In the wake of the Karen Carr homebirth debacle, homebirth advocates have trotted out a classic homebirth lie: “Babies die in the hospital, too.”

It’s time to set the record straight. No, homebirth advocates, otherwise healthy babies DON’T simply drop into the obstetricians hands unexpectedly dead. Otherwise healthy babies DON’T unexpectedly drop dead for lack of appropriate medical equipment and emergency personnel. The babies whose mothers would be eligible for homebirth (full term, no medical complications of pregnancy, no pre-existing medical conditions) hardly ever die during or after a hospital birth.

The following chart, adapted from Infant, neonatal, and postneonatal deaths, percent of total deaths, and mortality rates for the 15 leading causes of infant death by race and sex: United States, 2007 makes that clear. The chart shows neonatal death rates by cause.

As you can see from the chart, more than 50% of all neonatal deaths are due to prematurity and its complications (respiratory distress, necrotizing enterocolitis) and congenital anomalies. These babies, of course, are not otherwise healthy full term babies.

Consider the other major causes:

Maternal complications of pregnancy- not homebirth candidates
Complications of placenta and membranes (i.e. placenta previa, abruption, chorioamnionitis) – not homebirth candidates.

Together, these causes account for 68% of all neonatal deaths.

The fact is that neonatal death in otherwise low risk women in the hospital setting is quite rare. The best estimate that we can make based on CDC data is a neonatal death rate of 0.4/1000 in low risk, white women at term. That figure actually includes congenital anomalies, which account for nearly 50% of term deaths. In other words, the death rate for otherwise healthy babies is in the range of 0.2/1000 or 2 deaths for every 10,000 births.

Considering that there are approximately 10,000 CPM attended homebirths per year in the US, we would expect only two homebirth deaths per year. Yet in 2009 there were 4 neonatal deaths in the state of Colorado alone in 2009!

Otherwise healthy babies do not die in the hospital, too. Yes, “some” babies die, but those are born prematurely or born to women who would never have been candidates for homebirth.

Existing scientific studies and state and national data estimate that homebirth triples the rate of neonatal death, but that considerably under-counts homebirth deaths, which often appear in the hospital statistics, not the homebirth statistics. The real risk of homebirth is larger, possibly much larger.

Is it any wonder that MANA (the Midwives Alliance of North America) is hiding their homebirth death rates? Those death rates, which also under-count homebirth deaths, must be appalling indeed.

Yesterday, Washington DC based radio show hosted by Kojo Nnamdi explored the issue of homebirth:

A midwife in our region recently pled guilty to two felony counts in the death of a baby delivered at home. The case re-ignited a longstanding debate about “natural” versus “medicalized” birth. The American College of Obstetricians and Gynecologists note increased risks for both baby and mother in home deliveries. Natural birth proponents point to complications from hospital interventions that are often avoidable. We’ll explore the debate.

The guests included Mairi Breen Rothman, CNM; obstetrician David Downing, Brynne Potter, CPM, on Board of the North American Registry of Midwives (NARM); and Dr. George Macones of the American College of Obstetricians and Gynecologists (ACOG).

The discussion was exquisitely polite, with the participants talking past one another in an effort to get in their own talking points. No one questioned anyone on anything he or she said. Alerted about the show by a faithful reader, I called in. (You can read the complete transcript here.)

Nnamdi

Here is Amy in Boston, Mass. Amy, you’re on the air. Go ahead, please.

Amy

Hi. I have a question for Brynne Potter about certified professional midwife. I’m wondering why the Midwives Alliance of North America, which is the sister organization of NARM, is hiding the death rates for the 23,000 certified professional midwife-attended home births that they have collected in their database.

Potter

OK. Well, I can sort of speak — I can certainly speak to that that the MANA dataset that, I think, Amy is referring to is a private dataset that is not CPM’s exclusively. It’s not certified nurse midwives exclusively. It is simply a voluntary collection of data that is not specific to death rates, but specific to all information. And that information is available. Researchers can apply for that information. But mandated reporting — and I’m really speaking back to what Dr. Downing was just saying — mandated reporting review of outcomes really takes places on a state level under licensure and regulation.

And I completely agree with him that one of the benefits of licensure in all 50 states is having the option to create integrated systems in which perinatal review can happen that includes home birth. And it’s not just a review of bad outcomes, it’s a review of all outcomes. And an opportunity to really know what’s going on and what’s happening with birth isn’t just going to be a benefit to be able to analyze how we can make birth safer, but to optimize what systems of care are gonna give women the most choices.

Nnamdi

But I have to be more specific here, Brynne, because Amy specifically accuses your alliance of hiding the death rate of home birth. How do you respond to that?

Potter

Well, first of all, it’s not — she’s referring to the national midwifery organization, the Midwife she’s referring to the national midwifery organization, the Midwives Alliance of North America…

Nnamdi

Oh, I’m sorry

Potter

…that I don’t represent. So I can’t really speak to a specific about some assumption of hiding. What I would say is that MANA’s — I know MANA stands ready to meet the needs of any reporting mandate. It is a private data set in which isolated cases of death would only be isolated cases similar to this case that we’re talking about today. We wouldn’t be able to make any extrapolation of a trend to homebirth. The only place we can do that is from the CPM2000, which was a cohort study that mandated all CPMs to report in prospectively all of their data for one year. And that study was published in the British Medical Journal, and it is absolutely in line with outcomes of all other published studies around homebirth, which is…

What can we learn from Potter’s attempt to avoid answering the question?

1. Potter was familiar with the existence of the database and the refusal of MANA to release the death rates.

2. She asserted that MANA is not obligated to release the death rates because the database is private. It is not; it’s been offered publicly, but that’s irrelevant in any case. MANA knows the death rates of CPM attended homebirth and is keeping that information from American women.

3. Potter implies that the fact that participation in the database was voluntary means that the results are unreliable. I agree that the database almost certainly under-counts the number of deaths at CPM attended homebirth. The real number must be appalling if MANA refuses to release its best case scenario death rates.

4. She tries to claim that it doesn’t matter because mandated state reporting would be more accurate. That’s true; of course, in states like Colorado with mandatory reporting of homebirth deaths, the death rates are extraordinarily high.

5. Potter claims that she cannot address the issue because she is on the board of NARM, the sister organization of MANA, not MANA itself; yet despite that, she is completely familiar with MANA’s stance and can’t offer any justification.

6. She offers the Johnson and Daviss BMJ 2005 paper which is based on the MANA statistics of 2000. She neglects to mention that the paper is a bait and switch comparing homebirth with hospital birth in years extending back to 1969. She conveniently neglects to mention (perhaps she does not know) that the death rate for CPM attended homebirth in 2000 was triple the death rate for low risk hospital birth in the same year.

Potter deserves credit for deftly refusing to answer the direct question and offering a variety of different obfuscations. She would not have gotten away with it if I had been allowed to respond.

Nonetheless, she (and MANA) would have been better served if she had simply pretended that she didn’t know that MANA was hiding the death rates from 23,000 CPM attended homebirths. In essence, she publicly acknowledged the existence of the database, publicly acknowledged MANA’s refusal to release the death rates, and publicly acknowledged that the database almost certainly under-counts the number of babies who died at the hands of CPMs

Of note, she didn’t offer anything remotely approaching a justification for hiding the death rates of CPM attended homebirths from the public.

One of the hardest tasks of parenting is recognizing that your child does not exist to validate you.

That means acknowledging that your child is a separate person, with talents, interests and needs that do not have to mirror yours.

It means that your son does not exist to achieve your dream of baseball stardom. It means that your daughter’s learning disability should not be ignored for fear that others will label her and thereby you as not perfect. And it means that your child should never, under any circumstances, be identified by whether or not HIS birth was the birth of of YOUR dreams.

Just in case you were still wondering whether Gina Crosley-Corcoran is really a narcissist, even after she lives blogged her homebirth and only allowed her sycophants to comment on it (Feminist Breeder doesn’t kill baby; supporters dazzled), Gina helpfully demonstrates that in her mind, it really is all about her.

The title of her current post is Happy 3rd Birthday to my 1st VBAC Baby, a post with all the subtlety of a sledgehammer:

Today is Julesy’s 3rd Birthday. 3 years ago today, my son gave ME one of the greatest gifts he could have, and that was MY first successful vaginal birth. Of course, I had my gorgeous, red-headed, perfectly healthy baby boy, and that was the ultimate prize — but the way he came into the world was a special gift in itself.(my emphasis)

What is wrong with this woman? Her 3 year old did not give her anything. Without ever consulting her child, she chose to risk HIS life by attempting a VBAC. Fortunately, it was successful, but the reality is that she put HIS life at risk in attempting to fulfill HER dream.

My son’s VBAC allowed me to have MY recent homebirth with MY choice of providers. If I’d had a second cesarean, it would have been very hard to find a provider willing to attend even a hospital VBA2C, and downright impossible to find any licensed provider in this state willing to attend a home VBA2C. I sincerely doubt I would have even tried to have a VBA2C if I hadn’t been able to vaginally birth the last time. My son’s VBAC very much meant that I’m sitting here with only one cesarean scar right now, instead of three. That’s huge. And for that huge gift, I will forever be grateful to that child for working with me the way he did. (my emphasis)

These paragraphs couldn’t have more “I’s” and “me’s” if it had been about her. Oh, wait, Gina thinks is about her.

No doubt this will come in really handy for her child’s therapist when he is an adult. It’s one thing to tell your therapist that your mother is a narcissist, that she sees everything through the prism of her own needs. It is another thing altogether to be able to provide permanent documentary evidence that she couldn’t even celebrate your birthday without repeatedly referencing herself, her needs, and whether they were or were not met.

Consider this definition of a narcissistic parent:

The narcissistic parent regards his or her child as a multi-faceted [s]ource of [n]arcissistic [s]upply. The child is considered and treated as an extension of the narcissist. It is through the child that the narcissist seeks to settle “open scores” with the world. The child is supposed to realise the unfulfilled dreams, wishes, and fantasies of the narcissistic parent…

As the therapist will be able to explain, Gina considers this child as the one who allowed her to “settle the score” when deprived of a vaginal delivery with her first child. And by “giving her” a hospital VBAC, the child allowed her to have a homebirth and allowed her to take her self-obsession to masses, live blogging what most people consider to be an intimate moment.

I have a personal message for Gina. She may ignore it, but no doubt she will read it:

Gina, take a long, hard look at yourself and the way that you treat your children. It’s okay to want attention; it’s okay to have needs and try to get them met. However, it is not okay to view your children through the prism of those needs, particularly the desperate needs you seems to have for attention and for validation.

Your son did not “gift you” with a VBAC, and your daughter did not “gift you” with a homebirth. And most importantly, your eldest child did not fail to “gift you” with the validation that you crave. They were born, through no agency of their own and with no intention to meet or not meet your needs.

It is wrong, wrong, wrong to expect your children to serve your needs. Adults should look to other adults for attention. And when it comes to validation, adults should enter therapy if they feel they lack the inner resources to provide their own validation.

Talk to your husband, talk to your friends, talk to a therapist. Don’t talk to your children about your needs and absolutely, positively do not create a permanent, written record of whether or not they met your needs (which is not their job, in any case).

Your children are not here to meet your needs. You are here to meet THEIR needs. Their number one emotional need is to be valued for who they are, not what they’ve done for you lately.

And next year, when your son celebrates his 4th birthday, see if you can celebrate with him, instead of celebrating yourself at his expense. His birthday is about him, not about you. The sooner you learn that, the better for all your children.

Homebirth midwife Karen Carr forgot Mark Twain’s famous admonition: “It is better to keep your mouth closed and let people think you are a fool than to open it and remove all doubt.”

It wasn’t enough to let her actions speak for her after they led to the entirely preventable death of a baby at homebirth. It wasn’t enough to let her actions speak after she had plead guilty to felony charges in exchange for avoiding a manslaughter trial. Apparently, she felt she had more to say, so she gave an interview to The Washington Post. You can read the interview here: Midwife Karen Carr, convicted in Alexandria baby’s death, is under investigation in Md.

Ms. Carr’s observations on homebirth and the deaths over which she has presided (there have been more than one) have ignited a firestorm of protest. In the nearly 300 comments to data, most readers have expressed their horror at Carr’s cavalier attitudes toward neonatal death at homebirth.

Carr’s guilty plea to felony charges came in the wake of presiding over the death of a breech baby who’s head became stuck for more than 10 minutes before Carr even bothered to call 911.

The baby’s position wasn’t the problem, Carr said; the problem was that the baby’s head became stuck.

That is the obstetric equivalent of insisting that ‘it wasn’t the fact that I pushed him off a ten story building that killed him; the problem was that he hit the ground.”

It’s nothing more than a brazen attempt on Carr’s part to avoid responsibility for the choices that SHE made and the actions that SHE took. The mother had been counseled by every other medical provider to have a C-section precisely to avoid the “problem” of a trapped head and the neonatal death that is the nearly inevitable result.

According to prosecutors, it was this unwillingness to accept responsibility that led to Carr’s indictment. Apparently she still hasn’t learned a thing from the baby’s death and her acknowledgment of legal responsibility. As Alexandria prosecutor Krista Boucher points out:

The lack of integrity and veracity demonstrated by the defendant’s taking advantage of a plea arrangement to her benefit, standing before the court under oath and affirming that she was pleading guilty because she was in fact guilty, and then turning right around and claiming that she did nothing wrong, is extremely disturbing… It evidences the same arrogance that got her into trouble in the first place, and it does not bode well for her future clients.

Don’t worry, though. Carr has been “traumatized” by what happened. No, not by the baby’s death; don’t be ridiculous!

“I was very traumatized by attending that birth,” Carr said, hands clasped. “It really shook my faith in the process in a way that nothing ever has done. It was just — a very desperate, heartbreaking situation to be in.”

Her faith in the process? Of course. It is axiomatic in the homebirth community that the key to a safe, successful outcome is to simply “trust birth.” Carr “trusted birth” and it killed a baby. How traumatic for her.

It apparently never occurs to her that her “trust” was utterly misplaced. Birth is not inherently safe; it is inherently dangerous. Only an uneducated fool would think otherwise.

Anyone familiar with the world of homebirth advocacy will recognize that these are not merely Carr’s bizarre personal opinions. Carr is accurately reflecting the views and philosophy of Ina May Gaskin, American homebirth’s Fool-In-Chief. Carr is a walking, talking exposition of the “Midwifery Today” school of thought, complete with the trail of dead babies in her wake. She is a perfect example of what happens when we allow high school graduates to give themselves pretend degrees in midwifery and foist themselves on an unsuspecting public.

If we learn anything from this tragic episode, it should be this: American homebirth midwives (CPMs) are grossly under-educated, grossly under-trained and arrogant in their ignorance. They should not be licensed anywhere, because they are unfit to care for pregnant women and their babies.

I have written repeatedly about the fact that the Midwives Alliance of North America is hiding the death rates for certified professional midwife (CPM) attended homebirths. Not only does this deliberately deprive American women of critical data about the safety or lack thereof of CPMs, but it also deliberately deprives women of critical safety data about the typical claims of homebirth midwives.

When MANA is forced to release these statistics, as they will eventually be required to do, here are some questions that we can expect to have answered.

What are the death rates for breech deliveries attended by CPMs?

Homebirth midwives like to insist that breech “is a variation of normal,” that obstetricians are no longer appropriately trained in the delivery of the breech infant, and that homebirth midwives have the education and experience needed to safely deliver breech babies. MANA is in possession of the data that will answer the question, and, I suspect, demonstrate beyond a shadow of a doubt that homebirth breech delivery has appalling death rates.

What are the death rates for postdates deliveries attended by CPMs?

Homebirth midwives like to say that “babies are not library books,” due on a certain date. They conveniently elide the mass of scientific evidence that shows that the stillbirth rates begins to rise even before the due date and continues to rise dramatically after 42 weeks gestation. There is a growing body of scientific evidence that even earlier induction for postdates at 41 weeks is effective in preventing stillbirth. MANA is in possession of data that will address the question of expectant management of postdates pregnancy, and, I suspect, demonstrate beyond a shadow of a doubt that postdates homebirth results in an extraordinarily high perinatal death rate.

What are the rates of intrapartum stillbirth for CPMs?

In the hospital setting, intrapartum stillbirth in a term infant is an exceedingly rare event. Is it as rare at homebirth? It is axiomatic in the homebirth community that electronic fetal monitoring is literally worse than useless, failing to improve outcomes but increasing C-section rates. MANA is in possession of data that will address the question of whether intermittent monitoring at homebirth is safe, and I suspect that the MANA data will demonstrate and appalling level of intrapartum stillbirth.

What is the rate of uterine rupture and perinatal death at homebirth VBAC?

It is an article of faith in the homebirth community that VBAC is safe and that virtually any woman, regardless of how many C-sections she has had in the past and regardless of previous obstetric outcomes, is an excellent candidate for VBAC. MANA is in possession of data that will address the issue of uterine rupture at homebirth VBAC, and, I suspect, will show that homebirth VBAC results in disaster and death in an unacceptably high number of cases.

The MANA database is a treasure trove of information, not merely on the safety of homebirth with a CPM, but on the safety of a variety of empirical claims made by homebirth midwives. Of course, if the data shows, as I suspect, that those empirical claims are utter nonsense, it would hardly serve the “advancement of midwifery” to release them.

In fact, I’d be willing to bet a considerable sum that the MANA database represents a major blow to homebirth midwifery. When the data are released, and there is no doubt that eventually they will be released, it will show that MANA is deliberately withholding the death rates because they will establish, once and for all, that homebirth midwives are grossly undereducated, grossly undertrained, and purveyors of preventable perinatal deaths.

I finally read something on Mothering.com with which I agree. Unfortunately, it was written in the wake of yet another one of the dozens of homebirth deaths I’ve read about on MDC in the past few years.

This is from Loocy:

A beautiful, perfect baby girl is dead. A previously joyful mother and father are grieving.

Read this thread again. If those of you who told the OP that the first midwife was a fearmonger and should be ditched ASAP, that the OP needed to disregard professional assessments and ‘trust her body’ can read your words now and still hold your sniffy, holier-than-thou, sanctimonious opinions – you are odious. Vile. And dangerous.

What got Loocy so upset? She was upset by the fact that a mother with newly elevated blood pressure (130/100), was encouraged to dismiss her midwife and find another who would ignore the possibility of pre-eclampsia.

On 4/17, the mother wrote:

… After a last minute rescheduling to a much more stressful time of day, I came up with a higher than normal BP reading at my regular visit with my midwife, and she immediately changed gears into “worry mode” – she felt like a totally different person than the woman we hired, and it seemed like a lot of freaking out for a difference of 10 diastolic points.

She ORDERED me to take 3 days off of work and RELAX…

Then she sent an e-mail saying that we needed to take her care much more seriously

The story veers off into personal drama. Evidently the midwife did not feel safe in the presence of the mother’s partner and insisted that henceforth the mother must come to her office. Getting back to the medical issues, at a subsequent appointment:

She took my BP again, decided she didn’t like the number, and that she needed to refer me to high-risk OB in a hospital – she told me they’d most likely put me on medication and possibly induce me, but that I could always refuse the induction…

I went AMA and didn’t go to the hospital

Needless to say, she was encouraged in her defiance by most of the commentors. Interestingly, it was another midwife, Nashville Midwife, who interrupted the rah, rah, you go mama cheering to point out:

… Elevated blood pressure in pregnancy is serious, whether or not the liver is involved. The main risks of PIH are stillbirth, placental abruption, kidney damage, and stroke.

And sure enough, the baby died this past weekend, apparently during a 4 day labor. The mother can’t figure out how this happened:

I went through 4.5 days of labor, the last day very intense with painful contractions one on top of the other. Labor was progressing, and we were hoping for a mother’s day baby, but we (and our midwives) were starting to get worried that labor was lasting so long. It seemed like the head was presenting in a non-flex position and I still had a cervical lip (but was soft and fully effaced) – those factors were making labor slightly difficult, but other than that, the baby was still positioned well and had a healthy heartbeat around 2pm.

We decided to transfer to the hospital … the senior-most OB staff were unable to find any indication of fetal heartbeat and informed us that there was no way to resuscitate or otherwise fix the situation.

Defiant, even though her actions led to the preventable death of her baby, the mother boasts:

I gave birth to a beautiful little stillborn girl later that night – pushed her out in about 25 minutes even though the medical staff insisted it would take no less than two hours.

And, inevitably:

I checked myself out of the hospital AMA this morning (they wanted an extra 24 hours of observation beyond any treatment) …

Because what could those medical people know? No doubt if she had followed her original midwife’s advice to see an obstetrician, he would have played the dead baby card …

… and, tragically, he would have been right.

Here’s the original comment thread.

As I mentioned yesterday, Gina Crosley-Corcoran, The Feminist Breeder, aggressively demonstrated her astounding willingness to believe nonsense by washing out her vagina with soap in an attempt to prevent her daughter from acquiring Group B strep sepsis.

Unfortunately, as is often the case with homebirth advocates, that willingness to believe nonsense extends to infant care. She has “diagnosed” her daughter’s breastfeeding difficulties as “colic” and is dragging the baby off to a chiropracter for “treatment.” What’s wrong with Jolene?

… She has two modes: asleep, and mad. There’s pretty much no in-between. If she’s ever awake and NOT mad, it’s only a matter of mere minutes before her face screws up and the screaming starts. She pretty much hates side-laying nursing, too…

Here’s what I’m seeing: She starts nursing, soon she chokes and pulls away, and by the end of the session, she’s angry. She often starts crying in pain (obvious pain) with my boob still in her little mouth. My god – can you imagine how sad that sound is? Sometimes she just wakes up crying, and sometimes, she just fusses for hours on end for no apparent reason…

Hmmm. What could it be? I know, her spine is out of alignment! That makes sense … Oh, wait, it makes no sense at all. Why on earth does anyone believe such complete and utter nonsense?

It’s not like hasn’t been investigated. Chiropractic spinal manipulation for infant colic: a systematic review of randomised clinical trials (2009) by Ernst reviewed the world literature:

Collectively these RCTs fail to demonstrate that chiropractic spinal manipulation is an effective therapy for infant colic. The largest and best reported study failed to show effectiveness. Numerous weaknesses of the primary data would prevent firm conclusions, even if the results of all RCTs had been unanimously positive…

This is hardly surprising, since there is no plausible mechanism for spinal manipulation to have any impact on colic. How is it supposed to work? How does it supposedly work? According to Biodynamic Craniosacral Therapy Association of North America:

… [A]ll healthy, living tissues subtly “breathe” with the motion of life – a phenomenon that produces rhythmic impulses which can be palpated by sensitive hands. The presence of these subtle rhythms in the body was discovered by osteopath Dr William Sutherland over 100 years ago, after he had a remarkable insight … that cranial sutures were, in fact, designed to express small degrees of motion. He … eventually concluded it is essentially produced by the body’s inherent life force, which he referred to as the “Breath of Life.” Furthermore, … the motion of cranial bones he first discovered is closely connected to subtle movements that involve a network of interrelated tissues and fluids at the core of the body; including cerebrospinal fluid (the ‘sap in the tree’), the central nervous system, the membranes that surround the central nervous system and the sacrum.

That makes sense … NOT!

Okay, it’s nonsensical, but what’s the harm? Plenty, it turns out.

The Dutch Medical Journal reported on a case of infant death at craniosacral therapy.

A brief review of the literature reveals that this is not the first such tragedy. According to Adverse Events Associated With Pediatric Spinal Manipulation: A Systematic Review published in the journal Pediatrics, there have been at least two other infant catastrophic injures, a 3 month old boy who died as a result of a subarachnoid brain hemorrhage, and a 4 month old boy render quadriplegic after treatment for what turned out to be a spinal tumor.

In other words, not only is craniosacral “therapy” absurd; it can kill. So why are lay people like The Feminist Breeder embracing such a ridiculous, ineffective and potentially deadly therapy? It can’t be because “nature” was filled with chiropracters bending people’s spines to solve their medical problems.

The Feminist Breeder is taking her infant daughter off to the chiropracter for the exact same reason she washed her vagina out with soap to prevent Group B strep neonatal sepsis:

It fulfills the MOST important criteria for a natural childbirth “treatment”; it is a form of defiance of authority. And if that isn’t a good enough reason for an NCB advocate to subject her baby to a nonsensical, ineffective and potentially deadly “treatment,” what is?

Sometimes I get discouraged.

This blog rests on the premise that anyone is capable of learning the basics of science, medicine and logic and using that knowledge to see through the quacktivist claims of the purveyors of pseudoscience. But then I read about the pure idiocy spewed forth on a topic like Group B Strep and I wonder if that is an over-optimistic sentiment.

How could anyone be stupid enough to believe that washing your vagina out with soap will prevent neonatal meningitis or pneumonia? (Feminist Breeder, I’m thinking of you, among others.)

Let’s step back for a moment and consider what you ought to know before you can make an informed decision to decline antibiotics for Group B Strep (GBS) and to substitute washing the vagina with Hibiclens (chlorhexidine) instead.

1. How does GBS hurt babies?

2. What are the chances of a baby contracting GBS?

3. What is the neonatal death rate of GBS?

4. How does IV antibiotics change the risk of a baby contracting and dying of GBS?

5. Has Hibiclens been shown to be as effective as IV antibiotics?

The latest information on Group B Strep can be found in the Prevention of Early Onset Group B Streptococcal Disease in Newborns published in the April edition of the journal Obstetrics and Gynecology.

1. How does GBS hurt babies?

Group B streptococci … emerged as an important cause of perinatal morbidity and mortality in the 1970s. Between 10% and 30% of pregnant women are colonized with GBS in the vagina or rectum… Invasive group B streptococcal disease in the newborn is characterized primarily by sepsis and pneumonia, or, less frequently, meningitis.

2. What are the chances of a baby contracting GBS?

For the past 30 years, GBS has been the most common cause of neonatal sepsis. The actual incidence is 1.7/1000 live births (approximately 7200 cases per year).

3. What is the neonatal death rate of GBS?

More than 15% of affected infants will die (approximately 1080 deaths).

4. How does IV antibiotics change the risk of a baby contracting and dying of GBS?

Since the early 1990s, national guidelines have resulted in an 80% decrease in the incidence of early-onset group B streptococcal sepsis, from 1.7 cases to less than 0.4 cases per 1,000 live births.

5. Has any other treatment been shown in large clinical trials to be as effective as IV antibiotics?

No, absolutely not.

In fact, large scale studies done the use of Hibiclens in low resources settings where IV antibiotics are unavailable show that it is in INEFFECTIVE in preventing neonatal group B strep sepsis. For example:

Chlorhexidine Vaginal and Infant Wipes to Reduce Perinatal Mortality and Morbidity: A Randomized Controlled Trial:

… We performed a placebo-controlled, randomized trial of chlorhexidine vaginal and neonatal wipes to reduce neonatal sepsis and mortality in three hospitals in Pakistan….

RESULTS: From 2005 to 2008, 5,008 laboring women and their neonates were randomly assigned to receive either chlorhexidine wipes (n=2,505) or wipes with a saline placebo (n=2,503). The primary outcome was similar in the chlorhexidine and control groups (3.1% compared with 3.4%; relative risk 0.91, 95% confidence interval 0.67–1.24) as was the composite rate of neonatal sepsis or 28-day perinatal mortality (3.8% compared with 3.9%, relative risk 0.96, 95% confidence interval 0.73–1.27)…

CONCLUSION: Using maternal chlorhexidine vaginal wipes during labor and neonatal chlorhexidine wipes does not reduce maternal and perinatal mortality or neonatal sepsis…

What is Hibiclens anyway?

The active ingredient in Hibiclens is chlorhexidine gluconate also known as (1,1′-hexamethylene bis [5-(p-chlorophenyl) biguanide]di-D-gluconate). According to the FDA:

… adequate and well-controlled studies in pregnant women have not been done. Because animal reproduction studies are not always predictive of human response, this drug should be used during pregnancy only if clearly needed.

And:

It is not known whether this drug is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised …

Why are homebirth and natural childbirth advocates washing the vagina out with Hibiclens instead of using IV antibiotics?

It certainly can’t be because it works, since large scale studies show that it doesn’t.

It certainly can’t be because it doesn’t matter since GBS is the leading infectious cause of newborn death.

It certainly can’t be because IV antibiotics don’t work since they have reduced neonatal GBS deaths by 80%.

It certainly can’t be because Hibiclens [chlorhexidine gluconate also known as (1,1′-hexamethylene bis [5-(p-chlorophenyl) biguanide]di-D-gluconate)] is “natural.”

So why do women like The Feminist Reader wash their vaginas out with soap to prevent their babies from dying of Group B strep pneumonia or meningitis?

Because it fulfills the MOST important criteria for an NCB “treatment”; it is a form of ignorant, immature, self absorbed defiance of authority. And if that isn’t a good enough reason for NCB advocates to risk killing their babies, what is?

What a coincidence!

In honor of Mother’s Day, Ina May Gaskin, godmother of gobbledly-gook in midwifery has discovered that there is a “crisis” in maternity care, a crisis so enormous, so comprehensive, involving so many well white women that it can only be solved by … midwives!

Isn’t that amazing. Just like Amy Romano, but completely independently, both midwives realized that all solutions to problems in maternity care involve paying more money to more midwives. But while Amy Romano preferred to write a subtle, understated smear that tugs at your heart strings, Ina May shows us how it’s really done.

1. Declare that there is a “maternity crisis.”

That’s where both she and Amy Romano started.

2. Supply an anecdote to “prove” that obstetricians don’t know what they are doing.

It is absolutely critical to the natural childbirth project to convince women that doctors don’t know what they are doing, and willfully and cheerfully risk the lives of women and babies to promote a secret agenda.

Romano chose a heart tugging anecdote where an non-obstetrician made a mistake. Ina May goes for farce when recounting the story of a North Carolina obstetrician who made the mistake of believing a patient and failed to diagnosis a hysterical pregnancy (pseudocyesis).

According to midwifery “logic,” if one obstetrician makes one mistake (or, as in Romano’s case, a non-obstetrician fails to diagnose an obstetrics problem) that means that ALL obstetricians, everywhere and at all times, cannot possible be trusted to do anything right.

3. Insist that the dramatic progress of modern obstetrics is an illusion and that obstetricians oppressed midwives because they were afraid of economic competition. As Marketing Professor Craig Thompson has written:

“… [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. As this critical narrative goes, the medical profession leveraged its emerging economic-political clout and cultural affinities toward ideals of scientific progress and technological control to displace midwives (both socially and legally) as the authoritative source of childbirth knowledge.”

4. Lie about the scientific facts.

Ina May claims that the World Health Organization recommended a 10-15% C0-section rate, and “neglects” to mention that the recommendation has been WITHRAWN because, as the WHO acknowledged, it was fabricated without any scientific evidence to support it.

Ms. Gaskin claims that the maternal mortality rate doubled in the past generation, when that is flat out false. The purported “increase” is almost entirely due to two separate revisions in birth certificates that enlarged the classification of maternal death to include deaths that previously would not have been included. In addition, Ms. Gaskin conveniently “forgets” to mention that maternal mortality has actually DROPPED in the past two years for which we have data.

Ina May also neglects to mention the fact that in the 100 years after its advent, modern obstetrics dropped the neonatal mortality rate 90% and the maternal mortality rate 99%.

5. Cynically ignore the real crisis in the care of women around the world who die for lack of access to modern obstetric care, and pretend that the “crisis” is that there aren’t more midwives to care for well white women in first world countries. Cynically ignore the fact that the leading causes of maternal mortality in the US are complications of pregnancy and pre-existing medical conditions like heart disease and kidney disease. Midwives can have no impact on these deaths because they don’t care for these patients.

6. Insist that obstetricians overuse technology, AND at the very same time, under-use it. The battle cry of midwifery advocates is usually that obstetricians have “ruined” birth with their insistence on using technology, yet both Romano and Gaskin have invoked medical mistakes where the under-use of technology led to the bad outcome.

Which is it? Do obstetricians overuse or under-use technology? Or does it not really matter, when the goal is to use any means at hand to disparage obstetrics and encourage mistrust of obstetricians?

7. Sadly, but firmly insinuate that obstetricians don’t want to help women; they want to make money, show off, and get to their golf games as quickly as possible. Regretfully, but firmly imply that obstetricians actually want to HURT women by imposing their fancy technologies to ruin otherwise perfect labors simply so that they can apply even more technology.

And declare (this is the big finish), the only way you can prevent obstetricians from victimizing you, hurting you and profiting from you is …. give more money to midwives.

Tina Fey takes on homebirth.

Obviously this is a parody. If it were a real homebirth video there would be an inflatable kiddie pool filled with fecally contaminated water.