A former CPM, Leigh Fransen, has bravely stepped forward to blow the whistle on the illegal practices of homebirth midwives in the United States. Fransen attended direct-entry midwifery school in Florida. She founded a birth center with three other midwives in South Carolina. After Fransen's departure from the birth center, three babies died there. Fransen has posted her story on her website, honest midwife, where you can read it in full, High Risk: Truth, Lies & Birth.

EDIT: The report can also be downloaded here and here.

Fransen writes about using illegal maneuvers in midwifery school and during her practice as a direct-entry midwife,

"At my school, the head midwife would sometimes do illegal vacuum-assisted deliveries. The first time I saw one done I didn’t realize it was illegal, but when I started talking about it freely, I was quickly quieted by the more senior students. “We call it ‘the fruit,’” they said, a reference to the vacuum’s brand name, Kiwi. I rationalized that these other students and midwives would not be using “the fruit” if it was really harmful, so the law must be an unnecessary one. Soon, I was recruited to help usher family members out of the room “so the mother can rest,” as a cover for the vacuum use; I would then lock the door and stand guard. If I was instructed to cover the mother’s face with a cold washcloth “to help her relax,” I made sure her eyes were covered so not even she could see the vacuum being applied. I rationalized that surely she would have given us permission to do this to help her get her baby out without transporting, but that it wasn’t smart to ask permission to perform an illegal procedure. Toward the end of my apprenticeship, I was the one holding the vacuum, applying it to the baby’s head, exerting the carefully angled pressure to help pull the baby down."

"... I became complicit through a chain reaction of participation and justification. “The fruit” was only one of many “exceptions” I learned to make; many of these exceptions I carried with me to my later practice. Illicit use of medications, cavalier usage of toxic herbs, induction techniques, pretending not to see a cesarean scar, fudging dates, doctoring charts, “accidental” breech deliveries, cheating blood pressure readings, lying to doctors, ignoring borderline test results, pretending to know answers while furtively Googling, waiting just a little bit longer for baby’s heart tones to improve, purposely underestimating the staining of amniotic fluid, misrepresenting our personal statistics and the statistical realities of our “profession”… all of these practices are endemic to direct-entry midwifery in the United States. I know because I did most of them. I was present (and silent) as others did them. I heard the stories in “peer review.”

Fransen talks about the peer review process out-of-hospital midwives have,

"Midwives rarely ask hard questions, such as whether this mother truly was a low-risk candidate, whether or not the midwife was monitoring the baby carefully, and why she decided not to call for help sooner. Most peer review processes are characterized instead by soothing platitudes, an atmosphere of comfort and understanding toward the midwife, and reassuring all participants that they are indeed wonderful, special people."

Fransen talks about a time she was up for peer review for a severe postpartum hemorrhage she presided over at an out-of-hospital birth,

"I was very eager to hear my fellow midwives’ opinions on what I could do differently next time to avoid ever seeing a hemorrhage like that again. I got an answer I was not really looking for: “We know you didn’t do anything wrong. We know you. We know you’re a good midwife. Sometimes things just happen.”... what they really knew was what they would want to hear if they were in the hot seat. Peer review was more like an enabling therapeutic back-patting than any form of accountability."

Fransen writes about the financial incentive that motivates out-of-hospital midwives,

"Midwives make 100% of their income from women who decide to give birth in a nonhospital setting; they are obviously motivated to do everything possible to convince as many people as they can that this is an excellent idea. Midwives at a busy birth center may hit or surpass the six-figure mark during a good year. It is not uncommon for a midwife to earn $2000 or more per birth (after expenses), and some midwives take on 5-6 births on a monthly basis; birth center owners may also take dividends from the business’ profits. My take-home pay during our most profitable year would put many obstetricians to shame, and midwives have no student loans to pay off because our educations are dirt-cheap. (My entire midwifery education ran me $3000 in tuition, and this is not unusual.) Midwives often accuse doctors of being motivated by money, but midwives are at least as motivated by finances as doctors are."

Fransen writes of hearing about the deaths at the South Carolina birth center,

"In April 2013, I heard the first rumors of a baby’s death soon after her birth at the center. In September 2013, news of a second death was splashed across local newspapers. And in January 2015, a third death was reported. My thoughts and emotions ran rampant. One moment, I would arrogantly congratulate myself: No deaths on my watch, and three on theirs, who’s the best midwife now? Another moment, I would wonder at my favored status in the universe, that God had spared me from all the horror, and just in time. And in my most honest moments, I knew the truth of it: I had gotten incredibly, ridiculously lucky. And those three mothers who sat at home with empty arms, they simply had not."

Reflecting on her role in convincing women to choose out-of-hospital birth,

"A few years removed from the active practice of midwifery now, I find
myself wondering how I allowed myself to become so convinced that having and
encouraging others to have a nonhospital birth was such a good idea. I called up

a friend who had two home births, the last one with me, and asked her, “If you
had to buy a car seat for your baby, and one car seat had been rated by
Consumer Reports as having two to three times the risk of death or profound
injury compared to other car seats, would you buy that car seat?” “Of course not,” she replied. “What if it was the most beautiful, comfortable car seat in the world, really easy to carry around, easy to install, and your baby would just love sitting in it?” I continued. “No way,” she replied. “What would you say about a parent who did buy that car seat?” I asked. “I’d say they were making a poor decision.”

"If a mother was considering a nonhospital birth to avoid interventions, even though she was totally aware of the increased risk to her baby, I would encourage her to speak to mothers who have lost babies before making such a choice. I spoke to one such mother online under the condition of anonymity: “I didn’t realize the risks when I was pregnant. I thought having a c-section was the worst possible outcome, so I chose home birth to avoid that. I wish to God I hadn’t abhorred the idea of a c-section so much. I lost my child because I chose home birth, and I wouldn’t have at the hospital. I wish I would have instead been in the hospital, upset that I had a cesarean but holding a live baby, instead of at home with empty arms.” I asked her, “How many surgeries is a baby worth?” She replied instantly: “A million.”

It cannot be easy to come forward with these details. I know if I had read this when I was considering a birth center birth, I would have quickly changed my mind. Leigh Fransen's courage to come forward will certainly convince some women to question the choice to give birth outside the hospital and certainly save lives.

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