“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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I was hoping to see a response this morning - thank you!

Like everything in (corporate) America... "If it works well, SHUT IT DOWN!!" ...if the company is not the one profiting.

Even if it regards lives of mothers and babies. Sadly.

First of all, our deep, heart felt condolences to Riccardo and Catherine McKenzie. Only the ones that have gone through what you have can fathom your suffering. Let us share the weight of your burden with you if you need us. All life is precious! And if you are a parent that takes an even more special meaning.

I'm a parent as well as a journalist, a film producer and a cinematographer. I actually shoot and produced the film 'The Business of Being Born' with Abby Epstein and Ricki Lake and experienced 3 years of constant long hours in OB/GYN offices, dark hospital rooms, Labor and Delivery corridors, Operation Rooms, ERs, NICUs, birthing tubs, bathrooms, beds, couches and living rooms. Filming, listening, observing, taking notes and mainly being quiet. I witnessed all birth medical professionals at work - from famous obstetric surgeons operating and Labor and Delivery professionals to reputable pediatricians and brilliant NICU nurses to extremely skilled midwives and patient, kind Doulas. My profound admiration, respect and gratitude go to them all. The true unsung heroes of family building.

One of the serious root problems with our culture, maximized here in this country, is that we all want 100% positive outcome with the least amount of work and the 'safest' circumstances. That makes us forget we are part of a complex net of actions and makes us feel less responsible in the case of unwanted outcome. We have not matured, in that sense. Let's not forget nothing is ultimately 'safe'. It is by forgetting of this principle why 'birth' is where it is today.

While we can watch a clearly biased piece on Today Show that poorly, in-accurately and unfairly depicts a very serious and painful event and exploits tragic loss, we will NOT watch on TV the real state and appalling reality of hospital care regarding birthing in America. This is not journalism. Is just a desperate cry for viewers, in an already rather emotional date - September 11th - and nonetheless a Friday when no one could respond publicly in time for 'damage control'. As a Film/TV producer, believe me, it doesn't get better (or worst) than this. Is the 'Perfect Storm', speaking of clichés.

We will also not be exposed to the fact that mothers and babies die with constancy, at alarming numbers in hospitals in the United States. Hefty settlement between hospital attorneys and families will buy their silence. Unfortunately! I actually heard (off the record) directly from a member of the board of one of the biggest hospitals in New York City that, as lawsuits go, he wasn't too concerned with the ones regarding neo-natal death because is 'easy' to manipulate a jury with vague, inconclusive and complicated medical data, such as fetal distress and infant heart monitoring, etc. He was most concerned with justifying maternal loss, often result of medical malpractice. Those cases typically result in massive financial settlement outside court. Those lawsuits will break the bank.

One can not help but assume there is an on going, well organized, well funded effort from a professional association of hospital medical professionals, to totally discredit and extinguish out-of-hospital birth. Various official measures passed and biased articles (written by non-specialists) with that goal have already been published. They have the intent, resources and will to do it. Timing is right. 'What's good for the company is good for the country'! That seems to be the motto and the classic case of bottom line here. Profit, or the lack of it.

Very soon 1 out of 2 deliveries in the country will be through C-Section (an extremely invasive, risky and life saving medical procedure) if not already. Take in consideration that approximately 80% of these are medically unnecessary. Factor in that the cases of STAFF infections (mainly MRSA) contracted by surgery and invasive procedures performed in hospital have surged drastically and it now kills more than AIDS HIV yearly in America. According to CDC, a government source. The CDC concludes that poor hygiene practice by hospital personnel is the easily and avoidable cause of it.

Let’s suppose that, amidst a very difficult (and confusing) time when Health Care eminent reform fails and ACOGs, AMAs and similar groups succeed in banning out of hospital birth. And that the astronomical raise of untreatable infections contracted in hospital will not stop but will multiply it self as it has yearly. And that doctors and nurses will make less money and hospitals and health insurance companies will make more as the patients get inadequate services, less choices and more expenses. Where will the best place to labor and deliver in be then?

So, what can we really expect and do? For one Truth from journalistic sources as well as competent authorities that establish laws, practices and standards of public health. If there’s anything we can do is to avoid massive raise of birth related deaths by intelligently humanly practicing medicine and resorting to necessary life saving procedures when they are justly called upon while supporting, regularizing and raising the standards for out of hospital birth practices. They are marginally safer then hospital births, as statistics go. Otherwise the future is clear, we’ll be sending our wives, girlfriends, partners, friends, patients, mothers and sisters to the most dangerous place to birth in and countless more will suffer like the Mckenzies do today.

The hard truth that needs to be said and that the Today Show failed to observe (upon prosecuting CNM Cara Muhlhahn) is:
No one can guaranty a 100% positive outcome. No one! No hospitals can, as much as they may try and we may believe. Nor can midwives!

To my knowledge and time spent filming, observing, investigating, researching and mainly being quietly in the room, midwives’ rates of positive outcome exceeds the ones I’ve witnessed in operation rooms in big or small hospitals. Just go visit their NICUs to realize it.

But you shouldn’t take my word for it. I’m not a self-professed specialist. You should investigate it yourself. The conclusion is quite predictable. If we are speaking about the ‘Truth’.
You know, I have thought for hours about how to respond to the previous post because it is a condensed version of all of the hospital birth nightmare stories that I think America is fully aware of at this point. Despite everyone's best efforts, America still lines up for a hospital birth.

I thought it was striking because when people asked me why I was choosing home birth I cited many of the problems with hospital birth you cite- but I never thought the biggest problem would end up being my provider. The context is that in the state where I live, anyone can hang out a shingle (and deliver the baby on that shingle) and call themselves a midwife whether they are truly well trained, competent and educated, or a completely self ordained baby catcher.

Here is where a really odd departure from reason begins whenever I try to productively engage the home birthing public on this topic:

I am routinely told that home birth parents are MORE responsible for making sure their providers are practicing up to a standard of care that is safe and prudent (note: one poster on the ACNM blogspot suggested Ms. McKenzie should have gotten herself to a local hospital- after all she knows her body!)

Whenever someone wants to bash hospital birth and docs they just start going to town citing their deplorable track records, egregious mistakes, law suit motivated practices (and I am in support of all of these as true possibilities) BUT, then I see a community horrification whenever a family who has suffered at the hands of a sub standard home birth midwife considered some kind of "tragic person", exploited, or even worse, a pariah and "unbelievable." (like that could have only happened to you at your home birth.)

The next avalanche is the slide down the slope of "Well, I'm infallible, I make mistakes." (Midwife quote) which is also interchangeable at times with "Well everything has risks"- this one is priceless- (yesterday I saw this one in relation to a bad outcome at a home birth)-"When you get on a plane, the pilot certainly doesn't want the plane to crash but sometimes there is a bad outcome which no one expected." The pilot analogy is precious because pilots are so highly trained and can prevent a horrible outcome if they are astutely trained see that Sullenberger guy for details-and there are meaningful sanctions if they are not. In almost half of the United States of America, there is a "better luck next time" clause in the form of no regulation, no standard licensure and meaningless sanctions for poorly trained out of hospital midwives.
Better yet, is that several national organizations will allow any midwife under the umbrella in a virtual monsoon even if they are the worst provider ever. I am now personally asking these organizations to remove my midwife's name and you would think I was asking them for a kidney. I am trying to prevent the horrible outcomes that we seek to completely avoid by birthing outside of the hospital setting. With my midwife one can be routinely guaranteed a trip to the ER- double winner- home and hopsital birth in one!

This last departure down the road of reason is my personal favorite- this is the one used when I call an errant midwife to the carpet in discussion boards on her lack of a safe, discernible, standard of care or actual informed consent relationship, or education in midwifery skills after she runs her crazy mouth for a while. "you have obviously not healed yet, you need a certified counselor." By then, she has used every reason short of the one that is usually true- I am not adequately trained to deliver babies. period. (never mind in the home setting where you need extra skills.)

By the way, I am just writing this as a very loose gathering of thoughts and as you see it is funny- not funny but still funny odd around what I have gone through personally as a mother who lost a baby in my home with someone who turned out to be a completely substandard home birth midwife despite her shining and glowing reputation and seemingly appropriate credentials. This is not condemnation, but I just think someone has to begin this dialogue with America. It's not all birth tubs and candles. It's some real lunatics out there feeding into the bs that docs contend and that is what needs to be stopped.

Here is a horrible for instance, Dr. Erin Tracy, ACOG mouthpiece was interviewed in USA today (another gem in journalism) and she said that Canadian data could not be extrapolated from that study released I think today or recently- because OOH Canadian Midwives are required to get a bachelor's degree and that the CPM credential requires no formal training. (ooohhh ouch.) I know CPMs personally, I actually work for them- this statement is so damming, but you know what's worse- it's partially true. There really is a route to licensure that requires no didactic training. (this is not to say an apprentice wouldn't get that-it's just hard to wash that fact off while the mouth piece for ACOG is spitting it- it is her hit song by the way.)

Being honest isn't playing into the docs tired rhetoric, it is insuring that American home birth moves from being this always on the extinction form of health care to a viable and safe birth option.
We think you bring up some excellent points here and thank you so much for sharing them. And, of course, we are so sorry for your loss and your midwife's apparent incompetence. Frankly, we receive some terrible stories from grieving families who have lost mothers or babies during the birth process. Sometimes these women received inadequate care from doctors or midwives in hospitals and sometimes from home birth midwives. Not all the home birth stories we hear are glowing. So this is a public health concern, but it needs to be solved by the docs ultimately accepting the legality of midwifery and home birth in the US and not continually trying to snuff it out at the expense of women's safety. There will always be wildly diverse reports from women who use the same provider - the infallibility issue you mention. In fact, one couple we know lost their baby due to the medical error of a very well-respected OB/GYN who is also a central collaborating physician for the hospital's midwives and known for his humane birth philosophies. Yet, this same "good" doctor had a "bad night" and will be protected forever under the silence of the court settlements.
In our book YOUR BEST BIRTH, we tried to give some guidelines in choosing a homebirth midwife and some red flags that one should look out for, questions to ask, etc...
But you are right that a pregnant woman cannot be expected to second-guess a licensed midwife or have some "inner sense" of when she should be transferred to a hospital. Again, if hospitals and physicians would make it easier for home birth midwives to acquire collaborating agreements and hospital privileges, perhaps they would not be forced to practice so far outside the system and this would improve the all-around transparency.
I will try to address your post in the most neutral tone possible- I definitely do not seek a conflict at all just wish to be part of this dialogue- but I'm not buying it Abby- unfortunately. I also forgot to mention- the other stand by from people who would like to quasi console/challenge people who had poor outcomes at homebirths - this is coming from the president of the guild where my midwife is listed first btw,: "This is why we tell people to thoroughly screen their midwives." I read lots and lots of books prior to choosing home birth, one in fact, called: Varney's Nurse Midwifery- . You can bet I read it religiously afterward trying to figure out how an experienced midwife missed such a simple warning sign that ended the life of our son.
I actually would have liked to suggest my midwife read one simply entitled: u>b>Ethics but prior to her egregious behavior and after my nine month relationship with her- I didn't know one was needed.
I don't know at this point what's worse, a bad doc who is insured and bound by a confidentiality agreement, or a home birth midwife who after reviewing the "case" with an attorney makes certain to transfer her assets to her college aged daughter who would be listed as the owner of their 3/4 million dollar home in the event of a civil suit from a bereaved family. (just days after our son's memorial service- we actually just were hoping for our birth fee back- for services not rendered! plus something to cover the unintended expenses.)
I can see this issue from both sides because I lost my son- it is not hyperbole or conjecture, or a glorified horror story. Docs receive the women who have been put into a compromised state of maternal health (I'm trying to be nice here) from poor home birth transports, and we as a family actually went back to the hospital to meet with the doc on call in an effort to bridge this divide between home birth parents, the hospital and to help any home birth midwife who may have to transport there in the future. (we had con current care with an OB btw) I suggested to the doc that he write our midwife a letter asking her to stop taking clients in his practice area. (I thought this was brilliant.) His answer, I almost fell under the table with shock was:” No, because I am concerned that she will drive right past this hospital and go another half hour to the next one." It is not just the docs. They are certainly bound by their weird codes of not cooperating with anyone they see as a threat for sure, but don't forget what it must be like for a doctor to have to take a poorly diagnosed home birth transport where the end is tragic. I now believe this is where their reticence to accept carte blanche home birth midwifery comes from to some extent. He also said, ( find me under the table again)- "if what motivated me was a fear of being sued I wouldn't be an obstetrician. As misguided and ridiculous as docs are and can be, they want the same thing in the end- healthy mother healthy baby. They suffer too when they have a bad outcome. I am not defending docs or hospital birth- I know it is a deplorable state of affairs- just making a point.
Additionally, it is the embracing of all "midwives" because it is a "sisterhood" that requires some form of unity that has to stop. I would like to point out that my midwife is listed on mothersnaturally.org. . When a search for my zip code is entered my midwife's name comes to the consumer who has initiated the search. How are they going to know what happened? I have asked MANA (Midwives Alliance of North America) to please not allow her to list there and have invited them to review the files, peer review, autopsy and whatever else they would need to make an informed decision about whether or not they would like to keep her as a member of their voluntary professional trade organization, and to this date, they will not address this issue or simply take her name off the website. They are not bound by any law to keep her there btw- they are not a credentialing organization-I am not asking them to sanction her just asking them to not let unsuspecting home birth consumers get fleeced by her lack of training and plain ole' cash register type of honesty.
The disclaimer on their website protects them from being sued, the state organization that also lists her (she's the number one name) has now adopted and actually cut and paste the same disclaimer in order to protect themselves. It is not only docs that refuse to cooperate.

Legal and Illegal midwifery is a myth. Either you are in compliance with your state's regulations surrounding home birth midwifery or you are not. If you are not then you are risking the health of mother and baby. It's time to stop blaming the docs and hospitals. it's like shooting fish in a barrel.

I strongly ask that you allow the non glowing reports to come out- there is no real time information for consumers on who to avoid in states where home birth midwifery is still not fully regulated. (ps. take the birth survey- I put my midwife on there.) I tried to get women to contact me by posting on mothering.com and I was pretty much prevented by being cited as a "provider basher." I wrote "no, actually- I am trying to be a consumer protector."

What is out there for parents who lose a baby at a home birth is freak shows like Dr. Amy Teuter-(who said babies drown at water births recently in an article) if women are not allowed to share what happend to them with reasonable people they will possibly become anti-home birth advocates and help to support the tired rhetoric that docs and the media spews that home birth is not safe. (see "Roe no More" Ministry for details.)
Thanks CC Jen. All this dialogue is most definitely welcome and please never feel like you need to avoid conflict on our site when we can learn so much from each other. You seem extremely informed and aware of the issues and our goals are the same as yours - to improve options and outcomes for all women while demanding accountability and transparency. Your experience is so important and needs to be validated and shared. As you may know my own "attempted" home birth in BOBB went completely awry and we took a lot of heat from midwifery groups for ending the film on a Cesarean birth and also showing the featured midwife laboring with a breech baby at home and potentially missing an IUGR diagnosis. Just as we did not edit BOBB to "cover" any of these actual events, we would never try to edit out an negative home birth experiences from our online community.
There is no intention on our side to blame docs or hospitals. We also see their side of this and the way they are constrained by their own insurance carriers. I was mostly referring to the many midwives we have met (CPM and CNM) who really want to work within the system and be in compliance but they either can't get licensed or find any docs to sign their practice agreements or have to work "around" the outdated laws so that there is a "don't ask, don't tell policy." For instance, we met with midwives who serve mostly Amish women in states like Illinois where CPM's are illegal. These midwives know they are committing a felony every time they attend a birth but are embraced and supported by the Amish communities who depend on their services - and might otherwise have unassisted births. This type of system doesn't serve anyone.
We have met with several groups about starting a midwife/OB/doula directory where women could report issues or pos/neg experiences with their birth attendants. This is something we still hope to do in the future to create more transparency.
Yes, Abby I agree emphatically, and as has been said in discussion on a birth politics site (I can't remember which one) "Try and find a doctor who will deliver a baby for 800.00 and a quilt." I too know of midwives who are on the "outskirts" of the Amish/Religious community birth scene, and it is another kind of slippery slope altogether- on that one I will sit on my typing hands.
Thank You Abby, I would like to encourage you and other birth activists to pop into the ACNM blogspot asap-(this is where an anonymous poster suggested Catherine McK get herself to a hospital.) I was just writing about this-why CNMs who are OOH MUST comply and get a physician's agreement- but physician's don't have to comply and cooperate- cooperation amongst docs and OOH midwives is the key to better infant and maternal health.
Oh and one more quick note- I always say that medical interventions when needed during birth are life affirming. I hope this won't seem too non sequitor- but I actually have yet to see your film, (Mea culpa) I actually haven't seen a recent film in years-(Anyone seen Krush Groove? LOL) I'm one of those, but of course thank you for making it. I'm not surprised midwifery groups pitched you heat. *sigh* when will the embracing end- the goal is safe and healthy birth-not home birth no matter what.
I just wanted to say that I really appreciate your contributions, CC Jen. I think your points are very important indeed, and I say that ESPECIALLY as a home birth advocate. I am strongly considering a path from doula work (at present) to midwifery as a CPM, and adequate training is something I take extremely seriously. (I already have a bachelor's degree, but my aim is to get an additional Bachelor's of Science in Midwifery.)

And what are you waiting for? See "Business of Being Born" ASAP! ;o) I think you'll love it. I personally was very glad they included Abby's whole story in the film, partly for the honesty of a different outcome, and partly because it demonstrated what DOES happen in most cases if something goes wrong. I think including a transport was perfect.

I also have to say I'm so sorry for what you experienced with your substandard care. Just awful. I hope you're successful in getting someone relevant to listen to you (weird way to say it, but you know what I mean). You are spot-on right, unconditional sisterhood should not be the guiding principle behind midwifery organizations if the goal is to serve women as expertly and safely as possible.
That was well said. Thank you!
One of the serious root problems with our culture, maximized here in this country, is that we all want 100% positive outcome with the least amount of work and the 'safest' circumstances. That makes us forget we are part of a complex net of actions and makes us feel less responsible in the case of unwanted outcome. We have not matured, in that sense. Let's not forget nothing is ultimately 'safe'. It is by forgetting of this principle why 'birth' is where it is today.

This is so very true, and well-put.

Let’s suppose that, amidst a very difficult (and confusing) time when Health Care eminent reform fails and ACOGs, AMAs and similar groups succeed in banning out of hospital birth. And that the astronomical raise of untreatable infections contracted in hospital will not stop but will multiply it self as it has yearly. And that doctors and nurses will make less money and hospitals and health insurance companies will make more as the patients get inadequate services, less choices and more expenses. Where will the best place to labor and deliver in be then?

The first response to this that comes to mind is "Canada". :/ It really is a scary prospect, given that it looks rather grim at this point for universal health care, and given the new ACOG smear campaign against home birth. I hope that things somehow turn around. Sites like this are a wonderful start.
I watched Dr. Oz's premiere show yesterday, and I wonder if he'd be willing to take on the issue of maternity care in one of his episodes. In yesterday's show, he revealed that 3/4 of the 600,000 hysterectomies performed in our country are unnecessary. As always, he encouraged taking preventative measures to avoid such an invasive procedure; getting a second opinion; and sharing this information with others.

With a Reiki healer as a wife and a physician who prides himself on taking a more holistic approach (e.g. introducing mainstream America to the neti pot on Oprah), I don't see why he personally wouldn't want to share that at least 1/2 of C-sections aren't necessary.

I've been thinking about writing a letter/e-mail to him soon. Wanna join me? Have a bigger idea that we can help each other pull off?


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