Thursday, March 27, 2014

Wait, I thought we were discussing waterbirth

This last week, the American Academy of Pediatrics and the American College of Obstetrics and Gynecology jointly published a position statement regarding waterbirth.

Immersion in Water During Labor and Delivery

In short, it states that immersion in water during labor poses little risk of harm and appears to have some benefit, but that safety of delivering a baby underwater "has not been established."

OK - so midwives - of all stripes - are up in arms over this rather bland, cautionary statement. Apparently midwives believe waterbirth is their exclusive purview, and are taking this statement as an attack on midwifery.

The resounding tack is to change the subject by proclaiming that obstetricians have no right to scrutinize waterbirth when obstetrics is rife with non-evidence based practices.

From MANA's Facebook page:

An excerpt from an email to ACNM membership:

Wait, I thought we were discussing waterbirth...

The question comes up - why are midwives so loathe to engage in any self-reflection? Why are midwives afraid to examine their practices and critically evaluate them for safety and effectiveness? Why are midwives changing the subject when their own practices are being scrutinized?

If midwifery is what it says it is - safe, effective care for low-risk women -and does what it says it does: provides high-quality, personalized maternity care - why the defensiveness? Why change the subject? Safe and sound practices should hold up to scrutiny.

Why aren't midwives clamoring to answer these questions:
Is there evidence of increased risk of aspiration at waterbirth?
Is there evidence of increased rates of neonatal infection at waterbirth?
Is there evidence of increased rates of difficult management of complications (ie shoulder dystocia) during waterbirth?
Is there evidence of increased rates of umbilical cord avulsion during waterbirth? 
What are the safest parameters for waterbirth?
When is waterbirth contraindicated?

And will the ACNM include in their position statement recommendations about the following practices that are currently offered to women under midwifery care in the US:

These are "controversial contraindications" to water birth according to water birth 'expert' Barbara Harper of Waterbirth International:

Meconium staining "meconium washes off the baby in the water"
Maternal HIV, Hepatitis A, B, C infection "HIV is susceptible to warm water and cannot live in that environment"
Maternal GBS colonization "There is no evidence that GBS positive cases should be asked to leave the water."
Maternal herpes outbreak during labor "it is safer to deliver in the water due to the dilution effect of the water."
Breech vaginal birth "a perfect environment for a hands free vaginal birth"
Multiple birth "labor in water for multiples is well documented and recommended."
VBAC  women attempting VBAC in water "have a much higher success rate in giving birth vaginally"
Shoulder dystocia: "there is mounting evidence that providers find it easier to assist a shoulder dystocia in the water."
Placental delivery in water: "there is no reason not to allow the birth of the placenta in the water"

~ Barbara Harper (c) 2006 Guideline for a Safe Water Birth

To be clear, Barbara Harper is stating that the above indications are NOT contraindications to underwater birth and, in some cases, is asserting the superiority of water birth in these higher-risk circumstances.

If these things are being recommended by a "water birth expert" you can bet they're happening with midwives at planned deliveries in the US. Spend a minute Googling, and you'll find ample photographic evidence of these practices.

So no, ACNM, now is not the time to examine what OB/GYNs are or are not doing in hospitals with regard to c-sections, epidurals and whatever-all-else is happening that doesn't fit into the midwives' ideal model of care. It's time to examine what midwives are doing, and to address some of the reckless and negligent practices being promoted as "safe" and "evidence-based" without supporting scientific evidence.

We're looking forward to that position statement.

Monday, March 10, 2014

W T F ?!?

In the world of social media, the implication behind the letters WTF are well known.  The irony of these three little letters could be no more appropriate in considering the latest from the Willow Tree Family Center. 

 Willow tree might ring a bell.  We wrote about the new family center back in April of last year, in the post entitled "An Open Letter to the Willow Tree Family Center."  The concept of this new center is essentially to provide an open space where care providers can offer pregnant women their services and house resources for families.  Sounds nice right?  

In our open letter to the founders last year, we urged them to carefully consider the ethics of the care providers who functioned within their facility, and moreover to consider the ethics of the care providers they named on their website offering unsuspecting families their services.  As it turned out, the response received indicated they didn't like the affiliation with the Greenhouse Birth Center, and asked that we remove our original title, "Greenhouse Birth Center Reincarnated".  Politely we obliged, but in looking at the newly revealed website of care providers the title wasn't far off the mark.  In fact you could say it was dead on.  I wish I could say the founders of the Willow Tree Family Center are more concerned with safety and ethics than they are with their image. 

The Greenhouse Birth Center closed its doors in 2012 after the death of our baby, Magnus Snyder and numerous other accounts of deaths and injuries in the hands of the midwives working there.  After fund raising efforts to support legal fees for the center and midwives that didn't bother to carry malpractice insurance, the majority of the GBC board moved on to raise money for a new endeavor, and hence the Willow Tree Family Center was born.  The questionable care that took place at GBC was highly publicized.  The founders at Willow Tree were notified in our open letter that many of the midwives and other types of care providers they were considering were in fact involved with dangerous practices.  

The response?  

A handy little "Provider Directory"with a convenient disclaimer absolving themselves of any ethical responsibility whatsoever for having provided the public with such a classy list of care providers:

     "Disclaimer: This Provider Directory is a compilation of providers who have indicated 
      that they provide services related to pregnancy, birth, women and children. Willow 
      Tree Family Center does not guarantee the accuracy or validity of any of the 
      credentials listed, nor do we recommend nor endorse the competence or expertise of 
      anyone listed. Willow Tree Family Center shall not be responsible, directly or 
      indirectly, for any damages or loss caused or alleged to be caused by or in connection 
      with the use of or reliance on any provider in this Provider Directory. Willow Tree 
      encourages consumers to verify the credentials of providers and interview providers 
     to find the care that is right for each family."

The unsuspecting public may wonder why such a disclaimer might be necessary.  The answer...because the founders of the Willow Tree Family Center absolutely knew about everything that happened at Greenhouse Birth Center, and they worked hard to consult with lawyers to ensure they covered their own asses.  

The language is precise and purposeful.  To translate for families considering the care providers on this list, these people don't want to be held liable when babies die.  They know darn well babies have died, and been injured many times over in the hands of the people listed on their website, yet chose to name them anyway as a provider in our area.  The kicker is that they conveniently excuse themselves on any responsibility in doing so.

Need more precise examples:

Consider Audra Post, CPM, midwife extrordinare attended the botched delivery of our son, watched him born without breathing, even drove me to the hospital hours later so we could spend two weeks wondering if he would live.  She was named in our lawsuit that followed, and filed bankruptcy to dismiss the case from civil court.  Weeks later she opened a new business, her own home birth midwifery practice, backed up by the other two midwives who attended our son's birth.  

Nothing harmonious about that, and yet her name appears on the Willow Tree Family Center's directory as if nothing ever happened. 

Consider Heather Paris, Childbirth Educator and Mitzi Montague-Bauer, Doula, both former owners in part of the Greenhouse Birth Center.  Also both of whom played a timely part in convincing me that it would be a good choice to trust the midwives (Audra Post, CPM, Shelie Ross, CNM, and Clarice Winkler, CNM) to deliver a 10+ pound frank breech baby outside a hospital.  Also both of whom know every detail of the shady events and afterward lies that took place surrounding Magnus's birth.  How do I know this...because I told them personally by phone in the weeks after his death as I tried to sort out what had happened in my own grieving mind.  And finally, both of whom NEVER bothered to tell me they were part owners in the very business venture they were "recommending" for our care.    

Yep, they are both listed in the Willow Tree Family Center directory too, and had a hefty role in "town hall" type meetings that brought the creative idea of a reincarnated center to life. 

Consider Dr. Nancy Herta, OBGYN, and "Consulting Physician" for the Greenhouse Birth Center.  Dr. Herta provides advice when the midwives call upon her for consultation or referral.  In MI, there is no definition for what this role entails.  So even when a client is sent at 37 weeks to her office for a patient-requested ultrasound that reveals a breech baby, there are no established guidelines for what is actually assessed in that ultrasound, other than what the midwives requested.  Dr. Herta never reviews the case, supposedly never looks at the ultrasound, and doesn't advise the midwives providing the care.  

When bad things happen, it's easy to say she didn't know about it.  Another great example of self-absolution of any ethical responsibility.  

I don't know every provider named in the WTF Center's directory, nor do I care to.  Considering the reputation of those I do know, I would caution every family to think twice about the lack of ethical thought and responsibility that went into creating this public listing of "resources".  I would also caution every provider on that list to carefully consider the company you keep.  

In knowing who created the WTF Center, the motives behind the effort, and the providers they support in their attempt at "holistic, family-centered care", it is imperative that Lansing Area families understand who it is hosting this gathering place of questionable professionals.