Sunday, September 20, 2009

Response to Today Show's Perils of Midwifery

Noah Kotch
TODAY Senior Producer
30 Rockefeller Plaza
New York, NY 10112

Dear Mr. Kotch:

The TODAY Show, with its over 5 million viewers, has a public responsibility to air balanced journalism. A controversial issue such as maternal healthcare deserves investigation from many sides to paint an accurate picture. This was, unfortunately, not the case with the piece entitled The Perils of Midwifery, which aired Friday, September 11th. The title alone introduces this segment as a one-sided and biased presentation of the issue. America’s potential mothers deserve better.

The American maternity care system is broken. The U.S. ranks 35th for maternal mortality and 33rd for infant mortality worldwide, according to the most recent World Health Organization World Health Statistics. Widely recognized as barometers of a nation’s overall public health, these mortality rates show that maternal and child health is a serious problem in this country, one rarely recognized, and one that deserves comprehensive and fair coverage by the media.

For low-risk, healthy pregnant women, birth is a normal process in which credentialed midwives are highly trained to assist. Nowhere in your segment did you inform your viewers of the rigorous, experiential education a Certified Midwife (CM), Certified Nurse Midwife (CNM), or Certified Professional Midwife (CPM) receives. Peter Alexander said that the subject has sparked “passionate debate,” yet while we heard plenty from the American College of Obstetricians and Gynecologists (ACOG), we didn’t hear from a single midwife during the interview. Midwives in this country are members of the North American Registry of Midwives (NARM), as well as the Midwives Alliance of North America (MANA), a professional organization analogous to ACOG. Cara Muhlhahn, the midwife to the McKenzie family, is a Certified Nurse Midwife (CNM); CNM’s belong to the American College of Nurse-Midwives (ACNM). Any of these three groups (NARM, MANA, or ACNM) would have provided comprehensive resources for a balanced investigation.

We commend you for requesting an interview with Ms. Muhlhahn, and understand that she declined this request. Without her testimony, however, we have no way of knowing how, when, or why the McKenzie baby died. It was directly implied that this baby died because she was born at home. This may not have been the case. Furthermore, regardless of the reason for the McKenzie baby’s death, babies die in hospitals as well as in homes. There is much room for speculation and to imply that the McKenzie’s decision to birth at home with a midwife resulted in the death of their baby is simply exploitative. Midwives and physicians each have their place in maternal health care; only with true collaboration and mutual respect can we begin to heal a very broken system.

Peter Alexander called home birth with a midwife “extreme” because of the lack of drugs and doctors. Women who choose to give birth in this way were labeled as “hedonistic.” Mr. Alexander did briefly interject that studies show home birth with a midwife is as safe as hospital birth. The statement was, however, immediately followed by a familiar caveat against the evidence from the American College of Obstetricians and Gynecologists (ACOG), claiming that these studies are invalid because they fail to remove high-risk pregnancies from the equation. The latest study on the issue negates that argument, comparing low-risk pregnancies in hospitals with low-risk births at home with credentialed midwives. This study found that “planned home birth attended by a registered midwife was associated with very low and comparable rates of perinatal death…and other adverse perinatal outcomes compared with planned hospital birth.”

During the beginning of the segment, your cameras focused on the book Ina May’s Guide to Childbirth, as one of the works cited in the movie The Business of Being Born. The author of that bestseller is Ina May Gaskin, pioneer of the modern midwifery movement. When asked about her thoughts on The Perils of Midwifery, Ms. Gaskin replied, “We need to get beyond simple-minded doctor- or midwife-bashing and look at some of the structural failings that prevent us from clearly understanding why too many mothers and babies are dying in our country around the time of birth. We need both midwives and physicians, and we need them to work together.”

Ms. Gaskin will be participating in a panel discussion in Sarasota, Florida, on November 1st called Maternal Health Care in the 21st Century: Sarasota and Beyond. A copy of the press release for this program is enclosed. Another panelist in this discussion is Jennifer Highland, MPH, Executive Director of The Healthy Start Coalition of Sarasota County. In a conversation about The TODAY Show segment, Ms. Highland said, “All practitioners--in midwifery OR medical practices --have their rightful place in the provision of safe and satisfying prenatal care and delivery. Each must exquisitely recognize their own limitations and accept the appropriateness of their services to each situation, without bias. Unfortunately, babies die no matter what the setting. Neither the hospital nor the home is immune…having a chasmic divide between sides will get us nowhere. United we stand, divided we fall.”

This must be just one of many letters you have received about the one-sidedness of The Perils of Midwifery. We trust The Today Show will do a second, more evenhanded program on this vital issue, and look forward to your response outlining your plans in this regard. As part of a more balanced presentation, you might be interested in covering Maternal Health Care in the 21st Century: Sarasota and Beyond on November 1st. We would welcome the Today Show’s reporters and photographers at this discussion. We hope the program will pave the road to improved maternity care in our own community.

NBC and the Today Show have an opportunity to present a balanced report on maternal healthcare in the US and to thereby display an earnest effort of leadership toward improving maternity care in this country.


Laura H. Gilkey
Vice President, Florida Friends of Midwives

Sonia Pressman Fuentes
Co-founder, The National Organization for Women

(1) Encl.

Cc: Peter Alexander, TODAY / NBC News Correspondent
Matt Lauer, TODAY Anchor
Jeff Zucker, President and Chief Executive Officer, NBC Universal
Steve Capus, President, NBC News
John Eck, President, NBC TV Network and Media Works
Ina May Gaskin, Founder and Director, The Farm Midwifery Center
Jennifer Highland, Executive Director, Healthy Start Coalition of Sarasota County

1 comment:

  1. Beautifully presented! Thank you for being the voice for so many.