Time Magazine asks if you are Mom enough,

There’s only one way to find out …

Ask your children when they are adults.

In the meantime, I propose a new rule for attachment parents:

Don’t boast about the wisdom of your parenting choices until your children grow up and we can judge the results for ourselves.

Last week I shared the exciting possibility of becoming a birth visionista.

It’s a school for birth visionaries! So I thought, as I’m sitting there taking a shower, I’m like, “I wanna do a bootcamp! I wanna do a bootcamp for all of you birth workers who wanna be visionaries and want to step into that. You are a birth visionary already, you probably know it. But are you really, really incorporating that into your everyday birth worker life? That’s what I’m gonna be asking you, that’s what I’m going to be asking you to reflect on, and also begin to learn empowerment tools.

But perhaps the $697 fee to become a Fear to Freedom™ Birth Facilitator is a little steep for you. Don’t worry, you can attend The School of Shamanic Midwifery instead!

The School of Shamanic Midwifery (SSM) is a Women’s Mysteries School for midwives and doulas, a gathering of wise women, a year long Earth based ‘religious’ experience. It will awaken in you a deeper connection to the cycles – the way of life – and enable in you a range of ancient and traditional skills and tools to serve women and the birth process…

That’s right. Jane Hardwicke Collings, an Australian independent midwife:

… is herself a homebirth mother, a grandmother and a teacher of the Women’s Mysteries. She gives workshops called “Moonsong” – about the ancient wisdom of the cycles and “Pregnancy – The Inner Journey”. She is author of “Ten Moons – the Spiritual journey of Pregnancy, Preparation for Natural Birth” and “Thirteen Moons and Spinning Wheels” – the how to chart your menstrual cycle journal and handbook. She is currently working on her forth coming book “Birthing With The Goddess”.

I don’t know about you, but I’ve often felt the need for a handbook explaining how to chart my menstrual cycle. How thoughtful that Jane has shared her menstrual cycle journal with us! I’m looking forward to learning whether Jane prefers tampons or pads.

And how thoughtful of Jane that she has set up a Red Tent (get it? a RED tent):

The Red Tent is the special space co-created by Being Woman festival and the School of Shamanic Midwifery (SSM) for women who are in the bleeding phase of their menstrual cycle to retreat to, to rest, to renew, to be in their private inward space, supported by the Priestesses from the School of Shamanic Midwifery…

This sacred space is deeply needed by every woman as she comes to her ‘moon time’, and is gifted by her blood an exquisite embodied oppportunity to release all that is old and no longer serving her highest good. When we allow ourselves to ‘go with our flow’ and each dark/new moon let go of the old so that we may then dream up the new, we reclaim our inherent power for transformation and self-renewal – empowering us to create the lives that we desire.

Come and join us in the Red Tent… your Priestesses await you!

Ooh, priestesses! That’s way better than being a visionista.

How can The School for Shamanic Midwifery help you in your “birth work”? You can take the BirthKeeperIntensive course:

is an experiential workshop for BirthKeepers – doulas, midwives, doctors, folk who have made it their work to be a birth activist and a holder of the sacred wisdom of birth.

BKI has been designed to help you understand your hidden agenda, the unique gifts your bring to your work and to teach you shamanic tools and processes to add to your own medicine bundle in serving and facilitating the transformation possible around birth.

We will do shamanic drum journeys, rituals, ceremonies and craft. We will sit in circle, BirthKeepers united on a mission

“to heal the Earth, one birth at a time.”

See how it’s written in red (get it? RED words? like blood?).

And the best part? It’s only A$400.00, [Teas catered, BYO lunch, payment by paypal available].

Oh, dear. Can’t afford the ticket to Australia to take the course? No problem. You can buy one of Collings’ albums:

A Shamanic Drum Journey for Pregnancy to Meet Your Baby, and Drumming for Labour has been created to enable mothers and mothers to be to meet with and commune with their baby inside, if they are pregnant, and their “soulbaby” if they are planning pregnancy. The benefits of this process are explained and accompanied by women’s stories. Also included is a drumming track that can be played on repeat during labour for the benefits that will provide.

But for those for whom money is no object, there’s this:

The next Four Seasons Journey (2013) will be based in the Southern Highlands of NSW, 1.5 hours south of Sydney. This year long journey will run from November 2012 – November 2013. Fee: $3500.

No doubt, it’s worth every penny. But don’t forget:

Places limited. Book early to avoid disappointment.

There’s been another homebirth death in North Carolina:

I’m a police officer and just went to a call involving a family doing a home birth. There were complications so the family called 911. I was the first on scene and started doing compressions on the baby. EMS arrived a few minutes after and took over. I sat and watched, feeling helpless. I have a 9 month old at home and all I could think of was my little girl.

Proving yet again, as if more proof were needed, that if there is a life threatening emergency at homebirth, the baby will simply die for lack of expert care.

Mother’s Day is this Sunday and most of us anticipate hand made cards from our children and perhaps a present from our spouse. However, there is a gift that we could give to each other each and every day, and Mother’s Day would be a great day to start.

What is that gift? Replace words of shaming with words of support.

I’ve been thinking a lot lately about the concept of shame, especially in relation to the package of mothering choices known as attachment parenting. It seems to me that attachment parenting as the dominant contemporary mothering ideology has not done much for children, but it’s done a lot of harm to women by making them feel ashamed. Mothers have always felt guilty of course, but shame is a relatively new emotion in relation to mothering.

According to the article For Shame: Feminism, Breastfeeding Advocacy, and Maternal Guilt published in the feminist philosophy journal Hypatia. Quoting a variety of mothers who feel like “failures” because they could not breastfeed successfully, the authors explain:

What these examples have in common is that they indicate something other than just guilt (though all of these women may, in fact, feel guilty). [They] all say they feel like failures. In all of these cases, the mothers’ emotions go beyond guilt, or the feeling that a particular action, or lack thereof, has broken a rule and caused harm. Rather, they judge themselves as deficient: bad mothers, failures. Such negative global self-assessments suggest what scholars have identified, in contrast to guilt, as shame, which “involves the distressed apprehension of oneself as a lesser creature” or “a painful, sudden awareness of the self as less good than hoped for and expected…”

We can give mothers and incredible gift by not shaming them in the first place. Here are a few examples:

1. Epidurals

Support: I’m so glad you got relief from the pain.

Shame: You wouldn’t take drugs the entire nine months of pregnancy; why did you take them in labor?

2. C-section

Support: I’m so glad that your baby is okay.

Shame: Your C-section was unnecessary. If you had been more educated about birth, you would have known that.

3. Breastfeeding

Support: Breastfeeding is difficult. You shouldn’t blame yourself. The important thing is that your baby is thriving.

Shame: There is no such thing as “not enough” milk. And if you were in pain when you were breastfeeding, you were doing it wrong.

4. The family bed

Support: The best sleeping arrangements differ for different families and even for different children within the same family.

Shame: What do you mean you need private time with your husband? Your baby is only young once; you’ll be married to your husband for decades.

5. Baby wearing.

Support: It’s great if a sling works for you, but the baby really doesn’t care as long as she is with you.

Shame: Your baby won’t feel loved if you don’t “wear” him. And without skin to skin contact, babies suffer from stunted emotional development.

6. The all consuming nature and isolation of caring for small children

There are lots of different way to shame women about this issue: Isn’t being with your baby more important than making money? I love my baby enough to do without material things.

Or, what do you mean you need time for yourself? There is nothing that you could be doing that is more satisfying than meeting your baby’s needs.

Or, I can’t believe you leave your baby with a sitter just so you can go to yoga class for an hour.

There are lots of different ways to replace shaming with support for mothers who feel isolated and temporarily overwhelmed with parenting duties, but my personal favorite is this:

Bring the baby over to my house and I’ll watch him while you take a little time for yourself.

Whoopi Goldberg tells Mayor Bloomberg to “back off” pressuring women to breastfeed.

In the late 1960’s, a tobacco company executive circulated a memo among his colleagues. He was attempting to counter the large and growing body of research that demonstrated that smoking caused lung cancer and other serious illnesses.

Doubt is our product since it is the best means of competing with the “body of fact” that exists in the mind of the general public. It is also the means of establishing a controversy. Within the business we recognize that a controversy exists. However, with the general public the consensus is that cigarettes are in some way harmful to the health. If we are successful in establishing a controversy at the public level, then there is an opportunity to put across the real facts about smoking and health. (my emphasis)

The memo is startling for its insight. Simply put, tobacco companies did not have to refute the scientific evidence about smoking and cancer; merely creating doubt in the mind of the American consumer was all that was necessary to maintain or increase demand for cigarettes.

Homebirth advocates have taken a page out of the tobacco playbook. They don’t have to refute the large and growing body of scientific evidence that homebirth increases the risk of perinatal death; merely creating doubt about the evidence, as well as doubt about motives of obstetricians and hospitals is all that is necessary to maintain or increase the demand for homebirth.

In reviewing the book Doubt is Their Product: How Industry’s Assault on Science Threatens Your Health, a journalist explains the process, now used by pseudoscience aficionados from creationists to climate denialists:

They can always get it published somewhere. And if they can’t, they can just start their own peer-reviewed journal, one likely to have an exceedingly low scientific impact but a potentially profound effect on the regulatory process.

All of science is subject to such exploitation because all of science is fundamentally characterized by uncertainty. No study is perfect; each one is subject to criticism both illegitimate and legitimate — and so if you wish, you can make any scientific stance, even the most strongly established, appear weak and dubious. All you have to do is selectively highlight uncertainty, selectively attack the existing studies one by one, and ignore the weight of the evidence…

How does it work in practice?

1. Never mention the large and growing number of studies that demonstrate that homebirth increases (often spectacularly) the risk of perinatal death.

2. Never mention state or national statistics that also show that homebirth increases the risk of perinatal death. If someone else mentions them, declare that it hasn’t been published in a peer review journal; don’t tell anyone that government collected statistics don’t have to be published in a peer review journal since they are raw data.

3. Criticize one or two bad studies and imply that they are representative of the entire scientific literature. The go to studies for homebirth advocates are Pang and Wax. Don’t mention that the rest of the scientific literature shows the same thing.

4. Start your own journal to publish the “studies” that reputable journals refuse to publish. It is a little known fact that Birth: Issues in Perinatal Care, is owned by Lamaze.

5. Hide internal data that shows that homebirth increases the risk of death. One day, an enterprising state attorney-general is going to subpoena the safety data on 24,000 homebirths gathered by the Midwives Alliance of North America (MANA). The we will have confirmation that MANA executives like Melissa Cheyney have known all along that homebirth increases the risk of neonatal death.

6. Point out that obstetricians have been wrong in the past, even though that has no bearing on whether they are wrong about this issue.

Tobacco executives wanted only to cast doubt on the link between smoking and lung cancer. Homebirth advocates, on the other hand, want to cast doubt on the entire field of obstetrics. Prof. of Marking Craig Thompson detailed their methods and goals back in 2005 in a paper about their primary tactic, inculcating reflexive doubt.

Thompson is talking about natural childbirth advocates, of which homebirth advocates are a subset:

… Advocates of natural childbirth seek to inculcate reflexive doubt by countering two commonsense objections to their unorthodox construction of risk: (1) medicalized births would have never gained a cultural foothold if they were so risk laden and (2) the medical profession would not support obstetric practices that place laboring women at risk.

… [T]he cultural dominance of medicalized childbirth is explained as the historical artifact of a fin de siecle struggle between midwives and physicians, where the latter group held a decided economic and sociocultural advantage… [and used it] to displace midwives (both socially and legally) as the authoritative source of childbirth knowledge…

… [M]any obstetric interventions that were once deemed to enhance the safety of birth or to improve postpartum outcomes, shaving of the women’s pubic region; … lithotomy position; enemas; … have all been discarded as ineffective, unnecessary, and in some cases, potentially harmful. The natural childbirth community invokes this historical legacy to argue that many contemporary obstetric interventions are likely to meet a similar fate

Homebirth advocates recognize that they don’t have to prove that homebirth is safe, and they couldn’t do that if they tried. All they have to do it sow doubt about the existing scientific evidence that homebirth increases the risk of perinatal death.

And why not? If it’s good enough for tobacco executives in promoting their product, it’s good enough for homebirth advocates in promoting theirs.

[edited to include the full title of the journal Birth: Issues in Perinatal Care. The Journal of Perinatal Education, a journal for childbirth educators, is also owned by Lamaze.]

How do UK midwives feel about their patients. If you believe those who post at The Midwifery Sanctuary, they feel tremendous contempt for women who need pain relief.

Click for full size view

Fairy Naff:

… I appreciate that (a) I’ve not personally been through it and don’t completely get how difficult pregnancy and labour can be and (b) people are just scared when in pain or seeing loved ones in pain, I do think – Hang on – you chose to get pregnant (or do the deed that gets you pregnant). I didn’t ask you to – please take some responsibility for your actions and accept that I dont’ have a magic wand.

Morgana:

Lots of women are great but I find it hard when someone expects a totally pain free experience and screams at the first bit of period type pain. I know there can be a lot of fear etc etc etc and the whole fear pain thing…. But at times I do want to say “get a grip”. In days gone by women feared DEATH. Now we fear a labour more than 10 hours.

bombproof RM:

You hit the nail on the head when you say that you want women to take responsibility for what has happened/is happening to them…

My one biggest bug-bear is the woman who demands to be utterly, 100% sensation-free during childbirth. Not just pain-free, but totally numb. Then when the epidural fails, or works but doesnt relieve pressure, or wears off and needs topping up.. she is shocked.

And Im thinking (a) whoever told you that childbirth was pain free?? You must have KNOWN that this was an unrealistic explanation …

Back to Fairy Naff:

Haha – I can see this thread turning into a rant fest for midwives and students struggling to maintain a patient and caring facade!!! …

… When a woman is in pain and wants an epidural, you can tell her all the risks and disadvantages in the world and all she’s thinking is “yeah, yeah – just get on with it and take the pain away” …

Last night I took over care of a primip who, if she had gone home in the latent phase after SROM-ing instead of insistng on staying, might well have progressed better. Instead the fear and frustration mounted in her and her family, who wanted someone to take the pain away for hours and hours and hours and couldn’t understand why we didn’t…..she’ll have had a section by now, on top of her epidural and resultant interventions….and when it comes to her 2nd baby she’ll sit in front of a consultant and demand an elective section because she can’t face the same experience.

And it may have been her own “fault”…

According to Hobo RM, when describing her birth experience such a patient will say:

“…I went in and this midwife examined me and said I was only a cm, well I knew at that point something wasn’t right because I was in so much pain, anyway they tried to send me home, but I stood my ground because I just knew something wasnt right. They then wouldn’t let me on to delivery suite and made me go for a walk if I wasn’t going home, I managed about 10 minutes and I was in absolute agony, plus I was exhausted because I’d been contracting now for 10 hours and they wouldn’t give me a bed to lie down on. I went back to the midwife and she refused to examine me again and told me again to go home!

I’m going to put in a complaint about her. So this other midwife had a chat to the doctors (thank god for sensible people) and they said I could come onto delivery suite as they could see I was obviously in pain and something wasn’t right. I demanded an epidural straight away and although my midwife on delivery suite was nice she was a bit young and had obviously never had kids as she said that I wasn’t in proper labour yet …

I demanded my epidural, I was exhausted and crying and in pain and I couldn’t do it anymore, they finally agreed I was allowed (my body my choice anyone???) and the blessed anaesthetist came in and worked their magic… I could see the midwife wasn’t happy as she had to keep stepping over them but I desperately needed them both there for support.

Anyway they examined me again in four hours and I was still only 3cms so they asked if they could start the drip as apparently my contractions were still too far apart, well I’d only been on the drip 2 hours when the epidural started to wear off and I was in agony again, of course by this time the baby was in distress because my labour had gone on for too long and nothing was happening.

The midwife finally got the doctors in and they decided I needed an emergency section because the baby was tired. Imagine if I’d gone home when they told me to? Me and my baby could have both died???”[paragraphs created for readability]

Hedgehog:

Last week I had two women who looked at me with sad puppy eyes when I told them (in latent phase) that they could definitely NOT have an epidural on the antenatal ward! One had had 3 previous normal births and the other one had had an IVF pregnancy. The para 3 mystified me, but the IVF pregnancy – I can’t understand if you have gone through the long, heartbreaking months/years of trying to conceive, investigations, referral and finally fertility treatment, you are not then patient enough (there was definitely a lack of patience more than fear) to let labour happen, when it finally happens, at its own pace?

skanky:

I nearly posted something last week about a girl at work but thought you would think I was being cruel and a shit wannabe. Anyway she is a primip, 6 months. I stupidly asked if she had thought about the birth. She informed me she was planning on going to hospital for an epidural straight away, when I said that may not be possible and she should be aware of other reliefe like water ect she said it doesn’t matter as she ‘has a plan’, god only knows what that is.

Then it progressed to her saying she would demand a CS anyway as it’s less painful…..other carers chirped in what bollocks that was with the recovery etc, I then said some people find breast-feeding difficult after CS, cue ‘fuddle off, I’m not a fuddle animal’ I managed not to blow her simple little mind with the fact we are animals….

Barbara RM:

I have been getting tired of this can’t do attitude many women have. Labour ward is full of it. I don’t mind a bit of a moan if u are getting on with it but if your moaning is actually stopping u from moving it really gets my goat.

This appalling level of contempt appears to be a direct result of the emphasis on “normal birth.” Midwives are evaluating patients on their “performance” and their views are ugly indeed.

I’ve already put up a post for today, but I just came across this and knew that you would not want to wait to see it.

And no, it’s not a parody.

I’m sure that we’ll all be on that call on Monday. I can’t imagine anything more exciting that being part of a “tribe of birth visionistas.” Can you?

A reader sent me a link to this piece 5 Ways Pitocin is Different than Oxytocin by Robin Elise Weiss. As she pointed out, it is “a bunch of crap.”

I want to lay down the gauntlet to Weiss: Prove it or remove it!

Weiss’ piece an excellent example of the alternate world of internal legitimacy created by natural childbirth and homebirth advocates to support their pseudoscience claim, a world that:

that mimics all the features of the mainstream research world — the journals, the conferences, the publications, the letters after the names — and some leaders have gained access to policy-making positions.

Simply put, the world of NCB and homebirth advocacy is an echo chamber. That allows to advocates to legitimize each other by citing other advocates in a never ending circle of misinformation.

Robin Elise Weiss, BA, ICCE-CPE, ICPFE, CLC, CD(DONA), BDT(DONA), LCCE, FACCE is one of the leaders within the echo chamber of NCB. You can tell right away that she is a quack because of all the letters after her name. That’s how quacks try to confer legitimacy on themselves. These made up designations meant to impress the faithful and to fool outsiders. What does it mean? Weiss is a “childbirth and postpartum educator, certified doula, doula trainer, and lactation counselor.”

How does that qualify her to write about pitocin? It doesn’t. But in the world of NCB and homebirth advocacy, having no idea what you are talking about is the perfect qualification.

Weiss makes 5 claims, only one of which is true (but not particularly relevant), and the rest are false or, at best, the data are conflicting. She provides no proof for her claims, but does offer the classic bibliography salad of papers that sound relevant but don’t address the claims at all.

As we examine Weiss’ claims, keep in mind that pitocin, a tiny molecule made up of only 9 amino acides, is chemically IDENTICAL to and INDISTINGUISHABLE from oxytocin.

1. Pitocin is released differently.
Oxytocin is released into your body in a pulsing action. It comes intermittently to allow your body a break. Pitocin is given in an IV in a continuous manner. This can cause contractions to be longer and stronger than your baby or placenta can handle, depriving your baby of oxygen.

Yes, oxytocin is released in a pulsatile fashion. That’s basically the only true statement in her 5 claims and their elaboration.

What Weiss neglects to mention (or does not even know) is that most hormones are secreted in a pulsatile fashion.

Secretion of anterior and posterior pituitary hormones, adrenal glucocorticoids, mineralocorticoids and catecholamines, gonadal sex steroids, parathormone, insulin and glucagon is pulsatile (burst-like or episodic).

The pulsatile nature of oxytocin secretion sounds important, but appropriate treatment of a hormonal deficiency does NOT require pulsatile administration. For example, type I diabetics are treated with daily insulin injections to reduce their blood sugar levels. Without insulin, they die. With insulin they live long and healthy lives. I don’t notice anyone suggesting that it is better to withhold insulin than to give it in a less than perfect simulation of pancreatic function.

Similarly, some babies will die if they are not born in the very near future. They can always be delivered by C-section, but pitocin by IV infusion offers an excellent opportunity for vaginal delivery. Is Weiss suggesting that it is better to withhold pitocin and let those babies die or subject their mothers to unnecessary surgery rather than give it in a less than perfect simulation of pituitary function? If not, then what is she suggesting?

2. Pitocin prevents your body from offering endorphins.
When you are in labor naturally, your body responds to the contractions and oxytocin with the release of endorphins, a morphine like substance that helps prevent and counteract pain. When you receive Pitocin, your body does not know to release the endorphins, despite the fact that you are in pain.

False. Weiss just made that up or gullibly copied it from someone else who made that up. She offers no mechanism or explanation of how pitocin cause your body to “not know to release the endorphins” (whatever that means). And of course she offers no scientific citations for the claim because there aren’t any.

3. Pitocin isn’t as effective at dilating the cervix.
When the baby releases oxytocin it works really well on the uterine muscle, causing the cervix to dilate. Pitocin works much more slowly and with less effect, meaning it takes more Pitocin to work.

Really? Where’s the scientific evidence for that? Weiss offers none.

4.Pitocin lacks a peak at birth.
In natural labor, the body provides a spike in oxytocin at the birth, stimulating the fetal ejection reflex, allowing for a faster and easier birth. Pitocin is regulated by a pump and not able to offer this boost at the end.

Really? The evidence is mixed. Of course, Weiss provides no scientific evidence at all. But even if it were true, it’s easy enough to remedy; just provide a bolus (extra dose) of pitocin during delivery itself.

5. Pitocin can interfere with bonding.
When the body releases oxytocin, also known as the love hormone, it promotes bonding with the baby after birth. Pitocin interferes with the internal release of oxytocin, which can disturb the bonding process.

Weiss once again fails to cite any scientific evidence. That’s not surprising however since, to my knowledge, there is not a single human study on this issue.

As my reader pointed out, Weiss has offered “a bunch of crap” on the subject of pitocin. She has no idea how it works; even the little we know about it is far more complex than Weiss implies, involving changing numbers of oxytocin receptors that mediate the effect of the hormone itself and the multiple other hormones that interact with it during pregnancy, labor and postpartum. But that doesn’t stop her from trying to convince women that it is “bad.”

So Robin Elise Weiss, BA, ICCE-CPE, ICPFE, CLC, CD(DONA), BDT(DONA), LCCE, FACCE:

Please prove it or remove it.

For every incidence of preventable death at homebirth that are write about, the are many more near misses, but even I was surprised to find two separate examples on the same day. The first is almost a parody of homebirth midwifery ignorance and irresponsibility, but no one was in any real danger. The second was gross incompetence that easily could have resulted in the death of the baby if the mother had not insisted on going to the hospital. Interestingly, she had no idea how thoroughly her midwife had failed her.

The first case is I let go of my self-righteousness and had a Cesarean delivery — and I’m thankful for it. I have to give the folks at Offbeat Mama credit for publishing it at all even (or perhaps especially) with this caveat:

We hope it goes without saying that we LOVE midwives and home birth on Offbeat Mama. That said, some home births don’t go as planned and no health care practitioner is infallible, and we want Offbeat Mama to be a place for those truths, too…

Rachel, the mother, writes:

When I got pregnant last January I was stoked about the joyful, carefree unassisted birth I had always dreamed of. My husband and mom, though, were concerned about the safety of freebirths and so I compromised with them and hired a Certified Nurse-Midwife who only did home births… When I caught her voicemail, I noticed she signed off with “Namaste.” I thought: “Wow, this is going to be so great! She’s just like me! I don’t have to worry that she’ll force me to have medicines or procedures done that I don’t want.”

Then the near parody continues:

I don’t want to go into the gory details of my labor, but I will say that it lasted 92 grueling hours. My mom and dad holed up in the spare bedroom, crying; my husband held me and the baby’s godmother poured me wine and stroked my hair to try to help me sleep when I had been awake for the first 48 hours…

And what was the midwife doing all this time? Knitting! I kid you not. Well, that’s what she was doing when she was actually there.

My midwife kept coming and going; she would drive over and check my cervix, which dilated excruciatingly slowly. She would leave afterwards, telling me in none-too-caring tones that everything was “normal” and that every other woman in the room had gone through this, so there was no reason I shouldn’t be able to handle it…

At one point she felt my cervix and told me I had reached eight centimeters, and that she’d check me again in two hours. When the two hours were up, I asked if she would do it again. She said there was no need (she was knitting a scarf serenely on my floor). “Do you feel like you need to push? Then push.” I did, but nothing happened.

So much for homebirth midwives who stay with you throughout labor.

Finally, Rachel decided to ignore the midwife and head to the hospital. Imagine her surprise when, contrary to what she had been told, the doctors and nurses were caring and supportive:

Once at the hospital the nurses, anesthetists and doctors were more than kind. The head nurse held me close to her while I got the epidural I dreaded, and I was able to sleep for the first time in days. The obstetrician told me I would probably be able to have the baby vaginally, but that my midwife had lied to me — I’d never passed seven centimeters. The baby was “sunny side up,” presenting the wrong part of her head downward. After a few hours it became imperative that I have a Cesarean section: I had a fever and Baby’s heart was starting to race.

I was terrified. The anesthetist cradled my head as she held the gas over my face, and crooned to me in Afrikaans. Long story short: Rowan was born, and she was perfect.

There was an interesting little coda to the episode:

A few weeks after she was born, a representative from the Commonwealth of Virginia showed up at my door. Turns out, my midwife had let her license expire a while ago, and that was why she disappeared when I wanted to go to the hospital. I never had to appear in court, but I was interviewed for the record.

The second midwifery screw-up was published on a different online magazine, also for women who pride themselves on being different. The article is entitled Home Birth to the ER: A Life Changing Personal Story. Chiara’s son easily could have died from a classic childbirth complication, and although Chiara understands that this was a near miss, she apparently did not understand that her midwife screwed-up in the worst possible way.

Chiara was never an appropriate candidate for homebirth because of a pre-existing medical condition (beta-thalassemia), but:

… After watching The Business of Being Born, Jason and I decided we were having a home birth. We were 4 months in, and we found Gracefull Birthing in LA. We quickly fell in love with the two midwives…

Chiara’s pregnancy was complicated by a hospitalization for premature labor, but she made it to term.

The night before the 37th week began, I went into labor. I was calm. I was prepared. I had watched videos of African women having babies to learn what labor was like, unaffected by society’s perception of the experience. They hardly made a peep. We called the midwife with 7 minute contractions at 10pm. By 12am, we called back with 3-4 minute contractions. By 1am, they were 1 minute apart. My midwife and her assistant arrived. This is when everything fell apart.

Her labor was abnormal:

I was handling the pain, but [the contractions] were coming quicker than normal. My midwife measured me, 1.5cm dilated. She told me to get into the shower to relieve the pain, so I quickly undressed and hurried to relief. I was only able to stay up for about 4 minutes before I felt sick, so I called Jason in and that’s when I started to bleed. The midwife ran over, listened to Luca, and measured me at 4cm. It took less than 15 minutes for me to dilate 2.5 cm. I laid down for 30 mins and they blew up the tub. “You’re having a very fast labor.”

The pain was damn near excruciating. My contractions were back to back with about 4 seconds of relief in between accompanied by bleeding, vomiting, and a knife stabbing feeling in my lower abdomen.

Vaginal bleeding, abdominal pain, rapid uterine contractions, often coming one right after another: a textbook description of placental abruption. The midwife was completely clueless, but even Chiara recognized that something was wrong and insisted on going to the hospital. Imagine her surprise when, contrary to what she had been told, the doctors and nurses were caring and supportive:

… The OB knew I was in the middle of a home birth and instead of pointing her finger in condescension, she tried to deliver Luca naturally. I don’t remember much of the next 10 minutes. The doctor broke my water to stretch me the last cm, but I wouldn’t stop bleeding. I remember feeling Jason’s hand shaking, holding mine… I remember hearing the nurses around me buzzing about how pale I was and how much blood I was loosing… And then I remember…

.. Baby’s in distress. Prep the OR.

Fortunately, they got baby Luca out in time.

Chiara, though, has no idea that her midwife demonstrated gross incompetence in failing to recognize an obvious abruption. When I retweeted her story as an example of a midwifery screw-up, she responded:

I’d like to clarify something. What happened is not to be blamed on the midwife. She was very experienced, she just hadn’t seen placental abruption before. (Less than 1%) I genuinely believe it was because of our connection and her continued support that I was even able to communicate efficiently in a moment of crisis… After the delivery, she worked closely with pathology and the doctors on my case to find out more about what happened. She came over and we discussed symptoms, signs, and everything under the sun so that she would be prepared if placental abruption ever crossed her path again. It was an unforeseen emergency and the hippie ways of home water birthing and midwifery is NOT to be blamed.

Of course homebirth midwifery is at fault and ought to be blamed. The midwife demonstrated gross incompetence. She missed a life threatening major complication that was so obvious that even the patient recognized it. Any midwife who cannot recognize a life threatening complication when it hits her in the face is a danger to babies and mothers.

Both cases highlight the fundamental problem with homebirth midwives: the cult like belief that every deviation from normal, no matter how far it deviates, is just a “variation” of normal. But contractions one on top of the other, excess vaginal bleeding and precipitous labor are not normal. A 92 hour labor is not normal.

The most crucial skill for every birth attendant, indeed every health care provider of any kind, is the ability to distinguish between normal and abnormal. Any midwife who lacks the experience to recognize a major complication when she sees it, or lacks the wit to recognize a major complication because she has been taught everything is a variation of normal, should not be practicing at all.