This is Batshittery.

Sorry, but there is no other word that accurately describes what is going on here. “Crazy,” or even “insane” don’t even begin to characterize this phenomenon. What is it?

That homebirth advocates continue to support Lisa Barrett. And every other dangerous midwife out there.

Who is Lisa Barrett? She is an Australian midwife who is currently the subject of a coroner’s inquest. On her website she recounts — with pride — birth stories full of high risk scenarios and obviously questionable judgement, ranging from… twins whom she allowed to deliver more than 48 hours apart (Story comes complete with a google search whereupon she came back to inform the expectant parents that the average time between delivery of twins is FORTY SEVEN DAYS. Even though most reputable sources and common sense report it as being 17 minutes.)… to a 35 weeker who didn’t begin breathing until TEN MINUTES after she was born… to a HBA3C with a previous vertical incision. Pictures of limp, blue babies abound.

On her site, she also claims 20 years of experience “within the system” and :

I am experienced in all types of birth and this includes birthing at home with babies in a breech position, twins and birth after caesarean. Anyone who believes they want and need this service should be entitled to get it.

So what does all this experience include and why is she facing a coroner’s inquest? It’s not because THE MAN is after her. It’s not because, as she claims in her plea for money at the top of her page, “the authorities are trying to censure homebirth via its most vocal advocates.”  It’s not “another witch hunt of a sister midwife.”

No, it is because this is a woman has attended at least four birth-related deaths since 2007. These are spectacularly horrific numbers, and who knows if they’re even complete. As much as homebirth advocates love to parrot the phrase, it just isn’t true that “babies die in the hospital, too.” Yes, they die of anencephaly or heart defects, but it is unbelievably RARE for babies who were perfectly healthy before labor started to come out dead or dying. But somehow, in Lisa’s case, they do. The first two deaths were HBACs and the last two were twin births.

  • Tate Spencer-Koch, born in July of 2007,  suffered a shoulder dystocia for more than 20 minutes and was unresponsive by the time she was finally delivered. The ambulance officers testified in court that Lisa hindered their attempts to get the baby into the ambulance and to the hospital.
  • In April 2009, Jahli Jean Hobbs was breech, became stuck, and was eventually born when Gemma Noone, A DOULA who was not supposed to have a role in the delivery at all, freed her arm, enabling her head to be delivered, but she was not responsive. It was all too late for little Jahli Jean.
  • In July 2011, Lisa attended the homebirth and death of an unnamed twin in Western Australia, which — in an amazing coincidence –also happens to be where Annie Bourgault lives.
  • On October 9, 2011, Lisa crammed with the mother and lifeless twin into the front seat of a car (Do they not have emergency transport in Australia? Or, perhaps, was it that she does not want ambulance officers testifying at the next inquest…) when complications arose after the home delivery of a first twin; the second twin was later declared dead at the hospital.
After the death of Spencer-Koch, Lisa attempted to argue  in the Australian High Court that the infant was never, in fact, a live  human being, and thus not deserving of a coronial inquest. The court disagreed and the inquest began. Throughout the hearings, Lisa continued to trumpet her contempt for the system and her victims by tweeting from the courtroom, including the chillingly ironic:
Yep. October 6.  Three days before the fourth death. Looks like “normal service” resumed all too quickly. Actually, Lisa has been for the past several months attending births outside of the law. Earlier this year, she handed in her registration because she no longer wanted to work as a midwife, giving the excuse that she was not happy with moves last year to increase regulation of midwives. However, since relinquishing her registration, she has attended more than twenty births, including the last two deaths. She claims she is only acting as a consultant and advocate, but she is still advertising her midwifery services on the Maternity Coalition website, on the Bellybelly breech birth page for practitioners “who are skilled and experienced with vaginal breech birth” (apparently having a doula deliver a mostly-dead baby counts as experience), on the Essential Baby midwives page, and on Birth Matters.

Yet, in spite of her blatant recklessness and disregard for human life, the homebirth and midwifery community continues to support Lisa Barrett.  We have the 1400 strong  “I Support Lisa Barrett and That’s Final” facebook page, complete with the idiotic slogan “Freedom is in Peril. Defend it with all your Might.” These women are depositing money into her bank account. She also hosted a movie fundraiser night, where 60 people bought tickets at $25 each, and additional people made donations, in an effort to support her legal battle.

This phenomenon is not unique to Lisa Barrett, either. Karen Carr is a midwife who said after the death of a breech infant under her care, “The baby’s position wasn’t the problem, the problem was that the baby’s head became stuck.” She is also a midwife who practiced illegally in both the states of Virginia and Maryland, and who was prosecuted after two deaths and a case of severe brain damage, all within a years time. She recklessly accepted the care of a 43-year-old first time mom with breech positioning and tragedy resulted. But does the homebirth community condemn her recklessness? NO! She is hailed as a hero and the community is raising money for her “defence.” I don’t see anyone raising money for her victims, though.

What about Amy Medwin? Amy presided over the death of an infant in North Carolina, where CPMs are illegal. She is blatantly flouting the judges’ orders and continues to attend births, posting about them on her open facebook page. She too has bunches of acolytes supporting her and paying her legal bills.

And then there’s the great-grandmother of them all, self-taught Gloria LeMay. According to the College of Midwives of British Columbia, LeMay has had myriads of complaints against her, including several deaths; has been given a permanent injunction against practicing midwifery; has even GONE TO PRISON; but continues to flout the law and attend births. Has she been censored by the homebirth community? Of course not! In fact, she is teaching online midwifery courses which have enthusiastic reviews all over the (Oh, look! It’s Lisa Barrett endorsing Gloria LeMay!) internet.

WAKE UP, PEOPLE! If you truly wanted homebirth to be safe,  you’d be outraged at the outrageous behavior some of these so-called midwives exhibit. It’s not a matter of a woman’s “personal choice.” Any woman can have her baby at home with whomever she wants to attend. It’s a matter of who gets to give themselves the authority that comes with the title of midwife and use that title to profit.  And sorry, no matter how much you may protest to the contrary, calling yourself a midwife does indeed impart some semblance of authority. Do those of you who practice safe midwifery really want to be lumped in the same group with these mavericks who take risks with other peoples’ lives? I sure wouldn’t. Any other profession would be banding together to throw the bums out rather than circling the wagons around them. Is this an indication of the real values behind the culture of homebirth? That the advancement of lay midwifery is more important than the safety of women and babies? It is MIND BOGGLING to me that not only is no one speaking out against this egregious behavior, and in fact, they’re all throwing their support behind it.

What’s My Agenda?

Forced c-sections for all!! Muahahahahahahahahahaha!

That was a joke for those of you who are humor impaired. What is true is that I have an agenda. Top of the list? Safer mamas and babies.

I’m writing about this for two reasons. First of all, someone in the Fed Up Facebook group posted one of the ACNM Objectives for Healthy People 2020 and asked the Skeptical OB to write a blog post about how we can increase physiologic birth in hospitals:

 

 

I think that the goal of hospitals, doctors, midwives, and nurses should be improved outcomes and not necessarily less intervention. If there is evidence that less intervention improves outcomes, then, sure, we should strive for that. In some cases, such as elective induction before 39 weeks, I think that is the case. Overall, however, I think many of the poor outcomes in the US are unrelated to levels of intervention. It is true that the US has poorer outcomes than some countries in Europe. However, some of those European nations have both lower mortality rates AND higher rates of intervention *cough* Italy *cough*, so I’m not sure there’s even a correlation with rate of intervention and better outcomes. I do think that, in any case, experience should come after outcome on the importance scale.

 

The other reason I’m writing this is that I came across a comment from an older post on this blog, to which I’d neglected to reply:

 

 

I hope that my response to her makes my agenda when it comes to homebirth a little more clear:

 

First of all, it is true that I am *STILL* using the wonder database. It would be great if there were only RCTs regarding birth outcomes, but it’s impossible to do and get the numbers needed to show anything real. You have to have tens of thousands of births in order to show a pattern — anything less and the death numbers could be a fluke.

It is also true that many of the women who post here have been harmed because of an out-of-hospital birth with a CPM and they have not only been censored and shouted down by the natural birth community, but also ridiculed because of their experience. This blog does serve as an outlet for them in some ways.

I not against homebirth with a CNM. I believe that in certain situations (truly low risk woman, proper screening and precautions taken, location close to hospital in case of transfer), the risk approaches that of a hospital birth with an OB.

As far as what I hope to achieve…

I don’t necessarily want to have the CPM credential abolished, as many of my readers do, but I do think it’s redundant with the existence of the CM (A CM is a direct entry midwife with the same midwifery training and examination as a CNM but no nursing, currently only legal in New York and Rhode Island). If it’s going to stick around, it needs to require a minimum of a Bachelor’s degree from an actual accredited university (i.e., not Birthingway, Aviva Institute, National College of Midwifery, etc.), with the same science courses BSNs are required to take and pass with a B or better. If every CPM had the education that graduates from Bastyr have, I might be satisfied. I also want the NARM to reflect the same level of difficulty and accuracy as the AMCB exam (that CNMs and CMs take). If the requirements for a CPM aren’t changed/made more stringent, then I do want the credential abolished and would be happy to make the Certified Midwife (CM) a national certification.

Other things I’m working for:

  1.  Mandatory Licensure. Those practicing midwifery without a license should be subject to criminal and civil liability and actively prosecuted. No turning a blind eye as is currently happening, even in states where lay midwifery is illegal.
  2. Adoption of something similar to the Netherlands Obstetric Protocols for Antepartum, Intrapartum, and Maternal Postpartum Risk Assessment for homebirth in the US. While the Netherlands numbers aren’t the best, their homebirth numbers are certainly better than ours. Adopting their protocols will give homebirth midwives a solid guideline to safely serve women and families and restrict them to the low risk births in which they are trained and specialize. Those who choose to attend high risk births in violation of these regulations should be subject to supervision and/or suspension and if appropriate (ie in the case of a death as a result of their violation), civil and criminal liability.
  3. Adoption of an Infant Postpartum Risk Assessment Tool. The Netherlands protocols do not include comprehensive risk assessment for neonates, so such a tool could be composed by a team of GPs, OB/GYNs, pediatricians, and neonatal nurse practitioners.
  4. Disclosure…of training level, numbers of births attended, numbers and percentages of poor outcomes with comparison to national rates, complaints filed, malpractice lawsuits filed and settled — for all maternity care providers
  5. Immediate Suspension of the license or required supervision of any CPM involved in a maternal or infant death or major injury, pending investigation. Midwives involved in fatalities and major morbidity must be investigated and must stop practicing until it is determined that they are safe practitioners.
  6. Permanent Revocation of any CPM license after a second fatality or major injury if it has not already been revoked. A midwife might have one unlucky accident in the number of births that homebirth midwives typically attend, but a pattern of incompetence, recklessness, or negligence must not be tolerated. Once a practitioner has reached 750 births, the number of deaths allowed before suspension could be increased.
  7. Publicly Available Information about each maternity care provider’s record in a reliable online search tool. Patients must be able to see if their provider has had malpractice suits, complaints in the last 10 years, disciplinary actions, suspensions, or other indicators of poor performance.
  8. Malpractice Insurance for all CPMs and Birth Centers. Malpractice insurance is simply part of the cost of doing business as a healthcare provider. It protects consumers and the State from shouldering the costs of mistakes.
  9. Better Tracking and Public Availability of mortality and morbidity statistics.  If CPM is going to be a legitimate credential, it needs to be listed as a choice on birth certificate data. There must also be a spot for “planned homebirth” so that hospitals don’t get the blame for transfers that end in a death they could not have prevented by the time it arrived. Morbidity data is not currently collected and it needs to be.
So there you have it. My agenda is not to make homebirth illegal.  I have no naive illusions that if all I hope for comes to pass, the Gloria LeMay’s of the world will suddenly stop taking on risky clients and hiding in the closet when the sh*t hits the fan. If you spend enough time on MDC, it is pretty clear that there is no shortage of lay midwives willing to deliver footling breech post-dates twins being carried by over-40 moms in states where they are currently illegal. I do not support prosecuting parents for making risky choices that end in disaster. I do, however, support the prosecution of those who call themselves midwives and do the same. My desire is that women have the information they need to make the appropriate decisions for themselves and their babies, and that midwives are held accountable for their actions.

What changes do YOU think will make childbirth safer?