MANA and the homebirth stooges

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There are times when I could almost feel sorry for Wendy Gordon. Her desperation to fool her followers has become thoroughly pathetic. But then I remember that it takes a special kind of unethical to trick people into ignoring a growing pile of tiny dead bodies for no better reason than that she and her cronies make their money from it.

How desperate is she?

As I’ve noted before, Wendy’s efforts to discredit the Grunebaum study that showed that homebirth increases the risk of 5 minute Apgar score of 0 by nearly 1000% are not going well. As I pointed out, the Grunebaum study comports quite well with the data from Oregon that showed that homebirth increased the risk of death by more than 800%. Others have pointed that out to Wendy, and she has tied herself into a knot trying to explain why we should ignore the correlation.

Here is her pathetic effort:

The Grunebaum study does not examine deaths, so there is no correlation to be made here.

What breathtaking bullshit! The Grunebaum study most certainly looks at deaths since only a vanishing percentage of babies with 5 minute Apgar scores of 0 will survive. Think about it: a 5 minute Apgar score of 0 means that the baby had NO HEARTBEAT for at least 5 minutes. Moreover, the Grunebaum study excludes babies who died in the hours or days after birth so it actually UNDERCOUNTS early neonatal deaths.

A 5 minute Apgar of 0 is a terrible outcome regardless of whether in rare circumstances the baby might survive with significant brain damage and/or cerebral palsy. Wendy is insisting that the two studies have nothing to do with each other because one looks at the almost certainly dead and the other looks at the definitely dead.

The Wendy proceeds to recycle her original crap:

A misclassified death in the homebirth group causes the mortality rate to swing dramatically, while a similar misclassification on the hospital side has essentially no effect.

You’ll get no argument from me that homebirth midwives are ignorant clowns, but even I don’t think they are so incompetent that they can’t tell the difference between a dead baby and a live one.

I believe that midwives are eager to understand what the evidence has to say about the safety of our model of care and the location of birth …

Oh, please, Wendy. You won’t even acknowledge that the studies are true, let alone understand why the events described actually happened.

And guess what? You know those articles “in press” that will reveal the MANA death rates next year. Well it turns out they’re not really “in press” at all.

… When I say “in press”, that means that the research articles are in the hands of the editors and reviewers of the journal to which they have been submitted.

That’s bullshit, too. “In press” means just what it sounds like: the article has been accepted for publication and is being formatted and printed. The MANA “articles” aren’t in press; they haven’t even been accepted for publication and they may NEVER be published.

But Wendy, like the rest of MANA’s homebirth stooges, is so desperate that she is willing to say ANYTHING in order to direct your attention away from the growing pile of tiny dead bodies. The entire executive board of MANA are breathtakingly unethical. The stooges who publicly lie and mislead on behalf of MANA are more concerned about protecting the income they make from pretending to be midwives than whether babies live or die. They literally do not care WHO dies in order to preserve their ability to make money from their birth junkie hobby.

Wendy and MANA’s goal appears to be making stooges out of their followers. They don’t expect to be taken seriously by anyone in the mainstream medical or scientific communities. They’re merely hoping to provide plausible deniability so their gullible followers will continue to pay them for risking their babies’ lives.

Wendy Gordon and the other MANA executives should be embarrassed at their profoundly unethical behavior, but, apparently, nothing embarrasses them. They are stooges, attempting to preserve their income in any way they can, dead babies be damned.

  • NCBer No More

    Here is my comment awaiting moderation at Science & Sensibility:

    Does MANA share its homebirth mortality rate with its own member midwives? Or do they also have to wait for the publications?

    I looked on your blog and it says, “Midwives, mothers, and others interested in conducting research with MANA Stats data but who do not have academic affiliations and thus no access to IRB or ethics boards are invited to access the dataset through the DOR’s ConnectMe program.”

    It seems mortality rate is available by request only and after jumping through some hoops. Does that apply to your own members as well? If I was a midwife, I’d want that information, to know the honest chances of delivering a live baby at homebirth. Don’t you think ALL your members have a right to that information? They are the ones supplying the raw data, after all.

  • Lisa from NY

    And we still don’t know how many brain-damaged babies there are…

  • auntbea

    I don’t know if MomofMore is part of this board, but she is doing an Excellent job in the comments.

    • DaisyGrrl

      I like where she calls Wendy out on using Canadian data to justify the safety of CPM-attended homebirth.

  • I don’t have a creative name

    OT: http://www.scienceandsensibility.org/?p=4257 So Henci Goer can demolish any study that disagrees with her views, despite her lack of training or experience. Got it.

  • oryon

    Part of me wonders if they really are attempting to publish the articles, but the only way they can validate the death rate is by using really crappy statistics so no journal will take them.

    • Squillo

      If the articles are truly in press, they should be able to tell us which journals they’re in.

  • Monica

    Oh that’s good, it’s not our fault the death rates aren’t reported yet because it needs to be peer reviewed and this takes a really really long time. Ummm, could you imagine if doctors didn’t disclose their rates of deaths or c-sections because it had to be in a peer review study first? They are quite the bull shitters.

  • Amy Tuteur, MD
    • anion

      Signed.

    • Karen in SC

      Who’s registered at BabyCenter? I bet there are enough non-woo mothers there that would sign. We need numbers!

      Also, if you comment on the articles this study has generated on news sites, linking to the petition would be a good idea. I’ve got a free afternoon, I will try that myself.

  • moto_librarian

    I’ll post this here, since it’s in moderation at Science and Sensibility and unlikely to see the light of day:

    “Two articles are in press and two more are under review in peer-reviewed journals.”

    Clearly, you don’t understand much about academic publication. If an article is “in press,” that means it has been published. If it is not available to the public, it has either been “accepted for publication” or is “under review.”

    I tend to believe that if the MANA data proved that homebirth was as safe as Wendy Gordon asserts, it would have been published long ago. None of your arguments are even remotely compelling. If anything, the number of deaths related to homebirth are likely undercounted, since a baby that dies during transfer will be attributed to the hospital’s statistics. You claim that families need “the best information” for making decisions about where to have their babies. If you really believed this, you would make the MANA stats regarding perinatal mortality available.

    • Amazed

      Hmm, it made his way through moderation very soon after you posted it here.

      May I suggest an experiment? Everyone who tries to leave a comment that is not too favourable for CPM care post it here, too. I am curious to see whether it’ll make a difference. I am sure that they read us here, just like we read them there,

      • auntbea

        They moderated my first comment, and let the rest go through unmoderated.

      • moto_librarian

        I am shocked, but pleased!

  • Amy Tuteur, MD

    From Sharon Muza, editor of Science and Sensibility, in the comments section:

    “I will not tolerate disrespect, baiting or comments that do not support professional and respectful dialogue. Comments will be deleted without warning. Feel free to post elsewhere on the internet if you can not abide by our posted policy.”

    But she will tolerate transparent efforts to lie about scientific research that shows that homebirth dramatically increases the risk of perinatal death. What’s professional or respectful about that?

  • Ra

    OT: Saudi Cleric says that allowing women to drive cars will damage their ovaries…

    http://www.bbc.co.uk/news/world-middle-east-24323934
    Why does it seem like all people who have a vested interest in oppressing women’s freedom (homebirth midwives included) feel the need to reduce women to whether or not they are able to reproduce?

    • Hannah

      Because “tiny helpless people” is an easy way to keep a woman tethered in one spot and feeling helpless to break away. Mother’s emotions are seen as easier to manipulate women, so therefore they must have babies so they can be manipulated easier. Vicious, ridiculous cycle.

    • rh1985

      oh dang, I had been driving for 11 years and got 30 eggs on the lowest IVF dose. Guess that wasn’t true for me. 😛

  • Squillo

    I wonder what Gordon thinks “under review” means.

    • The Bofa on the Sofa

      We call it, “Submitted for publication”, but same diff.

      Someone should ask her for a preprint. There is no reason why she shouldn’t be willing to send one, since, if it is really submitted, and she thinks it is going to be published in a form similar to this, she should be anxious to send it out. There is no logical reason to deny a request for a preprint. Unless, of course, you think the work can’t stand up to scrutiny.

      • auntbea

        DO EET!

      • Amy Tuteur, MD

        It’s never going to be published.

      • CafeGirl

        I am an academic and I would be fired if I even hinted that an article under review was guaranteed publication.

        • The Bofa on the Sofa

          Absolutely. However, if you did have an article under review, you would never hide the data on the grounds that “it hasn’t been through review yet, so you can’t see it”

          • auntbea

            Well, I might not share the data until I was sure I had a publication out of it. But I certainly wouldn’t hide a key finding someone was asking about. And all my working papers are online anyway.

      • theadequatemother

        Not only that but its perfectly acceptable to present it at conferences as a poster or abstract or even a plenary session. And it would certainly be significant enough to be presented as a top-billed session/ talk.

        But crickets. Those numbers will probably require a freedom of information act or equivalent (do you have that in the US) to see the light of day.

        • Young CC Prof

          We do have a Freedom of Information Act, both in national and local versions, but as far as I know it only applies to groups that are at least vaguely part of the government. (A board of trustees for a public university counts, for example).

          I could be totally wrong about that, however.

          • The Bofa on the Sofa

            Research results obtained with public funding must be available to anyone who wants them (hey, it’s the PUBLIC’S data – they paid for it). If it is obtained with private funding, it can remain private.

          • Squillo

            If MANA (or anyone else) uses data from their database in testimony for state government (in favor of a CPM-friendly bill, for example), it could be FOIAed, depending on the state’s regs. Which is why I suspect it hasn’t been used.

          • The Bofa on the Sofa

            That refers to any of it, right? For example, if they reported c-section rates, then that would make the mortality rates fair game?

          • Squillo

            I would think so. An attorney could probably give a more definitive answer, though.

          • Squillo

            Remember back when Missy Cheyney told Oregon’s board of midwifery that, oops, no MANA wouldn’t let them use their stats to meet the state reporting requirements after all because those stats might be used against midwifery?

            I have to wonder if there was some concern about getting FOIAed.

  • The lack of desire to provide women with the tools needed for well informed consent (data on outcomes) – is reprehensible. Want to provide homebirth – GREAT – but then you should have an obligation to do so with clients who understand the choice they are making.

    I’d love it with there was a “Childbirth Choice” counsellor – someone who is trained to understand the clinical significance of the choices available and counsel women on the risks and benefits of their options. Ideally this would be someone who does not benefit from a woman making a specific choice (NCB or otherwise) and who could assist in facilitating informed consent and meaningfully useful birth plans.

    • PJ

      The ironic thing is that the very people who champion homebirth seem to fixate on the idea of “informed consent.” But then I guess they also fixate on the sovereignty of women’s right to choose while undermining women who have elective c-sections or reject birth without pain medication.

      • MaineJen

        Oh but you see, you only need to be informed of the potential risks of something if that something is meant to diminish your pain (epidural). Or, you know, ensure the safety of your unborn child during labor (continuous monitoring). Or save you and/or your baby’s life or brain function in an emergency (C section). The potential risks of homebirth are not relevant because…because…well, just trust them. Bad things hardly ever happen, pain is good and useful, and doctors just want your money. /snark

  • auntbea

    Yes, I noticed that they seem to have confused “in press” with “under review”. I wonder if I could try that at tenure time. “Don’t worry, tenure committee, I may not have any publications out, but I have 12 articles in press with top journals!”

  • Montserrat Blanco

    I am a doctor and work at a hospital. We are currently reviewing a practice that we only apply inside a clinical trial with strict entry criteria because we have the feeling that it might be dangerous for the patients to participate in that trial. In case the review shows no benefit for the patients we will stop the trial, we will not treat anybody else with that practice and publish the results if they are accepted for publication so that other patients and doctors benefit from that knowledge.

    Thinking about “alternative explanations” and “data interpretation” just stinks.

    • T.

      Torture the data, and they’ll tell you anything.

      (Bad Science, Ben Goldacre. Great book!)

    • Sue

      Exactly, Montserrat – the only ethical thing to do with a practice that is being measured and starts to show increased mortality is to terminate it.

  • stenvenywrites

    I think she’s saying that if a homebirth midwife were to mis-categorize a dead baby, that would have a greater impact on homebirth mortality rates than a doctor making a similar mistake in a hospital, because the doctor has a larger patient population, do I have that right? So the idea here is that no statistical comparison is applicable when the sample sizes are disproportionate? How is a pregnant woman researching risks of her various place-of-birth options supposed to proceed, then — with the ones who have by all accounts vastly more experience, or the ones who admit that they may not always be able to correctly diagnose death?

    • auntbea

      I believe that is her argument. But in the original study she was reacting to, the sample was quite large. A misclassification in the HB group would have a larger effect, technically, but a single misclassification is still not going to change the estimate in either group. She would have to believe that midwives are inexplicably classifying a HUGE number of live babies as dead ones.

      • Anj Fabian

        I read the Monty Python dead parrot sketch and it completely failed to cheer me up because all I could imagine was a CPM playing the part of the shopkeeper.

        • Young CC Prof

          Wow, you have just ruined that sketch for me, forever. Well done, and suitably creepy.

          • Anj Fabian

            Sorry!

            I thought of it, thought it might cheer me up. By the end of the script, I wanted to headdesk.

      • Squillo

        That’s essentially what she argues: that there’s something fishy with, what, 10% of birth certificates filed by midwives.

      • stenvenywrites

        I thought that was where she was going, but then I thought, surely not: “we haven’t killed that many babies; we just routinely miscount the bodies” cannot possibly be an argument?

        • auntbea

          I don’t think she really thought it through. Apparently some measurement error is enough, even if it can’t possibly explain the finding.

          But, if you look in the comments, there is actually someone concerned that midwives need better training because they assign Apgars of zero to babies who should be getting fives or sixes, and another who is sure that midwives just put zeros as a placeholder in the chart while they focus on mom and baby.

          • PJ

            I was actually under the impression that homebirth midwives were more likely to overestimate apgar scores than to underestimate them.

          • The Bofa on the Sofa

            They are. It’s not even close.

  • PJ

    It’s so disturbing to me that Gordon’s only reaction to this research appears to be to search out ways to deny its validity. A responsible healthcare provider would be deeply concerned by the possibility of unnecessary deaths and make it their priority to find ways to prevent them. She won’t even consider the possibility that there ARE unnecessary deaths!

    • T.

      It is common human bias. People always seem to be very good at pointing perceived fault at studies… that show things they don’t like.

      Ever since I have learnt this, I have tried to be harder on studies I find emotionally satisfing, as I dislike making a fool of myself, which is something apparently some CPM don’t care about.

  • I left a comment last week on the MANA page that they deleted. I quoted what Jeanette M. said about the “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” and asked when the information would be available publicly. I said I did not understand how they do not know the mortality rate since they have released information regarding all other aspects of their data-gathering project such as rates for transfer, episiotomy, C-section, etc etc…. how is it possible that those rates can be known and yet the mortality rate is unknown?
    They are moderating comments and did not allow my comment to be posted.

  • Zornorph

    I hate you for that picture of the clown at the top of this article. That’s going to give me nightmares.

    • libbycone

      This was in the Philly Inquirer the other day.http://www.philly.com/philly/blogs/birth-breath-death/A-birthing-womans-light-.html?c=0.6149436004639108&posted=y&viewAll=y#comments They do not seem to be adding my comment. The doula writing it has a degree in Religious Studies. I have a degree in Jewish Studies AND a degree in Medicine. I learned a lot in the Jewish Studies program, but they never discussed decelerations in the third stage of labor.

      • Amy M

        Cause the doula KNEW for SURE it was ALL the EEEbil epidural’s fault. Of course it was. Sigh. If only her damn husband had been somewhere else, she would have had the VBAC of the doula’s dreams, and that baby wouldn’t have been traumatized! what? That is such drivel, it saddens me that such stuff makes it beyond the borders of a blog post.

      • Certified Hamster Midwife

        I’m pretty sure it’s somewhere in the Talmud.

    • The Computer Ate My Nym

      The clown in the picture reminds me of a clown painted on the wall of a house that I lived in when I was a college student. The co-op I was living in had just bought the house and it had this huge clown painting on the wall of one room. We tried painting over it but it kept bleeding through the new paint. Someone eventually put a painting over it after 3-4 coats of paint failed to make a dint in the brightness of the clown on the wall. I was just happy it didn’t appear in the painting.

      Come to think of it, that was also the house where we found the advertising circular dated 1996…in 1988. It was altogether a strange place.

      Sorry, have I added to your nightmares now?

      • Kerlyssa

        Stephen King to the white courtesy telephone.