I am writing this article after the death of an infant, the second in 5 months, at a local birthing center. 
As a midwife, this is hard to write as I feel I am betraying my profession but as an advocate for safe
childbirth I feel the overwhelming need to speak out and speak up.  Even if just one mom or baby is
saved, it is worth the world. 

Even hospital births can have outcomes that are unexpected and unfortunate.  No one is immune to
potential complications, however, most would choose the path of safest outcome.  
Midwife, by definition, means “with woman”.  A midwife is someone who provides care and guidance
to women of all ages but especially before, during and after childbirth.  This can take place in the home,
birth center or hospital.  

I am a Certified Nurse Midwife (CNM), who is hospital based for more than 21 years.  I was a labor and
delivery nurse in a high risk facility for ten years prior. Even after 31 years, I wish I could say “I’ve seen
it all” but then the universe has other plans to keep me on my toes.  I will say, I am comfortable in my
skin and consider myself to be very experienced with an above average gut instinct.  

Buffalo and Western New York as a whole is an amazing and evolving area.  The people are friendly
and if you live in this area, you understand why Buffalo is called the “City of Good Neighbors”. 
Currently, businesses are thriving and the younger population is sticking around which is the underlying
cause of increased birth rate over the past few years.  It is not uncommon to have ten deliveries in a
twelve hour shift.  

There is a growing trend for home births or deliveries in a birthing center.  Now although this is out of
my personal comfort zone, I am not opposed to home births.  I actually am in awe of the home birth
midwife and I feel like a chicken in comparison as I love and want the safety net of my OB/GYN’s,
nurses, operating room techs and neonatal practitioners.  I have been witness to thousands of births
and although only a small percentage go wrong, when they do, there is no time to waste.  
The most recent infant death at a local birth center was most likely preventable.  This mom was
NOT a candidate for an out of hospital birth as she had had a previous cesarean section for
her first baby. By the time the ambulance was called to transfer her to a hospital in very close
proximity, the baby had likely been dead for hours.  There are other details that would have made
delivering out of hospital a bad choice, but I cannot confirm them.

Now I understand how disappointed this mom must have been when she ended up with a c/section
after months of visualizing a vaginal birth for her first baby.  I was one of them. The fact is, my baby
was too big for my pelvis...period. I often thought that back before advances were made in surgical
intervention my baby and I would have been casualties of childbirth.  For this reason, I would have
never considered myself a candidate for TOLAC (Trial Of Labor After Cesarean) and am grateful for
my health and that of my children. 
I’m sure the mom was told that she could indeed have a vaginal birth after a cesarean section and her
disappointment in her hospital outcome paved the way for the decision to give birth a try at a birthing
center.  As a credentialed and certified midwife, we too have safety guidelines that cross over to out
of hospital birth as well.  

I am in favor of a vaginal birth after a cesarean section if:   You had a c/section because the baby was
breech (not head down) or  the baby was in distress or at risk due to other medical conditions.  Under
these circumstances, you will find physicians who will agree to a trial of labor IN A HOSPITAL.  Only
hospitals with 24 hour anesthesia should be considered. I am not in favor of inductions of women who
have had a previous cesarean section.  I love when they come in in labor.  
I am NOT in favor of a vaginal birth after a cesarean section if your baby didn’t fit the first time or your
labor just didn’t progress after many hours. Second babies are usually bigger and still won’t fit.  If labor
has not ensued by 41 weeks, an induction would further increase the risk to mom and baby.

I have seen catastrophic uterine ruptures that have taken or almost taken the lives of moms and
babies.  A uterine rupture usually occurs at the previous incision scar of the uterus. The baby’s oxygen
and blood supply is cut off and mom is at an increased risk for hemorrhage.  For these reasons, I
prefer these moms to be under very watchful eyes with baby monitored. 
What many women do not understand is that it is THE BABY who is the first to raise the red flag when
something is not right.  If you are not being monitored at least intermittently, this valuable window of
information is not being used and you could potentially miss so much.  I am all for moms being out of
bed---but taking a good look at the baby once every 30-60 minutes gives us a great feel for how things
are going in there. 

I’m sure I will get many moms who have had very successful experiences with birth centers and
home birth stories.  I am very happy for you. I just wish I had a moment to speak to the mom’s who
shouldn't have been there in the first place.  These deaths were not necessary. Do your homework.
Speak to experts on both sides of the equation.  

The biggest concern now is the lack of medical support this birth center has.  They could have sent
women over in non emergent situations as well as transferred care when things became abnormal
or high risk in order to establish a good working relationship with their local hospital and physicians. 
This is what a birth center should be. Now, I fear, they would do anything in their power not to have
to transfer a mom in order to avoid backlash. This is a dangerous scenario that could lead to more
tragic outcomes.  

Catherine (Cathi) Stack is owner, facilitator and Doctor of Naturopathy at Journey II Health, LLC established
in 2007 and currently located in Niagara Falls.  Along with her naturopathic practice that specializes in colon
health and bio-identical hormone replacement, Stack is a practicing staff midwife at Millard Fillmore Suburban
Hospital.  She currently writes articles for local, national and international publications. Cathi’s first book,
Free Yourself from a CONSTIPATED Life”, is a multi award winning book available on Amazon as well as
her newest, “PUSH, Labor & Delivery from the Inside Out.” Visit for more info.  Connect
on Facebook: The Savvy Midwife


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