Midwife crowdsources life & death situation on Facebook; baby dies

Mind-boggling report here (from a blog ran by an obstetrician). Follow-up here.

A midwife based out of Las Vegas went on Facebook and “crowdsourced” info on a serious medical situation in which a baby two weeks past his due date had absolutely no amniotic fluid. Suggestions from the midwife community included a suggestion to seek out a “midwife friendly” acupuncturist.

Finally the midwife transported the mother to a hospital. A C-section was performed, the hospital staff worked on the baby for more than 45 minutes, only for the infant to die. The midwives, when called out by the online community for their negligence, attempted to delete all the facebook posts and erase the evidence – but others had already screen-capped the posts for posterity.

My mind jumps to Butterfly McQueen squealing, “I don’t know nothin’ ‘bout birthin’ babies!”

There are hopefully some midwives who actually know what they’re doing, but it’s stories like this that guarantee that I would never**** give birth outside of a hospital. Doctors make mistakes too, but at least they have legitimate medical training, access to medical equipment in case of an emergency, professional and ethical standards, etc. “Woo” around birth scares me. Maternal death is incredibly rare and so is fetal death for the most part, but why risk it?

A competent midwife will know when they’re in over their head and need to bring in an OB. I used to live in an area with a large Amish population; most of their babies were born at home and delivered by lay midwives, but man, they knew when they had something they couldn’t handle and needed to send the mother to the hospital. They usually called an ambulance with a solar-powered cell phone.

Out of semi-related curiosity, what’s the insurance situation like for being a midwife? I know OB/Gyns have some of the most expensive insurance rates in the medical professions. Obviously midwives don’t (or at least, shouldn’t) deal with complicated births, so I’d assume their rates are lower, but still, given how many midwives seem to basically be independent practitioners, how do they afford insurance. Certainly, I assume the midwife in the OP is going to be sued into oblivion.

My wife and I used a midwife. We were in the hospital and a doctor could have been there in seconds flat.

I’m not getting the outrage here. In the obstetrician’s blog, as he saw it:

Can someone explain what actions of the midwife were heinous?


Two weeks past due date is enough of a complication right there that the mother’s care should have been transferred over to a qualified obstetrician. The further past the due date, the larger the baby becomes, making birth more difficult, painful, and open to complications. There’s also an increased chance of stillbirth.

Too little amniotic fluid is considered a complication because it can mean that the kidneys aren’t functioning properly or that the lungs are under developed. Both conditions can kill the baby. NO amniotic fluid should have caused the midwife to drop everything and get the mother to an ER for immediate monitoring and intervention.

Why should she be? The parents have no responsibility for the birth of their own child?

Because the midwife holds herself out as an expert in the field and the parents most likely relied on her assurances?

As a non-medical professional, I suspect the answer to that question depends on whether a complete absence of amniotic fluid and/or a two week overdue pregnancy fall within a “normal biophysical profile.”

If that’s true, the problem here isn’t midwives - the problem is a particular idiot who happens to be a midwife.

Ironically, stringent laws that make it impractical for Certified Nurse Midwives (i.e., medical professionals with regulated levels of training and the proven competence to handle births) to practice in most areas cause women who don’t want hospital births (often for very good reasons, sometimes for really stupid reasons) to go to quack midwives with unregulated levels of training and expertise. Or just up and have the baby without any trained attendant.

Personally I think the answer is more, better midwives who are integrated into standard care and accepted by doctors and hospitals, not getting rid of midwives.

Finally, N.B.: who knows what the details really are, because the Skeptical O.B. blog consistently delivers deliberately inflammatory, artfully spun stories that generate clicks and support her foregone conclusions.

I read the blogs, and one thing I missed was that it sounded like the lack of amniotic fluid was due to the mother’s water breaking. It wasn’t said outright, but it was somewhat implied. Well, water breaking is supposed to be one of those things that you keep very close track of during labor, because the amniotic sack is what keeps the baby aseptic. The more time which passes after the water breaks but before birth, the more chance there is of the baby acquiring a bacterial infection. With no antibodies, the baby doesn’t stand a chance, and there’s a significantly higher risk of stillbirth.

On the other hand, I really didn’t respect the blogger’s use of inflammatory language. I understand this is a subject worthy of high dudgeon, but that means that we can use professional, neutral language and still get our point across.

The Skeptical OB has a link to a screen shot of the FB thread. The idiocy is damning. Among suggestions are eating Stevia, acupuncture and massage. Thread

There’s another fun story about a baby who is denied the Vitamin K shot, only to develop a brain bleed and undoing skull slicing surgery as an infant. WTF

That woman should be in jail. And I wouldn’t mind mid-wife only home births being illegal as well. The mind boggles when people turn their back on science.

Why should we use professional, neutral language? The current brand of crunchy mid-wifery isn’t deserving of such respect - babies are dying through lack of information and proper care, along with the pressure of Mommy Bullshit Culture.

Would you use professional, neutral language to address an anti-vaxxer? Or a person who pushes goat glands for cancer cures?

Midwifery is one thing, this culture of science-denying, feel good bullshit is entirely another. They do not deserve respectful discussion, IMO. They deserve to be shunned and mocked and made to feel ridiculous.

Judging by Sateryn’s link, it’s several dozen idiots.

I’m thinking they ought to crowdsource that prison sentence.

I’m with Sateryn76. This kind of thing is entirely unacceptable in this day and age; HUGE advances in neonatal care, childbirth and post-partum care have been made in the past several decades. And yet these fools are going back a century because they’re worried about dumb-ass stuff like the lighting in the room, or the “vibes” in the cave vs. a normal delivery room, or whatever other granola-chomping idiocy they’re spouting.

I have a theory that these people are the same idiots against vaccinations, normal food, and pretty much every kind of power save wind or hydroelectric. In other words, they’re total out-and-out morons without a concept of science or how the world actually works.

My experiences with midwifery is of a very science-affirming, realistic profession that collaborates closely with OB/Gyns. You have found IMO an outlier in the world of midwifery; granted there may be a significant minority of midwives who hold to outlandish thoughts.

But there are a significant minority of MDs who push snake oil and quack medicines. Are you willing to talk poorly of the entire profession because of a subset?

Midwifery as far as I can tell isn’t about going back to the stone age - it’s just a different approach to safe child birth that includes full medical care. I’m not sure if folks are saying that all midwives are kooks, or just this person, but it’s a pretty important distinction.

I don’t think all midwives are kooks, I just don’t see the need for them anymore. If your midwife is working closely with an OB, why the hell are they even there? Isn’t the OB enough?

If its a matter of having a birthing advocate, someone who may take more time to answer questions, set up arrangements, etc., then there’s no problem hiring a doula or whatever they are. But if you’re looking for medical care, then why would you go to a pseudo-OB with no medical training?

And if your midwife advocates home birth, no ultrasounds, blood work, etc., then they should be arrested. Pregnant couples are often confused and scared and super excited, and they are quite impressionable. I don’t think it’s okay for some fake OB to have any influence over that kind of arrangement.

Fair enough, but there is one instigating, but-for idiot at the start of it.

Sateryn76, there are perfectly sane, evidence-based reasons for wanting “the midwifery model” of care for a pregnancy. What I mean by that term is a model of care that begins with profound respect for the woman as the patient, who should be allowed input into her own care, as well as an expectation that most labors can proceed at their own pace and end with a healthy mother and baby, and any interference in the process should be justified by good risk analysis and balancing.

Now, it’s confusing because some OBs follow the “midwifery model” while some midwives follow the “medical model,” which favors many more routine interventions, and in some ways is based on good-feeling but unsupported techniques for controlling the situation, such as continuous EFM or routine IVs. Sadly it often also involves playing fast and loose with the patient’s right to informed consent.

You will, however, get no argument from me that there’s a certain contingent of loony granola mothers and midwives who eschew any science and make birthing choices based on demonstrable bullshit. It’s unfortunate that this band of creduloids winds up damaging the reputation and image of legitimate science-based midwifery and the parents who choose to use it.

(And yes, I had both my babies outside a hospital, with a midwife. But it was also in a licensed birthing center, the midwives were all licensed CNMs, and there was a plan for transferring to UNC hospital if needed. See, we’re not all chakra-loving woomeisters!)

It depends on the type of midwife you are talking about.

A lot of my girlfriends have used CNMs - these are nurses with master’s degrees. They work, as all nurses tend to do, under the supervision of doctors. They deliver in hospitals (or birthing centers) and tend to take on low risk births and refer riskier cases to the OB they are under. (My family is made up of advance practice nurses, although none of them are CNMs, and my own “doctor” for the past five years was a CNP and my kid’s “pediatrician” is a CNP - Certified Nurse Practitioner or advanced practice nurse. My own daughter was delivered by an OB, but I had pre-eclamsia, was strep b positive, Rh negative and “of advanced maternal age” - and pregnant after five years of infertility - I wasn’t the best CNM case). Because CNPs are less expensive than doctors, more and more people see CNPs.

There are also traditional midwives. They aren’t advanced practice nurses. Their capabilities vary a lot for midwife to midwife, but its far more common to get a lot of woo from them than it is from a CNM, and they are far more likely to be hostile to the idea of “intervention.”

I’ve heard this before, and I get it, but I have a hard time understanding why this happens. I’ve had two children, both born in hospital with OBs, and I ran into several incidents where I had to stand up for myself. One was when the OB wanted to induce because I was a week late. I didn’t like that, talked to him about the risks of not being induced, and my son was born a week later, after my labor starting naturally. He did ask me to be monitored in his office for a few hours, and I did - what could it hurt?

The second was just after I had gotten settled into my room at the hospital - a nurse jammed her hand in me to check dilation, etc. - it hurt far worse than it had to, and I twisted and demanded she remove her hand. She said “oh, no, it’s supposed to hurt a little” but I did not back down until she got out of there. Another nurse came in shortly afterward, and performed the exam with the normal amount of pain.

Why would someone be so willing to put up with care they don’t like? Why not find an OB who will listen?

And if the argument is that some/most parents are scared, tired, overwhelmed, whatever - why would we want these people to be working with midwives who are of dubious merit?