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Can midwifery educators use the “Failure to Deliver” article for teachable opportunities?

Published on 1/8/2019

Can midwifery educators use the “Failure to Deliver” article

for teachable opportunities?

Justine Clegg, MS, LM, CPM

Suzy Myers, LM, CPM (ret), MPH

Wendy Gordon, LM, CPM, MPH


The recent GateHouse Media article “Failure to Deliver: How the rise in out of hospital births puts mothers and babies at risk” ( describes some heartbreaking stories of tragic outcomes from babies born in home or birth center settings under the care of midwives.  The article looks at a very complex problem through a narrow lens that seems to assign responsibility to midwives to fix a system which is beyond our control.  The vast majority of CPMs are advocating for licensure in all 50 states which would not only solve the lack of regulation in certain states, it would also improve the ability of midwives to promptly and smoothly access medical care for clients who need consultation, referral or transport during pregnancy, labor or the immediate postpartum.


Although the article was written with obvious and apparent bias, the article brings up important issues for the midwifery community to consider. How can we midwifery educators use this article in preparing our students to become safe, compassionate midwives? 


We’ve prepared some ideas for discussions and assignments that educators can implement with students such as:

  • Discussion: After reading about the experiences of loss in this article, how can midwives support families through pregnancy loss? What effects might a prior loss have on the family system and on the client in a future pregnancy?
  • Discussion: What might be the effects of blaming and shaming families who choose to give birth in home or birth center settings? What might be the effects on the midwives who attend them? How might you cope with similar responses when you participate in a transport during your clinical training?
  • Assignment on information literacy: Examine the assertions made in this article. How would you know if they were true or false? Where would citations have strengthened their arguments? Why do you think there were none?
  • Assignment on epidemiology: What is the difference between absolute risk and relative risk?How were each used throughout this article? How might you use absolute and/or relative risk in a conversation with a client?
  • Assignment on epidemiology: In what ways might birth certificate data give an inaccurate picture of the risks of home versus hospital birth? Analyze the birth certificate in your state. Are planned/ attended home births able to be distinguished from unplanned/ unattended home births? Is it clear when a birth may have started at home but transferred to the hospital during labor? How might these things affect your ability to use this data for research purposes?
  • Assignment on evidence-informed practice:Examine the research about what makes birth in home and birth center settings safer, including an objective study of those hot topics – breeches, multiples and HBACs – through the lens of access, ethics, state laws and rules, shared decision making, and the responsibility of midwives for evidence-based practice and quality improvement mechanisms.
  • Discussion: What does “safety” mean when considering the risks and benefits of various birth locations?
  • Assignment on evidence-informed practice: Conduct a literature search on the evidence about the safety of home and birth center birth and compare your findings with the assertions in the GateHouse Media article.
  • Discussion: What are some of the negative effects this article might have on consumers? On physicians and other maternity care providers? How does perpetuating these negative images of midwives impact midwifery practice? How will you address the perception that home birth midwives are dangerous, unregulated and poorly trained?
  • Assignment on midwifery history: Use the book Witches, Midwives and Nurses to frame this article within the context of a long legacy of the denigration of midwives in the US. What are some of the differences in the utilization of midwives in the US vs other countries?
  • Assignment on professionalism: How do midwives in your region handle disciplinary issues within the profession? What are the ethical and legal obligations to address poor practice and whose responsibility is it?
  • Debate the issue: What are the benefits and risks of midwives carrying liability insurance? Discuss from a variety of perspectives: accountability, access, cost to midwife/profession and “system”.
  • Assignment on professionalism: Choose a state to examine. How are midwives implementing the Home Birth Guidelines in that state? Learn about NNEPQIN in New England and Smooth Transitions in Washington State. How might a similar project be started in your area?
  • Assignment on maternity care systems: Compare and contrast birth outcomes in the US versus other highly resourced countries within the context of the different health care systems. How does each country utilize midwives within their systems?
  • Assignment on maternity care systems: Learn about The Birth Place Lab’s study on Access and Integration Maternity Care Mapping. What does the data tell us about how the status of midwifery in each state correlates with access, equity, and outcomes? How do politics, like those displayed in the Gatehouse News article affect maternity care in different states? What changes in your state could advance the ability of midwives to improve pregnancy outcomes?
  • Assignment on professional organizations: Research some of the national maternity care stakeholder organizations (ACOG, AAP, AWHONN, SMFM, APHA) and their positions on midwifery care and home birth. How have those positions have changed over time? What role does USMERA play in shaping these positions? How might their positions be leveraged in legislation and policy making?


How have you used this article in your practice or classroom?  Please share with us!