“The Perils of Journalism:” Ricki and Abby’s Response to the Today Show

We were aware that the Today Show was producing this segment for several months now, but we were shocked at the heading: “The Perils of Midwifery.” A historical section of our film The Business of Being Born documents the public smear campaign physicians groups launched against midwives in the early 1900’s from which the midwifery profession never fully recovered. It is so disheartening to see these old tactics at work again, especially at a time when our country is in the midst of healthcare reform which could finally give all women access to midwifery care in hospitals and increased options for birth center and home births. It’s getting harder to ignore the systematic assaults on women’s birth options that ACOG (American College of Obstetricians and Gynecologists) has been orchestrating since The Business of Being Born premiered two years ago.

ACOG’s first public response to BOBB came in June 2008, when they introduced a resolution to the American Medical Association (AMA) at their annual meeting which commits the AMA to "develop model legislation in support of the concept that the safest setting for labor, delivery, and the immediate post-partum period is in the hospital." The second paragraph of the resolution read: “Whereas, There has been much attention in the media by celebrities having home deliveries, with recent Today Show headings such as “Ricki Lake takes on baby birthing industry: Actress and former talk show host shares her at-home delivery in new film.” The resolution did not offer any science-based information for the AMA's anti-midwife or anti-home birth position and after public backlash, ACOG wisely eliminated the specific reference to Ricki. (Read our initial response co-written with Jennifer Block: http://www.huffingtonpost.com/ricki-lake-jennifer-block-and-abby-ep... )

A few weeks ago, ACOG made a public plea asking its members to submit anecdotal, anonymous data about patients who planned out-of-hospital deliveries on their website. According to the request, which was originally linked from ACOG’s home page, they are “concerned” about the “problem” of growing numbers of women seeking out-of-hospital maternity care. Once again, this request was taken off the homepage and after public backlash and made accessible only by pass codes.

You may be wondering why women seeking expanded birthing options would be a “problem” for ACOG? “Just follow the money,” says Steff Hedenkamp of The Big Push for Midwives Campaign. “ACOG does not want to continue losing patients to Certified Professional Midwives and out-of-hospital birth, so they’re telling members to send in more of the same old tall tales that far too many OBs love to scare women with.” Analysts expect the group to use the anecdotal data collected from members to support its ongoing state and federal lobbying campaigns aimed at denying women access to out-of-hospital maternity care and Certified Professional Midwives.

Now of course we understand that ACOG is a trade organization representing the financial interests of its members but it’s still a wonder that with the United State’s unacceptably high infant mortality rate, skyrocketing c-section and premature birth rates and disappearance of options like VBAC, the physicians would waste so much money and energy waging a media campaign against out-of-hospital birth? As if home births, birth centers and midwives are the real “perils” out there. What about the perils of having no access to prenatal care? It’s also a wonder that the press doesn't expose the safety record of hospitals. But then again, most parents who have bad outcomes in hospitals are silenced by gap clauses with cases settled out of court. The fact that homebirth midwives demand transparency certainly conveys a more honorable stance towards letting the public evaluate the safety profile.

The Today Show should hold themselves to higher journalistic standards than playing up the tragedy of a stillborn baby born at home without explaining that this same phenomenon happens all the time in hospitals. Although our hearts go out to any couple who loses a child, it’s a shame to see a personal tragedy exploited to serve a political agenda. Yes, complications can arise at any birth and as we showed in the final climatic scenes of BOBB, it is essential that homebirth midwives work in collaboration with physicians and hospitals to ensure a safe outcome for their clients. But the Today Show failed to say that the midwife in question has an excellent safety record. They also chose not to mention the most recent study out from the Canadian Medical Association, which supports the safety of home birth for low-risk women. http://www.cmaj.ca/

On a positive note we’d like to point out that in contrast to the official position of ACOG, many of its members are not opposed to out-of-hospital birth and are embarrassed by the tactics ACOG is using to scare women into hospital births. Recently, we spoke off the record with the Chief of Obstetrics at a major New York Hospital about ACOG’s actions. This OB/GYN felt the public solicitations for anecdotes on ACOG’s website was a “huge mistake.” This OB/GYN, who attended a screening of BOBB at Weill Cornell Medical College last year, toured us through Labor & Delivery proudly sharing that he had banned the use of Cytotec, which he called a “toxic drug.” He said he has also placed strict limits on the use of Pitocin, which “drove everyone crazy” but had the direct effect of lowering the hospital’s c-section rate and drastically reducing the number of babies in the NICU. He recognizes the need for more evidence-based protocols in maternity care and was delighted to share his success with us. Like many physicians, he feels the solution is to make the hospital experience as “home-like” as possible. Apparently, he feels this is a more productive use of physician’s time and energy than trying to scare women out of home birth. Amen.

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Since 1972 I practiced as a hospital based labor/delivery nurse. But in 2000 I made the decision to work with a group of physicians that provided home birth. I enjoyed supporting women with their labor in the quiet environment of their home. I attended 62 safe and healthy home births. I also participated in the transfer of six women to the hospital for hospital birth. The complicated part about home birth is the 5 to 10% of women that need to transfer to the hospital. Sometimes women planning home birth are hesitant to go to the hospital because they don't know how they will be treated in the hospital. But they need to make the transfer before they are in crisis. Hospital staff get a very distorted picture of home birth when they receive patients in crisis.
I have written more about my experience on my blog: www.carolvanderwoude.authorweblog.com
I agree. I don't hate the obstetric and hospital communities. I just think the evidence shows an obvious need to reform the maternity system. Homebirth is shown to be as safe as a hospital birth for women who qualify for it (which is a subjective measure, right now), so lets all work together on this!
Thanks ladies for exposing the truth about the REAL political agenda at hand in the Today Show's segment and across the US. Sadly, far too many companies and business profit from hospital birth, the complications it can cause, and the medications used for pain and prevention of infection.

You stated "On a positive note we’d like to point out that in contrast to the official position of ACOG, many of its members are not opposed to out-of-hospital birth and are embarrassed by the tactics ACOG is using to scare women into hospital births."

Well ladies, THESE are the professionals that we as a "free birthing nation" need to call upon to stand up and do something about it internally or better yet EXTERNALLY. Just because midwives are taught and trained to listen to birth as opposed to trying to control it, doesn't make them any less capable of safely delivering a baby. The gynecologists and obstetricians who don't agree with the ACOG are the ones who can create real change within this cruel system that demeans women through protocols and separates mother and baby at birth. They need to unite and stand for what is RIGHT for the sake of birthing communities across America.

Excuse my passionate response. I am a Birth Advocate in training.
Great response! I am not a labor and delivery nurse, but a NICU nurse, and an advocate for nurses and advanced practice nurses. This Today Show piece was appalling on so many levels. From exploiting a tragic infant loss (which happens in hospitals also), to the biased nature of the medical model, to ignoring the research, and to treating CNM's like crazy witch doctors! (and yes, midwives were burned as witches back in Salem. I am afraid Matt Lauer's precious hair is singed a bit.) I agree with Dr. Grunbaum that we in the medical field should be focusing on making birth better in the hospital, where the vast majority of women want to delivery. We should not be scaring women off of home births, but working in collaboration to make them safer when something goes wrong. We are losing site of the main goal, healthy and happy moms, babies and families
Well, although some birth activists and advocates are having trouble saying it, I don't, nor do many seasoned providers within the home birth community- you can't embrace everyone. I have tried in the last 48 hours to post in the places where I think reasonable people are looking about the ridiculous story as crafted by the today show.

The main reason that Riccardo and Catherine McKenzie decided to do that story was not to become anti-homebirth advocates, but to become pro-regulated out of hospital provider advocates. The Andrew Goldman article although not very favorable toward Cara Mulhahn, CNM, brings up a very relevant point that being that Cara is having difficulty finding physicians not unlike any home birth midwife who will enter into a collaborative agreement with her which is how OOH providers are required to practice under New York State law. If you re-watch that rag of a story (I doubt it, it is nauseating) you will hear the journalist Peter Alexander mention the word collaborative agreement. What would have been a much better piece is why won't doctors give up their monopoly on birth and work with midwives? Are they so far flung that they don't care about mothers and babies? I am beginning at this point to think so.
I will defend anyone who is worthy of defense but have to note that Catherine and I met as mothers who are in the slim majority- we lost our babies at home birth with , ahem, credentialed providers present. After I met Catherine I decided to call Cara's midwifery practice to find out what her deal was especially after reading the Goldman article. All I will say, because I never stoop to he said she said matters when it comes to birth politics is that feel free to ask them about their policies regarding who monitors a laboring mother in early labor and whether or not a trained midwife will be there for your entire labor and birth. Feel free also to call and have them explain their doula policy to you. It is simply alarming. People may need as painful as it is to ask themselves- what did happen at this birth? Why did this family come forward?
They came forward in an attempt to continue to protect every mother and their partner that chooses home birth. Many perinatal organizations seems to be back peddling now- this organization is flinging mud on that one- is flinging mud and on and on it goes. Never forget please that on that day home birth did not lose a baby. A young couple lost a baby and that is what the story was supposed to be about- how if an out of hospital provider (any for that matter) is not practicing in compliance with the standards held by their peers, held by their profession, and as a matter bound by regulation that tragedy can strike. This was a tragic outcome on a day that was supposed to be joyful for this young couple.
In 1975 I had my first homebirth, since my niece had just had a baby in the hospital that stangled from a tight cord. That was the first question that I asked my midwife and I was very satisfied with her response that the neck is checked before the rest of the body is allowed to come.
Now I have been a midwife for 33 years and I have seen this many times and saw one in a hospital that could have been a dead baby as the baby neck was never checked and almost dropped the baby on the floor.
Fact is, babies die all the time in the hospital and we never hear of it unless we are family.

Ollie Hamilton, CPM, LM
I wonder if you are responding to the sensationalized non-fact about the demise of the McKenzie's baby. I certainly hope not. As I wrote in another forum- I don't remember the records release form going out to all of America. Very little of the facts as portrayed by the Today show of what happened to Noa Rose should be taken at face value, I emphatically assure you of that.
Yes, as much as I try and I whole heartedly invite everyone here to - try to get Oprah, Dr. Phil the Doctors, or the Today show for that matter to do a story on fetal demise by ACOG docs. That is one story you will not see. Of the mothers who I have the privilidge to have met through my own tragedy- most were in the care of a doctor in the hospital setting with intervention just mere feet away. The more disgusting truth is about the technocratic model of birth as purported by ACOG docs. If what they were servin' up was so great we'd all be linin' up for a hospital birth! Personally, I prefer a home cooked meal anyday- . If a mother or friend of someone who has lost a baby whether at home or in the hospital is reading this please join us on facebook at the Emmet Foundation:Offering Comfort to those who lose a Baby and private message me there- bereaved parents can help each other where no one else can!
It's hard to even contemplate what loosing a child would be like, especially at birth and in the presence of a trained and certified care provider, no matter what the setting. Families' feelings and the repercussions from these deaths should not be swept under the rug.

Families would benefit from the tightening of guidelines for midwifery and obstetric practice, especially when it comes to informed consent and monitoring. (Except if the OBs try to bring in BirthTrack or LaborPro OMG!)

It's good to know that there is support for families who've lost a baby.
I am saddened by this segment. How is it that MONEY is the driving force here? I do NOT understand this concept. I just had my first baby at home in January of this year. You would not believe the responses I got from the insurance company and the OB I saw for the first part of my pregnancy, when I told them I was planning on having a home birth. I was 39, "Advanced Maternal Age", I believe I was "labeled" and referred to on several occasions. I had to jump through some hoops, but in the end, I did have my planned home birth. I was in labor for over 30 hours and my son was born "sunny side up". There was talk about possibly transporting me to the hospital because my labor had stalled and I was exhausted, but one of my wonderfully experienced midwives helped me through and before I knew it I was ready to push! Had I been laboring those 30 or so hours at the hospital, I truly believe that they would have induced and/or C-sectioned me because I really believe that hospitals don't have TIME for you to be in labor.
I had two midwives, two doulas and my husband supporting me at my home birth. I never felt alone or scared. I felt supported and encouraged and that means alot when you're in that amount of pain. I would do it again. Getting the word out there is key. I tell my story to anyone who is interested!
I had to write in on this one. I don't usually do that.
Here's what I sent:


Your segment on the MacKensies who lost their child during a home birth broke my heart, both for their loss and for your lost opportunity to educate families on choosing their best birth.

As a new father, I cannot begin to imagine the grief and suffering. As a family physician trained to deliver babies, I respect the interventions that save babies' lives on a daily basis and know the inherent dangers associated with those interventions and in birth itself. Yet, as a husband who witnessed my wife birth a beautiful baby girl at home under a midwife's trained guidance, I am disappointed in your one-sided reporting of a practice that for most results in a safe, fulfilling, magnificent birth experience.

You briefly, but correctly, suggest that hospital births result in more complications than home births, as echoed by a September 2009 study in the Journal of the Canadian Medical Association (link: http://www.cmaj.ca/cgi/rapidpdf/cmaj.081869v1). But these attempts at balanced reporting are grossly overshadowed by your reckless use of fear tactics. In fact, your "perilous", "extreme" reporting does nothing to further constructive discussion around this sensitive issue.

Each woman's experience in pregnancy is unique and her birth a matter of deep personal choice. All too often that decision is forced upon her (insurance, hospital-based care, medical culture, etc.). TODAY should be encouraging women to understand pregnancy and explore all birth options, not fear them.

Dr. Casey KirkHart
Family Physician
Los Angeles, CA
Thank you Doctor!

How refreshing is to hear a frank and insightful opinion regarding this highly charged topic from a medical professional with intimate knowledge of the 'behind the scenes'. It feels as if we are back at the Index times or if 'Witch hunting' season had commenced again. If the self-professed specialists with loud microphones, in the likes of Mr. Goldman, head their ways not only Cara Muhlhahn would 'burn on the stick' and loose her rights to practice but so would the great majority of midwives in America.
We should maybe help them out a little and try to export that idea to the vast majority of Europe and all countries that have a way more successful history of birth outcomes and way lower rate of mortality and morbidity. They all adopted a model that supports out of hospital deliveries for 'normal' pregnancies encompassed with in hospital care for high risk ones or emergencies developing during labor at home. Just like a well trained obstetrician is supposed to do.

How about that? Good thing the Today Show is only watched here in America. But then again. That's bad enough isn't it.
Paulo Netto

p.s. please read my post just second bellow yours.
Amen to that!



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