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Discussion of NYT’s Op Piece on the Safety of Home Birth

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?!?


References (3)

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Reader Comments (5)

Very very well written. Each "rebuttal" (if you can call it that) has only been basically an attack on Dr Tuteur. No one can attack her information because she is right. Whether they like her or not, her facts and statistics are just that. There's no denying the facts. Yet, MANA and it's midwives continue to keep their heads in the sand while spouting statistics from other countries. Everything in the Op piece was fact checked. It amazes me that even with their own horrible outcomes on paper, they still deny that they are undereducated and dangerous.

May 6, 2016 | Unregistered CommenterKrystle

Thank you for saying this. It took so many terrible things to make me see the reality of the situation I was in as a CPM. I straddle my friendships with really awesome CPMs with some apprehension. I am afraid to speak my feelings out loud, for fear they will see it as an attack (I have been in that position, and yes, I felt attacked). I have concerns - deep concerns. Yet, I keep them to myself because who am I? A former CPM with a troubled past and no longer involved in birth. I'm easily dismissed.

My heart has hurt over this issue for a long time. While I'm still not quite ready to yell, I'm so grateful for those - like you, Barb - that are speaking out.

May 6, 2016 | Unregistered CommenterPamela

I too feel that Midwifery has much to offer the American mothers. I further feel that the Ideals of Midwifery too often become Discordant with it's Practice. Yes CPM needs, desperately, to be extensively Repaired. Enforcement of the ICM Criteria, without Grandmothering in the Legacy CPM contingent (sorry, they have to demonstrate Basic Skillset too) seems to be a reasonable, logical step. Unless we move to Abolish CPM instead, which in light of their often Terrible statistics might also seem perfectly reasonable, to Many. Dear Midwives, Don't let your beautiful thing stumble & die before it's Coming Out Celebration, from Neglect. That would be most Unseemly.

May 6, 2016 | Unregistered CommenterMichael Ray Overby


May 7, 2016 | Unregistered CommenterMarie

Hey there.
Appreciate you looking into our rebuttal and poking some holes in it. It is certainly nice to hear from someone who has gone through the training and to hear of their experience.
We too want to share the best information possible. In that spirit, can you show us what you mean by taking the MANA info out of the Oregon stats? Also, the info you provide on the CDC just has to do with home births in general and is not distinguishing between home births attended by CPMs and/or CNM or CMs. Do you have the info on that? Because that's the info that seems to be missing from a lot of these studies if we want to look at the training specifically being the cause of mortality.
We also have one of the highest first-day infant mortality rates as well as maternal mortality rates out of the industrialized world. With only a little over 1% of births occurring in the home setting total, how do you think this plays into the conversation?
And just to clarify again from our post, we don't disagree that standardization of CPMs might be a good thing! Thanks for keeping the conversation going!

May 9, 2016 | Unregistered CommenterBrilliant Bodies

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