploit the tragedy:
On February 9, 2018, a month before her due date, W. developed abdominal pain while working in the clinic. She was sent to the hospital for evaluation. Labs were normal, but the NST was ominous. She was rushed for cesarean section. The baby boy did well and was admitted to the NICU for observation … W. was awake in recovery room, and saw pictures of her baby boy. However, she unexpectedly suffered a sudden cardiac arrest in the recovery room and was unable to be revived. It is suspected she suffered from an amniotic fluid embolism.
From the description, it sounds as though W. may have suffered a concealed abruption, which seriously compromised her baby. If it were an abruption it could have killed her son and potentially killed her. This was a necessary — indeed a lifesaving — Cesarean.
Breedlove wants to know why we are losing “SO MANY WOMEN” post C-section in the 21st CENTURY.”
Curiously, Breedlove has already publicly acknowledged the reasons:
I believe the most profound reason – and the least talked about – is institutional racism and inequities in health care for marginalized populations, specifically African Americans. Most African Americans live down south, and that’s where the majority of maternal deaths are located. Access to care is limited. Government funding for agencies and facilities providing services to rural or uninsured populations has been on the decline for quite some time.
Other issues include increases in obesity, pre-existing hypertension, women who have chronic stress, and other variables that influence a woman’s health prior to and during pregnancy…
Notice that the C-section rate is NOT one of the reasons for the increased maternal mortality rate, no matter how much midwives try to imply that it is.
Breedlove deliberately left out the most important reason for maternal (and perinatal) mortality: physiological childbirth is inherently dangerous.
What about amniotic fluid embolism as a cause of death?
As the chart indicates, it is relatively unusual.
How about the overall trend for US maternal mortality?
As this graph from a recent Mother Jones article about maternal mortality demonstrates, it is indeed rising and that is a bad thing.
But how does it compare to the overall trend of maternal mortality in the past century?
See the tiny “x” to the right of the graph. That’s how today’s maternal mortality rate would appear if added to this graph. That puts it in perspective.
Breedlove, of course, seems to think that midwifery care is the answer to everything.
The next day, in response to news of a birth center opening in the UK, she tweeted this:
… @CallTheMidwife1 @BBC We need more Midwifery integration in US hospitals and all settings with seamless team based care to improve outcomes and #growmidwives @ACNMmidwives @neel_shah Why am I in ED right now with 11 week postpartum Mom and she has been dismissed for concerns expressed now for weeks?
How has midwifery care impacted the maternal death rate? As we can see from the Mother Jones graph, it hasn’t impacted it at all.
For most of human existence midwives were the exclusive providers of childbirth care and both maternal and perinatal death rates were astronomical. In the past 100 years midwives haven’t discovered anything or invented anything that served to decrease the mortality rate. The truth, a truth that midwives are loath to acknowledge even to themselves, is that physiological birth kills women and the interventions of modern obstetrics — especially C-sections — save tens of thousands of maternal lives in the US each year.
What could midwifery care have done to save the life of the midwife who recently died? Not a damn thing.
She was probably receiving midwifery care when she developed a serious complication that threatened her baby’s (and her) life. Her midwives handed her off to obstetricians because there wasn’t anything they could do about what was happening. How ugly then to blame obstetricians for being unable to do what midwives could never do, save her life.
Almost as ugly as exploiting her death to demonize C-sections.
Cause of death:
Autopsy determined cause of death was a dissecting aortic aneurysm
Wow!
What exactly caused that? Pushing? High BP?
I don’t know what caused it. It is a rare complication that can occur during healthy pregnancies. I’m sure this family is grieving in impossible ways right now. But it looks less & less likely that her death was caused by the cesarean surgery.
Whoa! But she never pushed, right? I wonder if the AA was what caused the abdominal pain that initially brought her in. In short, the delivery, by any mode, may have had nothing to do with her death.
Ginger Breedlove is the reason I canceled my membership in ACNM. There was a sizeable exodus of other CNMs from ACNM when she was president.
Is “Breedlove” her real name?
Honestly, ‘Ginger Breedlove’ sounds like the name of a Bond Girl.
“I must be dreaming…”
Are we sure it’s not the latest incarnation of Gina “The Feminist Breeder”?
Why were people upset?
I did not care for her pandering to CPMs.
I thought it incredibly reckless and dangerous that she was championing midwives with an inferior credential and a proven track record of causing harm.
I am not speaking for all or even many who left, but this was a point of discussion on some of the ACNM message boards. The CNMs who were commenting felt that she was pushing MANA’s agenda rather than staying with the evidence that showed that much of what CPMs and other lay midwives do is dangerous. The general idea seemed to be that if all the midwives followed MANA’s lead we could be a larger force in setting policy. However, many of the CNMs felt that lay midwives and CPMs were undereducated and that they should be meeting ACNM/ICM standards rather than CNMs dropping their standards to be more agreeable to lay midwives. Others suggested that if we all left ACNM there would be no voice of reason arguing for higher education levels and evidence based standards.
Is there any chance you’re misinterpreting what she’s saying, and that what she really means is that COMPLICATION rates from c-sections are too high, not that c-section rates are too high? And her point about being in the ED with a post-partum patient who isn’t being listened to echoes everything else we’ve discussed here over the past few months about the crappy state of maternal care. Because I can’t fathom that she would try to claim that a c-section for abruption was inappropriate. Her idea that midwifery care would improve maternal outcomes is not THAT crazy if it was part of an overall approach to train teams. For example, the safety protocols being developed in California must depend on the entire medical staff working together, not just doctors.
It’s part of the problem w/the internet, too, perhaps. Tweets are limited by number of characters. Unfortunately, even if she means what you said, most “interested” people will just read the Tweet and go “All the NOES!!!!! c-sections are the devil” Yadda yadda.
She had plenty of room to use the appropriate words, and all the knowledge and training to know what those words were. She chose the words, she chose what to prefer and what to minimise or leave out.
I couldn’t speculate on her motives, but it’s hard to imagine she didn’t mean to convey the message she did.
That’s how I read it too: That today’s post C section care is inadequate and worse than previously.
Given that today women are routinely kicked out of hospital 3 days after a C/S with only paracetamol for pain relief, and left to do the newborn care by themselves in hospital already, whereas it used to be a 10 day stay with nursery for the baby when I was born, I can’t disagree with that.
That’s how I read it too: That today’s post C section care is inadequate and worse than previously.
That isn’t what she said, but even if it is what she meant, what is that assertion based on? Nothing, as far as I can tell. Just saying care is worse now than it used to be doesn’t mean that’s actually true.
And frankly there is almost nothing that post-c-section or post-vaginal birth care can do about an amniotic fluid embolism. It happens so suddenly, and there’s no treatment for it, and there is to my knowledge nothing that has been shown to help prevent it. If you’re so fortunate as to survive it, awesome, but if not, it is not the fault of the doctors.
In this specific instance, I agree that the complications were not something anyone could do a lot about.
But my original point is that the comparison of the rate of fatal post-C-section complications in ’78 and today is not about C/S as such being bad, but about how it’s done.
It’s pretty obvious that this increase – if the numbers are even correct – is at least in part due to changes in the typical mum’s pre-existing medical condition, but the part where post-C/S care is being reduced to minimum certainly isn’t helping either.
You’d have to control for the increase in risky pregnancies – people are getting pregnant at later ages, with riskier medical conditions, and with a higher rate of multiples than in 1978.
Why are you talking about “this increase”? What increase? Breedlove is wrong:
– She talks about post-C-section deaths, but the figures she cites are for all maternal mortality, not maternal mortality for c-section deliveries only. So “this increase” in post-c-section deaths apparently doesn’t exist–in any case she’s provided zero evidence for it.
– She includes a link, which is to a 1980 medical journal article that she apparently didn’t read, because she thinks it supports her statement that the maternal mortality rate in 1978 was only 9.6/100k. But read the article (bit.ly/2nZkOcO). IT SAYS that that figure is artificially low due to reporting errors!
Then the article corrects for those errors and concludes the true rate is 12.1/100k. I’ve got $50 that says a major reason for any increase between then and now is because the way we define “maternal mortality” is different now than it was 40 years ago.
Oh, those are the all-birth numbers, not CS? I know how those changes came about, but it’s good to read it again. But of course that’s completely different to CS specific data and says nothing about CS care quality.
Thanks for doing the research where GB had those stats and exposing this fib! You are absolutely right.
I hope that poor woman’s family have given Breedlove their consent to have their personal grief used to further her own agenda. I don’t have much experience with amniotic fluid embolism, but my understanding is that it is rare, unpredictable, difficult to diagnose and has a very high mortality rate. What a vicious and unprofessional thing to do to use this to push her own agenda.
Ugh, I know. She may have covered her butt just well enough, only giving a profession and date of death. There would be more room for trouble if she had also stated age, or alma mater, or place of employment.
Profession, date of death, cause of death (cardiac arrest triggered by AFE), sex of the child, and the fact that this happened a month before the child was due.
I don’t think she’s covered her ass at all. That is way too much information. Frankly profession, date of death and the fact the death occurred right after childbirth is all that the woman’s relatives and friends would need to know who she’s talking about.
It would be tedious but not difficult to look for an obituary of a mother with an infant child. Then sort through the rest of the data to find the closest match.
It was actually the friends who made up the fundraising page that wrote the sex of the child, specific cause of death, and that it was one month early; but between the friends *plus* Breedlove, the butt covering was bad. That’s just the issue, though. You think you are covering yourself as some random sad “post-er;” but once the GoFundMe kicks in, privacy is over.
There is no privacy on the Internet. The instant you put something up there, there it will stay.
There was a previous discussion on another article about CNMs. This is a perfect example of how they are most definitely part of the problem, not just CPMs.
I’m still years away from being ready to have kids (and I’m American). Will OBs still even be around by the time I’m ready or will it all just be relegated to “you don’t really need medical care” by then?? Very scared.
I had a wonderful CNM with both pregnancies. Any time there was even a question that I needed more help, she would consult the OBGYN in the next office. We live in a rural area and there’s, like, 15000 women to one OB. I, of course, wanted to visit the MD, but they save them for the serious cases. My point: CNMs are not all terrifying. I wish we had more MDs though…bet CNMs like Breedlove don’t realize they are a second choice for which women are settling.
It’ll probably be like the Scandinavian countries, where the high-risk women have doctors (and better outcomes) and the low-risk women suffer with midwives (and have worse outcomes). In that case, it might make sense to make yourself technically high-risk, perhaps by gaining enough weight pre-pregnancy to be one lb. into high-risk.
Ooh I guess I’ll be super old by the time I’m having kids! That might do it! Though the other edge of that sword is that having a high-risk pregnancy will make me uninsurable for the rest of my life, most likely. Go USA!
Age is a pre-existing condition…
So – does Ginger explain how Non-Interventionist Midwifery would have let this unfortunate woman survive her embolism?
Childbirth isn’t just a marathon, it’s a marathon through a minefield. Poor woman and her family.
I expect that drivel from a CPM; but nasty and twisty of a CNM to do that.