Friday, September 11, 2009

The Non-perils of Midwifery

Earlier, the Today Show aired a sad, unfortunate piece called “Perils of Midwifery.” (They later updated the Web segment title to "Perils of Home Births.") Not only does it follow the heart-breaking account of a birth gone horribly wrong; it exploits the couple’s tragedy—turning it into a sensationalized story that scares women and grossly misrepresents midwifery.

The safety of midwife-attended births is well documented in a substantive and ongoing body of research. If ACNM, the professional organization for certified midwives and certified nurse-midwives, had been consulted during the development of this piece, the Today Show’s journalists would have known about these top 5 fact-based resources from the past year:
  1. Evidence-Based Maternity Care: What It Is and What It Can Achieve says that midwives top the list of “underused interventions” that should be used “whenever possible and appropriate.” Several systematic reviews showing improved outcomes associated with midwifery-led care are cited.
  2. A Cochrane Review concluded that “most women should be offered midwife-led models of care.”
  3. A study published in the British Journal of Obstetrics and Gynaecology found that planned homebirth is as safe as hospital birth for women with low-risk pregnancies.
  4. Just last week, Canadian researchers declared that “Planned home birth attended by a registered midwife was associated with very low and comparable rates of perinatal death…and other adverse perinatal outcomes compared with planned hospital birth....”
  5. Authors of an American Journal of Obstetrics & Gynecology article say they encourage midwifery care and “support future randomized trials to compare” home vs. hospital births.
Women and health care professionals need to be making decisions that are informed by evidence-based medicine—not reactionary interventions and unbalanced investigative journalism. Women deserve better.

19 comments:

Anonymous said...

Didn't Dr. Erin Tracy (featured in Today's piece on the Today show) read a statement on July 28th from the ACNM in opposition to the Massachusetts legislation that would license both certified nurse midwives and certified professional midwives under the same board of registration of midwifery? Who's side are you on ACNM....consumers or midwives?

Melissa Garvey, ACNM Writer and Editor said...

There have been articles written that cite both Dr. Tracy and ACNM. But I'm not aware of Dr. Tracy being asked to read a statement from ACNM. That seems highly unlikely. Here's a link to ACNM's stance on midwifery certification: http://www.midwife.org/siteFiles/legislative/CPM_FAQs_07_31_09.pdf

Anonymous said...

I think this same statement could be applied to "The Business of Being Born." As a proud CNM, I am continually frustrated by the support of ACNM for a home birth community that in many areas of this country (including Colorado) are extremely antagonistic toward CNM's and view all non-home birth midwives as "Medwives." I am a strong proponent of natural birth without intervention. However, nature is cruel and 100 years ago many women and babies were dying due to the lack of medical intervention. Are interventions overused? Yes! But we need to find the balance between medicine and nature. ACNM needs to make sure to present balanced information.

Susan DeJoy, CNM said...

Hi All,
Let's encourage all of our spouses, friends, patients and physician colleagues to email the Today show to complain about the gross misrepresentation of midwifery, CNMs, CMs, and homebirth; and the exploitation of this family. One comment I really liked is from a husband of a CNM in my group - he said he thought he was tuned into FOX news, not the Today show!
Susan DeJoy, CNM

Anonymous said...

I am in all liberty to correct you since I am the Mom that lost her baby during a homebirth with an ACNM certified midwife. We were not exploited and I find your article very offensive and unfounded since I don't recall you being involved in any way during our interview. The story is our story, our baby Noa Rose died because of negligence from our certified midwife. Why don't you address the FACT that there are incompetent midwives out there delivering babies when they were not even trained to practice outside the hospital setting. Is a CNM certified midwife trained for homebirths? Is part of their training also to practice outside of NY Law? Why don't you take the time to investigate the midwife that you seem to be defending? Don't you realize that you cannot place all CNM certified midwives under the same umbrella of protection just to advance in your own selfish movement to promote the very people you represent? There are facts and they are scary because it involves an ACNM-supported midwife yet you chose to call these facts stated in the interview as a sensationalized story. What part should NOT scare moms? The fact that they might find themselves under the care of a CNM who chooses to practice outside the laws of her state or the fact that she chooses to ignore best practices and in consequence risk the life of a perfectly healthy baby and a healthy mother? What part of this is NOT scary and sad? The interview shows a true picture of what can happen, or are you saying that all of this is a fabricated story? Let me set your record straight, this happened, under the care of not just one, but TWO, ACNM CERTIFIED midwives. If you don't want to correct your article, don't, but let me tell whomever reads it that we were not exploited and listening to my story should scare everyone into making sure they are under the care of a competent midwife and to not be fooled by her credentials, in our case credentials meant NOTHING.

miriam said...

Dr. Tracy DID read the statement from ACNM at the hearing before the MA Joint Health Care Committee on July 28, 2009 in opposition to the Massachusetts legislation for a board of registration in midwifery. I was also present that day and testifying in favor of the Bill. The question remains: Whose side are you on ACNM?

Anonymous said...

Melissa:
I'm not seeing our posts here-???
Hope that you will allow a productive discourse...

Anonymous said...

To the mother who lost her baby...I'm sorry for your loss. I do hope you did plenty of research before you decided to birth at home. Ultimately, it was your body during that birth and if you felt that something was wrong with your labor, you should have walked down to the hospital. Not saying your midwives shouldn't have transferred you after laboring that long, but listen to your heart, mind, and body. I do hope you can heal from this and consider delivering at home again with someone who you can trust. My heart aches for your loss, but not all midwives are incompetent and that is what I gathered from the Today show.

Anonymous said...

I agree with the post from the mom - making no comment on those particular midwives as I was not present at that birth - but there ARE midwives doing home births who are clearly not skilled/experienced enough to be doing so.

Having said that, I take umbrage with this tv story because that is not what the story was about...they were slanting it to say that HOMEBIRTHS are risky. Research has shown that homebirths are as safe or safer than hospital births. The issue is getting a QUALIFIED caregiver. And that is a huge issue that must be addressed!

Anonymous said...

This is to the fellow poster who wrote that the mother who lost her babe in an out of hospital birth should have known that something was wrong and walked to a hospital:You are absolutely ridiculous.This persistent myth that clients of home birth are somehow more responsible during their labor is a ridiculous assertion. This is becoming one of the more ridiculous things that home birth advocates say.No wonder we are painted as neo-hippies who are seeking a hedonistic experience by some yellow journalism on the Today show. Better yet, next time you are having surgery or any medical procedure or under the care of a health professional in a situation such as getting stitches or having a bone set- make sure if it isn't going so great that you stop the hospital staff and set the bone yourself.You sound pretty capable from your post. Your statement likens her experience to getting a bad meal, or missing a train. She lost a baby.The more overarching point to this discussion is how do we make certain that every state where mothers and their partners choose home birth are in the hands of competent, trained, credentialed, regulated and insured providers. Personally I think the ACNM could help in achieving this goal but seem to be more interested in making sure that their route to licensure is the end all be all. The other issue is that states recognize different credentials for out of hospital providers. If a state uses the CPM or DEM as the credential for home birth midwives then it infers that the midwife is trained in mostly out of hospital care as well as free standing birth center care without the bells and whistles of a modern maternity unit. If a midwife is a CNM- has she been trained in both in and out of hospital care for laboring mothers? This is critical in states where the CNM is the recognized credential for out of hospital providers. Does the ACNM want to see home birth- providers credentialed in every state? Can the ACNM stop opposing legislation so that the goal of safe and legal home birth in all 50 states can be achieved. Babies are waiting.

American College of Nurse-Midwives said...

Mrs. McKenzie, we ache for your loss, and that of other families who have lost a loved one in childbirth with a midwife, with a physician, in the hospital or at home. Loss of a child is devastating, no matter what the circumstance. Please accept our sincere condolences.
~The Staff at ACNM

Mary Adamson, CNM said...

First, as a CNM, woman, and mother, my heart goes out to this family and the loss of their precious child.

What is missing from this Today Show segment are the stories of babies lost to mothers while laboring in hospitals under the care of physicians or midwives, while utilizing the latest technology, including electronic fetal monitoring.

What we forget is that in spite of all our human efforts, science, technology and intuition, we do not have the power to prevent every bad outcome that may occur, regardless of place of birth and category of attendant.

I reiterate the many studies showing the safety of home birth in low risk women defend the practice. While I do not perform homebirths, I attend them prenatally, and in 16 years of practice, not one of my clients has had a fetal loss, serious injury or other adverse outcome.

Jill--Unnecesarean said...

Anonymous said: "Ultimately, it was your body during that birth and if you felt that something was wrong with your labor, you should have walked down to the hospital."


I can see why you stayed anonymous. That sounds really mean. Did you intend to sound like you were blaming Catherine for her baby's death and letting her know she should have walked her butt down to the hospital? That's how it came across. :(

Someone drew my attention to this post and I've never posted here before so this feels a bit trollish to jump in (sorry), but I'm really uncomfortable with that comment.

I, too, want to pass on my condolences to the McKenzie family.

Anonymous said...

I feel that the problem with the Today Show piece was that if they wanted to talk about incompetent providers they could have done so in a more inclusive way. The way it was done, appeared to make CNM's sound much more dangerous than physicians who deliver in the hospital. The exact same type of story could have been done on unfortunately, many board certified Obstetricians. If the goal of the piece was to inform women of ways to research their OB provider to ensure competence, then they should have included more helpful information about that instead of focusing on the "perils of homebirth". My heart goes out to this poor couple. No one should have to loose their child due to the incompetence of their provider, be it a CNM, CPM, OB/GYN, or Family Practitioner.

Anonymous said...

I watched the Today show and was at first upset by the portrayal of midwives. However, these past couple of days I have been thinking not about the travails of the midwifery profession in it's battle to regain positive publicity, but rather, wondering what we as a profession are going to do to be sure that we learn from this encounter so that we do not find ourselves attending a birth with the same result. I do not know the details of this tragic loss but I'm hopeful that we as a profession will take time to try and learn from this horrible event so that no woman ever experiences a similar loss.

Anonymous said...

"The way it was done, appeared to make CNM's sound much more dangerous than physicians who deliver in the hospital."


One thing I wanted to point out is that I don't think the Today show piece was intended to show that CNMs are somehow more dangerous. I think the problem amny CNMs face on a state by state basis is that despite the fact that they are fully capable of safely delivering babies in the hospital setting they are not ALLOWED to deliver babies because Docs want to stay on top. (I have heard where CNMs can't attend VBACS in the hospital, cannot deliver the baby if a doc is not present and so on. I think there is of course ample evidence to support that CNM attended deliveries are safe. The Today show piece wrongly did not address that in NY state CNMs are required by law to use a collaborative agreement and that is where a better story would have been- does the CNM featured practice within the law and why are CNMs as OOH providers required to have these agreements and why are docs not required to participate.

Anonymous said...

I too would like to offer my condolences to the family who so tragically lost their baby. As a CNM in a hospital based practice, and as someone else stated, babies can die there too. We will never know the details of this birth and we don't need to judge. It is most important for women to have all of their choices in where to birth and that their care provider is safe, I think we can agree.

mgainthebay said...

This was a very sad, sad story. But the facts are the facts. Home births attended by CNM/CPM has been proven to be a safe alternative to hospital births, but there is an exception to every rule, and this is it. Not every birth results in a healthy newborn. Not those in hospitals, not those at home, and not those at birth centers. Midwifery and medicine is art and science, but it is not absolute, life if often sad, tragic, and definitely not fair.

Anonymous said...

How about a Morbidity & Mortality Review?
Let's take a look at ourselves and apply some critical thinking to this.
Our hospital based Ob departments would apply this tool (M&M Review) to a bad outcome...can we?
My hearfelt condolences to this family, the attending midwives and all midwives.