A birth activist once told me that she had heard Judith Rooks express regret for undertaking a study on VBACs in birth centers. Rooks had been confident that the study would show that it is safe to have a VBAC in a birth center, but it showed the opposite. Prior to the study, VBAC was considered a reasonable option for birth centers; after the study it was prohibited. Yet even though she was disappointed with the results, even though they showed the opposite of what she had wanted to show, she published them anyway, because that’s what ethics requires.
I don’t know if the story is true, but it was one of the first things I thought of when listening to Rooks testify before the Oregon legislature about the appalling rate of death at the hands of Oregon homebirth midwives (8X higher than the death rate in the hospital). She sounded deeply grieved to have to report that homebirth, which she supports, is unsafe as practiced by Oregon homebirth midwives, yet she reported it anyway, because that’s what ethics requires.
Her testimony highlights the profoundly unethical behavior of the Midwives Alliance of North America (MANA), Melissa Cheyney, and the midwifery hierarchy of Oregon. All three conspired to commit what amounts to fraud: for many years they have been deliberately hiding that homebirth with a homebirth midwife has an appalling neonatal death rate both in Oregon and in the country as a whole. It is the midwifery equivalent of the Vioxx debacle. Although the hierarchy at the Merck drug company was aware that the pain killer Vioxx increased the risk of death from heart attack and stroke, they marketed it anyway. They took the position that it was more important to make money from Vioxx than to protect consumers. It eventually caught up with them. To date, Merck has paid out billions to the thousands of families of those who died as a result of taking Vioxx.
MANA, Melissa Cheyney and other homebirth midwifery executives have knowingly and deliberately taken the position that it is more important to be able to work as homebirth midwives than to protect mothers and babies. In many ways, the case for hiding the appalling death rates at homebirth is more compelling economically than the case for bringing Vioxx to market. While Vioxx represented a significant share of Merck’s income, it was no where near 100% because they have many other products. In contrast, homebirth midwifery usually accounts for 100% of the income of homebirth midwives. Revealing the truth about homebirth deaths would have a major impact on the ability of homebirth midwives to attract clients and make money.
I suspect, though, that money was not the only or even the primary motivation behind the unethical behavior of Melissa Cheyney and MANA.
We are currently immersed in a virtual epidemic of unethical behavior among scientific researchers. It is so easy and so tempting to report fraudulent results that it happens all the time. Partly it is the tremendous pressure to publish scientific papers, but often it is the result of a researcher believing so profoundly that his theory is correct that he (or she) feels no guilt about “massaging” the data to support the theory. They don’t believe that they are committing fraud because they are sure that future data will ultimately prove them right, but they can’t wait for future data because people can benefit from the theory now. Couple that with the fact that scientific journals rarely demand that a finding be reproduced before publication and you have the perfect formula for the plethora of scientific papers routinely published even though they are junk.
I have no way of knowing, of course, but I suspect that something similar has been going on at MANA. It started in 2005 with the Johnson and Daviss BMJ paper that claimed to show that homebirth was safe even though the data showed that homebirth nearly tripled the risk of neonatal death. And it has continued ever since with Melissa Cheyney and MANA waiting desperately for the data that would show homebirth to be as safe as they know it is. That data never came because homebirth midwives are grossly undereducated, grossly undertrained, unsafe practitioners. The longer they waited for confirmation of what they believed, the more they were required to contort themselves to hide the data they had. One thing is sure: they demonstrated consciousness of guilt by deliberately hiding the information from American women.
Many of their tactics over the years demonstrated their consciousness of guilt, but none more so than the decision to share the data only with those who, after being appropriately vetted, would sign a non-disclosure agreement complete with legal punishments for those who shared the data with anyone else. In other words, they understood that the death rates were so hideous that they had to take the incredibly heavy handed and revealing step of announcing legal punishments with anyone daring to share the truth with American women, the one group that was most entitled to have the information.
It appears that MANA, Melissa Cheyney and the midwifery hierarchy never considered their ethical obligations, and not just their obligation to release the data. Almost any other professional organization, when confronted with the evidence that their practitioners were responsible for an appallingly high death rate, would have instituted plans for improving outcomes. It seems never to have crossed the minds of Cheyney and others in MANA. Babies dying preventable deaths? Sad, but apparently a small price to pay for the freedom to be a pretend “midwife” and charge women for services that are apparently literally worse than nothing. The folks at Merck having nothing on Melissa Cheyney and MANA when it comes to the cold blooded sacrifice of innocent people (babies, no less) on the alter of expediency.
Now, of course, their efforts to hide data have been eclipsed by states collecting their own data and they have no one but themselves to blame. As I have written in the past, the biggest mistake that homebirth midwives ever made was their campaign to obtain licensure. They didn’t want to do it, but they wanted insurance reimbursement so badly (and insurance companies will only reimburse licensed practitioners) that they took the risk and it has blown up in their faces. You can fool some of the state legislatures some of the time, but not all of them, and it is hard to fool insurance companies at all. It was inevitable that they were going to demand data, and collect it themselves if need be. Now that data is coming in and it is very, very ugly. What insurance company is going to be willing to reimburse providers that have appalling death rates and, almost certainly, appalling injury rates? And birth injuries are not cheap. They can cost hundreds of thousands of dollars in acute care (think head cooling to minimize neonatal brain damage) and millions in chronic care for those left permanently impaired.
Judith Rooks modeled ethical behavior for midwives and it would behoove them to follow her example and release the data they are hiding and take the steps necessary to improve safety. I have little hope that will happen. The way I see it, the disclosure of the appalling death rates is not the end for the CPM credential, although I suspect that is where it will lead us. Rather, like Winston Churchill once said in another context:
Now this is not the end. It is not even the beginning of the end. But it is, perhaps, the end of the beginning.
It is the end of period in which homebirth midwives were able to hide the dead babies, and, as such, marks an important turning point toward the inevitable abolition of the CPM credential. CPMs are not eligible for licensure in any other first world country. It is time to insist that they are not eligible for licensure in the US, either.