Another day, another bunch of lies from the Midwives Alliance of North America

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Hey, MANA, how long do you think lying about homebirth deaths is going to work? Don’t you think women are going to notice the growing pile of tiny dead bodies? Do you really think you can continue to mislead American women as you have done in the past?

The latest mendacity from MANA is this piece of junk, Understanding Outliers In Home Birth Research.

It is written by Wendy Gordon, CPM, a member of the MANA Division of Research.

You may remember Wendy Gordon, CPM, LM, MPH, Assistant Professor, Bastyr University Dept of Midwifery (and placenta encapsulation specialist!). She’s been arguing with me in print for years, and she hasn’t been correct yet.

What’s Wendy up to now (besides withholding the death rates of the 27,000 homebirths in MANA’s own database)?

Wendy is upset that a recent study showed that homebirth increases the stillbirth rate by 1000%. I wrote about the paper when it first appeared online ahead of print in June.

The authors found:

Home births (RR 10.55) and births in free-standing birth centers (RR 3.56) attended by midwives had a significantly higher risk of a 5-minute Apgar score of zero (p<.0001) than hospital births attended by physicians or midwives. Home births (RR 3.80) and births in free-standing birth centers attended by midwives (RR 1.88) had a significantly higher risk of neonatal seizures or serious neurologic dysfunction (p<.0001) than hospital births attended by physicians or midwives. (my emphasis)

What does Wendy have to say? You guessed it, she advises homebirth advocates to ignore the new paper. The heart of her argument is this:

This research, which claims to be the largest study of its kind, relies on data from birth certificates (known as “vital records”). What we know about using information drawn from birth certificates is that they are pretty good for capturing information about things like mother’s age and whether she is carrying twins. They are not very accurate when it comes to rare outcomes like very low Apgar scores, seizures, or deaths (Northam & Knapp, 2006).

Too bad for Wendy that the Northam & Knapp article, says the OPPOSITE!

Birthweight, Apgar score, and delivery method agreed 91.9% to 100%. The high-percent agreement supports the reliability of those variables …

So the heart of Gordon’s argument is a bald faced lie. And Gordon referenced the lie with a citation that showed the opposite of what she claimed it showed.

In order to discredit the study that shows a nearly 1000% increase in stillbirth, Wendy Gordon and MANA apparently feel they have no choice but to deceive their followers, since telling the truth would require accepting the validity of the paper. Homebirth kills babies. MANA knows it; their OWN data tells them so.

So, homebirth advocates, I have some questions for you:

How can you trust that homebirth is safe when those you look to to inform you about the scientific literature lie about?

How can you trust that homebirth is safe when the organization that represents homebirth midwives is hiding their own death rates?

How can you trust that homebirth is safe when the most comprehensive study ever done of homebirth (and analyzed by a midwife) found that PLANNED homebirth with a LICENSED midwife has a death rate approximately 800% higher than comparable risk hospital birth, and even MANA can’t figure out how to criticize it?

The ONLY people who think homebirth is safe are those who make money from it. Everyone else, including the authors of the paper that showed a 1000% increase in stillbirths at homebirth, knows better.

 

Correction: In Gordon’s piece, DOR stands for Division of Research, not Director of Research. Therefore, Wendy is a member of the DOR, not the director. I’ve changed the text to reflect that.

  • inventedoatmeal

    What this murderer, I mean “midwife”
    says in the last line of this article is truly chilling: http://www.dailymail.co.uk/news/article-2430001/Valerie-El-Halta-71-charged-negligent-homicide-unlicensed-midwife.html

    • Amy Tuteur, MD

      No need to cut off her hands; putting her in jail for a few years should do the trick.

    • Bombshellrisa

      This woman has been mentioned before-she is a menace

  • Squillo

    There’s a longwinded post now about how everyone is misunderstanding the purpose of MANAstats. It’s not a research project, it’s just data.

    Then it goes on to explain how research projects need IRB approval, so that’s why they set up their program that connects “[m]idwives, mothers, and others interested in conducting research with MANA Stats data but who do not have academic affiliations” with a mentor who has IRB approval.

    So, it’s not a research project, but you can’t access it unless you’re hooked up with someone with IRB approval, because research projects require IRB approval.

    Got it?

    • Amy Tuteur, MD

      English to English translation:

      We’re NEVER going to release the death rates because they are hideous. We believe our followers are dopes who can be fobbed off with inane, incomprehensible excuses like this.

      • Squillo

        The responses are out of a standard media-relations course: don’t answer the question someone asks, answer the one you want to answer.

        I’ve posted a reply, but now that they require commenters to register, I wonder if I’ll get the banhammer.

  • oooh they are promising 2 peer reviewed papers with the death rate. I won’t hold my breath, though.

  • how is this not national news???

  • Squillo

    Gordon writes:

    In recent well-designed studies that captured planned place of birth andused better sources of data, there were no differences in 5-minute Apgar scores between home and hospital settings (Hutton et al, 2009; Janssen et al, 2009; van der Kooy et al, 2011).

    It’s kind of fun to realize that the studies Gordon holds up as better examples than this U.S. study compare home and hospital births in Ontario, BC, and the Netherlands.

    • that was exactly my issue when I was researching home birth. There weren’t any USA figures so it was difficult to decide if they were comparable. All I had were figures from other countries where things were different, but the NCB people all made it seem like it was the same here. The credentials and the oversight are different.

  • Amy Tuteur, MD

    Sometimes you could almost feel bad for the folks at MANA. Poor Janet McCullough,trying to respond to comments on Wendy’s piece is running out of ways to say “I’m not telling!”

    1. She’s not telling anyone the death rates.

    “In order to receive access to the data, researchers must have IRB and
    ethics approval from their home educational institution, which assures
    protection and ethical treatment of research participants.”

    Really, MANA didn’t think anyone needed IRB and ethics approval to find out the C-section rate. How come they suddenly need those things to find out the death rate?

    2. She refuses to define low risk birth. There needs to be “more research.”

    And she’s still hopeful that homebirth advocates are too stupid to her misrepresentations.

    3. Responding to a commentor who pointed out the study actually UNDERCOUNTED homebirth deaths because some deaths at homebirth happened during or after transfer and were included in the hospital group, she offers this bit of obfuscation:

    “while a small percentage of intended home birth deaths are wrongly
    attributed to hospital deaths using birth certificate data, a much
    larger percentage of home births with no injury to mother or baby are
    wrongly attributed to hospitals as well.”

    Sounds great until you think about it. The hospital group has 200X more patients. Adding a few successful livebirths has NO IMPACT on the hospital livebirth rate. But since perinatal deaths are a rare event and since the homebirth group is only a tiny fraction of the size of the hospital group, subtracting even 1 one homebirth death has a major impact on the homebirth death rate.

    I can’t figure out whether Jeannette is deliberately trying to mislead or whether she doesn’t understand something so simple as well.

    I tried to post a comment about this misrepresentation, but it wasn’t allowed (at least so far). Therefore, I suspect Jeanette understands precisely how misleading her claim is.

    • The Bofa on the Sofa

      Sounds great until you think about it. The hospital group has 200X more patients. Adding a few successful livebirths has NO IMPACT on the hospital livebirth rate.

      Perhaps something is not quite clear to me, but why should a HB that had to transfer to the hospital for complication be considered a success for HB? All it shows is that the HB was not appropriate.

      • Squillo

        Her assertion was the the majority of the 10+% of homebirth transfers are for maternal exhaustion and pain relief. Doesn’t necessarily mean that homebirth was inappropriate. Just not as fab as advertised.

    • Squillo

      (Psst–It’s Jeanette McCulloch, not Janet. And why is she responding rather than Wendy Gordon?)

      I posted on two of those points yesterday too, but so far they haven’t been published. McCulloch is only one person, though, so I’d wait a day before claiming she’s refusing to post them.

      • Amy Tuteur, MD

        Thanks!

    • Squillo

      Adding a few successful livebirths has NO IMPACT on the hospital livebirth rate.

      Moreover, adding the tiny number of “Apgar 0” births misattributed to the hospital back into the OOH column has a much larger impact on the OOH low-Apgar rates than does adding back in the 10% or so of successful livebirths.

    • Squillo

      The comments have been posted. She isn’t getting much help in the way of addressing questions.

      I can’t figure out whether Jeannette is deliberately trying to mislead or whether she doesn’t understand something so simple as well.

      I think she hasn’t done the math.

  • Amy Tuteur, MD

    There’s really no limit to what MANA will say to mislead people.

    In the comments section a MANA representative has this to say:

    “The result: while a small percentage of intended home birth deaths are wrongly attributed to hospital deaths using birth certificate data, a much larger percentage of home births with no injury to mother or baby are wrongly attributed to hospitals as well.”

    But there were 200 times as many hospital births as homebirths, so even if a massive proportion of homebirth attempts ended in a live hospital birth, it would have NO IMPACT on the overall rate of hospital birth death or hospital live birth. However, since the number of women attempting homebirth is only 1/200th of that attempting hospital birth, and since death is a relatively rare outcome, leaving a few deaths out of the homebirth group would make a very big difference in the homebirth death rate.

    In other words, the hospital birth death rate is basically unaffected by the liveborn homebirth transfers, while the homebirth death rate is considerably lowered by removing the deaths that occurred after transfer.

    The study shows that homebirth increases the stillbirth rate by nearly 1000% and that’s an underestimate of the true rate.

  • Squillo

    By the way, Gordon’s post seems to be part of a brand new blog on the MANA site. Should be a “target-rich environment,” to crib a phrase from Orac.

  • Squillo

    Too bad for Wendy that the Northam & Knapp article, says the OPPOSITE!

    It’s almost like she didn’t even read the study but just looked at the abstract’s conclusion.

    • Amy Tuteur, MD

      The abstract also says the opposite, so she didn’t even have to read it.

      • Squillo

        One might think she only read the conclusion, not the data synthesis section. She seems, elsewhere, to conflate the unreliability of birth certificates in capturing rare events with unreliability of capturing low Apgars.

  • rblazo

    Why aren’t NCB advocates up in arms about the unnaturalness of car seats, or cars, for that matter? After all, I’ve driven my infant thousands of miles without any accidents, clearly they are unnecessary and the result of an omnipotent car seat lobby, headed by people who are just out to make a buck. And fire alarms! Our ancestors never needed smoke alarms, and how many of them died from undetected fires in the home? Probably none!

  • Squillo

    I find it interesting that one of Gordon’s objections to using birth certificate data is that it doesn’t capture intended place of birth. It does, however, capture birth attendant, and the study used births attended by midwives and doctors. How many midwives attend emergency transfer to hospital of babies born in accidental or intentional unattended births? I’m guessing none. So who gets the “credit” for those dead babies? MDs and hospitals. And since it doesn’t include intended place of birth, only actual place of birth, any crappy outcomes from intrapartum transfers from midwife-attended homebirth get heaped in the MD/hospital column.

    So in direct contradiction to Gordon’s implication, the data for midwife-attended homebirths is likely even worse than the study reflects.

    • anonymous

      Yes. By her own reasoning the number should actually be higher, since there are probably a large number of midwives that “dump” a patient and the hospital takes up the slack. 800% is probably a lowball if that was taken into consideration.

      • Squillo

        Exactly.

      • amazonmom

        You have that right.

        • Bombshellrisa

          I wish you weren’t speaking from experience-and about midwives that Gordon probably knows personally (being Bastyr staff and all)

    • Squillo

      I left a comment to that effect on the post:

      From the study abstract (emphasis mine):

      Home births (relative risk [RR], 10.55) and births in free-standing birth centers (RR, 3.56) attended by midwives had a significantly higher risk of a 5-minute Apgar score of 0 (P < .0001) than hospital births attended by physicians or midwives. Home births (RR, 3.80) and births in freestanding birth centers attended by midwives (RR, 1.88) had a significantly higher risk of neonatal seizures or serious neurologic dysfunction (P < .0001) than hospital births attended by physicians or midwives.

      So I'm not sure your objection about intended place of birth means much. Or are you saying that unattended home births that result in low Apgars are mistakenly being listed as midwife-attended? Who's recording the Apgars for these unintended home births?

      We’ll see if it gets past moderation.

  • Squillo

    Gordon can produce this, but she can’t produce the “benchmarking” article with death rates MANA has been promising since at least last year.

    Watch for peer-reviewed article in 2013 – will include all relevant perinatal outcomes including mortality and morbidity. #MANA12

    Tweet from @MANACommunity to @ATutuer on Sept. 30, 2012.

    • Anonymous

      Lol. Peer reviewed. How much do you want to bet it’ll be “peer reviewed” by other people in MANA?

      • Squillo

        I don’t know, but plenty of crappy studies end up in respectable peer-reviewed publications. The proof, as they say, is in the pudding.

  • Kayleigh Herbertson

    I do appreciate your candor and passion but I don’t like lies just as much as you Amy.

    “The ONLY people who think homebirth is safe are those who make money from it. ” The NHS would disagree.

    • Kerlyssa

      Yeah, the NHS studies showing that home birth (for some carefully screened, multiparous, low risk women) would be more dangerous, but still cost effective have nothing to do with money.

    • Bombshellrisa

      Again, when speaking of the NHS, you aren’t talking about American homebirth midwives or MANA. Dr Amy is in this piece.

    • Amy Tuteur, MD

      I’m not sure that the NHS would disagree. They’re desperate to save money and therefore, they’ll say that homebirth is safe, but how many NHS executives and doctors choose homebirth for themselves?

      • Kayleigh Herbertson

        I do agree that there are more sides to the story than just “NHS is in love with homebirth” I just didn’t like the broad strokes you made with such a statement. Surely that’s as bad as what home birth obsessives do?

        • Amy Tuteur, MD

          True, the most important side, the one that is almost certainly driving NHS decisions is NOT safety, but money. It fits with my claim that only those who profit when a woman chooses homebirth insist that homebirth is as safe as hospital birth.

    • Dr Kitty

      No actually the NHS agree, by admitting that the relative risk of disasters happening at home is increased and screening women thoroughly prior to HB.

      The NHS think HB for low risk women is safe enough, but not as safe as, nor safer than hospital and is therefore not universally recommended for all women.

    • Stacey

      Of all the HUGE LIES by Mana, covered here, you are gonna complain about Dr Amy? Really? You are really upset that she was making a broad statement about HB, because you don’t like it being related to a country thats not even being talked about here? But saying HB is safe is OK???

      Priorities….

  • Dr Kitty

    Do you know what would refute the study?
    Saying “Here are 27,000 planned HBs with accurate reporting of APGARS and outcomes, planned place of delivery and type of attendant, and we don’t show the same findings as this study”.

    So, either MANA doesn’t believe MW’s self reported data is accurate and so their results can’t be trusted, or their results are similar or worse than the study they object to, or both of the above.

    Wendy- you have the data- if you don’t show it we are left to believe that it is either worse than useless data, or shows results you are trying to hide.

    PUBLISH IT. If you aren’t willing to do so, explain why.

    Don’t wait until someone finds a way to compel you to release it- do it yourselves and if it doesn’t show what you want, be big girls, stand up and admit it.

    • KarenJJ

      ” Director of Research for MANA”

      I wonder how long Wendy will be in this role for? How many delaying and diversionary tactics can she pull before she runs out of steam? When do we start seeing another excuse as to why it hasn’t been published? We must be up to at least 3 now.

      • MaineJen

        Oh, but if you read the piece she promises it WILL be published. Soon. On an undisclosed date. But trust her, the data is coming. Homebirths from 2004-2009. They have it. It must show something *horrendous* that they are trying to figure out how to spin.

        • Squillo

          Nine years of collecting statistics–and making them available to state midwifery orgs, but only them–and the public will finally get to see it in a spectacular show of four papers. Or maybe two, since two are in press and two are under peer review.

          I think I’ll reserve judgement until I can actually read the papers.

    • Squillo

      They told me back in October of last year (via a Twitter convo) that they had a “peer-reviewed” study to be released that showed the death rates to be similar to the CPM 2000 study.

      Where is it?

      *Cue sound of birds chirping.

    • Captain Obvious

      Their response…

      We appreciate the frustration you are expressing about the time it takes to make research available to the public. On average, it takes 1-2 years from the request for data to publication in a peer-reviewed data. This results in a lag time between data collection and publication.
      I also want to draw your attention to the last section of the post: “And watch for new research based on the MANA Stats dataset 2004-2009. Two articles are in press and two more are under review in peer-reviewed journals.” These will include all relevant outcomes, including neonatal mortality and morbidity.

      • Amy Tuteur, MD

        You don’t wait 4 years to publish good news. You only wait 4 years if you are desperately trying to figure out a way to hide the horrible death rates.

        • Squillo

          From the same response:

          The MANAstats data is available to researchers, as well as mothers, midwives and others without an academic affiliation. To learn more, see here:http://mana.org/research/facilitating-high-quality-research.

          Which leads to a page containing a link the their new ConnectMe program, which:

          …is to effectively connect student midwives/practicing midwives with established researchers that may serve as mentors and advisors to individuals passionate about conducting research on midwife-led care and normal, physiological birth practices, using the MANA Statistics Project dataset.

          Nothing about access to the stats for “mothers” there. The “Current Research” page is very careful to point out that:

          The MANA Stats datasets have been provided to every researcher who has applied to date.

          None of the listed projects seems to be about mortality or the comparative safety of homebirth, so I can only assume that the touted four yet-to-be-seen papers are not part of the list. One wonders why not.

      • Dr Kitty

        They told us the two articles were ‘in peer review’ over a year ago.
        A peer review doesn’t take a year unless it finds major problems with the data or the paper requiring a total re-write…several times.
        They’ve PUBLISHED the outcomes they’re proud of, ages ago.
        The only outcomes they haven’t published yet are the bad ones, and they refuse to publish the raw data to allow anyone who might be faster to publish it.

        None of that says “we’re really proud of our low death rate” to me.

        • Squillo

          They told me in October that the rates were “similar to the CPM 2000 study.”

  • ol

    If Avogadro’s number doesn’t embarrass those who believe and use homeopathy, why should any research about rare outcomes/small numbers (“I’ve never seen it”) influence in any way those who believe in HB?

  • Sue

    That photo is put to such good use on this site, Amy!

  • Sue

    OT – a new Lancet paper on caseload midwifery vs rostered midwifery – apparently showed a relatively small difference in cost but no significant difference in any of the other things they measured.

    • araikwao

      Was patient satisfaction measured? I always imagined it would be better for caseload.

      • Sue

        They’re apparently reporting that in another paper.

  • Young CC Prof

    You know, I’ve been thinking the last few weeks. My family is best described as rabidly pro-vaccine and fairly pro-medicine in general. Why? We didn’t forget the dead children. Even in the past few decades, we’ve had some unpleasant (though nonfatal, thank you hospitals) experiences with contagious disease.

    However, we don’t have any obstetric horrors in recent memory. We had scads of children back in the day, and yes, some of them died, but not peri-natally. No hemorrhage, no stillbirths, no dead mothers, not in the memory of anyone still alive.

    This is why my mother is all into natural childbirth. She doesn’t take it to the nutty extreme, but she did take risks with us that I’d never dare, like birthing center instead of hospital. Because those horrors aren’t real to her.

    • Mel

      My family is rabidly pro-medicine because we are walking OB disaster areas. We start to sweat when doctors say “Oh, don’t worry. There’s a very, very low risk of that happening.” Terry Prachett makes a running joke about 1 in a million chances happening all the time during emergencies. We joke about the fact that we seem to be a lightning rod for 1 in a million OB disasters. We’ve survived – mom and kiddos- since we firmly believe in giving birth in hospitals.

      • KarenJJ

        I know I’ve said it before, but my whole attitude towards risk changed when I was diagnosed with something that was a one-in-a-million. Actually my attitude towards doctors changed as well (mostly for the better).

      • Mel

        I’m reasonably sure my first pregnancy will end with a hidden abruption, uterine rupture, DIC and pre-eclampsia that appears 5 weeks after delivery. 😛

      • Happy Sheep

        My family is notorious for having rare issues and diseases. To me, I always figure someone will be that one, and there is no good reason why it can’t be me. Unless it’s the lottery, that one in a million would never be me!

  • Joy_F

    I’ve done extensive work in East Asia and SE Asia, as well as trips into Central America and West Africa. I don’t understand the natural movement at all. Women die from sheer pain and exhaustion, and their babies die from it too. Women die from hemorrhage (I have known at least one and it haunts me). Women end up torn with fistulas and horrible damage done to their internal organs. Babies die.

    Babies die because mother’s can’t produce enough milk. It happens. They die from birth injuries. Stillbirth is common. Many cultures don’t name the child until they are 100 days old. They don’t bind with them before that. It’s too painful. They die. Some are permanently disabled from the birth.

    I think my 10+ years of work overseas affected me greatly – when the doctor said the cord was around my babies neck and that the way he was turned meant it would be difficult to have him, I agreed to the c-section. I couldn’t bear to risk my son after what I had heard and seen. I had already agreed to the epidural. He was perfectly healthy. Many of the more natural leaning crowd said I didn’t even try. No, I suppose I didn’t. I wanted my baby alive. Who cares how he got here?

    Perhaps they should go teach or volunteer somehow in a developing nation, and hear the screams and tears themselves. It does shake you into reality.

    • Clarissa Darling

      Did you read the post about midwives going overseas to “help” these women in impoverished countries? Although, rather than show up with real medicine it seems they show up to practice third world birthing techniques before bringing them back home. It’s just incomprehensible that someone could go and see what limited access to modern medicine is like and STILL glorify it as more “natural” but, apparently it happens.

      • Joy_F

        I did read that one, and I have no idea how knowing what they have to know and seeing it they could justify bringing it back to the States! My Dad, an economics professor delivered a couple babies in the jungle in Ghana because the husbands came and asked him to do it – but he did it because they were desperate and there was no time to get to the hospital, not because he believed it was better for the baby.

        It is demeaning to people to come to them as the “Great white savior” many people seem to have a Messiah complex when they come and rather than learning, only try to see and hear what they want to see and hear. I wonder if try don’t write off the births that go badly in developing nations as a problem with diets and other things – surely the people don’t know what is best for themselves when they would desire to go to hospitals after all.

        It’s strange. Because often they ridicule ignorance overseas, yet seem unaware of their own. It’s like when Americans come to Japan and pretend that their gun control laws (10 gun deaths last year) mean nothing, because they don’t understand freedom (Japan is pretty democratic, and unlike the US they use that democracy to vote out their Prine Ministers about every year – pretty sure they understand democracy!). It is very much the same in the attitude towards people in the developing nations that they go to “help” – the attitude that we Americans already have the answers and we will bestow it on these inferior people. At its root, this thinking is racist

  • Captain Obvious

    And again, I report the coincidental association that despite CEFM did not decrease the CP rate as it was hoped to do, it has decreased the intrapartum stillbirth rare and neonatal seizure rate. And Homebirth midwives do not use CEFM. And what was shown to be increased in that study…the same parameters.