Despite counseling about the risk of a fatal outcome, a mother elects to attempt a VBA3C at home, her uterus ruptures and her baby dies.

A woman with a breech baby is advised that birth at home carries higher than average risk. The woman ignores the medical advice, the baby’s head is trapped during birth and the baby dies.

A women is told that her twins are in an unfavorable position for successful vaginal birth. The woman elects to have a homebirth and, as she was warned might happen, the second baby dies.

The women in these cases, didn’t simply choose to have a homebirth. They chose to ignore the guidelines for homebirth safety by attempting a high risk homebirth. They may argue about their right to choose and their actions may be legally protected, but that doesn’t change the fact that, morally, they have committed medical neglect.

What is pediatric medical neglect?

According to the American Academy of Pediatrics position paper Recognizing and Responding to Medical Neglect, written by Carol Jenny of the AAP Committee on Child Abuse and Neglect:

Several factors are considered necessary for the diagnosis of medical neglect:

1. a child is harmed or is at risk of harm because of lack of health care;
2. the recommended health care offers significant net benefit to the child;
3. the anticipated benefit of the treatment is significantly greater than its morbidity, so that reasonable caregivers would choose treatment over nontreatment;
4. it can be demonstrated that access to health care is available and not used; and
5. the [mother] understands the medical advice given.

In each of the cases above, a child died because of lack of appropriate healthcare. The recommended treatment (C-section) offers significant net benefit to the child. Access to healthcare was available, and the mother did understand the advice she received from physicians.

Homebirth advocates often argue that they don’t believe that a C-section is necessary in these high risk situations, but a parental belief system, whether religious or secular, is not a defense against medical neglect. For example:

Some families may refuse advice because they lack trust in physicians or organized medicine because of what they have heard from friends or the media or because of previous negative experiences with the health care system.

And:

Medical neglect evaluations should focus on the child’s needs rather than the caregiver’s motivations or justifications. Religious objections, therefore, should not be granted fundamentally different status from other types of objections.

Although competent adults have the right to refuse life-saving medical care for themselves, the US Supreme Court has stated that parents do not have the right to deny their children necessary medical care. The court made this clear in 1944 in Prince v Massachusetts. “The right to practice religion freely does not include the liberty to expose the community or child to communicable disease, or the latter to ill health or death. . . . Parents may be free to become martyrs themselves. But it does not follow they are free, in identical circumstances, to make martyrs of their children. . . .” The American Academy of Pediatrics has taken a firm stance on the rights of seriously ill children to receive lifesaving medical care even if their parents subscribe to religious beliefs that are antithetical to medical care.

In other words, there is no special status granted to medical neglect motivated by religion or by subcultural belief systems.

So it doesn’t matter if a mother thinks that birth is to be “trusted.”

It doesn’t matter that self proclaimed midwives, doulas and childbirth educators tell her that a C-section is not necessary.

And it doesn’t matter that she believes she will be traumatized in the hospital.

It is still, morally, medical neglect.

Of course, in the case of high risk obstetric situations, the medical needs of the unborn child are balanced by the medical needs and the personal wishes of the mother. Since every competent adult is legally entitled to refuse surgery, even indicated surgery, a pregnant woman cannot be compelled to have a C-section. Furthermore, since unborn children have no legal rights, the mother is legally entitled to place her medical needs, or simply her personal wishes, above the medical needs of her baby.

Legally, then, the mother cannot be prevented from committing this form of medical neglect, but that does not change the fact that in high risk situations homebirth is morally a form of medical neglect.

I admit it; I don’t understand it.

I understand if you let your baby die by choosing homebirth because you gullibly accepted the “trust birth” nonsense and didn’t believe that it could happen. And I understand if you let your baby die by choosing homebirth because you had faith that your God would not let it happen, or if He did it would be for a good reason.

But I don’t understand how you can let your baby die a preventable death at homebirth just because you valued your the birth experience more than the life of your baby. Most women I know (including me) would cut off their right arm rather than let harm come to one of their children. But as Lisa Barrett and her supporters make clear, they don’t feel the same way. Homebirth, for them, is about their experience and their rights, indeed ultimately their right to let their baby die if they feel like it. They don’t even bother to pretend otherwise.

Barrett herself has no qualms about the 5 deaths over which she presided. She doesn’t bother to insist that homebirth is a safe choice. She doesn’t bother to insist that it is a loving choice. The key point is the element of choice itself. Sure, 5 women chose to have Barrett preside over the preventable deaths of their babies, and, according to Barrett, that is their right. At no point does Barrett express any regret for 5 separate completely preventable tragic outcomes. Why would she when whether the baby lives or dies is beside the point? She facilitated women’s choices. That’s all that matters for her.

The comment section is filled with one stomach-turning diatribe after another. Not a single one of Barrett’s supporters expresses any regret over the deaths of 5 babies, either. Instead, they are deeply incensed that their “right” to let their own baby die might be threatened.

But for sheer cold-bloodedness, nothing beats yesterday’s testimony of Sarah Kerr, mother of the twin who died less than 2 weeks ago. Kerr asserts, and offers evidence, that she was well aware that one or both of her babies could die.

She had been told by a doctor that homebirth was dangerous for twins:

Ms Kerr said she was admitted to the Women’s and Children’s Hospital for rehydration during her most recent pregnancy when a doctor advised against home birth and said an epidural was mandatory for the delivery of twins in hospital, which she opposed.

She knew that Ms. Barrett had presided over at least 2 neonatal deaths. Indeed, she was at the recent coronial inquest to support Barrett.

In the Coroner’s Court yesterday, Ms Kerr said she was not discouraged from a home delivery despite in August hearing of the adverse outcomes of home births. Ms Kerr told Deputy State Coroner Anthony Schapel she took full responsibility for her actions and was aware of the increased risk of the delivery of twins.

“No one can say I didn’t make an informed choice, I sat through every day of evidence,” she said.

And:

Ms Kerr told the inquest that she and her partner understood and had weighed up all the risks before deciding to have the twins at home.

“My babies aren’t expendable. I love my babies,” she said.

“I didn’t make decisions to put them in danger.”

But her actions belie her testimony. She did make decisions that put those babies in danger and one of the babies died as a direct result. Evidently, those babies were expendable when compared with the birth experience that Kerr desired.

Lisa Barrett has done us a favor. She has stripped the issue of homebirth down to its essentials: the right of the mother to choose her birth experience regardless of whether or not that choice kills the baby. That’s the essence of the homebirth debate, not (purported) safety. It’s all about whether the pursuit of the birth goddess fantasy is more important than the life of a baby.

So here’s what I want to know;

Are you still a birth goddess if the baby is born dead?

After all, you exercised your rights. You didn’t submit to any of those evil interventions. You were free to move in labor. You “trusted your body,” and most importantly, the baby came out of the only approved orifice. Does it matter that the baby was dead?

I suspect that for Lisa Barrett, her supporters, and above all for the mothers of the 5 dead babies who continue to champion her, the fact that the baby was dead is perhaps unfortunate, but definitely not the most important thing.

You could have seen this coming.

In a flourish of righteous zeal, the March of Dimes went on record strongly opposing early elective delivery before 39 weeks gestation. They railed against the increase in NICU admissions; they railed against the increase in C-sections; and they railed against the increase in costs. What they inexplicably failed to take into account was the inevitable increase in stillbirths.

When the Christiana Care Health System in Delaware implemented the March of Dimes recommendations, NICU admissions decreased, C-section rates decreased and cost decreased. And more babies died.

Neonatal Outcomes After Implementation of Guidelines Limiting Elective Delivery Before 39 Weeks of Gestation by Ehrenthal et al published in the forthcoming issue of the journal Obstetrics and Gynecology looked at neonatal outcomes before and after limiting elective delivery prior to 39 weeks of gestation.

All singleton deliveries 37 or more completed gestational weeks during the periods of interest were included. Any fetal death was considered a stillbirth; all others were considered live births and were analyzed separately. Each stillbirth was verified and cause of death determined by review of the hospital medical record by the study investigators…

We assessed change in obstetric practice by determining the percentage of neonates delivered during the early term if the delivery was at 37 or 38 weeks compared with full term if the delivery was 39 or more completed weeks…

We had three primary neonatal outcomes for this study: admission to the NICU for at least 24 hours, fetal macrosomia, and stillbirth…

What did they find?

The new policy achieved the objective of lowering births prior to 39 completed weeks gestation:

… the overall percentage of deliveries during the early term fell from 33.1% to 26.4% (P<.001) after the guidelines were introduced when compared with before. This changed for the cohort overall and for both cesarean and vaginal deliveries. The magnitude of the change was greater for those women with an induced labor and repeat cesarean delivery; the change was greatest for those undergoing an electively induction of labor...

NICU admissions dropped:

The overall rate of admission to the NICU was significantly different between the two periods; before the intervention, there were 1,116 admissions (9.29% of term live births), whereas after, there were 1,027 (8.55% of term live births) and this difference was significant (P=.044). Multivariable logistic regression revealed a reduced odds of a NICU admission (adjusted OR 0.92, 95% CI 0.84–1.01) after the intervention…

But the stillbirth rate more than tripled:

… The overall rate of stillbirth of nonanomalous fetuses differed between the periods with an overall increased risk of stillbirth after the intervention (relative risk 2.14, 95% CI 0.87–5.26, P=.06); this overall increase was not statistically significant. However, stratification by gestational age group of the stillbirth revealed the increased risk in the after group was limited to stillbirths before 39 weeks, which increased from 2.5 to 9.1 per 10,000 term pregnancies (relative risk 3.67, 95% CI 1.02–13.15, P=.032), whereas there was no change in risk of stillbirth at 39 weeks or more (relative risk 0.91, 95% CI 0.23–3.64, P=.896).

Because this increase in stillbirths is so large, the authors reviewed each stillbirth to be sure that they were not the result of risk factors that would have triggered a medically indicated induction.

The authors carefully reviewed the medical records of each stillbirth to identify cause of death and the presence of a maternal risk factor … No definitive cause-of-death pattern emerged.

The reduction in early elective delivery achieved the aims for which the March of Dimes advocated. The reduction in early elective delivery reduced NICU admissions, reduced both the induction rate and the C-section rate, and (although the authors did not measure this) presumably reduced costs. However, these benefits were achieved at a very steep price. The stillbirth rate increased from 2.5 to 9.1 per 10,000 term pregnancies. Instead of 3 stillbirths between 37-39 weeks among 12,000 patients, there were 11 stillbirths between 37-39 weeks among a similar number of patients after reduction in early elective deliveries.

This finding is not unexpected. CDC data shows that the stillbirth rate rises from approximately 3 per 10,000 at 37 weeks to 4.5 per 10,000 at 39 weeks. An increase of 6 stillbirths in a population of 12,000 women is almost exactly what you would expect from reducing deliveries between 37-39 weeks.

This brings us to the heart of the matter. We have traditionally approached the inherent dangers of childbirth by attempting to reduce perinatal mortality. Our efforts have been so successful, that we have turned our attention to reducing perinatal morbidity under the assumption that any reduction in morbidity would be added on to the existing reductions in mortality.

That assumption in clearly not justified. That’s because low rates of perinatal mortality have been achieved, in part, by exchanging mortality for morbidity. There are fewer deaths when you deliver babies before 37-39 weeks (whether for indicated or elective reasons); those babies who otherwise would not have lived experience relatively mild, self limited problems related to borderline prematurity. Attempts to reduce these morbidities by preventing borderline premature delivery may simply result in the deaths of these babies, not an overall improvement in outcomes. That’s certainly what the existing data on stillbirths and gestational age would predict and that’s precisely what happened in this study.

A new Dutch study of homebirth appears in the forthcoming issue of the journal Obstetrics and Gynecology. Planned Home Compared With Planned Hospital Births in The Netherlands by van der Kooy et al. is large, comprehensive and raises troubling questions about the safety of homebirth.

The large amount of data is analyzed in a bewildering number of ways, but the bottom line is that homebirth is safe when nothing goes wrong; in the presence of life threatening problems, homebirth increases the risk of death. Moreover, while homebirth with a Dutch midwife in the absence of complications is nearly as safe as hospital birth with a Dutch midwife, the perinatal mortality rate in both groups is 33% higher than comparable risk women delivered in hospitals by obstetricians just across the border in Flanders.

This study is one of many undertaken in the Netherlands to investigate the high perinatal mortality rate.

The debate on the safety of home births continues in the literature … In The Netherlands, approximately 50% of women give birth under the supervision of a community midwife. The community midwives are independent health care professionals in The Netherlands operating either solely or in group practices.

The proportion of home birth deliveries in The Netherlands has steadily decreased over the last decade but is currently stable at 25% of all births. Several Anglo-Saxon countries are considering the reintroduction of home births based on recent claims of sufficient safety. The reverse trend is observed in The Netherlands, where the debate has intensified since the national perinatal mortality rate showed it to be one of the highest in Europe.

The authors started with a very large and comprehensive database, and analyzed it in a variety of ways. They started with 679,952 births: all the low risk births attended by midwives from 2000-2007. They looked at the difference in perinatal death rates (defined restrictively as intrapartum deaths and neonatal deaths up to 7 days of age) between home and hospital birth, first by analyzing what actually happened, then by constructing hypothetical groups of patients, all of whom were ideal candidates for homebirth.

As primary analysis, we present the results of the natural prospective approach resembling an intention- to-treat analysis. For comparison, we added a perfect guideline approach resembling a per-protocol analysis. The natural prospective approach establishes, within observational constraints, the intrapartum and early neonatal death of planned home compared with planned hospital births.

They further analyzed the data by removing deaths due to the “Big 4”: congenital anomalies, premature births, intrauterine growth retardation and low Apgar scores. The decision to analyze the data with these deaths removed is baffling. It’s baffling because it removes patients who received potentially substandard midwifery care during pregnancy (failure to diagnose anomalies and intrauterine growth retardation as well as failure to appropriately refer patients delivering before term) and it is baffling because it removes babies in need of expert resuscitation. This group is of prime concern when investigating the safety of homebirth because it is this group that faces the greatest risk when born outside the hospital.

Of note, both groups (real-world and hypothetically perfect) differed substantially by maternal characteristics.

Compared with women who planned birth in the hospital or with an unknown location, the women with a planned home birth were more likely to be multiparous, 25 years of age or older, of Dutch origin, and to live in a privileged neighborhood (all of which are favorable conditions). In home birth women, neonatal case mix compared also favorably. Premature delivery was less common as was the prevalence of a Big 4 condition (natural prospective approach home birth 8.7% compared with hospital 10.8% compared with unknown 10.5%; perfect guideline approach home birth 6.5% compared with hospital 8.2% compared with unknown 7.5%, P <001 in both cases).

In other words, the homebirth group was much lower risk than the hospital birth group.

What did the investigators find?

In the natural prospective approach population, crude mortality risk was significantly lower for women who planned to give birth at home (relative risk 0.80, 95% confidence interval [CI] 0.71– 0.91) … compared with those who intended to give birth in hospital (P <.05). All maternal and neonatal risk factors, except living in a deprived neighborhood, showed significant effect sizes in agreement with the expected direction. Mortality was significantly increased in neonates with a Big 4 outcome, especially in those with multiple Big 4 conditions (relative risk 276.6, 95% CI 240.3–318.3).

When looking at what actually happened, the death rate at home was lower than in the hospital, but that reflects both the difference in risk factors between the two groups and the difference in “Big 4” bad outcomes between the two groups. After adjusting for these risk factors and differences in Big 4 outcomes, home and hospital had similar perinatal mortality rates:

The nested multivariable logistic regression analysis showed that in the presence of adjusting maternal factors only (model 2), the intended place of birth had no significant effect on outcome. The maternal factors showed risks similar to the univariable (crude) analysis. The addition of Big 4 case mix adjustment (model
3) showed the intended place of birth to be a significant covariable, yet the contrast of planned home birth (odds ratio 1.05, 95% CI 0.91–1.21) compared with a hospital birth (reference <1) turned out to be nonsignificant. The effect of maternal risk factors was affected to a limited degree by the introduction of the Big 4 case mix.

The perfect guideline approach yielded similar results.

What does this mean? It means that when nothing goes wrong at homebirth, it is just as safe as midwife attended hospital birth. Since complications are uncommon, the overall rates of homebirth and hospital birth perinatal mortality are very similar. However, in the event of an unanticipated bad outcome, homebirth has a much higher perinatal mortality rate than midwife attended hospital birth.

In a nod to the BMJ study published by their colleagues last year, which showed that low risk birth with a Dutch midwife (home or hospital) has a higher mortality rate than high risk hospital birth with a Dutch obstetrician, the authors acknowledge that the mortality rate for midwife attended births, both home and hospital, are higher than expected:

… The data from an otherwise very similar country such as Flanders suggest that more favorable results may be expected in low-risk women in general from a hospital-based system. In Flanders, perinatal mortality is approximately 33% less than in The Netherlands, whereas the cesarean delivery rates show little difference.

The authors compare their results with other homebirth studies, noting that home and hospital populations differ markedly in risk profile and that any study of homebirth outcomes must correct for these differences.

Our conclusions apparently contradict those of De Jonge et al who concluded equal intrapartum and early neonatal outcome of planned home birth compared with hospital birth in apparently the same population… Our principal approach (natural prospective approach) compares neonatal mortality in the actual populations delivering at home compared with the hospital, whereas the approach of De Jonge et al compares neonatal mortality in a hypothetical group resembling our perfect guideline approach population.

What’s the bottom line?

Homebirth is as safe as hospital birth when nothing goes wrong. But when complications occur unexpectedly at birth, hospital is much safer than home.

Lisa Barrett has presided over 5 newborn deaths in the past 4 years and now she is being persecuted just because of a few dead babies:

They have raided my house so I no longer have a computer or a telephone, my husband can’t carry on his business as they took his computer and the children can’t do their school projects as they took their computer too. They have the power to prevent a grieving mother from being reunited with her baby. All for a political agenda, to scare and humilitate…

Five babies are dead and Lisa Barrett insists that she is the victim. It is, as usual, all about her.

Any expressions of sympathy for the 5 sets of bereaved parents? Nah. Any sense of regret for the 5 lives lost? Nope. Any explanation of why those deaths were inevitable? Not in 4 of the 5 cases, and in the 5th she offers an explanation at odds with the one the mother gave and not particularly believable in any case. According to Barrett:

It’s one thing to slander me and reprint downright lies about me, it’s totally another to take a woman’s story of her baby born with hydrops due to a brain infarct at 30 weeks (backed up by an MRI when baby was alive) …

1. Hydrops is whole body swelling generally the result of congenital heart failure. It has nothing to do with the brain.

2. Maybe Lisa just got her terms wrong and she meant hydrocephalus (excess fluid in the brain) instead of hydrops. We know that babies in the breech position have a higher incidence of hydrocephalus. That’s why it is IMPERATIVE, before attempting a breech delivery, to determine the exact position of the breech and whether the baby has any anomalies. So, if the baby did have hydrocephalus, that could have been determine beforehand, and the disastrous vaginal delivery could have been avoided.

3. Brain infarcts (strokes), while rare, are not incompatible with life. Depending on the extent of the damage, babies with prenatal brain infarcts can have mild impairment or none at all.

4. The technology for MRI has improved dramatically, but no MRI machine can tell when an old brain infarct occurred. Barrett’s claim that an MRI showed that an infarct occurred at 30 weeks is bizarre, and, as I mentioned above, does not comport with the mother’s claim that a non-specific brain defect existed that was present “at conception.”

But, hey, what’s a few absurd claims among friends? And why mention those four other dead babies anyway when it’s all about her. The 5 dead babies are merely a pretext for “a political agenda to scare and humiliate” her. It’s all a horrible coincidence. The government wants to prosecute Lisa Barrett for unsafe practice and for practicing without a license and they conveniently found 5 dead babies with which they can do it. Or, as a supportive commentor on Barrett’s site described the babies, “new carcasses to pick over.”

I have news for Barrett and her followers, it’s not about her; it’s about those 5 babies who died preventable deaths. No one cares enough about Lisa Barrett to persecute her; she’s just not that important, and not particularly threatening to anyone but innocent newborns. It’s about the “concept that must not be named” in homebirth midwifery circles: accountability.

Far from being an example of government persecution, Lisa Barrett is an example of rogue practitioners who deny the legitimacy of any regulation, who refuse to acknowledge their own limitations, who recklessly preside over multiple preventable deaths, and who feel accountability is for everyone else but them.

The government of Australia is not making an example out of Lisa Barrett. Lisa Barrett is making an example out of herself. She’s made herself Exibit A in a demonstration of the incompetence, recklessness and mind-boggling narcissism of rogue homebirth midwives.

Five babies are dead, Lisa. At least pretend that you care.

The Home Birth Consensus Summit is underway. There are quite a few people tweeting. I’ve put a a twitter gadget in the sidebar so we can follow the tweets. The tag #hbcs is being used to aggregate the tweets into one stream.

You can add your comments to the Twitter stream. Just include #hbcs somewhere in the tweet.

The theory of the “big lie” is that if you say it loud enough and long enough, people will believe it regardless of how ridiculous it is. Such is the case with Dr. Michel Odent’s claim that childbirth pain is necessary for mother-infant bonding. It is ridiculous, there is no evidence for it, which is not surprising since he made it up.

Odent went public with his fabrication in July 2006:

Women who choose to have Caesarean sections may be jeopardising their chances of bonding properly with their babies, a leading childbirth expert has claimed.

Obstetrician Michel Odent said that undergoing the planned procedure prevents the release of hormones that cause a woman to ‘fall in love’ with her child.

Speaking at a conference in Cambridge, Dr Odent warned that both C-sections and artificial inductions with drugs somehow interfere with the natural production of the hormone oxytocin.

The French expert said: “Oxytocin is the hormone of love, and to give birth without releasing this complex cocktail of love chemicals disturbs the first contact between the mother and the baby…

“It is this hormone flood that enables a woman to fall in love with her newborn and forget the pain of birth.”

He added:

What we can say for sure is that when a woman gives birth with a pre-labour Caesarean section she does not release this flow of love hormones, so she is a different woman than if she had given birth naturally and the first contact between mother and baby is different.

Why is this a big lie?

1. There is no evidence that oxytocin is required for bonding.
2. There is no evidence that a complex interaction like maternal-infant bonding is mediated simply by hormones
3. If oxytocin were the source of bonding, women who received pitocin would be more bonded to their babies than anyone else.
4. Odent and his supporters get around this difficulty by claiming that pitocin is different from oxytocin (false) or that the only oxytocin produced within the brain can have an effect on the brain (there’s no evidence for that).

The claim that childbirth pain is required for bonding is nothing but an offensive smear. No doubt Odent and his supporters wish it were true, so that simply asserted it.

Interestingly, this is not the only time that Dr. Odent has made up a theory to support his personal prejudices. Evidently, he could not stand to support his own wife when she was in labor, so he has made up a theory that the presence of fathers at birth is “dangerous.”

In April 2008, Odent declared:

That there is little good to come for either sex from having a man at the birth of a child.

For her, his presence is a hindrance, and a significant factor in why labours are longer, more painful and more likely to result in intervention than ever.

As for the effect on a man – well, was I surprised to hear a friend of mine state that watching his wife giving birth had started a chain of events that led to the couple’s divorce?

What is the genesis of this theory? Dr. Odent’s personally discomfort with attending the births of his children.

As it happens, at the exact moment our son arrived in the world, the midwife was on her way down the street and I, having made my excuses realising he was about to be born, was fiddling with the thermostat on the central heating boiler downstairs.

My partner did not know it, but I had given her the exceptionally rare, but ideal situation in which to give birth: she felt secure, she knew the midwife was minutes away and I was downstairs, yet she had complete privacy and no one was watching her.

I raise the issue to point out that Michel Odent fabricates his theories about childbirth out of thin air. In this case, as in the case of his offensive claims about childbirth and bonding, he announced a brand new scientific theory without any research and without any evidence. He seemed to think that it was enough that the theory made sense to him and confirmed his personal preferences.

It is easy for lay people to understand that Odent’s “theory” of fathers at birth is nothing more than a projection of his own anxieties and prejudices. It is important for lay people to understand that his “theories” of natural childbirth and bonding are also nothing more than projections of his own anxieties and prejudices.

This piece first appeared in July 2009.

I have received information that Lisa Barrett presided over a 5th homebirth death. The baby boy was born on May 31, 2009 and died due to brain damage on June 2, 2009. This was the mother’s second homebirth with Lisa Barrett. According to the mother:

Sunday at about 8:40 pm our son Ian was born at home. He didn’t breathe at birth despite our midwives’ best efforts. We went to hospital with him where he was put on a ventilator to help him breathe while they worked out what was wrong with him. Long story short, he had severe brain damage and other problems that the doctors reckon happened weeks or months ago, or even at conception. It’s just one of those things that’s out of our hands. He died this afternoon (Tuesday) at about 2:00 in my arms at Flinders medical centre with Darrin & Caleb in attendance as well.

Several days before the birth, the mother, Melissa, had posted that the baby was breech:

… Mine’s breech at the moment, I’m sure he/she will turn anyway, but even if that doesn’t happen, breech babies still come out in one piece most of the time. And my midwife is a big believer in that too, babies come out whatever way they’re positioned and there’s usually a good reason they chose an ‘unfavourable’ one if it turns out that way.

Barrett presided over the homebirth of the mother’s first child (story on Barrett’s website).

The mother continues to support unrestricted access to homebirth. Only 3 months after burying her baby, she attended a pro-homebirth march protesting proposed regulations for homebirth:

And the legislation, if/when it goes through, will NOT stop me birthing at home next time. Yeah there’s a few publicly funded home birth programs, but I wouldn’t qualify for them now because one of my babies died. Never mind that Ian was damaged long before his birth, and in the unlikely event I had another baby with the same issues, there’s nothing the almighty ‘they’ could do about it anyway…

Of note, Barrett presided over this homebirth tragedy, an apparent breech birth, only a month after the death of Jahli Jean Hobbs, a breech baby who also didn’t breathe at birth and died shortly thereafter.

Lisa Barrett’s ears must be burning. They’re talking about her in the Australian Parliament:

South Australian Deputy Coroner Anthony Schapel recently completed an inquiry into the deaths of two babies in separate incidents in 2007 and 2009.

Former midwife Lisa Barrett attended both births.

South Australian Health Minister John Hill told state parliament on Tuesday he had been advised that Ms Barrett was associated with two other incidents involving home births.

On October 7 this year, a twin died, with the Women’s and Children’s Health Network advising the state coroner of the death.

And on October 12, a woman presented at an Adelaide hospital in established labour.

A baby was born safely, but Mr Hill said the mother then took the newborn home, against medical advice.

The minister said the mother subsequently returned to get medical treatment for the infant, accompanied by Ms Barrett.

Mr Hill said he was also advised that Ms Barrett was involved in a coronial investigation in Western Australia relating to the death of a twin during another home delivery.

But Lisa Barrett has done more than recklessly put at risk and then lose the lives of four babies. She has betrayed the ideals of midwifery itself.

Everyone knows that midwife is the person (usually female) who assists women with childbirth. Where did the word “midwife” come from? According to the Free Dictionary:

… Wife in its earlier history meant “woman,” as it still did when the compound midwife was formed in Middle English (first recorded around 1300). Mid is probably a preposition, meaning “together with.” Thus a midwife was literally a “with woman” or “a woman who assists other women in childbirth.” …

Why would women need assistance with a perfectly natural function like childbirth? Childbirth is inherently fraught with life threatening dangers and having an assistant is known to improve the chances that both baby and mother will survive. A more complete definition of “midwife” would be “a person who provides life saving assistance to women during childbirth.”

Note that the definition is not “a person who helps mothers self-actualize by having the birth of their dreams.” Yet midwives like Lisa Barrett, who repeatedly preside over preventable neonatal deaths, have implicitly rejected the traditional lifesaving purpose of midwifery in exchange for a role as new-age life coach, exhorting women to self actualize through giving birth in a non-traditional setting while defying any notion of safety.

To understand just how much someone like Lisa Barrett betrays the heritage of midwifery, it helps to imagine how an African-American midwife of the 1920’s, or a European midwife of the 1500’s or even an aboriginal midwife of the Neolithic period would have greeted the notion that her job was to facilitate self-actualization through birth. They would have been utterly incredulous, assuming that they even understood the concept of self-actualization as opposed to mere survival.

How did some midwives go so wrong? It’s all about market share.

Midwives had the job description “a person who provides life saving assistance to women during childbirth” to themselves until relatively recently. In the past 100 years, though, it has become apparent that obstetricians can fulfill the primary purpose of keeping mother and baby alive well, and in many situations better than midwives themselves. To retain or gain market share, some midwives chose to diversify by redefining midwifery itself.

Instead of striving to give a healthy baby to a healthy mother, these midwives re-purposed birth as an exercise in self-actualization. They turned birth into an extreme sport whereby women are supposed to derive a sense of power and mastery by completing a self imposed task in the face of tremendous physical exertion or pain. It is a deft bit of marketing; the reality is that, in contrast to completing a marathon or climbing a mountain, any woman can have a baby without pain relief and in defiance of safety precautions and most mothers who have ever existed have already done it (or died trying). No matter; these midwives portray unmedicated birth as a rare accomplishment. The midwife’s role is not to prevent death, but to coach women in this effort to self-actualize.

Looked on from that point of view, the inexplicable becomes understandable. The claim that “a live baby is not the most important thing” is impossible to square with the midwife’s traditional role to prevent neonatal and maternal mortality, but it makes sense if the midwife believes her role is to facilitate maternal self-actualization.

The reckless encouragement to “trust birth” in the face of even the most serious complications makes no sense for the midwife who views her purpose as preventing death, but it makes perfect sense if she think that increased difficulty and risk (higher mountain, longer distance) equals greater accomplishment.

And it also explains the obsessive invocation of “choice” whenever the issue of safety comes up. The African-American midwife of the 1920’s, European midwife of the 1500’s and the aboriginal midwife of the Neolithic period privileged safety over “choice” whereas the midwife/facilitator privileges choice above all else.

Lisa Barrett may be a particularly egregious case of the betrayal of midwifery, but she is far from alone. Contemporary midwifery theorists, particularly those in Australia and the UK have provided the philosophical rationale for abandoning the traditional role of the midwife in preventing neonatal and maternal death for the more appealing (to them) role of midwife as facilitator of self-actualization. The emphasis on “normal birth” as a goal in itself, the rejection of rationalism for “other ways of knowing,” and the insistence that “a healthy baby is not the most important thing” represent a betrayal of the essence of traditional midwifery in which the health and safety of baby and mother is paramount.

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