Category Archives: home birth

Debunking the Business of Being Born: Part 9

This is part nine in a series on debunking the Business of Being Born. The other parts can be found here. The description of what is happening in the movie is in bold, while my commentary in in plain text.

A female OBGYN says “Fetal distress, cord prolapse, a fetal brachycardia that doesn’t come up… how are you going to get someone sectioned or emergently delivered from home? Its not so easy.” 

These comments being allowed in the movie provide a false sense of balance to the film. Noam Chomsky once pointed out that if you only allow two view points, and then allow vigorous debate between the two view points, you can achieve the appearance of democracy and free speech without ever actually having it. At this point in the film the arguments between the doctors and midwives boils down to hypotheticals, and only the midwives are allowed to discuss the research that they have reviewed. The film picked doctors unfamiliar with home birth rather than those who are well versed in it for a good reason- its much easier to control the debate and make it appear balanced.

Midwife Cara says “People think when you do birth at home, you’re not necessarily prepared for that eventuality, and that everything has to go great. But it doesn’t.”

No explanation given of how to resolve the conditions the OBGYN brought up earlier.

Marsden Wagner says “The netherlands loses fewer women than we do, the netherlands loses fewer babies than we do, and one third of their births are planned home births.”

The safety data Wagner cites simply is not true. Multiple studies exist to evidence the fact that planned home birth has horrible outcomes compared to hospital birth, regardless of what country it takes place in.

The scene shows Abbey Epstein and Ricki Lake discussing strollers. The scene changes to Abbey and her husband at an OBGYN office. They are discussing the baby’s position. They perform an ultrasound and say the growth is right on track. Abbey discusses home birth with the doctor. “We really are very, really considering the home birth with Cara.”

Abbey’s doctor replies “Go. I’ll be your back up.” He is very encouraging. They discuss the logistics of being a back up. He is concerned about his patient being treated poorly at the hospital if he is not their back up. 

Cara is talking to Abbey in her car now. Cara says “I’ve had (inaudable) back me many times. And, you know, I could go to saint vincents, or we could go there. It would depend on what the circumstances were. 

This exchange makes for a false continuity of care. There is none. A back up means the midwife dumps you there and may or may not come in, may or may not tell the truth to the staff. Having your doctor willing to be on call is a step up, but it might not matter depending on how emergent your transfer is. New York magazine has talked to former patients of Cara Muhlhahn and area hospitals- they say the same thing. 

Physicians that say they “back up” midwives never bet their insurance on it, and that’s because its a very bad bet.

Abbey mentions that she would love the possibility of transferring to a birth center. Cara points out that if they need transfer its going to be to a hospital because something is wrong. Abbey says she fears she would change her mind about home birth in the heat of labor. Cara replies that she personally begged for a cesarean during her home birth. Quirky music plays and footage from Cara Muhlhahn’s home birth is shown. It is obviously intended to be funny. 

I have taken a break from this series and haven’t been buttered up by the first half of the movie, so I feel absolutely terrible for a woman who desperately wants pain relief and denies herself. I know that Cara likely felt like she couldn’t get pain relief because of the business she works in and her ideological beliefs about child birth.

Cara says she felt like she was between a rock and a hard place, was trying to escape her labor. Footage shows her in obvious pain many times. She says “Every single woman that is having a natural birth feels that way at a certain point. The rock is ‘I’m not pushing because it hurts too much’, and the hard place is ‘Ok then, you are staying pregnant forever, and its going to hurt forever’. Its the most infuriating place to be.” Footage shows Cara crying and whimpering during labor. You can make out her saying “just awful” while she is crying in the labor footage.

This is terrible to watch. I personally would not have included this. It normalizes suffering that is needless. No one should hurt that bad and have a room full of people look on apathetically.

Cara discusses how mean she was to other people during her labor. She is shown in the bathtub crying. She narrates “I looked at the faucet and said thats me, I’m either dying or pushing the baby out.” She talks about having a difficult labor making her a better midwife because she knows how hard it can get. 

If you think about it, Cara was in an interesting position after her difficult labor. She was at an impasse, she knew she had aided other women that were obviously suffering like she had. In light of that she could have either chosen to stop promoting natural birth and worked in a hospital again. She could have stopped practicing altogether. She could have apologized to people she knew that she encouraged to suffer needlessly.
Instead it seems she took the easier option, which is to justify what happened. It is easy to forget pain when you aren’t feeling it right then, and it is easy to forget just how badly something hurt you.

We all have certain beliefs about ourselves or the world that are deeply painful to confront. I have a feeling that Cara’s self image as a helper, as a sacred journey keeper for women in labor, was more painful to betray than labor itself.

triumphant music plays. Cara is pushing. The baby emerges and is put on her knee. One of her arms is grasping someone elses with a white knuckle grip that she doesn’t release, even to hold her baby. Her other hand keeps the baby somewhat more secure on her lap. She looks down at the baby with a rather stoic expression.

Cara did not have the amazing moment that Ricki Lake did during her birth. There are editing tricks employed to imply that it happened, but from what I can see she was just terribly exhausted, to the point where it was difficult to enjoy her baby’s birth. The hand she haphazardly extends so her baby doesn’t fall on the floor seems to be all she could manage right then. The scene ends rather abruptly, making me wonder what else happened after that.

The fashion model patient is trying to hear something through a stethescope. Cara is examining her and helps her use it. The client talks about her insurance company being unsure about what to do with a non-hospital birth plan. She says its cheaper to have a baby at home. 

They cut to Carol Leonard, lay midwife and owner of Longmeadow Farm Birth center says that a spontaneous vaginal birth at a hospital costs about 13,000$. She exclaims “Hello! I’m charging 4000$ for everything!”

There are many factors as to why midwives charge less. These aren’t highlighted in a frank manner, so I will do so here:

1. They provide fewer services (no OR, anestesia, continuous fetal monitoring, emergent labs, blood bank, etc)

2. They do not have insurance (if they screw something up they won’t be able to pay, and if barred from practice in one state they can move to another one and set up shop again, unlike a physician that banks their whole career on retaining their license)

3. Their education costs next to nothing (a CPM can usually get their whole degree for about 3K)

The old addage that you get what you pay for is true here. So is the fact that insurance varies wildly in the US, you may pay less than 4K for a hospital birth depending on your insurance and its terms.

Fashion model patient wonders “what their agenda is” in pushing a far more expensive hospital birth on the insured.

I can tell you right now- it is making sure the insurance company doesn’t have to pay out for a costly NICU stay, or perhaps a lifetime of special education or disability related doctor visits from hypoxic brain damage. The bet of paying on a hospital birth pays off in the long run. The people who run insurance companies just crunch the numbers and charge based on the results. They do not have much of an agenda outside of trying their best not to screw over their stockholders by insuring things that will ultimately cost the company more than it makes.

Marsden Wagner says “The insurance companies, are part of the establishment, and so when the obstetricians who are giving the advice to the insurance companies say that home birth is dangerous or that midwives are not as safe as doctors and all of this nonsense, the establishment CEO in the insurance company believes them.”

Things really do not work that way, but that is beside the point. The assumption is that OBGYNs say home birth is dangerous because they have a bias instead of because they actually know what they are talking about. The questions brought up earlier about specific problems that require emergency c-sections are still hanging heavy in the air, and no one has answered them. I’ve been tracking home birth fatalities enough to answer the question- depending on the problem that occurs at a home birth, someone either dies, is injured, or disabled. There are far too many complications that cannot sustain life between home and the hospital, even if it is minutes away.

A woman says “I’ve interviewed many nurse midwives who noticed that once their practice reaches more than 30 percent of the patients in a hospital the doctors will start firing them, because that is too much competition.”

We are again inundated with gossip from the point of view of midwives with no opposing viewpoint given from the people who are (supposedly) firing nurse midwives. No one knows if this is actually happening or why. OBGYNs do much more than CNMs ever will. It isn’t as though every OB’s bread and butter is delivering babies. Here is a list of specialties that OBGYNs can branch into if delivering babies isn’t their preference. CNMs can do almost nothing that OBs can on that list.

A woman says “The AMA as the trade organization for physicians, has a very clear and public position that holds that they will not allow non-physicians to do anything that physicians do. You wanna talk big lobbies, big dollars, they can call a lot of shots.”

The name of the statement or any reference of it isn’t provided so that it can be verified.

The AMA has a lobby like every trade organization. They are infinitely more ethical than trade organizations like MANA, that had horrendous perinatal mortality rates on the books for several years before privileging the rest of us with them. The period of time between the collection of those numbers and the release of them was the period of time I was pregnant. I was not allowed to make an informed choice because MANA wanted to keep the data secret.

The biggest difference between MANA and the AMA is that the AMA changes its policies based on data. MANA does not. MANA only cares about protecting the legality of home birth instead of the safety of patients. They refuse of even define what constitutes a low-risk pregnancy, despite insisting left and right that home birth is only for low risk pregnancies.

The attempt to smear physicians and their organizations is pretty rich when its coming from midwives. They have very little room to speak.

stay tuned for part 10.

DO NOT TRIP ON MUSHROOMS DURING CHILD BIRTH

I never thought in a million years I would ever have to string together the words “DO NOT TRIP ON MUSHROOMS DURING CHILD BIRTH”, but here we are. The lunacy of natural child birth “professionals” has hit a new high today (see what I did there?):

trip on mushrooms when you give birth

“Does anyone have experience/knowledge about the use of psychadelics in labor? Small doses of psilocybin (mushrooms) in early labor. (Also curious about the use of peyote, ayahuasca, LSD, and DMT.) I’m info-starved on the matter. Please PM me with info if you would not like to share publicly. Thanks.”

A pregnant birth photographer is posting this inquiry to a birth professionals group. I hope she does not plan to use illegal drugs during labor.

Someone replies “Gals I wish we would distinguish known potential harmful synthetic or planet based products from plants etc… we are missing it all and it is becoming very confusing”.

There are deadly plants and harmless synthetic chemicals. Since all of these substances are illegal in the USA it is literally impossible for consumers to know what they will be getting when they decide to trip. This isn’t discussed at all. What is discussed, however, is mandatory drug testing in hospitals and how that would make it a bad idea. I wish I were making this up, but the same women who believe that epidurals and ultrasounds cause autism and c-sections decided to have a lively chat about how super it would be to take illegal drugs to enhance their labor experience.

Another poster writes “Check out this interview with midwife Katsi Cook, she speaks about the use of peyote in childbirth by Native American women, and how this use is traditionally not spoken or written of.” She goes on to say how using peyote has caused people to have really “great experiences” while giving birth.

It is hard to quantify what percentage of hallucinogen experiences are considered to be positive (or what factors cause drug users to view the experience that way). It is easy to demonstrate that its a gamble by reading experiences from drug users themselves on websites such as erowid. You could have the most horrifying experience of your life, a great time, or something in between when experimenting with these drugs.

If anyone reading this is seriously contemplating using hallucinogens during their labor- please don’t. It could harm you or your baby, or cause them to be taken away by CPS while you get charged with a crime. This is quite possibly the worst idea I have ever heard of in my life. 

Following In Dr. Biter’s footsteps

A North Carolina physician is being investigated after having presided over 3 home birth fatalities.

In a statement issued through his attorney Friday, Dr. John David Hayes also said families of the babies have continued to support him.

Of course they do, most people choose birth providers specifically because they trust them. It is terrifying to think that someone you trusted hurt you unnecessarily. The article actually notes that the information came from an unnamed source and that details of the deaths will never be released. Someone saw a pattern and spoke up out of concern for other people, and I commend them for doing so. The fear of repercussion or being ignored is very daunting when deciding to report other people for misconduct.

Dr Hayes expects to be cleared of wrongdoing. I do not expect that for him. Most obstetricians lose one full term baby that was otherwise expected to live in their entire careers, and he has lost 3 in 10 years. At least that is if you believe that he was only taking low-risk patients, which seems to be the only possible way for him to excuse taking a patient for home birth to begin with. His arguments are nonsensical in some portions of the article:

“I expect that after a thorough and impartial investigation, all of my home birth practices will be found to be within the standard of care for an obstetrician in North Carolina,” he said.

Home birth is not the standard of care for any obstetrician. The standard of care for obstetrics involves having ready access to blood transfusions and an operating room, something no home birth can offer without an unacceptably long transfer period. That is why ACOG and virtually every obstetrician discourages out of hospital birth for patients. Most pediatricians discourage home birth as well, on the basis of having treated so many brain damaged patients who were hurt by their parent’s decision to home birth.

However, as Dr Hayes and a few notable exceptions prove (Dr. Biter, and non-OBGYNs Aviva Romm, Dr Sears, and the late Marsden Wagner) an adequate education is not always enough to protect doctors from believing in quackery.

For those who are unaware, Dr Biter is another male OB who was dead set on home birth and insisted on its safety. Unlike dr Hayes, Dr Biters patients did complain in the form of a lawsuit. Dr Biter ultimately surrendered his medical license in light of the fact that he botched a home birth and killed someone’s child. He later decided to open a birth center as a non-physician, until social media pressure caused it to close. Dr Biter has also been the subject of sexual complaints, having taken advantage of the dr-patient relationship in order to obtain sexual favors from his patients. He is very scummy.

Many people who are aware of the debate about malpractice reform know that a minority of doctors are usually responsible for the majority of malpractice claims. When your doctor swims against the current in their speciality it is very difficult to know if it is because they are ahead of their time or because they are quacks. This I know for sure- there are far more doctors who succumbed to quackery than those who were ahead of their time. Be careful.

the deaths we don’t hear about

I’ve tried very hard to track home birth deaths (mostly via the internet and news papers), and it is a very difficult task. I know that many women who lost their babies to home birth do not believe the deaths were preventable, and don’t wish to sully the reputation of home birth by sharing their stories in public. There are others who understandably want to keep their grief private for reasons unrelated to choosing a home birth. I’ve had to ignore a lot of the home birth deaths I’ve found because a state and year were not available to properly catalog them on the home birth fatality map

However, there are statistics available to give the public an idea of how many of babies die as a result of home births and natural child birth ideology. 

 MANA (Midwives Alliance of North America) released the results of a non-random survey recently. They call it a “study” when it is nothing of the sort. It is a voluntary survey with less than half of participants staying with the project until its completion. Data was voluntarily reported on 16,000 births. The results of the MANA stats project under-represents the number of home birth related deaths, but I will still use these numbers to give home birth midwives the best chance to prove that their practices are safe.

According to an independent statistician, the results of MANA’s project are as follows:

So, for a comparable group of infants born in the hospital, with congenital abnormalities excluded, the combined neonatal and intrapartum death rate is at most 0.7 per thousand. The combined neonatal and intrapartum death rate for the MANA STATS group, with congenital abnormalities excluded, was 2.06 per thousand, which is significantly higher. (p<.0001, highly statistically significant.)

In other words, the expected number of deaths from causes other than congenital anomalies was at most 12, and the actual number of deaths was 35 (44 with anomalies included). It is clear that home birth substantially increases the risk of neonatal death and of intrapartum death.

According to the CDC the rate of out of hospital birth was 1.36% nationally as of 2012.

According to the CDC 3,952,841 births were registered in the U.S. in 2012.

1.36% of 3,952,841 is 53,759 births. 

If you use MANA’s overly optimistic numbers, 110 babies died at home births in 2102. The rate of death for the same number of babies in the hospital is 38. 110 minus 38 equals 72.

That means at least 72 babies died because they were born at home that year. It is likely more. Midwives who have multiple adverse outcomes likely chose to keep their data to themselves. 

I also know that there is no real tracking of the deaths that are caused by Unassisted Child Birth (also called “free birth”), and that freebirthers are encouraged to lie to authorities if their baby dies. They say they just couldn’t get to the hospital in time. I know that a midwife can make a birth more or less dangerous by being there- sometimes a UC mom will go to the hospital when a midwife would have discouraged doing so, or vice versa. There is no doubt that these deaths are overwhelmingly the result of natural child birth philosophy.

There is not any information on how many midwives failed to attend a birth that ended in death as a result, despite knowing that this can and does happen to mothers. Dreah Louis and Vylette’s mother both lost a baby this way. It does not seem possible for midwives to report on a birth that they weren’t even there for. 

The skeptical OB, who is very good at finding and posting about home birth deaths, only found 23 in 2012. Less than half of the minimum that could be expected.

Some people may be thinking that it is hard to use statistics for a five year period on any given year, but home birth midwifery doesn’t really change. Like all pseudoscience it has no advances, and practitioners believe things are fine the way they are.  

I am sure other people are saying that 72 deaths is too small a number to be concerned about. 34 children died of heat stroke from being left in cars in 2012, and the outrage over the deaths is considerable. The issue with deaths from home birth or being left in cars isn’t the number, its that they were completely preventable, and that parents have a duty to protect their children from preventable deaths. This is just an estimate of a single year, these tragedies are repeated each and every year.

Reading a number doesn’t really do justice to what these deaths mean. I am going to try and represent them visually, by posting 72 pairs of baby shoes. Each pair represents the unfulfilled hopes of parents for their children’s first step, first word, first everything.

baby shoesbaby shoesbaby shoesbaby shoesbaby shoesbaby shoesbaby shoesbaby shoes

 

name changes for negligent midwives

The skeptical OB has an article up about negligent midwives changing their names as to deceive their customers.

It happened to me, too. Ester Werbach now goes by “Nueve Lunas Maternity” on the internet. The Utah Midwive’s Association is well aware of it, and my complaints of sexual misconduct, and continue to support my abuser. They don’t care.

These types of actions also make it impossible for women to research their care provider. If you have a health care provider that has killed negligently, had their license suspended, or otherwise been reprimanded their patients have a right to know. Midwives rob women of the opportunity to know what they are getting into.

Gloria Lemay: pre-eclampsia is the mother’s fault

If you are unaware of Gloria Lemay, she was an illegal midwife in Canada who defied court injunctions that deemed her a danger to the public. She was involved in an infant death and subsequently sentenced to serve time in prison for her actions.

She still has quite a following in the world of Natural Child Birth, despite having no real qualifications and a ton of documented fuck ups to her name.

The most recent piece of idiocy can be seen on her facebook page. Here is the initial post:

gloria lemay 1

Gloria Lemay remarks that she would “love to see every baby in N America wearing this little message!” The message is “My mommy refused to induce me”. 

Some people rightly pointed out that there legitimate reasons to induce someone, such as pre-eclampsia, which can have serious health consequences (including death) if improperly managed. Here is Gloria’s reply:

gloria lemay 2“When a baby is at risk with “Pre-e” (pregnancy induced hypertension), what has been done to prevent the situation? Over and over, it has been shown that diet plays a key role.

 

The insistence that diet controls pre-eclampsia has absolutely no evidence behind it. A lot of women at the Pre Eclampsia foundation have a lot of anecdotal accounts of following the brewer diet religiously, and then ended up with the condition anyway. Some of them say they got pregnant again because they were confident they could beat pre eclampsia with diet, and in one case the mother almost died as a result. The idea that pre eclampsia is always a case of eating the “wrong” diet caused a lot of the moms on the forum to feel guilty. Lemay continues:

 

Then, if the situation is really out of control with high liver enzymes, is it a good plan to torture the woman/baby with an induction when you already have two ill patients? How is adding synthetic hormones to the situation going to help anything?

 

If you tell women that they are torturing their babies by inducing, you better have some damn good evidence. But there isn’t any. 

As for women being tortured by induction… that doesn’t seem to be what women actually say if you ask them about it.

 

 

There is a very high risk that the induction will end in c/s anyway. I would advise anyone in my own family to go straight to c/s in this situation, avoiding all the drugs, iv’s, of the induction.

 

C-sections include plenty of drugs and IV lines. I have no idea why she thinks she knows better than a physician about induction vs c/s for a case of pre-eclampsia. It is a complicated condition and the mode of delivery is chosen based on a number of different factors. Lemay talks about how horrible c-sections are all the time- perhaps she thinks a woman “deserves” a c-section for eating poorly? Its hard to know. There does seem to be a certain level of vitriol in her answer to a simple question.

 

Inductions are dangerous. Cesareans are dangerous. Ignoring sound dietary practice in pregnancy is dangerous.

 

Saying “x is dangerous” doesn’t really tell me anything about the danger. How dangerous is it? Are all three of those things equally dangerous? 

Lemay is again suggesting that mothers are to blame for eating poorly. I usually try to find a decent amount of evidence before blaming someone for a negative medical outcome. 

 

Birth is as safe as life gets. Medicine is for medical problems but it should be reserved for states of illness, not normal healthy women who have carried a baby to full term. “

 

“Birth is as safe as life gets” is bullshit. It can be pretty dangerous depending on what resources and technology you have available to you. Women still die all the time from complications of child birth, and women like Lemay are only able to ignore that because she is privileged enough to live in a place where obstetric care is very advanced and widely available. It is the same reason she can ignore the effectiveness of vaccination. 

Someone talked about how guilty this discussion made her feel, because she had been induced.

Here is Gloria Lemay’s response:

gloria lemay 3 After telling women they tortured their babies by inducing, which they obviously caused by poor diet or ignorance anyway, she decides to wash her hands of the obvious consequences of making these (extremely judgmental) statements. I don’t know how women are supposed to feel okay about torturing their babies, if they believe what Gloria Lemay has to say about it. In fact it seems pretty unethical of her to excuse people for baby torture, if she genuinely believes induction is an equivalent. 

The guilt heaped on mothers, regardless of the choices they make, is a symptom of a misogynistic society. It isn’t fair to women to add to that. 

 

The uneasy relationship between pro-life and anti-home birth rhetoric

There is an umbrella term for issues of abortion, birth control, and maternity care. “Reproductive rights”. Lumping these three topics together can make it very hard to have a meaningful conversation about the ethics of any specific obstetric or gynecological practice.

The way that home birth communities superficially appeal to feminism is something that contributed to my choosing an out of hospital birth provider. Con artists are skilled at  figuring out what selling point will work on any particular mark.

There were a lot of things that turned me off about anti-home birth web pages when I was doing initial research on maternity care. Certain phrases or arguments served as a  dog whistle to pro-choice feminists like myself. An abortion and a home birth are very different situations, but its hard not to have a knee jerk reaction to phrases like “The baby didn’t get to choose.”

An abortion is usually performed at 8 weeks (medicinally induced abortions can be initiated earlier). A fetus that was aborted was either not wanted or could not be adequately cared for if carried to term.

A home birth baby is very much wanted.

These are obvious differences that everyone knows. It is very difficult to let go of the dehumanization that women face when confronted with anti-choice rhetoric. The message is clear, over and over again: the woman matters less than the contents of her uterus. Its unfair, extremely unfair, especially in the case of elective abortion. Anything that even sounds like that makes me cringe, and that tendency caused a blind spot for me while researching home birth.

The mothers of home birth babies generally want them to arrive safely. They are overwhelmingly white, middle to upper class, and college educated. Outside of domestic violence and other outliers it would be hard to say that home birth mothers are forced into their pregnancies.

Talking about the rights of the baby to arrive safely means talking about what their mother is choosing as well.  There are some women who seem to think that having a home birth is more important than having a live baby, and it is a disturbing reminder of how disparate these issues are from abortion rights.  Virtually no one could condone the conduct of women who loved their home birth experience when their baby didn’t make it.

I am absolutely not arguing for revoking a pregnant woman’s right to refuse treatment or tests. That is a human right that everyone has.  That is not usually what is at stake in home births. Most home birthers are convinced that it is inherently better to have a natural birth at home, or that it is actually as safe (perhaps safer) than having a baby at a hospital. Most women choose home birth because they want a positive outcome, and have been lead to believe that home birth is the best way to accomplish it. Speaking about the babies that pay the price for misinformation is not at all at odds with what most pregnant women desire from birth. These women are being lied to. Just as crisis pregnancy centers twist facts about abortion to try to convince women of taking one specific path, midwives will twist information to make a home birth seem safer. By pushing for legislation to reign in home birth midwifery we are protecting a vulnerable population from predators.