Here’s the link for the full size printable version. Feel free to distribute it to friends and legislators.
https://dl.dropbox.com/u/27713670/Real%20midwives%20and%20homebirth%20midwives.jpg
Addendum: The original version had a typo (of course!) so I have replaced it with a corrected version.
Logic has never been the strong point of homebirth advocacy. That’s not surprising, since the central premise, that giving birth at home attended by a pretend “midwife” is as safe as giving birth in the hospital, defies both common sense and basic fact. Therefore, I’m used to goofy, illogical excuses from homebirth advocates confronted with appalling death rates.
Apparently desperate times call for desperate measures, however. Homebirth midwifery is entering a period of desperate times because homebirth midwives can no longer hide their hideous death rates. States are starting to collect the statistics on planned homebirth attended by licensed midwives and the results are nothing short of appalling. In Colorado, licensed homebirth midwives have a perinatal death rate more than double that of all hospital birth in the state (including premature babies). Most recently, the Oregon homebirth death rates have come to light. Planned homebirth with a licensed homebirth midwife in Oregon has a death rate 9X higher than term births in the hospital.
I brought up this point in a the comment section of the latest post by homebirth advocate Jennifer Margulis. The post is entitled When Obstetricians Hate Homebirth Midwives, Birth Becomes Less Safe For Everyone and it is the usual amalgam of mistruths, half truths and outright lies favored by all homebirth advocates. The fundamental problem with the post is that is has the cause and effect relationship entirely backward; obstetricians hate homebirth midwives (to the extent that they think of these fringe “providers” at all) because they are incompetent clowns who have horrifically high death rates.
The post itself is the worst kind of “journalism,” with its unsourced claims (“The government official (who spoke to me off the record)”), ignorance of childbirth (“Doctors in America are trained to believe that birth, even low-risk birth, is dangerous.” A glance at homebirth death rates confirms that even low risk birth IS dangerous), and outright lies (“Most American obstetricians have never even seen an unmedicated childbirth when they finish their residencies;”).
When I challenged Margulis to defend that lie, she could not. Then I moved on to the heart of the issue:
I’d also like to know why Ms. Margulis fails to acknowledge the hideous death rates at planned homebirth with licensed homebirth midwives in Colorado (4x term hospital birth) and Oregon (8x higher). No less an authority than Judith Rooks CNM MPH publicly testified that Oregon homebirth midwives are not safe providers.
And Margulis responded with the stupidest excuse for homebirth deaths I have ever heard:
Amy, Oregon has some of the safest best homebirth stats in the country IF YOU DON’T COUNT PORTLAND…
Duh. Homebirth is apparently very safe if you just remove the dead babies from your calculations. And what reason does Margulis provide for removing Portland from the calculations? None, of course. She hoping that homebirth advocates are stupid enough to be persuaded by that inane excuse, or, worse still, perhaps she actually believes that it is a valid excuse.
My response:
You’re joking, right? That has to be one of the most inane excuses I have ever heard. Of course Portland has most of the deaths; it has most of the homebirths. You can’t exclude it no matter how much you’d like to pretend that you can…
Homebirth midwives are not professionals. What kind of professionals, when confronted with an appalling death rate at their own hands, try to hide it and make absolutely no effort to improve their education and training? Homebirth midwives are lay birth junkies who lack the education and training of ALL other midwives in the first world. Their hideous deaths rates are evidence of their gross incompetence. Why are you defending them?
Margulis reponds with a nonsensical non-sequitur:
Good question. If you ask Marsden Wagner, MD, a perinatologist and perinatal epidemiologist from California and director of Women’s and Children’s Health in the World Health Organization for 15 years, he will tell you: Doctors.
And then goes on to share a McCarthy-esque claim
I have a binder of over 1,000 pages of evidence about the safety of out-of-hospital delivery in Oregon. I suspect you will discount this as evidence.
As if we should accept the blustering of “an award-winning travel, culture, and parenting writer” over the epidemiological analysis of Judith Rooks, CNM MPH.
She insists:
Dr. Melissa Cheyney is a careful and scrupulous researcher. I have a high regard for her work…
Melissa Cheyney has behaved with an appalling lack of ethics, professional or otherwise. She has known for YEARS that homebirth midwives in Oregon and across the US have horrific death rates and she has done everything in her power to hide that information.
Margulis concludes:
Let me try one more time: I would like for everyone who cares about birth in America, as you and I both do, to try to remember that we all want the same thing: the best possible outcome for mom and baby, a safe and happy birth, and a good start in life.
Actually, we don’t want the same things. Homebirth midwives and homebirth advocates couldn’t care less about the best possible outcome for mothers and babies. When babies die they ignore them, try desperately to hide the evidence, and make absolutely no effort to improve their education and training or hold responsible midwives accountable. When it comes to homebirth, midwives profit and babies pay the deadly price.
I am used to stupid excuses from homebirth advocates, but when confronted with the appalling death rate in Oregon, Jennifer Margulis offers the goofiest excuse yet. I had expected something more from Margulis than the intellectual equivalent of covering her eyes, putting her fingers in her ears and pretending that the deaths of these babies don’t count. My mistake.
Addendum: Surprise! Jennifer Margulis forgot to mention that her husband James di Properzio is a lay member of Oregon’s Board of Direct Entry Midwifery. Did she get her 1,000 pages of documents from him? Does this mean that she is publicly challenging the analysis of Judith Rooks, CNM MPH? I wonder what Rooks’ would say about Margulis’ pathetic attempt to excuse the hideous homebirth death rate in Oregon, and the blithe dismissal of Rooks’ conclusions.
One of the primary reasons that women give for deciding to breastfeed is the belief that it promotes mother-infant bonding. Breastfeeding advocates have emphasized this point for years. There’s just one problem. There’s no evidence that breastfeeding promotes bonding; it’s just another cruel deception advanced by those who adore competitive mothering.
In Breastfeeding and Maternal Mental and Physical Health, a chapter in the forthcoming book Women’s Health Psychology, Jennifer Hahn-Holbrook and colleagues supply an exhaustive review of the existing literature.
The authors appear to strongly favor breastfeeding, but even they have to admit:
Conventional wisdom holds that breastfeed- ing helps mothers bond with their babies. In fact, one of the most common reasons given by women for wanting to breastfeed is the opportunity to bond with their children. In the scientific literature as well, breastfeeding is often assumed to aid in maternal–infant attachment, without necessarily giving reference to direct evidence. Given this, it is surprising that only a few studies have actually tested this hypothesis in humans, and even fewer have found significant results. Here, we review the small literature on the impact of breastfeeding on the mother–child bond. Briefly, however, we found no studies with evidence that breastfed infants are more securely attached to their mothers than formula-fed infants.
So if there’s no evidence that breastfeeding promotes bonding, where did the idea come from? It came from the same place as most claims of attachment parenting advocates: they made it up. In the absence of any evidence to support the claim, why has it been promoted so vigorously and so widely? For a very simple reason: it raises the stakes in the ongoing battle of competitive mothering.
Competitive mothering, which reaches its apogee in the philosophy of attachment parenting, is all about investing relatively unimportant infant caring practices with major benefits, both real and fabricated, mostly fabricated. Why? Because parenting is hard, and pretending that there are only a few physical tasks that you must perform makes it much easier to feel good about your parenting. It’s hard to parent a child, involving years of caring, worrying, helping and standing by to pick up children when they fall. Even then, you will not find out how you’ve done for nearly two decades, when the child is finally grown, and you may find that your efforts have not produced the results that you would have desired.
How much easier then to pretend that a few relatively meaningless task of infant caring have outsize significance and can determine which mothers are the best mothers. That’s why many attachment parenting advocates cling desperately to attachment parenting behaviors whether they benefit a particular infant, whether they strain a marriage or whether a child has demonstrated that he or she no longer wants to be treated like an infant.
The bottom line is that there is no evidence that breastfeeding has any impact on maternal-child bonding. Despite the lack of evidence, attachment parenting advocates continue to promote this lie because it serves them well in their primary task: building their own self-esteem. Wait, what? You thought attachment parenting was about babies? Don’t be silly. This was never about babies, only about some mothers and their deep seated need to feel superior to other women.
Let’s make one thing clear: homebirth is an industry.
It’s an industry that involves providers charging large fees for services of dubious worth. If you have any doubt that it is an industry, consider the many groups devoted to lobbying on behalf of homebirth providers and the hundreds of thousands of dollars that are spent on lobbying on a variety of issues that always come back to the same thing: more opportunity for homebirth midwives to make more money.
Homebirth advocacy in the US is chiefly about the opportunities for homebirth midwives to profit. Contrary to the morally grotesque “human rights” argument advanced by homebirth advocates, every women in the US already has the right to have a homebirth and already has the right to be attended by anyone she chooses. Homebirth is completely legal and surrounding yourself with friends or even complete strangers of your choosing is also completely legal. The so called “right” to a homebirth is exclusively about the “right” of a layperson to pretend that she is a midwife, and most important of all, her “right” to charge for her services. In other words, homebirth advocacy is about the “right” of homebirth midwives to profit.
When viewed through the prism of profit, all major homebirth issues come into sharp focus.
The issue of licensing of homebirth midwives, which is currently playing out across the country, is at the heart of the drive to profit. The fundamental goal of the homebirth industry is to obtain access to insurance reimbursements. Insurance companies have deep pockets and access to reimbursement would allow homebirth midwives to collect the outrageous fees they already insist upon and to raise their prices even further.
There’s just a teensy, weensy little problem. Insurance companies will not reimburse providers who are not licensed. Therefore, homebirth midwives are seeking licensure, while desperately trying to avoid the standards and accountability that are always a part of licensing.
Licensing is designed to ensure public safety by standardizing education and training requirements, mandating malpractice insurance, mandating continuing education, and ensuring accountability for those who provide substandard care. That represents a serious problem for homebirth midwives who wish to be able to “practice” without any education and pathetically minimal training. Furthermore, the midwifery leadership has made it very clear that they reject the idea of ANY standards of any kind, and will almost never discipline members of their community regardless of how egregious the malpractice and regardless of how many babies die. And malpractice insurance is out of the question for two reasons; first, it cuts into the profits of homebirth midwives and second, malpractice insurers have standards that homebirth midwives have no intention of meeting.
The drive for profit stands behind homebirth midwives’ opposition any and all regulations of their practice standards and their scope of practice. Practice standards limit the number of laypeople who can pretend to be midwives, and therefore limit who can profit. Restrictions in scope of practice, designed to ensure patient safety, limit the pool of women from whom they can profit. Hence the inane insistence that a variety of high risk conditions (breech, twins, VBAC) are “variations of normal.” Acknowledging the greatly increased risk of these conditions would eliminate the possibility of profiting from them, and therefore is forbidden.
How about women and babies? Do they benefit in any way from homebirth midwifery? The answer is mixed. Women gain nothing directly homebirth midwifery that they didn’t already have. Women have the right to a homebirth regardless of the status of homebirth midwives. Women have the right to be attended by these women regardless of the status of homebirth midwives. What’s at stake is the right of these women to be paid and who will pay them. To the extent that licensing of homebirth midwives could lead to reimbursement, it might allow women to hire homebirth midwives without direct cost to themselves.
Who pays? That’s easy to answer. Women pay and babies pay.
Women pay because they are tricked into accepting substandard care from uneducated laypeople who they erroneously believe have been vetted by the state. They are tricked into paying women who call themselves midwives, but are just lay birth junkies who lack even basic knowledge about childbirth. Women risk complications such as hemorrhage and uterine rupture that threaten their own lives and have led to preventable maternal deaths at homebirth. They pay with months or years of bladder and bowel incontinence from unrecognized and unrepaired perineal tears. Women pay money, pain and suffering to finance the fantasies of a group of laypeople who misrepresent who they are and what they can do, with tragic results.
Of course no one pays as much as the babies. As the statistics from Oregon and elsewhere show, homebirth has a dramatically increased rate of preventable neonatal death. Extrapolating from the Oregon statistics leads to the horrific conclusion that nearly 90% of the babies who die at homebirth would have been saved in a hospital.
Homebirth is an industry. It’s an industry devoted to creating and expanding opportunities for lay birth junkies to profit from their fascination with birth. It is an industry that rejects regulations, standards, and malpractice insurance because all of them cut into the profits of homebirth midwives. And it is an industry built of deceiving women and letting babies come to harm.
The homebirth midwifery credential, the CPM, is a trick and it was designed to be a trick. By putting letters after their names, uneducated birth junkies dramatically increased their ability to fool women about their credentials while simultaneously rejecting the standards and accountability that credentialing implies. That’s why the CPM must be abolished and most surely will be abolished. The only open question is how many babies will die before the profits of these poseurs are eliminated.
Homebirth midwives, doulas and childbirth educators like to refer to themselves as “birth workers.” I find it an apt description that betrays the focus of their work and the massive gulf between them and obstetricians.
Obstetricians are health care providers. Specifically, they provide healthcare for women throughout the reproductive years, including, but not limited to: well woman care, contraception, sexually transmitted disease treatment and prevention, pregnancy care, childbirth care, care for pregnancy and childbirth complications, gyncologic cancer prevention, diagnosis and treatment, and care during menopause.
Most obstetricians, in keeping with the ethics of any profession, provide health care regardless of the beliefs of the patient. Moreover, professional ethics requires providing care in keeping with the patient’s needs and values, and disregards the provider’s values and philosophies.
Homebirth midwives, doulas and childbirth educators are not healthcare providers. They evince little or no interest in the health of mothers or babies. They typically provide no care outside of pregnancy, and very little care within pregnancy. Their purpose is to create a very specific type of birth experience, regardless of whether that experience is compatible with the health and safety of their clients. Their purpose is create a birth experience that the provider will enjoy and that will validate the provider’s needs and preferences.
They are the childbirth equivalent of wedding planners with one very important caveat. They will only plan the wedding of their dreams, not the wedding of your dreams.
If the childbirth experience of your dreams happens to coincide with the childbirth of their dreams, they’ll help you. Otherwise, tough luck; you’re on your own. They enter the relationship with primary purpose of entertaining and validating themselves. They are invariably “birth junkies,” women who enjoy the process of birth, and they are “workers” because they want you to pay them for entertaining them, and validating their personal choices. Indeed, some birth workers are quite candid about their lack of interest in the baby.
“Birth workers” ignore the responsibilities of real professionals. They don’t bother with a real education; self-study and a few seminars all the educational and financial investment they are willing to make in their training. They created credentials for themselves without the input of anyone else. They reject oversight of any kind. They reject regulation. They refuse to carry insurance. In short, they begrudge anything that might interfere with their ability to enjoy themselves and profit from the experience.
To give them their due, however, we should acknowledge that although they are ignorant of childbirth, science and statistics, they are brilliant at public relations. Like tobacco companies, they have managed to convince a segment of the public that paying them for their inferior and deadly products is a matter of “freedom” and “human rights.” And like tobacco companies, they are willing to lie and obfuscate in the effort to keep the profits flowing.
Birth workers are an industry, an industry devoted to their own profit and entertainment. They are not healthcare providers and they are not professionals. If you are worried about the health and safety of your baby and yourself, you would hire a healthcare professional, like an obstetrician or certified nurse midwife (CNM), who has years of specialized education and training, and is governed by state regulation and professional ethics that place your well-being above their profit and their preferences.
If, on the other hand, you care more about your experience than about the health of your baby or yourself, feel free to waste your hard earned money on a “birth worker.” She’ll enjoy the experience and hopefully you and your baby will survive it.
Another homebirth death …
From The Experience Project:
I lost my son … in Feb 2013 at 40 weeks 2 days during delivery, the last pushes killed him official cause was cord prolapse. The hospital staff tried everything possible to revive him for 26 minutes after his birth but he never came back to us. He was 8lb’s 6oz and absolutely perfectly beautiful. I miss him, my arms ache, my heart hurts, my breasts ache every time I am around a baby …
… with all the heartache, bewilderment and questioning that accompanies a homebirth loss:
I have gone through feelings of guilt I should have done something different … I do still blame the midwife as I do feel she was not monitoring him very well at all & was very against me going to the hospital & told my husband that all women say that they wanted to go & to ignore me until I insisted screaming for my husband to call 911 when she finally used the fetal doppler to check his heart rate & he was fading fast…
This was our first baby we had no way of knowing how things were supposed to be we were clueless thinking we were going to have this beautiful romantic home birth & instead we live in a nightmare…
The doctors and nurses struggled to save the baby:
His heart stopped almost as soon as I was transferred from the the stretcher to the hospital stretcher as they were trying to position him for an emergency C-section his heart stopped & the Dr said it was to late for a C-section he was wedged to far down in the birth canal. I pushed with everything I had & finally delivered him within minutes …
But it was too late:
He never took a breath I didn’t understand he was dead I didn’t believe them when they told me he was dead. I remember … thinking his little blue body was perfect & beautiful & thinking of course that is what he looked like. I petted his head as the Dr cut the cord & told him “Hello” then he was whisked away to a warming table set up in the room across from my bed & I watched as they were performing CPR the hospital staff did such a good job that he turned pink but his heart never beat on it’s own & he never took his first breath.
I kept saying they made a mistake as I cuddled his lil body I finally asked the Dr if there was a mistake & was he really dead & he told me with tears in his eyes that yes he was dead.
And the midwife?
She said her name was Sharon Kocher however we found out this was not her “real” name I think her “real” name is Victoria I don’t know her last name… I forgive her but I pray every night that God will block her from practicing again.
A bit of internet research revealed this:
Victoria Kocher helped bring tiny Ethan Criswell into the world in the home of his parents, William and Cheryl Criswell.
Despite Ethan’s diminutive size and physical ailments, Kocher said she saw no reason to call the hospital. “He looked tiny, but what’s my judgment of small?” she said. “He breathed good … I saw no risk.”
Ethan, who authorities said was delivered seven weeks premature, weighed less than 3 pounds and suffered from multiple birth defects, was born March 14. He died seven days later at an area hospital.
Ethan’s parents are charged with involuntary manslaughter. Kocher, who said she served as the family’s labor coach, is charged with child endangerment…
The Criswells, through their lawyer, tell a different story. “She represented herself as a licensed practicing midwife,” said attorney Lynn Johnson, who also accused Kocher of lying about her name. “The Criswells knew her as Sharon, not Victoria.” …
Kocher refused to comment on the allegation she used an alias. According to court documents, she has also used the names Sharon J. Kocher, Vicky J. Newman, Victoria J. King and Victoria J. Smith.
According to another news story:
Victoria Kocher later pleaded guilty to a charge of unauthorized practice of midwifery and was sentenced to five years probation.
The mother who posted her story on The Experience Project is left with empty arms and a broken heart:
I have felt that all this is a nightmare that I will wake up from since that day. I think about him everyday, I grieve everyday, I have returned to life in someways it does get easier to cope but I do not think I will ever stop grieving for him.
The Oregon homebirth midwifery statistics, described by Judith Rooks, CNM MPH as “the most complete, accurate data of any US state on outcomes of births planned to occur in the mother’s home or an out-of-hospital birth center,” show that planned homebirth with a licensed homebirth midwife has a mortality rate 800% higher than hospital birth at term. The Colorado statistics, which the licensed homebirth midwives have been desperately trying to hide, shows that planned homebirth with a licensed midwife has a perinatal mortality rate more than 300% higher than all births, including those that are premature. Six years in a row, the CDC statistics have shown that planned homebirth with a non-nurse midwife has a mortality rate 3-7.7X higher than hospital birth. And that number actually undercounts the carnage because babies who were transferred and died in the hospital aren’t included in the homebirth group.
Why is the death rate so appallingly high?
Because licensed American homebirth midwives have absolutely no idea what they are doing or even what they are talking about.
Consider this flourish of homebirth midwifery stupidity, What Makes Birth “Safe”? by Maryn Leister, CPM. I really appreciate the ironic use of scare quotes indicating that apparently even Maryn knows that homebirth at her hands isn’t actually safe; it’s “safe.” I wish I could reprint it all, because it is difficult to believe that anyone could stuff so much mind blowing nonsense into one blog post, so I strongly encourage everyone to read the entire piece. Unfortunately, I can only offer you excerpts.
Maryn starts with the typical brainlessness that passes as “wisdom” among homebirth advocates. In answer to the question what makes birth “safe,” she declares:
To me, it’s a trick question. Because nothing makes birth safer than it already is. In its truest form, of course. The delicate dance of mom and baby, to complete a sequence that is normal and physiological. It’s already “safe”; at least, as safe as anything else that our bodies are programmed to do. Eating, sleeping, eliminating. We don’t question that these processes are “safe” for the average person. They just are. We don’t ask “what” makes them what they are.
So homebirth in nature, with its inherent neonatal mortality rate of 7% and maternal mortality rate of 1%, is “safe” and it can’t get “safer.” But it is not safe (minus the scare quotes), and it only seems safe because modern American obstetrics lowered the neonatal mortality rate by 90% and the maternal mortality rate by 99%, saving the lives of nearly 200,000 babies and 40,000 women each and every year.
Not only is Maryn’s philosophy idiotic, it is ugly, including a large dollop of social Darwinism:
The problem is the thought that birth NEEDS to be made any safer than it already is. But it’s actually not “safe” that many people are after; it’s birth being infallible.
How is this possible? How can we erase the possibility of death from birth? We cannot. They are two sides of the same coin, but this is an uncomfortable subject and not addressed by those that think other humans or special machines can save every baby and every mama. That is not real, and that is not life, unfortunately. There is an element of risk in everything we do in life; whether it’s crossing the street, or driving our car. Birth is no different.
Some babies die and they’re meant to die. That’s why it’s okay that Maryn and the homebirth midwives who advance this philosophy apparently have no obligation to save them. Saving those babies and mothers would require Maryn and her fellow clowns to actually learn something and they don’t care to be bothered with knowledge. In fact, they don’t care to be bothered with standards at all. It’s not just Maryn and her colleagues who think so; the organization that represents them, the Midwives Alliance of North America has enshrined the “no standards” policy in their statement of values and ethics:
A. We value our right to practice the art of midwifery, an ancient vocation of women.
B. We value multiple routes of midwifery education and the essential importance of apprenticeship training.
C. We value the wisdom of midwifery, an expertise that incorporates theoretical and embodied knowledge, clinical skills, deep listening, intuitive judgment, spiritual awareness and personal experience…
It is hardly a coincidence that MANA gives pride of place to freedom of the midwife, and not safety of the mother and baby. In the entire document, they mention safety only once, only vaguely and only in connection with what homebirth midwives “value,” not in connection with any ethical obligation to patients:
We value the physical, psychosocial and spiritual health, well-being and safety of every mother and baby.
Back to Maryn and her nitwittery:
And as far as the WHO is “safe”; well, I don’t think it’s any of our business to determine this for ANY woman. There is no way to quantify risk …
Well, sure, for those who don’t know basic arithmetic there is no way to quantify risk, but people who can add, subtract, multiply and divide have no trouble doing so. In fact, not only is it the business of every healthcare provider to do so, they are REQUIRED to do, because they are required to obtain informed consent. That means that they are responsible for knowing exactly what the best estimates of risk are for any set of circumstances, and for accurately transmitting that information to women. No one can make an informed decision about homebirth if they don’t have information.
Maryn ends and she began, in a wave of blistering stupidity:
Walking with women is the TRUE job of a midwife. And this walk is done differently from midwife to midwife. Ideally, all midwives would be educated, compassionate, up on current research …
Wrong again, Maryn. It’s not the ideal. It’s REQUIRED.
It’s hardly surprising that babies, too many babies, are dying preventable deaths at the hands of these midwifery clowns. It is time to abolish the CPM credential and require anyone who wishes to call herself a midwife to meet that same educational and training standards (including a 4 year university degree in midwifery and extensive in hospital training) required of midwives in ALL other industrialized countries.
Of course, Maryn and her fellow clowns would no longer be able to call themselves midwives and would no longer be able to make money by offering their services. Don’t worry, though, I have a solution for Maryn and her compatriots. If all it takes to make homebirth safe is to pretend that it’s “safe,” all they need to do to make money is pretend that they are making “money.” That way homebirth midwives can make all the “money” that they want, while well educated, well trained healthcare providers can care for babies and mothers and keep them safe.
The following is a guest post from the doctor who wrote A cardiologist’s experience with a “baby friendly” hospital warning women about the off label use of domperidone (a drug typically used to suppress nausea) to improve milk supply in breastfeeding mothers. This message could save your life:
Domperidone is a non-FDA approved drug which is often touted to breastfeeding mothers as a remedy for low supply. It’s available over the counter in many European countries, and can easily be obtained from internet pharmacies.
As a cardiologist, I’m very concerned about this drug, and the European Drug safety agency agrees. Here’s why:
1. Domperidone prolongs the QT interval. This means that it alters the speed and duration of certain electrical currents in cardiac muscle cells, making them very susceptible to a dangerous arrhythmia called torsades de pointes. If this occurs, the heart stops beating and the patient will die unless she is shocked with a defibrillator within seconds. Survivors often suffer from HIE.
2. QT prolonging drugs are silent killers. The first symptom that anything is amiss is that the patient literally drops dead from a malignant arrhythmia. The only (imperfect) way to screen for it would be to do serial ECG’s before and after starting the drug in a hospital environment with full resuscitation equipment nearby. Obviously this is not going to happen with an off-label drug bought off the internet.
3. When a woman is taking this drug on her own initiative from an internet pharmacy, she probably won’t mention it to her doctor. If she is prescribed another drug with QT prolonging effects on top of the domperidone, eg a quinolone antibiotic for postpartum UTI, or antidepressant for PPD, she is at an extremely high risk for arrhythmias. The list of QT prolonging meds is very long and keeps growing, so ideally a doctor should consult it for every new prescription to a patient taking domperidone.
4. Advising a woman to risk her life with this dangerous drug only to be able to breastfeed, is so fundamentally unethical it makes my blood boil. The only excuse these lactation consultants and midwives have is that they don’t have the knowledge to understand what they are doing. Someone who hasn’t been to medical school really has no business playing with this stuff.
5. If the risk to the mother isn’t enough, there’s a risk to the baby too. Domperidone is transferred in breastmilk (LC’s often deny this!) and infants are exquisitely sensitive to its effect. How many ‘SIDS’ cases out there are in fact sudden cardiac deaths from arrythmias caused by maternal domperidone use?
6. Breastfeeding support organisations bear a shattering responsibility here. Where is the big lettered warning on the La Leche League website? Where is their official position statement forbidding their leaders to endorse this drug? They have blood on their hands.
My bottom line is: it isn’t worth it. If you need domperidone to keep your supply, throw it out and start supplementing. You risk death or permanent disability, not only for yourself but for your baby too. I know firsthand how heartwrenching it is to want to breastfeed your baby, and not be able to. The feelings of guilt, fear and inadequacy combined with postpartum emotional vulnerability are completely overwhelming. It’s enough to make the most levelheaded woman look into these harebrained methods. Please don’t make yourself a victim.
Editor’s note: The recommendation to use domperidone off label to increase breastmilk supply shines a light on the essential hypocrisy of the natural childbirth and homebirth movements. The same people who are shocked about the off label use of Cytotec, and imply that off label means illegal, seem to have no problem with the off label use of domperidone. What’s the difference? Modern obstetrics is “bad” and the off label use Cytotec “proves it.” But breastfeeding is “good” so anything, even the off label use of a drug that might kill the mother, must be “good.”
Years ago, when I was a chief resident, I received a call from the local women’s prison. They wanted to send over an inmate who was 9 months pregnant so she could have an ultrasound. I asked why and was flabbergasted by the reply. The woman had told the prison staff that she believed that she was carrying the child of the devil. Apparently the staff imagined that if I performed an ultrasound I could convince her that the child was not Satan’s baby. It seemed not to have occurred to them that the woman was suffering psychotic delusions and that an ultrasound was not the appropriate treatment for that problem.
I was reminded of that incident when I read about a recent tragedy in New York City.
On Wednesday afternoon, Cynthia Wachenheim did the unthinkable: She strapped her 10-month-old son to her chest and leaped from the eighth floor of her building.
Wachenheim, 44, died. But baby Keston Bacharach survived, his fall cushioned by his mother’s body, with only a few scratches.
New information reveals the motivation — guilt and fear — that led to Wachenheim’s fatal decision to end her own life and try to end her son’s.
According to a law enforcement official who spoke with the New York Times, Wachenheim left a 13-page suicide note explaining the guilt she felt over two previous incidents in which her child had fallen.
Wachenheim wrote of her belief that the “shameful incidents” — one, when Keston had fallen from a play set onto a wooden floor, and another, when he had rolled off a bed — were the fault of a series of seizures and concussions that would cause Keston suffering his whole life.
No, no, no. She was not suffering from guilt and fear. She was almost certainly suffering from postpartum psychosis.
According to the Massachusetts General Hospital Center for Women’s Mental Health:
Postpartum psychosis is the most severe form of postpartum psychiatric illness. It is a rare event that occurs in approximately 1 to 2 per 1000 women after childbirth…
… Women with this disorder exhibit a rapidly shifting depressed or elated mood, disorientation or confusion, and erratic or disorganized behavior. Delusional beliefs are common and often center on the infant. Auditory hallucinations that instruct the mother to harm herself or her infant may also occur. Risk for infanticide, as well as suicide, is significant in this population.
In other words, Cynthia Wachenheim was in the grip of a psychotic delusion that probably arose in connection with the hormonal changes of the postpartum period.
But amazingly, that didn’t stop Elie Mystal at the legal blog Above the Law, from writing this ignorant, unspeakably cruel piece:
I know that society requires and expects me to use restraint or even show sympathy for suicide “victims.” But I just can’t muster the will to conform to social conventions in this case. This woman left behind a 13-page suicide note (of course a lawyer leaves a 13-page suicide note) explaining that she thought her baby had cerebral palsy based on internet research (doctors found nothing wrong with the child). When nobody believed her crazy rantings, her solution was to try to kill her own child — as if even an actual diagnosis of CP was worse than death.
Screw this woman….
Screw this woman? The woman was in the throes of a psychotic delusion. Psychotic: that means it was the product of a mind afflicted with a very serious illness. Pretending she should have just “bucked-up” when people dismissed her delusional fears makes as much sense as pretending that an ultrasound is going to convince a psychotic woman that she isn’t carrying the devil’s baby.
The blogger continues to express his mind blowing stupidity:
Having just been through the process of having a newborn, I’m acutely aware of all the time hospitals, pediatricians, and psychiatrists put in telling new parents how to handle the feelings of anxiety and sometimes depression that affect new parents. According to the reports filtering in about Wachenheim’s suicide note, it seems like she refused to listen to anybody else or seek out readily available help for her mental health issues.
Of course she didn’t listen to anybody else, and whether she did or did not seek out psychiatric help is irrelevant. She was delusional!
Finishing with a flourish of ignorance, the blogger concludes:
I don’t know, Casey Anthony (allegedly) kills her child, and she’s a monster. This woman most certainly tries to do the same thing, but she’s a “victim” because she tried to kill herself at the same time?
Don’t let the fancy law degree and respectable job fool you; she’s a monster.
She was not a monster. She was suffering from psychosis. She should not be held responsible for her actions because they were the product of a mind that couldn’t tell the difference between what was real and what she feared.
Defending Wachenheim, Slate columnist Jessica Grose goes overboard in the other direction.
The specific anxieties that Wachenheim mentioned in her suicide note are extreme and obviously the thoughts of a disturbed mind. Still, it’s alarming how much they reflect the current thinking about how much mothers are responsible for the ultimate sound health of their newborns. What they eat, what they don’t eat, what mood they are in, how long they wait to get pregnant, even what music they listen to—mothers are constantly reminded that every move they make can leave lasting damage on a baby and make them more prone to get even serious diseases like autism and other developmental disorders… Of course Wachenheim’s psychotic mind could have grabbed onto some other anxiety if fears of autism weren’t so outsized in the United States. But her case should give us a slap-in-the-face reminder to lay off a little—new mothers can be vulnerable enough without the extra anxiety.
Grose’s heart is in the right place, but even she fails to appreciate that Wachenheim’s delusional thinking was a direct result of her illness, not societal pressures. Yes, those pressures exist, and I have spent a great deal of time railing against them on this blog, but that’s not even a small part of Wachenheim’s problem. It’s the equivalent of blaming the movie Rosemary’s Baby for my patient’s delusion about carrying Satan’s child. The pressures of contemporary parenting ideologies are responsible for tremendous amounts of anxiety, guilt and unhappiness, but they don’t cause psychosis or contribute to it.
Postpartum psychosis is an illness, just like type 1 diabetes is an illness. And like type 1 diabetes, it is almost certainly related to hormonal imbalances. It is not the fault of the patient who is afflicted by it and it is not the fault of society. It’s just a disease, a disease that can strike previously healthy women with little or no warning and like any serious disease, it deserves our compassion, understanding and intense efforts to understand and treat it. To blame a dead woman for her own psychotic delusions is a sign that we have a long, long, long way to go in educating people about postpartum psychiatric illness. Elie Mystal and Above the Law should publicly apologize to Cynthia Wachenheim’s family for adding to their unimaginable pain by expressing their painfully retrograde, woefully ignorant views.
Homebirth midwives, doulas and childbirth educators have a problem. They are obsessed with a paleo-fantasy of birth that has nothing to do with the reality of birth. And because they base their efforts on the paleo-fantasy, instead of reality, almost all their empirical claims are flat out false.
What’s a “paleo-fantasy”? According to Professor Marlene Zuk, author of the new book Paleofantasy: What Evolution Really Tells Us About Sex, Diet and How We Live:
It is striking how fixated on the alleged behavior of our hunting-and-foraging forbearers some educated inhabitants of the developed world have become. Among the most obsessed are those who insist, as Zuk summarizes, that “our bodies and minds evolved under a particular set of circumstances, and in changing those circumstances without allowing our bodies time to evolve in response, we have wreaked the havoc that is modern life.” Not only would we be happier and healthier if we lived like “cavemen,” this philosophy dictates, but “we are good at things we had to do back in the Pleistocene … and bad at things we didn’t.”
Starting with Grantly Dick-Read, and extending to contemporary homebirth midwives, doulas and childbirth educators, natural childbirth advocates have adopted the belief that birth evolved under a particular set of circumstances and that changing the way we care for childbearing women without those women’s bodies having time to evolve in response, has wreaked havoc on women and babies.
Zuk is not writing about childbirth, but her thesis applies just as well to childbirth as to contemporary beliefs about diet.
Zuk detects an unspoken, barely formed assumption that humanity essentially stopped evolving in the Stone Age and that our bodies are “stuck” in a state that was perfectly adapted to survive in the paleolithic environment. Sometimes you hear that the intervention of “culture” has halted the process of natural selection. This, “Paleofantasy” points out, flies in the face of facts. Living things are always and continuously in the process of adapting to the changing conditions of their environment, and the emergence of lactase persistence indicates that culture (in this case, the practice of keeping livestock for meat and hides) simply becomes another one of those conditions.
In other words, hunter gathers were never “perfectly evolved,” they represented the best adaptations to conditions as they existed at that time. Conditions have changed dramatically over the past 10,000 years, which means that what was good for them, has no relevance for what is good for us. Moreover, and this is the critical point that is completely ignored by the paleofantasists, we have continued to evolve in keeping with our changing environment. For example, consider:
… “lactase persistence” (the ability in adults to digest the sugar in cow’s milk), a trait possessed by about 35 percent of the world’s population — and growing, since the gene determining it is dominant. Geneticists estimate that this ability emerged anywhere from 2200 to 20,000 years ago, but since the habit of drinking cow’s milk presumably arose after cattle were domesticated around 7000 years ago, the more recent dates are the most likely. In a similar, if nondietary, example, “Blue eyes were virtually unknown as little as 6000 to 10,000 years ago,” while now they are quite common. A lot can change in 10,000 years.
The idea that contemporary women should be attempting to emulate the births of their foremothers, ignores evolutionary science and is fairly idiotic to boot.
There was never a time that women were “perfectly designed” to give birth, because there has never been a time that any species has been perfectly evolved for anything. Every species, at every time, represents a host of compromises that, together, make that species competitive within a specific environmental niche. As soon as the environment changes, and it always changes, sometimes very rapidly, the species, while exactly the same as it was before, is suddenly no longer as competitive. That’s why most of the species of animals and plants that have ever existed are already extinct. They couldn’t change fast enough and died out as a result.
Human beings have the added advantage of technology. We can change our environment and we can change ourselves in ways that evolution would never allow. Ten thousand years ago if a woman began labor with her baby in a persistent transverse position, both she and her baby were guaranteed to die, a slow, agonizing death. Today, the mother would have a C-section and both mother and baby would survive. Ten thousand years ago, that mother and baby would have been evolutionary losers. Today they are evolutionary winners, because the currency of evolution is offspring. If your offspring survive, you win. If they die, you lose. It is just that simple.
There used to be an evolutionary advantage to being able to give birth vaginally. Now, with the advent of the C-section, there is absolutely no advantage, evolutionarily or otherwise, to a vaginal birth. Venerating vaginal birth and attempting to emulate it as it supposedly occurred in nature makes as much sense as polar bears venerating their original brown fur and attempting to emulate it. The environment has changed and the evolutionary winners and losers have changed as a result.
Scientists are sometimes caught out as paleofantasists as well. Consider the latest “research” about C-sections and the infant gut microbiome. There are scientists insisting that C-sections prevent infants from obtaining the “good bacteria” that they previously acquired during vaginal birth. If there is one thing that we can say for sure, it is that the microbiome of the female genital tract is nothing like it was 10,000 years ago, or even 1000 years ago, because no microbiome is like it was 10,000 years ago or even 1,000 years ago. Bacteria evolve far more rapidly than humans and the idea that there are “perfectly designed” vaginal flora that are “perfectly designed” for the infant gut is nothing short of absurd.
The bottom line is that in the game of evolution, she who has the most living descendants wins. There are no extra points for vaginal birth, or breastfeeding, or any other attempt to emulate our foremothers. The woman who has lots of C-section born, bottle fed, fully vaccinated children who survive to reproduce is the winner. That woman is “perfectly designed” for the environment in which we live. Everyone who is obsessed with trying to emulate our hunter-gatherer past is much more likely to be a loser.
