Saturday, September 12, 2009

Code Mec! Code Mec!

*Now with more links*

Not only are home birthers irresponsible, selfish, and reckless, they are now, according to the Today Show, hedonists who are seeking a spa treatment experience during labor! (Never mind that it's okay for hospitals to market their maternity wards' spa-like amenities...)

The Today Show recently investigated the supposed "Perils of Midwifery" and their shoddy reporting is in for a drubbing.

The ACNM responded with a discussion of The Non-Perils of Midwifery. "Not only does it follow the heart-breaking account of a birth gone horribly wrong; it exploits the couple’s tragedy—turning it into a sensationalized story that scares women and grossly misrepresents midwifery," the ACNM commented.

Nicole at Your Birth Right wrote about The Perils of ACOG: "[D]uring narration about home birth advocates they decided to use the word alleged as if homebirth advocates are somehow perhaps liars or criminals....The word alleged is somehow missing when the DOCTORS are quoted,"  she wrote.

Speaking of perilous obstetrics, Jill at The Unnecessarean noted that ACOG just released survey data indicating that many obstetric practices are influenced by fear of litigation and ultimately harm the patient.

Radical Doula wrote that ACOG is making me nauseous.

Citizens for Midwifery claimed that the Today Show is in bed with ACOG.

The Big Push campaign hit back with its own (alarmist) rhetoric: Physicians take anti-midwife smear campaign to the airwaves. (PDF)

And I love (Keyboard Revolutionary) Jill's response: Iridescent tile makes all the difference.

Reality Rounds called Code Bullshit on Matt Lauer. She pointed out some of the many inconsistencies and flaws in the report, with comments of her own in italics:
  • A talking male head “expert” comparing home births to spa treatments.  “Yes, I will have my full body avocado massage while I am crowning please.”
  • Same talking male head talking about the “Hedonistic” style of birthing.
  • Flashy pictures of celebrities who have given birth at home.  Every  women I know has chosen their birthing options from reading US magazine.
  • ACOG says childbirth decisions should not be determined by what is flashy, trendy, or the latest cause celeb.  But it is OK for childbirth decisions to be dictated by defensive medicine, personal golf schedules, and “because I have always done it this way,” reasoning.
  • When the investigator speaks of midwives he uses terms like “they allege” medical births cause X,Y and Z.  As if the anger over the medicalization of birth is all a big conspiracy.
  • When the narrator states that studies by the CDC show home births to be safer than hospital births, they leave us with this quote:  “But doctors say it is impossible to compare the safety of home births with hospital births, becasue hospitals care for so many high risk cases.”  Really?  It is impossible to compare  similar low risk patient populations’ outcomes for delivery?  It is impossible to just remove the high risk populations from the comparative study?  This is called research idiots!
Amy Romano of Science & Sensibility just wrote Home Birth: The Rest of the Story. In this piece, she argued that home birth has been held to standards that not even hospitals can meet and that implementing Lamaze's Six Healthy Birth Practices would make both hospital and home birth safer:
I continue to believe that if hospitals provided the Six Healthy Birth Practices as the standard of care and offered evidence-based treatments for women and babies experiencing complications, hospital birth would be safer and so would home birth. That’s because midwives would initiate transfers with more confidence that it would improve the outcome, women would transfer more willingly, and care at the receiving facility would be safe and effective. What’s not to like about that plan, ACOG? Now, let’s make it happen!

I have an idea for Reality Rounds: let's up the ante a little. I can think of no stickier, gooier, ickier fecal substance than infant meconium. So from now on, anything particularly outrageous or ignorant or downright stupid, when it pertains to birth, gets a big old...


Anyone care to make a "Code Mec" button for me?


  1. As soon as Matt Lauer said the words "Extreme Birth" in the intro, I knew. Maddening! I can't help wishing Cara Mulhahn had been able to say more about the situation, though I know her hands were likely legally tied.

    The most frustrating moment for me was, as Reality Rounds points out, when they mentioned the CDC study that demonstrated home birth outcomes being equal to or better than hospital outcomes, it's just immediately dismissed by the claim that it's because of higher risk women, with NO further discussion. End of story. No mention of the recent Canadian study (among others) which specifically compares equivalent risk level!

    I feel terrible for the couple who lost the baby. But they're completely being used & manipulated into blaming this on home birth.

    *shakes fist at the sky*

    Thanks for the roundup of blog responses here. I'm totally adopting "Code Mec" for all such outlandish nonsense.

  2. I also found it a little funny that the higher risk women they talked about dealing with in the hospital were ones with "breech positioned babies, diabetes, and twins"

    ...because home births have never occurred under such circumstances.

  3. I also saw most of the Today clip you're referring to and was disgusted by it. I had my second daughter at home last Dec and wouldn't have it any other way if I have a third.

  4. That sure is some stinky mec! I want a button too!

  5. I saw the clip and agree that the reporting was one-sided to say the least, but I have to admit that it did get me thinking. It does seem that this death would likely have been avoided with fetal heart monitoring in a birthing center or hospital. Even with a top notch CNM like Cara things can go wrong.

  6. Janie,
    continuous fetal monitoring, or electronic fetal monitoring of any kind, can not prevent bad outcomes. As a matter of fact, it can not tell us anything other than when a baby most likely does not have metabolic acidemia (with the presence of moderate variability of the heart rate with or without fetal heart rate accelerations); on the other hand even when the fetal heart rate pattern does not have those features associated with the absence of metabolic acidemia (double negative, I know) the fetus may still be just fine.

    So, using fetal monitoring does nothing really, other than increase the rate of surgical birth.

  7. I don't even know what to say or where to start. after watching the story, both my husband and I are writing NBC, the Today Show, Matt Lauer, and the NY Times to tell our story of unnecessary section and wonderful HBAC. I hope everyone else who finds themselves here will do the same.

    flood them with your outrage!

  8. I just blogged about it too. OT, but do you or anyone else know if Dr. Wagner has had a stroke recently? He looks like he has aged drastically since appearing in TBOBB, and his speech seemed a little slurred like a stroke victim.

  9. Code Mec! That's funny, especially since I have been in some real life "Code Mec's" in my career. Code BS, Code Mec, Code Brown...they all apply to The Today Show's "investigative report." The only thing with meconium, it doesn't smell, and the Today's Show sh*t smelled real bad.

  10. Extra frustrating when you have a Today-show kind of family and not one who reads books or blogs (or listens to real mamas)

    Sigh. This isnt the first time womens bodily autonomy/ life and future empowerment gets mocked or made to look like something trendy/bad/foolhardy.

    I wonder what the point is. Everybody make sure you line up for your pit-section? For safety's sake? CUZ NO BABIES OR MAMAS WERE EVER EVER HARMED IN HOSPITALS, NO, NEVER!

  11. Hi Rixa! I've been writing letters and blogs for two days in response to the Today show piece on home birth and tonight I'm reflecting on the outrage generated in us, who are on the 'good' side of the debate. Why do we let them get us so riled up and then we spend soooo much time and energy defending our beliefs, our culture, and our practices? Why don't we put them on the defensive for a change? Let's get our own shows out there. Business of Being Born was fantastic at getting them riled up. Your blog is fantastic too! Let's keep putting it out there. Ideas anyone?

    Debbie Boucher CNM
    Home birth midwife in NE Illinois

  12. Its impossible to compare low risk hb to low risk hospital births because every birth is high risk in the hospital you know. @@

    I can't even watch the episode, my bp will go up.

  13. This is one hot tamale post! YIKES!!! I can just feel the heat and anger in this... and I'm right there with you!

    At one point I was proud my doctor was a member of ACOG, before I knew ANYTHING about this organization. And now I'm terrified. I am hoping to find another doctor. I don't care if I'm 5-6 weeks from delivery.

  14. Debbie, I think stuff like the Today Show clip is happening precisely BECAUSE ACOG is feeling attacked! Too bad instead of acting defensive as we do, they act OFFENSIVE and slam the opposition instead of defending themselves. Maybe cuz there's nothing worth defending?

  15. Ok, I grabbed a button using a screen shot and edited it so that it now contains the words "code mec". :-) It's just a graphic, but if you want it, here is the url: (

    I don't know for sure that people who aren't me can use it, since it's my blog's "files," but if you can't, you can take a screen shot of the button (left-hand sidebar, at the bottom; Ctrl+PrtScn/SysRq to take a screen shot), paste it into Paint, then cut out everything that you don't want, and there you have it!


  16. Is Cara involved in a malpractice suit with the couple featured? If not, it seems like this piece could be ripe for a defamation lawsuit against NBC. Especially after that *lovely* New York magazine article of a few months back.

  17. Oh yeah, I remember that character assassina- er, article!

    I'm sure no one will be surprised to find, as I just did when I went to re-read it, that the author of the article is actually also the source of the "hedonistic spa treatment" remark in the Today piece, citing a "doctor he spoke to".

    P.S. W2WCBE, that works just fine in my blog!

  18. Ok, so I fiddled some more with it, and added a picture of my oldest child as a newborn. Here's the new URL (, and you can see what it looks like on my blog. I think it's pretty cute. :-)


  19. Labor Nurse-

    Continuous fetal monitoring would have picked up the fetus' decelerating heartbeat. In a hospital or birth center this would have been closely monitored and a crash c-section would have been performed. There's no guarantee, but there's a very strong chance that that would have saved the baby's life. As you said, fetal monitoring increases surgical births, and this certainly would have been one of them.

    We attack the ACOG for their untruths, but let's not join them by pretending that the outcome of this home birth would have necessarily been the same in a hospital.

  20. Janie, I am sure that Muhlhahn was performing intermittent auscultation, meaning listening with a fetoscope or Doppler, frequently throughout labor. I know it is also standard among midwives to listen even more frequently once the second (pushing) stage begins.

    Not only does cEFM increase surgical birth, more importantly to what we're discussing, it has never been demonstrated to improve outcomes. Even the ACOG acknowledges this, at least on paper.

  21. Rixa,

    This is such a hard and very personal story...

    I have watched the segment, and when I was preparing myself to watch it, I cleared my head and just "watched" with an open heart and open mind.

    I don't really think that it's fair to say that this family was used, or that their story was sensationalized. I felt that there story of loss was pretty fair, to the point and they were able to tell the viewer what had transpired. The mothers comment about trusting her midwife hit me so hard. Of course she trusted in her midwife, so had I...and then her baby came out with no heartbeat...and then I was rushed to the hospital terrified if my baby would die.

    Their child died. Our child died.

    I don't feel that they were used & manipulated into blaming this on homebirth, I think that they actually believe it to be the truth, much like I do.

    What I really wanted to say here is that I feel really annoyed that you and the lot of the homebirth revolution that reads this blog feel that this story of tradgedy is sensationalized. It's unfair to you that FINALLY a story of the tragic loss of a baby that happened because of homebirth has been told in the mainstream media.

    What you all are now saying sounds a lot like the doctors speak that you are all so against.

    I'm pretty certain that if any of you had had the experience this family had, and my own family that you would be speaking out and about the death of your child, and that your baby died because of the choice to birth at home. So, yes, we have the right to call homebirth extreme if we so choose.

  22. I haven't really given any of my own commentary on this piece. I don't know if I would agree with some of the posters that the parents who lost their baby are being used/manipulated. I think we (not anyone specifically, but more as a culture in general) need to get beyond the divisiveness and combativeness that we so easily fall into. You know--the whole "Birth Wars" thing, the idea that X or Y group needs to "go on the offensive," etc. Now I do think some of the parts of this report were totally ridiculous: the hedonistic birthing thing, the spa experience comment, the quick dismissal of really good evidence.

    I guess I am trying to say: is there a way we can really talk about the issues at hand--even the really sad, uncomfortable ones like the couple who lost their baby--without needing to defend or attack or accuse either way? I really think Amy Romano's post is promising because, as she argues, the improvements in hospital birth will only make home birth safer too. It's something that all women stand to benefit from, rather than just 1% of the population.

  23. Has anyone ever heard of a legitimate study that says that home birth isn't safer? I've been doing a lot of research and so far the only arguments that I have heard are that the studies that say that home birth is actually equal to or better than hospital births, are flawed.


  24. Has anyone ever heard of a legitimate study that says that home birth isn't safer? I've been doing a lot of research and so far the only arguments that I have heard are that the studies that say that home birth is actually equal to or better than hospital births, are flawed.


  25. Has anyone ever heard of a legitimate study that says that home birth isn't safer? I've been doing a lot of research and so far the only arguments that I have heard are that the studies that say that home birth is actually equal to or better than hospital births, are flawed.


  26. Dou-la-la,

    Are you suggesting fetal monitoring wouldn't have helped in this case? I'm familiar with the studies that suggest monitoring doesn't improve outcomes, but the fact is, the fetus' heart stopped beating before she was born. If the heart rate were being monitored then, after signs of distress, the baby would have very likely been safely delivered in a hospital.

    This is exactly what we criticize OBs for: they rush for a section at the first sign of distress. So I think it's a safe assumption that this baby would be alive today if she were born in a hospital.

  27. Chara,

    The only study I've *ever* heard of that shows that home birth is not as safe as nor safer than a hospital (in developed countries -- we're not talking about the impoverished African countries where people have to walk miles to get to the nearest health professional for the simplest health care), as the Pang study from Washington. But that was fatally flawed, because they took all births that happened out of hospital, without regard to whether the birth was a planned or unplanned home birth. Many of the births were planned hospital births, but the woman gave birth before she could get there; others had no midwife in attendance. Since most women will not have unassisted births, logic alone will dictate that one should only include midwife-attended planned home births. Also, the study looked at births from 34 weeks and onward, although many midwives would not knowingly attend a preterm birth.

    Other than that, all studies that I know of show a similar rate of perinatal/neonatal mortality with home birth as compared to low-risk hospital birth. Of course, Dr. Amy will find fault with them, or find reasons why "they don't apply in America," but even if she's right, I can always counter, "Well, then, why don't you support the changes necessary for the situation in America to be similar to the situation elsewhere -- namely, support CPM legislation in the 24 states that don't have it yet, and support smooth home-to-hospital transfers with integrated midwives, so midwives and their clients don't feel like they will be harassed for transferring? Hmmm?" :-) That shows that she merely wants to denigrate home birth, rather than create a workable solution.


  28. Mama, I'm very, very sorry to hear of your loss. And you know, you're right, using the word "manipulated" is probably unfair in reference to the couple; I think the word came to mind because the viewers, on the other hand, WERE being manipulated.

    I have to stand behind my feelings on it being a sensationalistic piece of journalism, though. That doesn't mean that the tragedy was any less real, or that the parents' emotions were any less valid; it's about the editing, and about the facts being presented in an almost completely one-sided way.

    Janie, your previous comments made it sound as though there were NO monitoring being done, and I'm just pointing out that there was; intermittent (and probably frequent) auscultation with a fetoscope or Doppler. Am I saying that cEFM wouldn't have helped? There's no way we can know this for sure. Speculating about exactly what happened is futile without more details, and feels potentially disrespectful to the family. But briefly and over-simplistically, if a crash section was needed, that takes about 10 minutes to set up, right (I could be wrong, please correct me if so)? And it is my understanding that without oxygen, the baby has about 4 minutes until brain damage and about 6 minutes until death. Again, pros, please correct me if I'm wrong. So if there was an unpreventable cord accident with no prior signs of distress (which would have been picked up by frequent Doppler checks), how does that math add up to a *guarantee* of safety in the hospital?

    I hope such speculation isn't perceived as disrespectful. I really don't intend it to be, and I truly do keep in mind here that there is a real loss at the center of all this. Rixa is totally right about trying to get beyond the Us vs. Them dynamic, and pieces like this deepen the divide, which is what we're all really venting about here.

  29. Dear mama, I'm so sorry for your loss. I belive the couple is being sensationalized because their story is being used to scare people away from homebirth.

    Their tragedy is being presented as though it could have been prevented if they hadn't chose a homebirth, but we don't know that. They segment did not give any information on what caused the baby's death, only that she was born "limp".

    Not knowing the cause of death means we cannot conclude the homebirth setting and CNM care lead to the death. My opinion is that as the grieving couple searches for "why" they have determined it was because they weren't in a hospital. This may be true, but we the viewers were not given facts to support this claim.

    This event, and really this whole subject, should not be covered in a 3min morning news segment. There is no way they could provide enough infomation for the viewers to learn anything. It is presented simply to scare the public back into the hospital.

  30. It's important to know that not all hospitals can respond similarly to obstetric emergencies. It's not like there's a generic "hospital" experience when you need a crash c-section. ACOG's rule is that you need to be able to perform an emergency c/s in 30 minutes or less.

    My local hospital does not have an in-house OB or anesthesia; if there's an emergency, they have to be called in. During my hospital tour, the nurses said the fastest they have ever seen a c/s done is 10 minutes from decision-to-incision (for a cord prolapse). That's probably not typical nor normally reasonable; it depends how far away the OB and anesthesiologist are at the time of the emergency. Really, if the only "safe" way to give birth is to have access to a crash c/s in 10 minutes or under (and really, if the baby's oxygen supply is totally cut off, 10 minutes is too long), then all women should have to give birth in a tertiary care center with 24-hour in-house OB and anesthesia (which ACOG has recommended for women doing VBACs, despite the lack of evidence that this round-the-clock access improves VBAC outcomes). Of course that's not feasible or reasonable at all. In short, the public has this impression that if you're in a hospital, the staff can immediately respond to any emergency--which is not the case. It takes time to set up the OR, to assemble the surgical team, to prep the mother.

  31. When I saw this segment on the Today show, I immediately thought of you and I'm so glad to see that you and so many other bloggers are addressing this issue. I completely agree with Olivia - it is a disservice to the subject of birth but most of all to the grieving parents to think that a few minute piece would begin to cover such a multi-faceted topic.

    You're right, hospitals are not magical places where nothing ever goes wrong and giving birth at home is equally fallible. Things can go wrong anywhere, any time, in any setting. It's just a shame fair balance wasn't given to a mother who 'did everything right' by having all the interventions in the hospital and still couldn't save her baby.

    Thank goodness we can see that newspiece for what it was - a thinly veiled scare tactic that won't work on informed, educated, child-bearing women like us!

    Thank you for your continued dedication to education - as a newly pregnant woman I visit your blog daily as I begin my journey to my best birth!

  32. This comment has been removed by the author.

  33. See my earlier post this month about the 6 healthy birth practices: It's also in this month's archives.

  34. Rixa,

    I really hope that through your work, and your writing here on your blog that you can bridge the gap. To bring better practice to hospital OB's and to allow them to trust homebirth midwives, and the midwives trust the OB's.

    About crash c-sections...

    After I labored with Birdie for 24hrs, and her heart rate was found to have dropped out of the blue...and it did not change...and I was rushed to the hospital (normaly 5 mins away)...we got to the hospt. then the doc was paged (it was the middle of the night and no OB in house), we waited 30 mins for her arrival, meanwhile I was prepped for surgery...she arrived and had Birdie out in 3 minutes.

    You know the rest. Too much time had passed from when her first signs of distress were missed at home, to the next heart rate check....when she was around 80bpm's.

    Then there was the long trip to the hospital because it was a freezing night and the roads were slick.

    Waiting to get into the hospital because the doors were locked, waiting for the OB.

    There was around and hour of time that had passed, and it was too much time. Birdie was in distress and had been and I feel in my heart and in my gut, had I been in hospital that there would have been a much better change of catching this earlier and yes, perhaps a c-section, this too would have been performed MUCH sooner had I been in hospital (and this is NOT a c-section happy birth center!).

    It is that damned "gray area" that get's me and terrifies me for women thinking of homebirth. The monitor of the baby really isn't that bad especially if you have lived through what I have.

    While I did not want to have a repeat c. I was HELL BENT on a VBAC and everyone was all for this 100% no question. However, Holdyn's heart rate decelled really low after an even longer labor than with his sister (and I couldn't get passed 9.5cm's!). As it turned out, there was a reason for this (that might have been there with Birdie's labor!). I had a Bandel's ring, so there was NO FUCKING way that Holdyn was going to be coming our my vagina, he would have been stuck and totally distressed and the whole nightmare could have happened again if we were at home.

    It's the unpredictability that things can go wrong, and I know it's not often that they do. BUT, I now know SO MANY women that have had something tragic happen during birth or right before and their babies died...

    I just can't stand it any more the distrust between the homebirth community and birth center/hospital communities. This all leaves me with a really terrible taste in my mouth.

    The only thing that was OK about the Today SHow segment was the honesty of that family, yes there were some commentary parts that were totally stupid. But, that families grief and hurt and blaming...I totally get it, I feel that, I understand it. The whole of the segment def. could have been produced better with more facts etc. But, the idea of that story makes the silent majority of former attempted homebirthers with a dead baby because of it not so silent anymore and I am glad for that. Homebirth does not always end with a beautiful birth "experience", and that is a true reality that is not really addressed within the homebirth community as far as I can tell.

  35. Wow, mama's story is so powerful. I think it's important for us to acknowledge the risks.

    I have a friend that gave birth at a hospital, crash c-section. She said they had the baby out in less than 5 minutes! So in well equipped settings (this was a research hospital) it's definitely possible.

    I think it's important to remember too that with continuous (or at least consistent) fetal monitoring the practitioner would have at least been aware that the baby was in distress. If there were a delay getting the OB and anesthesiologist ready for surgery the nurses could work with the mother, trying different positions, giving her oxygen, etc., to try to increase to oxygen to the baby. There's also the availability of immediate care for the baby after birth. So "decision to incision time" isn't the only factor to consider.

  36. I have a thought about the studies which suggest that home births are as safe as hospital births. Wouldn't mama's first birth be considered a hospital birth? Even though the majority of birth took place at home? It seems like there might be some bias to these results if there are a significant number of home birth transfers that end in still births born at a hospital. Any thoughts? I'm not saying this would indicate necessarily that hospital births are safer, but that the results would be invalid.

  37. Anon--studies of home births look at intended place of birth when labor began, not *actual* place of birth. So a home birth transfer is still counted in the home birth states, regardless of where the final birth location was.

  38. I watched the NBC video for the first time this week and was horrified. Today I signed the petition being delivered to NBC headquarters. I thought some of the readers here might want the link in case they hadn't signed it, yet. Sorry this is so last minute. I think it's being delivered this week with it being Midwifery Week and all:


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