The latest scandal in American midwife attended birth out of hospital birth is occurring in Cary, NC. According to the The News & Observer:
Three-and-a-half years after its splashy debut in Cary, the Baby+Company natural birthing center has stopped delivering babies after the deaths of three newborns in the past six months.
The spa-like facility that enticed expectant moms with midwives and water-birth pools alerted its customers by email on Friday, March 16, that it would be sending all moms in labor to WakeMed Cary hospital, the birth center’s business partner, while it reviewed recent “incidents.” On Thursday, after inquiries from parents and The News & Observer, the center released the information about the newborn deaths.
The company said the Cary site has had a total of four deaths since it opened in October 2014. That compares to only one death at its other five centers in three states. According to Baby+Co, it has supported 1,200 pregnancies over its 3 1/2 years in business in Cary.
An additional baby is currently hospitalized in the NICU at Duke.
Four deaths in only 1,200 births is an extraordinarily high death rate of 3/1000. To put that in perspective, according to the CDC Wonder database, midwife attended hospital birth for low risk women has a death rate of 0.4/1000. The death rate at the Cary birth center is more than 600% higher than expected!
[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]The death rate at the Cary, NC birth center is more than 600% higher than expected.[/pullquote]
Is out of hospital birth safe?
I asked that question about homebirth in The New York Times back in 2016 and answered it.
[T]here are places in the world where home birth is relatively safe, like the Netherlands, where it is popular at 16 percent of births. And in Canada, where it appears safest of all, several studies have demonstrated that in carefully selected populations, there is no difference between the number of babies who die at home or in the hospital.
In contrast, home birth in the United States is dangerous. The best data on the practice comes from Oregon, which in 2012 started requiring that birth and death certificates include information on where the birth occurred and who attended it. The state’s figures show that that year, the death rate for babies in planned home births with a midwife was about seven times that of births at a hospital.
Many studies of American home birth show that planned home birth with a midwife has a perinatal death rate at least triple that of a comparable hospital birth …
Birth center birth is homebirth with a twist. The birth takes place outside a hospital but in a facility that has some safety standards and equipment.
Why is out of hospital birth in the US so deadly? There are a variety of reasons but one of the most important is the philosophy of “normal birth,” the self-serving idea promoted by midwives that the process of birth is somehow equally or more important than the outcome. It’s self-serving because “normal birth” is defined as what midwives can do autonomously, not by what is best for babies and mothers.
There’s a major problem with that definition: “normal birth” is inherently deadly. Since even apparently uncomplicated births in low risk women can naturally end in death for babies and mothers, birth outside the hospital is essentially a gamble. Women and the midwives who encourage them gamble that if complications occur (and some serious complications will inevitably occur), midwives can recognize them and transfer women to the hospital in time to prevent death.
But that can only happen if the midwives are proactive in making sure that women with risk factors are not allowed to give birth at the center, if complications are correctly identified and not dismissed at “variations of normal” and if complications are acted upon immediately before they become full blown disasters.
I’ve heard privately from a variety of people with knowledge of the Cary birth center situation who insist that this is just the tip of the iceberg. There have been serious safety concerns since shortly after the center opened, safety concerns that were not taken seriously.
The director of the center, Margaret Buxton, CNM was interviewd by a local TV station. You can listen here to her weasel words about a “cluster” of deaths and her false implication that this can happen in the hospital, too.
Buxton repeatedly reference to the “cluster” is both tasteless and misleading. A “cluster” did not die, four individual beloved babies are dead and at least on camera Buxton never offers her condolences. The deaths were almost certainly preventable. And while it is true that deaths can occur in a cluster, when those deaths are averaged over the number of patients delivered at the center, the death rate should be THE SAME as the death rate in the hospital, not 600% higher.
There should have been a maximum of 1 death among 1,200 patients. Once a second death occurred, it might have been reasonable to talk about a cluster and assume that the rate would average out over time. With a 3rd and 4th death, Buxton should not be talking about a cluster and in my view should be acknowledging a disaster.
Baby + Co is a birth center franchise. The News & Observer article claims that the other 5 birth centers have had lower death rates so the problem may be confined to the particular center and its staff. I wonder what kind of malpractice insurance Baby + Co carries. It looks like it may be needed.
