I get a lot of feedback, both positive and negative, but there is one comment that I treasure above all others. That’s the blast e-mail sent out by Katie Prown of The Big Push for Midwives, bemoaning my influence, because of my “highly negative, but to the average person, highly plausible, comments.”

Curiously, there is no mention about which of my comments are false, or why they might be untrue. That’s because, as even Katie Prown and the folks at The Big Push for Midwives know, my claims are true, fully sourced with appropriate citations, and difficult to rebut. Therefore, homebirth advocates are reduced to whining “Don’t listen to Dr. Amy because …”

It’s time for an English to English translations of these fine whines.

Let’s start at the beginning. It always starts with “Don’t listen to Dr. Amy.”

English to English translation:

Don’t read what Dr. Amy has written. If you do, there is a very high risk you will be persuaded by scientific evidence and logic. Since we can’t rebut her, we prefer that you don’t even read what she says.

Alternatively:

Don’t think about what Dr. Amy has written. If you do, you will have no choice but to accept a great deal of what she says since she explains it very carefully so you can understand it.

Let’s look at some specifics:

“Don’t listen to Dr. Amy because she’s biased.”

English to English translation:

Dr. Amy is biased toward presenting complete information. She won’t exclude the mass of data that we feel compelled to conceal.

“Don’t listen to Dr. Amy because she cherry picks the data.”

English to English translation:

Dr. Amy understands math; we don’t. Dr. Amy does not merely quote the data, but she breaks it down so you can understand it too. That means that instead of merely accepting what we tell homebirth and natural childbirth advocates, you will be armed with the actual statistics that show that homebirth is not safe and that natural childbirth does not improve outcomes.

“Don’t listen to Dr. Amy because she’s crazy.”

Only a crazy person would take the time to present the data, show you where you can find it yourself, and explain how even you can understand and analyze it. That’s dangerous. Listen to us and you won’t have to use your own intelligence and reach your own conclusions. Just accept what we tell you.

“Don’t listen to Dr. Amy because she hates homebirth.”

English to English translation:

Don’t listen to Dr. Amy because she hates the fact that 2 out of 3 homebirth deaths are preventable. If you listen to her, you might start to hate that fact, too.

The bottom line is that when someone tells you “Don’t listen to Dr. Amy,” what they’re really telling you is don’t read, don’t learn, don’t think. If you do, you are bound to conclude that they are telling you is false, and they can’t have that, can they?

Ask yourself: Are you brave?

Are you brave enough to read what I say, review the papers that I cite, analyze the data for yourself, and reach your own conclusions?

I’m not afraid of that, but homebirth and natural childbirth advocates are. That should tell you all you need to know.

The following is a guest post.

I am a nurse in a level 3 NICU at a large teaching hospital. I attend deliveries for preterm infants, infants with known defects, meconium, etc.

Several months ago, I went to a delivery that was paged as a “3.” In other words, it was a routine delivery, no signs of fetal distress, etc. We got there and were told it was light mec–we’re not always even called to light meconiums, but we were this time. Fetal heart rate on the monitor looked beautiful all during pushing.

Unexpectedly, the baby was born limp, dusky, and no drive to breathe.

The pediatric resident and neonatal nurse practitioner checked for meconium below cords, and there was none. We started tactile stim, with no response. We immediately intubated the baby, started PPV via the ET tube, and assessed there to be no heartrate. We then started compressions.

At 4.5 minutes of age, patient had a gasp and we were able to auscultate a heart rate of 160. While this went on, we had a code page sent out to the rest of our unit so that our respiratory therapist and neo doc could be there (only an RN, NNP, and resident attend a “3” page delivery).

The baby was brought to our unit on a ventilator, umbilical lines were placed, and just as we were getting ready to decide whether or not to body cool the patient for suspected HIE, he self-extubated and looked amazingly well by about 45 minutes of age. We dodged a bullet, and the baby most likely will be FINE! He will be in NICU for a day or two for observation and antibiotics, but should be able to go home with mom. This is even more remarkable when apgars at 1, 5, and 10 minutes of age were 0, 2, & 4.

Why am I telling you this?

There were absolutely NO indications–ever–that the baby was ever in distress. The meconium was light and there was no meconium below cord. There were no signs of distress in the baby ever noted during labor/delivery. NO ONE knows why the baby did what it did.

The attending OB and residents came up to the unit while we were stabilizing her and were visibly distressed and questioning what they could have done differently. We all assured them that we have NO indications that anything could have been done differently. I looked at the attending and said, “THIS is why babies shouldn’t be born at home!”

It took an entire staff of trained professionals to stabilize her–even the best CNM can’t intubate, bag, and do compressions at the same time. That baby, had she been born at home, would have died.

A totally normal, low-risk delivery, turned into an almost terrible catastrophe in the blink of an eye. Instead of a dead baby, I left a baby that was pink, breathing on his own, and looking amazing.

For people who claim that OBs and L&D nurses are heartless, they should’ve seen the look on the OB’s faces in the delivery room as they watched everything happen and then again when they came to the unit. These people truly care about their patients and want to do everything possible to ensure a healthy baby/healthy mom.

I’ve written many times before that midwives have a problem. The scientific evidence does not support their cult like belief in the superiority of “normal” aka “physiologic” birth.

One of the ways that midwives have attempted to fight back against the unfortunate fact that much of what they believe is contradicted by science is to misappropriate science that they utterly fail to understand.

That’s what midwife Soo Downe did in her hilarious attempt to hijack quantum mechanics for her own purposes.

“The implication of the new subatomic physics was that certainty was replaced by probability, or the notion of tendencies rather than absolutes: ‘we can never predict an atomic event with certainty; we can only predict the likelihood of its happening’… This directly contradicts the mechanistic model we explored above, and it implies that a subject such as normal birth needs to be looked at as a whole rather than its parts…”

Wait one moment while I picked myself up off the floor from laughing so hard. Prof. Downe seems to have missed the most basic, most important fact about quantum mechanics, which is not surprising since she doesn’t have a clue as to what it means. Quantum mechanics is an explanation of events at the atomic level, not on at the level of objects in the world. So unless Downe would like to discuss the individual atoms that make up the molecules that make up the cells of the fetus, quantum mechanics has no applicability

Now Downe is back trying to misappropriate epigenetics. She and other midwives, who have neither training in nor understanding of epigenetics, are trying to hijack it to claim … C-sections alter newborn DNA.

For many nurses and midwives, it’s about time the medical community focused on the potential environmental markers a C-section could impart on a child’s genome. In January, 11 women from the US, the UK and Australia gathered in Hawaii for a panel investigating the epigenetics of birth.

What is epigenetics and is there any reason to believe that newborn DNA is changed by C-section?

Epigenetics studies various chemical modifications of DNA that are the result of environmental influences. The classic example occurred in Sweden:

In the 1800s, Overkalix’s residents depended heavily on farmers. Pembrey and his colleagues had access to records about the community’s feasts, famines and death certificates, and pieced together data for a landmark 2006 study: If a grandfather lived during a famine, his grandson was four times as likely to die of diabetes than if he lived during a time of plenty. Somehow, the grandfather’s genes were switched on or off, helping his body conserve calories — switches that were passed down to his grandson. If the grandson had access to too much food, he could get diabetes and die.

There are several things to note about epigenetic events. They occur in response to major environmental stresses; they occur in response to stresses that last multiple years; they occur across populations, not necessarily in any specific individual from that population.

So how does this apply to C-sections? It doesn’t, but that hasn’t stopped the same fools in the midwifery community who have attempted to misappropriate quantum mechanics to attempt to misappropriate epigenetics.

Having a C-section, a group of nurses and midwives are now suggesting, could possibly be one of those twists. They are both eagerly and carefully launching studies to examine possible connections between C-sections and medical conditions. The idea is controversial, unproven and has many skeptics, but birth experts say that studying C-sections’ effects on infants and their descendents is an important question that requires experimental testing.

Who are these midwives who have no training in genetics, epigenetics or basic scientific research?Their flyer reveals that they include usual suspects, Holly Powell Kennedy, Soo Down and Hannah Dahlen.

One of them inadvertently reveals the primary motivation:

Hannah Dahlen, an Australian midwife, says it could increase respect and demand for vaginal birth. “We’re at the beginning of a very exciting time,” Dahlen says. “I think in 10 years we will potentially look back at what we are doing now and think, ‘What on earth did we do?’”

Dahlen helped spearhead the Epigenetic Influence and Impact on Childbirth meeting…

They were all frustrated “that despite the research, political activism and efforts they and many others were putting in to increase the rate of normal birth, intervention during childbirth kept rising and arguments about safety and outcomes all had a short term focus,” she wrote in an email.

Damn those obstetricians with the “short term” focus on whether babies live or die! Midwives reject that short term focus in favor of a long term focus: their own economic wellbeing and professional status. There is simply no question that interventions they do not know how to perform, including C-sections, dramatically decrease the importance and value of midwives.

What do real scientists in the field of epigenetics have to say about the midwives’ desperate wish theory that C-sections alter newborn DNA? They dismiss the idea that the method of birth has any epigenetic impact.

Studying the epigenetics of birth is a hot topic, says Louis Muglia, the director of the Center for Prevention of Preterm Birth at Cincinnati Children’s Hospital Medical Center. It makes sense that the fetus would prime itself for life during gestation, he says…

In context, birth is a relatively short life event. “You wouldn’t want the body to be reprogramming itself every time an event came up,” Muglia says. “To me it’s a little counterintuitive that the labor process would have as big an impact on epigenetic programming as pregnancy.”

In other words, in addition to the fact that there is no data to support a claim that C-section alters newborn DNA, there is no reason to believe that it would.

That doesn’t stop midwives from making ludicrous claims. Why not? According to panelist midwife Aleeca Bell:

“As midwife researchers, we view labor and birth as a time when small physiological changes can have enormous impact on the mother and infant,” she wrote in an email. “Epigenetics may be a useful tool in discovering how.”

In other words, midwives are absolutely, positively, 100% certain that C-sections deserve to be demonized. There is no scientific evidence to support that belief, but they will just keep looking until they find it.

There’s nothing like a lawsuit to focus a state’s attention.

That may be the reason behind a sudden flurry of activity at the Oregon Health Licensing Authority (OHLA). I wrote about the $50 million lawsuit, seeking to hold both midwives and regulators responsible for the severe brain injury sustained by baby Abel Andrews at birth.

According to the Bend Bulletin

… Kristine and Greg Andrews — on behalf of their son — are suing the state of Oregon, Motherwise Community Birth Center, midwife Nicole Tucker, CPM and midwife Christyn King, CPM for the medical problems they say the baby faces as a result of oxygen starvation during birth.

Among other allegations:

The Andrewses allege the state was negligent for several reasons, most notably because of the blood pressure level it lists as a risk factor. The lawsuit also alleges the state didn’t require a mandatory disclosure form … and that it didn’t implement “evidence based standards for the protection of Oregon citizens.”

Suddenly, after years of lackadaisical oversight of homebirth midwives, OHLA is taking a closer look into their practices … and, importantly, reporting their findings to the general public. It is a rather ugly picture.

Based on Department of Justice advice, the Oregon Health Licensing Agency (OHLA) is providing the following information regarding complaints against licensed direct entry midwives (LDMs) (as of June 8, 2012):

Number of open investigations: 40
Number of midwives under investigation: 22
Percentage of the licensing base represented in those investigations: 28 percent
Complaints that have come from mandatory reporters: 9 from five complainants
Complaints that have come from clients: 13 from eight complainants
Complaints from family members of clients: 1
Complaints originating from hospitals or hospital-based health care professionals, whether they are mandatory reporters or not: 10
Complaints originating from inter-agency referral: 5
Complaints originated by OHLA: 2
Complaints against unlicensed midwives: 3

More than a quarter of Oregon homebirth midwives are facing outstanding complaints! Contrary to the claims of Board Chairwoman Melissa Cheyney, a large proportion of the complaints have been filed by patients. Moreover, almost all the complaints were filed against licensed midwives, midwives under the direct regulatory authority of OHLA and the Board of Direct Entry Midwifery.

The state seems to be expressing concern on other fronts as well. After unconscionably allowing repeated extensions to regulations mandating specific informed consent disclosures by homebirth midwives, the Attorney General’s office appears to have developed a deep interest in the content of homebirth midwifery consent forms. A Board hearing set to approve the guidelines set forth in a Board brochure was abruptly cancelled without explanation, apparently to give the Attorney General’s office time to determine exactly how much liability the state was going to incur.

It appears that after finally recognizing that the state can be held accountable for its poor to non-existent supervision of homebirth midwives, the Attorney General wants to make sure that its regulations can be defended in court.

Homebirth is no longer a win-win for Oregon state politicians. They’ve discovered there are consequences to turning a blind eye to the deadly incompetence of homebirth midwives in exchange for the political support of homebirth advocates. That can only be a good thing for Oregon mothers and babies.

Here’s hoping that the Oregon Attorney General’s Office subpoenas the MANA death rates that Board Chairwoman Melissa Cheyney refused to hand over. Those statistics are likely to provide a clearer picture of the gross incompetence and deadly practices of Oregon’s homebirth midwives.

Here’s hoping that the state of Oregon will remove Melissa Cheyney from her position of authority, where she has tirelessly promoted the interests of her colleagues at the expense of a horrifying number of preventable neonatal deaths.

Here’s hoping that the state of Oregon will reverse its inexcusable policy of allowing anyone who desires to call herself a midwife, without any education, any training, or any oversight.

Bravo to Kristine and Greg Andrews, who have taken their pain over the preventable disabilities of their beloved son Abel, and turned it into legal action that has already captured the attention of Oregon state officials and is sure to benefit countless babies and mothers in Oregon.

Homebirth midwives in the US, Australia, the UK and elsewhere are absolutely, positively, 100% certain that they deserve to be treated as autonomous professionals.

Let’s leave aside for the moment that any practitioner who depends explicitly on the diagnostic talents and surgical skills of an obstetrician, without which she can not provide safe care, is hardly autonomous. Instead, let’s take homebirth midwives at their word.

If we do that, we face a curious paradox. Midwives wanted to be treated as autonomous professionals, but they reject the very methods of accountability followed by all other medical professionals, and most non-medical professionals. Consider that obstetricians, who are presumably the paradigmatic autonomous practitioners whom midwives wish to emulate, must accept, whether they like it or not, a wide variety of strictures that serve to hold them accountable to their patients, to the hospitals where they bring their patients, and to the public at large. These include:

1. Adherence to all hospital practice guidelines.

2. Weekly meetings of all clinicians in a particular discipline, known as Grand Rounds or morbidity and mortality conferences (“M&Ms”) to review complicated cases in order to strengthen their clinical skills.

3. Frequent (even daily) meetings and phone conversations with any other clinicians who might care for their patients now or in the future, in order to apprise them of complications that may possibly develop.

4. Obstetricians must fulfill onerous licensing requirements and fulfill them to the letter. Self-study is not an acceptable substitute; apprenticeship is not an acceptable substitute; simply passing an exam is not an acceptable substitute.

5. Licensing does NOT entitle obstetricians to send their patients to the emergency room of any hospital they happen to choose. In order to provide care for their patients within the hospital setting, an obstetrician must apply for and be granted permission to that bring their patients to that hospital. Such permission is known as “privileges.” In order to receive privileges, obstetricians must agree to follow all hospital policies whether they like them or not.

6. If an obstetrician does not have privileges at a specific hospital, the obstetrician cannot simply send a patient to the emergency room and expect that other obstetricians will care for her. He or she must find a specific obstetrician who will accept the patient in transfer, but the person asked is not required to accept.

7. Obstetricians, like most professionals, must carry malpractice insurance. Malpractice insurance is extraordinarily expensive because childbirth is inherently dangerous.

Make no mistake, these restrictions on ostensibly autonomous obstetricians are both onerous and costly. Moreover, they limit what obstetricians can actually do. An obstetrician may want to do a VBAC, but if hospital policy does not allow it, the obstetrician can’t do it. An obstetrician may want to lower his cost of practice by forgoing malpractice insurance, but he cannot do so. An obstetrician may want to send a patient to the nearest hospital because it is convenient for her and her patient, but if the obstetrician does not have privileges at that hospital, she cannot do it. An obstetrician may want a specific doctor to accept his patient in transfer, but that doctor has no obligation to agree.

These restrictions do not benefit obstetricians themselves in any way, nor are they meant to benefit them. They exist to protect the people whom obstetricians care for or work with. Malpractice insurance protects patients who are injured and holds obstetricians accountable. Licensing standards protect patients by ensuring a high level of education and clinical skill. Hospital policies protect hospitals by ensuring a high and uniform level of care and hold doctors accountable when they do not meet that high level of care.

To date, homebirth midwives have rejected all attempts to hold them accountable to anyone. They reject high licensing standards; they reject being bound to hospital policies; they reject the need for weekly or even daily consultations with obstetricians, they dump patients in whatever emergencies rooms they choose, and they reject mandated malpractice insurance.

Homebirth midwives don’t behave like professionals. Unless and until they accept the same restrictions placed on physicians, the same high licensing standards, and mandated malpractice insurance, there is no reason why anyone should consider them professionals, let alone autonomous professionals.

Imagine that a group of creation “scientists” at a fundamentalist Bible college announced that they were in the process of performing an experiment that would definitely disprove the central tenets of evolutionary biology. Their experiment would settle the issue once and for all by showing that the idea of humans evolving from more primitive primates is completely inconsistent with scientific evidence.

Now imagine that they performed their experiment, analyzed the data and found, to their horror, that their own experiment showed that creation “science” was incompatible with the evidence and that the evidence supported the fundamental principles of evolutionary biology. How do you think they would handle that evidence?

My guess is that they would never publish it. Why? Because they start from a conclusion that they firmly believe, that God created the human beings in His own image, and will not accept any evidence that contradicts that belief. How would they justify hiding their own data? They would tell themselves and each other that their own data must be faulty. They must have done the wrong experiment, or the experiment was contaminated, or they had improperly analyzed the data. They would assure themselves and each other that future experiments would, without a doubt, ultimately invalidate evolutionary biology, even though their experiment did not.

I suspect that this is the same thinking process followed by homebirth midwives and professional homebirth advocates. They are lying about the safety of homebirth by hiding their own data that shows it is not safe, yet they do not consider themselves liars. Rather their belief in the presumed safety of homebirth is akin to religious faith. In their view any data that shows that homebirth increases the risk of perinatal death, even their OWN data, must be faulty. If they just hide the bad statistics now and keep collecting data, eventually, at some unspecified future time, the data will ultimately show that homebirth is safe.

How else to explain the grossly unethical behavior of Colorado homebirth midwives? Despite the fact that in every year since homebirth midwives were licensed in Colorado their death rates have been extraordinarily high and despite the fact that these high death rates have been rising precipitously, they feel perfectly justified in hiding these facts from the women of Colorado, even though they are violating state regulations. The way they see it, there must be something wrong with the data. The alternative is too frightening to contemplate. If they keep collecting statistics long enough, sooner or later those statistics cannot be relied upon to show that homebirth is safe.

How else to explain the grossly unethical behavior of Melissa Cheyney and the Midwives Alliance of North America? They collected statistics on the safety of 24,000 planned homebirths and they refuse to release their own death rates. It does not take a rocket scientist to figure out that the death rates are horrendous and that is why they are hiding them. I have been writing about this point for many years, in a variety of venues, including national publications like Time Magazine, and MANA has never denied it.

Yet the way that Cheyney and MANA see it, there must be something wrong with the data. Therefore, they feel perfectly justified in their own minds in hiding the truth from American women. They are convinced that if they continue collecting statistics long enough, sooner or later those statistics will have to show that homebirth is safe and they can publish them then.

Most of us understand that for creation “scientists,” the biblical account of creation is a matter of religious faith. It simply must be true or their entire world view will collapse. Similarly, for homebirth midwives and homebirth advocates, the safety of homebirth is a matter of faith. It simply must be true or their entire world view will collapse.

When it comes to creation “science,” no one is hurt by believing in the biblical tale of creation. However, when it comes to homebirth, the stakes are far higher. Babies are dying because homebirth midwives refuse to acknowledge their own evidence; babies are dying because homebirth midwives consider maintaining their own world view more important than whether those babies live or die; babies are dying because homebirth midwives are hiding the data from American women.

Enough is enough. There is no moral, ethical or legal reason that justifies homebirth midwives, such as those in Colorado or those who are in charge of MANA, hiding data from American women. Sure, acknowledging the truth will be very bitter for homebirth midwives, but it doesn’t come close to the bitter grief of homebirth loss mothers who, had they received accurate information on the dangers of homebirth, would be raising their babies instead of visiting them in cemeteries.

Each year, licensed Colorado homebirth midwives (certified professional midwives, CPMs) are mandated to report their safety statistics. As I detailed in a post about the 2009 statistics, in every year since homebirth midwives were first licensed in 2006, the midwives had a death rate that exceeded the state as a whole (including all races, all gestational ages, all pregnancy complications, all pre-existing medical conditions). Even worse, from 2006 to 2009, the death rate rose dramatically.

Imagine my surprise, therefore, when I looked for the 2010 statistics and learned that the homebirth midwives had failed to released them. Now I know why. They were ever more horrendous than the 2009 statistics.

How did I obtain the 2010 statistics? It’s not because the midwives publicly released them. No, they were required to hand them over after a Colorado citizen filed a CORA petition (Colorado Open Records Request). She shared those statistics with me, both the raw data and the summary data complied by the midwives themselves.

I’ve created a table of mortality rates from 2006-2010.

As you can see, the perinatal death rate for planned homebirth with a licensed Colorado midwife rose from 11.3/1000 in 2009 to an astounding 16.4/1000 in 2010! Compare that to the overall perinatal mortality rate for the entire state of Colorado (all races, all gestational ages, all pregnancy complications, all pre-existing medical conditions) of 6.3/1000.

Colorado homebirth midwives cared for fewer than 1000 patients and managed to lose 15 babies. It is difficult to convey just how appallingly large a number that is. Colorado licensed midwives have a perinatal mortality rate nearly triple that of the state as a whole. That actually dramatically understates the danger of homebirth in Colorado since the correct comparison (if it were available) would be to the mortality rate of low risk white women at term with normal sized babies.

It’s easy to understand why Colorado homebirth midwives hid their 2010 statistics; they are an appalling indictment of the midwives and irrefutable evidence that they are unfit and unsafe practitioners.

This is the same tactic being employed on the national level by the Midwives Alliance of North America (MANA). MANA collected death rates for the years 2001-2008. While they were collecting the statistics, they publicly promised they would be used to demonstrate the safety of homebirth midwives, but once they saw the results, they decided to hide them instead.

Now that Colorado homebirth midwives have been licensed for 5 years and had appalling and RISING death rates over that period, it is time to acknowledge the obvious. Licensed homebirth practitioners are grossly incompetent. They lack the education and training required of ALL other midwives in Europe, Canada and Australia and required of US nurse midwives (CNMs). It is time to end the experiment and declare it a resounding failure.

Homebirth in Colorado (and everywhere else in the US) is not about babies, and it is not about birth. It is about a bunch of high school graduates who couldn’t or wouldn’t get real midwifery training and made up a pretend credential they award to themselves to fool an unsuspecting public.

Colorado homebirth midwives are unethical in the worst possible way; they don’t care how many newborn lives are sacrificed, indeed that will go to great lengths to hide how many newborn lives are lost, in an effort to continue collecting fees for appallingly incompetent care. Of course, they are merely copying the behavior of their national leaders. The entire leadership of American homebirth, from the President of MANA on down should be ashamed of themselves.

How do American homebirth midwives handle their mistakes? They bury them — both literally and figuratively.

Congratulations to Lisa Barrett!

Whereas Lisa Barrett has done more than any single individual to expose the scientific ignorance, moral bankruptcy, and narcissistic self regard that is the heart of homebirth advocacy …

Whereas by presiding over 4 separate homebirth deaths, Lisa Barrett has made a priceless contribution to convincing women that homebirth is dangerous and that homebirth midwives care more about improving their status and lining their own pockets than whether babies live or die …

And, whereas, Lisa Barrett has steadfastly refuse to apologize for the hideous waste of human life that has occurred at her hands …

Lisa Barrett is hereby inducted into the Homebirth Hall of Shame.

Way to go, Lisa!

First runner up Hannah Dahlen and the Australian College of Midwives are still eligible for induction into the Homebirth Hall of Shame in the future. Their willful misrepresentation of the Australian coroner’s report is a masterpiece in the growing body of midwifery literature that attempts to subvert regulation of dangerous rogue practitioners. Pretending that requiring midwives to provide accurate information represents a limitation of maternal autonomy is a classic tactic that is sure to be emulated by homebirth midwives everywhere.

Honorable mention to:

Australian homebirth midwife Joy Johnston for her hideous comparison of a “traumatic” IV to 4 homebirth deaths.

And:

American homebirth advocate Rixa Freeze, PhD (in American studies) who criticized the coroner’s report without even reading it.

My profound thanks to all four women. They’ve done more to discredit homebirth than I ever could.

Keep up the good work, ladies. I’m counting on you!

Dr. Anthony Schapell, the coroner who authored the 106 page report about the 4 preventable deaths presided over my Australian midwife Lisa Barrett, made the objective of his report crystal clear: to ensure that Australian women receive accurate information about the risks of homebirth.

The Australian College of Midwives, and spokesperson Dr. Hannah Dahlen, have chosen to deliberately misrepresent this objective. Instead of acknowledging that coroner’s recommendations restrict the autonomy of rogue midwives, they have chose to pretend that the recommendations restrict the autonomy of women to choose homebirth. Their tactics, while admirable from a marketing point of view, are unethical and betray the fact that their primary concern is themselves, not babies and mothers.

The coroner was quite clear in his condemnation of the misinformation spread by homebirth advocates including certain homebirth midwives:

… I refer to the commonly held misconception that appears to be promoted by those who advocate homebirthing in risky circumstances, that adverse outcomes that occur in a homebirth would inevitably have occurred in a hospital. There is also the misconception that twin births in hospital will inevitably involve the second twin, to borrow the expression of Dr Hannah Dahlen, being ‘whipped out within about 3 minutes’. There are other misconceptions that these Inquests have identified.

The ACM issued a statement in response:

… [T]he ACM is disappointed that there has not been a greater emphasis on strategies to prevent such tragedies as seen in these three cases.

What strategies does the ACM recommend to ensure that women receive accurate information about the risks associated with homebirth, particularly high risk homebirth?

Don’t be silly! They have no practical suggestions for that problem because they don’t see it as a problem.

Nonetheless, the ACM recognizes that opposing the provision of accurate information would be a marketing disaster. So instead, they’ve completely ignored that issue and substituted their favorite straw men. But let’s look behind their claims to see what they really mean, keeping in mind that their primary objective is to promote the autonomy of midwives.

1.

All these women had suffered traumatic previous births in the hospital system and some sought care in birth centres but this was not made available to them.

Means:

These women should never have been delivered at home, but the only other place where midwives are autonomous are birth centers and there aren’t enough of those. Of course, none of these women were candidates for birth centers, but so what?

2.

The recommendation to report women who are seeking to have a baby at home with risk factors is of grave concern as it may push some women further underground and lead to them not seeking any engagement with health services.

Means:

We have absolutely no evidence to substantiate this, but we are going to pretend that women who are advised that their babies will be safer in the hospital will ignore doctors, and deliver unassisted. The coroner explicitly rejected this claim, advanced by Dr. Dahlen in her inquest testimony.

3.

The ACM finds the statement that all these babies would have certainly survived if a caesarean section was performed concerning as such certainty is not possible with childbirth.

Means:

The ACM doesn’t care about the scientific evidence, it only cares about the autonomy and employment of midwives.

4.

Once a woman has had caesarean, complications in subsequent pregnancies are significantly increased.

Means:

And then midwives won’t be able to autonomously care for these women either.

5.

The ACM also recognises that until private midwives are allowed clinical privileges to be able to practice in hospitals that reluctance on the part of the woman and midwife will continue to compromise safety and seamless transfer.

Means:

We will refuse to transfer patients in an effort to save their babies lives if it means that we will have to give up control of those patients.

Let’s be honest about what is going on here. The priority of the ACM is professional autonomy for midwives regardless of whether those midwives are providing accurate information and regardless of whether babies live or die. Their behavior is morally bankrupt and they ought to be ashamed of themselves.

Damn those dead homebirth babies!

They keep ruining efforts to pretend that homebirth is safe. What to do? Why bury them, of course, both literally and figuratively.

That’s precisely what Rixa Freeze attempts in her post criticizing the recommendations of the Australian coroner. She manages to discuss the recommendations without mentioning why they were promulgated. The recommendations are a direct response to 4 preventable homebirth deaths.

When I posted a comment on her website asking why she is ignoring the 4 dead babies, she promptly deleted it. That’s how you bury those babies.

I suppose I shouldn’t have expected any better from a woman who proudly posted video of the near death experience of her daughter Inga at her own homebirth. Moreover, she’s simply following the lead of Homebirth Australia which issues a 350 word statement that didn’t include the words “baby” or “death.”

In general, the homebirth blogosphere has greeted the coroner’s report with the sound of silence. It’s just another example of the way that homebirth midwives and homebirth advocates hide statistics, scientific papers and individual neonatal deaths so as to keep their followers ignorant of the facts.

The Homebirth Australia statement piously declaims:

Any law reform around homebirth must recognise that all women (including pregnant women) have a fundamental right to bodily autonomy and a legal right to refuse medical care.

Yes, women have a legal right to INFORMED refusal of medical care, but how can women be informed when homebirth advocates keep hiding the dead bodies?

In 2012, there is overwhelming scientific evidence that homebirth for low risk women dramatically increases the risk of neonatal death. The increased risk of death is far higher in women who have risk factors like breech, VBAC and twins. Everyone knows homebirth leads to preventable neonatal deaths. Everyone, that is, but women who get their information from homebirth midwives or other homebirth advocates.

Homebirth Australia couldn’t care less about whether babies live or die, and apparently Rixa Freeze doesn’t care, either. No one from the homebirth community has made even a single recommendation about how to reduce the risk of neonatal death, because the ugly reality is that homebirth advocates don’t care whether babies live or die. Their “experience” is more important than the lives of their own babies, let alone the lives of other women’s babies.

As far as I’m concerned, any attempt to criticize the coroner’s recommendations without even mentioning the 4 preventable deaths is unethical. But acting unethically, or even illegally, has never bothered homebirth supporters in the past. Evidently a pile of tiny bodies doesn’t change that repugnant reality.