Thinking about homebirth?

Think again.

All the women below thought homebirth was a great idea, their bodies were “made to birth” and they were “educated” and their midwives were competent. They were wrong, and you might be wrong, too.

Is this fear-mongering? Damn straight it is! Only a fool doesn’t fear and respect the risk of death in childbirth.

It’s time for my annual review of homebirth, and this year the death toll is higher than ever before. I’m not sure if it’s because the death toll from homebirth, already triple that of comparable risk hospital birth, has risen further, or because homebirth tragedies receive more publicity, but both the news and my email inbox were filled with an extraordinary number of homebirth deaths.

Below are 23 cases of neonatal death at homebirth, plus one case of profound neonatal brain injury. Every single one of the deaths was preventable in a hospital setting. There were also 2 maternal deaths; at least one and probably both were preventable in the hospital setting.

These are just the highlights. There were additional cases of homebirth resulting in profoundly brain injured newborns that aren’t mentioned in this review.

Neonatal deaths

Another homebirth horror story
Unassisted birth of a single footling breech. Baby born dead

A medical student learns about homebirth
Mother attempting homebirth transferred to hospital and refused medical interventions. After ultimately agreeing to a C-section, baby was born profoundly brain injured and died.

I would do it all again … even knowing the outcome
Mother “cherishes” the attempted homebirth of a single footling breech, despite the cord prolapse that led to the baby’s death.

“Just watched a newborn die in front of my eyes.”
EMT called to a homebirth when midwife could not resuscitate the baby. The baby died in front of his eyes.

Multiple homebirth deaths, endless regrets
1. Fetal distress, transfer to the hospital, baby dead.
2. Fetal distress, transfer to the hospital, baby dead.
3. Baby born severely compromised, ultimately died
4. Shoulder dystocia resulted in a dead baby.
5. Florence’s homebirth was “perfect,” except, perhaps, for the part where she died.

Denial: for homebirth advocates it’s not just a river in Egypt
Fetal distress not diagnosed by midwife; baby unexpectedly born dead.

This week in homebirth deaths
1. Homebirth; baby died of sepsis.
2. Hemorrhage during labor; baby died.
3. Baby died 2 days after homebirth.

Dr. Biter presides over a homebirth death
Prolonged labor, chorioamnionitis, baby dead already dead when mother transferred to the hospital.

Third homebirth death in North Carolina
Four days of labor, mother transferred to the hospital, baby dead.

Ever more homebirth deaths
1. Mother and midwife ignored the fact that the baby turned blue in the hours following birth; baby died of overwhelming sepsis the next day.
2. Fetal distress, transfer to the hospital, baby born dead.

Jailed midwife yet another example of why the CPM credential must be abolished
Mother and baby transferred to the hospital 6 days after homebirth. Baby had bleeding in the brain and retinas. Mother had a major infection because the placenta had not yet been delivered.

It was an awesome experience … too bad the baby died
Mother still believes her experience was “awesome” even though the baby was born unresponsive and ultimately died.

Yes, it is your fault that your baby died at homebirth
Midwife failed to diagnose fetal distress. Baby unexpectedly born dead.

Latest in homebirth deaths plus a near miss
1. Baby died after delivery from the breech position by a midwife whose license had been suspended.
2. Baby died of overwhelming Group B strep sepsis.

Two more homebirth deaths
1. Attempted VBAC at home, uterine rupture, baby died.
2. Fetal distress, transfer to the hospital, baby already dead.

Maternal deaths

In Australia: No choice?
In England: Mother bleeds to death at homebirth, but at least she had “a really lovely spontaneous birth”

Homebirth in the scientific literature

Two new studies show increased risk of death and serious complications at homebirth
Cochrane Review on homebirth is a piece of garbage
Cochrane Review, already noted for childbirth reviews riddled with statistical errors, claims that homebirth is safe based on one study of 11 women.

Homebirth in the news

The death toll of California homebirth
First rally for homebirth safety
Idaho midwives responsible for 3 neonatal deaths pay $5 million for a fourth disaster
Brilliant series on the dangers of homebirth
No wonder Colorado homebirth midwives hid their 2010 death statistics
Homebirth in the Daily Beast
Coroner: Homebirth deaths at Lisa Barrett’s hands were entirely preventable

Are you thinking about having a homebirth with an American homebirth midwife?

If so, ask yourself if you really want to entrust the life of your child and yourself to a woman who “learns” how to manage life threatening complications from the “hints and tips” of other homebirth midwives?

Consider the following from the Facebook page of Midwifery Today, the premier publication of American homebirth midwives:

Can you share your favorite tips for stopping hemorrhage?

The next theme for Midwifery Today magazine, the print edition, is on Hemorrhage. We would like to include your favorite Tricks of the Trade to stop or prevent hemorrhage, in her pages. Could you reiterate (I know some of you have mentioned them before,) this time for possible publication in the magazine. Be a published author!

Postpartum hemorrhage is a life threatening medical emergency. There is a large body of scientific literature on preventing and treating postpartum hemorrhage. Moreover, there is consensus on best practices including the Obstetric Hemorrhage Toolkit, described as:

… [A] resource for health care providers to improve readiness, recognition, response and reporting of hemorrhage. Obstetric hemorrhage is a leading cause of pregnancy-related morbidity and mortality but has major opportunities for improved outcomes.

The folks at Midwifery Today either don’t know about the consensus on preventing and managing postpartum hemorrhage or plan on ignoring it in favor of unproven “hints and tips” from other homebirth midwives, as if a postpartum hemorrhage were the equivalent of a pesky wine stain on a tablecloth.

The editors and publishers of Midwifery Today are not the only buffoons. Consider the “tips” provided by the midwife respondents.

Amanda: If the placenta has not yet been delivered the cut end of an umbilical cord and also the amniotic sac have a higher natural oxytocin content than the placental tissue itself.

There is no evidence that ingesting any part of the placenta, umbilical cord or membranes can prevent or treat postpartum hemorrhage. Moreover, even if oxytocin were present in these materials, it would not survive the acid in the stomach. That’s why pitocin is given to women in an IV, not by mouth.

Amy: Prayer!

Really? REALLY??!!

Shari: I have heard cypress oil rubbed on belly directly over the uterus.

Sure. And the mechanism of action is ….??

The stupidity goes on and on:

Katie: Always keep my homeopathic phosphorus and secale around…

Lorinda Mae: lots of excellent suggestions already, but what has worked for me is CHLOROPHYLL.

And my personal favorite:

Ely: Someone mentioned chewing a hard cinnamon candy and blowing it in mom’s direction.

This is what passes for knowledge among American homebirth midwives, and this is what is being solicited by the premier homebirth midwifery journal in place of scientific evidence and consensus on best medical practice.

Sure, you may want a homebirth, but are you really willing to risk the life of your baby and yourself by hiring these clowns?

Another homebirth, another dead baby, another loss mother proclaiming that her midwife was really, really nice to her.

In this particular case it is not clear whether baby Sarah would have survived had the mother been under the care of an obstetrician, since the baby may or may not have had congenital anomalies; but there is no question that the baby would have had a much better chance of surviving if her mother had had appropriate care for a postdates pregnancy and an ultrasound that had revealed any potential problems that might have been addressed in a timely fashion.

Be that as it may, the story shares the defining characteristic of many homebirth loss stories; the mother defends the midwife. And the key point always seems to be that the midwife was really, really nice.

You know what? Hour long appointments are medically useless. They don’t prevent death or disability; they don’t improve recognition of deviations from normal; they don’t accomplish anything besides stroking the ego of the mother.

Reading between the lines, it seems likely that the midwife dismissed the value of the tests that she discussed. All prenatal tests are reliable. That’s why they are part of the standard of care in the first place. Are they accurate? Yes, they are quite accurate for what they are designed to do. Screening tests, like the serum AFP (alphafeto-protein) test are able to distinguish betweeen those babies at risk for a neural tube defect and those who are not at risk. Diagnostic tests like amniocentesis and ultrasound are highly accurate at diagnosing abnormalities. What decision would a mother be willing to make based on what she knew? Even women who would not terminate a pregnancy under any circumstances can obtain valuable information about the baby that may dramatically increase the baby’s chance of survival in the face of an abnormality.

It’s not merely “possible” that testing would have revealed anomalies; it’s virtually certain. Early tests and late tests would certainly have revealed spina bifida if Sarah did indeed have it. Screening ultrasound would have revealed any additional abnormalities. A routine non-stress test and biophysical profile at 41 weeks may have revealed that Sarah was dying and offered the opportunity to save her life.

If all this seems familiar, it is because it is. I’ve lost count of the many times I’ve written about babies who died completely preventable deaths because the homebirth midwives involved were grossly incompetent. Indeed, just this week I wrote about a woman whose midwife left her in active labor to go shopping (!), who returned to deliver a lifeless baby that nearly died during a shoulder dystocia, yet the mother was fulsome in her praise of the irresponsible and possibly incompetent midwife.

There are some who suggest that this is a form of Stockholm Syndrome, where an abused person becomes emotionally attached to the person who has kidnapped or otherwise harmed them. I suspect it is something different. Although it appears that the mother is defending the midwife, she is really defending herself and her choice of homebirth. To acknowledge that the midwife was irresponsible, undereducated or incompetent is to acknowledge that the mother, far from being “knowledgeable” about finding a competent provider, had actually been clueless when it came to determining the midwife’s skills. To acknowledge that the midwife failed to prevent or even contributed to the baby’s ultimate demise is to acknowledge that homebirth is just as dangerous as 99% of American women believe it to be.

The emphasis on how nice the midwife has been is no coincidence, either. Homebirth is about risking the baby’s life for the mother’s birth “experience” and that experience starts during pregnancy. Who wouldn’t enjoy a provider who repeatedly congratulated you on your “education,” your “strength” and your “inner wisdom”? Most people realize, however, that prenatal care is not about being patted on the head, but rather its purpose is to ensure a healthy baby and a healthy mother. A “nice” midwife might enhance a woman’s fragile self-esteem, but it won’t do anything to save a baby dying a preventable death.

That’s why I have the greatest respect for women who have endured the horrific experience of losing a child at homebirth who didn’t have to die and are able to take a clear eyed look at what and who led to the preventable death. Homebirth loss mothers who speak out about the incompetence of homebirth midwives face terrible treatment within the natural childbirth community and they are very brave to persevere in spite of that treatment. Yet they are braver still to be able to overcome a far higher hurdle: the acknowledgement that their choice (often made with the best of intentions) was wrong, that they were not “educated” and that their intuition let them down when they needed it most. These women are a small, but unfortunately growing, group. Instead of protecting themselves and their egos they are still mothering the child they lost by standing up for him or her, making sure that others do not forget, and alerting women to the very real dangers of homebirth.

For most of human history a woman was judged by her vagina, specifically what went into it.

As in the rest of the animal world, the male human’s greatest fear was of being cuckolded, raising another male’s child as his own. Hence the elaborate attempts to ensure virginity and fidelity, ranging from female genital mutilation to chastity belts, to burqas to honor killings. Women have been cut, confined and crushed, both literally and figuratively, in order to insure that their vaginae were not breached by any man besides their husbands. That extended even to forced sexual violation. Even today, women who are raped are married off to the rapist to preserve her “honor” or killed by the male members of her own family to preserve their honor.

In the past hundred years women have increasingly discovered what Sohaila Abdulai explained in a recent op-ed piece in The New York Times. Writing in the wake of a horrific gang rape in India that resulted in the death of a young medical student, she proclaims what should be obvious to everyone. Rape is horrible because it is a violation:

It is not horrible because you lose your “virtue.” It is not horrible because your father and your brother are dishonored. I reject the notion that my virtue is located in my vagina …

Here in the US we have undoubtedly made progress in divorcing a woman’s virtue from her vagina. That’s why it is very disturbing to find a group of women who continue to insist that women’s honor resides in her vagina, specifically what comes through it. Natural childbirth advocates have located women’s fulfillment and authenticity in her ability to push a baby out through her vagina. It is precisely this fetishism of the vagina that is responsible for the central tenets of natural childbirth advocacy, including:

• the veneration of process (vaginal birth) over outcome (healthy mother and baby)
• the insistence that vaginal birth is better for babies
• the desperate search for purported advantages in vaginal birth, ranging from supposed decreases in everything from chronic diseases to tooth decay
• an obsession with lowering the C-section rate
• a rejection of the autonomy of women who prefer C-sections
• hideous lies about the effects of C-sections on woman’s ability to bond with her baby
• the bizarre concepts of birth rape and obstetric “violence”

These ideas, which are central to natural childbirth advocacy, locate a woman’s virtue in her ability to pass a baby through her vagina, and her “shame” in being unable or unwilling to do so.

It is hardly surprising that the originators and greatest proponents of the philosophy of natural childbirth, Grantly Dick-Read, Fernand Lamaze, Robert Bradley and Michel Odent, were and are men eager to trap women in traditional gender roles. It is deeply distressing to me, however, that most contemporary natural childbirth advocates are women, wittingly or unwittingly seeking to trap women in traditional gender roles.

A woman’s virtue is NOT located in her vagina. She is not at her most authentic and fulfilled by pushing a child through her vagina. And no woman should ever be shamed into thinking that being unable or unwilling to push a baby through her vagina is a failure.

There is no honor in vaginal birth and it is despicable for anyone to insist that there is.

I’ve always believed that there is no limit to which a homebirth advocate will not go to rationalize her decision to have a homebirth. Now I’ve had that belief confirmed.

A woman whose son suffered a severe shoulder dystocia, was born lifeless, waited 25 minutes for an ambulance and had to endure cooling therapy to preserve his brain function and may have sustained developmental impairment is actually crowing that it was the decision to give birth at home that saved his life.

When I first got examined by a midwife at home when my contractions started I was just 1cm dilated. I was in alot of pain but as this was my first baby obviously we all thought I would have hours and hours to go until things moved along.

… [O]ur homebirth midwife went off to do her Christmas shopping while we waited for things to progress.

So much for one on one midwifery care.

… just 10 minutes after rose had left my waters broke. Daniel had noticed mec in the waters which meant I would need to go to hospital to give birth. He rushed downstairs to call the midwives. I had started to get the urge to push and couldn’t stop. Ten minutes later a midwife arrived to examine me and saw that I was pushing Freddy’s head out. Rose arrived and they both realized that this baby was coming and coming fast! They told Daniel to call an ambulance.

Then disaster struck:

… Freddy’s head was out, he was stuck and he was lifeless. An ambulance from Sandhurst was dispatched and on their way. Sandhurst was over 30 minutes away.We were on our own.

The midwives struggled to deliver the baby for 5 minutes and finally he was born.

All of a sudden I felt release. The pain had gone and I felt a them place a lifeless 9lb 2 Freddy on my tummy just 28 minutes from when I got out of the bath. one of them shouted. The cord is snapped clamp it clamp it.!!!!!

Then for 15 minutes …..silence. I had my eyes closed. I felt the panic but I truly can’t remember alot.

In those 15 minutes Karen had scooped the mec out of Freddy’s mouth with Daniel’s T-shirt… Rose and Karen began to perform CPR on Freddy. …….Nothing. He was gone. They kept going and going and going. ….Nothing. I was laying on the bed crying, bleeding and in shock while they pressed on my precious baby’s chest and blew air into his tiny mouth.

The EMTs managed to resuscitate the baby. At the hospital he was subjected to hypothermia (cooling) therapy to preserve as much brain function as possible.

In a spasm of blithering idiocy, Freddy’s mother believes that the homebirth saved his life.

If we had opted for a hospital birth-

I would of got out of the bath, gone upstairs and my waters would have broken.

Daniel would of tried to move me as he knew I would have needed to got to hospital but I was in so much pain pushing I could not be moved. He would have called the ambulance……..No ambulance.

It would have been up to Daniel to try and deliver Freddy. There would have been no midwives to perform the McRoberts maneuver, to clamp Freddy’s cord, to perform CPR on him for 20 minutes.

Daniel would of tried to get him out. He would have told me to keep pushing. He wouldnt of known his shoulder was stuck. He wouldn’t know how to release it. Freddy would have still been inside me apart from his head when the ambulance arrived. He would have died and I would have probably died too.

It’s as if someone who was ejected from a car while driving drunk and unbelted shortly before the car burst into flames were crowing that it was the fact that he was drunk and unbelted that saved his life. Yes, that he was ejected and was not in the car when it exploded may have saved his life, but it was the decision to get into the car in the first place that nearly ended it. The assumption that the crash would have occurred in the absence of being drunk is completely unwarranted.

Similarly, it was the decision to choose homebirth in the first place that led to the events that nearly killed the baby. If Freddy’s nother had opted for a hospital birth she would have headed to the hospital when she began experiencing severe pain. Since her labor progressed so quickly, she would have been far along in labor by the time she arrived at the hospital. Had the mother been under the care of a remotely competent provider in a hospital setting, it is quite possible that the shoulder dystocia would have been resolved more easily, the resuscitation started sooner, the need for cooling therapy averted, and the as yet unknown long term damage to this child’s brain would never have happened.

Once again a mother who chose homebirth for no better reason than her “experience,” risked her baby’s life, nearly killed him, subjected him to prolonged oxygen deprivation and may have sentenced him to a lifetime of developmental disability is now trying to justify that choice. Pretending that it would have been worse if she had chosen hospital birth is like pretending that it would have been worse to drive sober and belted. In both cases, there is every reason to believe that the disaster would have not happened in the first place had a different choice been made. It defies comprehension that anyone could pretend otherwise.

The email is entitled Reducing the c-section rate could save $5 billion annually and it was sent out by the Childbirth Connection, a group that lobbies on behalf of “natural” childbirth professionals like childbirth educators, doulas and midwives.

According to the email:

…For the benefit of public health – for the 4 million women who give birth every year…

What is at stake for payers? Not only do unwarranted c-sections create greater health risks for women and babies, this study shows that they also dramatically increase costs for employers and, through Medicaid programs, state and federal budgets. Medicaid programs paid nearly $4,000 more for c-sections than vaginal births, while for commercial insurers the difference topped $9,500…

Here’s my response:

Dear Childbirth Connection,

I’d like to reduce the C-section rate and associated expenditures. Please tell me exactly which specific C-sections of the more than 1 million performed last year are the unnecessary ones.

You do know, don’t you? Otherwise you wouldn’t blithely advocate that obstetricians reduce the C-section rate arbitrarily because that would result in preventable perinatal deaths, right? So don’t wait, tell me because I am breathless with anticipation. I, like most obstetricians wish I knew in advance which C-sections were unnecessary and which were not. You think you know so please share your incredible insights with the profession.

Wait, what? You have absolutely no idea which C-sections are necessary or unnecessary except in hindsight? And you have no intention of taking responsibility for determining which C-sections are unnecessary?

What methods have you developed to determine in advance which C-sections are unnecessary? None, you’ve developed none. Well it is a tough problem to solve, but surely you’ve spent millions supporting studies that will answer that question. What? You haven’t spent a penny researching methods to determine in advance which C-sections are definitely life saving and which are not?

Okay, but surely you’ve been researching technology that will demonstrate which babies will have shoulder dystocia, which breech babies will have trapped heads, and which babies aren’t getting enough oxygen. What? You haven’t spent a penny on that, either.

So let me get this straight:

The Childbirth Connection has absolutely no idea which C-sections are necessary and which are unnecessary, but they are sure that too many unnecessary C-sections are being done?

Why should we pay any attention to people who bleat about a problem they make no effort to solve?

And while I’m asking questions, I have a few more. Your letter claims:

…Maternal infections, prolonged pain, life-threatening complications, and childhood chronic illnesses…

First of all, there is no evidence that C-sections cause chronic childhood illnesses. I realize that the folks at the Childbirth Connection are desperately hoping that is the case, because then they could brandish it against those who point out that C-sections save literally tens of thousands of lives each and every year. But since is hasn’t been proven, why are you pretending that it has?

Second, how many lives are saved by C-sections and how many might be lost by arbitrarily aiming for a lower C-section rate. Let me guess: you have no idea about that, either.

You write:

The World Health Organization recommends a c-section rate of 15% or less for any country.

That’s not true, either. The WHO withdrew that recommendation more than 3 years ago, acknowledging that there had NEVER been any data to support ANY specific C-section rate. Why are you deliberately misrepresenting the position of the WHO, or do you simply fail to keep current with the latest recommendations in obstetrics?

And you say:

… [W]e must target the areas where we can reduce cost while simultaneously improving health and safety.

That’s about as helpful as saying that we should stop all violence and bring about world peace. Everyone wants it, but no one is sure how to reliably accomplish it.

Finally, I must ask:

Why are you obsessed with process? Isn’t the goal a healthy mother and a healthy baby? Shouldn’t the outcome be focus of our efforts?

Oh, right, I remember now. Your members can’t make any money from C-sections and you are promoting their economic interests. That’s why you concentrate on procedures and entirely ignore outcome.

I guess that’s why you complain about a problem that you are sure can be solved without having a clue as to the solution.

With apologies to Stephen Sondheim:

“Isn’t it rich?
Isn’t it queer?
Losing my judgment this late in my career.”

That’s the sad song that many homebirth advocates could and should be singing, having made total fools of themselves over Dr. Robert Biter.

I’ve been writing about Dr. Biter since his hospital privileges were suspended in 2010.

The supporters of Dr. Robert Biter, the San Diego obstetrician whose privileges have been suspended by Scripps Encinitas can’t seem to figure out why this has happened. They ought to check the public records of the San Diego Superior Court website. Evidently Dr. Biter has been sued 6 times in the past 5 years! That must be some sort of record, especially when you consider that he has only been in practice since 2001.

Dr. Biter’s supporters included Ricki Lake, Rixa Freeze, Jill Arnold of the Unnecessarean, Barbara Herrera of Navelgazing Midwife, many other pregnancy bloggers and a Facebook group entitled “I love Dr. Biter.” They reflexively supported him without ever doing the most basic research that would have revealed the 6 pending lawsuits.

When the existence of the lawsuits was publicized, Ricki Lake backed away. It took a bit longer for Barbara Herrera to recognize that she had been conned. The rest didn’t care. The facts made no difference to most of his supporters.

And those supporters put their money where there mouth is. They gave money for Dr. Biter’s planned birth center, despite his own acknowledgement that the money was being funneled to his personal bank account, and despite the fact that there was no public record of any attempt to start a birth center. I guess if you are intent on making a fool of yourself, you might as well go all the way.

In the intervening years, Dr. Biter has been the subject of disciplinary hearings that revealed the details of multiple instances of medical malpractice and gross negligence (reports available at the Medical Board of California website). Still his supporters clung on and women continued to hire him to deliver their babies. Then in July of 2012, having already put his signature to a legal document requiring him to have another physician supervise him, he attended a homebirth by himself. The baby died and, as in the previous cases, the findings of the inquiry included malpractice and gross negligence.

Now Dr. Biter faces permanent suspension of his license. Although Dr. Biter has not contested any of the allegations against him and has actually acknowledged the truth of the accusations by signing documents admitting to them, he is still trying to con his supporters and they are still acting like clowns.

Katie McCall, the creator of the Sisters in Chains, the appalling Facebook page dedicated to homebirth midwives who are “persecuted” for no better reason than the fact that a few babies died here or there, recently offered Dr. Biter her support.

Just stopping by to give my love this new year. My it be an amazing improvement on the last for both of us.

Biter replies with his usual self-absoprtion:

… Truth can be slow at times, and it is amazing how people use our tragedies to their own self interests or self importance in the social media world…

Earth to Dr. Biter:

What’s tragic is the loss of innocent life and the injuries to the women who trusted you. The suspension of your license is best described by another word: justice.

The story of Dr. Biter is an object lesson in the way that homebirth advocacy works. Find a quack you like; do no research of any kind; ignore facts you don’t like; give money to con artists, let innocent people be injured and die. Rinse and repeat until the quack’s license is removed or she is arrested. Then pretend it is all a conspiracy.

“Don’t you love farce?
Dr. Biter’s fault I fear.
He thought that you’d want what he wants.
Sorry, my dear.
But where are the clowns?
Quick, send in the clowns.
Don’t bother, they’re here.”

Kristen of Birthing Beautiful Ideas is angry that many people regard her homebirth as selfish:

“Why would you put your baby’s life at risk just for the experience of a home birth?” STOP SAYING THAT!

[A]t no time in my decision-making process did I think that my choice was between risking my baby’s life for “the blissful home birth experience” and guaranteeing a safe outcome for my baby with an okay experience in the hospital…

Here’s the thing: the “putting your baby’s life at risk for the experience” comment–which many home-birthing women and families encounter, either directly or indirectly– fails to grasp the multiplicity of reasons that people might appeal to when choosing home birth.

I’ve got some bad news for you Kristen. I can’t speak for anyone else, but I’m not going to stop saying that, because, whether you like it or not, and whether you admit it to yourself or not, you DID risk your baby’s life for nothing better than your “birth experience.”

Kristen, of course, rolls out all the inane “reasons” for the choice typically cited by homebirth advocates.

I have examined the research on home birth and hospital birth and am convinced of the potential benefits of home birth…

Newsflash: reading books and websites written by laypeople for other people is not research, no matter how much you would like to pretend that it is. If you haven’t read the scientific literature, the actual papers, not the abstracts, not Henci Goer’s summaries, you haven’t done research.

I do think that it is a safe option for my baby and me.

Newsflash: Thinking that homebirth is safe does not make it safe.

I have access to skilled home birth providers whom I trust to care for my baby and me prenatally, during labor, and in the postpartum period.

Newsflash: In the event of a life threatening emergencies, your baby does not need homebirth providers. He or she needs an operating room, an anesthesiologist, and a neonatologist. If your homebirth providers aren’t carrying those things, they are useless in an emergency.

I had a horrendous experience giving birth in the hospital and do not want to repeat that experience. I think that planning a home birth gives me a better chance of not repeating it..

I have a deep-seated fear of the hospital and am nearly paralyzed with terror at the thought of giving birth in the hospital. A home birth is a better choice for me…

Don’t worry. We’re completely clear on the fact that this is all about your experience. You don’t need to reiterate it multiple times.

I want to avoid both the maternal and neonatal complications associated with the high intervention rates at my local hospitals.

And so you are risking the ultimate complication, your baby’s death, to avoid the minor complications that you apparently fear more.

The reasons are unique. They are radically unique, just as unique as each individual person themselves. This is why two people can have the exact same situation and still arrive at different choices based on the uniqueness of their values and preferences.

Newsflash: Your baby isn’t radically unique. He or she will die without appropriate life saving measures in the face of an emergency.

Your homebirth midwives aren’t unique. They are the typical poorly educated, poorly trained hobbyists who wouldn’t be considered midwives in any other country in the industrialized world.

YOU aren’t radically unique. You are the gullible, woefully undereducated woman who thinks reading books for laypeople is “research;” who has probably never read a single scientific paper in its entirety, let alone the breadth of the literature on homebirth, but preen to yourself and others that you are “educated; who has written 10 reasons why you chose homebirth, using I, me, my, more than 20 times with never a single reference to the very real danger of death to your baby.

In other words, you are the typical homebirth advocate, risking her baby’s life for no better reason than your personal experience.

The cornerstone principle of preventive medicine is that it is better to prevent disease than to to treat it after it has developed. That seems to be a non-controversial principle, except, apparently, in the world of infant and child woo. There the typical response to devastating preventable diseases and injuries is to pretend that they won’t happen.

Homebirth advocates like to pretend that life threatening complications don’t occur in childirth; midwifery proponents like to pretend that there is plenty of time to transfer to physician care when life threatening complications do occur; anti-vaccinationists like to pretend that vaccines are unnecessary, and all of them delight in the fantasy that “good nutrition” and a “strong immune system” are magically protective against everything.

It has become highly fashionable among some Western, white, relatively well off women to refuse standard newborn preventive care, whether that is the Hep B vaccine, neonatal ophthalmic ointment, or vitamin K shots. Proponents of this transgressive behavior like to think that it marks them as independent thinkers. It doesn’t; it marks them as ignorant, gullible and willing to take terrible risks with the lives of their children for no better reason that to preen to themselves and others.

It also marks them as wishful thinkers who pretend that their child will never be exposed to hepatitis B, that their partner would never have an affair and become infected with gonorrhea and that their child’s blood will clot in the absence of adequate vitamin K.

As a result, children die agonizing preventable deaths like this poor infant who sustained massive intracranial bleeding because her mother refused the shot that would have prevented it.

According to the Coroner’s Court:

The baby’s … initial neonatal examination was also normal. In accordance with her parents’ wishes and the birthing plan, she did not receive Vitamin K, nor was she vaccinated for Hepatitis B. Information relating to the vitamin K injection was provided to the parents during their first antenatal visit. The information stated the reasons why vitamin K is recommended, namely that it assists the blood to clot and that newborn babies require it to prevent bleeding problems especially in the first few months after birth. The parents submitted a birth plan, which stated their decision not to have vitamin K administered…

The baby was exclusively breastfed (the major risk factor for vitamin K deficiency) and was doing well. Then:

One month after the birth, the mother noticed that the baby had been sleeping a lot and was not feeding as much as usual. She was noted to cry out at times and then settle. She went to sleep that night, but an hour later, she vomited. In the early hours of the next morning, the mother went to change her nappy and she was seen to be limp. The Queensland Ambulance Service (QAS) was contacted.

What had happened?

A CT scan … showed widespread subarachnoid haemorrhage and left sided subdural haemorrhage (bleeding on the surface and beneath the dura/lining of the brain). This was causing some effacement of the left ventricle (compression of the cavity within the brain as a result of increased pressure and mass effect). There was also loss of grey/white differentiation of the brain matter, which indicated damage to the brain and widening of the spaces between the skull bones. No fractures were seen. There was haemorrhaging within both eyes, and her pupils were non-reactive.

A blood test called an INR (International Normalised Ratio) was conducted. This test measures the time it takes for blood to clot and compares it to an average, with one being normal and 10 being extremely thin and prone to bleeding. The baby’s measurement was 10.

In other words, the baby had developed hemorrhagic disease of the newborn, the very condition that the vitamin K shot is designed to prevent. As a result, she bled into her head so much and for so long that her brain was compressed and destroyed.

The baby’s condition did not improve overnight or into the next morning. There remained markedly elevated intracranial pressure and her prognosis was considered to be extremely poor. She remained on ventilation over night. Following discussion with her parents, the baby’s life support measures were withdrawn the next morning and she subsequently died.

The baby died a painful, prolonged and entirely senseless death because the person she depended on to protect her, her mother, thought she knew better than the pediatricians for whom vitamin K has been standard prophylaxis for more than 50 years. Why did the mother think she knew better? Because she read it in a book or on a website and it sounded good to her.

Being a parent ought to mean putting a child’s health and brain function before anything else, including the mother’s desire to be transgressive, and even the mother’s distress at her child’s temporary discomfort as a result of an injection. It means taking the advice of experts, not pretending that you are an expert. It means doing whatever you can to prevent the child’s death and disability,not pretending that wishful thinking is a form of preventive care.

Colorado homebirth midwives have a serious problem.

No, I’m not talking about the fact that licensed Colorado homebirth midwives attending planned homebirth have a hideous perinatal death rate, nearly 2.5 times that of the state as a whole (which includes premature babies and high risk deliveries). They apparently don’t consider that a problem at all. To my knowledge, not a single conference, Board Meeting or legislative session has been held to address the hideous death rate.

The problem is that Colorado homebirth midwives are required by law to report the deaths at their hands. At first this wasn’t a problem since no one seemed to read the data or do the necessary calculations. Then I discovered the data.

I first wrote about it back in December 2009 (The horrifying death toll of homebirth in Colorado). I noted at the time that Colorado homebirth midwives were aware of the appalling number of deaths at their hands. In the newsletter of the Colorado Midwives Association, President Karen Robinson reported:

In looking back over the past couple years of statistics, I see that there were 5 perinatal deaths reported each year for 2006 and 2007. This represents a perinatal death rate of 8 per 1000 for those two years, and that is too high for the low-risk population we serve. The state perinatal mortality rate for all births from 2003 to 2007 was 6.4 per 1000.

She then explained why she ignored this huge red flag:

I don’t believe we have a poor perinatal mortality rate, but if solid data shows we do, then I will be at the forefront of the effort to improve our practices and lower the perinatal mortality rate for homebirth in Colorado.

Guess what? The death rate continued to rise. In 2008, 7 babies died. In 2009, 9 babies died. I reported on the rising death rate each year. As far as I can determine, the Colorado homebirth midwives did absolutely nothing. No investigation, no modification of practice standards, no restriction of midwives’ scope of practice, nothing.

Then, the Colorado Midwives, in violation of state law, stopped reporting their death rates. I reported on that, too, and then I obtained the raw data for 2010 and 2011 from someone who had filed a Colorado Open Records Request and found that in calendar year 2010 there were 15 deaths and in calendar year 2011 there were 14 deaths. In those years, the death rate for homebirth were more than double the terrible death rate that had moved Karen Robinson to pledge action were that death rate to continue. But, of course, as far as I can determine, no action was taken at all, and homebirth midwives managed to have their scope of practice expanded slightly.

Colorado homebirth midwives have produced a statistical report this year, and it is a masterpiece of obfuscation. Not only did Colorado homebirth midwives bury an extraordinary number of babies in the past year, they buried them again in an avalanche of extraneous statistics and graphs that are completely nonsensical.

What do we need to know to determine if planned homebirth with a licensed Colorado midwife is safe? We only need one figure: the perinatal death rate. What was the perinatal death rate for the period 10/01/2010 through 09/30/2011 (the period covered in the report)? It doesn’t say. It literally does not mention the single most important safety metric for Colorado homebirth. Not only that, in years past, the number of deaths and the total number of births were reported so that the perinatal death rate could be calculated by simple division. This iteration of the Colorado homebirth midwives buries that information, too.

Instead of reporting that the midwives did 719 deliveries, they presented this:

If you work at it, you can calculate the number of deliveries, as I did, but it is difficult to imagine a less clear way to present the information. Indeed, there is no possible reason to present a graph like this. Who cares how many midwives reported that they did 11 deliveries and how many 12? No one. But if you wanted to make it extremely difficult to calculate the perinatal mortality rate, it would be hard to find a better way to misrepresent the data.

Using a similar graph, I calculated how many transfers the midwives reported: 186. When you add 719 and 186, you get 905.  Using other similar graphs I calculated the number of perinatal deaths as 14. 14 deaths in 905 births means that the perinatal mortality rate during the reporting period was an astounding 15.5! That would be an embarrassingly unacceptable rate for the state as whole, representing as it does a perinatal mortality rate almost 2.5 times the actual Colorado rate of 6.4 for all deliveries including premature babies and all possible complications. For a group of low risk women, it is horrific.

Back in 2007, the perinatal mortality rate that Karen Robinson deplored and refused to believe was 8/1000. Now it is  15.5/1000.

So in addition to being grossly unqualified practitioners, Colorado homebirth midwives are shockingly unethical. They are doing everything in their power to hide the deaths at their hands. Indeed, they are so desperate to keep the information from the women of Colorado, they have buried the death babies twice: once in coffins in the ground, and then again in reports and graphs that hide the relevant information instead of reporting it.