The Risks of a Postterm Pregnancy

Home birth midwives dismiss many risks in pregnancy as being "variations of normal." They use this term to ease the mind of concerned parents, acting as though simply because a complication occurs in nature, it is harmless.

Unfortunately, most of the complications that home birth midwives dismiss as "variations of normal" carry real risk that increase the chances of harm to the baby or mother. And ignoring the risk does not make it go away, as many home birth mothers have learned the hard way.

Some of the risks most commonly dismissed by home birth midwives are the risks associated with going past your due date. "Babies come when they're ready," they say. "Babies know when to be born."

But if this is true, why are any babies born prematurely? Prematurity can result in serious long-term complications for baby, months-long NICU stays, and death. If those babies didn't know when to be born, how can a home birth midwife be so sure that *your* baby knows when to be born? Just like preterm birth, postterm birth can result in serious complications and sometimes death.

Postterm Death Rates

The different "terms" of pregnancy are defined as: preterm (before 37 weeks), early term (from 37 weeks to 38 weeks and 6 days), full term (from 39 weeks to 40 weeks and 6 days), late term (from 41 weeks to 41 weeks and 6 days), and postterm (42 weeks and beyond):

"Definition of Term Pregnancy"

At the end of pregnancy, there is a balance between babies being born too early and babies being born too late. Too early, and their organs might not be ready yet. Too late, and the chances of stillbirths, cord accidents, shoulder dystocia, meconium aspiration, and placental failure increase.

The chart below shows what those risks look like balanced against each other.

The risk of babies dying after they're born birth is higher before 37 weeks, decreases and is it its lowest point between 39 and 40 weeks, and increases from then on. The risk of babies dying before they're born (being stillborn) increases from 37 weeks on, increasing exponentially after 40 weeks. The following chart shows those trends, with deaths of babies after birth in blue, stillborn deaths in red, and the combined risk of the two in yellow:

"Risk of Stillbirth and Infant Death Stratified by Gestational Age"

As you can see, the risk of death from both complications after birth and from stillbirth rises after 40 weeks and just keeps getting higher.

The study that this table is from, Risk of Stillbirth and Infant Death Stratified by Gestational Age, shows that the risk of stillbirth is more than twice as high at 42 weeks than 40 weeks, and only keeps increasing from there. Medscape summarizes the findings of multiple studies as "Perinatal mortality (defined as stillbirths plus early neonatal deaths) at 42 weeks of gestation is twice that at 40 weeks (4-7 vs 2-3 per 1,000 deliveries, respectively) and increases 4-fold at 43 weeks and 5- to 7-fold at 44 weeks."

What are the risks of going postterm?

So why does the risk of death begin to increase so much after the 40th week of pregnancy?

In a nutshell: Your baby's organs are 100% ripe and ready to go by 39-40 weeks. There is no physical benefit to your baby for waiting any longer; there is only more risk.

There are only two things that can happen post-dates, and both are potentially bad. Either the placenta stays strong, or it doesn't.

If the placenta stays fully adequate, the baby keeps getting bigger and bigger, which is going to be a problem when labor finally starts. Complications for the baby can include "prolonged labor, difficulty passing through the birth canal, and birth trauma (eg, fractured bones or nerve injury) related to difficulty in delivering the shoulders (shoulder dystocia)." Risks to the mother "are related to the larger size of postterm fetuses, and include difficulties during labor, an increase in injury to the perineum (including the vagina, labia, and rectum), and an increased rate of cesarean birth with its associated risks of bleeding, infection, and injury to surrounding organs."

If the placenta starts to fail, then the baby gets weaker and becomes more stressed the longer things go on. The chance of oligohydramnios (low amniotic fluid levels) increases, raising the risk of umbilical cord compression (which cuts of the baby's source of oxygen). Babies are also more likely to pass meconium (baby poo) in the womb and inhale it, which can cause serious breathing problems and death.

The risks of postterm pregnancy are real

Clara Edith

Heather O., the author of the blog The Destiny Manifest, has written a heartbreaking account of how her daughter Clara died from postterm pregnancy complications. In a post called She Was Still Born, Heather writes,

"I reached the 40 week mark on June 14th. I was thrilled to have made it to my due date, feeling a little arrogant about how the doctors had said I would “never carry a baby to full term”, but also feeling ready for our baby girl to make her appearance. We had read all of the research that shows that 40 weeks is just the average length of a normal pregnancy — anything from 38 to 42 weeks is considered in the normal range, and I know of several women who have had their babies at 43 and 44 weeks. We weren’t worried.

At 41 weeks, I was still 4cm and baby girl was at 0 station. We discussed induction but decided against it. I wanted a vaginal birth after cesarean very badly, and pitocin is generally contraindicated in a VBAC, particularly when the mom has a “special scar” like I have.

By this point I was very uncomfortable and ready to not be pregnant...David and I had a long soul-searching conversation over the course of a couple days and decided that, since baby girl was still fine, with a great heart rate and passing every kick count, we’d give it until 42 weeks and then reconsider the hospital induction. We felt very good about this decision, having weighed all of our options.

On the afternoon of Thursday, June 28th, the day that I hit 42 weeks, we made the decision that if I was not in “real labor” by the next night...we would go into the hospital for a medical induction. We didn’t make this decision based on any worry about the baby’s health, as she was still kicking quite exuberantly in her very tight living quarters. We made the decision because I was uncomfortable and oh-so-ready to meet our baby.

I woke up on Friday morning to contractions, but this time they felt different...I told David that I was pretty sure these weren’t going to stop. They felt more real than any of the other times...The contractions slowed down that night but never stopped completely. The next day was much like the one before, painful contractions but nothing I couldn’t handle.

I woke up on Sunday in real pain. It didn’t feel like the labor I’d been having, and it didn’t feel like the way countless books and birth stories and friends have described labor. It was pain and it was harsh...I told David that something felt wrong, that it hurt too much and I needed to go to the hospital NOW.

The doctor came in and began the ultrasound. After a couple more minutes, David and I looked at each other and the realization that there was a problem began to dawn. I said, “Can you not find her heartbeat?” and the doctor said “No, here is her rib cage and there is no heartbeat there.”

Time seemed to slow to a crawl. I felt cold, lost in some surreal nightmare. David ran to the bathroom and collapsed to the floor, sobbing. The nurses and tech disappeared from our room. The doctor said “I’m so sorry.” David asked if he could possibly be wrong, that maybe he made a mistake. The doctor said that there are no guarantees in life and that there was a chance he was wrong. I asked “how quickly can you get her out?” and he answered “with a cesarean, we can get her out right now.” I said, “then do it, get her out now.”

Over the next 15 minutes, I signed a consent form, was shaved and prepped for surgery, and had my blood typed...I was crying, but still believed absolutely that they were wrong. I would hear her cries any minute. She might need some help, maybe she’d need to go to the NICU, but she would be fine.

The smell of infection filled the room when our doctor opened my uterus. David stood and watched as the doctor pulled our daughter from my body...My husband looked down at me and shook his head slowly. I began to sob in earnest and the anesthesiologist, with tears running down his own face, gave me “something for anxiety.” The nurse called David over and handed him our beautiful daughter, Clara Edith. He brought her to me and I touched her cheek, still warm from my body. I wanted to hold her so badly, and I was assured that they would take pictures of her right then and bring her to me as soon as I got out of surgery.

It took almost an hour and a half after Clara was born before the doctors were done cleaning out all of the infection in my uterus...I was taken back down the hall of crying and healthy babies to a room at the end, where my husband and I waited for our lifeless daughter to be brought to us. An hour after the surgery, a nurse brought in a cart with a white basket draped in a hospital blanket. She asked if I wanted to hold her and I said that I did. She laid my baby girl in my arms and told us to take as long as we needed.

...What if we had decided to medically induce at 40 weeks? What if we had decided 41 weeks was our limit? What if we had gone on to the hospital as soon as those contractions started on the Friday before she was born?

The doctor said she had been gone between 1 and 3 days...She died sometime between Friday evening and Saturday afternoon. The doctor’s theory is that my amniotic fluid level dropped drastically and she passed and ingested meconium, which poisoned her and ended her life."

I encourage you to read Heather's full account; there's a lot that I couldn't include here.

Daxton

Daxton Green is a baby who died shortly after being born at the Carolina Community Maternity Center (a freestanding birth center) on January 20, 2015.

In an inquest following his death, his death was ruled a homicide.

The Charlotte Observer explains:

"The jury had four options in ruling the manner of death – undetermined, natural, homicide and accidental."

"Homicide in this particular case is not a legal definition; it’s a description of the manner of death,” Gast said after Thursday’s verdict. "[The jury decided] there was enough information in the testimony today and the documents provided to them that...there was a responsible party for the death of Daxton.”

Daxton's mother's pregnancy was being overseen by midwives at the birth center, who, as she got closer to her due date, moved her due date so that she could still deliver at the birth center instead of a hospital.

Daxton's father testified that he and his wife "had no issues during prenatal care, but they started getting worried about risking out due to approaching 42 weeks gestation. Christine [the midwife] told them they could switch to using the ultrasound due date instead of the date established by “last menstrual period” to get an extra week. She did not discuss any risk factors of approaching 42 weeks gestation, only that the rules stipulated that it wasn’t allowed to go beyond that point. Thus, M.G.’s due date was moved from January 5th to January 12th."

So what happened on January 20th?

At the inquest,

"The midwives all told the same story: the baby’s heartbeat was always just fine, and they put the mother on oxygen only to treat her lightheadedness and help her collect herself. The amniotic fluid was clear until the baby’s head was born and shoulders released, at which point heavily meconium-stained fluid was revealed. They attempted to resuscitate him and called 911. The baby was declared dead shortly after arriving at the hospital."

"The medical witnesses (specifically the maternal-fetal medicine specialist, the pathologist, and the perinatologist) were all very clear that the midwives’ story did not make sense to them. They testified, based on their examination or on the records that they reviewed, that Daxton was completely overwhelmed by meconium, completely, inside and out. No one thought it was feasible that the midwives could have seen clear fluid. They indicated that the midwife should not have moved the due date, did not adequately monitor the baby during labor, and did not do a proper resuscitation. They indicated that oxygen should never be used for the purpose that the midwives stated, but that it could be used during repeated deep decelerations that should cause great concern for the baby’s wellbeing. The perinatologist made it clear, as the director of neonatal care at a well-known local children’s hospital, babies do not die like this in the hospital. This death would have been prevented in a hospital setting."

Gavin Michael

Gavin Michael's full story is already here on this blog. You can read it here: Gavin Michael.

Gavin Michael's mother Danielle was planning to have a home birth with the certified professional midwife Christy Collins. At 42 weeks, Danielle had a biophysical profile to check on the baby. The test showed that she had no amniotic fluid. Instead of telling her to go immediately to the hospital, her midwife told her that the baby "looked terrific and everything was fine," and to go home and drink water.

After she told them to go home, Danielle's midwife crowd-sourced for information from other midwives on Facebook. Shockingly, the other home birth midwives seemed as relaxed about the risks as she was.

After the baby was found to have a low heart rate the next day, Danielle and her husband went to the hospital and Gavin Michael was delivered by cesarean section, but it was too late. Since he had no amniotic fluid, Gavin had nothing to swallow or breathe but meconium, and it killed him. The doctors tried incredibly hard to revive him and worked on him for 47 minutes after he was born, but it was just too late.

Unbelievably, the midwife responsible for Gavin Michael's death posted this poem on her facebook page just four days after he died from post-dates complications:

The full poem reads:

I repeat - Gavin Michael died directly as a result of post-dates pregnancy complications. He died because the pregnancy went too long. And just 4 days after he died, his midwife posted this poem on her facebook page.

The risks of postterm pregnancy are real, and should not be dismissed by home birth midwives.

MANA's "Best Evidence" Shows Homebirth is Unsafe

Families thinking about home birth are often told, either by their midwives or by the blogs and websites that advocate for home birth, that "Birth at home is as safe or safer than the hospital." It is not. Every study on American home birth has shown it to have a significantly higher death rate than the hospital.

"But what about the studies on MANA's website?" some ask. That's a good question. On their website, the Midwives Alliance of North America has a section called "Research" in which they have six subsections (A-F) of studies which they say prove the safety of home birth.

Leigh Fransen, former CPM, LM, and part-owner of a birth center and author of the blog Honest Midwife, has gone through and helpfully summarized all of these studies.

After she finally read all of these studies after years of practicing as a midwife, what the data showed shocked her and eventually led her to leave the profession:

"The hours I had spent combing over all of MANA’s best evidence led me to this conclusion: nonhospital birth might be as safe as hospital birth, but likely only in health systems in which midwives are hospital-trained and well-integrated, and where exclusion criteria are strictly observed to permit only the lowest risk women to proceed. Nonhospital birth in the United States as currently practiced is responsible for lower numbers of interventions (such as cesarean section and medical pain relief) but a substantially higher risk of death or injury to the baby. 

Unbelievably, our 'own' evidence, upon close inspection, was almost unanimously against us."

You can read Leigh's summaries of all of the studies from the MANA website here:

Doing My Research
Section I: Meta-analyses and Systematic Reviews
Section II: RCTs and Section III: Cohort and Population Based Studies
Section III: Cohort/Population Studies Continued
Section III: Cohort/Population Studies (Re-Continued)
Section IV: International Observational Studies
Section V: Descriptive Studies
The MANA Study
The Other Side
My Days as a Midwife Close

In her post The Best Evidence MANA Does Not Want You To See, she writes:

"In my paper High Risk, I reviewed all the literature that the Midwives Alliance of North America (MANA) claims forms the “best evidence” for the safety of home birth. I found that most of the studies were either not applicable to the United States, did not address issues of safety, or actually demonstrated the opposite of what MANA claimed.

If MANA’s cherry-picked data paints a not-so-happy picture, wait until you check out what happens when you look outside of what MANA wants you to see. The literature on nonhospital birth in the United States is downright frightening. Despite what many midwives claim, these studies look at midwife-attended births, not accidental or unattended home births.

If you have had a nonhospital birth like I have, it is natural and normal to feel defensive about the safety of it. After all, to accept that you put your child at a substantial and unnecessary risk doesn’t feel good, even if you know that you made your decision out of love and a genuine desire to make a gentle, safe choice for yourself and your child. Sometimes knowing the truth hurts. I have accepted that my baby was one of the many lucky ones; I invite you to consider joining me in that realization."

Freestanding Birth Centers

When I was pregnant with my first and reading "What to Expect When You're Expecting" about hospitals, birth centers, and home births, I thought that a birth center was a kind of nice middle ground between hospitals and home births. I thought it was some kind of detached labor and delivery ward, like what you'd have at a hospital, just not attached to a hospital.

It is not.

First of all, and this is very important to understand, there are two kinds of birth centers. The first type is the kind that I originally thought they all were: they are attached to hospitals, and are staffed with licensed, nurse midwives. As this post explains, "If at any time during your pregnancy or labor complications arise, your care would shift to that of an obstetrician at the same birth center or hospital." Medical technology is available, everyone has insurance, and there are regulations and oversight.

The other type of birth center is a freestanding birth center, which is not directly overseen by a hospital. Choosing to give birth at a freestanding birth center is, in the words of Sara, whose son Magnus died at a birth center, choosing "a home birth in someone else's 'home.'" Freestanding birth centers are not some kind of detached labor and delivery wing. They do not have doctors. They do not have the equipment you would have at a hospital. They have the same midwives that deliver babies at home births.

The excellent website Safer Midwifery for Michigan has a good post about birth centers called What We're Seeking: Defining "Birth Center." In it, they explain: "Freestanding birth centers do not have emergency medical equipment beyond oxygen.  They cannot intubate or give medications that would be used in a resuscitation circumstance. They do not use Electronic Fetal Heart Monitoring, instead using intermittent Doppler assessments. Midwives working at a freestanding birth center may or may not be licensed as individual, may or may not carry insurance, and may or may not be trained in NRP (Neonatal Resuscitation Program). There is no requirement for any midwife at a birth center to have a license. The bottom line is that in the event of an emergency, they are under-equipped for life saving measures."

Babies born at freestanding birth centers are more than three times more likely to have a 5-minute Apgar score of 0 (no signs of life) than those born at a hospital. They are almost twice as likely to have seizures than those born at the hospital. And worst of all, babies born at freestanding birth centers are twice as likely to die than those at the hospital. 

Home Birth After Cesarean (HBAC)

What is an HBAC?

A vaginal birth after a previous cesarean section is called a VBAC. A home VBAC is often called an HBAC - home birth after cesarean.

Are HBACs riskier than hospital VBACs?

HBACs have nearly four times the newborn death rate that hospital VBACs have. VBACs attempted in the hospital have a neonatal mortality rate of 1.3/1000; this means that one baby will die for about every 800 hospital VBACs attempted. VBACs attempted at home (HBACs) have a neonatal mortality rate of 4.75/1000; this means that one baby will die for about every 200 HBACs attempted.

Why are VBACs considered "high risk"?

In other countries where home births are well-integrated into the medical system and they have regulated risk assessment criteria, having a prior cesarean section means you will be "risked out" of having a home birth. Your pregnancy and labor are considered "high risk." Why is that?

Well, one of the biggest reasons having a prior cesarean section makes you high risk is the increased chance of uterine rupture. In the place where the uterus was cut during the prior cesarean delivery, a scar has formed. The stress of stretching out during pregnancy and then undergoing labor can cause the uterus to tear open at the scar. This is called uterine rupture, and it is a life-threatening event for both mother and baby.

For women who have never had a cesarean section, the uterine rupture rate is only 0.012%, or 1 in 8,434.  For women who have had a previous "classic" cesarean section (vertical cut on the uterus), the uterine rupture rate is 2-11%, or at least 1 in 50 (and possibly as high as 1 in 9). For women who have had a previous low transverse cesarean section (the most common kind of cesarean), the uterine rupture rate is 0.5-2%, or about 1 in 200 (but possibly as high as 1 in 50).

What are the signs of a uterine rupture?

Signs of a uterine rupture include abnormal patterns in the baby's heart rate, tachysystolic contractions (that means where the contractions are one right after the other), vaginal bleeding, shock, prolonged labor, and abdominal pain, but by far the most consistent sign of a uterine rupture is abnormal patterns in the baby's heart rate. The absolute best way to watch for this sign is with continuous electronic fetal monitoring, which can only be done in the hospital.

Some women have been told that even if they have an VBAC at home, they will definitely be able to tell if they have a uterine rupture because they will experience abdominal pain. But as you can see from the above chart and reference, only one out of every four women who have a uterine rupture experience abdominal pain. Abdominal pain is specifically pointed out as being "an unreliable and uncommon sign of uterine rupture."

Sometimes CPMs and other home birth midwives claim that they have "better training" than nurses or doctors to detect uterine ruptures. This is not true. It may be possible for a home birth midwife to detect a uterine rupture with a doppler if they are listening for longer intervals than normal and at the exact same time as the rupture, but it's highly unlikely they will catch the rupture right away. It's also a myth that being at home with a midwife will prevent a rupture. It will not. Uterine ruptures occur at the same rate in the hospital and out; it's just far more likely at home that the rupture will go undetected until it is too late for the baby.

If the uterus ruptures, how long do you have to save the baby?

When the uterus ruptures, the biggest risk to the baby is lack of oxygen. Essentially, the baby cannot breathe, and the placenta is no longer providing them with oxygen. They are suffocating. A cesarean section needs to be performed immediately to save the baby from brain damage or death. Several studies have shown that you have at most about 18 minutes to deliver the baby after uterine rupture before certain brain damage or death. You can see those studies here and here.

Many families planning home birth are comforted by the fact that "we live just five minutes from the hospital" in case anything goes wrong. But living five minutes from the hospital means you are at least thirty minutes from an emergency c-section, as this post explains: Five Minutes to the Hospital.

VBAC at the hospital vs. VBAC at home, a summary

At the hospital: A woman is attempting a VBAC with continuous electronic fetal monitoring, the best way to detect a uterine rupture. She does, indeed, rupture. The baby's distress is detected almost immediately and the doctors can act immediately to save the baby's life and brain function.

At home: A woman is attempting a VBAC and the baby's heart rate is being checked every fifteen minutes with a doppler. The midwife checks the baby's heart rate. It sounds good. A few minutes after she checks, a rupture occurs. Fifteen minutes later, she checks again. This time she can tell the baby's distressed. They call the ambulance, which takes a few minutes to arrive and another few minutes to get to the hospital. Some more time (we'll estimate 15 minutes) is spent getting the mom ready for an emergency c-section. By this time, the baby's been without oxygen for over 30 minutes and is most likely lost or at the very least severely brain damaged.

VBACs are classified as "high risk" for a reason. 

Honest Midwife

Earlier this year, a former CPM midwife spoke out. She started a new blog called "Honest Midwife" to pull back the curtain and expose some of the unethical and illegal practices of the CPM world.

Her name is Leigh Fransen, and she attended a midwifery school accredited by the state of Florida. After graduating she moved to South Carolina and started a successful freestanding birth center in partnership with three other midwives. She left the practice in 2013. After she left, the birth center had three deaths within two years. She wrote of the experience:

"As I drove home, I gripped the steering wheel tightly, my heart racing in my chest. I GOT OUT. It was messy and confusing and ugly, but I was out of there for good. I was relieved, but I wasn’t ready to be honest with the world about why."

"That was January 2013. In April 2013, I heard the first rumors of a baby’s death soon after her birth at the center. In September 2013, news of a second death was splashed across local newspapers. And in January 2015, a third death was reported. My thoughts and emotions ran rampant. One moment, I would arrogantly congratulate myself: No deaths on my watch, and three on theirs, who’s the best midwife now? Another moment, I would wonder at my favored status in the universe, that God had spared me from all the horror, and just in time. And in my most honest moments, I knew the truth of it: I had gotten incredibly, ridiculously lucky. And those three mothers who sat at home with empty arms, they simply had not."

Her full account is breathtaking, and I encourage you to read it in its entirety.

In her account, she describes finally "doing her research" after years of telling parents that home birth was safe.

"I began in familiar territory, the website of the Midwives Alliance of North America (MANA.org). On this site there is a button titled “Research,” and it leads to an extensive collection of the studies that MANA has determined builds the case that nonhospital birth with a midwife is safe...I spent the next several hours using my university library (and helpful librarians) to track down every one of these 24 studies and print them out, filling a large 3-ring binder with my efforts."

"Shades of guilt danced in the back of my head: shouldn’t I have done this years ago? Perhaps before I decided to actually give birth to my own child in a bathtub in a residential neighborhood in Miami? Possibly during my years as a student of midwifery? Maybe before I had assured scores of women that “research showed” giving birth at my birth center was as safe as any hospital? I cleared my head to focus on the task at hand. The research was all here in front of me now. I sat down with my giant binder of studies, a cup of coffee, and a handful of pens and highlighters. I had a long day ahead of me. I began at the beginning of MANA’s list."

She writes about reading each study, one by one, and again, I highly encourage you to read her analysis.  What did she find?

"The hours I had spent combing over all of MANA’s best evidence led me to this conclusion: nonhospital birth might be as safe as hospital birth, but likely only in health systems in which midwives are hospital-trained and well-integrated, and where exclusion criteria are strictly observed to permit only the lowest risk women to proceed. Nonhospital birth in the United States as currently practiced is responsible for lower numbers of interventions (such as cesarean section and medical pain relief) but a substantially higher risk of death or injury to the baby."

"Unbelievably, our 'own' evidence, upon close inspection, was almost unanimously against us."

As damning as this is, it is not the worst thing that Leigh Fransen reveals in her account of CPM midwives. The most stunning indictment of CPMs comes as Leigh describes her first-hand experiences at her midwifery school and in the field as a fully-practicing CPM:

"When, as a student midwife, I first participated in nonhospital births, I witnessed some things that made me uncomfortable. At my school, the head midwife would sometimes do illegal vacuum-assisted deliveries. The first time I saw one done I didn’t realize it was illegal, but when I started talking about it freely, I was quickly quieted by the more senior students. “We call it ‘the fruit,’” they said, a reference to the vacuum’s brand name, Kiwi. I rationalized that these other students and midwives would not be using “the fruit” if it was really harmful, so the law must be an unnecessary one. Soon, I was recruited to help usher family members out of the room “so the mother can rest,” as a cover for the vacuum use; I would then lock the door and stand guard. If I was instructed to cover the mother’s face with a cold washcloth “to help her relax,” I made sure her eyes were covered so not even she could see the vacuum being applied. I rationalized that surely she would have given us permission to do this to help her get her baby out without transporting, but that it wasn’t smart to ask permission to perform an illegal procedure. Toward the end of my apprenticeship, I was the one holding the vacuum, applying it to the baby’s head, exerting the carefully angled pressure to help pull the baby down. I rationalized that now I would know how to get a baby out, if I were ever in a situation where there were no available hospitals."

"I did not originally plan to attend a school where I would learn to perform dangerous, illegal procedures; I became complicit through a chain reaction of participation and justification. "The fruit" was only one of many "exceptions" I learned to make; many of these exceptions I carried with me to my later practice. Illicit use of medications, cavalier usage of toxic herbs, induction techniques, pretending not to see a cesarean scar, fudging dates, doctoring charts, “accidental” breech deliveries, cheating blood pressure readings, lying to doctors, ignoring borderline test results, pretending to know answers while furtively Googling, waiting just a little bit longer for baby’s heart tones to improve, purposely underestimating the staining of amniotic fluid, misrepresenting our personal statistics and the statistical realities of our “profession”… all of these practices are endemic to direct-entry midwifery in the United States. I know because I did most of them. I was present (and silent) as others did them. I heard the stories in “peer review.” Not every midwife does all of them; very, very few, if any, do none. It all starts with one small step, and we justify along the way, until we are lost in the woods with no moral compass left to guide us."

To read Leigh Fransen's full account, click here: High Risk: Truth, Lies, and Birth
To read Leigh's account in blog form, click here: Honest Midwife 
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Hurt By Homebirth

When I was first learning about home birth, I found the site "Hurt By Homebirth." The stories that I read profoundly affected me.

A picture of Shridam, used with permission from his mother

Shridam's Story, as told by his mother Dhanya
Magnus's Story, as told by his mother Sara
Sheppard's Story, as told by his mother Marlo
Angela's Story, as told by her mother Nicole
Grant's Story, as told by his mother Rachel
Zen's Story, as told by his mother Elizabeth
Thomas's Story, as told by his mother Erin
Sam's Story, as told by his parents and his aunt
An update to Sam's story, after he passed away just before his third birthday
Wren's Story, as told by his father Josh
Mary Beth's Story, as told by her mother Bambi
Aquila's Story, as told by her mother Liz

These deaths and injuries were preventable, and these parents have to live with the sorrow of missing their beautiful children.
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