MANA (Midwives Alliance of North America) is just like Big Pharma

immoral, unethical, corrupt

Let’s do a little thought experiment.

Imagine for a moment that Big Pharma has invented a new pain reliever, Fly-ox. Fly-ox is terrific. It provides excellent pain relief to many who didn’t like standard pain medications, and patients are singing its praises. Fly-ox is such a big seller that it becomes a major source of income for Big Pharma. The stock price of Big Pharma soars and the stock holders are thrilled.

At first, Fly-ox is not in the formulary of insurance covered drugs, so patients have to pay out of pocket. But Big Pharma has been working assiduously to gain approval from each individual insurance company so the insurance company will pay the full price for Fly-ox, instead of the patient. They’ve had some successes.

There’s just one teensy, weensy problem:

In studies that done by Big Pharma, but carefully removed from its FDA application, Fly-ox increased the risk of death.

At first the executives at Big Pharma thought it might be a mistake and that’s how they justified to each other leaving that information out of the application that led to FDA approval for Fly-ox. But in the past 5 years, Big Pharma has funded secret studies that have shown over and over again that Fly-ox leads to increased deaths, far outstripping deaths caused by side effects from other pain relievers.

The executives at Big Pharma stay mum about the increased risk of death, hoping that no one will notice, but eventually doctors do notice and reporting the deaths to the FDA. The FDA issues a black box warning about Fly-ox, and the survivors of those who died after taking Fly-ox start filing law suits. During the discovery phase of the lawsuits, plaintiffs lawyers subpoena the internal emails of Big Pharma and find prolonged email exchanges about how to keep the news of Fly-ox deaths from the public and the public relations campaign mounted to convince patients and doctors to ignore the FDA warning and continue using Fly-ox. Not surprisingly, juries start awarding big payouts when they learn that Big Pharma knew all along that Fly-ox led to preventable deaths, deaths that Big Pharma worked assiduously to conceal.

That’s reprehensible, right?

Now let’s change the story just a little. Replace “Big Pharma” with MANA (the Midwives Alliance of North America), the organization that represents homebirth midwives, and replace “Fly-ox” with homebirth:

MANA offers a new option, homebirth. Homebirth is terrific. Homebirth provides warm, supportive care to many who didn’t like standard hospital childbirth, and mothers are singing its praises. Homebirth is so popular that it becomes a major source of income for MANA. The public profile of MANA soars and homebirth midwives and advocates are thrilled.

At first, homebirth is not covered by insurance, so patients have to pay out of pocket. But MANA (and its sister organizations like The Big Push) has been working assiduously to gain approval from each individual insurance company so they will pay the full price for homebirth, instead of the patient paying. They’ve had some successes.

There’s just one teensy, weensy problem:

In studies that done by MANA, but carefully concealed from American women, homebirth increased the risk of perinatal and neonatal death.

At first the executives at MANA thought it might be a mistake and that’s how they justified to each other leaving that information out of their public pronouncements about the safety of homebirth.. But in the past 5 years, has continued to collect data that have shown over and over again that homebirth leads to increased deaths, far outstripping deaths that occurred in hospital childbirth

The executives at MANA stay mum about the increased risk of death, hoping that no one will notice, but eventually doctors do notice and begin reporting the deaths. The executives at MANA begin a public relations campaign to convince mothers to ignore the increased death rate and continue to choose homebirth.

In other words, MANA and its executives, are behaving just like Big Pharma, hiding evidence of death caused by its product in order to keep making money from it.

The MANA public relations campaign is a wonder to behold. In fact, MANA is even more brazen than Big Pharma. Big Pharma omitted mention of deaths from its papers about Fly-ox, while MANA actually reveals the 450% higher death rate from homebirth and then brazenly asserts that the death rate is evidence of “safety.”

MANA has its executives and friends stringing together mistruths, half truths and outright lies in an effort to blind their followers to the simple truth that homebirth kills babies.

Melissa Cheyney, Wendy Gordon, and Judith Lothian, I’m looking at you, among others.

Frankly, ladies, I don’t know how you can stand to look at yourself in the mirror. Your behavior is so unethical that it takes my breath away:

You have known FOR YEARS that homebirth increases the risk of perinatal and neonatal death, but you have hidden that information from American women.

You refused to release your hideous death rates because you were fully aware that they demonstrate beyond a shadow of a doubt that homebirth kills babies who didn’t have to die.

You are lying through your teeth about the meaning of the statistics revealed in your latest paper.

You are behaving exactly like big Pharma, throwing women and babies under the bus in an effort to preserve your income and your prestige within the homebirth community.

Your efforts to hide the dangers of homebirth are grotesque, and if you had an ounce of integrity, you’d be ashamed of yourselves.

But then, if you had an ounce of integrity, you wouldn’t be behaving like Big Pharma in the first place, would you?

  • Katherine

    Aside from taking aim at the study with a great analogy, I have you documented your concers with MANA’s study’s methodology or resultus? Or is there a link that you could share to someone who has? Apologies if this is elsewhere on the site and I missed it.

    • Katherine

      Disregard – just found the other article.

  • Karen in SC

    Picking up from some points already discussed, has anyone looked at the improvement in safety switching to rear-facing 5 pt harnessed car seats vs whatever was the previous recommendation? (sorry my car seat days were a decade+ ago)

    Considering that a newborn might be driven an average of 5.000 miles per year – appointments, errands, play dates, holidays…how has that risk improved versus the increased risk of homebirth?

    I’m curious how many babies per thousand are theoretically kept safe vs older car seat numbers and how that stacks up to the homebirth debate. It may be considerably more. Personally, I’m a bit skeptical myself on the ultra-seats, as I call them, but I’m willing to hear the other side.

    • Trixie

      We have very good data that rear-facing from 12-23 months is about 5 times less likely to result in death and serious injury than forward facing in a 5 point harness between the same ages. Beyond that, there have been so few children rear facing until very recently, that we don’t have enough real world accident data to analyze. I personally choose to keep my children rear facing until age 3-4, because we do have crash test data that it’s significantly safer.

      Of course, the absolute risk of dying in a home birth is greater than the risk of dying because you’re forward facing at age 1. But, it’s not an either/or proposition. Rear-facing a toddler is relatively easy and inexpensive, and usually not a hardship.

      Now, if you’re talking about comparing the 5 point harness to the old 3 point harness/overhead shield seats? Yes, any car seat on the market today is vastly safer than those were.

  • Guesteleh

    The reactions to the MANA stats and the non-response to the Cornell study has got me thinking that the NCB movement is really a weird form of eugenics. By birthing “naturally” without the need for interventions, you prove your genetic superiority and your elevated social class status (or in the case of religious HB’s, it proves you have God’s favor). That’s why they don’t care about the dead babies–those mothers and babies are genetically inferior so who cares if they’re removed from the gene pool? And that’s why they have to lie their asses off over the stats because otherwise they’d have to own up to what this is really all about.

    (I’m exempting women who choose HB because of a history of sexual abuse from this because I think they are a group who could be persuaded to give birth in a hospital if they could be assured they wouldn’t be abused or triggered)

    • MaineJen

      I have had the same awful thought… What if they are all trying to prepare themselves for some imagined dystopian future where medical care will be unavailable and women will have to birth at home? Are they trying to prove that they are worthy of survival? I’m not suggesting that this is a conscious thought or intention, but it may be the unconscious motivation behind much of the behavior. And it would make their desire to pretend that interventions aren’t available / are evil / wouldn’t have helped anyway, make a lot of sense.

      • C T

        Survivalist/preppers already share information on how to deal with emergency childbirth. It’s remarkably similar to what a CPM would learn to do, but at least preppers don’t tell each other stupid things like “there is no need to impose limits on the length of the second stage.” Also, preppers don’t feel the need to sell breathing CDs/herbal concoctions/scented candles/essential oils/goddess art/etc. or promote self-righteousness at having “achieved” a natural birth. Survival of mother and child is their goal, unlike CPMs who are selling an “experience.”
        If TEOTWAWKI (“the end of the world as we know it”) comes, I’m hanging out with the preppers, not the CPMs.

        • Young CC Prof

          CPMs trust birth. Preppers trust firearms. Yep, I’m with you.

          • C T

            Indeed, if you take good care of your firearm, you won’t get an obstructed bullet. There is no such guarantee with childbirth. ;)

        • http://kumquatwriter.wordpress.com/ Kumquatwriter

          Is it pronounced Tay-oh-twah-key or Tee-oat-waw-key? Or what? Hubby is borderline survivalist – as are my parents!

        • MaineJen

          I know some ‘softcore’ preppers myself…hubby and I have both agreed, if the shit ever hits the fan, we are packing the kids up and heading straight to their place. :)

          • The Computer Ate My Nym

            My first place to go will be the satellite pharmacy in the ICU of my hospital. It has the good drugs in it and it looks able to withstand determined assault by terrorists, zombies, and probably hostile extraterrestrials. Anyone controlling it will be in a position to demand things from those on the outside (if you feed us, we’ll release some percocet). And if it all goes uber bad…I did mention the really good drugs, including lots of sedatives?

      • manabanana

        “What if they are all trying to prepare themselves for some imagined
        dystopian future where medical care will be unavailable and women will
        have to birth at home?”

        Ummm. I have heard this first-hand.
        From midwives.
        Recently.

        And frequently.

        Yes, it is a conscious thought and intention. (Clarification: Among some, not ALL.)

        Back in 2009 there were long involved discussions among CPMs about how in demand they will be when people become too fearful to give birth in the hospital due to the H1N1 flu. They believed this. Whole-heartedly. It was insane. I wanted to shake them and say “DO YOU KNOW HOW BAD IT WOULD HAVE TO BE FOR THE GENERAL PUBLIC TO AVOID GIVING BIRTH IN A HOSPITAL WITH DOCTORS AND EPIDURALS?”

        I wanted to say:

        “Screw your brain on straight. Let’s live in reality.”

        Instead, I think those delusional discussions – among others – solidified my exit from the ‘profession.’

        • Young CC Prof

          Do you know how hospitals actually respond to flu epidemics? They restrict VISITORS. Especially in places like the maternity ward, where contagious diseases should not be. Some of the women on my birth month club were talking about how they couldn’t bring their older children to meet the new baby in the hospital, because the maternity ward had responded to flu by forbidding all child visitors, even siblings. (The actual flu patients will be in a totally different part of the hospital.)

        • MaineJen

          Mind. Blown. I guess that gives new meaning to the phrase “Some babies were just meant to die…” The implication being, ‘Your baby would not have survived the dystopian apocalypse, and was thus removed from the gene pool. Soon only we, the Superbirthers, will remain.’ Please, please tell me I’m exaggerating???

      • AlisonCummins

        I don’t think it’s particularly delusional, though we aren’t talking next year either. The price of fossil fuels will be going up and along with it the prices of transportation, medication, disposable sterile drapes and gloves, hand-sanitizer and dispensers. Everything will just be more expensive and harder to replace.

        It’s not at all implausible that we might eventually be moving lower-tech and to approaches like small community maternity clinics rather than large hopspitals to make outbreaks more containable. We would need well-trained, science-based staff at these clinics, not CPMs from apocalyptic cults, but preparing for a time when we will need to do without is not in itself irrational.

      • The Computer Ate My Nym

        But do they have the right dystopian future? What if in the future the main problem facing humanity is that other midwife scare tale, antibiotic resistant bacteria? What if only those with particularly good immune defense against encapsulated bacteria survive? Hmm…how do you get good defense against encapsulated bacteria? Right: the spleen. What if only people with a mutation that causes splenic hypertrophy* survive? But a large spleen might be fragile and tend to burst during the second stage of delivery. So babies with this mutation might have to be born by c-section. And in a few generations, all humanity would have to be born by c-section.

        Yes, this is a highly implausible scenario. The point is, even if there is some horrid dystopia in our future, we don’t have any good reason to say that an ability to bear children “naturally” will be helpful in it.

        *Acquired splenic hypertrophy due to, for example, liver disease, does not improve immune function. I’m hypothesizing something novel and possibly impossible here.

  • Amy Tuteur, MD
    • Amazed

      Scienceandsensibility.org is kindly sending the posters who keep pestering them with insignificant details like mortality away to… hold your breath… the MANA blog.

      Admit it. You weren’t really holding your breath, were you?

      • LMS1953

        A quote from your link:
        . Done for reasons of institutional management and control, they are one more interruption and create risks of their own. Particularly in hospital settings, vaginal exams are one more occasion for the introduction of nosocomial infection.”
        *********
        I guess there is no chance of introducing a “home-ocomial” infection by birthing in a kiddie pool contaminated with feces. Is there an evidenced based study documenting the safety (re: infection) of water birth?”

        They are not needed. Water is woo. Woo is good. Therefore water is good. Woo is to be accepted as axiomatic truth. To deny woo is blasphemy. To introduce the science of penocrats such as monitoring the progress of labor with the Friedman Curve and deciding when to make appropriate interventions is not even on the table for discussion.

    • LMS1953

      I have a clearer understanding now why witches were burned at the stake

    • KarenJj

      “Big Medicine Plays Its Only Card: The Ace of Scaremongering ”
      The title was enough for me. And people complain of Dr Amy’s tone!

      • Susan

        yes, oh the irony. As if those NCB classes aren’t chock full of scare tactics. I mean, why try to tell someone about the risks of their baby dying when you should be telling them about the horrors of amniotomy, pain relief… and hatting.

      • The Computer Ate My Nym

        So what if it’s the only card? It’s the ace of trumps. Ultimately, the point of medicine is to reduce mortality and morbidity. And “big medicine” can do that much better (at least in OB) than big naturopathy or big homeopathy. It’s the only card that anyone should need or want.

  • Amazed
    • Mishimoo

      Good grief! That’s horrible, the poor child + parents.

      • Amazed

        Nothing short of horrible. They will now blame themselves for those 15 hours they delayed to take their baby to the hospital because they trusted the midwife. I don’t know whether it would have made the difference – but neither do they.

        Horrible.

        And she’s still a nurse, can you believe it? Can you imagine having her as a provider in any capacity?

        I think any hospital that tries to sneak her on me even to have my blood drawn is in for a nasty scandal. She should be never allowed to approach a patient again!

        • LMS1953

          Those were two separate cases. She was fleeing a CP case. The 15 hour thing was after a ruptured cord – it does not sound like that one had lasting damage, just very substandard care.

          • Amazed

            Right. One should never post before going to bed.

            Anyway, I don’t understand who pressed charges against her if the baby didn’t have a lasting damage. Maybe it was the parents. Or the hospital if they are entitled to? It sure as hell wasn’t her professional organization, whatever it was (if it even had the right to), given the fact she’s still registered.

        • Mishimoo

          I agree! If she had made a mistake in a hospital and was remorseful, I could see her being able to stay a nurse. Considering that it was at home, she falsified documents, tried to flee the country, delayed medical treatment, and had the years of experience, so should have known better, I am shocked that she is still able to work as a nurse. She should have been struck off.

    • LMS1953

      A couple of linguistic comments: Have you noticed that “disgruntled” typically describes “postal workers” and that “botched” typically describes a surgical mishap, especially as pertains to products of conception – “botched abortion”, “botched delivery”.
      Just when I thought I got it right “practice”. Is it really “practise” Down Under?
      Wouldn’t the multimillion dollar judgment have just thrown her into bankruptcy?

      • Amazed

        I think the “botched” and “disgruntled” thing is meant to signify the importance of the events they are describing. And since “botched” has the slight reek of slang that appeals to many, it just looks more expressive and pulls more heartstrings.

        As to the bankruptcy thing, we’ll have to wait and see.

        • Mishimoo

          Her wages can and will be garnished, her assets may be stripped. If she goes on the dole (welfare payments) those will be garnished as well. It often works out to be a very unfair payment of $5 – $10 dollars a week, due to ‘hardship’.

      • toni

        ‘Practice’ is the noun, ‘practise’ is the verb. Like advice/advise.

        • http://www.antigonos.blogspot.com/ Antigonos CNM

          And “licence”/”license”

    • Sally RNC-NIC

      So, so, so sad and so, so, soooooooo preventable. Bah!

    • Anj Fabian

      “The tribunal also found Ms Khalsa, who is aged in her late 60s, failed
      to make proper clinical records and later submitted a second set of
      records that were false or misleading.”

      In other words, she lied. Now why would she lie?

      • The Bofa on the Sofa

        I’d like to see how anyone could defend a midwife who submits false records.

        • attitude devant

          Bofa, you poor dear child. Our parachuting trolls do it on this blog all the time. You know, midwives are so persecuted that they can’t practice freely, and they have to hide their majick…. Blah, blah, blah.

          • The Bofa on the Sofa

            Forgive me. I was making the mistake of thinking they should be treated like professionals. That is a lot to expect from a group who tries to devise ways to lie to their providers, too.

            Then again, I should have just followed my own advice. Remember, I am the one who says that the distinction between real professionals and quacks is that the quacks have no problem lying.

    • guest

      If you search “will patterson” and Khalsa you can eventually find a full court decision with a few more details on the birth and diagnosis. It’s contained in http://www.austlii.edu.au but it won’t let me link.

      • LMS1953

        The Birth

        According to the material tendered, the plaintiff’s mother went into labour on the morning of 21 October 2006 at about 41 weeks gestation.
        When Ms Khalsa arrived at about 12 noon, the labour was strong, she detected foetal heart sounds of between 140 and 158 beats per minute. By 2pm, the plaintiff’s mother was fully dilated and the plaintiff’s head was high.
        Over the next four and a half hours, the birth was protracted and complex. The plaintiff’s head descended slowly and, apparently, in a variety of positions. The plaintiff’s head was delivered at 6pm, when thick meconium was noted. There was considerable difficulty releasing the plaintiff’s shoulders, and eventually the plaintiff was born at 6.50pm.
        At birth the plaintiff was flat, and oxygen therapy was commenced. He was slow to breathe. An ambulance was called, and the plaintiff and his mother were transported by air ambulance to the Royal Hospital for Women.
        The plaintiff was admitted to the Neonatal Intensive Care Unit. He was noted to have a right Erb’s palsy. He developed encephalopathy within 24 hours of birth, and upon imaging, changes were reported which were consistent with a diffuse hypoxic brain injury.

        The plaintiff also came under the care and supervision of Dr Jayne Antony, a paediatric neurologist.
        In a report of 19 January 2009, Dr Antony recorded this:
        “Despite the worrisome microcephaly and other adverse factors to suggest hypoxic damage, he was quite alert, aware and very motivated. It was my impression that he probably had some acute upon chronic hypoxic ischemic brain injury, rather than just an acute hypoxic injury towards to the end of the labour. His MRI scan reports also indicated that it was more likely to involve a chronic hypoxic ischemic injury, rather than just an acute hypoxic brain injury.
        *********
        If you read closely, this might be a case of the “good old girl” network Down Under. The baby boy (Will)’s head came out at 6 PM after mom was complete at 2 PM. The rest of his body did not come out for ONE HOUR. Yet somehow, months later, a CT could be read to show “chronic hypoxia”. That is the defense that is used to say, “Agreed, we encountered problems but most of the injury was due to a chronic in utero insult over which we had no control and Will’s condition would have been the same either way”.

        • fiftyfifty1

          Oh don’t be dramatic! He wasn’t trapped in a shoulder dystocia for an HOUR, merely 50 minutes.

          poor baby

          • LMS1953

            LOL. I recently had a shoulder dystocia delivery. Head out and then delivery 2 minutes later. McRoberts maneuver did not help much, but the corkscrew maneuver sure did. An episiotomy was cut and did not extend. Apgars 8/9 and the cord gases were fine. The epidural provided excellent analgesia and cooperation for the maneuvers. “Routine” care became a calamity for poor Will.

          • fiftyfifty1

            “and the cord gases were fine”

            And there you have it audience. THIS is why you want a woo-free delivery in a hospital. I don’t think Dr. Amy has discussed cord gas tests, so for those who don’t know, the cord gas test is a blood sample taken from the cord after the baby has already delivered. That blood is then analyzed to determine if your baby was getting plenty of oxygen rich blood, or whether it was oxygen deprived.

            Dr. LMS1953 was able to resolve this rather severe shoulder dystocia in 2 minutes and the baby looked fine with apgars of 8 and 9. But he decided not to rest on his laurels. No, Dr. LMS1953 recognized that the delivery hadn’t been “just a variation of normal” and decided to do a test to make sure that he hadn’t missed anything. He wants to be *sure* your baby is going to be ok. If the condition of your baby is actually worse than it seems to be on the surface he wants to know. He wants to know for you, for your baby, and also for himself: if the number is bad he’s going to analyze his actions during the delivery to see what went wrong and how he might have improved.

            Contrast this with midwife Khalsa. This midwife was University trained and extremely experienced. But she was also infected with woo. Baby was trapped in shoulder dystocia for 50 (!) minutes and born barely alive. But she lied to the parents and told them everything was fine. Baby was showing ominous signs of compromise, and yet she still hides her head in the sand and keeps the baby at home.

            When you chose someone to deliver your baby, chose someone with courage and humility. Dr. LMS1953 may be a bit of a crusty ol’ goat, but he’s looking out for you and your baby, seeking out information that will help your baby, even if that means the tests may throw him in a bad light. That midwife is looking out only for herself.

          • toni

            Do they always test the cord gasses or just when there is a complication? My husband tells me that the doctor squeezed our baby’s cord blood into a little vial after delivery (I didn’t notice) I assumed it was for stem cell research

          • fiftyfifty1

            just when there is a complication (or any concern about a possible complication)

          • Medwife

            It is routinely done at all deliveries where I work. Frankly it helps to defend against a malpractice suit, if it’s alleged 2 years down the road that the baby is now developmentally delayed because he was compromised at birth.

        • Young CC Prof

          “Chronic hypoxia” before birth in a normal-sized and normal-proportioned baby? Is that even possible?

  • LMS1953

    http://www.slate.com/articles/health_and_science/science_of_longevity/2013/09/death_in_childbirth_doctors_increased_maternal_mortality_in_the_20th_century.html
    I was trying to google an answer to “who lives longer – a lifelong G-0 or a woman who has had children. That is NOT an easy answer to find. There were several reports that if a woman has a child in her forties, she increases her chance of living to 100+. Too many kids and a pregnancy complication will kill you. No kids and you get cancers that can kill you. Nuns live long probably because of their cloistered lifestyle rather than nulliparity.
    Anyway, this is a great link with pictures and diagrams about trends and figures in maternal mortality.

    • theNormalDistribution

      I’m curious – isn’t the benefit of having kids/breastfeeding from reducing the number of ovulations you’ve had? If that’s the case, what about women who are amenorrheic using Depo-Provera, Mirena, or Implanon (to name a few)? Wouldn’t they have even better outcomes?

      • Medwife

        Mirena doesn’t work primarily by blocking ovulation, so you probably wouldn’t see a decrease in ovarian cancer, but you might see a decrease in endometrial cancer.

  • KarenJJ

    Exactly this! You’ve explained exactly what is going wrong with the thinking of these midwifery leaders. Women deserve better. We need to know the information and we need to have the resources to make up our own minds. We demanded better from the medical establishment in the past (and still do!) and we need to demand better from midwives and their leaders. Thankfully where I live we don’t have the issue with CPMs, but the woo surrounding childbirth and the judgement about women and their choices appears to be universal.

    • http://www.antigonos.blogspot.com/ Antigonos CNM

      Some years ago, in a book by Germaine Greer ["The Change: Women, Ageing, and the Menopause"] she made the point that no one has yet determined what exactly are symptoms of ageing as opposed to menopausal symptoms in women — very largely because women did not live in the past to reach the menopause in the numbers they do today — and because money for research is largely controlled by men who aren’t interested in finding out. That’s why we don’t really know whether it is better to bear children, or not, in terms of later health/illness.

  • Dr Kitty

    OT
    If you have access to BBC Radio 4 I strongly recommend today’s programme
    “Test Case” and the follow up “The legacy of Mr C”
    http://www.bbc.co.uk/programmes/b03sbmv6

    This is a dramatisation of the Re C case which codified capacity to make medical decisions in the UK.

    Mr C was a paranoid Schizophrenic who had been in Broadmoor maximum security psychiatric hospital for 30 years after stabbing his girlfriend. Over time his delusions had changed and at the time of the issues in the case he believed he had been a famous doctor. He developed gangrene in his foot and the medical advice was to amputate below the knee. He refused the surgery. The resulting case changed the practice of medicine profoundly.

  • http://Www.awaitingjuno.blogspot.com/ Mrs. W

    The question appears to be: how is Big MIDWIFE to be held to account? What regulation would be needed to transform the situation from one where it’s obvious there is a problem but sweet little anyone can do about it – to one where there’s a problem and it will be dealt with? Mandatory insurance? Minimum association reserves?

    • student

      INSURANCE! For God’s sake, an electrician has to have insurance to work on your house. Why not midwives who hold two lives in their hands. I bet they would start doing some serious damn risk assessment if they knew they could be sued.

      • fiftyfifty1

        The insurance industry. Everybody gives them so much crap, but they have something very valuable to offer: they make their decisions based on numbers, not on fads or ideals. They knew that drivers in their teens and early 20s were risky long before it was trendy to discuss the lack of prefrontal cortex maturity of the teen brain. They knew that people with some chub on them weren’t unhealthy years ago and they didn’t change their minds when it became all the rage to wring your hands over the so-called obesity epidemic. And they have known all along that homebirth with a CPM wasn’t safe. Hint: that’s why your health insurance policy doesn’t cover it.

        • Staceyjw

          Wish it was true insurance didn’t cover it. Many do cover it. Lots of states make Mediciad pay, and other states have madndated insurance cover these frauds.

          Sad but true.

          • http://www.antigonos.blogspot.com/ Antigonos CNM

            Midwives in Israel are required to carry insurance, and most carry more than they actually must, just in case. It’s not cheap.

      • Susan

        It’s really an interesting topic. The malpractice lawyers see themselves as the champions of the rights of the little people. Sometimes, indeed, they are. And maybe this illustrates it, that these midwives are safe only because we have a system where you are really only going to be able to get a lawyer to take your case if there is a means for compensation on the other side. As long as they have no insurance, they’re relatively, except of an attorney who takes a case without hope of being paid, safe. To me, really, it’s all evidence that the system is all screwed up. Most lawsuits seem to have little to do with the truth really. I don’t know what a good system would look like but I don’t think it’s what we have in the US. In our case it’s failing everyone.

  • attitude devant

    Gah! These people are vile. I am just so disgusted. Name one MANA exec or spokesperson who has said ANYTHING about safety in the wake of all this carnage. Just one! “Maybe we shouldn’t do twins?” “Wow, it looks like rupture of the uterus indeed DOES occur in 1/200 VBACs—let’s not do that at home.” “Breeches should not be caught at home.”

    The silence speaks louder than anything.

    • KarenJJ

      Maybe they’re still working hard at that informed consent form they were meant to have completed years ago?

  • http://kumquatwriter.wordpress.com/ Kumquatwriter

    *slow clap*

    ETA: Should be animated. Stupid disqus. http://giphy.com/gifs/37Ez5CZ8P0jSM

  • Rochester mama
    • C T

      Chortle-worthy Cheney argument at the end of the article:

      “Cheyney, however, said there are significant problems with using this data to study outcomes by place of birth.

      “For example, U.S. birth certificates do not reliably track intended place of birth,” she said. “This means that between 10 percent and 25 percent of women who intended to deliver at home, but who transferred to the hospital during labor, have their outcomes erroneously recorded as hospital deliveries.”

      “It is unreliable and potentially misleading to compare groups when such a high percentage of your sample cannot accurately be assigned to one group or another,” Cheyney said. ”
      And yet hospital deliveries still had better results, even with higher risk homebirth transfers being figured in. What a deceptive person Cheyney is. And here I thought Dr. Amy was being too harsh about her before. Sorry, Dr. Amy. You were right about Cheyney.

      • LMS1953

        After re-re-re-re-reading this, trying to give Cheney the benefit of the doubt, I think this is what she is trying to say. A CPM takes on 100 women who INTEND TO BIRTH AT HOME. She delivers 75 and transfers 25 (kicking and screaming at the maw of the cascade of intervention). Let’s say she has ONE neonatal death from her cohort of 75 – her rate/risk of neonatal death would be really be 1 in 75. Cheney wants the CPM to be credited with the other 25 to make I lower at 1 in 100. Now, let’s say there is 1 neonatal death in the 25 hospital transfers. If we apply Cheney’s rule, then the CPM’s rate/risk increases to 2 in 100. However, the presented data still say the CPM rate/risk is 1 in 75. The other neonatal death is credited to the hospital. CONCLUSION: Missy, be careful what you wish for. I know you are trying to lay the groundwork that CPMs are so “expert” that they know exactly who, what ,when, where and why to transfer and that they should be credited with the “good” outcome. If the newborn dies, well, that was caused by the money-grubbing penocracy who made the transfer difficult, or who didn’t have the OR ready when the client hit the door, etc, etc., so the death should “rightly” go to the hospital anyway. But, playing by YOUR rules, the CPM rate/risk is only going to get worse.
        Missy, after that, then the next question you will have to answer is why there is a (what?) 18 fold increase in head bleeds in home birth. I am looking forward to the gyrations you are going to go through to try to pull that one off!

      • Amazed

        She can as well say, “We transferred all our mothers who were low-risk and stayed low-risk. Then poor us had to deal with the highest-risk deliveries.”

        Which begs the question: just how incompetent should one (ot 20-30% of all) be to achieve such a glorious result?

    • Young CC Prof

      I love that Cheyney quote about how transfers make the statistics unreliable. If all the transfers live, your numbers get SLIGHTLY better, effect on hospital numbers less than is a rounding error. If a substantial percentage of the transfers die, hospital numbers improve modestly and your numbers get even more atrocious.

      • The Bofa on the Sofa

        If transferring to the hospital saves the babies’ lives, how is that an argument for homebirth?

        • Young CC Prof

          Hmm, that too. I mean, if there’s a “10-25% chance” you’re going to wind up in the hospital anyway, why not just go at the start of labor? It’s sure easier than, say, transferring in the second stage.

      • LMS1953

        CC, that is not how I understand the effect of INTRAPARTUM transfers works. The HBer who gets transferred IN LABOR to the hospital and if the baby delivers in the hospital and then dies in the hospital – THAT neonatal death gets credited to the HOSPITAL. Even though the mismanagement that CAUSED the neonatal death was by the CPM/DEM.

        I think you were looking at it from the aspect of a newborn transfer from home AFTER delivery, where the CPM would get credit for the baby that was SAVED by the hospital

        • Young CC Prof

          Sorry, I was unclear. I was explaining how the results would change if we could track all transfer outcomes, that is, things would almost certainly look even worse for home birth if full data on transfers were available.

    • LMS1953

      “Although the study found a higher risk of infant death with home births, it did not establish a cause-and-effect relationship.”
      The Classic Statistical Triad.
      When the data or statistical findings don’t go your way, try these dodges:
      1) Claim “small sample size”. If you can work that dodge, you can keep on losing babies at a hideous rate for another 5 years. (“Only 20% to 30% of the CPMs reported their births)
      2) Claim “corrupted data” – eg, “No, no, what we wanted to measure was results by “intended place of birth” and not “actual place of birth”. And since intent was not tracked but actual was, then we’ll need another 14 million deliveries to work this out – another 5 years to kill and maim babies.
      3) Claim post hoc ergo propter hoc (as in the quote above) CPMs will use no end of intervention and woo and unicorn flatus that have NO EVIDENCE BASED efficacy (benefits from reproducible causality). For example, a religious dogma of any level of midwife is the Hokey Pokey Positioning ritual (You put your right leg in, you put your left leg out, you do the knee-chest position and you shake it all about. You do the hokey pokey and you turn yourself around. That’s how the tot comes out!). The point is that as part of our Maintenance of Certification last year there was an article to read about a study on the efficacy of the maternal hokey pokey on OP vs the dorsal recumbent position. CONCLUSION: it did not make a difference. Midwives will do Moxibustion. Midwives will encapsulate placentas for consumption. When it comes to woo, there is no need for correlation/causation consternation. No, indeed, the woo is to be accepted as axiomatic truths and articles of faith. But when it comes to a FIVE-FOLD increased risk of neonatal death with HB, there must be some sinister chimera of the penocracy at work for causality.

      • AmyH

        This comment seriously deserves to be given its own post. I love it.

    • Sally RNC-NIC

      “Although the study found a higher risk of infant death with home births, it did not establish a cause-and-effect relationship.”

      Ummmmmm…..what?

  • sacteyjw

    Biggest difference? At least if someone dies or is harmed, they can get a settlement. MANA and HB MWs? Judgement proof.

    • attitude devant

      A little typing problem on your name today SJW?

      • Staceyjw

        Yeah, the mobile is such a PITA to edit I gave up and left it :-)

  • LMS1953

    Somewhat OT: If Smirk, the maker of Fly-ox made a Big Pharma Push for Gardibucks after they had to make a large settlement for their Fly-ox fraud, might it not be best to cast a skeptical eye at Gardibucks?

    • http://www.antigonos.blogspot.com/ Antigonos CNM

      I’ve been worrying about Gardibucks for quite a while…

  • Guesteleh

    Check out this steaming pile of shit just posted on Science and Sensibility

    It is reasonable to talk about how recent this language of ‘risk’ is in
    pregnancy and in birth – but the language of danger, that which we are
    in risk of, has long been an accepted part of birth. Calling it “Risk”
    is adding the numbers – sure there are dangers, but precisely what are
    the odds? That there are dangers in pregnancy and in birth, and that
    they can be avoided or overcome, this is not news. Dangers, disasters
    even, could happen in the best and healthiest of pregnancies and
    births. The difference perhaps is that now there is no such thing as a
    healthy pregnancy and birth. There still is an understanding of such a
    thing as a ‘healthy meal” and even a “healthy diet,’ but no longer, it
    seems to me, a healthy pregnancy – the best you can hope for is a low
    risk pregnancy.

    • Medwife

      Hey, if you google “food+risk”, it gets LOTS of hits, just like “birth+risk”, hence being born is as risky as eating! Wow. I never thought of it like that. Deep.

      • Mel

        You know what is also dangerous according to Google-risking?
        Fugu + risks is 4.9 million hits.

        What does fugu + home birth risks have in common? Needless death and suffering.

    • Young CC Prof

      Under what possible circumstance (other than the slight reduction in certain cancer risks, or motivating changes in behavior) is pregnancy actually beneficial to one’s physical health? I really can’t see any overall direct benefit.

      • FormerPhysicist

        Some women report beneficial changes in skin complexion. My friend was terribly hypoglycemic before pregnancy and now is not. Overall benefit? I doubt it, there were some negative side effects too.

      • Expat

        A long term benefit from pregnancy? Well the permanent liver damage has made me quite thin, so that I never have to count calories. I have to limit my salt, sugar, and fat intake, though.

      • Trixie

        I had strong and lustrous hair and nails? Of course, the hair all fell out, then.
        No wait, my seasonal pollen allergies went away while pregnant and breastfeeding. That was nice, too.

        • Medwife

          My skin cleared up!

        • Young CC Prof

          Hmmm. That’s true. My allergies subsided a little, and I wasn’t cycling, so no PMS. But on average, yeah, not worth it.

          • auntbea

            I suddenly became lactose tolerant again, which I think isn’t actually possible.

        • toni

          My hair got curlier! Don’t think it got any thicker but definitely more waves. I always thought straightness was determined by the shape of your follicles not your hormones.. I suppose hormones could change your follicles…?

        • KarenjJ

          I felt better then I had for years. I think it pregnancy dialled back my immune system a little – not as many aches and pains. Of course, being on medication now is even better again.

      • LMS1953

        From an actuarial basis, which women live longer, a multip or a lifelong G-0?

        • Dr Kitty

          Nursing homes in West Belfast are full of nuns in their 80s and 90s…mothers of 8 in their 80s and 90s not so much…

          • Therese

            How do you know that’s not just because moms of 8 are less likely to need nursing care due to having more family support?

          • Dr Kitty

            I know I’m not doing home visits or taking phone calls about nonagenarian grandmultips living at home either. The beauty of GP, I know everything about everyone.

          • Certified Hamster Midwife

            Mothers of big families have to raise 9 kids in addition to birthing them, though. That’s stressful, to make a gross understatement.

            If they had small children in the pre-antibiotic and/or pre-vaccine era, as our theoretical grand multipara might have, they would have lost a few. Which is very stressful, too.

      • C T

        It’s as if the only real biological reason for pregnancy is to get a live child out of it or something….
        If I want an awesome experience, I’ll take my kids to SeaWorld.

      • The Computer Ate My Nym

        Um…I lost some weight after delivery compared to my baseline. Given that I was overweight, that’s probably good. Of course, in a thinner woman, that same effect could have been anywhere from inconvenient to deadly.

      • Mishimoo

        After having kids, my period went from being 7 days to 5 days long, decreased in volume, and the cramping eased noticeably. It’s still pretty bad, but I can function now instead of spending a week in bed.

      • http://kumquatwriter.wordpress.com/ Kumquatwriter

        Personal Pros: post baby weight loss, milder cramps and stronger orgasms (true story)
        Personal Cons: appetite never returned, hips still go out of joint, worsening carpal tunnel, minor back problems.

      • Anka

        I lost (and am still losing, seven months postpartum) some weight , though that could be attributed to somebody FINALLY treating my subclinical hypothyroidism, which was first identified and paid attention to in pregnancy, or possibly to my nearly-gluten-free diet (since it seems like I have gluten intolerance too). But I’ve also noticed that I used to get hypoglycemic-like reactions when I didn’t eat for long periods of time, and now I don’t. My migraines are shorter and easier to deal with. I haven’t gotten my period yet (despite mostly formula feeding at this point–take THAT, lactivists who insist that not EBFing will bring your period back in a few weeks!), so I can’t compare, though my periods were pretty wretched before. And my hair is straighter. But I suspect that most of these things might be attributed to the thyroid meds and change in diet.

    • Trixie

      Bullllllshiiiiiiiit
      “We’ve been trying to tell you that it’s not risky, but that wasn’t true, so now we’re just going to tell you that you shouldn’t care if it’s risky.”
      Also, why the bread analogy? Baking bread is not and never was a risky activity from a food safety perspective.

      • Trixie

        Also, why does she cite as a reference an article on adult manifestations of childhood sexual abuse? WTF does that have to do with anything?

        • Young CC Prof

          Maybe the “risks” of vaginal exams? Which can indeed be traumatic for an abuse survivor, but there’s no evidence that a CPM with no mental health training is better at managing said trauma. (In fact, we have anecdotal evidence to the contrary…)

          • Trixie

            And most hospitals have screening and protocols in place to try to make those situations as comfortable as possible.

    • LMS1953

      B-b-but PREGNANCY IS NOT A DISEASE! Trust birth! Abhor the cascade of intervention! Eat more kale!

      • Trixie

        I feel like swiss chard never gets a fair shake.

        • LMS1953

          Agreed, neither does morning primrose when evening primrose waltzes into the room.

          • Susan

            Sounds like a country song…

    • Squillo

      Engish-to-English translation: Don’t worry your pretty little head about a little increased risk.

    • Therese

      How would ending driveway parking save lives?? The only thing I can think of is preventing rollovers, but that could happen with curb parking too. And if that were the concern, detectors in the back of the car or video cameras would make more sense. Is there some other danger to driveway parking that I’m not aware of??

      • Young CC Prof

        I suppose if people lived in little developments that were entirely car-free neighborhoods and parked in a single diagonal-parking lot outside, that might slightly reduce accidents. Might. And obviously it would be really inconvenient for things like grocery shopping.

        Curb parking definitely isn’t safer than driveway parking, because curbs which are solid cars obstruct visibility at intersections, in driveways, and for pedestrians trying to cross.

      • Amy M

        Maybe she is thinking of children playing in driveways, getting run over by people pulling into or out of said driveways?

      • Trixie

        You can virtually eliminate that risk very simply by making a habit of always walking fully around your vehicle before getting in, and looking for any small children in the surrounding area. And actually, rearview cameras or sensors are being phased in to all new cars to help reduce this risk because NHTSA determined that it would save lives.

        • The Bofa on the Sofa

          It would also save bikes

          • Dr Kitty

            And pets…

    • Mel

      “That there are dangers in pregnancy and in birth, and that they can be avoided or overcome, this is not news.”

      NCB has been claiming for years that pregnancy and birth are totally natural and safe. So safe, in fact, that you don’t need any sort of advanced medical training or even a high school diploma to deliver babies. If the dangers of pregnancy and birth were then known to NCB advocates, why claim pregnancy and birth are safe?

      Oh, wait. I forgot the obvious. Money. No one’s gonna fork over $4,000+ for NCB services if the selling point is “Yeah, I’m clueless; you and your baby might die.”

    • Mel

      OMG: Look at the references:

      [i] Beck, U. (1992). Risk society: Towards a new modernity (Vol. 17). Sage.

      [ii] Lichtman, R. (2013). Midwives Don’t Deliver or Catch: A Humble Vocabulary Suggestion. Journal of Midwifery & Women’s Health.

      [iii] Katz Rothman, B., (2014) Risk, Pregnancy and Childbirth, Risk, Health and Society, edited by Alaszewski, Intro by Barbara Katz Rothman. Volume 16.1, forthcoming.

      [iv] Adult manifestations of childhood sexual abuse. Committee Opinion No. 498, American College of Obstetricians and Gynecologists. Obstet Gynecol 2011: 118:392-5.

      One is an English translation of an anthropology text. The second is a slap at the linguistic quirks of midwives. The third is self-referential to the book she authored. The fourth is an actual paper that is marginally connected to risk management.

      • Dr Kitty

        Go to Pubmed, look for the Lichtman article and click on “related citations”.

        Number 7 is a Finnish article (in Finnish, sadly all I have is the title) called “Midwives are expected to be professionally competent”.

        Yes, yes they are.
        Which is why CPMs aren’t midwives.

        http://www.ncbi.nlm.nih.gov/pubmed/2072617?report=docsum

        • Trixie

          How much do you want to bet they cited it without reading it either?

    • LMS1953

      ” Thus the MANA data is not merely a comparison of place: What we are seeing in this data set is a study of midwifery-led care, or as Ronnie Lichtman has called it[ii], midwifery-guided birth, birth in settings where midwives and the women they are guiding have control over practice.

      MANA’s data and these articles are showing us that the United States, for all of its problems, is not exceptional: Fully autonomous, informed midwifery care provides better birth outcomes than does care under Obstetrical management. Obstetrics and Gynecology is a surgical specialty, magnificently equipped to manage particular illnesses and crises, but neither the discipline nor the hospital settings it has developed for its practice are appropriate for normal, physiologic birth.”
      ******************
      OK, I get it now. If you are having a “normal, physiologic birth”, then it is OK to have the product of that birth die at FIVE times the rate of one of those “abnormal, cascade of intervention births” To quote Ina Mae “Birth Matters” – even more than the baby.
      Let’s say that we had Certified Professional Rocketeer guided space launches that wanted to compete with (pre-Obama) NASA. The only problem is, the rockets crashed and astronauts died at FIVE times the rate of a NASA guided launch. Would you want to be a CPR astronaut?

    • theadequatemother

      “Home birth involves a set of skills, practices and competencies that people trained in hospital birth most often never have learned.”

      like…

      placental butchering and dehydration
      cinnamon gum breath blowing
      blow-up kiddie pool sanitization
      kiddie pool turd straining
      using a dirty t-shirt to suction meconium
      avoiding calling for help
      fleeing the scene
      avoiding your former clients
      avoiding responsibility and accountability
      avoiding the truth

      • Amy M

        You forgot aromatherapy and moxibustion.

        • Dr Kitty

          And:
          Space holding
          Knitting
          Back rubbing
          Administering “minerals”, which may or may not be illegally obtained prescription medications
          Doing Neonatal CPR on a tea tray
          Sleeping on your clients floor because she has been in labour four days and you have no back up…

          • Trixie

            Googling how long it should take for the second twin to deliver …

          • Amazed

            Calling 911 to get your client to the hospital (none of them hospital slaves can do that. Being already in the hospital screws this important skill) when 20 minutes on neonatal CPR (for reference, see Dr Kitty a post above) finally move your client to the low-risk category that should land them in the seventh circle of hell, aka hospital.

          • Amazed

            Not running away when being ordered to pay 6.6 million $ for a damaged baby. (No need to mention that it was because you were caught at the airport. No cudos for the police, they are all for you!)

          • Amazed

            … on the 46th day after the first one’s delivery. It’s very important not to let the kid be overdue!

        • theadequatemother

          That’s because my medical school and residency education is sorely lacking

      • Trixie

        I have, in fact, strained turds out of a kiddie pool.

        • Mishimoo

          I hope that you demanded a certificate of accomplishment!

          • KarenJJ

            Wow. With a high school diploma you’re half way to being a CPM. Can you knit?

          • Mishimoo

            I can crochet and embroider beautifully, do they count?

          • Amazed

            I can read very fast. More time to consult Dr Google when things go south. I can prevent them from actually reaching the South Pole. I think so anyway. Naturally, I cannot give any guarantees. Birth is as safe as life gets.

          • fiftyfifty1

            Do you hold the embroidery thread in your vagina?

          • Mishimoo

            No, my left nostril. It symbolises the beauty of the umbilical cord as well as demonstrating how nutrients and oxygen perfuse into the neonate despite the placenta no longer being attached to the uterine wall.

          • fiftyfifty1

            No I’m sorry, despite the beauty of what you describe, it does not qualify. Only thread that is held and then emerges from the sacred yoni has the power to earn you credits toward your CPM degree.

            ETA: but we might make an exception if you store it first for a time in your yoni before transferring it to your nostril. That and a small service fee and perhaps MANA will grant you an exception for credit.

          • Mishimoo

            It should! I am a womyn, and I have other ways of knowing. To say otherwise is to bow to The Patriarchy and their control over our bodies and shestories. I demand those credits and additional ones in the “Holding Space” category.

          • fiftyfifty1

            Credits granted!!!!!

        • theadequatemother

          Great! Want to deliver my next child?

          • NoLongerCrunching

            Tsk tsk Midwives don’t deliver, they catch.

            (Formerly LynnetteHafkenIBCLC)

          • Trixie

            Sure! Ad to my credit, I felt like fleeing the scene when the turds appeared, but I stuck it out. You can count on me in a crisis.

        • auntbea

          I just now strained a poop out of bathtub with a scoop shaped like a stegosaurus. How many more poops do I have to scoop before my apprenticeship is complete?

          • Trixie

            See, this is distance learning at its finest.

          • auntbea

            Hey, can I get observation credit for the poop you scooped? I mean, with your description, I feel like I was right there with you!

          • Squillo

            Observing or scooping?

      • fiftyfifty1

        collecting the $ ahead of time. in cash

        • Trixie

          The cash part is important, so you can avoid paying taxes to the patriarchy.

      • fiftyfifty1

        pressuring your client into preparing a meal for you
        eating that meal your client prepared for you

        • Trixie

          Wait, did this happen? Or are we talking about that person from yesterday, Tilde something?

          • fiftyfifty1

            This has come from a number of different stories posted by homebirth moms. Those that are still into NCB will do things like say that when they started early labor they started cooking because they wanted to have something nice for the midwife when she arrived to impress her. Those that have re-evaluated describe situations where they are actually pressured in a passive aggressive way. It’s totally bizarre I know.

          • Trixie

            So weird.

          • OBPI Mama

            The midwife DOES ask for food (snacks, drinks, etc) to be available to them during labor. My mom made them potato soup…

          • OBPI Mama

            Oh and I forgot that my sister baked a cake (that is kind of a tradition in our family… a birthday cake on the birth day).

            A few friends have remarked that they failed in providing the midwife and assistant adequate food during birth. They honestly felt bad about it. Many had their family bring over a meal to them.

          • NoLongerCrunching

            Wow. When I do a home visit, I won’t even accept an offer of water (unless I have dire need) because I am not a guest; I am there to work for the patients.

            (Formerly LynnetteHafkenIBCLC)

          • Dr Kitty

            I get offered tea all the time on house calls.
            I generally do not accept.
            I think the only time I have had a cup of tea was a call to verify death and the widow wanted me to stay until the undertaker collected the body. Having her make tea got her out of the room while I verified the death.

            “Actually, I will take that cup of tea now, if you don’t mind” seemed nicer than asking her to leave the room or just going ahead while she was there.

          • OBPI Mama

            I always ask my son’s visiting dev. specialist, his BCMH nurse, and any of professionals that visit my house if they’d like some coffee or sweet tea or something to drink and some cookies. It feels good to give refreshments to someone who has come to help you and your family. They usually say “no” (pretty sure it’s policy for gov. workers here), which stinks, but I understand. So, I be sure to bake cookies and whatnot for them and bring them to the office every once in awhile (as well as to my obgyn’s office…I love them all and the office women!). Small thank you’s.

            I do think it’s unrealistic for midwives to expect to be given a meal and snacks all that when attending a woman in labor… esp. since you don’t usually know the day you are going to go into it! haha. And I think a lot of homebirthers are like me, trying to make everything from scratch, which means we don’t have a lot of snack food.

      • fiftyfifty1

        being BFF with your client

        • OBPI Mama

          until the birth goes downhill… then you drop off the face of the planet and never answer a phone call! Be sure to leave the mom super confused because you *were* her bff!

      • fiftyfifty1

        reminding your client to “own” her outcome when it is bad

      • Trixie

        Not chatting, not patting, not hatting

  • Trixie

    Brilliant essay, Dr. Amy.

  • http://Www.awaitingjuno.blogspot.com/ Mrs. W

    It goes a bit further than that – not only do they claim “homebirth is safe” – but they also claim “cesareans are dangerous” and “hospital birth is dangerous” – so not only do they lie about their product, they attempt to slander the competitions’ product. There is nothing a woman has more exclusive ownership of than her body – and witholding information that is critical to the exercise of bodily autonomy is a reprehensible violation of that woman’s rights. Homebirth might be appropriate for some women in some cases – but only if it is undertaken in the context of fully informed consent.

    • http://Www.awaitingjuno.blogspot.com/ Mrs. W

      Note: just as vioxx might be appropriate under certain circumstances – but what MANA has done is put its interests ahead of those it allegedly serves, and that should never end well.

      • The Computer Ate My Nym

        Vioxx might have been appropriate under certain circumstances and would likely have survived with a black box warning, except for one thing: Merck didn’t fail to find the cardiac risk, they deliberately hid the cardiac risk. That was what did in the medication. Lying about biology doesn’t pay in the end: the truth will come out. As MANA is finding out…

        • Young CC Prof

          I agree. There are other NSAIDs with a similar cardiac risk still on the market. The FDA pulled it not because it was super-deadly but to punish the manufacturer for lying. Then they fined them, yelled at them, and left them naked before a flood of lawsuits. Justice, I’d say.

          Pity quacks so seldom get judged as thoroughly.

          • LMS1953

            I guess after that flagellation we can fully trust that Merck has not hidden anything adverse about Gardisil

          • Young CC Prof

            What precisely do you think the adverse effects are? That one girl who died (months after the vaccine) probably died from a hereditary heart condition. Unfortunately for her younger brothers, her mother insists on blaming the vaccine, and refuses even to have the boys tested for heart problems.

            Besides, the profit motive for vaccines is a heck of a lot smaller (one or a few doses per person in a lifetime, as opposed to a bottle a month for decades), which means the incentive to do evil things in order to sell them is seriously lacking.

          • LMS1953

            I guess there are none. I guessed there weren’t any exceptional ones for Vioxx when I prescribed it for my patients – except Merck hid them. As far as profit motive goes, in 2007 Rick Perry, as Governor of Texas brought a young woman up on stage would had developed cervical cancer when he was trying to make it a law in Texas that Gardisil be a required for school like the litany of other required vaccinations. I guess his motives were genuine and pure, but things got a little iffy when the stench of nepotism started to leak out. Here is a quote:

            Merck’s Texas lobbyist at the time was Mike Toomey, Perry’s former chief of staff.

            Toomey is now one of Perry’s most important fundraisers, heading the Make Us Great Again PAC for Perry in Austin.

            According to the Perry Administration’s internal emails, Perry’s staff were aware at the time that the Texas mandate would benefit only one company, Merck:

            Brandon LeBlanc, the governor’s community affairs public liaison, forwarded to fellow senior staffers an article quoting critics’ who “point out that the legislation right now benefits just one pharmaceutical firm, Merck & Co.”

            At the time (2007), Gardisil was the only HPV vaccine on the market. Gardisil is listed at $130 per dose times 3 doses – although many does are given through much cheaper programs. There are 2 million 12 year old girls each year. If it became a nationwide mandatory vaccine, there was a potential revenue of $260 million dollars (ie, a quarter of a billion dollars) per year – albeit just a tenth of the $2.5 billion in annual Vioxx sales. Not a bad sum, especially if it can be divvied up to lobbyists and Governors and other critters.

          • Box of Salt

            There are large studies from Sweden and Denmark demonstrating the safety of Gardasil (here’s one):
            http://www.bmj.com/content/347/bmj.f5906

          • The Computer Ate My Nym

            Merck’s a huge company. Are you really avoiding all Merck manufactured drugs after this incident or only gardisil?

            And no, of course we can’t trust Merck not to hide something on Gardisil, norfloxacin, losartin, or any other product they make. That’s why we have the FDA and why they should (and did) get into serious trouble if they try to hide anything from the FDA.

        • Dr Kitty

          I sit patients down all the time and write down their increased risk of heart attack/stroke with certain NSAIDs, and offer them a safer one.

          Most of the time, they are on the riskier one because the safer one didn’t control their pain and they are willing to take the small future risk for a better quality of life now.

          But at least I can be sure they have the facts they need to make the choice.

          • The Computer Ate My Nym

            Ironically, the trial that established (well, revealed the evidence that was previously hidden) the cardiac danger of vioxx also demonstrated that it is protective against colon polyps in people with high risk (i.e. familial polyposis). It’s irrelevant now, since vioxx was pulled from the market, but for a young person with no cardiac risks and FP greatly increasing their risk of colon cancer, might not the benefit outweigh the risk? I’d like to see a celebrex trial to see if it works the same way (with the same risks, of course.)

  • Joe Smith

    Except…….Big Pharma also does a lot of good.

  • Susan

    How deep are MANA’s pockets?

  • GiddyUpGo123

    When I was pregnant I avoided everything that might cause listeria … Cold cuts, mushrooms, smoked salmon, cookie dough, hollandaise sauce, bagged salads, everything. Friends who were also pregnant or who recently had been would tell me that it was silly to be so cautious when the risk was really very low (the whole “even though the risk of listeria is 20 times higher for a pregnant woman, 20 times a small number is still a small number” argument). But I remember reading an article about a woman who lost her baby to listeria, and she said, “statistics mean nothing to you if you’re one of that small number.” That resonated with me and still does, which probably makes me a really over cautious parent (I once freaked out for weeks about hantavirus because a mouse got into my kids’ closet). But it also means that I don’t take risks with my kids lives, even if they’re only small risks and especially when it’s so easy to avoid them. Using a car seat is not a hardship. Neither is avoiding bagged salads and cookie dough, or giving birth in a hospital.

    • Zornorph

      Doesn’t Listerine cause listeria?

    • Trixie

      Wait, I should’ve been avoiding mushrooms? Whoops

      • GiddyUpGo123

        Just raw mushrooms … If you heat up almost all of that stuff it’s safe to eat.

        • Trixie

          Well, too late now anyway. I probably was mostly eating cooked mushrooms but I wasn’t careful about cross contamination or anything.

    • Young CC Prof

      When it came to risks during pregnancy, I always asked 4 questions.

      1) What is the harm that might result from doing X?

      2) How much evidence is there that the harm actually exists? (I won’t act on old wives’ tales!)

      3) What is the probability that the harm will actually occur if I do X?

      4) What is the cost of avoiding X?

      If the harm is loss of or serious damage to baby, the evidence of harm is solid, and the cost of avoiding is negligible, then, logically, you should avoid X even if the probability is small.

      I did eat cold cuts a few times while pregnant, but only when I found myself in a situation where it was literally the only food available that I wasn’t allergic to. At that point, the cost of avoidance was either eat something that would definitely harm me, or skip a meal entirely and risk fainting, which outweighed a tiny risk of food poisoning.

      Risk-benefit analysis. We don’t all have the same values or live with the same circumstances, which means we can come to different conclusions about which risks are acceptable and which are not. But we can all use the same system of logic to get there, and we all benefit from accurate information to make our decisions.

    • MLE

      I was just ill with listeriosis recently. It was no picnic, and even though I “knew” it could happen, now I KNOW. I am like a home birth advocate in that respect (if it hadn’t happened to me, I might still be taking it lightly).

    • http://shameonbetterbirth.wordpress.com/ Shameon Betterbirth

      All I could stomach during my first pregnancy were things with a higher risk of listeria (and peanut butter toast, but 3 meals a day of that is horrible too). i was losing weight bc of hyperemesis so I chose the risk of listeria over not eating enough.

    • Jessica S.

      I didn’t know I should avoid bagged salad! Not that I eat it very often, but if we have salad, it’s of the bagged variety. I wonder if that’s true about all bagged produce, like say, carrots?

      • GiddyUpGo123

        I think it’s anything that is purchased prepared but uncooked, so yeah that would apply to carrots too. The problem as I understand it isn’t because those foods themselves are particularly risky but because of the way they are prepared, on surfaces that might be cross-contaminated.

        • Jessica S.

          Good to know, thanks!