Debunking the Business of Being Born: part 8

This is part 8 in a series on debunking The Business of Being born, the popular documentary by Ricki Lake and Abbey Epstein. You can find the other parts of the series here. My descriptions of the movie are in bold. My commentary is in regular text.

Dr Michael Odent says that there are people that claim “that in the future most women will prefer to have an elective cesarean section. But when you talk about that with certain women, [they] still have some sort of intuitive knowledge of the importance of what’s happening when the baby is being born. They cannot accept that cesarean section is the future.” 

It is indeed true that certain women prefer some things and other ones do not. Its almost like we are individuals!

Rickie lake is talking with Abbey Epstein. Ricki Lake says  “I couldn’t get enough information. I was just blown away by what I didn’t know the first time around. I knew, even before I planned a second pregnancy, that I wanted it different. I wanted to do it on my terms. “

That’s fine. The unfortunate part about The Business of Being Born is that they pretend that unmedicated births are the only way to have a child on your own terms. Women who want c-sections, or who do not want assistance at all, are not represented. The contrast between the extremes would make for an interesting movie, but it becomes obvious that this is a movie intended to make home birth look good in the public eye, not to explore any issues surrounding womens preferences during child birth.

Abbey Epstein remarks that she thought it was just an eccentricity for Ricki to prefer home birth. Ricki replies that she loves pain medication and takes it when she has a headache. “But when it came to giving birth, it wasn’t an illness. It wasn’t something that needed to be numbed. It needed to be… experienced, you know?”

Ricki Lake filmed her home birth and footage of it is shown. She has multiple people trying to relieve her pain during contractions.

Rickis voice narrates over the footage “I remember I was in a LOT of pain. I was enduring just about the worst part, almost the worst part. I didn’t lose my sense of humor. I was naked and going ‘uhhh’ and we heard an ambulance go by, and I was like ‘That’s my ride, get me the fuck out of here! I want to go to the hospital, I want my epidural.’ “

Footage is shown of Ricki’s home birth where she is obviously in a lot of pain and says “I don’t think I can do this.” Ricki narrates over the footage saying “My midwife reminded me of all the reasons I was at home, and what I wanted to avoid, and the gift I was giving my baby.” and I thought “yes” and I got through that contraction, and I was one step closer.

This footage would be extremely disturbing if you hadn’t been prepped with natural child birth talk for 40 minutes beforehand. If you had seen the footage without being pummelled with the film’s conclusion (that vaginal unmedicated childbirth is optimal, is an amazing experience, etc) you would have thought it is cruel to deprive a woman of pain relief when she was in intense pain and requested relief. I also have a feeling that when women trust their midwives it is easier to go with their narrative of birth rather than to see their actions for what they are- cruelty. It is cruel to deprive someone of pain relief when they are desperate for it. After all, ricki isn’t experiencing the pain now, so it is easy to look back on it and make light of how horrendously painful it was.

More footage of ricki’s birth. She is in pain and her midwife wispers “this is you having a baby.” 

Ricki says “I feel like pushing.” her midwife responds encouragingly. 

Ricki’s narration over the footage says “At a certain point, I just gave in to the pain. I just let go and surrendered, and that’s when things went really quickly. “

Again, incredibly disturbing to someone who hasn’t been told repeatedly that doing things this way is optimal. It seems so needless to hurt that much. Ricki looks exhausted and dazed by having endured hours and hours of painful contractions. I remember that before I had my baby, I thought that midwives who acted like Ricki’s were acting like they believed in her, but after having been that patient, in tons of pain, with a midwife inadequately prepared to deal with my pain… it seems very cruel. I think that midwives witnessing pain so regularly without the means to solve it can harden them to the pain other women are enduring.

There is footage of ricki pushing her baby out in her bathtub, her midwives encourage her to pick up the baby.  Ricki is crying and saying “My baby” over and over.

This is the bread and butter of the business of being born: birth footage chopped into bits that emphasizes the baby being born and minimizes the labor and pain. I just wish that they would have been forced to show footage in proportion to the time spent on different portions of the actual labor. Women typically labor for hours, and the moment of birth is just that- a moment. There is a disproportionate amount of focus on the end of the birth.

Ricki remarks “That was just…everything to me. I mean, I could start sobbing right now. It was so empowering.”

Statements like this try to establish the objective supremacy of natural birth, when in reality it is just Ricki’s opinion of home vs hospital. Other women with different experiences are not represented.

A Doula is giving a couple lessons in their home on how to deal with contractions and talks about different techniques to provide relief. The woman’s husband is interviewed and talks about how he was on board with home birth from the start. Footage is shown of the midwife providing prenatal appointments in the couples home. 

Eugene Declerq, an MPH says “The research on home birth is pretty consisten in showing that in a supported environment, (he clarifies this to mean well trained attendants with quick hospital transfer), the outcomes of home births are very, very good. Generally better than they would be at a hospital birth.”

The outcome of home birth with nurse midwives with quick transfer are better than the outcomes of home births without those things, but the majority of home birth midwives have none of the things he listed. Regarding the numbers, its quite a stretch to call them “very, very good”, and its an outright lie to say the outcomes are better than hospitals. It is difficult to evaluate what studies he is referencing because they are never named, nor do they tell you what they believe to be a good outcome. I can bet that they care more about the c-section rate than the death rate.  The majority of studies show a decrease in interventions and an increase in perinatal death. MANA’s numbers, which came out this past year, demonstrate the same thing (if you look past their flowerly press release that tries to ignore the obvious conclusion that comes from looking at the numbers and then comparing it to hospital statistics).

The midwife talks about screening out patients for risk and other safe guards in place to protect moms (like preparing for transfer and making the call to do so in time). 

That’s nice and all, but those things only matter if the midwife actually decides to do them. There are so many cases of midwives taking high risk patients, of midwifery publications calling dangerous conditions “variations of normal”, etc. This seems like another attempt to make home birth midwives look like something they are not. Most of them are not nurses, most of them do not have adequate training, most do not have adequately quick transfer, and most of them do not have a good working relationship with hospitals.

OBGYNs express doubt that midwives could adequately manage complications without the equipment available in the hospital. One dr compares it to driving without seat belts using previous safe driving as a justification for the risk. Eugene comes back on the screen to dispel the myth that midwives are using archaic methods to manage labor or pain. He says they bring pitocin, oxygen, etc to births. Home birth midwives are shown packing up this gear.

Once again, this movie tries to make it seem like most midwives are nurse midwives (the only highly trained midwives in the usa), but most home birth midwives aren’t. Most home birth midwives are direct entry or “lay” midwives who do not have adequate training to deliver babies. Direct entry midwives are not allowed to carry medicine in all states, and some don’t do it because they think that complications should be managed by homeopathy or other techniques.

It is worth noting that midwifery is “traditional” or “ancient” when it suits natural child birth advocates, and its contemporary and evidence-based when it suits them.

Eugene continues “Home birth midwives are incredibly skilled at what they do.”

Then why is their death rate so high? Why is it that in many states I can become a home birth midwife simply by calling myself one? I have no skills or training outside of a doula class, but no one can prevent me from attending home births in my state because the standards are non-existent.

An OBGYN says “In a postpartum hemorrhage, you can lose your entire blood supply in about five minutes.” 

The midwife says “if you think a mother has a higher risk of bleeding you have the pitocin drawn up. You have the IV warmed here, right by her side.”

Anyone who has attended codes or traumas knows how hard it is to start an IV on someone who is bleeding heavily.  Having it ready doesn’t mean a lot if it isn’t physically inside the person’s vein. When they get really desperate for a line they jam a huge IV into your bone to provide fluids. Its not pretty. I doubt midwives have the equipment for that. Anyone who has watched the beginning of this movie knows home birth is all about NOT having IVs or other medical interventions, even “just in case”. They only bring it up when safety concerns are being addressed, to make it appear safer than it actually is.  They again they ignore the fact that the majority of american home birth midwives are not nurses and have no real medical training.

My patience for this is wearing thin. There is so, so much deception at this point that it is hard to conclude that it was not intentional. Either that or the film makers are in so deep that they are basically acting as cult members, who believe that it is okay to lie as long as you are serving the cause.  An entire portion of the film is dedicated to talking about how skilled and trained and prepared home birth midwives are, but they take absolutely no time to discuss the difference in training and preparation between the majority of home birth midwives (direct entry midwives) and the majority of hospital midwives (certified nurse midwives). Its a truly glaring omission.

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“do nothing”- the official slogan of home birth

With a few exceptions (namely placenta previa) the home birth midwife’s theory of practice is to not do anything. Their strategy of not doing anything (often euphemistically called “trusting birth”) is what patients shell out thousands of dollars for. Home birth midwives seem to believe that active management of risk factors causes deaths, when there are plenty of statistics that evidence the safety of hospital birth when compared to home births. Here are the numbers from Oregon. The midwives have a theory, that doing nothing is better than doing something nearly all of the time, but they ignore all the available data to check and see if their theory is correct. They put peoples lives on the line and do not check ahead of time to see if their idea is true.

The way that midwives come to believe such nonsense is that the majority of the time no one dies when they decide to do nothing. The issue with doing nothing isn’t usually death, its usually brain injury caused by oxygen deprivation. There is not any accountability or tracking of brain injuries in babies by home birth midwives, but a paper by perinatal specialists found an 18 x higher rate of them. Sometimes it takes years before the effects show up.

I began thinking about this matter because of an article on the Thinking Midwife’s page about how nuchal cords (cords wrapped around baby’s neck) are a “scapegoat” for interventions. Heres her advice:

  • During birth DO NOTHING.
  • IF the cord is preventing the baby descending once the head is born (extremely rare) use the ‘somersault technique’ (Schorn & Blanco 1991) – see below.
  • Once the baby is born, unwrap the cord (the mother/family can do this).
  • If the baby is compromised at birth encourage the parents to talk to their baby whilst the placental circulation re-establishes the normal blood volume and oxygen for the baby. if the baby requires further resuscitation do it with the cord intact.

She emphasizes over and over again how rare it is to have to use the somersault technique, but to me that says that american home birth midwives specifically will be unlikely to actually learn this technique during a birth. Would you want to be the first patient a midwife has used this technique on? Would she even know if she were making a mistake? States that actually regulate direct entry midwives require that they fulfill educational criteria that is woefully inadequate, You can take the NARM exam and get certified after attending only 20 births- most non OBGYNs deliver more babies in med school than that.

The thinking midwife’s theory is that compressed cords are providing compromised, but not completely absent, blood and oxygen to the baby. That may or may not be true in any specific case, but there isn’t any electronic fetal monitoring to detect distress at her home births, so midwives are forced to form an opinion based on intermittent Doppler readings.

I sometimes wish I could get midwives together with malpractice attorneys sometime to talk birth injuries. Midwives who do home births attend to far fewer births than physicians, midwives get to pick their patients with more freedom than physicians, and lay midwives are less likely to actually recognize their mistakes. Home birth midwives are less likely to see the impact of their practice choices in any representative way, which probably makes it easy for them to pass around useless advice over and over. Malpractice attorneys deal exclusively in cases where someone died or was injured because critical decisions were made (or not made). They tend to have a much more common sense explanation of the problems caused by nuchal cords because they actually have to see the parents of the injured babies, and file the documents in court, and see the costs associated with the injuries, interview medical experts who explain what went wrong, etc. Malpractice attorneys have to face what these midwives would rather forget or blame on the parents. You will notice that it says in some cases the only way to treat is emergency c-section, and the only way to make sure its not an unduly delayed c-section is to use fetal monitoring. Home births have neither of these things at their disposal, so they have to push the lie that doing nothing is better than doing something that can only be done in a hospital. Admitting that it is more dangerous would lead them to having to obtain actual informed consent, and very few people would be willing to sign on for the risks of homebirth if they were honestly represented ahead of time.

 

No, radical feminists did not hijack midwifery

Dr Amy Tutuer has once again strayed far outside her area of expertise to say that radical feminists are at fault for the current natural child birth debacle. No real evidence is provided of that assertion throughout the post, and in fact radical feminists have been the most supportive of my message out of all the different types of feminists I have talked to. I am an avid reader of feminist literature, including books by many radical feminist authors (Andrea Dworkin, Catherine McKinnon, Susan Brownmiller, Sheila Jeffreys, etc) and have seen no support for Dr Amy’s assertions about radical feminist support for underqualified midwives in home births. Her understanding of the humanities is lacking (you can tell when she discusses issues like trigger warnings for abuse survivors, white privilege, rape, and LGBT parents) and I wish she would just stop talking about things she doesn’t know much about. She has a lot of great knowledge about obstetrics and gynecology that needs sharing, when she decides to say ignorant things it makes her extremely easy to dismiss.

If anything, it seems to me like liberal feminists are the ones who are into “crunchy” things like home birth. They have many belief systems that rely just on how a woman thinks or identifies instead of on concrete, reality based observations.

I’ve pointed out before that midwives aren’t feminists, they just use feminist rhetoric to get clients. They will use ANY rhetoric that gets them clients, because at their core these women are either con artists or akin to a deluded cult member. A con artist knows they are scamming someone, and a cult member is so blinded by delusion that they think its okay to lie for it. Anyone familiar with home birth knows that there are extreme left wing and extreme right wing people involved who have found common ground on a few issues (usually home birth and vaccinations) in which to bond over.

 

The reason the #notburiedtwice campaign exists

The reason the #notburiedtwice campaign exists

I came across a link for a radio show called Progressive Parenting, which decided to discuss the Vickie Sorensen manslaughter case. They had someone from the human rights in childbirth campaign and Katie McCall of Our Sisters in Chains. These women are trying to bury the memory of the baby that died a preventable death in Utah, they are trying to make sure people do nothing in response to the deaths.

The focus of the show was how prosecution of midwives for attending preventable deaths would affect the community. There are a few major claims in the show that are questionable:

Claim #1 is that Doctors are never charged with manslaughter for killing a patient.

It took me one google to debunk that, there are many cases of physicians being charged with manslaughter when they have done something incredibly negligent. The reason that doctors or midwives are charged with manslaughter is that their negligence was so egregious that it could be considered criminal. I think it is safe to say home birth midwives are more likely to do something outrageously negligent because of their dogmatic belief system about the nature of birth combined with paranoia about being persecuted. The women on the show complain that physicians only have to worry about being sued, but are not in favor of mandatory insurance for midwives so that they too could “just” be sued in the case of a death. If midwives want to be sued instead of charged they should carry insurance. The ones with risky practices cannot secure insurance because insurance companies know the risk involved would make for a very high rate for services, and midwives cannot charge prices high enough to justify the insurance cost. Its common sense that if you do a risky job then you open yourself up to these problems, but midwives and natural childbirth advocates believe that they should be exempt from the rules that the rest of us have to play by. They want all the glory of being a physician without any of the responsibility, which leads me to the next claim.

Claim #2 is that home birth midwives are experts in vaginal birth and should be regarded as such by the medical community.

The women on the show praise Utah’s midwifery laws, despite the fact that you need no training or experience to become a home birth midwife in the state. They later refer to Utah as a ‘haven’ for midwives because the law is so lax. I don’t know how they can claim that our laws are great because they require nothing of people who want to practice home birth midwifery, but then demand that untrained or undertrained midwives be regarded as experts in childbirth. Physicians are sick and tired of cleaning up after the mistakes made by lay people and have a negative view of home birth midwives for a reason. I’ve noted before how a non-nurse midwife’s complete ignorance of electronic fetal monitoring makes them unable to detect distress patterns outside of brachycardia, and likely explains the wealth of intrapartum deaths that home birth midwives preside over that are completely unheard of in a hospital setting (the long labor, heart rate was fine, then suddenly the baby is dead story you’ve seen so many times before). The human rights in childbirth rep says that collegiality needs to be in place so that the midwife and hospital can trade info, but if you’ve read From Calling to Courtroom (the guide for home birth midwives to avoid liability) you know the standard advice to avoid liability is to make a chart in your own special code that only you understand.

Do not chart emergency medical procedures. Use a “made up” code that only YOU understand. Don’t ever think it can’t happen to you. I believe I was careful BEFORE I was prosecuted. I am even more careful now.

 

-Chapter 1 of From Calling to Courtroom

It is absolutely impossible to take information from someone in this profession seriously because there have been so many cases where home birth midwives lied to the hospital, EMTs, police, etc.

Claim #3 Anyone working with birth is bound to see a ‘bad outcome’.

Lets assume that by bad outcome they mean a newborn death, since that is the case being discussed on the show. Vickie Sorensen was a midwife for over 30 years, and has delivered ‘over 1000 babies” (according to her fundraiser page). Contrast that with an OBGYN, which would take about six years to get that number of births (delivering 140-180 or so babies a year). OBGYNs still manage to lose significantly fewer babies in the hospital despite taking on cases where newborn death can be expected.  It seems to me that if most OBGYNs were working at the same pace as home birth midwives, and could be as selective in choosing their patients, that they would be extremely unlikely to see an unexpected perinatal death. The culture of home birth has a creepy way of trying to normalize preventable newborn deaths as being unpreventable, but the numbers say something different. The vast majority of home birth deaths can be prevented.

Claim #4 There is an anti-home birth agenda that causes unmerited arrests of midwives and causes the media to falsely report information.

I’ve never actually seen a midwife be exonerated after being accused of manslaughter or homicide, so unless the agenda extends to juries its a bit hard to take seriously. A lot of evidence would need to be produced to support this claim, which is essentially a conspiracy theory to try and excuse the allegations against midwives. I’ve seen no evidence of it anywhere. It seems as though this would be a pretty low priority target, considering the minority of births are taking place out of hospitals. I’ve pointed out why I believe in the charges against VIckie Sorensen, and I talk specifics exactly because I know that these natural child birth advocates won’t. Its a manipulation tactic to keep things vague.

Claim # 5 The right of midwives to practice is about the right of women to choose when and how they give birth.

I find this incredibly dishonest and appropriative of legitimate feminist issues. This is and always has been about letting midwives do whatever they please without accountability. People who are actual feminists think that women deserve to have skilled birth attendants who can actually adequately explain risk vs benefit to them, not a bunch of anti-vaccine nutjobs who idealize the history of human child birth, despite its high mortality rate. Letting midwives get away with being unaccountable and untrained means that we are letting women fall into the trap of charlatans, and many of them are choosing home birth because of fear of hospitals or a lack of finances.

Claim# 6- if midwives have restrictions placed on them, women will have to choose between c-sections and unassisted birth.

Of course this is a false dichotomy, there is a lot of space between those two things. Many hospitals have tried to incorporate as many features of home birth as they can into birth centers attached to hospitals. You could have a vaginal unmedicated birth in a hospital.  Illegal home births attended by midwives happen all the time.

The claim here supposes that going unassisted is much worse than having a midwife, a claim that is false in many cases. Midwives have a mantra of ‘trust birth’, and it means that they are more likely to say that everything is fine when there is a real risk or a real problem happening. There have been many times where home birth midwives prevented transport or insisted it wasn’t needed while the patient knew that they needed urgent help. Midwives have a history of making things much worse than they needed to be.

math is an intervention

math is an intervention

…or at least home birth midwives must think it is, because they seem to have such difficulty with it.

MANA (midwives association of north america) had a voluntary survey to collect outcome data. They found a death rate for HBAC (home birth after cesarean)  of 5/1000, which is much much higher than comparable hospital birth. MANA did not understand that this is equivalent to 1/200, and denied it when it was pointed out to them. Here is what MANA had to say on their facebook page:

…[I]t does show a combined 5 deaths of 1000 (which is not the same as 1 in 200, since 1000 subjects were necessary to find those 5 deaths).

They deleted the post instead of correcting their error. Typical.

Vickie Sorensen and Camille Wilcox learned nothing from the death they presided over

Literal scum, taking twins from a 41 year old diabetic woman after they caused the death of a different pair of twins previously.

Safer Midwifery in Utah

The title of this post is a bold statement to make,  I know. How could someone preside over a preventable death and not change their practices? I can’t pretend to know the mental gymnastics needed to justify the practices at Pathway to Wellness birth suites. I have very good evidence that Vickie Sorensen and Camille Wilcox learned nothing from taking on a twin birth with additional risk factors, because they took on another twin birth with additional risk factors after that poor baby lost its life at the path to wellness birth suite (its called a birth suite because legally its not a birth center).

This birth story is told enthusiastically by the mother as a ‘success’, when to just about anyone else its clear that the midwives agreeing to take this case on nearly cost a baby their life. Its pretty horrifying. Here is the way the mom found Pathway…

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