Ina May runs away

I try to follow as many natural childbirth pregnancy blogs and websites as I can to keep up to date on what women are reading across the web. As I have repeatedly noted, most of them are chock to the brim with misinformation, misleading information and wacky “information.” Occasionally I will comment when I see a particularly egregious example, like a recent blog entry about maternal mortality on Babble. I have written a great deal on the subject (Hold the handwringing: is maternal mortality really rising?) and wanted to correct the manifold errors in the piece.

No, maternal mortality is NOT rising. It has fallen in 2006 and fallen again in 2007 to 12.7/100,000, facts that this piece completely ignores.

Moreover, it is far from clear that maternal mortality was ever rising. A careful review of the data suggests that changes in the way that maternal mortality is assessed may be leading to a spurious “increase” in maternal mortality.

The author of the piece had no response, not surprisingly, but the other day Ina May Gaskin parachuted in, once again attempting to cynically exploit this tragic issue as she has been doing for years on her “Remember the Mothers” website. She calls for “honesty” and then proceed to offer a bunch of out of date bibliography salad and never addresses any of the issues that I raised.

Here are just a few examples of articles that have been published during the last decade or so about the too high US maternal death rate: “Pregnancy-related deaths: Moving the wrong direction,” published in OBG Management, January 1998; “Maternal mortality: No improvement since 1982.” ACOG Today, August 1999; Maternal mortality: An unsolved problem. Contemporary Ob.Gyn, September 1999; “U. S. maternal death rates are on the rise.” The Lancet, 1996; “Pregnancy-related deaths increasing,” Contemporary Ob.Gyn, December 2010.

To anyone who knows anything about obstetrics, this bibliography salad is not only out of date (newsflash: anything before 2000 is NOT in the last decade, and, considering that we are discussing maternal mortality from 1998 to 2005 has absolutely nothing to do with this purported rise), but it is laughable. OBG Management, ACOG Today and Contemporary Ob.Gyn are what is known as “throw away” magazines. They are not journals, and they are mailed to almost all obstetricians for free. It’s the equivalent of citing “House Beautiful” to make a claim about architecture.

Ina May was obviously cutting and pasting from out of date claims she has made in the past (she accidentally pasted twice), and actually makes my point for me:

Prior to 2003, only 2 states used the US Standard Death Certificate—the only one containing the questions that CDC epidemiologists designed to prevent misclassification of maternal deaths. Many states still refuse to use the standard death certificate. This makes the CDC’s data much less accurate and useful than they should be for such an important statistic. Underreporting maternal deaths leads to a false sense of security and misunderstanding of the true causes of preventable deaths.

Yes, Ina May, that’s just what I said. Prior to 2003,there was considerable under-reporting of maternal deaths. And just as under-reporting can lead to misunderstanding about the scale of maternal mortality, correcting that under-reporting can lead to a spurious “increase” in maternal mortality.

Babble began promoting the exchange on Twitter:

Are you team Ina May Gaskin or Dr. Amy? See what they have to say about pregnancy related deaths in the U.S.

I responded to Ms. Gaskin:

You represent yourself as shocked at the current rate of maternal mortality. Yet as far as far as I can tell, direct entry midwives in general and you in particular have done NOTHING (no research, no education, no fund raising) to reduce the incidence of maternal mortality. In contrast, modern obstetrics has lowered the maternal mortality rate 99% PERCENT in the past century…

Anyone who visits your “Remember the Mothers” website will notice something rather curious. There is NO information about the causes, treatments and research into maternal mortality…

… You want to leave the impression that maternal mortality is caused by obstetric interventions…

The reality, as you OUGHT to know, iatrogenic deaths represent a tiny fractions of maternal mortality. The most common causes of maternal mortality are complications of pregnancy and pre-existing medical conditions.

You should be embarrassed at the way that you have deliberately misrepresented the issue for your own personal ends.

Then Ina May ran away. I’d like to think she was ashamed, but I doubt it. She had simply used up everything she had to say on the subject (relevant and irrelevant) and had no response. Like all professional natural childbirth advocates, she was not going to engage in a debate that required her to defend her claims.