Blood in your stool? Leg pain? A weird skin rash? We've all been guilty of using “Dr Google” as our healthcare provider. Yet when something appears to be really wrong, most of us are sane enough to follow that Googling up with a visit to an actual medical professional.
We know that nothing — not even the internet — can replace the education, experience and expertise of medical professionals. Except, that is, if your healthcare provider isn’t really a medical professional.
Would you hire someone who knows so little about their chosen field that they feel compelled to crowdsource a life and death medical situation on Facebook? We didn’t think so either, but then again, you might not know that some people practice medicine with a credential that would not be accepted in any developed country but the United States.
We’re talking about the Certified Professional Midwife (CPM) credential and you’ll be horrified to hear that a very public face of US midwifery did, indeed, crowdsource a life and death medical situation on Facebook. What happens when midwives have to turn to Facebook to make medical decisions? Well, in this case — the baby died.
American Homebirth Midwifery Causes Preventable Deaths
Jan Tritten, the editor of the midwifery journal Midwifery Today, apparently believed asking for medical advice online to be perfectly acceptable when she posed this question on Facebook on behalf of another homebirth midwife:
“What would you do? Primip with accurate dates to within a few days who has reassuring NST at 42.1weeks, as well as reassuring placenta and baby on BPP, but absolutely zero fluid seen. 42.2 re-do of BPP and again, mom has hydrated well, but no fluid seen. Baby’s kidneys visualized and normal, and baby’s bladder contained normal amount of urine. We’re in a state with full autonomy for midwives and no transfer of care regulations past 42 weeks. Absolutely no fluid seen…what do we truly feel are the risks compared to a woman whose water has been broken and so baby/cord has no cushion there either. Cord compression only? True possibility of placenta being done although it looks good? Can anyone share stories/opinions?”
You read that right; zero amniotic fluid seen in an overdue mother. While crowdsourcing medical advice might be shocking, you’ll be equally surprised to hear that many of the midwives who responded to this question recommended trusting the mother’s intuition and “leaving things alone”.
Less than eight hours after Tritten posted this question on Facebook, she followed it up by sharing: “Very sad news on this baby: the baby didn’t make it. Had aspirated meconium a while back they believe”.
Unskilled Midwifery And The Unnecessary Death Of Baby Gavin Michael
What happened here? Dr Amy Tuteur is an OBGYN who has been writing against homebirth for years on her blog, the Skeptical OB. Having followed the case from the time Tritten solicited medical advice on the internet, she obtained the following information from a source:
“The parents and midwife had gone for a biophysical profile on Wed 2/19 in the morning. The amniotic fluid was 0, supposedly everything else was normal. The midwife then did a NST with a hand held doppler and told the parents baby sounded good and to go home and drink lots of fluid and take a bath. They repeated the BPP later that afternoon. There was still no amniotic fluid and an NST with hand held doppler was again “good”.
A biophysical profile was repeated the following day, Thursday 2/20. There was still no amniotic fluid, and listening with hand held doppler revealed a heart rate in the 90′s.
The midwife called Dr. X (he provides backup for many homebirth midwives their city) and told him the biophysical profile was normal, but heart tones were “variable.” He told her to immediately come in. She didn’t share with Dr. X that they were at at an ultrasound office attached to Hospital Y. They left that hospital and the midwife got in the car with the clients, put oxygen on the mother and drove 30 minutes to Hospital Z where Dr. X was located. They were immediately taken for a cesarean. They worked on baby for 47 minutes before they stopped.”
So, what does Jan Tritten have to say about all this? Exactly nothing. Those who inquired about what happened had their Facebook comments deleted, but Tuteur didn't let that stop her. Further online evidence eventually led her to identify Christy Collins CPM as the primary midwife.
Collins gave herself away by addressing the incident on Facebook, and though she denied having been the primary midwife in this case, she was also found to have written the following:
“I wish I could go back in time, and have said stronger words – enough to make you hate me, and fell you had no choice but to go into the hospital the day before. I could’ve lived with you hating me, over this feeling of devastation.
I know we say that we don’t know if it would’ve been any different; maybe he would’ve been very sick, but alive. I don’t know. But I wish I wouldn’t pushed much hard and said the things that we never want to hear the ‘experts’ say…
I blame me. I would rather have you hate me for pushing you harder into a bad birth experience … so you could hold a live baby instead.”
Collins lives in Nevada, a state without oversight of midwives. She will not be held legally accountable for the preventable death of a baby, but that doesn't mean there is nothing we can do.
Abolishing The CPM Midwifery ‘Credential’
Homebirth midwives often claim that homebirth is “as safe as hospital birth, or safer”. Dr Tuteur, currently the most vocal voice against homebirth but certainly not the only one, certainly rubbed me the wrong with her continuous claims that homebirth mothers care more about their own comfort than about the safety of their babies.
Let me assure you, that is not true. I chose homebirth twice, because I believed it to be the safest choice for both me and my babies. I believe in informed consent, and in autonomy over one’s own body. Every individual’s circumstances are unique, and there are certainly cases in which homebirth is the best or only choice.
Yet in order to make informed decisions, we need to have the facts. The Midwives’ Alliance of North America (MANA) — the organization that represents CPMs — collected data on the safety of homebirth, but refused to give anyone who couldn’t demonstrate they were a homebirth advocate access to that data for five full years.
Are you surprised? Perhaps you wouldn’t be, if you knew that CPMs wouldn’t be able to practice in any other developed country with a tradition of homebirth midwives, including the Netherlands, the United Kingdom, Canada, and Australia.
Certified Professional Midwives do not have to be trained nurses, and they only practice at birth centers and preside over homebirths. Before being licensed, these midwives have to meet the requirements of NARM, the North American Registry of Midwives — an organization founded by the Midwives’ Alliance of North America (MANA).
Patients should certainly be aware that a class of midwives that should not be able to call themselves midwives at all practices in the United States. I believe in a woman’s right to choose homebirth, but not also in a woman’s right to pretend to be a medical professional when she simply isn't.
Let’s keep women and babies safe by ensuring that everyone knows that even midwives with a professional-sounding title can be fake midwives, and that choosing to have them at your homebirth increases the chance your baby will die by a whopping 450 percent compared to hospital birth.
What can you do? Raising awareness of the situation is the only start we can make. Dr Tuteur told SteadyHealth: "We have started a petition drive (557 signatures so far), a Facebook page for the Not Buried Twice campaign, and are posting tweets with the Twitter hashtag #notburiedtwice." Sign the petition or find the Facebook page by clicking on the links in the "Links" box below this article.
Why "Not Buried Twice"? Because after the preventable death of this baby, the midwives in question are attempting to delete all evidence of his existence — and with that, their own responsibility. There is nothing anybody can do to bring this baby back, but you can think twice before choosing homebirth with a CPM yourself.
"My most important advice for women thinking about homebirth is this: keep in mind that CPMs (and Lay Midwives and Direct Entry Midwives) are not real midwives. They lack the education and training of all other midwives in the developed world, and therefore, the studies they quote in support of homebirth don't apply to them," Dr Tuteur warned us.