Married to Medicine

Married to Medicine

Sunday, March 9, 2014

The Home Birth, "Natural" Child Birth, and U.S. Hospital Birth Debate Part I: Hospital Safety, C-Section Rates, and Paternalism

Aaaaah friends.  Just when I vowed to extricate myself from the black hole of vaccine debates and finally start going to bed on time, along came a parallel and equally frustrating universe:  That of the home birth (HB), "natural" child birth (NCB), and U.S. hospital birth debates.  Without further ado, here's what I think you should know about all this:

In direct contradiction to what you might have heard, U.S. hospitals have excellent safety stats.

Although it seems incredible, there is no shortage of NCB/HB proponents who will tell you that "infant mortality" in the U.S. is very high, as if that's a reason you should birth at home and/or live in fear of your healthcare providers.  Alarmingly, many of the people spouting this nonsense are paid birthing "professionals" ("childbirth educators," "doulas," and even so-called CPM "midwives" - paraprofessionals, really).  Here's the deal:  Infant mortality is a statistic counting every baby born alive who dies before 12 months of age.  Ours is high compared to other first-world nations because we lack universal health care coverage and we have bigger pockets of poverty.  

The relevant statistic is perinatal mortality.  Perinatal mortality counts deaths during labor (intrapartum deaths - stillborn babies) and deaths within a week of birth.  Guess what?  We are not too shabby.  The World Heath Organization gives us a rate of .7%, comparable to other Western nations and better than many of them - better than the U.K.   Other Western nations that have us beat generally have a rate of .6%, so just a .1% difference.  You can check out the WHO's report on perinatal mortality here.  And keep in mind that maternal obesity increases the risk of perinatal death by about 20% per every 5 BMI points… so really, our safety stats are actually pretty darn phenomenal.  And that's without universal coverage too!

On our c-section rate.

Speaking of comparative statistics, here's a fact you won't hear from NCB/HB advocates:  Yes, Canada (for example) has a lower c-section rate than we do (22.5% versus 33%).  But their rate of operative vaginal birth (OVB), meaning forceps and vacuum-assisted deliveries, is much higher.  Theirs is 14.9% versus ours, which recently dropped again to 3.5%.  Guess what that means?  It means that our rate of unassisted vaginal delivery is actually just about the same, or higher, than theirs.  And this is true of other comparable nations as well.  Check out the U.K. (12.8%; 25.5% c-section rate)Australia (11.1%), and Ireland (16%).  None of those other nations have our legal climate, and none of them have our (alleged) profit incentives, either.  What gives?  Probably that doctors fear hypoxic brain injury whether or not they also fear a law suit, and whether or not they can charge extra for a c-section.  

Why have our doctors essentially replaced OVBs with c-sections?  It's a complex topic.  If you're interested, I would encourage you to read "The Score" by Atul Gawanda - a fascinating article on the history of childbirth in the U.S.  You should also be aware that there is a new movement to bring back more OVBs - check out the ACOG's press release about the new c-section reduction guidelines.

So why is our c-section rate high, other than our OVB rate being so low?  Here are a few other reasons.

And for the record, I'm not arguing that our c-section rate isn't "high."  I don't know what an "ideal" c-section rate would be for our demographics, and neither does the WHO; the oft-quoted 10-15% is a 27-year old statement that was retracted in 2005.  I'm simply pointing out that our c-section rate is not as comparatively "high" as it's made out to be and that there are many legitimate reasons behind it … reasons you never hear about from NCB proponents or uber-crunchy "mommy blogs."

On the alleged "Paternalism" of U.S. OBs and whether you can expect your hospital experience to be miserable.

If you're following this topic at all, you've likely heard that U.S. hospital births are miserable experiences in which women are utterly disrespected, to the point of being "birth-raped."  Here's what I think is worth noting on this issue:
  • It's definitely true that some physicians have terrible bedside manners and/or are incompetent - not even following the current ACOG guidelines themselves.  All professions have incompetent practitioners, midwifery and nursing included.  As someone who sacrifices every day so that my perfectionistic husband can offer the best care possible to his oncology patients, I have to say that I find incompetent and/or slacking doctors really reprehensible.  Physicians who short-change their jobs are not only endangering their own patients, but they are making it more difficult for other people to trust and feel comfortable with medical providers; they are directly fueling the anti-vaxx and the home birth/NCB movements.  Plus, their slacking is making more work for dedicated physicians like my husband - physicians who do care and who will take the time to explain everything to the questioning, misled patient.  
  • All that said, many NCB/HB courses and proponents give a highly skewed idea of what a typical hospital birth is like.  This sets women up not only to go into their births with fear, but also to find things wrong with their experiences that are not, in fact, wrong.  Here's an article with statistics on that, but possibly more compellingly, here is my friend Dani's blog that describes what she was led to expect from a hospital birth versus what her experience actually was, when she ended up unable to avoid one.  She's a doula, by the way, and remains supportive of natural child birth… but she's science-based and she doesn't inflate the "benefits."  
  • On "pushing interventions" - I really think it's of utmost importance that physicians explain why they are "pushing" an intervention; if they don't, they're leaving the door WIDE open for some new mom's friend to tell her that her birth was "ruined" for no reason - and that will happen.  I hear so many stories where (allegedly, anyway) all the OB says is "I feel strongly that we should do X right now."  No.  If studies show that given the conditions presented, there would be a 5 per thousand (.5%) increase of perinatal mortality if, for example, labor continues past a certain time, tell the patient!  Tell them that since you deliver an average of 500 babies per year, you WILL SEE babies die or be born damaged who didn't have to be, if you aren't risk-averse!  Admit to them that yes, not intervening might significantly increase their chance of a vaginal delivery… but tell them that in your opinion, even a small risk to the baby's life or long term health isn't worth even a significantly greater chance of a vaginal birth!  And please be sure to also tell the women who are not fighting or questioning you!  They are questioning in their minds but too polite and/or overwhelmed to ask, and they deserve to know.
  • Meanwhile, some patients need to realize that the laboring mother is NOT the OB's only patient. The baby is equally the OB's patient and the OB's highest duty is to protect life, not to avoid c-sections.  
  • Did you know that over 80% of current OB residents are female, and OBs as a demographic are getting younger?  These women are feminists and trail-blazers ... they're strong and dedicated women who usually care deeply about getting it right.  They're not out to cut you open for money.  When I asked my OB about an induction at 39 weeks with my second baby (because of my first baby's macrosomia) she strongly discouraged it.  Now… compare all that to the roots of the NCB movement:  Male physicians deciding that childbirth pain was all in women's heads.  And to the current NCB movement - paraprofessionals feeding women inaccurate, misleading, and false information in order to make their system look more necessary than it actually is - see my other post on myths about epidurals and 41 week inductions.  Who's paternalistic now?  And whose business is completely dependent on all this ... and who has the luxury (and the scientific resources) to simply seek truth?  I'll give you a clue:  Home births represent .5-1% of all U.S. births - ZERO impact on any OB's salary.  But they represent 100% of the revenue for home birth practitioners.
  • I often see the idea perpetuated that OBs will perform a c-section because it's "better for their schedule."  ????  Are you living in a rural area?  I labored 15 hours at home and 18 more at the hospital.  I went through at least two OBs; when their shift was over, they left.  My labor didn't make any difference to anybody's work schedule.   
I have to cut this off for tonight.  But here's some food for thought:  If you didn't like your attorney, or you suspected that he or she was incompetent, would you replace your attorney with a paralegal or a legal secretary?  Why not just find a better attorney?  CPMs (lay midwives) and "childbirth educators" are not professionals.  No professional organization is holding them accountable for anything they say or present to you.  Compare that to OBs and hospital-based CNMs (nurse midwives) who function as part of a team under layers of accountability in hospital settings - oversight boards, patient satisfaction surveys, safety protocols, and potential legal action.  It's cost-prohibitive to sue CPMs or "lay midwives" because they don't carry malpractice insurance … more on that later.

Like vaccines, the best answer here is to find a physician or hospital-based CNM you trust.  Just as surely as you cannot adequately represent yourself in court (or fly your own airplane), you cannot be your own "best" physician via google, mommy blogs, or any other non-science based source.  

Part II discusses the dangers of U.S. home birth and how NCB propaganda fuels home births.

My first baby was 9 lbs 10 oz and at a bad angle for pushing, as seen in his swollen-shut eye.
As with many macrosomic (8 lbs 13 oz+) babies, my labor (NOT induced) was protracted -
15 hours at home to get to a 4, 18 more before he came out.
His head was 99/100th percentile circumference, and It.  Was.  Stuck.

My second baby was a full 3 lbs lighter and with a much smaller head.  She came out in 5 pushes.

My OB is a mom herself.
She strongly discouraged my request for a 39-week induction with #2,
which I made because of #1's macrosomia.
… was that "paternalistic" of her?
… did she "push" a natural childbirth on me??
(Irony intended).
Click HERE for Part II.


  1. This research video seems to be a very valuable explanation of the research on the topic of US perinatal mortality and c-section rates. Have you watched or read any of the studies here? I'm not sure it jives completely with what you present but I appreciate some of the points you raise. It seems agreeable that we figure out how mothers can be supported with good information for their decisions.

    1. Briefly - I don't have time at the moment to watch and analyze all of the statistics in this video; I will try to later. But right off the bat, this is (1) a Lamaze video (see the article I cited about the origins of Lamaze) with (2) Eugene DeClercq presenting. DeClercq, who is a PhD not an MD, was one of the makers of Ricki Lake's propagandic film "The Business of Being Born" and in this video he's once again up to his old trick of citing infant mortality instead of perinatal mortality. I've also seen highly misleading information approved by him on UpToDate, which is a practitioner-source my husband uses that I often also use when I research a topic. In fact I complained about it! For an excellent debunking of his film, see this blog entry from my doula friend who originally bought the film hook, line, and sinker. Also, my stats are from the World Health Organization - definitely not a biased source!

  2. And on that note - you should know Canada has a very high rate of obstetric trauma - the rate of third and fourth degree tears sustained during delivery. So is a lower cesarean rate really worth more third and fourth degree tears - along with the implications of those third and fourth degree tears?

    1. Ah so interesting! I definitely have mixed feelings about attempting to return to more OBVs. My first birth was an OBV and it was wonderful - I was in a top hospital (MGH - Adele came here from the UK for her vocal cord surgery) and I could tell that the OB knew just what to do. I did have a rough recovery from the tearing and also from 2.5 hours of pushing, but it paved the way for my super easy second birth.

      I don't know how I would have felt had I been in a lesser hospital. There was recently a push to make forceps-assisted deliveries illegal… it followed the devastating case of an incompetent physician who I believe severed the baby's spinal cord. :( The article I link to above, which I'll post again immediately below, has a really good discussion on the pros and cons of OBVs.

    2. I had a 4th degree tear and then later, a scheduled c-section. I will take a scheduled c-section any day over the agony and years of trouble from my first natural birth.

  3. This is a fantastic post. I'd love to share with with my FB birth group, but unfortunately every time I point out the above, they think I'm a fearful sheep. it's very frustrating.

  4. CPMs are certified. They are NOT lay midwives, in which you are correct, are not licensed or certified. CPMs go through a rigorous didactic and apprenticeship/preceptorship program and then sit for their boards. Their certification is through NARM. Many states, such as New Hampshire where I reside and have CPMs oversee my pregnancies and births (on my 3rd with them), regulate CPMs and hold them accountable to their specific scopes of practices. It would be prudent of you to have all your information correct before blogging about things in which you clearly know little about.

    And citing from The Stir is hardly scientific.

    1. The typical route to become a CPM or LM (and is the *most popular route of all currently practicing CPMs and LMs*) is the Portfolio Evaluation Process which consists of an apprenticeship program and passing a skills assessment and one written exam. ONE written exam.

      The certification process to become a CPM and/or LM is incredibly lacking. It is NOT EQUIVALENT to the training of midwives in any other first world country. Here's how little it can potentially take:

    2. When you have to get a 4+ year degree to get a CPM then I would concede your point that they are in a rigorous program but distance learning degree for a very hands on field? Get real!

    3. If you look at the data from Colorado, California, Oregon, the MANA study, the CPM 2000, the 2 AJOG studies from 2013 and the new study from Cornell, it is incredibly clear that the training and education to become a CPM is not nearly enough. Each of those studies/datasets shows the significant increase risk. Babies are dying preventable deaths because midwives (CPMs, LMs and DEMs) do not have the skills or training needed.

      A home birth with a CNM or CM with *current* hospital privileges and a good working/consulting relationship with an OB/GYN (not just any MD, but specifically an OB) who practices under the guidelines set forth by CABC birth centers, that's another story. Then you are looking at a situation more comparable to how things work in other first world countries.

    4. CPM that are certified by NARM are accredited by the same body which accredits CNMs (NCCA).

      These are not individuals who are just calling themselves midwives for prosperity's sake. They are educated individuals, who have their skills assessed and then pass their appropriate boards/exams.

      I am a RN. I had a formal didactic education, skills assessed and then passed my requisite exams to become licensed. And now I am able to practice under the role. Am I any less credible than a CPM who goes through their appropriate education, training and certification?

    5. The CPM certification is grossly lacking. The educational requirements are a joke. Here they are, for everyone's reference:

      To summarize the highlights:
      Step 1 includes attending 50 births in varying capacities and completing education (distance learning is acceptable here, yo!)
      Step 2 is to take an exam
      Step 3 is to attend 5 more births.

      So online correspondence "education", a dumbed down test, and attendance at 55 births makes one an expert in the eyes of CPM world.

    6. @ doula dani, CPMs are NOT LMs or DEMs. Not even close. Its disingenuous to say that they are all the same.

      @Awesome Mom, CPM training can easily take that many years (sometimes even more so) to get all the necessary hands-on training/births in, dependent on where in the country you are being precepted (more rural areas the births are few and farther in between).

    7. To give MANA credit where credit is due, they did recently (in 2012) tighten up their educational requirements a bit more.

      They now require a high school diploma.

    8. @TMG do you take issue with CNMs who completed their didactic online? Because many programs offer this to those students/candidates.

    9. I've seen Frontier come up a lot for online nurse midwifery programs.

      Their program is rather intense, both the didactic and hands on pieces.

    10. that still doesn't answer the question TMG. You discredit online edu with regard to CPMs, but what about CNMs? And I'll further that question with what would be acceptable, by your standards, in terms of education and credentialing for CPMs?

      Georgetown, Midwifery Institute of Philadelphia University, Frontier, University of Cincinnati, and East Carolina all have fully distance/online CNM programs (with preceptorship at a location of your choice/choosing) that I can think of off top of my head.

    11. These CNM programs, as far as I know, also require a BSN. The entrants to these programs are already very educated and have passed licensure testing for nurses. Some day, you should compare the online courses of an online CPM program versus an online CNM program. The differences are vast.

      These programs are also not entirely online for didactic.

      And the apprenticeship component of a CNM program can head into the thousands of hours, which is on top of all experience in the medical field that may have been gained while practicing as a BSN-level nurse.

    12. you are still refusing to answer the question. Typical.

    13. Anonymous -

      The professional association for CNMs is American College of Nurse-Midwives (ACNM).

      The professional association for CPMs is Midwives Alliance of North America (MANA) and National Association of Certified Professional Midwives (NACPM).

      The certifying organization for CNMs is American Midwifery Certification Board (AMCB).

      The certifying organization for CPMs is North American Registry of Midwives (NARM).

      There is NO DEGREE required for CPMs. Until 2012, they didn't even need a high school diploma!

      There is not much of a difference between a CPM and LM, depends on the state where a midwife becomes licensed. Each take the same ONE exam through NARM.

    14. That's because your question is nonsensical. I will help you understand why. First, please list the 'courses' required for the CPM 'credential'.

      Now, list the courses for an ADN or RN and the additional requirements for a CNM or CM.

      Right there is a huge gap. There's even further gaps when it comes to competence, professionalism and oversight. Even further, and as an RN you should know this, having hospital privileges and physician oversight for smooth transfer of care should it become necessary can be the difference between life or death. Fear of ramifications alone can keep CPMs and other lay midwives from timely transfer.

      Despite your wish/assertion to the contrary, CPMs are NOT equivalent or equal to professional midwives either abroad or here in the states. No other country has this 'credential'.

    15. All midwives should have a 4 year undergrad degree plus at least 2 years of master level studies, culminating in a masters degree. And an apprenticeship under someone with the same level of experience. Number of births attended should be more than 50. Let's aim for at least a couple hundred AFTER completing schooling.


    16. Not "same level of experience", but getting their experience under someone who has a masters degree and is qualified to serve as an apprentice. So not someone fresh out of school.

    17. @FooFKittlen, CPMs in my state are credentialed. Further, my hospital works closely with the CPMs at the local birth center for the very reason of ensuring timely transfers and continuity of care should a woman need more advanced care. CPMs and the medical establishment can, and do (at least in my state) have a working collaboration that serves the benefit of women. Perhaps you live in an area where these relationships do not exist, and for that I am saddened for childbearing women.

      @Doula Dani and others, CMPs certified through NARM, on average, have 2 years worth of required didactic with an additional 3-5 years of a clinical component (the 3 phases process). Then they must be signed off on their skills/deemed proficient...all of this is before even sitting for the written exam. I am not quite sure where we are coming up with the assumption that any ole bumkin off the side of the road can deem themselves as a CPM? They can't. Now if we are talking LM then sure, you may have an argument right there.

      @TMG, thanks for finally answering. At least now I understand where your POV is stemming from. I disagree with a Masters being the entry level of education for a midwife just like I believe that there is a place and role for different types of midwives (CNMs and CPMs). It doesn't have to be one or the other. And I am sure it comes as no surprise that I also believe that not all birth need to happen in hospital...which is why I also believe in the need for credentialed, out of hospital midwives.

    18. Anonymous - I know exactly what it takes to become a CPM b/c it is something I thoroughly considered doing. I decided to go the CNM route.

      Again, the training to become a CPM is incredibly lacking. Do you understand the requirements would not be enough in any other first world country?

      Do you understand no education beyond a high school diploma is necessary?

      Compared to a CNM, who must be an RN and have a 4 year bachelor's degree (typically is a BSN) and a graduate degree in nurse midwifery from an ACNM midwifery program.

      Or even compared to a CM, who must have a 4 year bachelor's degree with a minimum of certain science courses and a graduate midwifery degree from an ACNM midwifery program.

      You think the CPM is enough? After 2 years of apprenticeship and only 40 births and a woman can qualify to take the test. You think this is thorough?

      Have you seen the data collected from California, Colorado and Oregon? Have you seen any of the new studies regarding home birth in our country? I asked you this before but you didn't answer.

      Have you looked at the MANA study and compared it to hospital data or even compared it to the Birth Center study? I wrote it all out on my blog. What's your response to these numbers?

    19. You didn't answer or address anything I said. Typical.

    20. you never asked a question of me FooFKittlen. And I responded appropriately to issues you addressed. If reading comprehension is lost on you, that is not my problem.

      I have seen the MANA study Doula Dani. And as a consumer, I prefer their number over some of the local hospitals in my area.

    21. What about the other questions I asked?

    22. I already addressed it in a response to another poster. But the short answer is yes. I believe in CPMs. I don't necessarily think that years upon years are a requisite for the makings of a good provider. I also believe in physiologic birth and no, I do not believe that ALL birth has to happen in hospital. I believe in women being able to choose the provider, and type of birth, that they feel is best for them.

      I am an informed consumer. I pick my providers based on many things. Their education, their certification/licenses, and their statistics. And there are exceptional CPMs out there who have attended hundreds and thousands of births, that have no maternal or perinatal/neonatal deaths, that properly risk women out of their care (meaning they are properly screening their population), that have low transfer rates (and excellent relationships/collaboration with local OBs and hospitals despite not having hospital privileges) and even lower c/s rates for then those transfers do occur. Its completely arrogant and disingenuous to claim that all CMPs are essentially "midwife" wannabes and that they are all bad providers and all uneducated and inexperienced.

      I've read your blog and I see why YOU PERSONALLY are against CPMs. And thats fine. You (and others here) are free to hold those opinions. But what becomes a problem is when you make blanket statements about a whole profession. You are just as bad as those in BOBB stereotyping OBs as c/s happy surgeons. The are good OBs, there are bad OBs. There are good CNMs, and there are bad. There ARE good CMPs and there are bad.

      Okay that wasn't a short answer, but there is is anyway. Tear it apart as you wish.

    23. The problem with the CPM and why I *can* make blanket statements is b/c training and education are lacking. With a MD or CNM or CM - you know the very minimum required skills/education/training is enough - if they earn that title of OB/GYN or CNM or CM, then they are qualified to deliver babies as soon as that title is earned, as it is a rigorous process to earn it. With a CPM you do not. While, yes, there may be some CPMs that are more than qualified but that is not b/c they simply met their requirements. It's b/c they went above and beyond what was required.

      Majority of all currently practicing CPMs went through the PEP process - which is *not enough.* The CPM credential should mean something on it's own. A woman shouldn't need to go digging to figure out if her particular CPM is well-trained enough. If a woman earned the title CPM it should mean she is well-trained enough -- but that is not the case.

      A CPM does not have hospital privileges. Why would this not be a basic requirement of the process like it is in all other first world countries? Think of how many women transfer during labor, especially first time moms... how nice it would be to have her care provider there with her, continuing care. Most importantly, think of the ease of transfer if a midwife could call into her hospital in the middle of the transfer to fill in the hospital/OB/charge nurse with the details of the situation in case of an emergency. Hospital transfers take time b/c monitoring and assessment takes place before they can do anything... and in the event of an emergency, those are precious minutes.

      Philosophy is a different ball game. I'm talking about what makes someone qualified to deliver babies or not. Yes, I, too, believe that a belief in the normal process of birth when caring for low risk women is important. But when I go searching for a care provider, what I want to know first and foremost is: are they qualified and well-trained? Are they going to keep my baby and me safe?

      These are things that matter to me the most. Most of the time, for a low risk woman who goes into labor spontaneously, it will be an uneventful situation. But a philosophy or trust in birth is obviously not going to keep a woman protected if things become an emergency or when actual life-saving skills and life saving meds/equipment are needed.

    24. so the CMPs training are not up to par by YOUR standards. I don't know why you think your standards in a health care provider should be everyone else. Like I said earlier, I make educated decisions. I researched my providers. And I am comfortable with their numbers. Thankfully I live in a state where I reserve that type of autonomy over my care. I know what level of risk I am comfortable with and I get that it isn't the same as yours--yet I am not sitting here telling you what type of provider you must choose, why, and where you must give birth. I do not think that highly of myself to where I feel the need to make that type of decision for another.

      I am not quite sure why you have an issue what in what I, or any other birthing woman does for that matter, or how exactly that it affects you in the slightest. As a doula, I am somewhat appalled that you think you have the right to make such decisions for another woman--that you are so vocal against a woman making a particular choice for herself. Your role is to support woman in their birthing choices and I am not really seeing a lot of that here.

      Transfer of care can and does happen seamlessly. Maybe not in all states, but again, thankfully I live in one which values CPMs, their role and a woman's choice in choosing them. When my midwives make a labor transfer, they call up the local hospital and OB on call, tell them the situation and that's it. They go to the hospital with their patients, but then they are just there as labor support, not as a provider. They just don't dump women off on a hospital's door step and then wipe their hands clean. My particular CPMs have never had an truly emergent transfer (where it was a life or death situation for either mom or babe) and again, have never had a mom or baby die under their care. You want to know why? Because their care is regulated where I live. Their scope of practice is clearly delineated and the types of patients that they can see in pregnancy and attend in labor and delivery are plainly laid out. Any deviation from this and you risk out/transfer out.

      A CMP in a state where their practice is regulated ARE good for the child birthing population. It holds them responsible for their care that they give. It gives women options, choice and a voice. And yeah, I am a-fucking-okay with that.

    25. I am not making decisions for anyone. Where did I say I'm trying to make decisions for someone? I'm putting information out there so women can make informed decisions. You can hire whoever you'd like. You are making a strawman argument. I never told you who to hire or who not to hire.

      You wrote in your first comment that CPMs have rigorous training. They do not. That's what this conversation is about. It's not about trying to force women into making certain decisions. The conversation is about training and education of CPMs.

    26. "so the CMPs training are not up to par by YOUR standards."

      Not just MY standards but the standards for midwives in the rest of the developed world.

    27. "Your role is to support woman in their birthing choices and I am not really seeing a lot of that here."

      That's ridiculous. If someone wants to make a dangerous choice with her pregnancy and/or birth, I do *not* have to support it just b/c I'm a doula. I *know* my scope of practice very well and understand my role as a doula and I take it very seriously.

      When I signed up to be a doula, I didn't sign over my soul. There was nothing in the literature I received from my certifying agency that stated I must take any client that wants me and must support all birth choices. I'm allowed to have my own personal beliefs and preferences.

    28. clearly I struck a nerve. I wonder why that is?

      Anyway, you clearly have your head stuck far in the sand. You are absolutely right, there are no CPMs out there with adequate education, training, licensing and regulation of their practice to make them viable options to the birthing community. Doula Dani knows best!

      And now I bid you adieu. Its not even worth considering continuing the conversation because your POV is just so completely skewed that you cannot even FATHOM the possibility that there are other ways for women to safely give birth that do not include the hospital setting.

    29. It's no wonder you want to hide behind your computer, without revealing your name. You can't answer any of my questions, you can't admit that the training for CPMs is lacking and doesn't meet standards for the rest of the developed world, you clearly hate that there is someone out there advocating for the truth about things you clearly didn't know or understand, you are pulling one strawman argument after the next and now you are trying to act like you are ending the conversation b/c of "my POV" when it's obvious that you don't know how to respond to what I've said. It's ok, I (and anyone reading this) can see the truth of what's going on here. I know you are reading my response and you just don't know how to respond sensibly, without strawman arguments, without trying to put me down b/c *I* have clearly struck a nerve with YOU.

    30. "you cannot even FATHOM the possibility that there are other ways for women to safely give birth that do not include the hospital setting."

    31. You might also like to know that I used to attend home births and was planning to have home births myself...... until I dug a little deeper and found out how seriously flawed our home birth midwifery system is here in the USA

    32. Oh Dani I can't tell you how much I admire and appreciate what you do. You provide a reasonable, educated and comprehensive argument every single time. BirthUSA makes the same tired, unseasoned and unreasonable arguments. I think it's very difficult to believe you're on the evidence based side and then have someone so thoroughly and thoughtfully poke holes through your every belief. While you might not change anonymous' mind, you certainly have managed to convince many others. The simple truth is that the facts and evidence are against homebirth with CPMs. While some may be wonderful and well qualified, the total lack of ability to effectively distinguish between them and charlatan birth junkies demonstrates the need to abolish this fake credential. Thanks for doing what you do. Please don't stop...we need you and Lisa and others to keep fighting for safer homebirth. 30+ preventable deaths a year is too many. Hugs. KW.

  5. and I think as someone who is interested in maternal and neonatal health that you attend the Partners in Perinatal Health conference in Norwood MA in May. You'll learn a lot, and I think will rightfully be put in your place with regard to some of your misconceptions on American pregnancy and childbirth today.

    Its an excellent conference. I've attended twice (am an OB RN) and you'd be surrounded by highly educated individuals in this specific field.

    1. I learned in 500 comments to my vaccine post that "Anonymous" posters are, almost always, the crazy ones (sorry, but it's true). Unlike the NCB boards and groups, though, I refuse to delete comments and ban commenters just because I disagree with them. I consider such manipulation of conversations to be an unethical misrepresentation in a public forum.

      Every statement in my blog is sourced to valid, scientific non-biased sources. There are somewhere around 26 sources cited. *If* what you were saying is true - and it's not - then gee, I guess there must be some other explanation for why *both* of the studies funded by MANA itself found a 1.7-2.0 per thousand perinatal death rate (the 2005 Johnson-Daviss study and the recently released death statistics). Assuming all its practitioners are indeed competent, I guess home birth must simply be inherently dangerous. Imagine that…

    2. I choose to stay Anonymous for many reasons Lisa. When you are active on many blog, new sites and their message boards, its prudent that you don't leave yourself easily accessible to those "crazies."

      Do what you wish with my comments.

    3. Wow interesting. Why would anyone want to miss out on presentations by chiropractors, herbalists, seminars such as "Traumatic Birth and The Neonate’s Consciousness".

    4. these are all organizations and professionals who come in contact with women at various points in their pregnancy.

      so the MOD, AWHONN, ACNM, MMA and MDPH are not reputable organizations, nor their members reputable health professionals? Alrighty then.

    5. You're obviously a professional at PWIOPM, and I'm pretty sure of your identity.

    6. iFoofKittlen, considering that I don't even know what PWIOPM is, me thinks my identity is safe. :-)

    7. That's cause that flew right over your head, hon. We have interacted before.

    8. keep on keeping on FooF

  6. these are all organizations and professionals who come in contact with women at various points in their pregnancy.

    so the MOD, AWHONN, ACNM, MMA and MDPH are not reputable organizations, nor their members reputable health professionals? Alrighty then.

  7. My husband just finished a OBGYN clinical rotation and delivered 40 babies in one month. I have a hard time imagining why it would take someone several years to attend 50 births. It seems like someone could easily meet the requirements in a matter of months. That's pretty troubling.

    1. Because the CPMs are only involved in home births. Unlike CNMs and midwifes of all other comparable nations, they have no hospital-based training whatsoever. That's why they call themselves "experts in normal birth." They are not trained in emergency medicine of any sort and other than hoping to catch the signs to transfer to a hospital in time - if there even are such signs, which there sometimes are not like in the case of a baby born with a diaphragmatic hernia - they have neither the training nor even the equipment to handle medical emergencies. That's why you'll hear them say things like "birth is the safest day of your life" and "birth is not a medical procedure." Those things would have to actually be true for their system to work. And they are true… just not always true. A "low-risk mom" is not a "no-risk mom."

  8. Not a criticism but more an observation - I was surprised not to see 'maternal request or choice' cited above as one of the factors driving caesarean rates in the U.S. and also in many other countries around the world.

    I wonder if you might be interested in reading the book I co-wrote with Magnus Murphy MD called, "Choosing Cesarean, A Natural Birth Plan"; it was published in 2012 by Prometheus Books NY.

    I have been battling the 'infant mortality' issue versus 'perinatal mortality' (the rate we should really be looking at if we're going to compare intrapartum care outcomes) for many years now, so I really appreciated reading your distinction for readers here. Thank you.