Why did the Midwives Alliance of North America wait 5 years to publish its statistics?

Year 2014

There’s so much to say about the new MANA study by Cheyney et al. that I’ll be covering it in several posts.

Earlier today I gave a brief overview of the results (Homebirth midwives reveal death rate 450% higher than hospital birth, announce that it shows homebirth is safe). In this post, I’d like to address the timing of publication of this study.

Specifically, if the results of the study really show that homebirth is safe, why did MANA wait 5 years to publish them?

The answer is that the study doesn’t show that homebirth is safe and Cheyney et al. are fully aware of that fact. They didn’t want to publish the results, but they were pressured into it, and are now trying to convince people that a death rate more than 5.5 X higher than comparable risk hospital birth is “safe.”

Their reluctance to publish damaging data is known in technical terms as publication bias.

MANA did not pioneer this type of publication bias. That was done by the drug companies. They have a vested interest in publishing studies that promote the use of their medications and failing to publish study results that call the efficacy or safety of their drugs into question. The classic case of this type of publication bias is Vioxx. Merck had commissioned and paid for a study that showed Vioxx had dangerous side effects. Merck did not publish these results and did not share them with physicians.

How do we know that the failure to publish the MANA statistics for the past 5 years was publication bias? Since we are not privy to the thought processes of the investigators, we can only tell by process of elimination.

The failure to publish was not due to the lack of availability of the statistics: As early as the summer of 2006, MANA was offering the statistics up through the previous year … but only to people vetted by MANA who were willing to sign a non-disclosure agreement promising not to let anyone else see the results.

The failure to publish the results was not due to a need to withhold the data pending journal publication: As far back as April 2011, MANA was publicly boasting about the 5% C-section rate in this cohort. But they wouldn’t tell anyone how many babies died to achieve that C-section rate.

The failure to publish was not due to any need to publish them in the context of research: I had been pounding MANA on my blog about the failure to release their death rate since 2006, but it wasn’t until November 2011 that I gained a large national readership with my piece in Time.com. The executives at MANA were so alarmed that they felt the need to respond publicly.MANA executives implied that statistics could only be released in the context of research. That is completely untrue. Every state and the US government releases annual statistics on the number of births and the number of neonatal deaths (not to mention a myriad of other health issues). This information is publicly available to anyone for free through the CDC. MANA could have released its data to the public for free in the same form as the CDC data. There was nothing preventing them from doing this beside their unwillingness to reveal the numbers.

MANA has been quite creative in fabricating new excuses: In October 2013, Melissa Cheyney claimed that MANA could not release its statistics without IRB approval. That’s not true. First, MANA itself has published almost all the data from the database EXCEPT the death rates. Second, while IRB approval could be required for publications based on the data, IRB approval is not required to read and review the data.

It’s difficult to conclude that MANA had any other reason for holding back the statistics besides the fact that they KNOW this data shows that homebirth has a dramatically increased risk of death.

Why did they suddenly relent and publish the data?

I suspect that there were two reasons.

First, increased public pressure such as the Change.org petition demanding the release of the data.

Second, their failure to publish the death rates had led everyone to the obvious conclusion that the death rates were hideous. Therefore, I suspect that they gambled that they had nothing to lose by publishing the data and then pretending it shows something different than what it actually shows. Everyone already knew that the death rates were horrible so the only way to combat that impression was to publish them and slice and dice the data in a million ways to confuse readers, while simultaneously misrepresenting what the death rates mean.

Simply put, MANA refused to release the death rates until now, because they know and have always known that these death rates are horrific. If the death rates were even close to demonstrating safety, MANA would have been shouting them from the roof tops since 2006, when the first analysis was complete. Instead they waited until they were pressure to release the data and are now hoping to hoodwink their followers by declaring that a 450% increased risk of death at homebirth is an indication of safety.

The only thing that remains to be seen is whether their followers are gullible enough to ignore the evidence of their own eyes in favor of the deliberately misleading spin put forth by MANA.

If any homebirth advocates have another remotely plausible reason why MANA withheld data of “safety” for the past 5 years, while publicly releasing every the C-section rate, the intervention rate, the transfer rate, etc. etc. etc., I’d love to hear it … but I’m not holding my breath because I could turn mighty blue.

 

More on this study:

Homebirth midwives reveal death rate 450% higher than hospital birth, announce that it shows homebirth is safe.
The many deceptions, large and small, in the new MANA statistics paper.

  • Guesteleh

    Do you think MANA read up ondoublethink before publishing the study?

    The power of holding two contradictory beliefs in one’s mind
    simultaneously, and accepting both of them… To tell deliberate lies
    while genuinely believing in them, to forget any fact that has become
    inconvenient, and then, when it becomes necessary again, to draw it back
    from oblivion for just as long as it is needed, to deny the existence
    of objective reality and all the while to take account of the reality
    which one denies – all this is indispensably necessary. Even in using
    the word doublethink it is necessary to exercise doublethink. For by
    using the word one admits that one is tampering with reality; by a fresh
    act of doublethink one erases this knowledge; and so on indefinitely,
    with the lie always one leap ahead of the truth.

  • perpetual lurker

    Wow. Is this right? I just ran the CDC Wonder stats and my only limits were full term or postdates, in hospital, and first 27 days of life, and I got 0.81/1000. Does this include intrapartum deaths? Because if so, that’s 0.81 vs. 2.59 for the MANA group (left in lethal congenital anomalies, since hospitals do, too). Over 3x as high!

    Even if we just take early and late neonatal stats, leaving out HALF of the homebirth deaths (22/44) it’s 1.29/1000 for MANA’s almost all white, majority college educated, mostly singleton, mostly low-risk healthy women in their 20s and 30s, vs. 0.81 for EVERYONE delivering at term in the hospital. Even if you include late preterm babies in the hospital, it’s 1.06/1000 – STILL lower than the homebirth set. And this with almost all voluntary reporting to MANA.

    So in sum, if you take EVERYONE who gives birth late preterm or beyond in the hospital, and compare them to voluntary reporting of a highly self-selected, generally healthier and more advantaged homebirth population, then EXCLUDE half of the homebirth deaths, then the homebirth numbers for infant death are ALMOST as good.

    Sounds great. Someone please check me on this, cuz I am dumbfounded.

    • Dr Kitty

      Nope, you got it right. the numbers are as bad as you think.

    • Trixie

      And remember, only 20-30% of members reported data to the study, and 25% of those did not report for the full period of the study. So they could just stop reporting when bad stuff happened and then start again.

      • Anj Fabian

        This wasn’t a demographic carefully chosen to be representative of the group as a whole. The reality could be very different. We can assume that the midwives who participated were those who were the most responsive, motivated and responsible – all attributes which should give the best outcomes possible.

        The ones who didn’t participate? The majority of lay midwives? That’s so much missing data, and there’s no reason to expect those missing outcomes would improve the current conclusions.

    • Trixie
  • Votre

    Regardless of whether or not the stats get interpreted correctly by the press, science usually takes a backseat in this new anti-science andti-reason magical thinking USA.

    If pressure mounts to the point of where legislation threatens to get passed, MANA can play any one of the favorite three “booyah! cards” used to get around the inconvenience of reality by saying: the legisation was written with gender or racial bias as its ‘true agenda’ – or, argue that homebirth is protected and not subject to legislation or government oversight because it is the religious belief of the mother that “God hath so commanded me.”

  • Hey Dr. Amy!

    You have never mentioned to your readers that you may or may NOT have made the cover of my magazine!

    http://bloggingmothersmagazine.com

    The eight year love fest between you and I as Birthy Bloggers really should be celebrated on such a significant day in the history of online Childbirth Activism.

    I would like to once again invite you to be the most beloved and welcomed guest on my radio show to discuss the MANA study and statistics!

    NOT holding my breath! Might turn as blue as a baby who was just born after being deprived of oxygen cause Mama used WAY too many labor drugs!

    Hugs and Kisses!

    XOXO

    Jenny Hatch
    http://WWW.JennyHatch.com

    • Zornorph

      I couldn’t resist reading a bit of your website. My, are you a kook!

      • Guest

        My thoughts exactly! I’m sorry, Miss Jenny, but please don’t take it personally that I don’t quite feel comfortable accepting medical advice from you after perusing your webpage and blogs. I get that Dr. Amy is no longer practicing clinical medicine, but I’m afraid a medical degree and a Harvard education may give her, oh, a bit of an upper hand in dispensing legitimate information. Good luck in your progress towards Zion, though. I really wish you the best!

      • The Computer Ate My Nym

        I saw the bit about the “dark night of medical fascism under Obamacare” and thought, “Ok, we’re done here”. Because if you equate giving everyone medical insurance with fascism, you don’t understand either one.

        • Zornorph

          I read on because usually homebirth nuts tend to be left-wing freaks. I had not read much from the perspective of a right-wing freak and was curious as to the thought pattern that went into it. I get it now – womyn’s bodies are perfectly designed to give birth not because they evolved that way but because God made them that way. (I guess she forgot about that whole incident with the apple that forever denies womyn orgasmic birth. As a believer myself, I didn’t feel it was right to turn away just because the nut was coming from my side of the aisle – it’s important to remember that any set of beliefs can be taken to the ridiculous extreme.
          BTW, has anybody else noticed that the ‘Trust Birth’ woman has now made her Facebook page private? I used to go there when I needed a good laugh and now I can’t!

          • PrimaryCareDoc

            I find that it’s like a moebius strip. If you go far enough left, you run into the right-wing, Young Earth creationists.

          • An Actual Attorney

            The Manchurian Candidate was such a great movie.

        • The Computer Ate My Nym

          Just to be clear, since it is a controversial subject, I do NOT equate all opposition to Obamacare with the crazy. Say that Obamacare’s a bad idea, I’m happy to have a discussion. Say it’s poorly implemented and clunky, I’ll probably even agree. But fascist? Not.

          • Zornorph

            It was her search for the ‘divine feminine’ that first set off my alarms, but I had to read on to find where she was really coming from because that’s usually a big ol’ feminist calling card and she seems more a Colossians 3:18 type.

    • GuestB

      If you were trying to come here and be taken seriously, you should have omitted that link to your website. Although I’m not too sure that would really help, either.

      • I never expect anyone, especially a highly credentialed PROFESSIONAL like Dr. Amy to take me seriously. I am curious however, why she has persisted in ignoring my attempts to have her on my radio show when I have always been so respectful in my requests.

        • Nicole Petersen

          I guess I will just point out the obvious, that you weren’t at all respectful.

        • Zornorph

          Because you suggest that she doesn’t exist and is, in fact, 10 men blogging who are paid by medical companies? Since you can see footage of her on Youtube, wouldn’t it have been more realistic to suggest she’s a robot?

          • realityycheque

            No, no. Not a robot. Shape-shifting reptilian!

          • deafgimp

            Flesh avatar!

        • GuestB

          You never expect anyone to take you seriously, huh? So you and your website exist for pure entertainment value only? In that case, well done!

        • theNormalDistribution

          To quote Richard Dawkins quoting Lord Robert May,

          “That would look great on your CV, not so good on mine.”

    • anne

      The quality of comments/commentators on opposing sides of this debate is pretty instructive in and of itself.

      seriously . . . XOXO?

    • OBPI Mama

      To quote Joel Salatin to describe parts of myself, I am a “Christian-libertarian-environmentalist-capitalist-lunatic-Farmer” (add homeschooling mom of many), yet I find you very disturbing. VERY disturbing. Promoting unassisted childbirth/dangerous homebirth… I am at a loss for words. No words.

      • And I should give a rip of what you think of me WHY?

        You forgot Mormon, Tea Party Organizer, Recovering Psychiatric Survivor, oh did I forget anything? Right…extreme breastfeeding, family bedding, non Vaccinating FREEDOM activist and Health Care Blogging Mother of Five!

        • The Computer Ate My Nym

          I shouldn’t, but I can’t resist…what the heck is “extreme breastfeeding”? Breastfeeding while snowboarding? Breastfeeding until age 18? Breastfeeding your puppies to promote interspecies harmony? And why do I suspect that it’s something even weirder than what I could come up with?

          • Trixie

            I breastfed while eating flavor blasted Doritos once, does that count?

          • The Computer Ate My Nym

            Absolutely! I breast fed after drinking a caffeinated beverage once. Once. The results convinced me that that act was too extreme for me.

          • Zornorph

            Extreme breastfeeding is getting the milk to squirt out across the room into baby’s mouth.

          • GuestB

            Through a flaming hoop.

          • The Bofa on the Sofa

            Rule 38

          • Zornorph
          • deafgimp

            No, no. Extreme breastfeeding is expressing into a cup, then holding the milk in your mouth. You pull down your eyelid, and squirt the breastmilk out your tear duct using air pressure. Your baby will learn to feed by just holding her mouth open and you will squirt the milk directly into her mouth. Very similar to how cats in a barn learn to swallow milk from a squirt of milk from a squeezed cow udder.

        • Zornorph

          Sigh – and here I was thinking that all of the anti-vac nuts were in the other party. Thank you for spoiling my illusions. It’s no fair! The rules are we get the Creationists and the Dems have to take the Anti-Vac people. You can’t be GOP if you are anti-vac, you daft hippie!

          • Box of Salt

            Sorry Zornorph, you are way wrong on that one. Anti-Vax under the banner of Health Freedom has always aligned with the GOP and libertarianism.

          • Box of Salt

            I’ll add that Health Freedom is not the only flavor of anti-vax, but if you have any doubt about the politics check out the Canary Party. They’re not Democrats!

          • Zornorph

            As a politics junkie, I should have remembered Michelle Bachman’s weird anti-vac moment in one of the debates in 2012 but I’m doing my best to block her from my memory.

          • AlisonCummins

            No, anti-vax is actually very much a right-wing thing. No government is going to force me to vaccinate my child! (This is also libertarian.) Plus right-wingers tend to care a lot about purity: don’t contaminate my precious bodily fluids!

            It can be a daft hippie thing too, of course. But lines get very blurred. There are whole movements of far right fundie christian authoritarian libertarian hippies.

          • Zornorph

            I guess that’s the trouble with going by anecdotes because all the anti-vac people I know are left wing nuts. I can see why it would be something that would appeal to the Libertarian fringe, though I could make a very strong Libertarian argument against the right of schools public and private to demand vaccinations before admission.

          • Guesteleh

            Same here. The antivaxxers I know are all way, way, way left.

          • AlisonCummins

            Yeah, like the famous commie Jenny McCarthy.

          • Trixie

            The fringes on both sides are horribly anti-science in their own way. On the right you’ve got creationists and global warming deniers, on the left you’ve got crazy GMO fear mongering. They’re both into home birth and not vaccinating, for somewhat different reasons.

          • Medwife

            The extreme right and left go so far out there, they tend to start meeting each other on certain issues. Anti-vaccination is one of them.

          • The Bofa on the Sofa

            I know that these days you will find anti-vaxxers on both ends of the spectrum (and Orac has talked more about that), but personally, I suspect that a very large amount of the opposition to vaccination in the right-wing world is due to the fact that Obamacare supports it.

            As politicians go, most left-wingers support vaccination (except maybe Dennis Kucinich), including Obama. Therefore, there are going to be right-wingers who must oppose it in response, such as Michelle Bachman. I don’t think she was anti-vax until it became a politically prudent way to appeal to the anti-Obama right.

          • Trixie

            Well, another factor in the right’s opposition to the HPV VAX in particular has to do with their belief in abstinence education.

          • Young CC Prof

            Because obviously vaccinating youths against one single STD (and not the most feared one by far) will immediately cause them to go out and have lots of anonymous sex.

          • Trixie

            I’m going to invoke Rule 34.

          • AlisonCummins

            You think that right-wing antivax paranoia mostly didn’t exist a year ago? What was Jenny McCarthy then?

          • C T

            There have been anti-vaxxers for as long as there have been vaccines. The End of Plagues (2013, author John Rhodes) is a comprehensive yet readable survey of the history of vaccines from the beginning to present.

          • The Bofa on the Sofa

            Former playboy model Jenny McCarthy is a right-winger?

          • AlisonCummins

            She thinks that taxation is theft and that it should be up to individuals to decide whether to donate to “charity” or not. At least she said that when she was younger. Whether she’d defend that view again today at a cocktail party I couldn’t say. That makes her more libertarian than right-wing, I suppose.

          • deafgimp

            I recently read an article where she states that she never said that her son is not autistic, he is autistic and always will be. I laughed and laughed at that comment. Not because of her poor kid, but because of her backpeddling. And I say “poor kid”, because what kind of shit did she subject him to until she finally, years later, accepted that he has autism? First he was an indigo child, then she cured him. It’s sad that she was very obviously grabbing at straw s and it’s sad that her son was the recipient of her nonacceptance. She just can’t say that she was wrong and her son is doing better because he’s gotten appropriate therapies. She also roped Jim Carrey into this nonsense and he’s a firm supporter of not vaccinating now.

          • Young CC Prof

            If you want to skip vaccines because Natural Is Better and your kids will be perfectly healthy if they just do enough kale and yoga, you’re a left-wing nut.

            If you want to skip vaccines because no government will tell you to impurify your precious bodily fluids, and we should just Trust in God instead, you’re a right wing nut.

            Different roads to the same nutty end.

          • AllieFoyle

            No, you guys take them. You can even have all the hippie yoga ones, gratis.

        • AllieFoyle

          Zzzzzzzzz

        • araikwao

          Non vaccinating AND “Health Care Blogging”? If you’re doing the former, then it’s a real shame you’re also doing the latter, because it’s a fair indicator that you don’t know what you’re blogging about.

        • theNormalDistribution

          What in the world is a ‘Psychiatric Survivor’?

          • I went into the belly of the beast when I was 21 and made it safely out…

            but not before being gang raped by a few orderlies and court ordered to eat psychiatric drugs for a year.

            I have soent the past 24 years learning how to live with profound mental illness without taking psychiatric medications.

            We call ourselves survivors.

          • Don’t feed the troll.

          • Votre

            No. Please let Ms. Hatch continue on her rant. It’s becoming increasingly out of control and more entertaining – and revealing – as it goes on.

            It’s also education. Not having huge amounts of time to cruise the fringe-blogs, I never realized just how nutty these nutters actually are until I started reading some of Ms. Hatch’s snark. :-))

          • Troll Antigonas? Why we are old pals…Hugs and Kisses to you too, it’s been a long time.

          • Siri

            Do you like to pretend you’re a Bond villain?

          • anion

            Jenny, I mean this sincerely and kindly, I honestly do. I bear you no ill will at all. You are a person with whom I share this planet, and I genuinely care about your well-being and that of your no doubt beautiful children.

            Please seek help. Treatments and medications have advanced. There are plenty of doctors who will help you, who will listen to you, who won’t force things on you, who just want you to feel better. I absolutely believe you when you say your previous experiences were negative, that you were hurt and abused. I’m not at all trying to tell you that didn’t happen or you’re mistaken or anything like that. But that doesn’t mean it will be the same now. It really doesn’t.

            Untreated mental illness is a terrible thing. You don’t have to suffer like this. (I know you’ll insist you’re not suffering. Your comments–the tone, the word choices–tell a different story.)

            Seriously. I’m not trying to belittle you or insult you, and I hope that whatever you think of what I’m saying, you believe that.

          • Why do you assume I am not seeking care?

            I have been hospitalized four times for suicidal depression and have had two years of therapy four times over the past 25 years.

            I am currently working with a wonderful licensed traditional therapist. In what way am I not being “treated”?

            You broads who make up Dr. Amys fan girl base have no clue how it feels to live on the fringe of society and make difficult, heart wrenching decisions that fly in the face of every convention currently in practice in our society.

            Yet knowing what I know about the lonely and difficult path of non conformity, I would still make the exact same seemingly crazy choices all over again.

            Dr. A heckles and mocks and dismisses and hates every freaking day here on her blog, and has done so for many years.

            I am just one blogging Mom who questions the status quo, every bit and particle of it.

            The consistent question I have asked Dr. Dumbass is Why do you care how I choose to live my life? It continues to baffle me.

          • Mishimoo

            I actually grew up in that sort of environment with an interesting mix of beliefs that I have (luckily) mostly discarded as false or detrimental. I am a survivor and a work-in-progress. There is not enough power or money in this world to ever make me return to it. I can not comprehend willingly living like that as well as trying to convert others to that worldview.

          • Box of Salt

            Jenny Marie Hatch: “You broads who make up Dr. Amys fan girl base have no clue how it feels to live on the fringe of society and make difficult, heart wrenching decisions that fly in the face of every convention currently in practice in our society.

            “Yet knowing what I know about the lonely and difficult path of non conformity, I would still make the exact same seemingly crazy choices all over again.”

            You’re right. I have no idea why anyone would repeat the same mistakes that did not work out well for them the first time.

          • Tim

            They’re people who deny the validity of psychiatry and psychology as a science, usually diagnosed schizophrenics and other paranoid delusional types that have slipped through the cracks, and rant about on the internet about how psychiatry abused them and is abusing everyone left and right non stop and should be shut down immediately. Some of them post videos on youtube of themselves in shadow wearing sunglasses with a voice modulator, because they claim if their former doctors figure out who they are, they will “get them” and force them back on their meds. It’s sad, because our laws in the US are setup in such a way that adults can fall through the cracks easily like this, and be left to fester alone.

        • Jane Lucas

          Is your blog satire? I really can’t tell.

          • Guest RN

            Yes – that website is a bingo of bat shit crazy.

        • Jessica S.

          Yes, that does about cover it.

        • C T

          Jenny, I’m LDS. You don’t represent most LDS women that I’ve met. Dr. Tuteur is performing a service that is the essence of charity. She, on her own time and at her own expense, is shining a light on the unnecessary baby deaths that occur due to a very frequently ill-informed movement that puts the experience of childbirth over the child’s well-being. You mock her childishly, but she has the truth on her side. You are an advocate for “birth freedom”, but she is an advocate for that as well as correctly-informed consent and the well-being of those little ones who can’t speak for themselves. As part of our religion, we believe strongly in the agency of the human soul…and the responsibility to use it to choose wisely and well. You’re only accepting the first part of the deal.

          • And you CT are a typically naive Mormon woman. No group of people is more brainwashed than our medically minded Saints. I will agree with you that I am not typical, but you know nothing about what motivates me or the definition of responsible mothering or what it means to be wise.

            I have observed the lengths this Blogging Bitch will go to denigrate the life style I have chosen to live.

            If you believe she has provided a service to Mothers and Babies I am not here to try to change your mind.

            When the medical profession crumbles just remember that a few of us saw cracks in the infrastructure 25 years ago and decided to become medically self reliant in order to care for our babes.

          • theNormalDistribution

            “Blogging Bitch”? Classy.

          • siRi

            There is a fine tradition of weiRdos and nUtcases Capitalising their Insults to give them an air of je ne sais quoi. When I tell my kids they’re a bunch of untidy brats, you can clearly hear it’s all lower case; when a mad blogger calls Amy an Evil Witch, the capitals add gravitas, at least in their own mind.

          • Anj Fabian

            Medically self reliant?

            Sounds like “relies on natural remedies that make us feel like we are treating the disease, but in reality have no impact”.

            But congratulations on sticking to the man. Go you.

          • LibrarianSarah

            More like “lucky able-bodied blowhard that can’t see past her own privlege”

            I’m sure all the sick and disabled people out there just didn’t eat enough kale.

        • Siri

          T is o this agnostic, Socialist, pro-choice, breastfeeding-for-a-while-but-mostly-bottlefeeding, occasionally co-sleeping (with those of my kids who liked it; not everyone does), vaccinating Ordinary Person and Mother of Five, you seem like the kind of weirdo that makes us Norwegians shake our heads and say, Americans really ARE mad, aren’t they? Which is really unfair, as most of the other Americans on this blog are wonderful, intelligent, perceptive people. So I guess it’s just you.

          • Siri

            T is o? That should read To, sorry.

    • Trixie

      Interesting how much you hate Dr. Amy and yet you come here with a pointless inflammatory post with a bunch of links to try to generate web traffic to your own crappy site.

    • Mel

      Jenny,

      Do you know the definition of “hubris”? Placing yourself and Dr. Amy in the same category simply because you both blog is going to be a great example for my adult students. Thank you for that.

      Also, XOXO and “Hugs and Kisses!” is redundant.

    • anion

      Why in the world would or should she mention you to her readers? I certainly don’t write about random people I don’t think or care about and am not interested in. It wouldn’t even occur to me. Just because *you* think you’re important doesn’t mean anyone else has to spare you a second’s thought.

      There’s no big conspiracy against you; you’re just not important.

      • Tim

        ‘Alt med’ people always want to have live debates of actual physicians and scientists, mainly for two reasons

        A) it makes them look legitimate if an actual educated person is willing to engage them in debate
        B) since most people don’t understand reasonable debate, they know they can just gish gallop the whole time and make the actual educated person look bad by their inability to counter seven thousand simultaneous claims per topic

        • C) Dr. Amy is too big of a Chicken to have an open conversation…bawk, bawk, bawk…

          • Melly

            Wow! I don’t know how Dr. Amy can reply to such a mature, sensible argument as this.

          • Stacy21629

            Really, I can’t imagine why she wouldn’t want to respond to your totally respectful request for an interview.

          • Votre

            We really need to do something about the silly 5-year olds posting here. “Chicken…bawk, bawk, bawk…”? Seriously?

          • Tim

            I would seriously like to know what part of your brain thinks that physicians should stoop to “debating” with homemakers on medical topics. Seriously.
            I’m interested in WW2 history – does that mean that I should be entitled to challenge Antony Beevor to live debates and call him a chicken when he ignores my ignorant ass? No.

    • Karen in SC

      Blue and purplish babies turn up all the time in homebirth photos, care to explain? I even saw one captioned “Lavender is the color of life”.

    • Siri

      I keep trying to click on that link, but my thumb refuses to cooperate. Perhaps it’s the oxygen deprivation I suffered being born in hospital. Or only being breastfed for 3 months. Or all those vaccines. I seem unable to access uneducated, prejudiced woo. Is there a treatment? (Rhetorical; no answer required).

  • Nicole Petersen

    This is a landmark study that redefines “safety.” It turns out that drunk driving is safe now too, check out this graph I made:

    http://mamaandmaya.wordpress.com/2014/01/31/mana2-png/

    • moto_librarian

      I love this!

  • You know what – I think I’m a little more tolerant of Tabacco executives than of those wannabe healthcare providers at MANA. The Tabacco execs had a product that took decades to do life threatening damage that showed up statistically – MANA on the other hand has a product that has devastating consequences over the course of hours. It wouldn’t take decades to figure put the product was harmful – it takes just a few months and the courage to actually look at the statistics and report the findings. Real women fear birth and don’t fear math….fauxminists on the other hand…

  • Young CC Prof

    Ug, one of the women on my birth month club just delivered. She got her all-natural water birth in a birthing center. Then she got shoulder dystocia IN THE TUB. They somehow resolved it, she remembered a midwife telling her she HAD to push the baby out now. There was so much panic in the room that apparently someone cut the cord without putting two clamps on it first. “They cut the cord and blood went everywhere.” The baby was purple and not breathing when laid on the mother’s chest.

    Happy ending, this was in the birthing center wing of a major hospital. They called a NICU team, who were there in moments and resuscitated the baby. Her APGARS were 2 and 9, and there seems to be no lasting damage.

    Mother is grateful as anything to the NICU team. I wonder if she realizes that more monitoring, and delivering someplace where people could more easily work around her, might have prevented the near-disaster. I don’t dare tell her. She did listen when they explained that she was at high risk of repeat dystocia with another pregnancy, so I suppose it doesn’t matter.

    • LMS1953

      I was in a discussion on My OB Said What? and I complained about 3 consecutive primip deliveries done by CNMs on a “birthing stool” that I was called in for to repair hideous stellate obstetric lacerations – 3 episiotomy repairs for the price of one! The other poster thought it would be a great idea to have a study to compare pool birth with stool birth. Her theory was that the water pressure in the pool would support the perineum and thus prevent perineal lacerations. OK, intrauterine pressure is monitored as Montevideo units as a sum of the peak pressure in mmHg from the contractions in a 10 minute window. The typical contraction peaks at about 70 mmHg. This does not include the transmitted pressure from maternal pushing efforts. The 70 mmHg converts to about 37 inches of water. Let’s say the typical woman is 5’6″. When she sits in the pool the top of her head would be about 33″ above floor level, under 4″of water. She would drown. Moreover, kiddie pools are seldom over two feet deep because, well, you don’t want your kiddie to drown. For this to be at all feasible, the woman would have to deliver in a swimming pool wearing a scuba tank with a dolphin doula. Dang, better not give them any ideas.

      • LMS1953

        I just realized that wouldn’t work either. The hydrostatic pressure would be transmitted to her abdomen as well. She would have to be fitted with a suit of armor with her introitus exposed. Alternatively she could lower herself by rope until the pressure squeezes the baby out. The pair could then bond in a decompression chamber. How’s that for birth as performance art! Water woo beats those mean old forceps any day. Now, I would PAY to see that on YouTube!

        • Susan

          Don’t give them any ideas here…it kinda fits with dolphin assisted birth.

        • Siri

          Darling, is my introitus exposed in this outfit?

      • Karen in SC

        70 mmHg is more like 3 inches of water. 760 mmHg is atmospheric pressure, so I was wondering if you meant that contractions are 760+70 mmHg.

        • AlisonCummins

          70 mmHg = 2¾” Hg = 37.3″ water = 947 mm water

          No?

          • Karen in SC

            Okay, I was missing the calculation from inches of mercury to inches of water.

  • Dawn

    Thank you, Dr. Amy. Articles like this are the reason I no longer home birth or do NBC. I am 10 weeks pregnant with my 7th baby and seeing an OB. I will deliver in a hospital, and I don’t care how the baby comes out, I just want her to make it into my arms safely. I am embarrassed that I was so taken in by NBC, but glad I learned how dangerous it really is before any of my children were harmed by my ignorant decisions.

    • PrecipMom

      Dawn, from one ex-homebirth mother of a large family to another, *hugs* and congratulations!

      • Dawn

        Thank you! And I meant NCB, not NBC. jeesh….You can tell I hadn’t finished my cup of coffee when I wrote that!

        • The Bofa on the Sofa

          Or got done watching the Today Show.

  • anion

    I posted this on the previous post, but perhaps it belongs here instead. I apologize for re-posting, but it is directly about why MANA delayed releasing these rates for so long, and what one possible motive may have been:

    Is anyone else curious about what the rate of reporting was–or if/how it changed–from the beginning of the study to the end?

    In other words, did MANA start discouraging reporting after they saw how bad the numbers were in 2006? And perhaps the reason for the delay in releasing the numbers was to wait for plenty of “good” reports to cancel out the bad? I wonder if private words were said to members, to encourage reporting only of positive numbers.

    I’m not saying it absolutely happened, only that I really wonder.

    • Local woman

      A very good midwife has told me she was at a MANAstats meeting for midwives where the attendees were assured that if they had a bad outcome they could leave it out of their stats. Obviously she wouldn’t name names.

      • anion

        Thanks for that! It’s sadly unsurprising.

      • Busbus

        That’s crazy… But probably not too surprising. 🙁

      • Ashley L.

        Do you honestly believe that MANA is out to deceive people and deliberately mischart and lie so that a slightly higher fraction of 1% of women will choose to birth at home or hire a CPM? What would be their motivation? Money? Do you really think that every CPM is out to fudge data and encourage people to do something dangerous for the sake of money or to cover their asses? I don’t get it. That would be like me saying that all nurses and techs and doctors make up data and chart stuff that they say they did but didn’t do. Really, why do you imply that there is some sort of conspiracy or cover-up?

        • Young CC Prof

          Um, yes, money.

          If a homebirth midwife has 4 clients a month, and recruits one more, her income goes up 20%. If a hospital has one patient go elsewhere, it’s not even a blip on the balance sheet.

          Do doctors and nurses and techs make things up and lie? It’s pretty rare, because in a hospital, there are mechanisms in place to track what’s really going on and liars are punished harshly. No such mechanism in place at a home birth. No one but the midwife and the mother really knows what happened–and the mother might not have been in any condition to remember properly.

        • LynnetteHafkenIBCLC

          I think most CPMs believe in what they’re doing and are just naive and have an overinflated sense of their own skills. They literally don’t know what they don’t know. But the higher-ups at MANA? I do think there is some corruption there. Maybe it’s about money, maybe it’s a religious belief in traditional midwifery, maybe it’s just being too stubborn to admit they’ve been profoundly wrong for years. I’m sure it’s not easy to consider the idea that your beliefs have literally killed innocent babies.

        • Guesteleh

          Here’s what the Navelgazing Midwife had to say:

          The study says they enrolled the clients before they knew the outcome of the births, but I beg to differ. They may do that now, but back when I was doing them (2004-2009), we didn’t even fill out the paperwork until the woman was past six weeks postpartum. In fact, we used to sit with a
          pile of charts in our laps and fill out stat sheet after stat sheet, some women even a year (or more) postpartum. At that time, the stats were filled out on paper and sent in, so I know we weren’t supposed to send in any statistics before the woman was six weeks postpartum. I can’t imagine we were the only ones that did it that way.

        • Amy Tuteur, MD

          Yes!!!

        • AllieFoyle

          Well, what’s your explanation?

        • attitude devant

          Gee, I don’t know, Ashley L, but I’ve had midwives lie at transport right to my face, lie on the records they brought with them (always much later—we had a near 70% ‘forgotten’ record rate, and the records were always super neat and new-looking when that happened), lie to their patients about their risks, so why wouldn’t they lie in the MANA data?

        • Susan

          I think that midwives having a financial interest in seeing things in a light most supportive of homebirth is pretty damn obvious. Most of them get 100% of their income from homebirth. Doctors really aren’t that motivated financially by the 1%. I think if you were able to ask most of them off the record they would say they would rather lose 1% of their business if that business was people who were unhappy with doctors in general. I think the concerns of doctors about the safety of homebirth does indeed come from less self interested motives than the lack of concern homebirth midwives show.

        • AlisonCummins

          Anyone who can only do one thing is going to be more committed to doing that one particular thing than is someone who can do lots of things.

          An obstetrician can monitor or not, prescribe pitocin or not, order ultrasounds or not, perform a cesarian section or not, prescribe antibiotics or not, perform an episiotomy or not. Obstetricians look at the evidence, decide what the best thing to do is on the basis of outcomes, and that becomes the standard of care.

          A midwife can’t do any of these things except an episiotomy. Midwives look at the evidence, realize that they can’t follow the guidelines that keep people safe and… what? Quit midwifery? Tell their clients that they need to be followed simultaneously by an ob? Get their CNM and work in a hospital? Refuse to believe the evidence? Refuse to collaborate with the gathering of evidence?

          All of these strategies appear to be in operation among midwives.

        • AlisonCummins
        • araikwao

          I think it’s just ideology worship, and avoiding cognitive dissonance

        • Jessica S.

          Well, if that was said at a meeting, how would you interpret it? I mean, you can just refuse to believe that it happened, which is reasonable since it’s not a direct quote or something. But she wasn’t stating a theory, she was relaying something she was told.

        • Siri

          Do you hear yourself? That’s exactly what NCB nuts have been saying about OBs, nurses and hospitals for years. The conspiracy to turn low risk high risk so they can come to the rescue. The financial motivation to get women to deliver in hospital. The fudging of data so as to cover up the ‘thousands’ of women and babies who die due to unnecessary interventions every year.

          Doesn’t feel so good having the same things said about your holy cow homebirth midwives, does it?! Especially when it’s not just lies and fantasy, but a quote from an actual midwife.

    • No longer drinking the koolaid

      I contributed stats for almost all the years of the study. My outcomes would have been in the good column, although my transport rate was probably higher than they would have liked. They contacted me last year to ask a question about one of my patients and I told them, then sent a follow up letter telling them that I wanted ALL my charts removed from their database and the research. haven’t heard back whether they did that.

      • You should email dr amy to give her more information about your participation in the study. It would shed a lot of light on how things really are.

      • Susan

        Can I vote that you have the best user name?

  • citygirl

    Either no one is actually reading the study or they’re willfully ignorant because they’re all posting it on Facebook and blogs with a “Yay!! Homebirth is safe just as we’ve been saying all along!”.

  • Guesteleh
    • areawomanpdx

      They didn’t find an increased risk because they didn’t compare it to anything. If they had compared it to something, they would have found increased risk.

    • Stacy21629

      They did exactly what Dr. Amy said they would – took MANA’s word on the conclusions and didn’t actually read the paper at all.

    • realityycheque

      This is disgraceful. How can they not be held accountable for such irresponsible “journalism”? I wonder if it’s worth pointing them in the direction of Dr. Amy’s blog?

    • Trixie

      Well, HuffPo is where science reporting goes to die.

      • Jessica S.

        100% AGREE.

    • Mel

      At the bottom of the article, there is a section to report corrections. I gave a concise explanation of relative neonatal death rates and how 210 dead babies per 100,000 is significantly more risky than 38 dead babies per 100,000. (Funny how much easier numbers are to visualize when they are all whole numbers…..)

    • LMS1953

      Would anybody care to set the over/under on the percentage of HBers who have hyphenated last names? I’d put it at 85%. You know, eventually there is going to have to be a genealogical meiosis. Kinda like the deal the guy who invented chess made with the emperor – with the exponential power of 2^x, there was not enough wheat in the world to complete the deal. Likewise with Smith-Jones mating with Johnson-Murphy. It wouldn’t be too many generations before there wouldn’t be enough paper or ink in the world to fill out a birth certificate. Again, mating as narcissistic performance art.

      • Comrade X

        As a feminist, I have to say that this is a *little* harsh. I’m not saying cluster hyphenation is any kind of a solution to the problem, but you have to admit that it’s not totally unreasonable to think that patriarchal naming traditions ARE a problem….right?

      • Mel

        I’m a happily hyphenated woman who loves being pro-chemical. My choice worked well for me since my teaching license was issued in my maiden name and cannot be changed – ever – and my husband’s family is well-known in local agricultural circles. Hyphens as power-play if you will…..

        Many Hispanic cultures have practiced dual last names for centuries along with more than two given names. It hasn’t been much of a problem.

      • theNormalDistribution

        There’s nothing narcissistic about wanting to keep your own name and give it to your children; men have been doing it since the beginning of time.

        There are a lot of different ways to manage hyphenated names in the generations to come. My personal favourite is for an newly-married couple to hyphenate the husband’s father’s half of his double-barrelled name with the wife’s mother’s half. I get a graph theory boner just thinking about all the new information we could glean from those extra links.

        This blog is about home birth. If your only argument against hyphenated names is that you can’t figure out how they work, then maybe you should stick to what you know and comment on the topic at hand.

      • Siri

        Would you care to undermine your own credibility further by offering up other examples of irrelevant sexist opinions you might hold?

  • Stacy21629

    “women with higher-risk pregnancies still choose home birth”
    And their midwives are so STUPID as to take them on…Way to blame the mothers for their dead babies, MANA.

    • LynnetteHafkenIBCLC

      Exactly. Any real HCP would advise the mother to see a specialist because attending her is outside her scope of practice.

      • Stacy21629

        I love that folks repeat the mantra “For healthy low-risk moms and healthy low-risk babies, homebirth is as safe or safer than hospital birth” – in defense of their planned twin, breech vba3c.
        There’s a blog I follow – the mom is pregnant with mo/di twins, had TTTS, has had 3 procedures to correct and account for complications, baby A died…and she’s still holding out hope to homebirth baby B. Gah!!!!!!! Just waiting to be in the next Dr. A post…

        • Rea

          ZsuZsu?

          • Stacy21629

            Indeed.

          • Sally RNC-NIC

            I’m going to need a link to this blog…stat!

          • Stacy21629

            Name/nickname already mentioned above…google with “TTTS” and it’ll come up. Pertinent posts start December 6th.

          • Sally RNC-NIC

            Sweet. Sorry, apparently my search skills were lacking last night! On it.

          • Guest

            Her actual blog is for The Anderson Family and it is something like “Are They All Yours?” I just spent the last 30 minutes perusing it…seems like another stay-at-home mommy, natural living, homeschooling, fairly fundamentalist blog. It is very sad to read about her recent pregnancy loss of one of the twins. Hoping she decides to stick with sound medical care for Twin B!

          • Sally RNC-NIC

            Thank you! On it.

        • amazonmom

          You’ve got to be KIDDING me. Why go through all of that treatment and than you want to HOMEBIRTH ??? Ok rant over

          • Stacy21629

            Very sadly NOT kidding.

          • amazonmom

            That’s horrendous. We do TTTS procedures at work , I’ve never met a parent that would dream of homebirth after learning about TTTS and what comes along with it. Usually the parents would prefer to be as close to or in the hospital, because we have the OR and the NICU and other useful things.

          • Stacy21629

            Nope, and she’s had a laser ablation AND an amniopatch. So I suppose “just” 2 procedures…but like I said, she’s still carrying the dead baby around and will have to deliver that too. She just posted today about how her MFM is “supportive” of her homebirthing if she makes it to term (she’s in the neighborhood of 28 weeks now). Which I sure is just patting her on the hand and saying “Of course, honey, if you make it to term you can homebirth”, knowing full well that likely won’t happen. Oh yea and she’s a grand multipara too. Oh the complications! It’s like watching a train wreck in slow motion. The fact that she would even consider it though just makes me want to scream.

        • Guest

          I know exactly which blogger you mean (crazy ZsuZsu and her crazy hubby) and all I can think of is her other poor kids and the trauma they will go through watching their mother deliver a dead baby (hopefully just one dead baby, not two) at home. Those poor kids.

          • Stacy21629

            Does anyone outside of FJ refer to her as ZsuZsu? 🙂

          • amazonmom

            Oh my, especially when the dead baby has been dead more than a few days. I hope that’s not inappropriate to mention.

    • PrecipMom

      And their midwives lie to them about their risk category. It was a running line in online communities about 7-8 years ago based on a study a lot of years ago (have newborn, brain is gone right now) that even the highest risk people will have better outcomes in the home setting vs the hospital.

  • Ashley L.

    Where can we get intrapartum death rates (alive at onset of labor but dead at delivery) for hospitals? Amy T. says they are practically nothing and pulled a neonatal death rate from the CDC wonderbase. Is there a databse which measures intrapartum death rate the same way as the MANA report? The MANA stats reveal an intrapartum death rate of 1.3 per 1,000 for all babies, and the same when including babies with fatal anomolies. However, when the high risk moms are removed from the analysis, the intrapartum death rate is 0.85 per 1,000. What is the rate in a hospital for low risk moms? Does this number vary from hospital to hospital? Can one easily find this number?

    All that I can find for my state (Alabama) is a neonatal death rate (not divided between hospital or home births), which I am assuming is 0-7 days or 0-28 days. At its lowest in recent history, It is still over around 5/1000 for whites women.

    When I look at the data from other studies, I get different measures of neonatal death rates (and very few that report intrapartum death rates): 4/1000 from http://data.worldbank.org/indicator/SH.DYN.NMRT; 3.61 per 1,000 in 2007 for white mothers (http://www.cdc.gov/nchs/data/nvsr/nvsr59/nvsr59_06.pdf) In 2011, the rate among infants born to non-Hispanic White and Hispanic women (3.43 and 3.62 per 1,000, respectively). (http://mchb.hrsa.gov/chusa11/hstat/hsi/pages/206npm.html),

    • Guesteleh

      Can someone who is qualified answer this question? I think it’s important to respectfully answer questions regarding the numbers when it’s possible.

      • Ashley L.

        Thanks. I am just trying to sift through it all. It seems that the rates reported in this database for low-risk pregnancies (excluding malpresentation and other factors) are all as good as or better in every category other than intrapartum death rate of babies, which I am having a hard time finding in the other literature on hospital births in the U.S. for low-risk, white women. Am I correct, or off base?

        • Young CC Prof

          I honestly don’t know where to get hospital intrapartum death rates. I assume it’s because they’re so rare that you don’t just track them, you launch an investigation every time one occurs.

          As for neonatal death rates, yes, the USA’s overall neonatal mortality rate is 4 per 1000, 3.35 if you look only at white women. However, the neonatal mortality rate among babies over 2500 grams (not preemies) is 0.73 per thousand. This includes congenital defects.

          • Ashley L.

            And the rate the MANA database reports a neonatal moretality rate of 0.77/1000 (included anomolies). Don’t know how big those neonates were.

          • Ashley L.

            Crap. sorry I didn’t spell check. “mortality.”

          • Squillo

            No, that rate excludes congenital anomalies.The overall rate for neonatal mortality was 1.29. The rate excluding congenital anomalies was 0.76.

            The rate of early neonatal death (death occurring after a live birth, but before 7 completed days of life) was 0.88 per 1000; and the rate of late neonatal death (death occurring at 7 to 27 completed days of life) was 0.41 per 1000. When lethal congenital anomaly-related deaths were excluded (n = 0 intrapartum, n = 8 early neonatal, n = 1 late neonatal), the rates of intrapartum death, early neonatal death, and late neonatal death were 1.30 per 1000 (n = 22), 0.41 per 1000 (n = 7), and 0.35 per 1000 (n = 6), respectively

            If I run the CDC numbers for a similar population (gestation 37 weeks and above, singleton or twins) and exclude congenital anomalies that resulted in death, I get 0.40 for the same period (2005-2009) for hospitals. That number also includes deaths from “special causes (terrorism) and “external causes” (including vehicle accidents and poisonings.) I’m guessing the MANAStats don’t. If we exclude those, the rate falls to 0.37 for hospitals.

          • Ashley L.

            Hmm, then this is reported in the discussion section:

            The early neonatal death rate in our home birth sample was 0.41 per 1000, which is statistically congruent with rates reported by de Jonge et al[10] and the Birthplace in England Collaborative Group.[2] Our combined early and late neonatal death rates, or total neonatal death rate, of 0.77 per 1000 is statistically congruent with the rate reported by Hutton et al.[12]

            wonder why the discrepancy?

          • Ashley L.

            Okay, now I see what I was doing wrong in the CDC Wonder database. I didn’t know how to exclude causes of death and compare, so I included them all.

          • Ashley L.

            I can’t seem to get my replies in order..sorry. Did you also read in the discussion section what I posted two below? Wonder why they reported something different in the discussion than in the results?

            “he early neonatal death rate in our home birth sample was 0.41 per 1000, which is statistically congruent with rates reported by de Jonge et al[10] and the Birthplace in England Collaborative Group.[2] Our combined early and late neonatal death rates, or total neonatal death rate, of 0.77 per 1000 is statistically congruent with the rate reported by Hutton et al.[12]”

          • Ashley L.

            I see..that is the combined early and late neonatal death rate when anomalies were excluded. Thanks.

      • Jessica S.

        I agree, b/c I know I’ve read a few of the commenters address this (in addition to Dr. Amy) but I will fail miserably if I try to paraphrase. Plus, I wouldn’t have the numbers and the source, which is the important part.

    • R T

      This study puts it at .8/1000 for otherwise healthy white women, but I don’t know if place of birth was part of the criteria or if home birth transfers were included or not. It doesn’t indicate they were excluded. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3326407/

      • Squillo

        That’s for antepartum stillbirth.

        This study puts the intrapartum stillbirth rate in developed countries at 0.16 per thousand. Which seems low to me, but I can’t put my fingers on the other estimates I’ve seen.

        • R T

          Awww, okay I missed that!

        • R T

          Yes, that does seem really low!

          • Squillo

            I only have two sources to hand: that one (which only measures by developed/undeveloped, so it includes some very homogenous populations, i.e. in Scandinavia) and another that looks at data from Missouri between 1986 and 1997 that puts the rate at 0.5 for whites and 1.1 for African-Americans, but I’m sure there are others that are better and might give you a better idea.

            I couldn’t access the NCHS or HRSA pages you cited; can you provide titles of the reports, as I’d like to have a look at them.

          • Ashley L.

            Does this link work? Mortality rate, neonatal (per 1,000 live births) (http://data.worldbank.org/indicator/SH.DYN.NMRT/countries/1W?display=default&cid=DEC_SS_WBGDataEmail_EXT) Again, just neonatal death rate.

          • Squillo

            Those work, thanks!

          • Ashley L

            And also, trying to find the 0.38/1,000 neonatal death rate that Dr. Amy came up with in the CDC wonder database. I ran a query for 2007-2010 on all states including only infants that were greater than 2500 grams (term babies) among white and non-hispanic white women. I included all aged women and all education levels. I’m getting an avg of 0.96/1000. Can someone else run the same query (can’t do it exactly for the years of the MANA study b/c it is divided up..unless you can actually download the data from both intervals and then sort through it)? Can someone please double check that rate or tell me how Dr. Amy got 0.38/1000?

          • Squillo

            Cross-posting from the other post:

            Not Amy, but I ran the numbers using the following parameters:

            In-hospital (no unknown)
            Attended by MD/DO/CNM (no other midwife or unknown)
            Gestation 37 weeks and up
            Singleton and Twins
            2005-2009 (since MANAStats includes November 05-Dec 09)
            Death from <1 hour to 28 days of life

            I got a neonatal morality rate of 0.84
            Excluding deaths from congenital anomalies: 0.40
            Excluding deaths from congenital anomalies, "special causes" (terrorism), and external causes (vehicle accidents, poisonings): 0.37

            EDITED TO ADD: I suspect Amy excluded non-white women when she ran them, as the majority of homebirthers are white. I included all races in my query.

          • areawomanpdx

            Dr. Amy is comparing to CNM rates in the hospital, which is a proxy for low-risk birth. I ran a query for white women with a high school diploma or better (because the MANAstats said that their sample was 92% white and 92% high school graduates) with a gestational age of 37+ weeks and got .39. If I excluded birthweights less than 2500g, I got .33.

          • Ashley L.

            And this: http://www.cdc.gov/nchs/data/nvsr/nvsr59/nvsr59_06.pdf , again it is a neonatal death rate, not intrapartum…

          • Ashley L.

            And this link: http://mchb.hrsa.gov/chusa11/hstat/hsi/pages/206npm.html Sorry for the broken ones above..I put parentheses after them which is why they messed up.

        • Ashley L.

          So I just found the abstract from that study. Is it just me or is that confusing? At one point, the rate of intrapartum stillbirth for developed countries was 0.16/1000. Then later in the paragraph, it reports an average rate of .9/1000 for developed countries. And at the end, it says that for every 1% increase in c-sections, the intrapartum stillbirth rate decreased by 1.61/1000. Then in the very next sentence it states that there was NO relationship between c-section rates and intrapartum stillbirth rates. Talk about confusing! At any rate, if the intrapartum stillbirth rate is higher in populations with lower c-section rates (which makes sense), then is it wrong to venture to say that .85/1000 in the MANA stats is commendable with a c-section rate of 5%?

          • Squillo

            It is written confusingly. As I read it, 0.9 is the average rate in developed countries. I think what they are saying is that c/s rates above 8% don’t have a significant effect on intrapartum stillbirth. I’m guessing that most developed countries have a c/s rate considerably above that.

          • areawomanpdx

            The MANAstats says the intrapartum fetal death rate was 1.3/1000, not 0.85

          • Ashley L.

            It clearly states, as I said above, 1.3/1000 for intrapartum deaths when high-risk mothers are included and 0.85/1000 when the high-risk moms are excluded from analysis:

            When higher-risk women (those with multiple gestations, breech presentation, TOLAC, GDM, or preeclampsia) were removed from the sample, the intrapartum death rate was 0.85 per 1000 (95% CI, 0.39-1.31).

          • areawomanpdx

            sorry, I was skimming your post I guess!

          • areawomanpdx

            It says there is no relationship between csection rate in developed countries. The only relationship is as the cesarean rate goes from 0% to 8%

  • Squillo

    It is also possible that the unique health care system found in the United States—and particularly the lack of integration across birth settings, combined with elevated rates of obstetric intervention—contributes to intrapartum mortality due to delays in timely transfer related to fear of reprisal and/or because some women with higher-risk pregnancies still choose home birth because there are fewer options that support normal physiologic birth available in their local hospitals.

    English-to-English translation: Homebirthed babies die at a higher rate in the U.S. because they aren’t born in hospitals.

    • Guesteleh

      some women with higher-risk pregnancies still choose home birth
      because there are fewer options that support normal physiologic birth
      available in their local hospitals.

      Why the fuck are they wanking on about high-risk women not being supported in “normal physiologic birth” in the hospital? Aren’t high-risk women by definition women who need interventions to prevent a tragedy? That’s why they’re supposed to be in the hospital in the first place!

      • AlisonCummins

        It sounds like a more formal way of saying, “I was forced to have an HBAC because my local hospital wasn’t adequately staffed to offer me a safe ToL.”
        There are other situations — twins, breech, placenta previa — where “normal physiologic” is likely to kill one or more of you, which is why “surgical extraction” is the better option.
        I have “normal physiologic” teeth grinding which damages my teeth and “normal physiologic” snoring which increases my risk of diabetes, so I wear various “invasive orthotic” devices at night to prolong my life and the lives of my teeth.
        I had a “normal physiologic” reaction to malarial parasites that almost killed me, but I had “synthetic pharmaceutic” treatments to keep me alive anyway.
        Normal physiology is pretty impressive but it’s not magic.

        • Guesteleh

          But they didn’t specifically reference VBAC, so I presume they also mean vaginal breech, twins, and other seriously dangerous things. Also, there’s always going to be a significant percentage of women who are not good candidates for VBAC no matter what the setting.

          Anyway, point being, what part of “high risk” don’t you understand, MANA?

  • hmm hmm

    Maybe they were just looking around *really hard* for all that missing data. See Table 3:

    5-minute Apgar score <7 =245 (1.5%)

    but hey, they're "missing data for 401 neonates" (!!!).

    Any NICU admissions in the first 6 weeks=479 (2.8%)

    but hey, they're "missing data for 130 neonates."

    • Maria

      If I were MANA I would be embarrassed at the lack of professionalism and ability to provide the most basic records of births attended. The death rates are appalling and the fact that so many “high risk” births were allowed to go forward as home births is also appalling, I would suggest that a lack of training among non-CNM midwives would be obvious to MANA based on the fact that they can’t even follow up with their clients for the most basic of information. It makes me feel like a woman seeking a home birth midwife is really flying blind based on whether their MW is smart enough to keep good records or is seriously more interested in the “Warrior Woman,” Earth Mother aspect of birth than actually making sure the baby is born safely and the mother is not severely damaged in the process. Sounds like it is a crap shoot and there isn’t really a way to know if your midwife is good until after the fact!

  • I don’t know if I still would have chosen out of hospital birth after knowing this, but I surely deserved the information in order to make an informed choice. I wasn’t afforded the opportunity because mana didn’t think that I, and other women, deserved to know. Does anyone else get the feeling that they chose cut off dates for the data that made it look better?

  • Mel

    Question: How many babies died in 2007 onward? By burying the data, MANA allowed midwives to continue spouting the “home birth is totally safe” propaganda machine.

    Follow-Up Question: How the hell does anyone involved in this sick cover-up sleep at night? Do you dream of the (at least) 35 babies who died due to incompetency?

  • mostlyclueless

    This is the most dishonest part in my opinion and should not have been permitted by reviewers:

    >Low-risk women in this sample experienced high rates of normal physiologic birth and very low rates of operative birth and interventions, with no concomitant increase in adverse events

    If you don’t compare the number of adverse events to another birth setting it is simply impossible to conclude whether there was an increase (or decrease) in adverse events.

    • anne

      But, lots of them were breastfeeding at six weeks! Divert, dismiss, diminish. That’s all MANA does.

      • Mel

        Well, except for those babies that died at HB…..

  • moto_librarian

    Oh, MANA, how I loathe you! Let me count the ways:
    1. Complete inconsistency about who should be birthing at home. You are always holding up the Netherlands and the UK as model home birth situations and even acknowledge that they only allow low-risk women to deliver at home. Yet in your own publication of this data, you demonstrate that high risk deliveries are indeed occurring at home. 222 breech births resulting in 5 deaths? Contemplating that number makes me want to vomit.
    2. Your claim that the absolute risk is low. That is cold comfort to the people who are the “bad outcomes” in your data set. They have dead children. It’s always something that happens to someone else until it happens to you.
    3. 20-30% of midwives actually submit data. If I were in a position of regulatory authority, I would be shitting bricks about that. Extrapolating the numbers from this data set do not paint a pretty picture.
    4. No mention of other bad outcomes of homebirth appear in your data. How many women required reconstruction due to bad tears that either were not or incompetently repaired? How many brachial plexus injuries due to soldier dystocia? How many babies with CP and HIE? Since your membership can’t be bothered to carry insurance, you should be damned concerned about long-term disabilities and their effects on the families. Don’t you want to know? If you really care about women and their babies, the answer should be a resounding yes.
    5. Boasting about your 5% c-section rate. Guess what? My CNMs (hospital-based) have a 10% c-section rate. That is with incredibly rigorous screening and testing (they section for breech, for example). How much damage is being left behind in your attempts to keep c-section rates this low?

    I could go on and on, but I can’t. Everyone at MANA should be ashamed.

    • Mel

      Boy, if schools could only submit student data from 20-30% of students, we would hit NCLB in about 2 years……

  • mostlyclueless

    “CONFLICT OF INTEREST

    The authors have no conflicts of interest to disclose.”

    LOL

    • laughing foreverrrrr at that. Seriously???? You would think they would hand their data over to independent researchers if they wanted the appearance of being unbiased.

  • no longer drinking the koolaid

    I love the comment in the conclusion of the study which state they are unsure why the death rates are higher. They seem to imply that the fault lies with uncooperative physicians and hospitals with regards to accepting transfers.

    • Ugh yes that seems to be the new go to excuse- “the doctors must have been mean and wouldn’t help!” That is just the dumbest thing I’ve ever heard. I’m the last person to put hospital staff or doctors up on a pedestal, but I know that outside of sociopathy there is no chance that a doctor or nurse would refuse to help a NEWBORN BABY because they didn’t like their parents.

      • Amazed

        Hey, look at the comments of the previous post. The Informative Mother is hilarious in a chilling way. You see, some midwives don’t accompany the mothers when transferring because big bad doctors might yell at them and make unfounded accusations. It’s all about midwives’ fine sensitivities.

        Now you ladies want them to ponder over unpleasant facts like death rates. How can you be so mean! Mothers should pay them and let them recover after traumatizing them with births that veered way outside the norm and of course, it was all the mothers’ fault because babies don’t die all that frequently at all. Just ask the Informed Mother.

        • Guestll

          I love that so much. I think that’s one of my fave NCB comments on this blog, ever. Shit goes south, and the midwife doesn’t accompany BECAUSE PERSECUTION!

          I wish I could be that irresponsible when the shit hits the fan in my profession. Sorry, everyone! I don’t do accountability, I’m just here for the good parts, including my paycheque, which should always be forthcoming regardless of outcomes!

          Unbelievable.