No, maternal mortality is NOT rising. It has fallen in 2006 and fallen again in 2007 to 12.7/100,000, facts that this piece completely ignores.

Moreover, it is far from clear that maternal mortality was ever rising. A careful review of the data suggests that changes in the way that maternal mortality is assessed may be leading to a spurious “increase” in maternal mortality.

In the last two decades, there has been growing awareness that maternal mortality is under-reported. Vigorous efforts have been made to correct that problem, by both increasing surveillance and expanding categories included within maternal mortality. The CDC report Maternal Mortality and Related Concepts (2007) explains these changes:

” In 1999, the coding guidelines used in the United States were expanded to cover additional categories … Furthermore, if only indirect maternal causes of death (i.e., a previously existing disease or a disease that developed during pregnancy that was not due to direct obstetric causes but was aggravated by physiologic effects of pregnancy) were reported in Part I and pregnancy was reported in either Part I or II, the death was classified as a maternal death. [Previously] the pregnancy had to be reported in Part I for the death from indirect causes to be considered a maternal death.

“Along with the new definitions, the [new coding guidelines] introduced new details and categories in the cause-of-death titles associated with pregnancy, childbirth, and the puerperium…”

Furthermore, in 2003, the US Standard Certificate of Death was revised to ask explicitly whether any female death was associated with pregnancy, instead of relying on the person filling out the form to voluntarily provide that information.

The 1999 coding revision and the 2003 death certificate revision captured more maternal deaths just as they were designed to do. Those increases almost certainly reflecting changes in reporting and not increases in maternal mortality. Together they account for 80% of the observed increase since 1998 (5/100,000 out of a total change of 6.2/100,000).

In fact, if you analyze the causes of maternal mortality over time, almost the entire increase is accounted for by an increase in “other direct causes” and “indirect causes,” the two categories that were expanded in the death certificate revisions of 1999 and 2003.

Every maternal death is an extraordinary tragedy. That’s why it’s extremely important that we accurately record and analyze each death. The death certificate revisions were designed to do that and they have done that. The apparent spurious increase is caused by better reporting. And, as mentioned above, the rate of maternal mortality in the US went down in 2006 and went down again in 2007.

P.S. As regards the WHO recommendation of a 15% C-section rate, they have RESCINDED it, acknowledging in In its handbook Monitoring Emergency Obstetric Care (2009), that the figure was not based on solid evidence (in fact, it was based on no evidence at all):

“Although the WHO has recommended since 1985 that the rate not exceed 10-15 per cent, there is no empirical evidence for an optimum percentage . . . the optimum rate is unknown …”

Ms. Gaskin,

Your cynicism in attempting to exploit the issue of maternal mortality in order to advance your agenda of promoting direct entry midwifery is nothing short of appalling.

You represent yourself as shocked at the current rate of maternal mortality.Yet as far as far as I can tell, direct entry midwives in general and you in particular have done NOTHING (no research, no education, no fund raising) to reduce the incidence of maternal mortality. In contrast, modern obstetrics has lowered the maternal mortality rate 99% PERCENT in the past century.

It’s hardly surprising that direct entry midwives (CPMs) have made no contribution to lowering maternal mortality. CPMs have less education and training that midwives in ANY other first world country and are ineligible for licensure in the UK, the Netherlands, Australia or anywhere else..

Anyone who visits your “Remember the Mothers” website will notice something rather curious. There is NO information about the causes, treatments and research into maternal mortality The site is exclusively devoted to criticism of American obstetrics

Look at the page of “related articles”. There are no scientific papers about maternal mortality. There is nothing about the epidemiology of maternal mortality. Twelve of thirteen articles are about medical mistakes. You want to leave the impression that maternal mortality is caused by obstetric interventions. Indeed, in your public discussions of the issue, you are quite explicit. CafeMom reported:

“Most of these deaths are iatrogenic, Ina May explained. Iatrogenic means the treatment of the physician, the drugs administered and the surgeries performed harm rather than heal.”

The reality, as you OUGHT to know, iatrogenic deaths represent a tiny fractions of maternal mortality. The most common causes of maternal mortality are complications of pregnancy and pre-existing medical conditions.

You should be embarrassed at the way that you have deliberately misrepresented the issue for your own personal ends.

PS- That should read “thus giving them the opportunity to AVOID being forced, bullied…etc”

@Amy – I find it funny you bring those countries up because all have lower maternal mortality rates, all have more births attended by midwives, whether or not they are CNM’s still shows the lower number of OB/GYN’s may be better.

I think American women deserve way better than the maternity care system that is failing pretty bad right now in our country.

Meagan, I agree… There needs to be serious tort reform for malpractice, not only that but we also need our OB/GYN’s TRAINED in natural childbirth. The way they are being taught today is to constantly intervene. Heck, OB’s today aren’t even being taught how to deliver a breech baby, and that right there is a BIG problem.

The smiley faces should eights…

BTW… My masters degree will have very little (if anything) to do with being a midwife. But then again, neither does a nursing degree. I’m just saying…

Just because something works for you personally doesn’t make it a universally workable solution. As I said above because their will always be women who simply can’t birth at home, the homebirth experience will never be the cure all many of its advocates purport it to be. Also the problem with apprenticing is that it requires vigorous monitoring which simply doesn’t happen in your country. There is very little that protects mothers from frauds and incompetents which is why I disagree with the practice in the first place. Also part of why medical school is so revered is because its hard as hell and is designed to weed out those who don’t care. People who make it through medical school at least have the benefit of training and controlled experience something many midwives are sadly lacking. Also a lot of the “personal care” people revere in midwives was never the job of doctors in the first place but rather the job of nurses who unfortunately have become a victim of funding shortages.

@Amy – I am not a “home birth advocate” in fact, I am a c-section mother x2, and having a third in May. I am also aware of the false statements you have proclaimed to be facts, like this.

“I am also aware of the false statements you have proclaimed to be facts, like this.”

Are you denying that the Netherlands has the highest perinatal mortality in Western Europe? Are you denying that the Netherlands has a high and rising rate of maternal mortality?Are you denying that the perinatal mortality rate for low risk women cared for by Dutch midwives is higher than the perinatal mortality rate for high risk women cared for by obstetricians?

Danielle, it’s a bit much for you to compare maternity care statistics in the US to other countries as a way of demonstrating the superiority of midwifery, and when someone demonstrates that the OB’s in one of those countries actually have way better stats than the midwives to turn around and say it’s irrelevant. Sort of a debating bait-and-switch. You opened that door, dear. You can’t close it now.

“No, just denying they are worse than the United States is. This is not about what is going on in other parts of the world, it is about what is going on right here at home.”

Then you should be interested to learn that the US statistics are not worse. According to the World Health Orgaization, the US has a lower rate of perinatal mortality than the Netherlands, which is impressive considering that the US population is a much higher risk population.

When it comes to maternal mortality, you need to control for risk factors. Unfortunately, African descent is a risk factor for maternal mortality. It is not a surprise that the countries with the lowest maternal mortality are the countries with the whitest populations.

Every single maternal death is a tragedy, but those tragedies will not be prevented by wishful thinking about the causes. It is not clear that US maternal mortality is rising because virtually the entire “rise” is a direct result of expanding the categories of maternal death on the US death certificate. There is NO evidence that midwifery care reduces maternal mortality. The countries with the highest rates of midwifery care do NOT have the best rates of maternal mortality. Iatrogenic factors are a rare cause of maternal mortality; far more common is complications of pregnancy and pre-existing medical conditions.

If we really want to reduce maternal mortality (as opposed to criticizing modern obstetrics which has already dropped maternal mortality by 99%) we should do everything we can to improve the health status of women before pregnancy, carefully monitor women for complications of pregnancy and treat those complications promptly, and investigate the factors that place African American women at much higher risk than everyone else.

Not as much fun as criticizing modern obstetrics, I know, but much more likely to save lives.

Kim Wilson- How does a nursing degree have nothing to do with being a midwife? you’re kidding right? better to learn about crystals,acupuncture and herbs, and how to handle birth with positive thinking right???

Thanks DR Amy. I dont know how people can read the FACTS you talk about and still deny them. CPMs like Ina May are a menace, and they always deny the stats even when they are printed by midwives themselves! (see CPM death rate for Colorado, as reported by DORA, a CPM MW group).

How anyone thinks having a baby at home, with a provider that has zero medical knowledge or clinical training, is going to be safe, I just don’t know.

Nurses spend way more time learning about how to take care of men and women of all ages than they do learning the very little bit they learn about pregnancy and childbirth. I’ll take a CPM with 3 years of school devoted to pregnancy, nutrition, labor, delivery, and postpartum to a nurse who did a six week class and probably has never seen a natural childbirth ANY day of the week.

Danielle have you looked into what it takes to get your CPM? The answer is “not much.” You take courses, which can be online, and take a qualifying exam. You observe 10 births, and then you are the midwife of record for 10 supervised births. That is it. The end. You are done. How is that enough training to preside at an event that throughout history has been the cause death for countless moms and their infants? You talk about modern OB like it’s a scourge, when it’s the blessing that allows you to have your children in safety.

Marti I don’t know where you’re getting your info but you are misinformed. The only people who can become CPMs with only 10 births (out of a hospital setting) are those who are already CNMs.

From NARM: NARM recognizes that the education of a Certified Professional Midwife (CPM) is composed of didactic and clinical experience. The clinical component of the educational process must be at least one year in duration and equivalent to 1350 clinical contact hours under the supervision of one or more preceptors. The average apprenticeship which includes didactic and clinical training typically lasts three to five years.

In addition:
I. As an active participant, you must attend a minimum of 20 births.

II. Functioning in the role of primary midwife* under supervision, you must attend a minimum of an additional 20 births: (that’s 40 if you’re counting)

A. A minimum of 10 of the 20 births attended as primary under supervision must be in homes or other out-of-hospital settings; and

B. A minimum of 3 of the 20 births attended as primary under supervision must be with women for whom you have provided primary care during at least 4 prenatal visits, birth, newborn exam and 1 postpartum exam.

C. At least 10 of the 20 primary births must have occurred within three years of application submission.

III. Functioning in the role of primary midwife* under supervision, you must document:

A. 75 prenatal exams, including 20 initial exams;

B. 20 newborn exams; and

C. 40 postpartum exams.

Whereas a doctor at Wake Forest:

The clinical Obstetrics and Gynecology rotation during the third year of medical school lasts six weeks. Students spend 3 weeks at Forsyth Medical Center covering Labor and Delivery and the high risk obstetric service. The other 3 weeks are spent at NCBH, where students are assigned to either the Gynecologic Oncology service or the general Gynecology service.

Three whole weeks? Wow… sounds like one of your off the street guys! I’ve met plenty of residents who have never seen a woman deliver without an epidural in place. They have no clue…Thank God for experienced nurses.

I find the worst form of attack to be the ad hominem. You cannot refute Dr. Amy’s presented facts, so you choose to attack her degree. Behold the day when a medical degree from Harvard means nothing; long live the reign of the naive internet poster. I mean, CPMs deliver 10 babies and can get licensed. Totally ready for that home delivery! That medical degree? Useless.

Furthermore, I am not impressed by the CPM mentioned you delivered 700 babies in 26 years. That’s about two to three births a month. This is supposed to make you a proficient caregiver? You’ve never even seen enough births to get a handle on the complications.

Kim I must say that I am perplexed, because I got those number off the NARM website. Hmmm.

Marti you may have been looking at the requirements for someone who is already a certified nurse midwife who wants to obtain the CPM credential. That’s an honest mistake. The stuff I copied and pasted was from the NARM site. Believe me…it’s NO easy task to become a CPM.

“A CPM has to have participated in at least 40 births before she gets her credentials but a doctor has to have actually delivered…zero”

You seem to be extremely confused, Kim. Although CPMs pretend to be qualified to practice on receiving their degree, MDs are not allowed to practice on receiving their degree. The MD degree certifies that they are qualified to BEGIN the four ADDITIONAL years of training required to be eligible to apply for a license to practice as an obstetrician.

But not only are you confused, you keep avoiding the main issue. No other first world country thinks the CPM is adequate. Indeed, the only people who think that the CPM is adequate are CPMs and their supporters. CPMs are grossly undereducated, grossly undertrained and have TRIPLE the neonatal mortality rate of certified nurse midwives.

1) The real rate is rising. The WHO Trends in Maternal Mortality from 1990 to 2008 (published in Sept of this year) shows that the US has doubled it’s MMR. Even with reporting differences…that’s insane. But they cover those in the report. (http://whqlibdoc.who.int/publications/2010/9789241500265_eng.pdf)

2) The rise can be attributed to the rise in cesarean deliveries, the refusal of ACOG to “allow” VBACs, and insanely early elective inductions. The NIH did a conference on VBACs this year and told ACOG to cut the crap and go back to allowing moms to chose to VBAC. (http://consensus.nih.gov/2010/vbacstatement.htm) And JCAHO has seen fit to make hospitals accountable for the elective inductions by instituting a standard prohibiting inductions prior to 39 weeks (unless medically indicated) which went into effect this year. (http://manual.jointcommission.org/releases/TJC2010B/MIF0166.html)

Babies aren’t dying at amazing rates under ANYONE’S care in the US. Seriously? The problem isn’t with the credential…it’s with the legislation. Do you know that there are states where it is illegal to give birth in your home with a qualified attendant? It’s not illegal to have your baby at home but it’s illegal to have someone there to help you. THAT is a problem. There are only about 60 practicing midwives in Colorado (according to their website) and there are 12 who are prohibited from practicing in the state. How many babies do you think those 12 women “killed” before their licenses were pulled? I mean…they probably take 2 clients a month so between them they probably (maybe) do 288 births a year? It’d have to be a seriously screwed up system for them to be losing babies left and right. You do understand though, that statistically even ONE death when there are so few being born, will totally skew that “rate” and make it seem alarming. Kinda like taking 3 classes and getting one F will kill your GPA. (I know babies and grades are different but I’m trying to give you an analogy that most people can grasp.) And on THAT note… I’m going to bed! G’Night!

Kim, you miss my point entirely.

You rant on and on about how much better-trained CPMs are and when I compare the actual hours spent (1350 clinical contact hours for CPMs vs 100,000 on OB and 100,000 on GYN for resident MDs) you just tell me about menopausal women. Read my post again: half of the four years, at the rate of about 100 hours per week, is spent on OB alone. That’s 100, 000 hours. And I delivered thousands of babies as a resident, not 20.

“CPMs study midwifery” === CPMs have such a narrow focus and limited training that they have no basis to evaluate the whole patient who, after all, may actually be a whole person with other issues than being with child.

” CPMs study midwifery. It is not medicine. It is an entirely different mindset which is hard for some people to grasp.”

Oh, no, we get the difference. Medicine is based on facts, evidence, science and rationality. CPM midwifery is… not.

Well, the problem is, Danielle, you’ve reported on what may or may not be a real rise in maternal deaths without doing any real analysis of what the possible or probable causes may be. Aren’t you the reporter here? If so, that is your job.

You start out your column with a picture of an anesthesia module turned sideways, as if that were representative of maternal health, jump to the C-section rate in the US, then summarize the CDCs report, then weigh in on the comment thread blaming OBs and OB care for the (real or apparent) problem without any evidence, statistical or otherwise, to support your assertions. It’s clear to anyone with a background in public health or statistics that you have a very poor grasp of the issues.

OBs are taught that pregnancy and childbirth are problems waiting to happen. Midwives know that those states are natural for the body and when you allow the natural course of labor to continue that it works better than 90% of the time. Midwives know when there is a problem because they are experts in normality. Marti and Amy, during those 10 years of study how much was devoted to normal birth and what it looks like? How much was devoted to problems and bells and whistles? I am also interested to know what your MMD and section rates are.

Thanks Kim and Ina May for stating the facts succinctly.

Amy, you haven’t changed a bit over the last 10 years!

Marti – No, there was no cut and paste in my post at all. I read a news article and reported it from my point of view (part of blogging) and linked the article I read, as required.
But it is apparently clear that no matter what anyone says, you and your friend Amy aren’t going to discuss the real issues, and will continue to deflect the facts. Have a great holiday!

“The clinical Obstetrics and Gynecology rotation during the third year of medical school lasts six weeks. Students spend 3 weeks at Forsyth Medical Center covering Labor and Delivery and the high risk obstetric service. The other 3 weeks are spent at NCBH, where students are assigned to either the Gynecologic Oncology service or the general Gynecology service.”

This is a classic case of you not even knowing what you’re talking about. You must be so proud that you thought you outed OB’s as only having 3 weeks of training. But you are talking about the OB-GYN rotation that every med student (regardless of ultimate specialty) participates in. There are several required rotations of this nature — pediatrics and psychiatry are two others. Every med student –even if he or she has no desire or intent to be an OB-GYN — winds up seeing more deliveries than CPM’s.

After an MD graduates medical school, they go on to have several years of residency in their specialty — 4 for OB-GYN, more if they go into a sub-specialty.

Aren’t you more than a little embarrassed, Kim Wilson, to have made such an elementary mistake?

So who copied who???

http://www.inflexwetrust.com/2010/12/21/pregnancy-related-deaths-on-the-rise/

How can something that isn’t even yours be copyrighted?

All original materials written on Babble.com are copyrighted materials.

“All text, images, design, titles, recipes, and other matter appearing on Babble.com (“Babble.com Material”) are copyright of Babble.com unless otherwise specified and may not be transferred or copied – digitally or otherwise – in any manner without written permission of Babble.com. No alterations or modifications whatsoever may be made to Babble.com Material including to any of its images, designs, or recipes without written permission. Violations will be prosecuted to the fullest extent of the law.”

It is on every page on Babble.com

@ Marti – There is a difference in obtaining statistics from a news article, and plagiarizing and entire copyrighted article on your own website without crediting where it came from, or asking for permission first.

Ahh, thank you ladies for clearing that up.

How about women take charge of their obstetrical care and if a doctor wants to do a C-Section speak up and say no. I did it. We hire who we want to deliver us, thus we are responsible for that decision and to be knowledgable about all procedures and interventions and determine what is best for ourselves. Women need to know about pre existing conditions and make an educated decision about the risks involved in child birth. Too many women go into this ignorant and having a baby is a huge decision that only YOU have complete control of. Not your doctor or midwife!

I mean, a doctor who has other ideas of how a woman should be “delivered” of their baby.

“How about women take charge of their obstetrical care and if a doctor wants to do a C-Section speak up and say no.”

That only makes sense if you have an understanding of obstetrics, science and statistics, so you can evaluated whether you need a C-section instead of reflexively saying “no.”

Homebirth and “natural” childbirth advocates like to boast that they are “educated” but most of what they know is factually false. You CANNOT become educated by reading the websites and books of professional “natural” childbirth advocates. Most of what they say isn’t even true. That’s why you will never find them appearing in any venue where they can be challenged by doctors and scientists. Ina May Gaskin put in an appearance here and then immediatesly disappeared when she could not defend her made up claims and could not deny that she has never, in any way, sought to address the issue of maternal mortality; she has only attempted to exploit it to further a personal agenda.

The biggest problem with homebirth and “natural” childbirth advocates, though, is that they subscribe to a view that women must be slaves to their biology. They glorify anything that women can do with their uteri, vaginas and breasts as somehow “superior” to what women can do with their brains.

Ironically, they apply the same standards to women that men have used to deny women access to political and economic rights. In their view, “authentic” women never interfere with the biological process of birth, which is supposedly “sacred” (the process, not the actual arrival of the baby).

They do not appear to have noticed two very important things: many women ARE obstetricians, other kinds of doctors and scientists. They value and respect advanced education and training and demand it of themselves.

Second, many women DON’T believe that women ought to be controlled by their biology. They take charge of their fertility and those who experience pain and discomfort from menstruation treat that pain. Similarly, they believe they have every right (and are not sacrificing their “authenticity”) by taking control of childbirth. Why “should” they venerate childbirth pain? Why should they pretend that unmedicated childbirth is “best” if they have no interest in experiencing agonizing pain? Why shouldn’t they embrace every and any bit of technology that can keep them and their babies safe?

Frankly, I think Babble ought to examine the biological essentialism is at the heart of tje writing of almost all their pregnancy bloggers. Sure these women are capable of writing about the experience of pregnancy, but they attempt to explain obstetrics without having the most basic knowledge of obstetrics, science or statistics. A great deal of what they write (including this piece) is either factually false, misleading and ideologically driven.

Hey Babble – Dr Amy raises a good point. How about hiring writers with critical thinking skills or a scientific background?

How about hiring Dr. Amy?

Marti-Prove it. What are your stats? Where is the proof that CPMs have three-fold increase in death?

Well, Lisa, let’s start with the Colorado midwives, for whom we have the most recent and the most conveniently accessible numbers. Look at their own official newsletter (www.dora.state.co.us/midwives/Newsletter2010.pdf) and do the math. In 2009, Colorado licensed midwives cared for 799 women. In that group 9 babies died. That’s a rate of 11.3 dead babies per 1000 births. Exactly one of these babies died before labor started. The rest died in labor or in the immediate post-delivery period. An intrapartum or peripartum death in a planned term hospital delivery is so rare, that the last time I know of one was over five years ago, and that was a meth overdose causing a catastrophic abruption. I have been delivering babies for over 20 years, delivering thousands of babies, and have never seen a death related to labor and delivery in my practice. On the other hand, I have accepted more than one homebirth transport where the baby was dead on arrival to the hospital. How is this OK???

@kim – I am an RN, and I take issue with how you disregard my education. i spent a semester in OB, spending almost 100 hour time attending all sorts of births- in the hospital but both natural and more medicalized. And now I have spent 10 years of my life taking care of sick people, and most importantly learning how to keep people healthy (that is the focus of nursing: health not illness). Then, if I were to become a midwife I would spend 3-4 years in furthur training and education to get a masters degree specializing the care of pregnant women and childbirth and postpartum. And althought I am a highly educated RN, I still respect the education and expertise of physicians – as all nurse midwives do. I had a CNM during my two births – and it was in a hospital. I was happy to have the care and focus and holistic nature of the Nurse-Midwife – but also comforted to know that MDs and all the positives of modern medicine right there should we need it. Seriously – we need to work together to make childbirth safer for all concerned.

Now that I’ve stirred up the bees’ nest, I’d like to insert a few facts about maternal death in the United States and explain why I have taken an interest in this important topic. Amy Tuteur makes an unsubstantiated claim that I began the Safe Motherhood Quilt Project in order to exploit my “personal agenda” about midwifery, when in fact http://www.rememberthemothers.org makes no mention of midwifery. Let’s stick to the subject at hand.

I was actually drawn into the problem of preventable (and lack of accurate reporting of) maternal death by obstetricians and nurse-midwives, whose stories of deaths they had witnessed in hospitals (and the lack of lessons drawn from such deaths) left them fearing for the quality of maternity care in this country. Around the same time, I also became aware of the system of Confidential Enquiries into Maternal Deaths (CEMACH) that is used in the United Kingdom (Scotland, Wales, England, and Northern Ireland http://www.cemach.org.uk/) and was interested to see open discussion taking place on the subject of maternal death, with the goal of making it possible not only for midwives and doctors but the general public to understand the chief causes for preventable deaths in the four countries of the UK. The British way of organizing maternal death reporting and analysis manages to do so without exposing their doctors and midwives to increased risk of malpractice lawsuits. Instead of having to write about a huge factor of underreporting of maternal death (as epidemiologists from the CDC must), the CEMACH epidemiologists get to brag about how they have 97% complete counting in their system.

The difference between what the British have and what we have is striking. The goal of the Safe Motherhood Quilt Project is to educate us in the US about putting sufficient value in mothers’ lives that we demand an equivalent system of counting, analyzing, and learning from mistakes made in our maternity care here—regardless of where babies are born or what caregiver is the birth attendant. Until we do that, doctors, midwives, and nurses in the US will continue to work without a good system of feedback about what is and is not dangerous in maternity care, and preventable maternal deaths will continue to take place. By the way, I have never claimed that the problem of preventable maternal death will be solved by everyone having babies at home with midwives—that’s a straw man that Amy constructed because she doesn’t have a good argument to counter what I have written about maternal death.

Here’s a look at the US “system” for reporting maternal deaths and its shortcomings. This first notice from the Centers for Disease Control (CDC) on underreporting was published in 1998. http://www.cdc.gov/mmwr/PDF/wk/mm4734.pdf
Here are some salient quotations from that article:
• “Since 1982 in the United States, no progress has been made toward achieving the Healthy People 2000 goal of 3.3 maternal deaths per 100,000 live births set in 1987.”
• “The United States has not reached an irreducible minimum in maternal mortality; WHO estimates demonstrate that 20 countries have reduced maternal mortality levels to below those of the United States.”
• In this report, maternal mortality ratios are based solely on vital statistics data and are underestimates because of misclassification. The number of deaths attributed to pregnancy and its complications is estimated to be 1.3 to three times that reported in vital statistics records. [Emphasis mine].

Keep in mind that it’s possible to achieve a goal of no more than 3.3 maternal deaths per 100,000 live births and the last figures published for the US (all mothers) is 12.7 deaths per 100,000 live births. Multiply that figure by 3 or 4 for women of color. And consider that it’s quite possible that each of those figures might need to be multiplied again by 3—by the CDC’s own estimation.

I will believe that the CDC has fixed its problem of “gross underestimation” of maternal deaths (the language used by Ob.Gyn News reporter Timothy Kirn), when the CDC is able to announce this achievement in its own words—not when Amy proclaims it so. Does anyone really think that the CDC won’t issue a publication claiming full (or near full) counting when they’re able to? The truth is that the CDC has very limited power to fix the problem, because Congress has never given the CDC the direction or the funding to fix the problem. That’s the real reason why so many maternal deaths get swept under the rug in the US.

Amy thinks that those articles that I cited in Contemporary Ob.Gyn, ACOG Today, and The Lancet (whose editors would be surprised to be called a “throwaway journal) refer to a problem that has already been miraculously fixed. I would love it if that were actually true, but since it isn’t, I encourage those readers (including Amy) to take a deeper look at this troublesome subject.

In 2007, a CDC publication on maternal mortality described the agonizingly slow process that has been started to improve counting maternal deaths in the US http://www.cdc.gov/nchs/data/series/sr_03/sr03_033.pdf. On page 4, author Donna Hoyert clearly stated: “In 2003, only four states could capture information consistent with the standard,” referring to the questions related to a deceased woman’s prior pregnancy status on the US Standard Death Certificate.” [Emphasis mine]

On December 9, 2010, we got some new figures from the CDC, which make it clear that by 2008, only 31 states and the District of Columbia had changed their state death certificates to conform with the US Standard Death Certificate questions on pregnancy status. That means that two-fifths of the states still refuse to use the US Standard Death Certificate. In some states, this means that there is literally no question at all regarding a deceased woman’s prior pregnancy status, and that makes it very tempting for the certifier of the woman’s death to leave out the true cause of death. How do I know this? Because I have interviewed many officials who work at state Vital Records departments, and several have told me so. Why is this so important? What this actually means is that some of the states stubbornly keep using death certificates that don’t include even one question (let alone the 5 that the CDC wants included) regarding a dead woman’s pregnancy status in the previous year. It’s awfully tempting for a hospital to be deliberately vague about filling in the “cause of death” line on a death certificate, knowing that the woman’s family will have access to the document. I know of two cases in which an accidentally cut uterine artery during a C-section resulted in a woman’s death, and the “cause of death” box was filled in: “Amniotic Fluid Embolism” in one case, and “Anemia” in the other. What makes this even worse is that it’s perfectly legal. Maternal death reporting is done via an honor system in the US!

Why, we might ask, should the states be given the choice about whether they use the US Standard Death Certificate? The very title of the document implies (as does the name “United” States) that we gather death statistics in an orderly fashion, using standardized definitions. But we don’t. Other “civilized” countries don’t have to argue with their states or provinces about using standardized definitions and methods of data-gathering surrounding death statistics. It is women in the US who are getting short-changed here. Amy apparently thinks this is okay.

Amy should be embarrassed to write that “maternal mortality has dropped by 99% in the last century.” If she said that kind of thing before an audience of midwives or doctors in most well-to-do countries, they would burst into laughter. The maternal mortality rate in the US began to go down in the mid-thirties, largely because of improvements in transportation, telephones, blood cross-matching, and the use of antibiotics, and it hasn’t improved a bit since the early eighties.

I urge everyone to read the recent report: “Maternal Mortality in New York: A Call to Action”, which is dated 12/14/10. Is she going to call it “outdated”? It’s published by the New York Academy of Medicine. It may make her angry, because the report quotes me in its first paragraph, but she should know that there are a lot of doctors (most of whom are still in practice), who respect what I have to say on maternal mortality and who invite me to speak at their hospitals on this subject. Furthermore, I have had epidemiologists and obstetricians who have urged me to continue with the Quilt Project, who say, “Keep doing this. It’s really needed.”

At any rate, here’s an important finding of the report from the NY Academy of Medicine:
“In New York, significant work has been done over the years to improve reporting and case review, develop hospital-based interventions, and to improve community-based prenatal care. Some of these efforts as well as evidence about best practices are summarized in a white paper prepared by The New York Academy of Medicine that is available at http://www.nyam.org/news/docs/MMdraft_061610.pdf. Despite these efforts, the failure to make significant reductions in either the overall rate or the disparities in maternal deaths suggests that much more needs to be done.”

So, yes, I have parachuted in, and January 1, 2011, is as good a time as any for me to become the National Nag about Maternal Mortality.

By the way, Amy chastises me for not writing about the problem of maternal mortality, ignoring the articles that I have published on the subject in the Journal of Perinatal Education (“Maternal Death in the United States: A Problem Solved or a Problem Ignored”?) and Mothering (“Masking Maternal Mortality”). Google “maternal mortality” and you’ll find them, or go to inamay.com. See also Ina May’s Guide to Childbirth, which contains a chapter on the subject.

Anyone who takes a look at http://www.rememberthemothers.org will see that if there is documented information about a maternal death after an attempted home birth, that information is added to the website. I don’t discriminate at to intended place of birth. That makes what I have shown there thus far (I actually have more than 100 additional names and stories to display there when I am able to do that work) an interesting kind of randomized sample. It’s easier to collect the name of a woman who died after an attempted home birth than from a hospital birth. The highest risk for home birth when it comes to maternal death, according to the data I have gathered, seems to be belonging to a religious cult that forbids medical attention to the mother or baby even in the event of a complication. I know of 6 or 7 such cases and will be putting up photos of the quilt blocks and names as the blocks are finished.

The reason that I have decided to devote part of my time this year to educating on the subject of maternal death is that I have just finished writing my newest book (to be released in March) and now I can devote a little time each week to correcting false information on the subject when I encounter it. I may not be as fast on the draw as Amy (who seems to have nothing else in the world to do with her time), but I have already devoted enough time to studying maternal death that I’m not prepared to tolerate the flippant statements that she often makes. As for ad hominem attacks, if she sticks to her old habits, she’ll feel that she has to indulge in these from time to time, but I’ll trust the rest of you to sort out what’s fair argument and what is not.

Bottom line is that until the CDC is able to get above 90% in its reporting of maternal deaths and know for sure that they’re getting accurate cause of death in each case, and until maternal mortality/morbidity committees are made mandatory in every state, nobody–no matter how great a reporter he or she is—is going to be able to tell us on the basis of good data all of the reasons for the rising maternal death. My sample of 350 or so deaths tells me that you have to look at more than 42 days after the end of pregnancy, and that the CDC should be including the reporting of all pregnancy-related deaths within a year after the end of the pregnancy. I have counted more than 40 postpartum depression/psychosis suicides, and these deaths are rarely counted in the official figures. These women are usually highly educated, and sometimes they’re even medical caregivers themselves.

Ina May Gaskin, CPM, PhD(Hon.)

“So, yes, I have parachuted in, and January 1, 2011, is as good a time as any for me to become the National Nag about Maternal Mortality.”

Ms. Gaskin, you are not the national “nag” about maternal maternal mortality. Most people outside of the natural childbirth world have no idea who you are. And those in the general science community who are aware of you criticize you for you anti-rationalism and pseudo-science quackery that postulates strange “energies” and “laws” of childbirth.

You have made NO attempt of any kind to address the issue of maternal mortality. You have only tried to exploit the issue of maternal mortality to further your own agenda. A brief perusal of your website shows that there is NO scientific information about maternal mortality; there are only anecdotes and main stream media reports of deaths that you believe to be iatrogenic (generally those of Western, white and relatively well off women). Maternal mortality strikes the African American community hardest, yet you include no information about African American women who die from complications of pregnancy and pre-existing medical conditions.

For some reason, you seem to think that you can baffle everyone with a massive amount of words that mean essentially nothing, but the bottom line is quite clear: your sincerity on this issue should be judged by what you do to prevent maternal mortality, and you do absolutely NOTHING.

@Marti – If there is no relation between cesarean sections and the increasing problems women see, why is there currently such a big push to lower c-section rates, as well as increase VBAC numbers?

If you will allow me to quote you, Ina May:

“….until the CDC is able to get above 90%….and…..accurate cause in each case…nobody, how great a reporter he or she is, is going to be able to tell us, on the basis of good data, all the reasons for the rising maternal death.”

So, Leanne, Danielle, Kim, Jennifer, where in the world do you get the idea that there’s evidence that obstetrical care is a huge contributor to maternal death? What evidence do you have to support it?

And if we care about moms, why do we not care about babes? Why does no one bother to reply to my post above citing the mortality rate for homebirth with CPMs in Colorado in 2009 being 11.3 per 1000 term births. That’s as compared to the typical term death rate of 3.8 per 1000 in hospital care.

The only one ignoring anything, Dr. Amy Tuteur, is you. You completely overlooked the problem Ina May Gaskin highlighted: that maternal deaths in this country are reported on the honor system. There is no standardized method of counting maternal deaths in this country so your statistic on the maternal mortality rate lowering in recent years is bull!

Petition for Mandatory Reporting of Maternal Death in the United States:

http://www.tinyurl.com/savemothers

@Vicki – ((Hugs)) Thank you for sharing your experience with us.

You know, I was almost a name on Ina May’s quilt. I very nearly died during the process of bringing my last child into this world. My life was saved by a very quick thinking paramedic and a couple of great surgeons, backed up by some pretty hot work from an ICU team. I am truly grateful to them for saving my life and the life of my baby.
I almost died from placenta percreta. A complication which was caused by my placenta burying itself deep into my previous caesarean scar. At 33 weeks and one day of pregnancy a major blood vessel in that portion of placenta through the scar tore and I collapsed, at home, with massive blood loss, somewhere in the region of 6 pints. I am lucky to be alive. Very lucky.
That previous caesarean was done because I had been in labour with a previous child for more than 12 hours. No other reason. I had given birth easily and spontaneously with the baby before that, but I did spend a long time in early labour. I was held down and physically forced into surgery I did not want and did not need, because the doctor wanted to go home. I was screaming stop, but it made no difference. It was assault, but have you ever tried to sue a doctor for battery? My medical notes went missing and there was not enough evidence for a law suit… Read into that what you will.
Just looking at the death rate does not tell you all you need to know about how healthy and safe mothers are giving birth. I am physically and emotionally scarred and unable to have more children, but I am not on your death roll, I escaped that by the skin of my teeth.
I find the debate which says that women clearly do not know what is good for them and they should trust medicine absolutely to be a very, very dangerous place. Many women no longer feel safe to give birth, their bodily confidence is being eroded and their ability to choose is being dictated by professionals who may NEVER have seen a physiological birth from start to finish, let alone supported a woman throughout that process.
Midwifery is the art of supporting normality, and of knowing enough about normal in all its variations to know when things are not normal and the help of a medic or a surgeon may be required. It is about giving women the confidence to be the owners of their body and their mind and having the skills to help not hinder the birth process.
If birth was really so dangerous that 1/3 of babies should be born surgically and less than 10% of women get a birth with no medical intervention, the human race would not have reached 2011, and we certainly would not be populating the planet at the rate we are.
I hate being a near-miss statistic, but it gives me a place to say that modern care was WRONG for me. I’d feel safer with Ina May at my side than my doctor…
P.S. You should really go and read the full study from the Netherlands, the conclusions are not quite as you are reporting.

Also, back to the topic at hand – maternal mortality. I have done my own research into several areas of maternal mortality (national, state and local levels) for my nurse-midwife MSN degree. What I have found is very discouraging for maternal health across this country.

The baseline rate of maternal mortality (reported) in 1998 for Healthy People was an average of 7.1 deaths per 100,000 live births. The goal for Healthy People 2010 was to reduce that to 3.3 deaths per 100,000 live births. What I found, however, was alarming: 13.3 deaths per 100,000 live births in 2006 (Amnesty International). 15.1 deaths per 100,000 live births in 2005 (CDC Wonder Data 2010). Looking at the CDC Wonder Data, the breakdown for 2005 for maternal deaths by race:

Asian/Pacific Islander 11.7/100,000
African American 36.5/100.000
White 11.1/100,000
Hispanic 9.6/100,000

Breakdown by age range, same year, same citation:
<20 yrs 7.4/100,000
20-24 yrs 10.7/100,000
25-29 yrs 11.8/100,000
30-34 yrs 12.8/100,000
35+ yrs 38.0/100,000

We need to look closer at those who are at higher risk for maternal mortality: African American women, and women over 35 yrs of age. We need to look at WHY they are dying, and how we can reduce those death rates.

As for my own educational background, I am a Registered Nurse x 9.5 years, including 2 years in L&D/postpartum/newborn/NICU/GYN (a small hospital where everything was in one unit), and then for the past 7+ years in a high risk tertiary inner city teaching hospital where we have over 4500 births per year. I am exactly halfway through my midwifery program at Frontier School of Midwifery and Family Nursing, working on my MSN degree and becoming a CNM.

Ms. Gaskin,

Not only have I demonstrated that what you have written is intellectually dishonest, misleading and entirely self serving, you have helped me do it.

You wrote:

“Here are just a few examples of articles that have been published during the last decade or so about the too high US maternal death rate: “Pregnancy-related deaths: Moving the wrong direction,” published in OBG Management, January 1998; “Maternal mortality: No improvement since 1982.” ACOG Today, August 1999; Maternal mortality: An unsolved problem. Contemporary Ob.Gyn, September 1999; “U. S. maternal death rates are on the rise.” The Lancet, 1996; “Pregnancy-related deaths increasing,” Contemporary Ob.Gyn, December 2010.”

To anyone who knows anything about obstetrics, this bibliography salad is not only out of date (anything before 2000 is NOT in the last decade, and, considering that we are discussing maternal mortality from 1998 to 2005 has absolutely nothing to do with this purported rise), but it is laughable. OBG Management, ACOG Today and Contemporary Ob.Gyn are what is known as “throw away” magazines. They are not journals, and they are mailed to almost all obstetricians for free. It’s the equivalent of citing “House Beautiful” to make a claim about architecture.

You wrote:

“Prior to 2003, only 2 states used the US Standard Death Certificate—the only one containing the questions that CDC epidemiologists designed to prevent misclassification of maternal deaths. Many states still refuse to use the standard death certificate. This makes the CDC’s data much less accurate and useful than they should be for such an important statistic. Underreporting maternal deaths leads to a false sense of security and misunderstanding of the true causes of preventable deaths.”

That, of course, is just what I said. Prior to 2003, there was considerable under-reporting of maternal deaths. And just as under-reporting can lead to misunderstanding about the scale of maternal mortality, correcting that under-reporting can lead to a spurious “increase” in maternal mortality.

Ms. Gaskin, take a look at the graphs on my blog that I linked to above. Address the specific points made in those graphs. Then we can see who is explaining the evidence about maternal mortality and who is twisting it for personal reasons.

Maternal mortality has dropped 99% in the past century. Could it be lowered even further? Absolutely, but since the overwhelming number of maternal deaths each year are the result of complications of pregnancy like pre-eclampsia and pre-existing medical conditions like heart disease and kidney disease, your implication that less medical care is needed is simply absurd.

And by the way, how do you explain the fact that maternal mortality has declined for 3 years in a row since 2005? Intervention rates have gone up, not down, so your theory about modern obstetrics appears to be thoroughly debunked.

Really Marti, so rare? I know of three in the state of MD in the last few months alone. One truly egregious one where a doc abused a vacuum and refused to call in a backup doctor even though the NURSE was saying they should get someone else in. I had six children. My only dead one was born in a hospital. My home birth babies all lived. Deaths can happen in any setting. How many of those deaths occured because the baby could not survive. Did you know that some women with children they know have birth defects choose homebirth because of the callous way they are handled in the hospital? Like the damn teardrop they put on the door of my room that every f’in personnel in the place ignored and would walk in and cheerily say “how is you baby” to which I would reply, “dead you idiot, why do you people even bother with the leaf when you don’t even look for it.” If I ever had another baby that was stillborn or I knew had severe birth defects and would not live, I would still birth at home. I have seen first hand how you all handle assembly line care in this country. No thank you!

Amy, you still didn’t read my post closely enough to get that the CDC still isn’t getting anywhere near full reporting of maternal deaths. Can’t you read?

Vicki, who almost died from the placenta percreta, do you happen to have your operative record from your C-section? (Good for the medical team who saved your and your baby’s life!) I’m curious to know how your uterus was repaired after your C-section. For more than a decade many ob.gyns in the US were repairing the uterine incision with only a single layer, a practice that most have moved away from, now that it is generally recognized that this method came with a higher rate of uterine rupture or placental problems in the next pregnancy.

I am greatly saddened by this discussion. First as a pregnant woman and second as a birth professional who has dedicated my life to providing quality care during the childbearing year for women and families. This discussion started out covering a critical topic in our health care system: Why are women dying due to pregnancy related reasons? This discussion unfortunately has sadly turned into a debate about CPMs and their legitimacy as care providers in our country.

As a pregnant woman I feel blessed to live in a state that allows myself and my partner to look at all of our options and then choose what is best for us. There is absolutely NO ONE more capable or responsible for my health and my baby’s health than myself. Thankfully I live in a place where that choice is respected and not devalued or made illegal by individuals bent on limiting choices for women and families instead of increasing them. There are always going to be women who choose and need to birth in the hospital setting and thank goodness that choice is available and wonderful, qualified and experienced professionals are available to care for them!!! There are also always going to be women who will choose to birth outside of the hospital system and thank goodness that choice is available and there are amazing, talented, trained and experienced professionals available!!! Within ANY profession whether on OBGYN, CNM or CPM there are going to be a wide range of care providers with different levels of training, experience and education. In addition, within all three there will be care providers who vary in quality. There is not ONE right care provider, right way or place to have a baby. That should be one fact we can all agree upon! That’s why we as pregnant women have the responsibility to do our homework, research who is out there, ask the hard questions and carefully choose who is the best care provider and place to have our babies. What would be even more groundbreaking is that as a society and culture we encouraged careful decision making for childbearing women when it came to their health care. It is always shocking to me that people often spend more time researching what car to buy than they do when it comes to who will care for them during the childbearing year. That includes women who are choosing to birth with the traditional medical model of care. So many of my clients are being guided by their insurance companies into who will care for them and they never even consider they have a choice among OBGYN’s. Of course the ultimate responsibility sits with the woman, but I also strongly feel that as a culture we have done a great disservice to women in regards to dis empowering them when is comes to their personal health care………….this is especially so during the childbearing years.

Clearly everyone chiming in on this conversation has a real passion and a lot of energy towards discussing women’s health. Let’s turn that collective energy towards looking at what we as practitioners, citizens and advocates can do individually to improve women’s health care instead of spending useless energy on trying to disqualify one another in an effort to feel “right” about our own perspectives. The facts are out there, they are being reported so let’s look at those and then come together and figure out solutions.
Trying to disqualify CPM’s and their legitimacy as practitioners does absolutely nothing to change the fact that women die from pregnancy related causes. Why that was ever introduced into this conversation is mind boggling. What bearing does it have? Let’s return to the original concern and spend our energy discussing how we as a community and that includes ALL of us on this board on brainstorming ways to make this situation better. Let’s keep our personal opinions to ourselves and have a real discussion about what we can all do.

So I will leave you with what I can do as an individual. Within my own practice as a doula,childbirth educator and founder of a non-profit serving high risk women and families, I will continue to work towards our organizations mission of: educating pregnant women on what does a healthy pregnancy look like, what inter conception health looks like and making sure our clients have access to health care and resources that support a healthy pregnancy. Most importantly, I and the organization I run will continue towards educating women on how to empower themselves with research based information and education in order for them to make their own decisions based on what THEY feel is best for themselves and their baby.

So, I ask the simple question: What are you doing? What will you do?

Dear “Dr. Amy:”
Bottom Line:
You think your degree makes you better: It doesn’t.
Your disrespect of Ms. Ina May is simply disgusting, and I hope you’re embarrassed at the way you are trying to scream at the top of your lungs like a four-year-old. Shame on you.
No one but a midwife will ever again come NEAR one of my births. An OB-GYN killed my son, and nearly killed me, at age 20. I will never again trust someone like that, and hold Ms. Ina May in THE highest regard. I’m not coming back to this post, but I hope this comment brings shame to your face.

I work with OB’s & CNM’s and love working with them equally. They are very competent, safe & evidence based practioners (important words – evidence based). I would advise NO ONE to see a provider who did not have OB/GYN or CNM behind their name!

The women I see come in and out of our unit are obese, diabetic, chronic hypertensives… When are we going to hold people accountable for their health? Let’s not be so quick to point fingers at OB’s & the hospitals. Why not lay midwives who let a severely preeclamptic woman labor at home? Or the lay midwife who tried to deliver a breech baby? And, who’s there to clean up that mess? Oh YEAH, obstetricians! Women beg for inductions but don’t look at the risks of doing so. They beg for epidurals, c-sections & the quick fix. So, while you all shake your fingers at OB’s & western medicine, maybe you should consider one other factor – yup, it’s the pregnant woman!

Ina May, we were both close, it has been classified as a near miss on both our records. I’ll send you the story.

There have been a lot of opinions offered about Ms. Gaskin and homebirth midwives, so now let’s try a few facts::

1. The Farm is a cult, led by her husband who preaches his philosophy and has run The Farm as a personal dictatorship.The Farm cult was explored in a long Vanity Fair article for which Ina May and her husband were interviewed.

2. Ina May has no midwifery training of any kind, nor does she believe that any training is necessary.

3. Ina May is a proponent of anti-rationalism and pseudo-science. She is well aware that much of what she proclaims is directly contradicted by scientific evidence, so she ignores evidence and focuses on mystical forces and energies.

4. The pulished statistics from The Farm are terrible (Durand 1992). The perinatal death rate at The Farm was much higher than the perinatal death rate for low risk women in the same years. Most people don’t realize it when they read the paper, because they don’t understand the language, but Durand and Ina May acknowledge within the paper that they compared the death rate at The Farm with a sample created to study high risk pregnancy in which premature and high risk pregnancies were emphasized.

6. Since then, Ina May has not allowed anyone to study The Farm’s statistics.

7. Ina May started MANA (the Midwives Alliance of North America) and created the CPM credential (which doesn’t meet the standards for midwifery in ANY other first world country) so she could award the credential to herself and her friends. She couldn’t even meet the pathetically inadequate CPM standard, so she declared that the CPM could be awarded on the basis of a “portfolio.” To this day, the CPM credential is awarded to people who have no education and training at all.

7. The entire fact resistant, anti-rational world of homebirth midwifery is controlled by a series of interrelated organizations started and/or run by her. MANA, MEAC (the credentialing arm of homebirth midwifery), and Midwifery Today, all belong to Ina May.

8. Ina May’s organization MANA, has collected safety statistics on homebirth since 2001. Over the years, they have promised that these statistics would be presented when collection was completed in 2008 to show the world that homebirth is safe.

But when the analysis was finished, MANA decided that they couldn’t release those statistics at all. They have publicly offered the statistics only to those who can prove that they will use them for the benefit of midwifery, and sign a legal non-disclosure agreement.

MANA has been quite upfront about the fact that they feel they represent CPMs and therefore will not release statistics that show them to be unsafe practitioners. MANA’s OWN DATA shows that homebirth with a CPM is unsafe, so they are hiding that data withholding that information from women.

Ms. Gaskin, if you have any FACTS to offer in dispute of these claims, please feel free to share them.

Kyle is right about the fact that the CDC has never been set up to get every maternal death recorded. What he’s missing is that a handful of states have set up their own ways of gathering up some of the women’s deaths that are apt to be misclassified—for instance, they might take the woman’s name (if she’s of childbearing age) and search for a baby born to that woman within 42 days of her death. That’s one way that epidemiologist came up with the estimate that the CDC could be missing 2/3 of the actual deaths within the 42-day period.

My point has always been that the CDC figures are far from accurate. The first panel of the Safe Motherhood Quilt was displayed at the Summit for Safe Motherhood conference sponsored by the CDC, ACOG, and the ACNM in September, 2001. The CDC people would not have displayed the Quilt if they had not considered it as an important addition to the conversation about preventable maternal death in our country.

Amy probably doesn’t believe that the CDC would do this, and she’ll continue to try to distract others from the subject at hand (which she tried to squelch with her initial post).

Other countries have had to deal with underreporting of maternal deaths at the national level (France and the Netherlands are two examples). What is different about us is that we actually have Amy ( for instance) and maybe Marti, as examples of doctors that apparently believe that the CDC is going to be able to fix the underreporting problem without external pressure.

I forgot to mention that France and the Netherlands were able to deal with their underreporting problems because each country has a national health system which allows national directives to be made that hospitals and birth centers must obey. Here in the US, business interests override public health concerns—a fact that too few people realize.

@PartlysBabe – Actually I think Amy has published a couple books. I picked one up on Amazon.com once for a penny.

Okay, we seem to agree on this much—that the CDC could be doing a better job and that maternal mortality is a problem.

However, I can’t agree with your point:

My disagreement is with your use of “almost entirely”. I would agree with you if you had written “partially”. I don’t see how you can say “almost entirely”, given the data that has recently come in from New York and California—not to mention what the Joint Commission has had to say on the subject of maternal death.

In California, greater than a 300 percent increase in the maternal death rate has been reported between 1996 and 2006. Dr. Elliott Main, the principal investigator of the California Maternal Quality Care Collaborative, a public-private task force investigating California’s higher maternal death rates, has stated that it has been hard for the task force to ignore the fact that C-sections have increased 50 percent in the same decade that maternal mortality increased. Please note that most of the time period of the increase he refers to had passed before California improved its death certificate. You may consider this irrelevant, but I don’t.

Dr. Charles Mahan, Dean of the USF College of Public Health, (Florida), wrote in 2007: “Having sat for many years on Florida’s excellent Pregnancy-Associated Mortality Review committee at the Department of Health, I have some personal observations as an obstetrician and public health practitioner about some dangerous trends feeding into this increase in deaths: a growing number of uninsured women; the obesity epidemic; small hospitals keeping high risk women in order to keep the insurance money, instead of referring them to a hospital that had doctors and staff that could better handle the problem; lack of care in between pregnancies for women with chronic disease problems like diabetes and high blood pressure; a diminishing quality of care for pregnant women by some doctors, nurses and hospitals; and lack of access to pregnancy prevention and spacing services. Dr. Mahan was commenting on the overall maternal death rate in Florida having risen from 16 per 100,000 to 23 per 100,000. Again, this rise took place almost entirely before the CDC began trying to persuade states to use the standard death certificate. Notice that both Florida and California had considerably higher maternal death rates than the national average before they rose.

In 2007, Donna Hoyert from the CDC wrote (in reference to the possible impact that somewhat better reporting on death certificates in a few states might have on apparently rising maternal death rates): “When the data were collapsed across time, there seemed to be a tendency for the states with a question [on the death certificate relating to prior pregnancy status] to have higher rates than those without a separate question; however, the differences were still not statistically significant.” If you are basing your argument on what Hoyert has written, you must see that your original statement regarding the question at hand (that maternal death rates are NOT rising) is insupportable.

For all of these reasons, I cannot feel as optimistic as you apparently feel about US maternal death rates. I’m curious as to why you have written so little about the problem (except to minimize it), given that you have written that you find maternal death extraordinarily tragic.

About your graphs and the “falling maternal death rates” that you want me to comment on—I think it’s far too early to feel comforted by the comparatively small drop that we saw between 2005, 2006, & 2007, given the depth and the grave implications of the underreporting problem. (2/5s of the states still not use the standard definition, we still no laws providing for stiff penalties for false reporting, there is still no mandatory training for certifiers of maternal deaths to how to fill in the cause of death boxes accurately, we still have no laws requiring mandatory mortality/morbidity review at the state level, there are still very few autopsies after maternal deaths (meaning that many “causes of death” are erroneously diagnosed, etc.). So, despite the slight “drop” in the maternal death count that your graphs note, recognizing this as progress is not convincing to me. I’m surprised that you make so much of it, given that you advertise yourself to be a skeptic.

Do you deny that for-profit hospitals have great incentives to minimize maternal death reporting as long as inaccurate reporting remains legal? Do you believe that a system of maternal death reporting should leave a trail that can be audited? If not, why not?

Let’s face it. We’re going to be stuck with uncertainty about whether reported rises (even if only in some states) in maternal mortality are due to actual rises or better reporting until we have a system in place that can compel accurate, comprehensive reporting. If earlier generations had done a better job putting such a system in place, we wouldn’t be having this argument. But they didn’t, so it’s our job to fix things now. Why don’t you help?

And let’s not obscure the very real fact that even the most rosy view of maternal death rates reveals rates higher that exceed those of every European country. I hope that you are not satisfied with this.

Following my unnecessary cesarean after “failure to progress” with my first daughter, I read Mrs. Gaskin’s book ‘Guide to Childbirth’ and it raised this question for me: “how were all of these woman–who seemed just like me– having babies naturally with midwives and more safely than hospital births?” The answer was clear, it was a mind and body thing. Our bodies shut down when we’re stressed. Being with an unsupportive person, doctor, nurse or anyone during labor will cause labor to stall. It did for me. Ina May Gaskin’s farm’s statistics alone would be a great study in birth outcomes for moms and babies. I was unable to pack up my family and move to Tennessee to give birth to my next baby, but I did learn enough to hire 2 amazingly experienced and educated CPMs. I learned from other moms just like me at ICAN meetings. I read every related book I could find on midwives and pregnancy. I found studies to review. But none of it was as compelling to me as Ina May’s book. Thank you Ina May! You have done so much for so many women. With your wisdom and experience, you have changed my life. I feel I am a better mother and trust my instincts, wisdom and education more now than I would have placing my body and baby within the medical model of care a second time. I have become an advocate for the Midwifery Model of Care directly related to my experience of labor and delivery of my last daughter. I am wondering if you too Amy, have a biased need to express you opinions and select statistical outcomes because of your traumatic birth experience of natural labor in hospital? You told me once on a thread that was an experience you had had. I can tell you that my attempt at a natural childbirth in hospital was too a horrible one. Though it works for some, I feel natural childbirth should be attended by someone who has experience in natural childbirth and believes in it as well.

As for the debate about ethnic disparages in Midwives’ care vs Ob’s care, just look at the work of Ruth Lubic here in DC at the Family Health and Birthing Center or Jennie Joseph’s birth center in Florida (Commonsense Childbirth Inc.) Both of these Midwives are making differences in communities where the medical model of care has failed these families.

If we lived in a society such as you are comparing in Europe, you are correct that the medical and Midwifery communities would be integrated to enable women choices and care far better than we currently give here in the US. I have good friends in and from Europe who find our maternity care system appalling and would not dream of giving birth here unless it was with a Certified Professional Midwife. The training of a CPM is far greater suited to an out of hospital birth. It is quite different from European qualifications as it should be. As you and I both agree, if we had similar systems of care we would have better integration of the system. But for our current situation and shrinking options for women to birth out of hospital, we can to turn to CPMs to provide qualified, safe options for women and their babies. I am personally thankful to Jennie Joseph for speaking on behalf of CPMs on Capital Hill. She is a huge supporter and wonderful example of the Midwifery Model of Care and what US Certified Professional Midwives do for women like me.

I also have to mention that if you want to debate the qualifications and quality of care one gets from Certified Professional Midwives, just look at who is heading up organizations to legalize them. They are predominately run by consumers- those that have had safe, healthy home births with these same midwives. I have never talked with one woman who chose home birth with a Certified Professional Midwife that would then choose to go to an ob for a normal birth. However I have talked with many (well into the hundreds of) woman who’ve had a birth in hospital with an ob that would only use a CPM for subsequent births.

@amom – Do you have anything to cite for your comments, or are they opinion?

Midwives generally make 1/3 or less of the annual salary that a typical US obstetrician makes. It is the former clients of CPMs who head up organizations to keep them legally practicing in the US. There is little, if any greed, involved in keep Midwifery accessible in our country. Midwives save lives and keep women healthy and safe during birth. Midwives understand the physiology of normal birth and intervene when necessary. We discussed fully the risks of my pregnancy before my home birth and had a plan of action for any and all conceivable emergencies that could arise. Midwives are not complacent in their work or their passion for healthy women and babies.

The tone these comments have taken is exactly what is wrong with our medical system today in regards to pregnant women and their birth choices. Sad.

a fascinating discussion and an important one for the health of women and babies in the US. I would like to include the realization that the toxic soup of an environment in which we all live, has an influence on the health of the mother, which may influence birth outcomes, like preterm birth. How we intervene adversely in our primary environment- our Mother Earth- is very similar to how we intervene with the primary act of creation- our baby’s births. We upset the natural processes of our life ecosystem and we end up with very poor results- unhealthy children and a diminishing quality of life, including mother and infant mortality.

Amy, it’s you who keep changing the subject. You should notice that I’m the one who is staying on track. The article that you first responded to was about a “rising maternal mortality rate,” and you apparently decided to nip any discussion of the topic in the bud. This had nothing to do with home birth or CPMs or my character.

You began this entire thread on December 21 with an emphatic statement (“No, maternal mortality is NOT rising.” ). You have not been able to support that misleading claim with convincing evidence. By January 2, you had altered your claim enough to write: “My claim about maternal mortality was NOT that the figures are completely accurate, was NOT that the CDC is a perfect organization, was NOT that maternal mortality isn’t a problem.” Forgive me if I’m wrong here, but I don’t think you would have written that sentence if I hadn’t pointed out the weakness of your original statement that challenged Danielle’s blog subject.

By January 2, you wanted to make a different claim: “… the observed increase appears to be almost entirely accounted for by a change in reporting.”

Again, you were unable to support that claim with evidence from the CDC. I suggest that you keep accusing me of changing the subject when I refuse to respond to your changing the subject.

Your claim that the Safe Motherhood Quilt Project exploits tragedies is off-base as well. So far, I have received nothing but thanks from relatives of women honored on the Quilt. No one has asked me yet to remove a name from the Quilt. I am in touch with many widowers, mothers of daughters on the quilt, and people whose mothers are on the quilt. I would love to quit working on this project, but I’ll only do this when we put together a federal infrastructure for accurately reporting and reviewing maternal deaths. I’m still curious as to why you apparently don’t find this a goal worth achieving. Maybe you think it an impossible goal. If so, there’s a big difference between you and me. The choices that I have made in life have taught me that positive change is possible but that it can take a long time.

As a mom who was coerced into a c-section by an OB with anger-management problems, and who has tried to VBAC, I am infuriated by the whole debate. The bottom line is it is impossible to have anything but an adversarial relationship with my OB. This state of affairs is really unjust to birthing women.

My first child was breech, and my then-OB immediately said “c-section!” I tried an external version, but it failed. I asked her about moxibustion, but she had never heard of it.

I switched OBs for my second child, in order to go to a “VBAC-friendly” OB, who ended up verbally abusing me when things didn’t progress on her schedule. (http://4moms2b.blogspot.com/ “Coercive C-Sections and the Hostile State of Obstetrics”). My second c-section had nothing to do with the baby, as there was NO sign of distress. Instead, it was about scheduling. As my OB shouted at me in the O.R., “I made her miss her blind mother’s doctor appointment.”

Now I am back with my first OB because, although she is clamoring for a repeat c-secion, at least I feel she understands where I’m coming from. She is willing to give me a trial of labor (but I don’t expect that much of a trial). However, in my past few visits, she has threatened that I will die. She keeps saying, “I don’t want you to leave your husband alone with three children.”

I am back with her because I trust in her skills as a surgeon. Having had 2 c-sections and at my age (over 40), I would not feel comfortable going with a midwife (nor could I find one!)

I am all but resigned to another c-section. I just wish that OBs would stop acting like this major surgery is no big deal and saying things like, “The most important thing is the health of the baby and your health” as if you didn’t know that already and as a way of obscuring a real discussion. I don’t entirely believe that it’s the safest route, or I wouldn’t bother to attempt a VBAC. I don’t relish the pain in the incision site for 6 months.

Unfortunately, at my last office visit, my blood pressure was high, so now she wants to induce at 39 weeks (although my pressure has gone down). I do feel that inductions don’t work unless the cervix is ready and that my chances for a vaginal delivery just dropped to nil.

I feel that the whole system is geared to force women into a c-section. For instance, for my second pregnancy, I had gestational diabetes, and the radiologists at St. Luke’s Roosevelt kept telling me the baby was going to be 10 lbs! Then they started to say over 10 lbs! Of course, this is another excuse for medical intervention. Well, my baby was late by over a week and even then was only 7 1/2 lbs.

I have to wonder if the radiologists weren’t told about the g.d. if they would have estimated on the large end.

On the other hand, regarding advocates of natural birth, I had read that hiring a doula helps improve your chances of a VBAC. For my second baby, I hired a DONA-certified doula who seemed experienced and knowledgeable. But, in fact, she did absolutely nothing during my 30+-hour hospital stay. She chatted about her family vacations. That was about it. It was a waste of $12,000. And during the post-partum visit, she clearly was coming over just to pick up the second half of payment and talked about nothing but her own 3 easy vaginal deliveries.

So Dr. Tuteur isn’t wrong about quackery in that sector of the birthing business.

The only loser in this battle between obstetrics and natural birth is the woman.

“You have not been able to support that misleading claim with convincing evidence.”

You haven’t even deigned to look at the evidence. I asked you specifically to look at the graphs on my post (http://skepticalob.blogspot.com/2010/03/hold-handwringing-is-maternal-mortality.html) and comment specifically on whether they accurately represent the data on maternal mortality. You’ve ignored that request.

“So far, I have received nothing but thanks from relatives of women honored on the Quilt. No one has asked me yet to remove a name from the Quilt.”

So what? Where are the names of the women who died from complications of pregnancy? Where are the names of the women who died from pre-existing medical conditions?

You have collected 211 squares for your quilt commemorating maternal deaths that have occurred since 1982, but during that time more than 14,000 women have died from complications of pregnancy. Your quilt represents less than 1.5% of maternal deaths, yet you misleadingly present those deaths as representative of all maternal deaths and you misleadingly represent the issue of maternal mortality as being caused by interventions and as being preventable by “natural” birth.

As I said yesterday, I have put forth a variety of empirical claims about maternal mortality, about CPMs and about your attempts to exploit the issue while doing absolutely nothing to reduce maternal mortality. Since you refuse to address these empirical claims, we have no choice but to take your continuing and very disturbing silence as acknowledgment that what I have written about maternal mortality, about CPMs and about your attempt to exploit these tragedies are true.

If you knew any way to contradict those claims, you would surely make the attempt. Yet you haven’t even bothered to try.

PLEASE, please, please stop misleading women.

PLEASE, please, please stop ignoring scientific evidence in favor of “intuition.”

PLEASE, please, please insist that MANA release THEIR OWN STATISTICS that show that homebirth with a CPM increases the risk of neonatal death, and which they are actively hiding from American women.

PLEASE, please, please address the fact that homebirth with a direct entry midwife is the most dangerous form of planned birth in the US.

Ina May, I’m so glad that you continue to support birthing women and their families. I met you in Boulder some years ago and it was a pleasure listening to you speak.

Amy, I am continually frustrated by your posts and you seem to crop up everywhere home birth is mentioned. I applaud what you seem to feel is “passion” just as I do Ina May’s. However, every time I read posts from you somewhere on the internet, you only dole out attacks. You attack the people who write blog posts, their posters and women in general. I don’t see how this is helpful when considering having open dialogue. I hate to say that you represent the worst attitude of OB/GYN’s that so many women have to face. I’m not saying this to be rude or to criticize you directly (so please Danielle don’t be upset with me because I’m honestly not “attacking” Amy) but rather to point out that this is exactly the kind of attitude that is driving women out of hospitals and to CPMs or to even try to go it alone. So many women these days feel that they are degraded, spoken to like they are stupid, incompetent breeders rather than courageous, intelligent, feeling women.

You constantly tell Ina May that she is misleading women, is harming them and isn’t do anything positive to assist them. You have also told her that she’s avoiding the questions you pose to her. However, you have been asked a few times by other posters what positive changes you are making to change our system. I’d like to expand on that question so as to give you very specific questions that I’d like you to answer. That way there is little confusion.

1) What are you doing to enforce change so that women and babies are safe having prenatal care with OB/GYNs
2) What are you doing to ensure that women are safe having hospital births with OB/GYNs
3) What are you doing to ensure that doctors will change their tone and behavior so that women feel valued, listened to and respected while experiencing prenatal and birthing care with them?

Until these three conditions are met in the hospital birthing arena, women will continue to have babies at home with CPMs or alone. So in my opinion, your time and passion would be better served trying to improve the side you live on rather than trying to convince people that home birth isn’t safe. Women want respect and want to be heard and respected. Until the attitudes of doctors change, birthing our babies at home will be a “chance” (at least I’m sure that’s how you see it) a lot of us are willing to take.

Ms. Tuteur,

Would you mind sharing your personal matermity mortality rates and cesarean statistics? Ina May is very open about her group’s success rates.

And I find your comments overall apalling, and predjudiced. You call the Farm a “cult”? Who do you think you are? I’m glad you’re on leave… do us childbearing women a favor and stay there. I hope one of your children decides to opt for a homebirth and you one day eliminate your own fears.

Have you even attended a birth at home? Your bias is plain as day and discrediting to your arguments. Ina May has supporters in both the medical and natural fields, bulding bridges between the two worlds and exploring how we can work together in harmony.

You seem to be seeking to eliminate choices and halt educational opportunities.

Sorry for the typo.

Dr. Amy, I find it amusing that someone who has to rely on her husband to support her internet addiction would consider it relevant to comment on Ms. Gaskin’s personal life. Perhaps you are envious that, despite her husband’s early influence in the counter-culture movement, Ms. Gaskin’s international and highly-acclaimed work in midwifery education and maternal/infant health long ago eclipsed his legacy. While psychiatry is not my field, one might wonder what personal relationship issues at home are driving your bombastic rants against Ms. Gaskin and other maternity care providers, who unlike you, continue to practice their profession.

@J.C. – I didn’t see anyone, anywhere, at any time, say that “OBs are not saving lives or needed in certain circumstances”. Every member of the natural birth community I have ever met, spoken to, read, or heard of acknowledges that there are true medical emergencies that require medical intervention and all are grateful that it exists for those circumstances. This comment thread has taken the detour Dr. Amy intended, into the “natural v. medical birth” debate, despite the original subject of the post, and as Ina May has done a great job of outlining the outstanding questions surrounding the original topic of maternal mortality rates, I’ll address the detour for a moment.

All of my children have been born out-of-hospital under the care of midwives, and I am grateful for those experiences. I am also grateful that my health and my babies’ health did not require the assistance of a doctor. I am grateful that the medical expertise is available to me to treat an emergency should one arise. But I am afraid, AFRAID, when I think of the possible consequences of entering a hospital to give birth under normal, healthy circumstances. Because I know that I want my feet firmly planted on the ground when I give birth, because gravity works and my body knows what to do. Because my babies are notoriously “late” (born 18 days, 11 days, and 7 days after my “due” date). Because my contractions slowed down to almost nothing at around 6 centimeters during my second birth so I could nap on and off for a couple of hours before the final rush of birth. Because OB/GYNs in hospitals like moms to deliver babies lying down, feet in the air. Because OB/GYNs in hospitals encourage inductions, not for evidence-based medical concerns, but for convenience and liability insurance. Because OB/GYNs in hospitals don’t think mom’s body knows what it’s doing when it takes a break to let mom rest. I am afraid of giving birth in a hospital under normal, healthy circumstances because major abdominal surgery, (with its own associated risks of infection, future uterine rupture etc.) is not normal or healthy, though it IS the all-too-common outcome of a normal, healthy pregnancy in our current healthcare system. Anecdotes are not evidence, I get that. But statistically, at least one of my births would have ended in a c-section had I been under the care of an OB/GYN in a hospital. Instead, I had healthy babies, quick recoveries, a much lower out-of-pocket expense (though I had medical insurance, and it didn’t cover a dime of my out-of-hospital births, I STILL paid less than if I’d been covered by insurance in a hospital), and yes, there were spiritual and emotional benefits for me as well. I wish that the relationship between midwives and the medical community was less adversarial. I wish that I did not fear to enter a hospital, with all of its technology and expertise, and thereby mediate the risk, however small, of an emergency arising that my midwife is not trained or qualified to handle. But I don’t trust a hospital or its staff to respect the process of birth and allow it to happen on its own time, in its own way, so I choose the smaller risk of a true medical emergency arising out-of-hospital, over the statistical probability of a unnecessary medical intervention that can be regarded as harmful in itself.

OK folks, by the anger I was referring to the bizarre Haiku.There’s a lot of disrespect going around, not just from Dr. Tuteur.

Is this mom’s death in your quilt?

http://www.highbeam.com/doc/1P2-580574.html

Article: Midwives Charged in Death of Va. Woman
Article from:The Washington Post Article date:January 21, 1999 Author:Maria Glod; Josh White CopyrightCopyright 2009 The Washington Post. This material is published under license from the Washington Post. All inquiries regarding rights or concerns about this content should be directed to Customer Support. (Hide copyright information) Related articles

Two unlicensed midwives have been charged with involuntary manslaughter in the case of a woman who bled to death hours after they helped her deliver a baby girl in her Stafford County home.

Cynthia Caillagh, 45, and her assistant, M. Elizabeth Haw, 42, both of Williamsburg, also were indicted by a Stafford County grand jury on misdemeanor charges of practicing midwifery without a license and practicing medicine without a license.

Authorities said the two women helped Julia Peters, 30, deliver her fourth child on Sept. 8, 1997. Although the baby, Alexis Marie, was healthy, Peters suffered complications during the delivery, and about 10 hours later, she was taken to a hospital

http://www.religionnewsblog.com/15011/women-tried-for-practicing-midwifery-without-license-after-mothers-death

More articles about: Linda and Tanya McGlade:
Women tried for practicing midwifery without license after mother’s death
CourtTV, USA
June 1, 2006
http://www.courttv.com

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ReligionNewsBlog.com • Thursday June 1, 2006 Share • Save • Email

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(Court TV) � For her second child, 25-year-old Mara McGlade opted to give birth in the comfort of her Florida home rather than in a hospital. Assisting her were her mother-in-law, Linda McGlade, and sister-in-law, Tanya McGlade, both members of Mara’s close-knit church fellowship.

http://www.news-leader.com/article/20101227/NEWS01/12270336/Midwife-case-leads-to-scrutiny-of-state-laws

“What Diamond did have was a work history that included an earlier brush with authorities. She was barred from practicing as a midwife in Colorado in 1997 after she left a woman who had given birth bleeding uncontrollably.

According to court documents, Diamond, who was not registered as a lay midwife in Colorado, called 911 and fled.”

“@amom – You know all the research on doulas has shown positive outcomes right?”

Danielle625 commented on Jan 03 11 at 9:43 pm

What is “all the research” Please use citations. That pubmed thing I mentioned, ya know, where like, abstracts of research are found? Studies. Data?

And define “positive outcomes”. Since many midwives deem an unmedicated vaginal delivery as better than a live unbrain damaged baby many women may not find your outcomes quite so positive.

You seem to be oblivious that you are parroting midwifery promotion party lines instead of data, studies, or facts.

I have listed several well-known sources and all I get in opposition is vague unsubstantiated assertions of “no it’s not” and laughably people who don’t recognize references, demand them, and then don’t provide any themselves!

Do you think JC had a positive outcome. Or do we just ignore her because it doesn’t fit your agenda?

“@Amy – Please stay away from personal attacks on commenters. Thank you”

Danielle625 commented on Jan 02 11 at 10:58 am

“@PartlysBabe – Actually I think Amy has published a couple books. I picked one up on Amazon.com once for a penny.”

Danielle625 commented on Jan 02 11 at 12:09 pm

Yeah, Danielle, let’s all stay away from the personal attacks….unless they are from NCBers…geez.

And, umm Steve, Haikus are much shorter and more cogent.

“What stands out most to me is a provider in Chicago a couple years back that was the “on call” for the night, and “punished” a mother for not getting to the hospital sooner and abused her while she was in labor”

And get your facts straight. He was pissed she didn’t call beforehand. The coming in late was his excuse to cover denying the epidural. All illegal (so long as labor is considered a medical event).

http://www.nbcchicago.com/news/local-beat/Doctor-Intentionally-Made-Delivery-Painful-Woman-Says.html

http://www.chicagobreakingnews.com/2009/07/doctor-disciplined-in-womans-labor-treatment.html
And he was disciplined for it.

Look at the difference in this story when reported by regular news and and by an NCBers.

And you know what’ s hysterical. The Ob’s main punishment of the woman? Refusing her an epidural — exactly what midwives do routinely!!! So when an OB does it is abuse, but when its the midwifery norm, it’s everything from empowering to natural?

Is every woman’s pregnancy tragedies midwifery property to be twisted and exploited to promote midwives’ careers?

I guess, since all the midwifery maternal deaths have been reimagined to be OB iatrogenic ones.

NEWSPAPER ACCT MCGLADE: Though Linda and Tanya McGlade were not licensed midwives, the pair had successfully assisted at the births of several church members’ children.
But something went tragically wrong as Mara McGlade gave birth to a son on Dec. 8, 2004. Though baby Gabriel was born a healthy 7 pounds, 6 ounces, Mara suffered internal bleeding following the birth. Instead of calling an ambulance immediately, church members held hands and prayed, finally calling for help four hours later. Mara McGlade died two days later.
The two women were charged with practicing midwifery without a license, which carries 21 months to five years in prison. Representing themselves, Linda McGlade, 55, and Tanya McGlade, 26, went to trial in April 2006 before a Manatee County jury.

QUILT ACCT MCGLADE:
Mara McGlade gave birth at home in Bradenton, Florida, on December 8, 2004. Her mother-in-law and sister-in-law assisted her with the birth. However, she had a slow but steady hemorrhage following the birth. Her mother-in-law’s family were part of a religious group that did not believe in seeking medical care, even in the event of an emergency in birth.

Two days following the birth, Ms. McGlade’s mother-in-law did take her to the local hospital, but it was too late for her life to be saved.

She was 25 years old at the time of her death. Her baby, Gabriel, survived.

DIFFERENCES: Quilt doesn’t mention she was attended by midwives. Quilt falsely claims their religion did not allow them to seek medical care. Quilt falsely claims the woman was first hospitalized two days later, when it was 4 hours.

SIGNIFICANCE: She bled out massively from an unmanaged third stage. The sudden loss caused shock which went unaddressed for some time and caused irreversible damage to all organs and they slowly gave out and she died over the next two days. I guess waiting to give that prophylactic pit and avoiding other things until absolutely needed (according to someone who doesn’t know when they are needed) just doesn’t work out all the time.
Quilt also hides that this was a very easily preventable death of midwives.

NEWSPAPER ACCOUNT PETERS:
A Williamsburg midwife and her assistant both pleaded not guilty yesterday in Stafford County Circuit Court to involuntary manslaughter in the 1997 death of Julia Peters, who bled to death after giving birth in her Stafford home.
Cynthia Caillagh and Elizabeth Haw, who assisted Peters in the delivery of her fourth child in September 1997, also pleaded not guilty to charges that they were practicing midwifery and medicine without a license. Circuit Court Judge James Haley scheduled the trial to begin July 23, and pretrial motions will be heard in early April.
Prosecutors also have charged Peters’ mother-in-law, Claire Peters, with perjury in connection with the case, alleging
Caillagh, 45, and Haw, 41, fled Julia Peters’ house moments before an ambulance.
Two unlicensed midwives have been charged with involuntary manslaughter in the case of a woman who bled to death hours after they helped her deliver a baby girl in her Stafford County home.
Cynthia Caillagh, 45, and her assistant, M. Elizabeth Haw, 42, both of Williamsburg, also were indicted by a Stafford County grand jury on misdemeanor charges of practicing midwifery without a license and practicing medicine without a license.
Authorities said the two women helped Julia Peters, 30, deliver her fourth child on Sept. 8, 1997. Although the baby, Alexis Marie, was healthy, Peters suffered complications during the delivery, and about 10 hours later, she was taken to a hospital,

QUILT ACCOUNT PETERS:
Julie Anne Peters
On September 9, 1997, Julia Anne Peters died at Mary Washington Hospital in Richmond, Virginia. The 30-year-old woman gave birth to her fourth child on September 8, 1997 at her home. Although the baby, Alexis Marie, was healthy, Peters suffered complications about 10 hours after delivery, when she suddenly complained turned pale and began gasping for breath, according to her husband and mother-in-law. She had had three previous cesareans before giving birth vaginally.

Peters’ mother-in-law, a registered nurse, had been with her continuously following the birth. She and the midwife who attended the birth believe that Peters’ death was probably due to amniotic fluid embolism. However, the medical examiner who performed the autopsy stated that the cause of death was postpartum hemorrhage due to uterine atony. Peters’ hematocrit was found to be 22 percent.

DIFFERENCES: Quilt claims (again) complications were delayed, while news accounts claim complications were immediate but medical help was delayed.
Quilt mentions her mother-in-law’s claims that she had sudden symptoms of an amniotic fluid embolism and fails to mention the mother-in-law was charged with perjury for that. Quilt mentions her hematocrit apparently believing this bolsters the embolism theory, when it does not.
Quilt doesn’t mention the midwives fled and abandoned her.
SIGNIFICANCE: Again, she had a slower postpartum bleed which midwives did not recognize or respond to. Midwives also don’t know that young people can compensate hemodynamically for quite some time until they no longer can and then they suddenly crash and go into shock. Damage all organs, death. Again, could have been easily prevented with the prophylactic pit.

SUMMARY: Seems like the quilt is more about lying about midwives role in easily preventable, completely unnecessary maternal death and trying to act like medical help is the cause to bolster midwifery’s patient numbers and line their pockets. .

It took me about 1 hr to read all the previous comments and am happy to have arrived at Tiffany’s last contribution . Appaled at some of the vicious comments, bashing CPM’s and especially Ina May I would like to share some insights. Being a CNM myself, with graduate studies in Public Health and Midwifery in the US and trained as a Registered Nurse in Germany, the direct entry midwifery 3 year program in Germany is similar to the requirements of the direct entry 3 year programs of midwifery in the US. As a matter of fact, the german midwifery law (Article 4) states that at every birth (whether home birth, Birth Center, or hospital) there must be must be a midwife. Midwives are the specialists to attend normal pregnancies and births, that’s what they are trained for and equally trained for recognizing complications during pregnancy or labor to work in coordination with OB’s. And Ob’s are supposed to be trained for attending complications. At this point only approximately. 8 percent of births are attended by midwives in the US and the ratio Midwives/OB”s should be just be the opposite. In my experience as a midwife working in a Birth Center as well as in a hospital I have seen very few Ob’s when attending normal births being at the bedside, walking with the woman, giving massages ,accompaning and encouraging the normal process of labor.(yes that’s what’s supposed to happen, not being tied to a monitor al the time), surely there would be fewer unnecessary intervention, less C/S etc. But above all a country where 44 millions of its residents have no medical insurance and no acces to services, can hardly have better outcomes. So thanks to creative self help initiatives, which women like Ina May and others had the courage or necessity to start decades ago in the US, there are many more options today and hopefully midwifery keeps growing taking a more prominent role in the care of pregnant women and their families.

@gisela jung

Thanks for treating all women like cattle and telling us what to do.

Thanks for advocating for us to have the “choice” of forced midwifery which 90% of us should have and denying us medical options because you think that is the way it is supposed to be. It just so happens that that puts money in your paycheck. Coincidence? And since when did berating women wanting pain meds and denying them for hours on end get to be called “encouragement of normal”?

Did it ever occur to you that some of us don’t want to walk around? don’t want massages? want our epidurals?

They have may less c-sections, but a whole lot more pain and more dead babies. If you only compare insured in both countries, the gap is huge.

Beverly Beech, the chair of AIMS (aims.org.uk) has this to say about the paper Amy cites on the tripling of home birth deaths in the Netherlands:

It is time that women were properly informed of the risks of hospital deliveries. This research is not worth the paper it is written on and anyone analysing it will see that its own conclusions are not supported by the evidence it is quoting. When women judge safety it is not based on death alone but also on the future health of herself, her baby and the rest of her family.

In their enthusiasm to inform the world of the alleged tripling of the neonatal mortality rate the researchers failed to mention that their own deeply flawed meta-analysis found that women choosing home births have significantly better outcomes in every single measure of maternal and neonatal well-being when compared with women having hospital births.

People forget that the American College of Obstetricians and Gynecologists is a union and far more powerful than any other union. Its main purpose is to maintain medical control of childbirth and home birrth is too big a threat to ignore.
- Beverley Lawrence Beech, Surbiton, 16/8/2010 11:12

Quote taken from: http://www.dailymail.co.uk/news/article-1303422/Leading-midwife-hits-claims-home-births-dangerous.html#ixzz0wxw1x5dR

@Bobbie – My plan for my first son was to have a natural birth, no epidural, no monitoring, etc with an OB/GYN. I didn’t realize until a week before my due date when my OB insisted I NEEDED an induction that the possibility of having a real natural birth under OB care is a rarity. I went along with the induction because I was told this would be best for my son.
I told them I didn’t want an epidural, etc, and the hospital staff, including my OB/GYN all LAUGHED at me.
I ended up with an epidural, and c-section after only 6 hours of induced labor, which is nothing.

It is not the mothers wanting to be crunchy… it is most know the real possibility of having a “natural birth” in the hospital is slim.

@Danielle What does your one birth experience prove? What if I say I popped one out in a hospital with only an IV and a monitor and an OB? One, it would show it’s possible to have no one bothering you in the hospital if you aren’t having any problems. Two, it would still be counted by you as an “unnatural” delivery and raise my docs’ count of them.

At least 2/3 of women don’t have sections. That is hardly a slim chance. And some who do want them, plan them. Others want them when their baby is at risk. Not 100% surefire risk. But risks moms generally won’t take with their kids. What if your child had died in the womb going post-dates? Would avoiding an induction attempt and c-section have been worth it?

The average woman considers the babe squeezing out down there natural no matter what else is going on. And all new moms — whether by c-section, induction, forceps, or some cosmic epiphany — consider themselves normal whether you do or not.

@amy

Because midwives want to best help by treating pregnant women like their property and having the right of first refusal at our births. When problems arise and after they are neglected for hours in the midwife’s pursuit of her idea of ideal birth she hands us over to an OB to fix. Then she cites OB “hostility” towards the long overdue transfer and blames that, not herself and midwifery’s neglectful approach for the delay in treatment that costs a life.

Midwives help best by using us for their birth junkie fix. OBs help best by enabling this dysfunction and by either fixing or taking blame for midwifery created problems.

Wow, why don’t we all stop arguing?

We all want the same thing: less babies and mothers dying.

That being said, why don’t we all just focus on our chosen way of birthing and making that safer, rather than pointing fingers at and vilifying people who do not agree with our choices/opinions?

Oh man, at the risk of entering into this fray… It is possible to have a natural birth in the hospital, even in labor and delivery, depending of course on the hospital, the nature of the OB, and whether or not there are complications. I am considered high risk due to preexisting conditions and could not give birth at home even if I wanted to. However, my doctors were totally willing to let me go as natural as I wanted so long as everything was fine. I had no iv, was monitored frequently but could change go off monitor to walk around, and was even in the tub for a good portion of my labor. The second labor was the same. I should add that in both cases, my OB was unavailable for my deliveries, through no fault of his own, and the two doctors delivering were also willing to let me do what i wanted so long as I was okay. My doctor let me go beyond the due date as well, since everything was fine and my conditions were under control. The problem here seems to be when a woman has no control over her situation, no choices. But even women who cannot give birth at home, like me, can have a wonderful experience in a regular hospital with regular old doctors and nurses, as long as they have options and can choose who they give birth with. It is easier in a big city.

I just don’t get why anyone could not want more training for CPMs?

What’s the harm in taking a physiology course taught by someone who really knows the subject, rather than spending precious didactic coursework hours on homeopathy and flower essences?

NEWS ACCT OF AMA THOMAS:

Fundraiser aims to ease burden of mom’s illness
August 15, 2005|By Dawn Turner Trice

Last November, they were expecting their fifth child. Their two daughters and two sons had been born at home with no complications. So Phillip Thomas said there was no reason for the couple to expect any problems with the new pregnancy.

QUILT ACCT OF AMA THOMAS:

Ama Thomas
Ama Thomas suffered a missed abortion at five months of gestation in 2005. This event led to the eventually fatal complications of disseminated intravascular coagulation and organ damage. She lingered in a coma for two years before dying at home in Chicago in May, 2007. Ama home-schooled her four children.

DIFFERENCES: No mention that she was under the care of a midwife or a homebirther. (many hospitals are mentioned)

SIGNFICANCE: A missed abortion is a really an inappropriate term here. At 5 months this is fetal death. It means the child has died in utero but has not come out. It is know to lead to DIC and other serious problems if unaddressed for a long time. It seems likely either the midwife didn’t notice the baby had died or chose to not intervene and let things resolve “naturally”. A very preventable death.

Amy, I mean AMOM, can you provide a link to the news account of this story about Ama Thomas? I’m not finding any news stories that mention negligence or lawsuits in the case. Also, at 5 months could be referred to as a missed abortion if the fetus had not yet reached viability, 5 months being about 20 weeks gestation.

Amy, it seems to me that there are also many women that do not find the drivel you continually spout to be remotely compelling either.

If you are a little bit good at debating you would understand “Dr” Amy’s dialogic tactics here and stop feeding her. It’s the one thing she is apparently very good at that she learned back in her uni days. Seriously girls, not worth your time and effort. As someone said a very efficient troll she makes. Let it go already. She is not one to be convinced by natural childbirth or maternal mortality stats so why waste your time? And even if any of your arguments here struck a cord, she would never publicly acknowledge it anywhere becomes she roams the blogging world just to get in your hair. That’s what she does. For a living. So let it go, it’s a completely futile effort (oh and just in case you’re wondering I have a Masters in English Literature and a Masters in Teaching – I am VERY familiar with debating technique)

Tinks is right, of course. I never expected to convince Amy or whoever employs or enables her to do what she does.

However, if any readers live in Missouri, Arizona, Mississippi, Alabama, Alaska, Tennessee, North Carolina, Louisiana, Colorado, Hawaii, Iowa, Kentucky, Maryland, Massachusetts, Minnesota, Wyoming, Pennsylvania, Wisconsin, Virginia, Maine, and West Virginia, you should know that your states still haven’t complied with the CDC’s recommendation to use the US Standard Death Certificate. If any readers care about the fact that our maternal death counting infrastructure is woefully inadequate, I urge you to help me do something about it. Continuing to accept invisibility of the hidden maternal deaths in these states keeps birth more dangerous for women than it should be.

I don’t see why it should be on anyone’s agenda to deny that better data gathering would be an essential first step to reducing maternal mortality.

@Ina Mae

If you want better data on maternal mortality, why not start with your quilt?

Whoever is employing or enabling you to do what you is covering up preventable maternal deaths by midwives and misrepresenting hospital deaths as due to unnecessary intervention.

A standard death certificate won’t do much to uncover preventable midwifery deaths and lead to improvements.

It won’t uncover midwives who deny they were in charge when a death occurs and will provide data to feed your myth that homebirth deaths are only when there’s no midwife, like you did with Mara McGlade.

It won’t uncover easily preventable deaths due to rejection of simply safety measures as “unnecessary interventions” and will provide data to feed your myth that deaths with midwives are all unpreventable tragedies, like Julia Peters. Her own mother-in-law lied trying to make it look unpreventable (and you thought your mother-in-law was bad). I bet her death certificate says “amniotic fluid embolism”, instead “allowed to bleed out and no one did anything”.

Midwives, and oddly enough the families that use, them will either deny their involvement or lie about what happened to make themselves appear blameless. It took law enforcement and autopies to get to the bottom of those stories, not forms! Unlike hospitals, home deaths have a few biased witnesses and are much more vulnerable to midwifery-protecting falsification.

You are only in favor of this because it will allow you and your cronies to put false information into a public database and then it will get analyzed as if true and you will use it to promote your profession.

And no, I’m not doctor amy and neither is SB or JC or other women here. We are moms. 90% of us give birth with hospitals and doctors because we want it. There’s a lot of us. Deal with it.

@midwife
It’s OK to exploit deceased moms stories to promote a career that causes more people to be deceased needlessly to benefit midwifery egos and bank accounts.

It’s not OK to point out those exploited stories have been altered and edited to further midwifery careers.

Saying c-section is a factor in maternal death is like saying defibrillation is a factor in cardiac death. It is simply the thing commonly done when those patients are going south. If it was done no one, there would be much, much more death, not less. By the same “logic”, let’s close the hospitals. Because, everybody dies there getting a boatload of treatments. We will all be immortal without them, right?

But then, again, this idea is brought to us by the people who treat moms like we are stupid. They tell us if we don’t believe what they do, if we don’t reject scientific research because it is unflattering to midwives, we are unscientific, uneducated, sheeple. Also these are people who think they are so smart and we are so dumb that we will never catch on to what why they want this quilt project.

When midwives call for cooperation it is almost like politicians. What they really mean is everyone else should sacrifice and give them what they want.

I haven’t seen you volunteer your numbers either, Amy.

“I haven’t seen you volunteer your numbers either, Amy.”

Actually I have written about them numerous times, but, that, of course, is beside the point.

I am one person. MANA represents ALL CPMs. Are you actually trying to justify the fact that MANA is hiding the number of babies and mothers who have died at the hands of CPMs?

The hypocrisy of homebirth advocates is truly breathtaking. They are interested in analyzing the death rates of physicians in the hopes that there will be something to criticize, but if MANA refuses to release the numbers of babies and mothers who die at homebirth, that’s just fine with homebirth advocates.

You’ll notice that Ms. Gaskin has absolutely nothing to say about the fact that MANA is hiding homebirth deaths, (a situation she could actually influence) and instead is making a quilt about maternal deaths which does absolutely, positive NOTHING for anyone.. What kind of activism is that?

And where’s Danielle who claims to care so much about mothers and babies? Why isn’t she demanding that MANA release their death rates?

It’s a simple question, Danielle. Why don’t you use your blog to publicly call for MANA to release their death rates?

Do you think American women do not deserve this information?

Do you think this is not important information?

How, exactly, are women supposed to make an “educated” decision about homebirth, when CPMs hide the number of babies who die at their hands?

The Midwives Alliance of North America (MANA) doesn’t represent CPMs. That organization would be the National Association of Certified Professional Midwives (NACPM), which does not collect statistics from its members. Any midwife can join MANA, and at least a third of its members, including its President, are Certified Nurse-Midwives. But there are no actual requirements for membership. No certification, no proof that you even are a midwife. Nothing. Worse, members have the option to submit their statistics or not, some of their numbers or all of them, facts which together make the data worthless. Why anyone would put stock into any data collected by MANA is beyond me.

WHY DON’T ANY OF THE MIDWIVES AND FRIENDS ADDRESS THE POSTS ABOUT HOW THE QUILT STORIES ARE ALTERED TO MAKE MIDWIVES LOOK GOOD AND MAKE HOSPITALS LOOK BAD?

Here’s why Ina Mae (honorary Ph.D. from traffic school) started it, to “prove” what promoted her career. More like she collects women’s names and stories only if they say what she wants (ie what will make her and other midwives more money), and if that means lying so be it. And if it leads to even more maternal death, that’s OK with them too, I guess.

“In the early 1990s, Ina May began to research maternal death rates in the U.S. She was concerned that with escalating hospital birth interventions, such as induced labors and planned C-sections, the rates of maternal deaths would rise dramatically despite the profound medical advances enjoyed by people in the United States.”

@Meredith Only the childish with no real response to the issues pick on typos in internet postings. Only the illogical would speculate that internet typos predict much in the rest of life. Only those with something to hide attack people who raise criticisms, instead of addressing the issues.

Where did Ina Mae get her Honorary (as in not real) Ph.D.? What does it say about her that she has no relevant education.

Would any of you Mean Girl Attack Dogs like to weigh in on why these quilt stories don’t match news accounts and why all the changes make midwives look a lot better as far as causing maternal mortality goes? Or does it strike such a blow to the facade that this is a movement for mothers, not midwives, that the best you can do is keep silent because you don’t want this to spread?

@Meredith

If posting comments on the web is your idea of “work” then that is telling. If the King’s English is required in all electronic communications to demonstrate intelligence then the nxt genrtion is byond hpe 4 gd. Or maybe we are just average geeks. Can design the next spaceship to Mars. Can’t speak in complete sentences.

But, please educate me. Can you post my lines and correct them? Perhaps some citations to bolster your claims. You can’t argue with grammar texts, right?

NO STORIES ARE ALTERED ON THAT QUILT!!!!!!!!!!!!!!!!!!!!!!!!!!! HOW COULD YOU SAY THAT? that is heart breaking I spent a summer making my sisters piece every single stitch on there is from my heart. You are a heartless person.

“I give these doctors a lot more credit than I give to “Doctor” Amy because they actually do something in the field of obstetrics”

But you didn’t read a single one of those papers, did you? So you have no idea whether the conclusions of the papers are supported by the evidence. You are not entitled to make claims about studies that you have not read.

Read them, analyze them and then get back to us.

Meredith Your (you’re? yer? please educate us) citations aren’t (are not? shan’t? que pasa?) about the maternal mortality. Obviously, people who are good at punctuation aren’t good at science. You are still evading the main issue. Why are there differences between the quilt stories and news stories? Why does one quilt death story change midwives into lay people? That changes a midwife’s maternal death into an unattended death. Why does one story mention an account of death that led to charges of perjury and a conviction for obstruction of justice? That changes a midwife’s preventable death into an unpreventable one. I looked at a handful of stories and found three whoppers. Almost every hospital death story mentioned induction or section. The deaths had nothing to do with them. And since you are (r? our?) so smart, tell us all why Ina Mae doesn’t answer? She was very active on this thread. Where’s Ina? She has posted gigabytes of comments. Why do all changes to the stories on the quilt imply blame to hospitals and absolve midwives? Why don’t you have citations on materal mortality? Why don’t you have citations on punctuation?

Anyone who wants to know where the honorary PhD is from can google for him- or herself. It has been a pleasant surprise that the degree is taken seriously by people who have non-honorary doctorates. My place in the 500-person procession came right after the Chancellor and Vice-Chancellor at Wembley Stadium.

There are more maternal deaths in the narratives posted at http://www.rememberthemothers.org that were planned home births (no midwife or doctor) or birth center (midwives). I don’t like generalizing about the two professions that are both necessary for maternity care.

It’s hard to get death certificates. I managed to get one in 1999, and the cause of death didn’t match what was in the newspaper. Who should be believed when this happens—the d. c. or the news article?

Doctors who were speakers at a recent maternal mortality conference where I spoke talked about how amniotic fluid embolism is a “wastebasket” diagnosis—a catch-all term that is sometimes used when a true cause of death is either unknown or guessed at without autopsy.

Newspaper accounts are sometimes mystifying—such as the one that reported that a mother died from postpartum bleeding about a week after discharge from placenta increta. This mother must have had some symptoms previous to her death that could have been picked up by a postpartum home visit. These visits should be mandatory and part of the standard maternity care package.

Grieving family members continue to contact me and share their daughter’s, sister’s, or wife’s stories with me. There is a family in Illinois who asked if they could borrow the panel that has a block for their beloved daughter, who died from a stroke. It comforts them to have it with them for a while, and I know they’ll send it back when they can bear to part with it. They are grateful that someone cared enough to recognize that it matters when a mother dies and that death becomes invisible (in a very real sense).

It’s horribly sad when a baby or a child of any age dies. Sad as a child’s death is, when a mother dies, the center of the family is lost. Many of these widowers never remarry. Occasionally when one does, he shares that with me, too. This project shows how important it is not to focus solely on neonatal mortality (excluding maternal mortality and near-misses) when evaluating maternity services.

I will continue to post blocks on the website as they come in. Donations are tax-deductible. There is a button on the website.

@Ina Mae So nice to see you, again.

But, could you actually address the issue, instead of crassly soliciting money and promoting mandating services that you would get paid for? (oops ended a sentence in a preposition!).

Why do so many stories on this quilt allege or imply causes of death that support midwifery’s financial goals when versions from other sources do not. Who (or is that whom?) do we believe? Not the ones from people convicted of crimes for telling them to the authorities! Why do you have an account from a woman convicted for giving it? Why do you always choose the one that make midwifery look better?

If you admit you don’t know why they died, then why does every death get paraded around as one that could have been prevented if everyone paid more midwives? And if you can’t tell why they died, then how can you know if a midwife was there or not? Why are you publishing details at all if you don’t know if they are accurate or not? Why not honor them by listing they died in the relevant timeframe and other personal details the family wants to share?

Amniotic fluid embolism isn’t a wastebasket diagnosis. It is considered by some to be an unpreventable cause of death. Therefore, it is frequently used as an excuse to hide negligence by all who attend birth. AFE abounds on midwifery accounts on your site (as proffered by those convicted of crimes for said account). But, on the hospital accounts, it always has to be tied to the mention of a c-section or an induction, implying a connection. Why?

How do you respond to the concern that your actions indicate your real motive is to badmouth hospital birth and promote midwifery and the details of these stories are adopted when they fit your agenda?

How do you respond to the concern that your actions indicate you want to focus on maternal deaths to make your competition (hospitals) look bad? Are you ignoring baby death because midwives have much higher rates of them and home midwives can cover-up their maternal deaths more easily?

How do you respond to the concern that you really don’t care about moms at all, because you are ultimately working for changes that would cause more death, because you would profit from it?

it’s at northrup dot com. She’s a buddy of yours, Two stories for each death, two explanations for why the quilt.

” a proven safe method of delivery.”

If it’s so safe, why is MANA hiding how many of the 18,000 CPM attended deliveries ended with dead babies?

I wouldn’t be surprised if Ms. Gaskin actually knows the number, since MANA is her creation, but she’s not telling either.

The fact is that the only people who think homebirth is safe are homebirth advocates. And now that their own data shows that homebirth kills babies, they’re not telling anyone. Can you think of any good reason to hide one simple number?

MANA, just tell us how many babies died: ten, fifty, a hundred. I’ll bet MANA executives know the number by heart because they wasted tens of thousands of dollars collecting, collating and analyzing the data and now have to waste more time and energy hiding it.

Creating her own version of the truth? Look no further than “Dr” (honorary degree from some midwifery program you’ve never heard of in England) Gaskin. I’m sure she likes England a lot. Between England and the Netherlands, there’s a wealth of strategies to get midwives to dominate the maternity system and hide the dead bodies.

She has an alternate universe for her maternal death stories. Ditto for her explanation for why her quilt. In both cases, the public version she pushes promotes midwifery. The private verson shows her selfishness and callousness. The private versions show she schemes to help midwives, their careers and paychecks and to malign hospitals. And it’s all at the expense of mothers’ and babies’ lives.

Anyone who thinks midwives are making money and that this whole issue is about MONEY, pe-lease think again. Obgyns on the other hand are doing just fine. Hospitals are making tons of money off births and it is in their very best interest to keep women there. Let’s just not forget that shall we?

Ok is any one on here really taking Dr Amy seriously???? I haven’t see too many people who do? Really if someone is seriously considering her remarks speak up now…otherwise let’s move past her.

“Anyone who thinks midwives are making money and that this whole issue is about MONEY, pe-lease think again.”

Do they do it for free? No.

Do they pass by other lucrative careers to do it? No, they only have high school diplomas.

Since homebirrth with CPMs account for 1/4 of 1% of all births, the average obstetricians loses only pennies a year to homebirth. What percentage of income does homebirth represent for CPMs. 100%!!!

Only someone extraordinarily naive could believe it’s not about the money for CPMs.

Celeste, of course it doesn’t “Dr” Amy doesn’t know what she is talking about. For someone who says that she is reading studies and an objective scientist she is AWFULLY biased. She cuts and pastes whatever she needs to reinforce her own argument (even the feminist studies she pretends to grasp). I have seen her cut and paste bits and pieces of sentences from articles that actually show the safety of homebirth to state the opposite. The problem is she makes a lot of noise (and those who are responding to her lashing out only give her more space to be heard). The problem is people who are ignorant and who don’t read the research read her. That’s the problem. I think it will be much more valuable to continue educating the women we meet with accurate science then to try and deflate “Dr” Amy’s oversized EGO (she thinks midwives call her she who must not be named http://sciencebasedparenting.com/2010/07/31/exclusive-interview-skeptical-ob-dr-amy-tuteur/ – give me a break).

Dr Amy, Ina May is busy attending ACTUAL BIRTHS. Buy you may keep posting your thoughts though. I mean, obviously you have too much time in your hands anyway. Good luck.

Your link is outdated.

Here’s is a Dutch study from 2008:

Higher perinatal mortality in The Netherlands than in other European countries: the Peristat-II study

Mohangoo et al.

* Ned Tijdschr Geneeskd. 2008 Dec 13;152(50):2707-8.

Comparison of perinatal mortality in The Netherlands with that in other European countries (Peristat-II), and with data collected 5 years previously (Peristat-I).

DESIGN: Descriptive study.

METHOD: Indicators ofperinatal mortality which were developed for Peristat-I were used again in Peristat-II. Data on perinatal mortality in 2004 were delivered by 26 European countries. The Dutch data originated from national registers of midwives and gynaecologists and the National Neonatology Register.

RESULTS: In Peristat-I, from 22 weeks gestation, The Netherlands had the highest fetal mortality rate (7.4 per 1,000 total number of births). Furthermore, after Greece, The Netherlands had the highest early neonatal mortality rate (3.5 per 1,000 live births). In Peristat-II from 22 weeks gestation, after France, The Netherlands had the highest fetal mortality rate (7.0 per 1,000 total number of births). Of all western European countries, The Netherlands had the highest early neonatal mortality rate (3.0 per 1,000 live births). Over the past 5 years the perinatal mortality rate in The Netherlands has dropped from 10.9 to 10.0 per 1,000 total births but this drop has been faster in other countries.

CONCLUSION: The Netherlands has a relatively high number of older mothers and multiple pregnancies, but this only partly explains the high Dutch perinatal mortality rate which still ranks unfavourably in the European tables. More research is necessary to gain insight into the prevalence of risk factors for perinatal mortality compared with other European countries. In addition, perinatal health and the quality of perinatal healthcare deserve a more prominent position in Dutch research programmes.

Perinatal mortality is getting higher in the Netherlands COMPARED to other European countries (although France is still doing bad and there are almost NO homebirths in France, shall I repeat that? Almost NO homebirths in France and they have worse numbers). Again this is not due to homebirths (which are actually decreasing in the Netherlands) but due to an array of factors. First of all not all European countries count their perinatal deaths in the same way (ring a bell?) This study gives a number of reasons why perinatal mortality in the Netherlands might be getting worse. It is easy to throw studies around. So easy. Compare what is comparable.
http://www.demographic-research.org/Volumes/Vol11/13/11-13.pdf
Isn’t it SO easy to pounce on home birth when a country’s statistics aren’t peachy? France is doing really bad in terms of numbers and yet no one is accusing the hospital midwives there for doing a bad job…

“So that means that homebirth advocates who claim the countries with the midwifery model of care have the best mortality statistics are flat out wrong … which has been my point all along”
RTFM AMY That’s all I can say. Did you even read the demographic study I posted? The midwifery model of care works fantastically in the Netherlands and elsewhere and is not a viable criteria to measure perinatal mortality. In other words look elsewhere to find a reason why babies die.

@everyone who denies the greed factor in midwifery

If a mom pays the same for a hospital and a homebirth, homebirth has to be much, much more profitable for the only one getting paid — the amateur midwife.

The hospital birth pays for a building, equipement, utilites, an Ob, anesthesiology, a host of nurses and other medical techs (and the years of training and costs of tuition to become them), a host of cleaning, admin, and cafeteria people etc., insurance (if you slip on their floor, or a are victim of medmal).

Homebirth you get a lady with minimal time and tuition investment in her know-how.

If all the hospital people weren’t involved in maternity services, they would do just as well in other areas of medicine or other fields.

If the lay midwife weren’t involved in birth, she wouldn’t be able to do anything in other areas of health care. No one would pay her to doing routine physicals because she declared herself an expert in normal people. Most likely, she would be limited to low wage jobs, like retail, or she’d be using her empty nester skills, like working in a daycare, or as a housekeeper.

With hospital, you get pain relief that works and safety measures, everything from small to heroic help when you need to save lives.

Midwife at home you get someone who probably won’t respond to a problem in time and when she does she turfs you to the hospital!

It should surprise no one that midwives are willing to do any pregnant lady that they can get. Almost no one wants them. If only a 1/2 actually pay her, she is still making far far more money than anything else she can do, as easily. Docs don’t get paid a certain percentage of the time too.

Adding to that, they way they scheme and manipulate to increase their turf. Ina Mae’s disciples come out on cue to defend her. But never by addressing serious concerns. Only by proclaiming their self-serving, cult-like beliefs without related support (no, random citations are not documentation). Only by personal attack on those who raise concerns.

Midwives worried about becoming obselete because of better medical technology in the 90′s. As per Dr. C. Northrup, a enthusiatic supportor of midwifery and as claimed on her website (northrup dot com they won’t post my links on that), Ina Mae brainstormed and decided that she would blanket the airwaves and the internet with the notion that the stuff she could not compete with, that was putting her out of business, killed mommies.

The Motherhood Quilt project was born (completely without logical or moral intervention). Although now, she pretends like she just wants it looked into and addressed. Every story has to be selected or altered to fit the midwifery pocketbook agenda. Midwives — good, hospitals — bad.

I also found this from the WHO–statistics on estimated infant mortality for 2009 starting on pg 11:

http://www.childmortality.org/stock/documents/Child_Mortality_Report_2010.pdf

“I also found the WHO on infant mortality and again the USA was worse than the Netherlands.”

I have been talking about perinatal mortality (deaths from 28 weeks of pregnancy to 28 days of age. You are talking about infant mortality, which is different. That’s death from birth to 1 year of age. According to the World Health Organization, perinatal mortality is the best measure of obstetric care. Infant mortality is a measure of pediatric care.

On this thread I’ve made a variety of empirical claims and defended every single one. Homebirth advocates have made a series of empirical claims and been shown to be wrong about almost every single one.

That’s why I say most of what homebirth advocates think they “know” is factually false.

@tinks Really? A master’s in what? Since when does a lecturer position at local college this pay a thousand bucks or more for, oh maybe 20-40 hours, of work? And can you bring your own kids along? Can you schedule half of it whenever you want?

I knew lecturer family once. They lived hand to mouth. The dad (the lecturer with said masters degree) gave it up to apprentice in his uncle’s housepainting business because the pay was so much better. And he might actually have a shot at health insurance!

The only reason it might be more per year is because midwives often have trouble getting patients. Per hour it is big improvement.

@all those still deluding themselves that europe has better birth outcomes that US

Newsflash. You have to STANDARIZE statistics and rates from different countries before you compare them. This bit about the US ranking 10,294,857th really just demonstrates how little those promoting midwifery know about science, and medicine, and public health.

http://whqlibdoc.who.int/publications/2006/9241563206_eng.pdf

Intrapartum stillbith (a strong indicator of an incompetent birth attendant) is .4 and 1 in Northern and Western europe. It’s .3 in North America. Perinatal rates (also an indicator of birth attendant, much better than infant rates) in the US are 7, Netherlands rate is 8, UK’s is 8, Ireland is 9. These are all midwifery intensive countries. Add them together and the US is about the same, if not significantly better than most.

“The Peristat I and II studies, based on data from 1999 and 2004, showed that the Netherlands has almost the highest perinatal mortality (11.4 and 10.0 per thousand) in Europe.”

In Europe, not Western Europe. I specifically said Western Europe. See the difference?

“If we really want to reduce maternal mortality [...] we should do everything we can to improve the health status of women before pregnancy,”

This is actually something that BOTH Amy Tuteur and Ina May Gaskin keep telling.

Just a question (looks like no feminist was here this far ;-)): is this really the point of debating over 0.001 differences in statistics, which, we all know, CAN’T be consistent data because of ever changing immigration (and poverty) rates, ever changing insurance and healthcare laws, not to say about caregiver/client rates (and, consequently, quality of care available for any given groups of population within a certain amount of time)?
Do we really want everyone to choose between Ina May and Amy, instead of trying to figure out the issues behind choices (or, lack of choices) and address the issues themselves? (Ignorance, poverty, no care available, wrongly estimated risks, doctors needing to follow schedules and having to bend into their hospitals’ protocols without any academic liberty, midwives not always having adequate knowledge to transfer certain clients PROMPLTY, VBAC regulations influencing women’s decisions towards out-of-hospital births when the decision is no longer about what is “better” for them but what is “less worse”, women having no idea about their own “informed” – well… who has a grade 12 in biology, phisiology, chemistry? – choices.)
This is ALL in the statistics. And so is pure chance.
What really does a 0.001 – range difference tell us?
We can kill each other over numbers but does that improve women’s education, nutrition and all those ever-important pre-pregnancy factors that actually DO influence maternal mortality?

well, I’ve heard of Ina May Gaskin, and I’ve never heard of this Amy Tuteur person but she is like a troll or something? The comments are LULZ; I like to sit back and imagine her heart racing as she wipes sweat from her brow and bangs on the keyboard.

I’m no birth professional but I’m the mother of 3 and I live in a community of diverse women. Every birth horror story I’ve ever heard has involved the word “induction.” I’ve never heard a woman who has had a homebirth (even those who transferred to the hospital because of some unforeseen complication!) say that they regretted their decision.

From personal experience, I had an induction and epidural and almost died in the hospital from complications (my heart rate plummeted from the epidural) and then I had a nurse hold my baby inside my body while she waited for the doctor to arrive in which time my baby flipped sunny side up and became stuck behind my coccyx which led to a vacuum extraction. That would never happen at home. My son has a severe language delay and it is suspected that his brain was damaged in birth. The complications of a hospital delivery peppered with intervention cannot be denied. Period.

I am cracking up at the person who said there is a greed factor in midwifery. CPM here, my family is on food stamps and state aided medical insurance. we do this because of a passion to do what we feel is right. Maybe i could take on lots of clients and make a comfortable low-middle class salary, but I am dedicated to giving my clients one-on-one attention and the best care possible, while still having the time to dedicate to my own family. The horror stories I hear from my clients about their previous hospital births (tons of clearly unnecessary cesareans) and the deaths that happen in my community (in a fairly decent hospital) counter all of the anecdotal crap I’m hearing about no babies or moms dying in hospitals…Doctors are human, and from my estimation, make a whole bunch of mistakes! And do a lot of selfish things that cause complications and misery for families. When i do transport a mom, i see so many weird and uncalled-for procedures performed on mom and baby, and feel sad for their loss of autonomy in their birth experiences. Thanks, helen, for your herb comment, how silly to criticize that which created modern medicine. Good for all of the moms on this thread who are educating themselves on the choices available- I hope everyone has access to the most appropriate care for them!

I am an RN with two years of sporadic experience in Labor and Delivery. My brother’s wife, (SIL), pregnant with their third child opted to have a home birth with a Certified Midwife, (CPM) because she was turned away by her OB due to lack of maternity Insurance. They were planning to pay cash and that was unacceptable for this Obstetrician…according to the receptionist. (7 years earlier, this particular physician delivered my nieces, (twins), vaginally.)

This pregnancy started out perfectly. Ultra sounds revealed a placenta that was close to the cervical opening but in time, as the uterus grew, the placenta moved and was no longer a potential complication…or so the MW stated.
The nightmare occurred during the last 6 hours.

MY SIL had “Bright Red or FRANK BLOOD” at 12 midnight, in the toilet upon urinating. This is typically an emergent sign which signals something is wrong. (It is also a cardinal sign for placenta abruption.) The midwife came at 12:30 AM, May 17th, 2010. The MW saw the blood in the toilet because my SIL saved it for her.

So, to recap, the midwife was told about the blood at 12 midnight and saw the blood at 12:30 AM. She opted to call a physician that she said was a part of her “backup plan”. This backup plan (which turned out to be worthless), is outlined on her website and was talked about extensively at a meeting held with those planning to attend the birth. The OB that supervised the MW’s practice would step in and take over the case IF any emergent situation arose. She also described an affiliation with a hospital that her clients would be taken to, if necessary, where this particular physician would oversee the care of the mom and baby.
I heard every word because I was there.

The OB who was her “backup” did not answer the call. She called a second physician that was “on call” and the MW said that he told her to “observe the patient”.
The contractions started coming one after the other along with extreme pain which my SIL spoke to the MW about. (This is another cardinal symptom of placenta abruption.) The intervention made at that time was to put her in the hot tub. The MW monitored the fetal heart tones with a Doppler and by 3:15 AM, the fetal heart rate had dropped and stayed in the 60′s and then 50′s.
At this point, the MW told my SIL to get out of the tub for her babies sake…they had to get to a hospital. Naked and wet, with a blanket put around my SIL, my brother, under unspeakable pressure, proceeded to drive to the closest hospital. The MW called them at that time and asked if an OB was on staff. She was told “no” and advised to take my SIL to Memorial Hermann which was another 15 plus minutes away. The drive took at least 30 minutes.
It was clear to my brother that no one in the ER was expecting them. He ran in and got the wheel chair and then went back to the car to get his wife. She delivered shortly after arrival and the Dr. (who was a new OB) was on the scene and ended up taking over the care of my SIL and her baby.

He cut a very large episiotomy in order to accommodate the size of the baby and “get him out”. He, the baby was not breathing and in severe distress upon delivery. Resuscitation procedures began for the infant and he was taken to the nursery. The MW said to my brother, that the baby was fine. “She had seen bluer babies then this.”
I arrived at the hospital about 4:10 AM to see my SIL, legs in stirrups, white as snow, bleeding, with two physicians trying to get the bleeding to stop. Blood covered the delivery room. Nurses were in chaos. Both MDs were VERY concerned.
My SIL was taken to the OR. The MW with her asst. MW remained with my brother and me reiterating that this birth was dedicated to “The Lord “from the beginning and “it would be fine”. The primary MW proceeded to talk about her frustrations regarding the “first physician”. Her concern was focused on the episiotomy that he had performed. (The MW thought that he had “butchered my SIL and she had to tell him to stop cutting in order for him to stop”. It turned out to be a 4th degree episiotomy which has been healing well since the delivery.)
The two physicians WERE NOT able to stop the bleeding…plus there were no blood products at the lab. This is at 4:30 AM. About 6:15 AM, my SIL had a Hgb. of 3 and a temp of 91.4 F. She was still in the OR.
Both physicians came out one at a time, again and again. They told us that they did not think that my SIL would survive. They said she was bleeding from everywhere and was in DIC.
The MW and her asst, MW, left at some point after the Dr.’s projected outcome for my SIL and remained in the waiting room. My brother and I sat together on the floor outside of the OR. We prayed, cried, talked about his children being w/o their mom, and planned a funeral, kept our mother updated (who was taking care of his twins). It was hell!
Blood products were hung once received by the lab…around 6:30 AM. A total of 51 units of various blood products were infused and my SIL was taken to ICU where she, my brother and I remained for several days. She survived. She was moved to the floor and discharged home on Sunday afternoon. No residual physical damage has been noted so far. The emotional toll however, is and has been enormous especially given the following events that they are now facing.
(My nephew, Sam, apgarred at 3, 3, 6, and after 20 minutes, 8. Later that morning, 5/18, my brother and I were told by the physician who was on call for the nursery / NICU, that the baby was stable.)
The baby began to seize early morning, May 19th. My brother told me the medical personnel were starting an alternative IV. I thought if he was “stable”, why would he need another IV? I went to the NICU and the new Dr. who took over the care told me that the baby was seizing last night and he was being transported to Memorial Hermann, downtown Houston Medical Center to the NICU. The explanation was that the infant needed an EEG and further evaluation.
I rode with the baby to the Houston Medical Center via ambulance while my brother stayed with his wife. The infant was taken to the NICU, level 3 nursery. I was greeted by the receptionist at the front desk who had me wait for 20 minutes until I could see a nurse manager and find out what was happening.
(I refer to the receptionist now as the Gestapo because of her extremely poor social skills. In my opinion, she is in dire need of training and supervision when it comes to dealing with families and patients that are tired, vulnerable, and in tremendous distress!)
Finally, I was allowed to be with the baby per the Nurse Manager, Tyra. She was a ray of sunshine in comparison to my initial contact at the NICU with the receptionist.
I spoke with Dr’s, Nurse Practitioners, and staff nurses throughout my stay. I had the freedom to go in and out of the NICU day and night. The nursing staff from the time I arrived, to the time I left Friday evening, was amazing! Dr. Carbehol, Betina, NP, the EEG tech, and Jen at the Ronald McDonald house where I stayed for 3 days, were outstanding. Their efforts to include me as a team member, accommodate my needs, serve, and answer the ongoing questions in order to educate me, made this nightmare for my family, and me, a bit more bearable.
To summarize my nephew’s status, the EEG, (electroencephalogram) taken within 24 hours revealed that his entire brain had been affected by the lack of oxygen due to the loss of blood that he had sustained. A MRI was completed and read one week after admission and clearly delineated that there was global brain damage which ultimately validated the results from the EEG.
Our family now waits to see what the baby will recover an hour / a day at a time.
We celebrated when he finally had his first wet diaper because that meant no more urine catheter! His kidneys were working and there was no need for long term dialysis. He could pee!
We celebrated when his pupils constricted (even though they were sluggish), when exposed to light via an ophthalmoscope because that meant he was not brain dead. There was a response.
We were happy to hear that the sedation medication, Phenobarbital and Ativan, were maintained at adequate levels in order to keep the brain from seizing. It was critical to have the brain rest so it could recover and heal to whatever extent he was capable of. (Seizures can be very hard to control.)
We were so glad to have him taken off the respiratory equipment (CPAP) days after the incident because given time, he was able to take deep enough breaths to satisfy his blood oxygen levels. He could breathe on his own!
Today, he actually looks at Mom, Dad and his sisters. He sucked Dad’s finger laced with sugar yesterday during a visit. Unfortunately, he is still at the NICU, away from home, because he is not able to feed from a breast or bottle. His gag reflex is weak which means he can’t swallow without choking.
We are waiting and praying for this to return or my nephew will have to be fed by a tube…in his mouth, nose, or directly, surgically placed in his stomach. (GTUBE).
I have come to understand from other parents and medically trained practitioners who have walked this path that this is how it will go for the duration of his life. One celebration at a time with each step of recovery from the trauma he endured during his birth.
In conclusion, my nephew has been diagnosed with SEVERE ENCEPHALOPATHY due to a HYPOXIC, ISCHEMIC, EVENT or HIE. He is going on 3 weeks of age.
The primary MW is a trainer of midwife interns and plans to open a birthing center in Katy, Texas within the next few months. She claims 17 years of experience delivering babies, pre nursing coursework (that was never completed), a certification from NARM and a license to practice midwifery in the state of Texas. Her “stated record” is next to perfection with only 4 babies going to the hospital. All outcomes were great.
(Except now, given the experience with my nephew and his mother.)
The Primary MW has met with my SIL this past week. The MW is convinced that she has done the right thing and made all the correct decisions. Her thinking is that if she referred my SIL to the hospital initially when the blood was first observed at 12:00 AM, the “outlying hospital that they would have gone to most likely would have done a C-section and my SIL would have bled to death”.
The truth is that the placenta was abrupting or pulling away from the uterine wall which is an emergency situation! My SIL needed to be taken to a hospital immediately…at 12:00 AM! This was the first indication that the delivery was not normal.
The second cardinal warning of abruption was the pain. MY SIL told the MWs that she could not take the pain. (I am sure that the pain level that my SIL complained of WAS NOT congruent with the dilation stage of her cervix. Her pain level was intolerable and both MWs ignored this.)
The third sign which accompanied the second sign / pain was that the uterus was having a continuous contraction. The uterus was not resting in between contractions. THIS IS NOT NORMAL!
The intervention, given all the symptoms mentioned above, was to place my SIL in a hot tub and monitor the fetal heart rate via Doppler. By 3 PM, the fetal heart tones were in the 60’s and then 50’s. My nephew was dying and this is what finally motivated this MW and her Asst. to go to a hospital.
Neither midwife knew what was happening when the signs of an emergent delivery started!!! They were both clueless and way out of the scope of their practice outlined by the TX Dept. of State Health Services. Both midwives were planning to perform a delivery without a Physician, Hospital or “emergency backup” plan in place. Two lives, approaching death rapidly, were in their hands and they chose to wait until the last minutes prior to getting medical help.
I am furious and very sad for my nephew who will never have a normal life due to the negligence and ignorance displayed by these Midwives.
This did not have to happen. It could have been prevented!
If a registered nurse, physician or hospital practiced medicine with negligence of this caliber, they would be paying tremendous consequences…not to mention the potential for losing their professional licensure!
FYI: The primary MW, who has been paid $3000.00 in cash for her services (which is her fee per birth), does approximately 4 home births per month. That totals $150,000.00 per year. There has been no refund to date.

Candice SanPietro

PS: For all of you who are Home Birth Advocates, this particular CPN has a stated 17 yr history delivering babies. Imo, that is a VERY sad commentary given her choices / decisions made at this delivery. 17 yrs and she placed an abrupting mom in a hot tub compromising two lives. This is why CPM’s should be legally mandated to carry insurance and have ongoing medical supervision in addition to education / training.

By the way, does anyone have a recommendation for a houston / Austin attorney? There are other families coming forward with similar complaints and I think it is time to start taking these issues to court! Let a judge and jury decide who is responsible and set a financial amount for the damage done to these families and their children.