After reading Wren’s story on the 1st anniversary of his birth and death, people have been wondering what they might do to spread the word that garlic for Group B Strep (GBS, the leading infectious cause of neonatal death) is ineffective and indeed has NEVER been tested. For my part, I’ve assembled a GBS Hall of Shame: homebirth midwives and advocacy organizations who blithely risk the deaths of babies to promote a bogus “treatment.”

The following homebirth midwives actively promote the GBS-garlic quackery. And if you cannot trust them to tell (or even to know) the truth on something so utterly basic as the fact that no one has even looked to find out whether garlic prevents the transmission and development of GBS, you probably cannot trust them to know the truth about a lot of other aspects of childbirth.

Barbara Herrera of Navelgazing Midwife

Bellies and Babies

Empowering Birth Blog

Rixa Freeze of Stand and Deliver

Gentle Birth.org

Joy in Birthing

Joyous Birth

Lori the Midwife’s Space

Midwifery/Comadrona

Midwifery Today

Mothering Magazine

Natural Childbirth.org

Dr. Momma at Peaceful Parenting

These are just the most influential members of the GBS Hall of Shame. There are countless other homebirth midwives, doulas and childbirth educators who also counsel garlic for GBS. And of course, everyone refers back to the blithering of Judy Slome Cohain.

These members of the GBS Hall of Shame have put the lives of countless babies at risk for no better reason that to defy medical authority. They have recommended a “treatment” that is not only unproven, it has never even been tested. They have routinely and deliberately misinformed women about the dangers of Group B Strep, and the effectiveness of antibiotic treatment.

To these women I say: You should be ashamed of yourselves and you should IMMEDIATELY alter you websites to reflect accurate scientific information.

I wonder, do you have any words in defense of your reprehensible behavior?

Wren’s story, as told by his father Josh, has been posted on Hurt by Homebirth, today as his Dad requested, on the first anniversary of his birth and death. Just hours after his beautiful and uncomplicated homebirth, and without his parents even being aware that he was ill, Wren died of Group B Strep (GBS) pneumonia.

Months later … we finally got the definitive answer from the autopsy (the police required an autopsy). Wren had died from pneumonia due to an invasive Group B Streptococcus infection. Everything else about him was perfect.

By the time we received the report we had a pretty good idea that’s what it was. You see, in our very first checkup at the OBs GBS showed up in Tweeny’s urine sample. They prescribed some oral antibiotics and she took them. Later, as we were approaching the time to take our 35-37 week GBS test, our midwives recommended Tweeny start putting a garlic clove in her vagina nightly to try and kill the bacteria. Tweeny followed the regimen faithfully.

But what Wren’s parents didn’t know at the time is that homebirth midwives and natural childbirth advocates recommend garlic even though it has NEVER been tested.

Josh explains:

We’ve learned a lot about GBS since then. Here are the things that went wrong in our case:

If GBS ever shows up in your urine during a pregnancy, you must get the antibiotic IV when you go into labor, end of story. It means you are heavily colonized and far, far, far more likely to infect your baby during childbirth.

There is no scientific evidence of any sort that garlic or any other homeopathic remedy will offer any protection from a GBS infection…

We focused all our worries and attention on the pregnancy and the delivery itself. We subconsciously believed that if we just got Wren out and he was healthy, we were home free. Unfortunately, GBS-infected babies will show no signs of the infection for several hours after birth. They’ll have lusty cries and high apgar scores and be perfectly normal. There’s nothing genetically wrong with them, they just get sick. And you need to treat a sickness with medicine.

There is so much to worry about when you’re pregnant, and unfortunately, most of it is out of your control. Preventing GBS is one of the few things that is. All you have to do is get the test, and if you’re positive (and 30% of women are), get the antibiotic IV as soon as you go into labor, and you’ve just (provably) decreased your baby’s chance of getting infected and dying by 99.8%…

Wren’s story made me wonder how and why homebirth midwives (CPMs and some CNMs) recommend an untested “treatment.”

As far as I can tell, it can be traced back to a single article that appeared in Midwifery Today International Midwife in 2004, by the infamous Judy Slome Cohain (who has also claimed that epidurals are akin to drug abuse.) Amazingly, Cohain’s recommended garlic regimen rests on nothing more than a conspiracy theory.

Garlic kills GBS, but because no profit can be made from its use, no research exists on the use of garlic to prevent GBS in newborns. Women are encouraged to consider following the protocols described in this article at 35 weeks and culturing for GBS at 36 weeks, as a proactive way to research the use of garlic to prevent newborn GBS disease.

Cohain acknowledges that garlic for the prevention of GBS disease in the newborn has NEVER been tested, not even once. In fact, her protocol for use of vaginal garlic is just a way for women to “research” whether garlic works. But that’s not how she and others have promoted it. It’s been promoted as a “treatment,” not as an untested personal theory of one individual. In other words, women have been encouraged to risk their babies’ lives based on nothing more than Judy’s defiance of medical authority.

Wren’s father came to a painful conclusion:

It eventually dawned on me that real smoking gun in this situation was our decision to do a home birth. My wife had gotten interested in home birth partly through seeing “The Business of Being Born” and because she didn’t like going to hospitals. She really just liked the comfort of being at home. I was skeptical about the risks at first, but after we went to a couple different providers around Los Angeles, I came up with a mental model that made me comfortable with the idea: home births were like whole foods!

His regret is palpable. Anyone contemplating homebirth should heed his powerful words:

Overall, I just feel like a fool. My entire focus throughout the pregnancy was on the labor, the delivery, Tweeny’s experience, and maybe the first few minutes after birth. Once he had ten fingers, ten toes, and a lusty cry, I figured we were in the clear.

I was wrong, and our poor defenseless baby boy Wren paid for my ignorance. I thought I had everything figured out, I thought we would glide right through it all, I thought we were so cool.

I learned so much on March 9th, 2010. But it wasn’t worth the price.

Two days ago, I commented that unassisted birth advocate Rixa Freeze has inadvertently produced the ideal teaching video for demonstrating how and why babies die in increased numbers at homebirth. (See the video here). The video includes the immediate aftermath of the birth when baby Inga became profoundly blue and lost all muscle tone due to lack of oxygen. Ultimately Rixa was forced to provide mouth to mouth resuscitation and fortunately, the baby responded.

Many people commented to tell me that Rixa herself was spinning the near disaster as though it was nothing serious and that she had educated herself to handle the situation calmly and with ease. Rixa seems to imply that what happened to Inga is the worst emergency that can happen at homebirth and all you have to do is take a neonatal resuscitation course and you will be adequately prepared to save your baby’s life.

The reality is quite different. It’s not the worst situation; not even close. And in viewing the video and using our imaginations, we can conjure very different outcomes in which other women attempting to emulate Rixa precipitate disaster instead.

Just imagine that the baby was born alive but without a pulse.

The mother would have to get herself out of the tub, find a hard surface on which to place the baby, begin CPR and continue mouth to mouth until an ambulance arrived. It would take time to start effective CPR and a lot of time for the ambulance to arrive. The chance of the baby surviving? Very low.

Just imagine if the baby had gotten stuck?

There’s the mother, straining and pushing away in the fecally contaminated tub and the head emerges … then nothing happens. How long would it be before the mother realized that the shoulders were stuck? How would she get herself out of the tub with a baby’s head wedged between her inner thighs? Homebirth advocates like to pretend that the Gaskin maneuver would save the day, but the scientific evidence shows that the Gaskin maneuver is no more effective than any other position for releasing a shoulder dystocia. Who would apply the maneuvers that are the ONLY way to resolve a severe shoulder dystocia? How long would the mother wait, with the baby’s head between her legs, and the baby’s brain being deprived of oxygen until help arrived? Chance of the baby surviving? Even lower.

Just imagine if the baby had been breech with a trapped head?

Once again the mother would be pushing and straining away in the fecally contaminated tub and the baby’s body would emerge but the head would be stuck behind the public bone. Once again she would have to lever herself out of the head with a baby’s body hanging between her legs. No amount of position change is going to resolve the trapped head. A trained attendant would need to apply the correct maneuvers and be vert lucky in order to save that baby. Chance of the baby surviving? Miniscule.

There are many more scenarios that we can imagine, and almost none of them would have ended happily.

Lately a typically goofy mantra has been circulating in the NCB Twitterverse: “Babies know how to be born.” Really? The same babies who aren’t smart enough to take a breath are smart enough to be born? And if the babies “know” how to be born, they also “know” how to die, and they are pretty good doing so, generally when you least expect it.

Rixa and her minions are not going to change their minds. How could they? It would mean admitting that they risk their babies’ lives for a piece of performance art, and they will never admit it.

Nonetheless, the video remains a priceless teaching tool for anyone wondering what it looks like when something goes wrong at a homebirth. Parents contemplating homebirth should watch the video and consider these questions:

Would you be able to live with yourself if your baby did not survive despite your (or the midwife’s resuscitation efforts?

Do you really want to risk the horror of trying to get out of the birth pool with a baby’s head or body between your legs?

Having watched how quickly baby Inga became hypoxic, cyanotic and floppy, do you really think there is enough time to get to a hospital before the baby becomes brain damaged?

Just imagine, and then decide.

Skeptimommy [skep-ti-mom’-ee] noun

Faster than a speeding toddler. More powerful than pseudoscience. Able to leap logical fallacies in a single bound. Look, up in the sky. It’s a bird! It’s a plane! No, it’s Skeptimommy!

Introducing a social network for skeptical parents, Skeptimommy: Parenting Powered by Science! Skeptimommy is a place to connect with those looking to educate themselves about the science behind parenting choices. Most importantly, though, parents will be able to interact with other like minded parents through discussions, chats and to create their own groups organized around specific topics like natural childbirth and vaccination.

It’s not only about serious issues, though. Participants have their own pages and can share their own thoughts and stories, as well as pictures and videos. And unlike a Facebook group, they can preserve their anonymity if they desire.

Membership is open to anyone and I welcome those who disagree to create pages to express their views and take part in discussions and every other aspect of the network.

Skeptimommy is a work in progress. I’m just learning its features and capabilities as well as how to manage it and code for it. I apologize for any glitches or mistakes in advance. I welcome any and all feedback. If you want features that aren’t present, let me know and I will try to add them. Ultimately, this is a place for the people who use it, so Skeptimommy will be very responsive to your imput. Let me know what you think.

When obstetricians counsel patients about the dangers of homebirth they usually stress three points. The first is that a life-threatening emergency can happen with no warning. The second is that a normal birth is a retrospective diagnosis. The third is that the baby will be dead long before there is time to get to the hospital. Predictably most homebirth advocates will dismiss all three reasons. It would be so helpful if obstetricians could show patients what might happen. Now we can.

Homebirth and unassisted birth advocate Rixa Freeze has done what is de rigeur for homebirth advocates: she recorded her labor and birth in excruciating detail and than offered publicly it for the world to admire. I had no intention of watching it, but several people e-mailed me and urged me to do so.

The video includes the immediate aftermath of the birth when baby Inga became profoundly blue and lost all muscle tone due to lack of oxygen. Ultimately Rixa was forced to provide mouth to mouth resuscitation and fortunately, the baby responded. When I first watched it, I was so angry I was shaking, but then I realized that Rixa has done obstetricians a wonderful favor. She has inadvertently produced the ideal teaching video for demonstrating how and why babies die in increased numbers at homebirth.

Before you click away to watch the video, let me set the scene. Rixa is a healthy woman who prides herself on the care she takes with diet and nutrition. She had a completely uncomplicated pregnancy and a short, uncomplicated labor. She was as perfect a candidate for homebirth as there could be. There was absolutely no reason to assume that the baby would have any problems.

You can find Inga’s birth part 2 (surprise unassisted birth) in the pull down menu on Rixa’s YouTube page.

I realize that I could embed the video here, but frankly, it makes me sick and I’d prefer not to even catch a glimpse of it. The relevant portion of the video begins at 7:50 and resolves by approximately 10:01.

In a long post that included endless detail about the labor, Rixa dismisses her daughter’s near death experience in a few brief sentences:

Soon after the birth, Inga lost muscle tone and color. I quickly realized that I needed to perform mouth-to-mouth. Fortunately, I became certified in neonatal resuscitation several years ago, so I knew what to do. It was tricky getting the angle right, since the cord was short. I gave her five breaths. After each breath, she coughed and perked up a bit more.

But by posting the video, Rixa helpfully and inadvertently demonstrates that several important claims of homebirth advocates are nothing but nonsense:

1. Delaying cutting the cord does NOT prevent neonatal hypoxia. The circulation through Inga’s umbilical cord appears to have shut down promptly (possibly because the cord went into spasm when exposed to air). She was born relatively well oxygenated, failed to breath and quickly became profoundly hypoxic, cyanotic and floppy. One minute Apgar score appears to be either 1 or 2 ( 0 for muscle tone, 0 for grimace, 0 for skin color, 0 for respiration and 1-2 for heart rate).

Moreover, if you want the baby to get the benefit of delayed cord clamping the baby must be LOWER than the placenta. Otherwise, because of gravity, the baby may be transfusing the placenta. So to the extent that any blood transfer was taking place while Inga was becoming cyanotic, Inga was probably sending blood away from herself and back to the placenta.

2. Skin to skin contact cannot keep a wet baby warm and it is critical to keep a hypoxic baby warm. By refusing (or forgetting) to dry off and wrap the baby, Rixa and her husband made a bad situation worse by adding cold stress to hypoxic stress.

From Neonatal Resuscitation:

Preventing heat loss during the resuscitation is essential…

Several factors lead to increased heat losses in the newborn infant. The neonate has a large skin surface area–to–body weight ratio, which increases heat and fluid evaporative loss. The fluid loss from the skin … results in massive heat loss… Animals ordinarily attempt to decrease heat loss by decreasing exposed surface area (ie, “curling up”). This reduction in exposed surface area is accomplished by assuming a flexed position; however … depressed infants are unable to accomplish flexed positioning…

The video makes this quite clear. Inga is wet and cooling and as she becomes hypoxic, not only can’t she curl up to conserve heat, she basically becomes unconscious and is as exposed as she can possibly be.

Why is this a problem?

Infants who experience heat loss … use more oxygen. Increased oxygen consumption can be dangerous in infants who are experiencing respiratory compromise. The addition of cold stress in infants who are poorly oxygenated potentially can lead to a change from aerobic to anaerobic metabolism… [C]old stress can lead to both metabolic acidosis and hypoglycemia. Infants with asphyxia have thermoregulatory instability, and hypothermia delays recovery from acidosis.”

3. ANY baby, no matter who the mother is, how healthy she thinks she is, how well she thinks she ate, how fabulous her labor is, can fail to breathe at birth. In other words, a life-threatening emergency can develop from one second to the next without any warning at all.

4. There needs to be someone available who knows how to perform neonatal resuscitation. In this case, starting the resuscitation was enough, but that was purely a matter of LUCK. It easily could have ended very differently.

The only problem appears to be that Inga, who tolerated labor well, and was therefore uncompromised at birth, nonetheless failed to breathe. She only need a little, non-technical help to get started. But Inga could have been born already compromised by lack of oxygen during labor. In that case, she would have required a lot more help. She might have needed real and prolonged positive pressure ventilation, she might have needed CPR, she might have needed intubation. Had she been born requiring any of those things (and none of them were available) she likely would have died.

Fortunately, there was only one complication, a neonatal complication Had there also been a maternal complication, a disaster may have ensued. If Rixa began hemorrhaging, it is possible that she would have been able to perform even the minimal resuscitation necessary. In that case, her husband would have had to choose between attending to the baby or attending to her. That’s not a choice any husband and father wants to face.

5. Had the baby not responded in short order, there NEVER would have been enough time to get to trained medical professionals and save the baby’s brain and life. This is an outstanding illustration of how fast a baby can begin to die even if that baby was not suffering from low oxygen before birth.

All in all, Rixa and her husband, in an effort to brag to the world, have produced a fine teaching video on why and how babies die at homebirth.

A disaster can arise literally from one second to the next. In a true life threatening emergency there isn’t nearly enough time to get to the hospital. And an uncomplicated birth is a retrospective diagnosis. There was every reason to believe that this would be an uncomplicated birth, but it wasn’t. Though Rixa seems to be in complete and utter denial about how close she came to losing Inga, anyone else can see the truth.

Fortunately, Inga did come around relatively quickly. Even though her 1 minute Apgar was only 1-2, her 5 minute Apgar was fine. It is unlikely that she sustained any permanent damage in what turned out to be a 2 minute hypoxic episode. That’s the best part of this video and it was purely a matter of LUCK.

Hopefully, after viewing the video no one, not even a homebirth advocate, will be able to dismiss the very real dangers of homebirth: a life-threatening emergency can happen with no warning, a normal birth is a retrospective diagnosis, and in a life threatening emergency, the baby will be dead long before there is time to get to the hospital.

One of the reasons I enjoy writing about childbirth issues is that every time I fear I have exhausted the topic, I find a new aspect to study. Particularly interesting to me is the sociology of childbirth. That’s why I was delighted to find the paper Selling the Ideal Birth: Rationalization and Re-enchantment in the Marketing of Maternity Care. It is written by Markella Rutherford and Selina Gallo-Cruz, the same women who wrote the piece on midwives and marketing.

This piece, which is a chapter in the book Patients, Consumers and Civil Society edited by Chambre and Goldner, also focuses on marketing, in this case, the marketing of mainstream maternity services by hospitals. In analyzing their results, Rutherford and Gallo-Cruz apply the principles first enunciated by Max Weber, the famous German sociologist and political economist.

For Weber the disenchantment of the world lay right at the heart of modernity… It is the historical process by which the natural world and all areas of human experience become experienced and understood as less mysterious; defined, at least in principle, as knowable, predictable and manipulable by humans; conquered by and incorporated into the interpretive schema of science and rational government. In a disenchanted world everything becomes understandable and tameable …

Weber describes this process of disenchantment as “rationalization.”

On the one hand, there is secularization and the decline of magic; on the other hand, there is the increasing scale, scope, and power of the formal means–ends rationalities of science, bureaucracy, the law, and policy-making.

In the face of rationalization, some have embarked on a process of re-enchantment:

… [(Re)]enchantment will be taken to refer to [a tendency] which insists that there are more things in the universe than are dreamed of by the rationalist epistemologies … [and] which rejects the notion that calculative, procedural, formal rationality is always the ‘best way’. Among other things, the first encompasses everyday explanatory frameworks of luck and fate; long-established or ‘traditional’ spiritual beliefs; ‘alternative’ or ‘new age’ beliefs; and ‘weird science’.

Sound familiar? Rutherford and Gallo-Cruz think so:

In many ways, the contemporary scene of childbirth services can be characterized as one of cyclical rationalization, re-enchantment, and rationalization. In the first half of the 20th century, childbirth was subject to intense rationalization and birth was culturally transformed from a potentially risky even to a pathogen-like state to be medically managed and controlled.

In other words, the technocratic model of birth gained ascendancy. Neonatal and maternal mortality dropped dramatically as a result. But:

As is often the case, rationalization came with dehumanizing consequences … The birth experience was stripped of many of its subjective qualities… [A] techno-scientific approach to birth often denied — and at least downplayed — the sense of mystery, spirituality and aesthetic beauty that have accompanied childbirth throughout most of human history. Scientific rationalization, in Weber’s words, meant that the birth experience was “disenchanted.”

That’s certainly the way that natural childbirth and homebirth advocates see it.

However, the natural birth movement attempts to re-enchant birth by allowing nature — unpredictable and uncontrollable — to have free reign and by recapturing the subjective experience of birth with its sensuality and mystery. This is most clearly seen in the emphasis by homebirth advocates on the spiritual and/or symbolic meaning of birth

Moreover:

[I]t is also seen in the emphasis on the birthing mother’s individual empowerment as well as the important of birth being a shared family experience, as these themes reassert the power of human autonomy and interpersonal connection over the dehumanizing aspects of birth in the technocratic model.

I agree with Rockford and Gallo-Cruz … up to a point. Their description is accurate, but they are not necessarily describing reality, but rather the way that natural childbirth advocates have rewritten history. The “sense of mystery, spirituality, and aesthetic beauty” which supposedly accompanied childbirth “throughout human history” is mostly a figment of NCB advocates’ imagination. Childbirth was viewed as inherently dangerous and agonizing, and most of the spirituality around it was concerned with placating a higher power in order to ensure the survival of mother and baby.

And the claim that birth was “culturally transformed from a potentially risky even to a pathogen-like state to be medically managed and controlled” is yet another bit of wishful thinking. Birth was not culturally transformed is was actually transformed, Previously it had been viewed as extremely risky, not simply potentially risky. Childbirth prayers and the admonishment to pregnant women to write their wills attest to the historical fear of death in childbirth.

Finally, the supposed transformation of childbirth into a “pathogen-like state” reflects the fact that natural childbirth advocates never ask obstetricians how they view pregnancy; they substitute their own fantasies. That’s because natural childbirth advocates have no idea how dangerous childbirth really is and seem to be unable to grasp the fact that childbirth appears safe because of the “technocratic model of birth.”

In other words, faced with discomfort at the rationalization of childbirth, NCB advocates have chosen not to to re-enchant it, but to enchant it to a state that never actually existed. Rutherford and Gallo-Cruz are correct in the emphasis that they place of the process of rationalization and re-enchantment, because that process does drive the demands of NCB advocates. But they neglect to subject to scrutiny the empirical claims on which the process is based.

NCB advocates think that they are attempting to re-enchant birth because they believe that it was “better” that way. The reality is altogether different and quite harsh. The women who lived prior to the advent of modern obstetrics demanded and welcomed the rationalization of childbirth and they did so for a very simple reason: they abhorred the pain and death that had always accompanied it.

Judy Slome Cohain doesn’t know anything about pharmacology, but that doesn’t stop her from making hysterical, unsubstantiated allegations about epidurals.

Two million American women will take an epidural trip this year during childbirth. In most cases, they’ll be ill-informed as to possible side effects or alternate methods of pain relief. In many ways, epidurals are the drug trip of the current generation. Similar to street drug pushers, most anesthesiologists in the delivery rooms maintain a low profile, avoid making eye contact and threaten to walk out if they don’t get total cooperation. Women get epidurals for one of the main reasons so many women smoked pot in the 1970s—their friends are doing it.

Gee, Judy, why don’t you tell us what you really think about epidurals and the women who choose them?

Today, health authorities tout epidural analgesia as the safest, most effective method of pain relief available for childbirth. You could not pull that off on my generation. We lost enough creative artists—Janis Joplin, John Belushi, Jim Morrison and Lenny Bruce—to injectable pain killers. We are aware of the potential of painkillers that are injected into your body—let alone into the delicate spinal cord—by someone else …

While we can figure out why Judy is hysterical: she is desperate to convince women to forgo the most effective form of pain relief in labor, her utter ignorance of chemistry and biology may not be as apparent to the lay people who read her garbage article. Judy is very, very confused. She does not know the difference between intravascular injections and epidural injections. And she apparently thinks the placenta is a sieve, allowing direct transmission of everything in the mother’s blood stream. Judy needs a lesson in pharmacology.

The basics:

1. To get to the baby, a medication needs to get to the mother first. Specifically, the medication must enter the mother’s blood stream. A medication can enter directly through intravenous administration, but if the medication is injected elsewhere, only some of it will find its way to the mother’s bloodstream. Epidurals are injected into the epidural space and that means that considerably less medication (local anesthetics and/or opiods like fentanyl) ends up in the mother’s blood stream.

2. Dose counts. In her frantic rush to indict epidurals, Cohain conveniently forgets to mention that the effect of a medication depends on the dose. Janis Joplin, John Belushi, Jim Morrison and Lenny Bruce OVER-dosed on medication. They were not using the drugs in question for approved uses, either.

3. The placenta is not a sieve. Cohain imagines that whatever is in the mother’s blood stream always and easily crosses the placenta. The reality is quite different. The chapter of the Obstetric Anesthesia Handbook entitled Perinatal Pharmacology has a brief explanation:

Substances in the maternal circulation can cross the placenta by one of four mechanisms. The majority of substances are subject to passive diffusion, in which the compound flows across lipid membranes down a concentration gradient… Some substances are subject to facilitated diffusion, in which a carrier protein in the lipid membrane aids passage of the substance … Glucose crosses from the maternal to fetal circulation in this way. Active transport refers to an energy-requiring process in which a transporter molecule moves the substance … Amino acids appear to cross from the maternal to fetal circulation in this way, co-transported with sodium… Finally, some large molecules, such as immunoglobulins, are transferred via pinocytosis …

And even molecules that theoretically can pass freely across the placenta (passive diffusion), there are additional factors that modify how much gets across. These include utero-placental blood flow, maternal protein binding, and lipid solubility, among others.

The bottom line is that what is gets to the baby is far smaller than the amount of medication injected into the mother’s epidural space. Therefore, if an epidural does not sedate the mother, it certainly won’t sedate the baby.

There’s more than the breathtaking cynicism of Russ Fawcett and the North Carolina Friends of Midwives (NCFOM) behind today’s planned “Birth Freedom March.” The cynicism, of course, is glaringly obvious: homebirth advocates are rallying to support a midwife arrested in connection with the death of one baby and the potentially fatal injury of another, yet they refuse to support the families devastated by these tragedies. Indeed, as I detailed two days ago, NCFOM has made it official policy to avoid any mention of the babies at all.

But that cynicism partly obscures the ugly truth at the heart of the march, indeed at the heart of all homebirth advocacy. Certified professional midwives refuse to be held accountable to anyone for any reason. It doesn’t matter who dies at the hands of a CPM; it doesn’t matter how the baby or mother dies; it doesn’t matter that the deaths could be prevented. All that matters is the ability of homebirth midwives to do whatever they want and get paid for it.

Here we have the specter of a midwife literally arrested for violating the law, trailing one dead and one dying baby in her wake, and it apparently has never occurred to homebirth advocates to investigate her conduct. It is IRRELEVANT to them whether she was incompetent, negligent or possibly practicing in violation of supposed standards of CPM practice. There has been no attempt, nor has anyone even pretended that there will be an attempt to hold the CPM accountable.

The absolute refusal to hold CPMs accountable extends from the lowest to the highest echelons of homebirth advocacy. In the state of Colorado, where the tally of babies dead at the hands of licensed CPMs is appalling and rising, the President of the Colorado Midwives Association acknowledge that the death rate was double that for the state as a whole (including premature babies and babies with serious medical problems) and then utterly dismissed it:

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

That was written almost two years ago. Since then the homebirth death rate has risen further, but there has been no attempt to investigate the extraordinary death toll or to hold anyone accountable. Quite the opposite. Colorado homebirth advocates appeared before the Legislature to declare the program a success and lobby to extend it. If a death rate that is 100% higher than the state death rate is a success, one shudders to think what a failure would look like.

There is no more egregious attempt to deny accountability than that being perpetrated by the organization that represents homebirth midwives, the Midwives Alliance of North America (MANA). MANA is aware and has been aware for some time that homebirth has an unacceptably high rate of neonatal death. Their own data makes that clear and that’s why they are hiding it.

MANA has collected data on the safety of approximately 18,000 planned homebirths attended by a CPM. The number of babies who died at the hands of CPMs is known to the leaders of midwifery, but the rest of us cannot find out how many babies died. That’s because MANA’s official policy says that the data will be released only to those who will use it for the “advancement” of midwifery. Even the leaders of homebirth midwifery understand that acknowledging the number of dead babies is unlikely to “advance” the cause.

And that gets to the heart of the ugly message being sent by today’s planned march in support of “birth freedom”:

There has not been and there will not be any attempt to hold CPMs accountable in any way. It does not matter who has been hurt; it does not matter if professional negligence is involved; in fact, it doesn’t even matter how many babies have died. CPMs have no intention of being held accountable and homebirth advocates have no intention of holding them accountable.

*American midwives who hold a post high school certificate (CPMs and LMs), as opposed to American certified nurse midwives and European, Canadian and Australian midwives who have university degrees. American homebirth midwives have less education and less training than ANY midwives in the industrialized world.

How do homebirth midwives and their supporters handle their mistakes? They bury them, of course.

It has belatedly occurred to Russ Fawcett, President of the North Carolina Friends of Midwives (NCFOM), that the arrest of a homebirth midwife* in the wake of the death of one baby and the serious injury of another is perhaps not the most persuasive reason for legalizing homebirth midwives.

In the wake of his bone headed move sending out a 450 NCFOM word press release without devoting a single word to the baby still hospitalized and still fighting for its life, Russ has rushed to compound the damage with an even more bone-headed “urgent message” to the NCFOM mailing list.

URGENT Request

This message in being sent to all NCFOM members.

The leadership of NCFOM is moving to change the direction of the media. We will be crafting a new press release that is ENTIRELY focused on Wednesday’s Birth Freedom March and legislation, with NO mention of the investigation.

At this time, please STOP ALL COMMUNICATION WITH ALL MEDIA INQUIRES that may arise that have any connection with Amy. Direct all media inquiries to myself (Spigget@aol.com) and Amber Craig (ambercraig@nc.rr.com).

Friends – I think this has been very successful, but not without concern over worsening Amy’s circumstance. Nevertheless, there is a lot of positive press out there, and some negative, but had we done nothing, it could have been all negative.

Please DO NOT CONTACT OR DISCUSS with any media outlets until further notice. This includes leaving comments on newspaper, television and other media’s web pages. It would be better to miss an opportunity at turning around a bad article, or celebrating a good one, than to negatively affect our need to now change the conversation. Please direct any questions about media to myself, or Amber Craig.

I love your enthusiasm! Please help to make our Birth Freedom Walk NCFOM’s biggest event ever. There is lots to do to prepare for Wednesday and we can ONLY do it wit YOUR help. Get on our Yahoo group and get involved. If you are not yet a member of the Yahoo group, please email Rebecca Walton (rw@nchomebirth.com) so that she can invite you.

Thanks,
Russ

As I wrote just last week:

That is what is known as “reframing the conversation.” North Carolina homebirth advocates aren’t going to persuade anyone of anything by discussing the babies injured under the care of CPMs. They don’t even bother to try to justify the conduct of the CPM, her medical judgment (or lack thereof), or the appropriateness of a homebirth in either case. That argument is a total loser, so effort is expended to divert attention from the homebirth disasters.

Once again there has been a homebirth disaster (actually multiple disasters) and NFCOM is following the homebirth playbook. But this time, no one should let the NCFOM get away with it.

How about sending emails to Russ and Amber to let them know precisely what we think of the shameless attempt to bury the babies hurt by homebirth, both literally and figuratively? For those who live in North Carolina, it may be helpful to pass on Russ’ message in full to your state legislator. And it can’t hurt to send a copy to any newspaper or TV station covering the arrest of the midwife or the forthcoming rally to alert them to the deliberate attempt to manipulate press coverage.

It is time to put an end to the legalization of a second, inferior class of midwife, with less education and training than any other midwives in the industrialized world. The evidence of their incompetence continues to mount. Indeed, their own organization, the Midwives Alliance of North America (MANA), spent 8 years collecting safety data on homebirth midwives and is now refusing to to release the number of babies who have died at the hands of homebirth midwives. They, too, are trying to bury the incompetence of homebirth midwives.

The behavior of NCFOM is repugnant. First they planned a rally in support of a homebirth midwife who has been arrested twice and involved in the serious injury of two babies and the death of a third. Then when their callousness was exposed they had two options: acknowledge the injuries and investigate the midwife or ignore the injuries and hope that no one else will notice. When faced with a choice between protecting babies or protecting themselves, they chose themselves.

*American midwives who hold a post high school certificate (CPMs and LMs), as opposed to American certified nurse midwives and European, Canadian and Australian midwives who have university degrees. American homebirth midwives have less education and less training than ANY midwives in the industrialized world.

The foreskin fetishists have struck again. Those who devote their lives to the preservation of foreskins are hurriedly gathering signatures to put a circumcision ban on San Francisco’s November ballot. The measure would assess fines as high as $1,000 and provide for up to one year in jail for someone who performs a circumcision.

The signature-gathering is being run by a committee of about 10, he said. Schofield would not divulge the identities of the committee members, but said several are spending their own money to pay for signature-gatherers to help out. Schofield said he is out there himself — not being paid — collecting the signatures outside grocery stores and in neighborhoods like SoMa, the Castro, the Haight and Noe Valley.

“We say: ‘Would you like to help protect the children from forced circumcision? This is a human-rights issue,'” Schofield said.

Actually, it’s a First Amendment issue, and a ban on circumcision is unconstitutional, because it violates the right to free expression of religion. Circumcision is an integral aspect of Jewish religious practice and is important in the practice of Islam. Of course the foreskin fetishists are not concerned with anything as piddling religious belief.

In fact, [the] proposal contains language that could be construed as an intentional poke in the eye to organized religions calling for circumcision: “No account shall be taken of the effect on the person on whom the operation is to be performed of any belief on the part of that or any other person that the operation is required as a matter of custom or ritual.”

According to Peter Keane, dean emeritus at Golden Gate University School of Law and a constitutional law professor:

San Francisco can have its proposed circumcision ban, or it can have the First Amendment. But it can’t have both…

“It’s not Constitutional. It would be a violation of the First Amendment right to Freedom of Religion — religions like Judaism that require [circumcision] as an essential part of the belief system.”

As Keane explains:

There’s a general First Amendment right stating you cannot make any laws that infringe the exercise of religion,” says Keane. “And a parent has a First Amendment Constitutional right to make choices for his or her child.

Anti-circ activists insist that cirumcision is barbaric. Would a court agree? Keane says no.

If I’m an Aztec and my religion says I have to go high atop a pointed building and tear out someone’s heart — that’s nice, but there’s a murder statute that trumps that. But in terms of state interest in preventing the foreskin of male infant from being detached — that interest is very, very minor… [T]he interest is so marginal, the state does not have the right” to trump freedom of religion.

Anti-circ activists have gone a step too far by trying to ban circumcision. And in so doing, they have revealed their contempt for both organized religion and the US Constitution.