No Matter How You Run The Numbers, The Result Remains the Same:

Homebirth, with or without a non-CNM midwife, is more dangerous than giving birth in the hospital.

Keeping in mind that homebirth midwives all claim to work with only low-risk women, lets look at the numbers I posted Friday:

“This Must Be a Joke” rants and raves in the comments of the previous post, calls me biased and stupid, and claims I shouldn’t have used the numbers from 32 weeks on. Other than the insults, she has a point. (I assume she is a she. If not, I apologize profoundly.) So I re-ran the numbers. Several times. Keep in mind that homebirth midwives all claim to work only with low-risk women. If women are having footling breech babies at home, it is only because some CPMs and DEMs lack the education and skill to diagnose the problem ahead of time and are shocked to see feet coming out first down the birth canal.  Or they believe that breech is just a “variation of normal” and low risk enough for birth at home. But I digress. We’ll compare the “other midwife” category (Notice this is midwives who are not CNMs we’re talking about here. There are no women in this category who intended to give birth with their OB at the hospital and somehow ended up giving birth with a midwife in their car on the way instead) with both the hospital numbers that include high risk hospital births — those attended by all hospital caregivers — and those that are only low risk, which are the births attended by CNMs.

Here are the numbers from 37 weeks on:

 hmmm. Looks like homebirth midwives are doing even worse in comparison to the hospital than they were in the 32 weeks-and-beyond numbers. How could that be? Because the 32 week numbers were increasing the hospital death rates! Once the pregnancy approaches term, hospital numbers improve, but it sure looks like the homebirth midwives don’t. Keep in mind, homebirth midwives claim to work only with low-risk women. But wait! These numbers include those babies born before 39 weeks. We all know those are slightly more dangerous than those born after 40 weeks. What happens if you throw out weeks 37 through 39?

 

Even WORSE numbers for homebirth! The homebirth death rate with an other-than-CNM midwife is now virtually TWO TIMES the higher risk hospital numbers, and more than three times the lower-risk CNM numbers. Keep in mind that homebirth midwives claim they work only with low-risk women. But wait, that 42nd week can get dicey! Totally ignoring the fact that most homebirth midwives claim there’s no expiration date on pregnancy, lets just take that out of the numbers. SURELY that must be the problem for homebirth midwives.

 

 

Hmmmm…nope!  While in all three cases above — while their numbers are slightly higher than CNMs working in the hospital — homebirth CNMs have a much more reasonable rate of death than other homebirth midwife death rates, which are yet again twice as high as higher risk hospital rates and more than three times as high as lower risk hospital rates.

Ahhh, but then we have another commentor, NaturalMamaNZ, who takes issue with my numbers. She complains that I have not properly accounted for confounding factors. Fair enough, she could be right. However, a confounding variable in this case would be high risk situations- but it’s quite an anomaly because midwives themselves accept high risk patients — all the while claiming to accept only low risk patients — and create high risk situations (remember, there’s no expiration date on pregnancy…) so there is really no way to seperate that from the data because that would be “cherry picking” good numbers, just like Johnson and Daviss did in NaturalmamaNZ’s favorite study. The data shows what it shows because of the current unregulation of midwifery and the carelessness in their want to accept patients of all levels of risk. Other confounding variables can easily be accounted for by changing the comparison groups to make them more alike. In this case, I changed the search criteria to include the same criteria Johnson and Daviss used – U.S. non-hispanic white neonates of 37 weeks + gestation. I further narrowed the criteria to women between the ages of 25 and 45 attended by the “other midwife” category, in order to remove any higher risk teen moms. I also only included those women with 12 years or more of education, meaning those who are, at a minimum, high school graduates.

 

 

 

WHAT? These numbers are even higher!!! Two times higher than the higher risk hospital births, the ones that include all caregivers, malpresentations, fatal birth defects, and so on,  and MORE THAN THREE times higher than those numbers for the low risk women who deliver with CNMs in the hospital.

But I can hear it now. “This must be a joke” will not stand for the fact that I left women up to age 45 in the group, because we all know they are higher risk. And those numbers include other potential confounders — single mothers, lack of prenatal care, twins, etc., etc. OK. Lets run these numbers, then: non-Hispanic white, singleton, 37 weeks + gestation neonates born to married women ages 25-39 with a minimum 12 years of schooling who started prenatal care before the 7th month of pregnancy. Surely these women — who are the epitome of the woman who hires a homebirth midwife in the US — will have stats that show that homebirth is safe!

 

I’m shocked. SHOCKED. (that’s sarcasm, for those of you who couldn’t tell. By the time I ran these numbers, I had ceased to find any of it shocking. I kept thinking I would be proven wrong with the next set, but alas, it wasn’t the case). These numbers are just as bad. Two times as high for the higher risk hospital births, and three times as high for the lower risk ones.

These numbers are sad. Yes, sad. They represent PREVENTABLE deaths.  Preventable by restricting the kinds of births that homebirth midwives can attend and requiring much higher standards for CPM/DEM education.  Or, better yet, doing away with CPMs and DEMs altogether and requiring a CNM to attend h0mebirths.

(Keep in mind that homebirth midwives claim they work only with low-risk women.)

Guest Post: How to Choose a Safer Homebirth Midwife — A CNM’s Perspective

Please welcome today’s guest blogger, Deb O’Connell CNM, MS. Deb has a private homebirth and well-woman gynecology practice in Carrboro, NC. She has been a midwife for 11 years and has attended over 800 births. Deb has experience teaching at the university level while managing low and high risk pregnancies, community hospital midwifery, gynecological clinics and homebirth.

While writing this for 10Centimeters, I am reminded of the intense debate that surrounds midwifery care for homebirth here in our country. While this is not an exhaustive list by any means, it is meant to give families an idea of some of the important questions to ask while interviewing a midwife for their homebirth.

I am a Certified Nurse Midwife and I personally feel that CNMs with experience managing high and low risk pregnancies are best equipped to attend a laboring woman who plans a homebirth. Why? CNMs are the only credentialed midwife legal in all 50 states. CNMs have been trained and have worked within the hospital setting – exposing them to both high/low risk pregnancies. Most hospital trained CNMs in practice will “catch” anywhere between 50-150 babies a year depending on the size/volume of their practice. CNMs have a master’s level education. CNMs have the lowest neonatal mortality rate of any other provider documented by the Center for Disease Control. Most CNMs are registered nurses that have then decided to move forward with their midwifery education. RNs have a vast knowledge of assessment skills, clinical skills and documented excellence of care. RNs are also licensed in all 50 states and a consumer can go to their state board of nursing to view complaints/grievances filed against their licensed CNM/RN. Finally, CNMs are credentialed to provide full scope midwifery which includes well woman care beyond pregnancy as well as contraception management and menopausal management.

However women will choose whom they want to attend them at birth – regardless of the midwives’ education level, training, experience, credential (or lack thereof) or even licensure.

Let the buyer beware.

Homebirth is not safe for every woman and any midwife who tells you that is grossly misinformed. Birth is not to be trusted – it is to be RESPECTED.

Homebirth is not as safe for baby as being born in a hospital – the NCB community can state it is (and in the past I have stated it as well) – however research has proven differently and parents need to be made aware that if the midwife they choose does not know how to recognize / anticipate when normal is turning into abnormal during the labor or birth, the results can be disasterous for mother and baby. A mother’s birth experience does not trump the safety of her fetus/newborn .

Parents who choose to have their birth at home should be sure their midwife has the following:

  1. Has experience in managing both low and high risk pregnancies.
  2. Licensed and credentialed to practice in your state.
  3. Carries malpractice insurance.
  4. Has a professional relationship with an OB/GYN or Maternal Fetal Medicine team for collaboration, consultation, referral, transfer and transport if needed.
  5. Has a well- organized transport system for her clients and reviews this with you during the pregnancy.
  6. Is willing to share her risk- out criteria, her practice guidelines, her stats and her professional license numbers with you (This should actually be a printed disclosure statement that accompanies the informed consent she has you sign).
  7. Asks you about the distance your home is from the hospital that has an OB Unit – ideally you should live no further than 30 minutes from your nearest hospital.
  8. Has another midwife or RN that attends each and every birth with her and they are both current in their BCLS and NRP certifications and have also had experience managing both low and high risk pregnancies.
  9. Follows you through your pregnancy to six weeks after birth.

Friday Fallacy: Babies Die in the Hospital, Too

So this Friday, we’re going to debunk 3 things.

1. The homebirther battle cry every time a homebirth death is mentioned, “But babies die in the hospital, too!”

 

2. The “fact”  that hospitals actually cause deaths.

 

 

3. and finally, that homebirth is “as safe or safer” than hospital birth.

 

 

So what does the data ACTUALLY say? I “did my research” using the CDC Wonder data sets for all births from 1998-2006.  In the search, I used the following parameters:

 

I used the ages from birth up through 27 days, which is the accepted definition of perinatal mortality. I searched using place of birth (either in hospital or out of hospital) and I searched for all care providers as well as searching only for CNM delivery data.
I also searched the most common causes of perinatal death: Respiratory issues, which includes things like birth asphyxia, neonatal hypoxia; Complications of labor and delivery, which covers everything from malpresentations (breech, etc.) and injuries from the use of forceps or a vacuum to complications of cesarean section andabnormal contractions; and complications of the placenta, cord, and membranes. In addition, I searched maternal (pregnancy) complications — high blood pressure, multiple gestations, etc. — complications of anesthesia during delivery, and infection. Because the argument I’ve often heard against using the CDC database numbers is, “It includes all those babies born in the car on the way to the hospital,” I did the complications of labor and delivery search twice, once with precipitate delivery removed as a cause of death. I also only included data from 32 weeks of gestation and beyond, because I imagine that even the most hardcore homebirthers would head for the hospital if they went into labor earlier than that.

 

This is what I found:

 


So here’s the thing. Technically, “Babies die in the hospital, too,” is true. However, the implication is that “Babies die in the hospital at the same rate and because of the same things as they do in homebirth.” And THAT is not true. Out of the hospital, babies die at a rate 2.5 times the hospital death rate. And with Certified Nurse Midwives? It’s better, but still one-and-a-half times the rate with CNMs in a hospital! So babies do not die at the same rate in the hospital as they do in homebirth.
Not only that, they don’t die of the same things.
  • Babies outside the hospital die at nearly 3 times the rate of in-hospital babies of complications of the placenta, cord, and membranes. That’s things like placental abruption, nuchal cords, true knots, and so on.
  • They die of respiratory issues (birth asphyxia, neonatal aspiration, hypoxia…) at four times the rate.
  • Infection causes death at nearly twice the rate outside of the hospital.

But the most shocking number of all is the number for complications of labor and delivery. It is nearly eleven times –ELEVEN TIMES!!! — as high for babies born outside the hospital. This is the category that contains breech birth and other malpresentations. These babies aren’t dying from congenital abnormalities; they’re dying preventable deaths. The only category where homebirth is better than the hospital is maternal pregnancy complications, and that’s nearly equal. Homebirth should be blowing hospital birth out of the water, here — they are all “low risk” women, whereas the hospital numbers include all risk levels.

As for hospitals causing deaths, look at the numbers.
  • Not a single death attributed to complications of anesthesia and analgesia, which can only be done in the hospital.
  • I hear lots of scare mongering going on about infection in the hospital, but the out-of-hospital numbers are more than TWICE as high!
  • Complications of delivery — the category with those awful c-sections that are slicing babies open and vacuums crushing babies’ skulls — are, best-case-scenario, more than eight times higher outside the hospital, and if you add in precipitous birth, it’s almost eleven times.

Now, I know what you’re thinking: “Those numbers include all births outside the hospital, even those which are unattended!” That’s right. Many births attended by midwives are not reported as such, simply because the midwife is illegal and hides in a closet before the EMTs arrive, telling her clients not to mention she was there when the you-know-what hit the fan. Not only that, many of the same people promoting homebirth are also promoting unassisted childbirth as safe. But I understand your great concern. That is why I ran some numbers for the “other midwife” category out of the hospital:

 

 The death rates are 1.3 times higher than hospital rates, but that is for all risk levels. The best comparison is to CNM’s in the hospital. Other midwives outside the hospital have a death rate almost THREE TIMES the rate of CNMs in the hospital. And in comparing respiratory related deaths with ALL hospital births (including those attending by doctors), the rate of death for out-of-hospital births is more than four times for other midwives, and is a shocking nine-and-a-half times higher than the rate for CNMs in the hospital.

These are the cold, hard numbers. Excel did all the math for me, so I’m pretty sure they’re correct! These clearly preventable deaths are the reason that I am so passionate about this. Please, the next time someone tells you that homebirth is “as safe or safer” than hospital birth, do me a favor and tell them they haven’t done their research.

WHAT?? Birth at Home With Placenta Previa?

**note** My apologies for the lack of a baby in the picture. None of the ones I drew actually looked like a fetus, so I gave up.

Placenta previa is a very dangerous condition for both the mother and the baby. It occurs when the placenta covers the cervix — causing either complete previa or partial previa (fairly self explanatory) — or when the placenta is very close to the cervix, causing marginal previa. A recent study published in AJOG found that, in cases of marginal previa, at least two-thirds of women with a placenta farther than 10 millimeters were able deliver vaginally without increased risk of hemorrhage. The study is very small, though, and I would have liked to see a third group with normal placentas as a control. In any case, when it comes to complete or partial previa, good outcomes for both infant and mother depend on prenatal diagnosis and cesarean delivery before the membranes rupture. If not, they are at risk for some very nasty complications, including preterm delivery, blood clots, infection, placental abruption, hemorrhage of both the fetus and the mother, shock, and death. Placenta previa is not a joke.

This is why it is unconscionable for Unhindered Living to continue publishing the page Handling Placenta Previa At Home.

A few choice bits:

It seems like she realizes it’s terrible advice, because she’s qualifying every other statement, yet she still gives it! Placenta previa is NOT a “variation of normal,” so if you are diagnosed and it continues late in your pregnancy, please do not consider that page as a justification for a home birth. **Note** An early diagnosis of placenta previa (with the anatomy scan, 20ish weeks) may resolve itself as the uterus grows, and if that is the case, you would not need a c-section for previa. However, this is something that should be taken care of between you and your doctor or midwife, not by taking advice from websites.

If you’re gonna hate, please do it publicly!

Don’t be like “Bethany Morningside” and write nasty things using a fake profile where only I can see them. Not that it will do you any good. Also, I would like to extend my congratulations to Ms. Morningside  for proving my point so eloquently!

ETA:
Ahahahahahaha!! And after they were SO INDIGNANT that someone would come to their forum and “troll.” Pot, meet kettle.

Just to Clarify…

We here at 10centimeters aren’t against natural birth. Several of us have even had one. We’re not even against homebirth, given the right woman and the right midwife! We support women who choose to give birth without pain relief, women who choose c-sections, women who can’t have children, women who adopt children, and women who choose not to have children at all.  What we don’t support is the way the way the leaders of the natural birth movement try to shame women into having a very specific kind of birth using misinformation, half-truths, and occasionally outright lies. We also don’t support sanctimommies bashing women for their choices. We, however, DO NOT CARE how any individual chooses to give birth.

 

What are we for?

  • Better training and stricter clinical standards for homebirth midwives in the US
  • Mandatory malpractice insurance for all homebirth midwives
  • Mandatory reporting of outcomes and better recording (i.e., no planned homebirth transfers counted in hospital stats, no unintentional homebirths counted in planned homebirth stats)
  • Real evidence-based maternity care, with the understanding that science/medicine changes practices as the body of evidence changes
  • Open and honest discussion without stifling one viewpoint under the guise of not wanting to scare people or being “supportive”

C-Section Moms are People, Too

So a while back, I posted a picture taken of me during my c-section on a birth-focused facebook page. I’ll admit I was tweaking them a bit with the caption, “Me and my daughter while they were sewing me up during my fabulous planned c-section!!” See, I really love this picture, and I think it shows that a lot of things Natural Childbirth Advocates ™ like to say about c-sections simply aren’t true. My hands weren’t strapped down, my baby wasn’t taken away from me for hours, etc. This wasn’t even in some crunchy organic-food-serving hospital in Portland *cough*OHSU*cough*, but at Riverside Hospital in Columbus, OH, home of the much-maligned-in-NCB-circles show “One Born Every Minute.” It really was a fabulous birth experience. But I digress. Anyway, I was tweaking them, but I never expected to get this response:

 

I suppose I should have expected it.  My introduction to the nastiness brought on by NCB rhetoric came early on in my career as a mother, in the livejournal pregnant community after I posted my son’s birth story. It was immediately arm-chair quarterbacked, with most commentors implying that I should feel terrible about my failure. I’ll never forget being told that I wouldn’t be a “real woman” until I pushed a baby out of my vagina (so… does that mean nulliparous women are sitting around waiting to become real??).

Any time I’ve mentioned it since, the NCBer I’m talking to claims that never would have happened; no one would really say that. But they do.  Someone recently brought to my attention a thread on Joyous Birth to my attention.
The OP posts, complete with a “trigger warning” (WAT? LOL) that she is traumatized that her friend is going in for an emergency c-section. She mourns the loss of the friend’s natural birth and blames her for choosing an OB to care for her and not taking care of herself “properly” during her pregnancy.

 

 

So let’s see. We have an apparently necessary c-section (high blood pressure, swelling, headaches…), and the sanctimony here is STILL so thick you could cut it with a knife. But that’s not all.  After many condolences and (((hugs))), she worries that something has gone wrong, since she has not heard anything for three hours. Finally she announces that the baby has arrived safely. And THEN Janet Fraser herself has something to say:

 

Bahahahahahaha. Really? It almost seems that Janet thinks it would be better for babies to die from pre-eclampsia than be delivered via the sunroof.
See, the NCB movement wants to make sure you know that c-sections aren’t really birth. From this idiocy to the oft-posed-on-NCB-websites question “Do c-sections count as birth” to the NCT refusing to cover c-sections in their birth classes, they’re attempting to denigrate both the method of birth and the women who have one.  The latest iteration of this attack on c-section moms is a little more subtle than telling them they’re not real women, but it’s just as hurtful. It’s telling them that they haven’t really given birth. This attitude is all over the internet and permeates the hardcore parts of the natural birth community.

 

Doulas say it:

 

Natural Childbirth websites discuss it:

 

Even women on mainstream websites feel the need to talk about it:

 

Last but not least, there are actually forums dedicated to telling women that they have not given birth unless their children came out their vajayjay:

 

I used to feel hurt and angry when I read statements like these all over the internet. Why do other women feel the need to diminish the birth of my children? Or the births of anyone’s children? What is the purpose of saying anything like, “Cesareans are not really birth,” to a woman who has had a cesarean (or even to anyone who may need a cesarean in the future!!)? Is it a need to feel superior? To inform them of their supposed stupidity and gullibility in listening to their doctor? To warn them that they have somehow damaged their children? What is actually being done with this ridiculous assertion is to make her feel inadequate, feel like less of a woman.  She starts to feel defensive. Maybe it has even contributed to her postpartum depression or helped to create feelings of animosity toward her care providers that didn’t exist before someone’s fat, blabby mouth opened up and spewed out that filth.
So let me make it clear. The way you give birth not a referendum on your worthiness as a woman, mother, or human being. The way our children came into the world has NO BEARING on our abilities as a mother. It’s wonderful that there are those women who have the good fortune to give birth with little to no intervention.  But, really, in the scheme of things, birth is only a short moment in the lives of our children.  We have so many opportunities to be amazing mothers throughout our children’s childhood and even as they become adults. Let’s not get so hung up on a 3-inch difference in the location from which they emerged.

Friday Fallacy: The Netherlands Are a Fantastic Model When it Comes to Birth

It’s on every birth blog and pregnancy forum out there: the claim that, because the Netherlands has a high rate of homebirth, the country is some sort of exemplar for how birth should be done.

Case in point:

(side note: I love how not only do they delete any information that doesn’t fit their world view on their pages, but they flounce whenever they find a page that doesn’t delete it.)

First of all, the homebirth rate in Hollandthe Netherlands is nowhere near 92%. In fact, it’s currently around 29% and rapidly declining. Why is it declining you ask? Maybe it’s because they have some of the worst birth statistics in all of Europe.

According to a 2010 study published in the British Medical Journal, The Netherlands has a shockingly high perinatal mortality rate, one of the highest among European nations. In the study, the researchers found that infants of LOW RISK pregnant women whose labor started in primary care under the supervision of a midwife in the Netherlands had a higher risk of delivery related perinatal death and the same risk of admission to the NICU compared with infants of HIGH RISK pregnant women whose labor started in secondary care under the supervision of an obstetrician. Doesn’t sounds like all those Dutch homebirths are lowering the perinatal mortality rate to me.

And what about maternal health? That’s an indicator of the level of maternity care, too, right? Well, even with it’s relatively heterogeneous population and universal access to healthcare, the Netherlands has consistently had one of the highest maternal mortality rates in Europe as well, especially in the last 10 years.

You’ll notice that even though the Netherlands has by far the lowest c-section rate in Europe, they have a much higher maternal mortality rate than, say, Italy, whose rate of cesarean delivery exceeds 40%.

So…the next time you see someone lauding the Netherlands for their fabulous statistics, ask them for their proof. Chances are they don’t have any, because this country’s stats SUCK when it comes to maternity care.

Oops! We could not locate your form.

Darby and Laura Speak Up

And now for something completely… related to yesterday’s post about blaming mothers for homebirth loss!

Shortly after they attended, as “midwives,” the recent tragedy in Eugene, Darby Partner and Laura Tanner were back on Facebook (though not on their business pages…those got deleted) telling us all how our birth is our responsibility, and if something terrible happens…well, it’s not the midwives fault!

In early August, Darby came popping onto the Made to Birth facebook page to tell those posters who are concerned with the lack of education offered in most CPM/DEM correspondence courses to avoid hiring midwives with that education. The post has since been deleted, probably because some of the other commentors were making too much sense.

 

Interestingly enough, Darby doesn’t even have THOSE qualifications; in this email sent in June to the MANA Students and NewMidwives yahoo group, she explains that she is self-taught:

 

Wow, apparently taking any sort of organized course-work before the NARM exam to become a CPM is OPTIONAL. But I digress.

Even more telling is Laura Tanner’s comment on Birth Without Fear, when asked what should be done with negligent midwives. Just two days after she attended Margarita Sheikh’s labor and the death of her beautiful son Shahzad, she wrote this on a post in the facebook community Birth Without Fear asking the question, “What can/should mamas do when their care providers act negligently?”

So let me get this straight. Some actions may be criminal, but not really. Parents need to “own their birth experience” (whatever the hell that means). Must mean nothing should be done to negligent midwives, because it’s the parent’s fault for hiring them. Am I right?? This is utterly brilliant. I can just advertise myself and accept money for midwifery services, and then when I screw up, I can just blame it on the people who hired me for picking such an idiot!

What do you think? What should be done about negligent midwives? How can we prevent them from practicing in the first place?

 

You Should Have Done Your Homework!!

One of the more heinous things Natural Childbirth Advocates do is blame mothers for poor outcomes. The latest tragedy is no exception. Every news article, every facebook thread, every blog post where it’s mentioned, brings them out, chastizing the grieving parents for not doing enough research.

But why wait for a tragedy? Carla Hartley, owner and instructor extraordinaire at Ancient Art Midwifery Institute (training a lot of those CPMs!) tells her clients up front that they shouldn’t ask about malpractice insurance, because nothing she does is her fault!

Not to beat a dead horse, but this attitude is ALL OVER THE WEB:

And I could post these every day until next year; this is the prevailing attitude NCBers seem to have about homebirth. It’s “as safe or safer than hospital birth,” but when something goes wrong, YOU are responsible for it. If your midwife forgets her birth bag, monitors the baby by listening to your belly with her naked ear, performs gloveless vaginal exams in an attempt to determine if the baby still has a heartbeat after your water breaks, thinks that telling you to stop bleeding is an effective way to end a postpartum hemorrhage, and then brags about it on the internet, it is YOUR responsibility to recognize something is not quite right there in the throes of labor or potential hemorrhage and demand a transfer. (BTW, don’t bother deleting that page; if you haven’t guessed, it’s all capped). I know, I know… but not every midwife provides such a stunning display of her incompetency for the world to read. The mom in the story probably had no idea she’d hired such a flake before it all went down.

My question is, just HOW are women supposed to do their proverbial homework? Look up their midwife’s license with the state? HAHAHAHAHAHAHAHAHAHAHAHAHA. HAHAHAHAHA. HAHA. HA. HA. Many states don’t offer licensing, and even those that do *cough* Oregon *cough* have precious little information easily accessible. Most midwives don’t bother with malpractice insurance (see Carla above), so there’s no way to look up malpractice suits, because lawyers just won’t take the cases without money involved. Oh, I know. They can ask the midwife! HAHAHAHAHAHAHAHAHAHAHAHAHAHA. HAHAHAHAHAHAHAHAHA. HAHAHAHA. HAHA. HA.

I’m sure there are plenty of perfectly honest midwives out there who will tell the truth, but I’m also sure that there are not only those who will lie outright — as evidenced above — but also justify it by telling themselves it doesn’t count, because that baby would have died in the hospital, too.

There really is no way for a woman to be sure that the midwife she’s chosen is a competent, caring provider. So maybe this blame is really because these loss mothers haven’t “educated” themselves enough about pregnancy? Maybe we should require everyone who wants to have a child become a CNM or OB — or at the very least a CPM – first. That way, when they’re in the midst of transition, they’ll know if something is wrong, right?

NO. NO. NO. And NO, again. If this is really the case, why do midwives even exist? The expectation is that you are hiring someone for their knowledge and expertise, not because you want to pay $4,000 for some idiot to sit around and tell you what a great job you’re doing.

One final note before I go and dunk my head in a bucket of ice water. I don’t blame any mother who experiences a terrible outcome for choosing an idiot for a midwife or for choosing homebirth when she shouldn’t have. The world of pregnancy and childbirth is chock full of books telling women that if they don’t birth a certain way, they aren’t thinking; blogs telling them that OBs are out to birthrape them and give them a c-section just to make more money; Certified Childbirth Educators telling them that hospitals will force pitocin and an epidural on them, and giving them outdated information about interventions; and their friends all telling them that hospitals will force feed their infant formula and ruin their breastfeeding relationship, causing their child to be dumber than everyone else’s.  There has been a wall purposely created between women and medical care providers, and for some women, that’s hard to get over. Here we have a thread on mothering.com where 40 different women said they would have no problem with hiring an illegal (not just unlicensed, ILLEGAL) midwife, some of them even preferring a midwife who flouts the law.

They even talk about how it’s better because then they can do the very things that lead to these tragedies! More than likely, all of these women and their babies are perfectly fine, so the natural birth community celebrates them and their choices. But for those who make the exact same choices with tragic consequences? Well, they should have done their homework.