Thursday, October 23, 2008

A letter to Judy Norsigian of Our Bodies Ourselves

Several days ago I responded to an opinion piece in the Concord (NH) Monitor written by the former Chairwoman of the New Hampshire Midwifery Council, the state organization of direct entry midwives.

I reviewed my 15 reasons for not licensing direct entry midwives:
This is fundamentally a public safety issue. The question: Is it safe to license a second class of midwife with less education and clinical training than any other midwives in the industrialized world? The answer:

1. This is NOT about having midwives in the US. We already have midwives (certified nurse midwives) who are among the best trained midwives in the world.
2. This is about creating a SECOND class of midwives with less education and training.
3. No other country has a second class of midwives.
4. The standards for direct entry midwives, in terms of educational requirements and clinical training, are far below those of any other midwives in the industrialized world.
5. Direct entry midwives are NOT trained for out of hospital birth, since no special training is required. The many taxi drivers, police officers and family members who deliver babies each year could tell you that. The only thing that requires training is dealing with unanticipated complications, and this is precisely what direct entry midwives lack.
6. Direct entry midwives are not "specialists" in out of hospital births. They are restricted to out of hospital births because they are considered unqualified for birth centers or hospitals.
7. Direct entry midwives are not "specialists" in normal birth. Claiming to be a specialist in normal birth makes as much sense as a meteorologist claiming to be a specialist in good weather.
8. Homebirth carries an increased risk of preventable neonatal death in the range of 1-2/1000 ABOVE the neonatal death rate for comparable risk women in the hospital.
9. To date there is not a single study that shows homebirth to be as safe as hospital birth. There are studies that claim to show that, but they do so by comparing low risk women at homebirth with high risk women in the hospital.
10. This is not about "choice". Any woman can choose to have a homebirth. This is about licensing of health care professionals who do not have the necessary education and training.
11. The insurance industry will not write policies for homebirth or charge extraordinary premiums because their data indicate that homebirth carries an unacceptably high incidence of bad outcomes and big payouts.
12. There is no uniformity in direct entry midwifery credentials. There are many different credentials with differing education and training requirements. Direct entry midwives cannot agree among themselves what baseline training is required.
13. Direct entry midwifery credentials were created by direct entry midwives without input from medical or public health sources. These credentials are the "seal of approval" of some DEMs in regard to other DEMs. There is no independent objective basis for these credentials.
14. The Midwives Alliance of North America (MANA), the group that collected the statistics for the BMJ 2005 study, has collected statistics for the years 2001-2006, but refuses to release them to the public. They will only be released to individuals or groups that can prove they will use them for "the benefit of midwifery." The public has a right to know these statistics.
15. There are no statistics at all for long term outcomes of homebirth with direct entry midwives. We have no idea (nor do they) about the incidence of brain damage, oxygen deprivation or birth injuries.

The bottom line is that we already have well educated, well trained, highly competent midwives in the US. We are being asked to accept the licensing of a SECOND class of midwives with less education and less training than any other midwives in the industrialized world.
Today the paper published a Letter to the Editor from Judy Norsigian, the executive editor of Our Bodies Ourselves, in response:
Re the debate about homebirth and certified professional midwives:

The distortions and inaccuracies in Dr. Amy Tuteur's comments on the Monitor website are typical of her many postings at various websites and newspapers. For evidence-based, balanced information, we refer your readers to the items noted at our website,, including the new, peer-reviewed report "Evidence-Based Maternity Care: What it is and What it Can Achieve," issued Oct. 8 by the Milbank Memorial Fund, the Reforming States Group, and the Childbirth Connection.

What readers need to fully comprehend is the extent to which documented "best practices" are not followed in many hospitals across the country. That fact alone justifies retention of the option of homebirth with trained, licensed caregivers.
I promptly wrote back:
If there are truly distortions and inaccuracies, it should not be difficult to point them out, yet you could not think of one distortion or inaccuracy to include in your comment. That suggests that you are merely making accusations to change the subject. All the existing scientific evidence shows that homebirth with a direct entry midwife increases the risk of neonatal death. Direct entry midwives (unlike certified nurse midwives) have less education and less training than ANY midwives in the industrialized world.

Your mention of, and inaccurate characterization of "Evidence-Based Maternity Care: What it is and What it Can Achieve," issued Oct. 8 by the Childbirth Connection is telling. First, it does not discuss either homebirth or direct entry midwifery. Second, the title is rather Orwellian since the report is not based on the scientific evidence; it is based on the personal opinions of the activists at the Childbirth Connection. Third, it is not a peer-reviewed journal publication; it is a privately funded and privately produced position paper.

I challenge you, Ms. Norsigian, to provide proof that anything I wrote is either a distortion or inaccuracy, with the scientific citations to back up your claims. Feel free to post it here or on my website Homebirth Debate.
I look forward to her response. Of course, I am not holding my breath. If she is like Henci Goer, Judith Rooks, and Johnson and Daviss, she will find limit herself to casting unfounded aspersions from afar rather than risk debating the issues with me.


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