What do homebirth midwives and tobacco executives have in common?

The Midwives Alliance of North America (MANA), the organization that represents homebirth midwives*, thinks it’s time to reframe the debate about homebirth safety.

According to a MANA press release issue two days ago:

We believe it is time to re-frame this conversation. Midwives and obstetricians have been debating the safety of homebirth for far too long. In North America today planned homebirth for healthy women, attended by skilled providers, with access to medical consultation when necessary, is a safe option….

In other words, as the evidence mounts that homebirth leads to preventable neonatal deaths, we should stop talking about it.

Evidently, MANA and homebirth midwives have decided to copy the tactics used by the tobacco industry to divert attention from the fact that cigarette cause preventable deaths. SourceWatch explains the tobacco industry’s attempt to reframe the debate:

The “reframe the debate” strategy consists of moving the topic of a contentious dispute onto a wholly different topic. This involves making dire predictions of a more extreme outcome, portraying the original action as dangerous, tying activists to the dangerous outcome, linking the originally-proposed action to a fear-inducing outcome …

As the Tobacco Institute explained to its members:

Our judgement, confirmed by research, was that the battle could not be waged successfully over the health issue. It was imperative, in our judgement, to shift the battleground from health to a field more distant and less volatile…

Evidently MANA has made the same calculation. As I have detailed many times in the past (So tell me again why MANA is hiding its own homebirth safety data), MANA’s own data shows that homebirth has an unacceptably high rate of neonatal death. MANA knows that “the battle [can] not be waged successfully over the health issue” of homebirth safety. Therefore they have to “reframe the conversation.”

Let’s compare the tactics used in the MANA press release with the tactics of the tobacco industry.

Choice and responsibility


First, we must understand the bio-ethical principle of autonomy as it relates to the human right of self-determination in making health care choices. Only then can we support women in their mastery of self-determination as they navigate the complicated worlds of obstetrics and maternity care and attempt to make good decisions for themselves and their families.

Tobacco industry:

[C]reate a campaign which frames and answers this question: Does America want prohibition? Will we tolerate a puritanical wave to infringe, to restrict and possibly to eliminate personal freedoms and individual choices?

Broaden the issue


… [W]e can no longer tolerate the abysmal maternal and child health disparities that exist for our most vulnerable women and populations of color. We have our plates full with the daunting task of improving the health status of all women and infants in the United States within a social justice framework.

Tobacco industry:

The tobacco industry typically diverts attention away from a problematic topic by broadening the issue to encompass other issues. For example, the industry broadened problem of secondhand tobacco smoke or environmental tobacco smoke into a discussion of overall indoor air quality, and moved discussion of the issue to include pollutants in the air other than tobacco smoke, such as wood smoke or automobile exhaust, or shifted the focus to the efficiency (or lack thereof) of mechanical ventilation systems.

Change the focus MANA:

… We must address the fact that certain costly obstetrical practices that are not supported by science are overused, while other beneficial, low-tech practices are overlooked. Of particular concern to the Midwives Alliance and the clients we serve is the trend of increasing rates of cesarean sections, contributing to increased rates of premature birth, low birth weight infants and rising healthcare costs, while women across the country still struggle to find providers willing to attend vaginal births after cesarean (VBACs).

Tobacco industry:

…Finally, we try to change the focus on the issues. Cigarette tax become[s] an issue of fairness and effective tax policy. Cigarette marketing is an issue of freedom of commercial speech. Environmental tobacco smoke becomes an issue of accommodation. Cigarette-related fires become an issue of prudent fire safety programs. And so on.

Clearly MANA and the tobacco industry have followed the same playbook for the same reason: to divert attention from the issue of safety.

The MANA press release concludes:

… We can no longer be diverted by the distractions of disagreements among maternity professionals. We have serious work to do that cannot wait…

But homebirth safety is NOT a distraction. It is the central issue. And the only people who “cannot wait” to confirm the fact that homebirth has an unacceptably high rate of neonatal death are homebirth midwives.

The Midwives Alliance of North America already KNOWS that homebirth increases the risk of neonatal death; their own data tells them so, and that’s why they are desperately trying to hide that data. MANA “cannot wait” because they understand that more research will only confirm that fact. They need to act now before everyone learns that homebirth kills babies.

*American midwives who hold a post high school certificate (CPMs and LMs), as opposed to American certified nurse midwives and European, Canadian and Australia midwives who have university degrees