Jen Holloman Told Her Home Birth Story to the Boston Globe
Tuesday, July 12, 2011 at 5:05AM
By Jill Arnold
A dear friend of mine was featured in an article by Catherine Elton in the Boston Globe this weekend. First interviewed in February, Jen experienced the other side— that is, what readers never see— of the 
construction of an article about home birth and a lawsuit. The epic battles never cease for her, having already battled the Cape Cod Chupacabras last month.
Boston.com is owned by New York Times Digital, which means that the story was picked up all over the place.
The spokesfarmer’s article is titled Her home-birth battle.
Jenifer Holloman hadn’t been doing many chores on her farm in the past few weeks on account of the sheer size of her belly. But that evening, she had to tend to a ewe that had given birth a few days earlier. The lamb wandered off in a snowstorm and died of exposure. Now the ewe’s teats were heavy and swollen with milk, and there was no lamb to relieve her. Everyone who heard the story lamented the loss of the lamb. Holloman agreed that sometimes animals’ lives on earth are too short. The only thing she, as a farmer, has control over, she told them, is the quality of care she provides them.
Reader Comments (19)
The goats were returned- one has now gone to live as a pet in Connecticut and the other follows me around the barnyard. I am not sure what her fate will be.
In Connecticut, "pet" means "dinner." It's a little known fact.
Just as when the article about your goats being on the lam (groooooan) came out and I was so excited that I personally knew one of those goats, I am proud of you, amazed by your strength in dealing with everything, let alone this article. If only people knew what goes into it all before it hits the press.
That is one of the best and most in-depth article I've read on home birth and lay midwifery care vs. hospital birth. It seems that the modern obstetrical climate makes both of them less safe for women and babies. I'm so sorry about Jen's loss of baby Emmet.
Thanks for your comment, KK.
Emmet was a beautiful baby.
I left this comment elsewhere just so you know:
Just for the record- interview participants do not, and can not control the content of a story, this story has gross exaggerations and omitted details and facts that would have more accurately portrayed everyone involved, and for the record we asked that the Globe grant us anonymity and they reneged on it after the interview was granted. They also flatly REFUSED to cooperate with our requests that they remove damaging details. We did not want further harm to come to any person, midwife, or doctor involved with this story. And IF I thought for one second anyone here besides the people that I actually know IRL would understand and respect the nuances of my full opinion I would sit here all day long explaining it. Sadly, I find most people here cannot and will not even try to explore the full spectrum of the argument. Try telling a stillbirth mother who would never have a home birth after she finds out she is pregnant again that she gets to go get the same lackluster care (if negligence played a role). This story would be we had hoped a story about making maternity care accessible to working families (they got that detail wrong, at the time our premium was 179.00/ adult in my household and I was unable to access maternity care until I was 16 weeks pregnant- talk to Mitt Romney about that please) I paid my way for years, and when you find yourself uninsured after paying for health insurance it is a very murky situation. I didn't know what I didn't know- my choice of OB wouldn't take me- and I should have just walked into an ER and said I had a stomach ache. Now I know and my baby Emmet paid the price(s). This is an issue about patient safety and about holding ALL providers accountable. If a person holds themselves out as skilled and knowledgeable they should be. That is the message we wanted to convey-. Anyone who reads this should be more digusted that the DA in Barnstable county, the investigator from the state police, the Massachusetts dept. of public health and Massachusetts Attorney General Martha Coakley's office did nothing to stop her midwifery practice. That is the take away. No one cared- because what's one dead home birth baby right?!
It's not that Amy is abrasive, it is that Amy is behaving exploitative with my story. She sees this story as another plank on her soap box against home birth. She can be against home birth all day long why golly, she has made a career of it. But her and other people's fallacious reasoning is that no licesnure is better than licensure. That does not make sense- read above who I contacted to hold my health care provider accountable.
Additionally, I will say that there are families who come here that I have met through the internet who have lost babies at home and they find solace and help in Amy. I think this is a very good thing for them, bereaved parents need special care and I am glad she is here to help them through it by allowing them a space in which to talk about their grief and pain.
It is not however my trajectory, but I respect Amy for allowing and holding a safe space for them to grieve and tell others of their pain. I think whether Amy realizes it or not she does more for the cause and justification of licensure of home birth midwives than she knows- so I guess Thanks Amy- for making sure that subpar providers are compelled by state agencies to get licensed and be accountable to the clients they serve. Thanks Amy! Thanks Amy's army. :)
That was an excellent, non-biased article. True journalism still exists.
Jen- May the universe continue to shine upon you in your journey. I'm sorry for the loss of your son. If you need a home for your goat, I wonder how expensive it would be to get it to Missouri?
Katie
I am so sorry, Jen. Thanks for sharing your story and for fighting for what you believe in.
I am appalled by the description of the care you received.
I think it's unfortunate that you are getting resistance by people who think homebirth should be completely unregulated and people who think it should be completely illegal. There has got to be an in between that is better for practitioners, moms and babies.
Jen, I am truly humbled by your courage and your rational, well considered approach to this tragedy. There are few indeed who would have approached the aftermath in the manner that you have. There is a raging debate within the home birthing community regarding licensing. I work with and know many very competent lay midwives who are adamantly opposed to a licensing bill that is currently before the North Carolina legislature. Their point, and it is a very valid one, is that the conditions of licensure will make it impossible for them to practice real midwifery. They they will be forced to "risk out" virtually everyone that comes to them. For example, you would not have been able to have a home birth under our proposed regulations nor under the regulations of any state that I'm aware of on a number of grounds, your age at time of delivery, your previous C/S, your prolonged rupture of membranes; all of these would have prevented a licensed home birth midwife from attending your delivery. (For the record, I am an obstetrician. I do attend home deliveries, and I would gladly have attended anyone with those risk factors at home). So while licensure is a necessary evil, there is a down side.
Let me also add, I am suspicious of the listed cause of death. Chorioamnionitis is a not uncommon and not particularly devastating infection of the chorioamnion - the gestational sac. Chorioamnionitis occurs quite frequently and is probably greatly exacerbated by unnecessary cervical exams both prior to and during labor. It is so common because the chorioamnion has no blood supply and thus no effective means of fighting infection. The cervix does a pretty good job of keeping bacteria at bay, even during labor when large quantities of cervical mucus continuously flush vaginal flora out of the babies path. However that mechanism is easily overwhelmed by cervical exams (which have never been shown to improve neonatal outcomes nor are they particularly predictive of the course of labor).
Deaths associated with Group B strep are invariably due to neonatal sepsis - an overwhelming blood born infection the most common cause of which remains Group B Strep. It is somewhat unusual for GBS sepsis to cause intrapartum demise. Most cases are post partum. Just information I thought you should have. Certainly allowing labor to continue without intervention in the context of maternal fever and chills is heart-wrenchingly inappropriate care and the diagnosed cause of death may just be sloppy paperwork. But I wouldn't exclude a cause of death that wasn't diagnosed.
I am deeply sorry for the horrendous path by which you came here but I applaud the direction you have turned that energy. Congratulations on the birth of your daughter.
Thank you for sharing. I am deeply sorry for your loss of sweet Emmett but so happy for the arrival of your daughter. Thank you for your work.
This point is so important, perhaps the most important, that Home Birth is safest when there is a trained attendant and hospital collaboration. If people stopped arguing over WHICH is safer/better/right and saw the possibility in open communication, open education and acceptance it would be a different world. My last birth was a transfer and, aside from having to repeatedly explain myself, it went fairly well. I wish that my CNM had been allowed to accompany and attend me there instead of the skeptical stranger I got by default. Instead of hearing "you did what was right in the situation" I hear either "you could have stayed home" (the classic you sold out and harmed HB criticism) or "hah, I told you so". The way I see it- We helped HB by proving that a good provider knows when to choose the hospital option, thereby making BIRTH safer/better/right.
Jill, thank you for sharing. Jen, I am so sorry not only for your loss, but the heartache of attempting to set things right. What I am going to say is really obvious, but apparently needs saying. Licensure and regulation are no panacea - there are dangerous licensed providers in every state. There are dangerous docs who fight the hospital process to get them to shape up and IF they lose their privileges, the process can take years, while they continue their practice . There are dangerous midwives reported to the state with no consequences. On the other side, there are competent midwives who get reported to their state board after a proper hospital transfer - leading some midwives to delay transfers.
I support licensure of midwives, but I have no illusion that licensure will change very much. I work in a state with licensed midwives and have great respect for most of them, just as I have great respect for most of the docs in my community. Rooting out the bad apples will take much more than licensing.
I am one of a handful (100 or so) Certified Nurse Midwives who attend births at home. I read Jen's story with sorrow and a sense of being transported to a familiar landscape- the beauty of Cape Cod; the sounds and smells of the sea and the farm and the labor all rolling into one; seeing in Jen my own tall, determined goatfarming client from years ago with a good baby and a bad hemorrhage; the frustrations of transporting; the shocking silence of stillbirths. Please express to her my deepest thanks for being willing to share it with us here.
And however misrepresentative of important facts and details, the journalist is a good writer, pacing the story well, doling out the details bit by bit so you read the in-between parts about licensure and safety that otherwise most readers would skip.
The arguments for and against licensure beg the question of education. The reason that laws regulating midwifery practice end up being written with excessive detail is the need to establish a lowest common denominator of skill to have a reasonable assurance of safe practice. If "licensed" midwives can only attend women whose babies could pretty much have fallen out on their own then the midwife's level of training, expertise or competence doesn't much matter. The alternative, as was done in New York, is to have the educational standard for licensure high enough that it acts as a barrier for those midwives who have not obtained the necessary training to function as clinicians when that is indicated. The CPM title can be obtained through multiple educational routes including a portfolio review after apprenticing under a midwife who can herself/himself, have attended as few as fifty births. That is not a reasonable standard of eduction under the international definition of a Midwife: www.internationalmidwives.org
Birth is about as safe as life gets and reproduction is a normal body function. But normal body functions can be broken and fail - ask anyone who has had a heart attack. Normal birth doesn't need to take place in a medical environment any more than the general population needs to go around on heart monitors or live in the ICU. But if you call yourself a midwife, then you had best be able to recognize when something isn't normal and know what to do next, in which regard it appears Ms Allen failed the family who had looked to her for expertise.
BTW: I appreciated the OB's comment here questioning the cause of death as chorioamnionitis, a condition of the mother, not of the child. GBS sepsis is a diagnosis in its own right, and if that was established it should be listed as cause. Why? Because moms with chorio most often deliver live babies who are not infected with GBS (only 4% transmission rate with documented untreated chorio). And liveborn babies with GBS sepsis often die, regardless of where they were born (up to 50% if untreated). It doesn't bring Emmet back, but he deserves a truthful description of his life and it's loss.
I've come to relucantly support the licensure of midwives although I share Quietly's concerns about the standard of education required for the CPM. However, I can only support licensure if there is accountability. The purpose of state licensure is to provide a group a monopoly on a service by erecting barriers to entryr. In exchange for the monopoly the group sets minimum standards and self polices its members. Without the self policing licensure doesn't help consumers because only the group with the monopoly reaps the benefits of the monopoly. I am not convinced that CPMs will adequately self police.
How many licensed midwives have lost their licenses for bad outcomes or unprofessional behavior? I think we're all familiar with Liz P's case. What happened to her was shameful. It doesn't give me confidence that CPMs will sanction their own. If CPMs want to be treated like professionals and bill insurance and Medicaid, they should behave like professionals and hold their members accountable which is not what happened in Liz's case.
I would only support licensure statutes that included penalties for non-licensed midwives. Non-licensed midwives should be subject to criminal penalties just like non-licensed physicians. I realize that this means that some midwives would go underground. Licensed midwives would only be able to take certain kinds of cases and women deemed to be high risk who still wanted a homebirth would either have to UC or work with a unlicensed midwife. But the overall benefit of licensure (if enforced properly) outweighs the risk of a few women UCing or working with unlicensed midwives.
There would also need to be consensus about what constitutes risk that is too high for a homebirth. I know this is controversial and it would be difficult to reach that consensus. Certainly some women would be excluded. But overall it benefits more women even if it limits the access for some women to homebirth with a licensed midwife. I'm sure that I would be one of those women excluded because I'm over 40 and have had a prior c-section. Although admittedly I would never consider having a homebirth and working with a CPM so it's not any sacrifice on my part. Jen would probably have been excluded as well.
Overall any kind of state licensure is a "one size fits all" solution. In specific individual cases it won't be fair. But overall the benefits to the majority outweigh the burdens placed on the few.
I was forwarded the Boston Globe article via another mama who thought that I might try to get in touch with Jen after reading it.
Jen, I am so sorry for the loss of your sweet baby Emmet. I read your article, reflecting so many parts...parts of my own homebirth experience that ended in the death of our first child, Birdie. We lost her on March 3, 2007 after more than 24 hrs of labor at home, no progress, a sudden drop in her heart rate, emergency c-section...she was not born alive and never was revived.
I read your story and am moved to get in touch, for a time after Birdie's death I wondered if there was anything I could do to prevent another Mama from having a loss such as ours. The whole homebirth debate has bothered me every since she died....thank you for advocating for this legislation. Not sure how I might be able to help, but I will if I can.
Congratulations on the birth of your baby girl. What a miracle!
In Kindness.
Erin (Birdie's Mama & Holdyn's Mama - born alive October 3, 2008)
I am so sorry for your loss, Jen.
Jen, I appreciate so much your telling your story and the work you are doing.
There are so many parallels here with the abortion debate--I know that's a touchy topic and all, but it's so clear to me that the desire of women to control what happens to their bodies is a constant battle in both cases.
And it should not be. It should be respected, and included as a basic assumption when women seek care, so that we aren't constantly choosing between our agency and our safety.
Licensing midwives is not perfect, but it's a step, and it's the only logical way forward.
Emjaybee, I agree that licensure is needed but I'm not sure that it supports autonomy. With licensure there will be cases when a woman wants a homebirth but licensed midwives will not be able to attend her because they would risk losing their license. With professional responsibility there will always be a conflict between what the patient wants and what the professional is obligated to do. For example, an OB will fear a lawsuit (rightfully) so will refuse to attend a high risk VBAC even if the woman chooses to VBAC. If there is no accountability because the professional is simply doing what the patient wants then licensure has no meaning.
Anon, but OBs and midwives are not monolithic. There is a wide variety of opinions among any group of medical practitioners, and I don't believe that licensing midwives will mean that most women will find themselves risked out of care, if only because midwives could not make a living if it did.
There will always be women who choose to birth unassisted or with someone who's unlicensed; I support the right of women to do so, provided they are aware of the risks (by support I mean, I don't think any woman should be prosecuted or fined for it should something bad happen, any more than we throw people in jail for taking folk remedies that turn out not to work or that make them sick).
Though I would *still* hold their attendant responsible if something goes wrong that they should have been able to spot; that's the responsibility that comes with the job, and if someone wants to call herself a midwife, lay or certified, she needs to be up to that responsibility (just as I would hold the seller of a folk remedy responsible for someone who got sick using what they sold).
Emjaybee, your language is interesting to me.
First, we need to make an important distinction here between taking folk remedies and choosing to UC or using an unlicensed midwife. Parents have been held legally accountable for giving their children dangerous folk remedies and withholding standard medical treatment from their children. Courts have stepped in and overrode the parents' medical decisions in some cases. That's not analogous to homebirth because legally a birth doesn't harm a child because a fetus isn't a child according to the law. (admittedly that's a very broad statement and there are women who have been prosecuted for attempting suicide while pregnant or drinking or using drugs which undermines this) Therefore, women have the right to UC because adults have the right to make bad medical decisions. But this not related to a state's regulation of a profession. This falls either under a criminal statute or under the state's right to protect children.
Second, you state that they have this right "provided they are aware of the risks." Their rights have nothing to do with their awareness of the risks. You don't earn your right to make decisions about your medical care through education. (this is one of the reasons why I am so troubled by the idea that it's acceptable for women to get epidurals if they're knowledgeable about the risks)
Third, you would hold the attendants accountable if something went wrong and they could have prevented it. That's not how licensure statutes work. An unlicensed doctor is breaking the law regardless of whether he/she harms anyone. It's not the act of giving bad advice that is illegal but rather that only a licensed professional can practice medicine.
Fourth, you would hold the seller of a folk remedy responsible if there was a bad outcome. How? The seller is not a licensed professional. There is a potential for accountability but not under the state's regulation of a profession. The seller of a folk remedy is not comparable to a healthcare professional licensed by the state.
I don't see much evidence that the supporters of the licensure of midwives actually understand what licensure is supposed to mean and that concerns me. My fear is that there will be licensure without accountability because of this misunderstanding. The root of the misunderstanding, in my opinion, is a misunderstanding about what it means to be a healthcare professional. The recent Karen Carr story illustrates this point. The mother to be in that case was risked out of homebirth by her licensed CNMs and her licensed OB. The licensed professionals here believed because of their professional obligation to the patient they could not support her in a homebirth that was too risky. She still wanted to homebirth and found an unlicensed midwife who believed that her role was to do what the mother wanted, even if it was too risky. That to me illustrates a fundamental difference in attitude. My fear is that licensed CPMs and, even worse, the licensing boards for CPMs will have that same mentality.
Of course you're right that there are differences of opinion between professionals. That does not mean that there can't be minimum standards. In medicine, the minimum standard is the standard of care.
"and I don't believe that licensing midwives will mean that most women will find themselves risked out of care, if only because midwives could not make a living if it did"
I forgot to address this in my post above. Are you suggesting that midwives would be financially incentivized to not risk women out of homebirth? I believe that's a real concern which is one of the reasons why I doubt state midwifery boards will do their job and hold midwives accountable.
There are two conflicting ways of self policing a profession. The first is that the profession regulates their own to protect their own, e.g. the State Board of Medicine punishes doctors who act unprofessionally or pose a risk to the public to protect the reputation of the profession. This hurts the sanctioned physician but benefits the profession as a whole. This is usually the way state medical boards and state nursing boards operate. It's a form of enlightened self interest.
The second view is that the profession sees its role as protecting its members at the expense at those outside of the profession. This is only sustainable in the short term because eventually those on the outside lose respect for the profession. In my observation this second view is what motivates most midwifery boards. They see their role is to protect homebirth and homebirth midwives. It's very short sighted and is only "self interest" not "enlightened self interest."
I think most of us believe state licensure is inevitable. If for no reason other than midwives are cheaper than OBs. My fear is that the licensure will come but the boards will be motivated by the second view, not the first, and and that puts all women who use midwives in danger. Further it doesn't eventually advance the interest of midwifery even if it protects a few midwives practicing today.
My question is whether the advocates of CPM recognize this danger and will work to ensure that there is a change to the first view. I'm not optimistic.