There’s an uproar over Dr. Amy Tuteur’s New York Times opinion piece on April 30, 2016, "Why Is American Home Birth So Dangerous?"... Inflammatory! Judgmental! Incorrect! I have heard it all. They are common and frequent refrains when talking about her. People despise her so much they refuse to either click on her Skeptical OB site or read anything she writes.
I am here to say that sticking your head in the sand is not the answer! Unless you read what the “enemy” says, how do you know how to rebut? You can’t!
And then, what if you just happen to read something that resonates? Might Tuteur have something to say that is valid? Is every word suspect?
In the New York Times Op Ed piece, she uses the Oregon statistics as her jumping off point for showing how dangerous home birth is in the United States. Why does she only use these? Why isn’t she using the beloved MANA Stats? Because the MANA Stats were done so incorrectly and are only with self-reporting midwives, who can believe what they say? And even the MANA stats showed increase in death for babies in home births! And they climb even higher if breeches, twins and VBACs were included.
But what about the statistics from the Netherlands? The UK? Canada? Those statistics are absolutely irrelevant here in the US. Certified Professional Midwives (CPMs) do not have the same education as midwives in those countries. When CPMs have hospital privileges, learn pharmacology in school, and a standardized education, only then can we compare those countries’ stats with our own.
So, say you disagree still with what Tuteur has to say and you want to argue with her… in writing, of course. I have only read three rebuttals so far from the home birth midwifery community.
The first was from MANA in their “Women Are Choosing Home Birth: The Infant-Maternal Health Care System in the U.S. Owes Them A Safe Option,” a rambling piece about why women choose home birth. (Yes, yes, we know… the medical model does suck a lot… yes, women do want more autonomy….) But, one of Tuteur’s main points is that US CPMs don’t pass muster with the International Confederation of Midwives’ standards for midwives around the world.
MANA says: “Families deserve the support of a provider that meets international standards. The International Confederation of Midwives, with input from over 100 countries’ midwifery associations including those from the United States, have created standards that are increasing safety for families globally. The International Confederation of Midwives supports the ‘recognition that midwifery is a profession that is autonomous, separate and distinct from nursing and medicine.’ and does not expect, nor recommend, that midwives be nurses first. MANA, among other midwifery organizations, is working on continuing to meet and even exceed the recommendations of the ICM.” (emphasis mine)
Criminy, even MANA states, in black and white no less, that CPMs don’t even meet the minimum standards of what midwives around the world should be giving their clients!
This is completely unacceptable.
The second rebuttal comes from Faith Gibson, LM, CPM in California. She writes in “MCDG ~ Amy Tuteur & the question of why people think ‘… American Home Birth So Dangerous?’” I’ve known Faith for years, watching as she tirelessly fought for home births and then licensing in CA. So, when I saw she’d written a rebuttal, I thought, “Finally! Someone might be able to argue cogently!” But, oh, how very wrong I was.
Not only did she mock Tuteur’s name (on more than one occasion), sounding like a pre-schooler taunting a classmate, she also advocated non-consensual bondage of Tuteur, saying:
“I’ve had more than one delicious fantasy of tying her to a chair and making her watch 48 straight hours of Sponge Bob-Square Pants cartoons.”
Wow. Advocating violence against another person and attempting to make it humorous makes Gibson look almost monstrous to those of us who have been held against our will at some time in our lives.
And then, quite oddly, Gibson picks Sweden’s statistics to use as proof of the safety of home birth. Sweden? Again, a totally different system of education and midwifery. She went into a great deal of detail about Sweden, all completely irrelevant to the conversation.
When she morphed into a historian, I sat shaking my head. She discussed maternity care from the late 1800’s through the 1940’s. What in the world does that have to do with countering Tuteur’s opinion piece?!? Not one thing. This part of her piece went on and on. And on. Even saying PBS should do a History of Maternity Care segment. Not a bad idea, but not fit for such an article as this.
I need to mention the horrific picture Gibson chose to highlight her article, a baby being removed from (most likely) an anesthetized mother in the 1940’s. She couldn’t have picked a more gruesome photo if she tried. Yet, again, it has zero to do with birth today.
Brilliant Bodies writes in “In Response to Tuteur's ‘Why Is American Home Birth So Dangerous?’": “There is no solid evidence to show that C.P.M's mortality rates are any worse than C.N.M's mortality rates as C.P.Ms are typically the ones working with economically disadvantaged and rural populations, there are far too many factors to point to their training as the cause of death.”
This is patently false. There is evidence (see the MANA Stats as a start, but the Oregon Stats if you weed out the MANA ones like I do) and CPMs are not… ARE NOT… the midwives that primarily work with economically disadvantaged and rural populations! From the CDC, "The uptick in home births began in 2004, and, so far, the majority of these have been among non-Hispanic white women." The CDC also says, “In 2012, 1 in 49 births to non-Hispanic white women were out-of-hospital births.”
And one last note from this blog says, “And none of us (including Tuteur) have been through C.P.M training so we have no right to speak to the quality of the education involved.”
Well, I have been through the CPM training and have every right to say how inadequate it is. So much needs to be done to fix this CPM mess we’re finding ourselves in. There are answers. Fix the holes. NOW.
So, to date, no one has effectively been able to counter what Tuteur was saying in her Op Ed piece. Anyone else want to give it a try?
Just to inform you all, Tuteur is not going anywhere. She is only going to get louder and more pervasive in our lives. You can try to ignore her all you want, or you can listen to what she has to say AND BLOODY WELL FIX IT! (Sense a theme here?)
There isn’t a month that goes by that I don’t hear about a fetal death or disability from a home birth midwife (most are CPMs). One helacious 2-week period showed one of each from one midwife! These that I am hearing about have parents still in their early grieving periods, so haven’t reported the midwife. Yet. I guarantee you will hear about these incidents within the next 2-3 years.
This is unacceptable! NARM simply must standardize the CPM education. It cannot allow schools around the country to make up their own curriculum any longer. Just reading that schools do this is absurd!
If MANA and NARM want midwives to step up to the International Standards, then, for goodness’ sake, DO IT ALREADY! What are you waiting for?!?