Marian MacDorman, liar

MacDorman amended copy

The Midwives Alliance of North America (MANA), the organization that represents homebirth midwives, is desperately lying about the death rate at homebirth.

No, they’re not lying about the rate of neonatal death at the hands of homebirth midwives, 2.06/1000. They are lying about what it means.

Specifically, they are attempting to conceal the dramatically increased risk of death at planned homebirth during the years 2004-2009 by comparing it to everything except the only valid metric. That metric is the death rate for comparable risk hospital birth during the same years, publicly available on the CDC Wonder website.

They know, as as I have written, that the death rate for babies of comparable risk women who delivered with a certified nurse midwife in the hospital 20004-2009 is only 0.38/1000. That means that the death rate at the hands of homebirth midwives was 450% higher than the death rate in the hospital.

I’m not the only person to use the CDC numbers. Researchers like Amos Grunebaum, MD use the same numbers to reach their own conclusions that homebirth dramatically increases the risk of death.

MANA can’t change its own hideous numbers, the same numbers it has refused to publish for the past 5 years. Instead, MANA, and executives Melissa Cheyney CPM and Wendy Gordon, CPM have attempted to discredit the the CDC’s mortality data. In a recent piece on its blog, MANA says:

Why doesn’t the Cheyney study compare home birth to hospital birth mortality rates?

It makes sense to want to draw these comparisons. However, hospital rates in the U.S. are derived from vital statistics data (birth certificates and/or death certificates). A number of organizations, including the American College of Nurse Midwives and Citizens for Midwifery have spelled out the limitations, which include a failure to capture the intended place of birth and inaccurate reporting of some outcomes. (my emphasis)

This is a lie.

MANA has received aid in propagating this lie from an unusual source, CDC statistician Marian MacDorman, a long time ally of the homebirth movement, previously a member of the Editorial Board and now the Editor-in-Chief of the Lamaze sponsored journal Birth:Issues in Perinatal Care. Indeed, MacDorman was interviewed for in a recent article about homebirth in The Daily Beast:

Most of the alarmist studies come from data pulled from vital-statistics data, from birth certificates and infant death certificates that are linked together. These administrative records “aren’t designed for research,” says Marian MacDorman, a statistician at the CDC who studies birth trends. “There are quite a few limitations in using that data for that kind of analysis.”

First, the researchers aren’t able to follow women who intend to deliver at home but later transfer to the hospital, which removes trauma patients from home-birth statistics. Then home-birth data fail to account for planned vs. unplanned births. (my emphasis)

That’s two separate lies about the data.

Indeed, the researcher who performed the first published study using the data, United States Home Births Increase 20 Percent from 2004 to 2008, noted:

Almost all the home births attended by certified nurse-midwives⁄certified midwives (98%) or “other” midwives (99%) were planned

Who performed that study? None other than Marian MacDorman, that’s who.

This is not the only study that MacDorman has published using the CDC data. Far from it.

So the only question that remains is:

Marian MacDorman, were you lying about the validity of birth certificates in your own published papers or are you lying about it now?

  • Amy Tuteur, MD

    Just published: http://www.cdc.gov/nchs/data/databriefs/db144.htm

    And guess what? This MacDorman paper is based on BIRTH CERTIFICATES.

  • MCH PhD

    The idea that McDorman’s statements are contradictory is preposterous. There are separate boxes on the birth certificate for place of birth and birth attendant. It is perfectly possible for one researcher too look at only the place of birth field (and lump all home births together) and another to look at both fields, in which case one would assume that homebirths attended by a midwife were planned. Anyone who tries to use birth certificate data for a study comparing home and hospital birth is an idiot. In fact, anyone who uses the data to draw medical conclusions overall is misusing the data. Almost all of the health and medical data on the certificate is unreliable–hospitals rarely complete all of the fields, and because the certificates are usually filled out soon after birth, many neonatal complications are missed. But why think things through when you can rely on rhetoric and slander?
    You can view the complete form here: http://www.cdc.gov/nchs/data/dvs/birth11-03final-acc.pdf Here is a screenshot of the fields:

    • Amy Tuteur, MD

      Then why does MacDorman use the exact same data to compare homebirth and hospital birth in her own studies? Is she an idiot, too?

      • MCH PhD

        Do you not understand the difference between descriptive and analytical statistics?

        • Amy Tuteur, MD

          What analysis do you think is involved with determining whether birth certificates are reliable for place of birth? MacDorman herself says they are reliable, so it’s a little too late to say they are unreliable.

          • MCH PhD

            If you don’t understand the difference between descriptive and analytical statistics, this debate is pointless. Repeating your rhetorical point over and over does not mean that MacDorman used the data in the same way as Grunebaum. As MacDorman said, “There are quite a few limitations in using that data for that kind of analysis.” If you don’t understand the subtleties of that statement, I can’t teach you Stats 101 in a comment thread. Enjoy your glass house.

          • Young CC Prof

            But Gruenbaum didn’t use birth certificates to track neonatal complications. Gruenbaum used the CDC’s infant death database, in which death certificates are linked to birth certificates.

            The birth certificate provides date and time of birth, mother’s demographical data, birth weight, and gestational age if known. It also provides the key piece of data here: place of birth and type of attendant. The death certificate identifies whether the baby died, and, if so, how soon after birth.

            The difference between descriptive and analytic statistics has nothing to do with it. Place of birth and birth attendant are categorical variables, sort by both at once and you get a nice accurate count of planned attended home births. Yes, MacDorman published a simple count (descriptive) and Gruenbaum checked for an association with another variable (analytic), but if the birth place record is accurate, it’s accurate for both types of study.

            Now, if MacDorman claimed that infant DEATH records were inaccurate, that would at least be internally consistent. But I would find that claim very implausible.

          • MCH Phd

            I actually work with this data regularly and know the folks at the CDC, including MacDorman, who work with it–MacDorman is anything but a homebirth fanatic. I evaluate birth outcomes, and understand the ins and outs of this data and its limitations. MacDorman is right that it is rarely appropriate for anything beyond descriptive analysis, though there are some fields that are consistently filled out and are usually pretty accurate, such as birthweight, that could potentially be used in a comparative analysis. As I said, to explain what fields are accurate; where you can do analytical vs. descriptive work; the inconsistencies between the ways that hospitals vs. homebirth midwives fill out the certificates; the strengths and faults of the homebirth vs. hospital birth studies studies that use this data; and how the data can be twisted to suit anyone’s agenda are far beyond a comment thread. Accuse me of flouncing all you want–you don’t understand the data and are therefore making simplistic statements and ad hominem arguments, as well as slandering someone who works tirelessly to advance maternal child health rather than promoting a misguided political agenda. I don’t expect you to change your mind–I’m posting mostly so others can pursue sources of accurate information if they choose.

          • Trixie

            So basically, you’re saying homebirth midwives do a crappy job of filling out forms, and therefore they aren’t as reliable as hospital stats? Gee, there’s a real shocker. Although it still begs the question of why she said it was reliable before.

          • Young CC Prof

            OK, so you’re saying that certain other fields aren’t consistently or accurately filled out? Which ones? Do you know what the mistakes tend to be and what biases would be introduced? Can you identify a better source of information?

          • Amy Tuteur, MD

            I figured you might be a colleague of hers because my web analytics program tells me where every visitor is from and I saw where you are from.

            You still haven’t done anything besides insists that I am wrong. I hope that in your job your are required to provide rigorous analysis, not your personal opinion, since your opinion is worthless.

            I’m going to go out on a limb here and suggest that you haven’t bothered to read the paper under discussion and the other papers that use the same data (including at least 4 separate papers by MacDorman herself) since you appear to be ignorant of the data that was used and how it was used. Am I right?

            Many of the commentors here also have PhDs and so far you haven’t convinced anyone of anything.

          • fiftyfifty1

            ” As I said, to explain what fields are accurate; where you can do analytical vs. descriptive work; the inconsistencies between the ways that hospitals vs. homebirth midwives fill out the certificates; the strengths and faults of the homebirth vs. hospital birth studies studies that use this data; and how the data can be twisted to suit anyone’s agenda are far beyond a comment thread. ”

            This sounds interesting. It sounds as if you are saying you know this data set well, but that it is too complicated to explain in a comment thread. I have a solution: do a guest post. This blog has welcomed guest posts in the past. Explain in as much detail as you can why, say, the birthweight data are reliable, but the birth attendant or death data are not. Give us the information about this dataset that you say we lack. I really want to know more.

          • Amy Tuteur, MD

            In other words, you have realized that you are wrong and you are trying to flounce before you are thoroughly humiliated. Thanks for proving my point.

          • theNormalDistribution

            I don’t think you can even explain what Stats 101 is.

  • http://www.friv2.org/Flappy_Bird.html flappy bird

    Hey, you guys are making a lot of assumptions here. EHarmony haven’t
    even decided what the matching process will involve yet, so how do you
    know that people will be filling out lengthy questionnaires To be fair, MacDorman could have simply been wrong in her earlier statement and learned better later on. ?

  • The Computer Ate My Nym

    To be fair, MacDorman could have simply been wrong in her earlier statement and learned better later on. Though if so she should publish a retraction of the earlier claim.

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

      I’ve been burned too many times by giving NCBers and midwives the benefit of the doubt. The ones with integrity seem to quit after so many years.

  • LMS1953

    http://www.dailymail.co.uk/news/article-2440105/Mother-gave-birth-daughter-bush-garden-names-daughter-ROSE.html

    Homebirth in the UK
    I imagine this outlier really screwed up the stats. Lesson to be learned: when a 29 y/o G3 P2 presents at term with an 8lb baby with regular contractions with a cervix at 2cm, you can do worse than admit her, do an amniotomy and catch the baby a hour later. I wish they gave her due date. This sounds like the work of a 39 week Nazi.

    • LMS1953

      http://bossip.com/848402/jesus-take-the-wheel-woman-in-labor-gives-birth-on-healthcare-center-lawn-after-they-refused-to-admit-her-graphic-photo/

      Meanwhile in Mexico, at almost the exact, same time, there was another lawn birth. Must be a trend. This one WAS the work of a 39 week Nazi. I was stuck by the tone of social injustice angst with the lawn birth in Mexico as opposed to the “stiff upper lip” humor of the one in the UK.

      • Wren

        They were totally different situations. In the UK, the woman was sent home when she should not have been (although within the guidelines) having paid nothing and medical care was provided as soon as the problem was recognised (paramedics and admission to hospital). In the other, a poverty stricken woman was charged, was sent away and gave birth on the lawn of the clinic without medical assistance and money clearly was a factor.

        • LMS1953

          The cases were as identical as could possibly be. Both happened in October, 2013 – maybe even on the same day. Both moms were 29 year old G3 P2. Both moms went into early labor and made their way to a birth facility. Both moms were told they were not in labor. Both of this assessment were wrong, biased by financial constraints. Both of these women delivered within an hour or two of assessment. I did not read anything about the woman in Oaxaca being charged and I am not really sure whether the Mexican system is socialized or not – I think it is. I thought I read where she was later brought into the clinic. The main difference is this. In the US, we are trying to figure out immigration reform. The majority of immigrants who have not followed legal pathways are from Mexico. However, Mexico gives no leeway to Latino immigrants traversing their country and is remiss in its treatment of its own indigenous peoples.

          • Wren

            The article you linked stated the woman in Mexico was sent home with a prescription and other items and stated the cost. Read a little closer. The two cases are superficially similar, I will grant you, but arguing they are identical involves a selective use of facts. One can, with effort, make almost any two births “identical” with selective use of facts. Heck, the two times I have given birth were in the same hospital, with the same parents involved and I went to the same post-partum room. I guess my C-section in November for my son’s birth and VBAC without meds (thanks to getting to the hospital late) in August for my daughter’s birth were completely identical, right?

    • Dr Kitty

      Not the 39week rule…the very strict “only admit women in active labour to labour wards” rule, which a lot of NHS hospitals have had to implement because they LITERALLY do not have the bed space otherwise, even with 4hr post SNVD discharge home. There are maternity units that have had to close their doors because there is nowhere to put new labouring women.

      My thoughts are that if you have a multip who has labour pains bad enough to need pain relief, she’s going to hit active labour imminently.

      • LMS1953

        Mom is 29. Dad is 26. She was pregnant with her first child when she was 15. They live in a beautiful brick home with a recently sodded lawn and a shiny car in the driveway. Not many pregnant 15 year old girls in Mississippi have all that in their future. But, having worked the four corners of the state (the poorest in the Union) there are PLENTY of maternity beds, nearly universal Medicaid coverage for that demographic, state provided transportation, excellent interstate highways and a reasonably good network of state roads. I don’t think anybody is more than a 2 hour ambulance ride from an MFM center and Level III NICU, closer by helicopter. Very low out of hospital birth rate. Tell me again how great socialized medicine is.

        BTW, 25% of moms carry GBS. Our standard of care is to give IV PCN intrapartum and to closely observe the infant for a minimum of 24 hours – 48 is advised: GBS sepsis can kill a normal appearing newborn within 3 days of birth. All in all, it looks like that rural clinic in Oaxaca has y’all beat. Have y’all considered doing something waaay out of the box like, oh, I don’t know, like providing more maternity beds? Just a thought.

        • NoLongerCrunching

          >nearly universal Medicaid coverage for that demographic

          Am I missing something? This is the very definition of socialized.

          • The Bofa on the Sofa

            “Keep your hands off my Medicare!!!!”

          • The Computer Ate My Nym

            Medicare’s actually excellent insurance. And easy from the physician point of view: They may have crazy requirements and pay, at best, 40 cents on the dollar, but they have one great advantage over private insurance: The bureaucrats of Medicare couldn’t care less if you get paid or not. That makes them much better than the bureaucrats of private insurance which has a vested interest in making sure that you don’t get paid.

          • The Bofa on the Sofa

            Oh, I know. But that message (“Keep your hands off my medicare”) was on a sign at a Tea Party rally once, and it is very famous. Actually, the sign said, “Keep your GOVERNMENT hands off my medicare.”

          • auntbea

            I prefer the sign held up in protest of a plan to teach Spanish immersion at a North Carolina school that proclaimed, “If English was good enough for Jesus, it is good enough for our children.”

          • The Bofa on the Sofa

            I know a lot of people refer to this statement, but I also know that the origins of it are pretty hard to track down. I read the other day that it was being referenced as far back as 1920.

          • auntbea

            I think I actually saw a photo of someone holding up said sign about five years ago. But my mind may be playing tricks on me.

          • Dr Kitty

            That is awesome!
            An Aramaic immersion programme would blow their minds!

            OT: the Coca Cola advert, where two of the languages used are Keres and Senegalese-French, and the response in some quarters has been “if you choose to come to the USA you better speak English”.

            Really?
            You want to use that argument about a Native American language and a language spoken in one of the areas in Africa where many slaves came from?

          • The Computer Ate My Nym

            Not to mention that a fair amount of Mexico was annexed, along with people who spoke Spanish and had no particular desire to either be part of the US or speak English…

          • auntbea

            If you choose to get captured by the US, you should really learn to speak English.

          • Mel

            Oh, that’s awesome!

          • Trixie

            Not to mention the Louisiana Purchase.

          • Jocelyn

            :o

          • Certified Hamster Midwife

            I refuse to believe that sign wasn’t a liberal troll of some sort. Had to be.

          • The Bofa on the Sofa
          • http://shameonbetterbirth.wordpress.com/ Shameon Betterbirth

            A canadian psychologist published a free online e-book called ‘the authoritarians’, it is about people exactly like tea partiers. Very interesting read. Authoritarian followers have very poor logical and reasoning skills, but are excellent at compartmentalizing contradictory beliefs.

          • AlisonCummins

            Thanks for that recommendation, Shameon Betterbirth. I just read he whole thing. Illuminating.
            http://members.shaw.ca/jeanaltemeyer/drbob/TheAuthoritarians.pdf

          • LMS1953

            Do you mean Medicare or Medicaid. Medicare pays about 80 cents on the dollar. Medicaid pays about 30 to 40 cents.

          • The Computer Ate My Nym

            I meant Medicare (the federal program), just was wrong on how much they pay. I don’t actually see the claims data and was going on rumor. I don’t especially care how much they pay given that they do pay regularly. Except the Medicare HMOs, which are again private companies with a strong motive to not pay.

          • LMS1953

            Yes you are missing something. In the US, about 45% of the 4 million deliveries are covered on Medicaid. About 75% in Mississippi. It is means tested and funded jointly by the state and federal government. I treated it just like any other form of insurance – BC/BS, Aetna, TriCare, Medicare, etc. The only time I asked was to make sure the Medicaid Sterilization Consent was signed if mom wanted a post partum tubal. Socialized medicine would have EVERYONE on Medicaid. The US warp and weave of health care funding (prior to ACA) has made it so women don’t have to deliver under a bush on a lawn here – yet. And it gives Canada the ability to brag a-boot their wonderful socialized system without going through all the hassle of building enough NICUs and Cancer Centers and Thoracic Surgery Centers and employing the teams of doctors and personnel to staff them when they can just dump those patient on the US – paying the bill no doubt but NOT the immense cost and overhead of the infrastructure.

          • NoLongerCrunching

            >Socialized medicine would have EVERYONE on Medicaid.

            Which would be great, because then young healthy people would be paying into it. And you can have the last word, because I dont really want to debate this anymore :)

          • VeritasLiberat

            This is not the crowd to argue socialized medicine with. The Brits love the NHS like a mama loves her juvenile delinquent teenager. Remember the giant creepy baby at the 2012 Olympics?
            That said, thanks to Obamacare my family’s health insurance covers less and costs more. I’m not happy. Something needed to be done about people who fall through the cracks on health insurance, but that was not the something to do. You don’t fix a flat tire by blowing up your car.

          • LMS1953

            Thanks. I am baffled by the pervasive attitude here. The lying, deceipt, mendacity, arrogance, ignorance, manipulation and zealous dedication to a destructive philosophy that we encounter with home birthers are all the same techniques used by Obama and his minions.

          • auntbea

            I am amused that when everyone here INCLUDING you agrees on homebirth, you conclude that we see clearly. And then when everyone here EXCEPT you agrees on politics, you conclude it must be that all of the rest of us are deluded.

          • Amy Tuteur, MD

            You know, LMS, I am baffled by your incredibly disrespectful attitude toward me. If anyone ought to understand what I am trying to accomplish with this blog it’s another obstetrician who appears to care about babies as much as I do.

            Therefore, I cannot understand why you persist in derailing serious conversations with your ignorant, childish taunts in order to brag about your ignorant, childish political philosophy. If you think you are impressing anyone, think again. You are coming across like an obnoxious. self-righteous fool. Cut it out!

          • Trixie

            Amen!
            LMS seems to have lots of time on his hands, maybe he should start his own blog. The problem is, probably no one would read it, and he has more chance of his weird conspiracy theories being read by people here.

          • Karen in SC

            Yes. Please, LMS, stick with the topics at hand. When you comment on obstetrics or homebirths, it’s great. When you detour to political topics, it’s not.

        • auntbea

          Whoa. You’re from Mississippi? That explains SO MUCH. (Former Mississippi resident here.)

          • LMS1953

            No, but I practiced there for about a decade.

        • Wren

          Oh, just FYI NHS trained and employed midwives see babies regularly after they leave the hospital. In most cases, those are home visits though they did request we bring my daughter in to them as we had transportation and they were stretched. I say we, as my husband was off for the usual 2 weeks paternity leave. I left the hospital within 12 hours of her birth but she was seen again three times before she was 10 days old. I really didn’t feel we should have been in hospital when we were both fine and I wanted to be at home.
          Yes, we need more beds (or technically more midwives in most cases). We also need more classrooms in the area I live in . Those things take time and funding though.

      • Wren

        I delivered both of mine at a very stretched hospital. With my first, I would have been sent home for that same reason had he not flipped, ending up as a footling breech last minute. With my second, I was stuck waiting for a bed for a while but made it to one before the birth. Sending women home to deliver on their lawns is pretty rare, or it wouldn’t make the newspaper that way.
        And FYI, I grew up in the US with very good health insurance and have lived in the UK for the last 17 years. I’m happier with what we have here than what most of my friends and family are left with now in the US. My sister who spent 2 weeks trying to see the right doc, someone actually covered by her insurance, when she broke her collar bone recently would attest to that. My kids owe their existence to the NHS and free fertility treatment. My nephew owes his to socialised medical care for the US military. I’ve never once had to balance my child’s health and the cost of a co-pay and/or prescription against rent or groceries, unlike many friends in the US. Bankruptcy in the US is most commonly due to medical costs, even with insurance. But yeah, use this example which ended with all healthy and still financially sound as an argument against socialised health care.

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

        I wish there was some kind of program that kept laboring moms from having to go all the way home when they aren’t admitted. Like a hotel across the street w/8 hour room rentals for cheap or something. The only other thing you can really do is hang out in a car. :/

  • LMS1953

    OT: CNN had a report on Deanna Fei – the mother of an extreme premie weighing less than 2 pounds. The AOL CEO Tim Armstrong scapegoated “2 distressed babies” who each cost the company $1million and made him cut benefits. The little girl Mila looks beautiful and perfect in every way. No neonatal death there. Just an example of how awesome the American medical system is despite what its detractors say. You can put your trust in our NICUs and know that they will do their very best to save your baby’s life and in the majority of times succeed.

    Anyway, the guy gave enough identifying data that he committed a HIPAA violation (yeah OK, he’s not a covered entity because he doesn’t file electronic claims. But the bastard makes $12 million in salary so the $50,000 fine would be pocket change. He should be fired immediately and sued for slander: Asshat.

    • Elizabeth A

      Tim Armstrong may not personally be a covered entity, but AOL (which apparently self insures for employee medical coverage) certainly would be a covered entity, and Armstrong was speaking for the company at the time…

      I think AOL’s shareholders should sit up and take note that the company has inadequate stop loss insurance on its benefits plan.

      • LMS1953

        “I think AOL’s shareholders should sit up and take note that the company has inadequate stop loss insurance on its benefits plan.”

        ….and that their CEO is an asshat. Just take the $2 million out of his golden parachute and push him out of the plane.

        • Dr Kitty

          He makes $12 million ANNUALLY and the $2million required to care for the babies made him cut all his employees’ benefits…
          Because life on £10million for a year is just UNBEARABLE (or $11 million for 2 years, or 11.5million for 4 years…I’m sure he could have worked out a payment plan).

          Once you’ve bought the houses and the cars and paid the kids college tuition, you’d think that your disposable income could take the hit…But I’m not super rich, so what do I know.

          Anyway, he’s clearly no Bill Gates.

          • LMS1953

            Dr Kitty, well said. I don’t mind the CEO of a widget factory who started out selling lug nuts on the street corner and grew their business into a multi-billion dollar conglomerate employing thousands of people with good salaries and benefits from making a phenomenal salary. Good for them, hats off. But CEOs who succeed the founder and just stand around like the Tin Man thinking big thoughts, not so much. Especially if a big thought is to cut promised benefits.

      • PrimaryCareDoc

        I wondered the same thing. How could they not have stop loss insurance? My guess is that they did, and he’s just scapegoating the “distressed babies.”

    • The Computer Ate My Nym

      Well, more or less. The neonatal mortality rate for micropremies doesn’t go down to less than 800 per 1000 until after 21 weeks. Any survival at all is an astonishing achievement, but don’t over-claim. Also, Armstrong is a sleazebag.

      But the bastard makes $12 million in salary so the $50,000 fine would be pocket change.

      This is why I favor income/asset based sliding scale fines. It’s not equal protection to demand that a person making minimum wage and one making $12 million per year pay the same fine: it’s pocket change to one and potentially the difference between life and death for another.

    • The Computer Ate My Nym

      Also, this is basically the argument for taking health insurance away from private companies and especially for decoupling it from employment.

  • Captain Obvious

    What the hell. MarleneCPM comments on a women thinking about a HBA2C. “guess a lot depends on why you had pit in the 1st place. Pit leads to epidurals & epidurals lead to pit, which ever came 1st, that combo doubles your risk of surgery. If your body or your baby is not ready, it won’t work to force it. Another thing to consider is your vit D level. women deficient in vit D are twice as likely to need a surgical birth.” Where did she get these stats? But MarleneCPM doesn’t state the MANA stats on HBAC.

    http://community.babycenter.com/post/a47656117/i_dont_know_what_to_do.

    • R T

      Sadly, that’s nothing compared to the stuff she usually writes to encourage high risk women to plan home births.

      • Trixie

        Who is this woman and where does she practice?

    • Trixie

      Dear lord. I hope that woman doesn’t manage to kill her baby.

    • Jessica S.

      I’m not an expert or a professional, but I think opinions like this – let the body do it naturally – miss the point that not all bodies WILL go into labor naturally by their due date (or before the point where the risk of still births start to increase, not sure if that starts right at 40wk or what). Of course, that goes against the grossly simplified “it’s a natural process” natural birth narrative, that our bodies are “designed” for this and “know” what to do. But my point here is that it could be stated from the flip side: women who need augmentation to get labor started are being given the chance to deliver vaginally, instead of waiting until your 43wks and it’s crisis mode, straight to a CS. So by inducing, you’re increasing the likelihood of vaginal delivery, in women that are already more likely to need a CS.

      Again, I’m not a professional do I may be totally wrong. I also have a three year old in my face so this may not be coherent. I shouldn’t try to type and parent at the same time! :D

      • Young CC Prof

        Yes, that’s right. At least one study showed that women who were induced as soon as they hit 41 weeks were LESS likely to wind up having a c-section than women who waited longer.

        Pretty much Marlene’s entire opinion is crazy and not based on anything at all.

      • An Actual Attorney

        I know — let me give you a long list of things that bodies generally do naturally, that mine doesn’t:

        -see correctly
        -make thyroid hormones
        -have feet that work without pain
        -breathe pollen
        -make seratonin

        And there’s all the things I get checked for once a year to make sure that it’s still doing right.

  • LMS1953

    MacDorman opened with the very unusual Godwin Gambit instead of the typical There You Go Playing the Dead Baby Card card. There are several possible counters. The most elegant of them is to play the What a Fncking Idiot Card.

    • Mishimoo

      Almost sounds like you’re a sports commentator for something graceful like gymnastics or diving.

      • LMS1953

        Are you familiar with Chess Notation? You can go back and review historic matches. It is a play on that

        • Mishimoo

          So, to the ‘Other Ways of Knowing’ Defence, one would play the ‘Your mother was a hamster’ Card and for the ‘Trust birth; your body is not a lemon’ Thrust, one would counter with the ‘Your father smelt of elderberries’ Card?

          • LMS1953
        • theNormalDistribution

          I’m sure there is a midwife somewhere who has attempted the “he’s not dead, he’s pining for the fjords” stratagem.

          • Siri

            The only reason that baby is still lying in his crib is ’cause he’s been NAILED there.

    • Guestll

      I just barked a laugh and woke my sleeping toddler. Thanks for that. :)

  • KarenJJ

    Homebirth advocates don’t think much about the intelligence of other women, do they? Hoping women will fall for their patting us on the head and saying “there there, it’s OK, the nasty doctors won’t get you, we’re still good people and can prove it”.

    I’d have a lot more respect if they said “yes it shows homebirths with the current range of midwives has a higher level of adverse outcomes including death and brain damage for the baby”.

    Heck, women are told to “own their birth” and “accept all possible outcomes”, but midwifery and homebirth advocates can’t do the same.

    • Melissa

      Exactly. Just tell the truth. Homebirth has an increase in death and injury to the baby. Now, maybe the homebirth/midwife community could say that this increased risk is worth it to keep the c-section rate low or that the experience of the mother in being able to labor in a comfortable environment makes up for the increased risk. That is a personal choice (not one I’d make, but to each their own) but when they are lying about the FACTS it drives me nuts. People can’t make an informed decision when you are giving them false information.

      • Amy Tuteur, MD

        It’s like Vioxx. Merck got in trouble not because Vioxx increased the risk of heart attacks and strokes, but because they hid that information from patients. They believed, probably correctly, that if patients knew the risks, they’d be much less likely to use Vioxx.

        Similarly, MANA and other professional homebirth advocates reason, probably correctly, that if patients knew the risks, they’d be much less likely to choose homebirth. Hence they are hiding the risks and attacking other researchers who are honest about the risks, just like Merck did.

        • KarenJJ

          If homebirth advocates weren’t in it for the money (unlike obgyns, of course) then surely they wouldn’t be worried about losing any business by telling women a few facts and by giving informed consent?

          • auntbea

            It’s the mothers, Karen. They are doing it for the mothers, who might otherwise be scared away from their beautiful, empowering birth.

  • Amy Tuteur, MD

    I amended the graphic to highlight the fact that MacDorman’s comments refer to the CDC Wonder linked birth-infant death files.

  • areawomanpdx

    This argument against using the CDC stats defies all logic. What unplanned OOH birth is going to be attended by a midwife? If someone goes into labor and was planning on being in the hospital, they start driving that way, they don’t call a homebirth midwife. If the baby is born at the side of the road, they are attended by a paramedic or UA, not a homebirth midwife. This lie is so easy to see through, how anyone could believe it is beyond me.

    • Danielle

      I do not follow the argument either. The only way to have a home birth midwife present at a home birth is to hire one in advance. This means one is planning a home birth (and theoretically receiving advanced care/consultation, etc). I can’t think of any other mechanism by which the midwife manages to attend the home birth than to be hired by a woman planning a home birth! Maybe once or twice a midwife has rushed to the aid of a neighbor in distress, but such care and special cases need not concern us in a data pool as large as the CDCs.

      So unless there’s a super secret “batphone” for midwives…. I’m not seeing it..

      • Young CC Prof

        Home birth midwives have a map of their region on the wall and an alarm on top. Whenever a local woman is about to have precipitous labor, the alarm goes off and the midwife slides down her pole and jumps on a motorcycle, cord clamps in her saddlebags.

        Clearly you need to watch more cartoons.

        • KarenJJ

          With pictures of the women’s faces and flashing lightbulb eyes.

          Clearly we also need to watch more clay-mation.

          • Siri

            My 3-yr-old boy giggling in the bath, nosy Mum asks what’s so funny, Robert? Robert: I finkin about Wallisandomit. Domit funny!!

            When watching the sad scene in The Wrong Trousers where Gromit packs up his belongings and leaves, ousted by the Naughty Penguin, Robert would climb on to my lap, give me a hug and say, Don’ worry Mummy, he soon be back again. Sniff.

      • Haelmoon

        In Canada it is possible to have an unplanned homebirth with a midwife. Often, the midwives will go to a home to to an early labour assessment. On rare occasions, there will be a precipitous delivery at home this way. More often, however, this happens with multips, who are not strongly for or against homebirth and they use that initial assessment to decide whether or not to come to hospital or if labour is progressing quickly, to just do it at home. For the record, those unplanned homebirths almost always still come into hospital for assessments and monitoring if mom wasn’t planning an early discharge, to have proper baby monitoring after.

        • Alexandra

          Sorry, where in Canada is this? This would NOT happen in Ontario. Why would a midwife ever come to my home if I am planning a hospital birth? They would meet me at the hospital.

          • Guestll

            Yes, it can and does happen in Ontario with RMs, even if you give birth in the hospital. Sometimes they meet you there, sometimes they come to your house and assess first.

          • Haelmoon

            Depends where you are. I have worked in Ontario and BC and seen it in both places. It likely depends on the midwife practice. Even moms planning hospital births are assessed at home sometimes. It also depends on the hospital. If moms aren’t sure they are in labour, its nice that they don’t have to drive in and be sent home again. It avoids clogging up triage. It is actually a service I strongly support inspite of not being overly keen on homebirths in general.

    • Jen

      I’ve known friends who have had their midwife come and see them at home whilst in early labour so there might be a small number of unplanned homebirths that do occur with a midwife. I’m in Australia though, and as I had my babies privately I’m not entirely sure on all the details.

      • Young CC Prof

        That doesn’t usually happen in the US. If you go into labor, you just go to the hospital. If you aren’t sure, you call your midwife or doctor on the phone and explain what’s going on.

        I suppose there might be a few women who wind up delivering at the midwife or doctor’s office when they come in for an exam and are surprised to find they’re fully dilated, but that would be unusual.

  • PrimaryCareDoc

    FYI, Judy Slome thinks Dr. Amy is Hitler, and a lying liar who never actual practiced as an OB.

    “Originally Posted by judyslome

    Amy’s dialog reflects how she is unable to formulate a logical argument.
    http://www.skepticalob.com/2011/03/epidural-hysteria.html She calls my article garbage, but her conclusion at the end, actually supports my research.
    Amy- “The bottom line is that what gets is (sic) to the baby is far smaller than the amount of medication injected into the mother’s epidural space.”
    (judy- I certainly hope so!)
    Amy- If the epidural does not sedate the mother, it certainly won’t sedate the baby.”
    (judy- but the mother is sedated!)

    But now that she is a spokesperson for AJOG, supposedly spoke at their conference in Hawaii last Sept, it is time to confirm if she is who she says she is. Her medical license lapsed in 2003, when she was about 40 years old. I would like to know if she finished her residency and am asking everyone to find out she ever practiced. judyslome@hotmail.com

    I think it is no longer the time to ignore her. The comparison to Hitler is apt. Everyone ignored him until it was too late.

    Please everyone post to their facebook to find someone who actually ever worked with Amy as an obstetrician. I am not sure she ever did work as an obstetrician, and we know 100% that since 2003, 11 years ago, she was not licensed as a doctor. But we dont know the circumstances that caused her to stop working. Her children were already school age, so she didnt need to be home all day for them. If she cannot formulate a logical argument, could she possibly have worked as a doctor?

    Judy Slome Cohain, CNM
    75 first author publications
    https://www.youtube.com/watch?v=Bk0nLRlFbrQ

    why homebirth is 1000 times safer than hospital birth for low risk women in the US.”

    http://www.mothering.com/community/t/1396708/this-dr-amy-tuteur-woman-drives-me-crazy/160#post_17567413

    • An Actual Attorney

      Godwinning, the way prove you are definitely not the crazy one. /snark

    • auntbea

      AJOG. A group of doctors that like to go for light runs in the morning.

      • Young CC Prof

        Actually, that IS the name of the journal. But not, alas, the name of any professional society.

        • auntbea

          Stop ruining my jokes with your factual information.

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

            Trust comedy!

      • Jtmo

        I belong to one of those groups! Weather stinks, so we met at the gym and hit the treadmills together before work today. Of course we are 2 internists and a family doc, but the family doc (me) does maternity care/deliveries. Love this pun.

    • Lisa Murakami

      This video can’t possibly be taken seriously. The death rates are all a “simple miscalculation”? Really? The Johnson-Daviss study itself puts the home birth death rate at 2+. That’s straight from the horse’s mouth. Gosh, if you people can’t even do simple calculations, how can you deliver babies?

    • Young CC Prof

      So, the way you find out whether someone practiced as an obstetrician is to ask your facebook friends if she ever treated any of them. Yup, that’s accurate.

      Or, you know, you could look things up. http://www.acog.org/Education_and_Events/~/media/Districts/District%20V/20130926PreliminaryProgram.pdf See schedule pages 8-9 if you don’t believe she spoke at an ACOG meeting last year.

      • Trixie

        Damn, I want to go to that Grand Wailea spa now.

        • fiftyfifty1

          “Damn, I want to go to that Grand Wailea spa now.”

          Yeah Dr. Amy! Next time let us docs know in advance to we can plan our yearly CME!

          • Trixie

            I think Judy S-C is just jealous. I mean, look at that Roman bath!

        • Lionessong

          I’ve been there, it was amazing! My mom goes every year for a conference and she let me tag along one year, she still brings back their toiletries for me!

        • auntbea

          I think the government should give us all regular massages. I think it would seriously cut down on violent crime, road rage and divorce rates.

          • KarenJJ

            Now that’s a worthwhile study I’d be happy to participate in.

          • auntbea

            I know, right? My MIL is training for a post-retirement career as a massage therapist. I think I may be the only wife in the world who begs her husband to invite his mother over for an extended stay.

    • Trixie

      This kind of reminds me of that time that a a journalist tried to write an exposé of Mr. Rogers. Assuming there had to be some seemy underbelly. Nope. Nothing. He dug and dug and all he found was that Mr. Rogers was exactly as he said he was, except possibly even nicer.

    • Lisa Murakami

      Also, why is Judy Sloame’s screen name “PrimaryCareDoc” if she’s just a CNM? Is this a case of “whoever smelt it dealt it?” LOL! Judy, here’s a clue: Why don’t you call BWI and just ask them. But try to be honest when you report back to us. I know it might be difficult for you.

      • Karen in SC

        Lisa, I may have confused you with my FB post. PrimaryCareDoc is a regular poster, she is just copying and pasting this insane drivel from this CNM.

        Very sorry for any confusion. I refuse to link to mdc , ever, and never go there myself.

        • Lisa Murakami

          Oh I see! I should have read more carefully.

    • Susan

      That makes me squirm. It comes off as, does anyone know anything about her we can use to embarrass, humiliate or otherwise throw at her? And the audacity to say she doesn’t need to be home for four children from the attachment parenting crowd. They have NO SHAME.

      • realityycheque

        They can’t dispute the information she posts, so they go after her character. Typical.

        • Young CC Prof

          Hey, if someone who can’t look up simple facts, doesn’t know the difference between a journal and a society, and thinks an epidural is a sedative said I was evil, I’d consider it a compliment.

    • Mishimoo

      Correct me if I’m wrong, but an epidural is pain relief, not sedation because it doesn’t affect the critical faculties. As a well-read professional, how can she not understand the difference?

      • Elizabeth A

        I did go to sleep shortly after receiving my epidural, but that had something to do with being tired. Effective pain relief allowed me to rest comfortably. It also kept me coherent enough to argue effectively with doctors.

      • Staceyjw

        well, theres your problem, you think she’s a well read professional, instead of a closes minded, BSC zealot!

        • Mishimoo

          She professes to be a professional, so she should be judged as one, rather than as just a dear sweet granny-woman that is only here to help.

    • Amazed

      Actually, I happen to agree with Ms Slome. Homebirth is absolutely safe for those who are low risk in the WORLD. Of course, forestbirth would also be safe for them, provided that there aren’t any bears or boars around.

      The problem is, those who are low risk are not women but births – and you can label them only after it’s all over. Actually, a poster on scienceandsensibility.org is trying to do just that – discard the results of all high risk homebirths from MANA stats because, you see, they weren’t low risk.

    • realityycheque

      “I think it is no longer the time to ignore her. The comparison to
      Hitler is apt. Everyone ignored him until it was too late.”

      Nearly spat my coffee out reading that!

      • Karen in SC

        Well, look what happened when Hitler found out about homebirth:
        http://10centimeters.com/hitler-learns-homebirth-is-dangerous/

        Maybe she watched that video!!

        • Jessica S.

          Oh my WORD! That video was hysterical! And perfect! Take that, Hitler-name-slinger. (I mean, really – Hitler? She complains about Dr. Amy’s reasoning skills but she goes all Godwin’s Law to make such an assertion? Crazy!)

    • Medwife

      Judy Cohain is stone cold crazy. Way out there.

      • fiftyfifty1

        So if she is so out there, has the ACNM (American College of Nurse-Midwives) sanctioned her or at least denounced her?

        • Medwife

          I don’t think she’s a member, actually. I was on an email list with her (how I know for sure that she is batshit crazy) and she raged about membership fees.

          • no longer drinking the koolaid

            She shows up frequently on the ACNM home birth list. You can only be on those lists if you are an ACNM member.
            She has a persecution complex as far as JMWH is concerned because they won’t publish her “research”. In fact they won’t publish any of her stuff.
            She always seem to be trying to get other midwives to participate in her “studies”. Most of the CNMs on the list think she is “bat shit crazy”, however as long as she pays her membership dues she is allowed to participate. There have been calls to have her removed from the list for her divisiveness. I have also seen a couple of calls for her to be removed from the MDCG list, but I think the moderator has had a talk with her about her behavior.

          • Medwife

            Well that’s too bad. That’s the list I was on. I left because of the crazy, JSC being the leader thereof. I was hoping she’d defected.

        • Esther

          Given she now lives in Israel (thanks a lot guys. You couldn’t keep her on your side of the ocean?) and practices unlicensed midwifery here, and doesn’t bother to hide it much either (look up her Facebook page), I’d like to see our Health Ministry sanction her and perhaps press charges against her for practicing medicine w/o a license. Unfortunately, right now the Health Ministry has a lot on its hands and is chronically understaffed.

  • KerBearRN

    I’m a NICU nurse (and also a former L/D nurse). I have seen the sad consequences of home births. The homebirthers operate on a combination of faulty premises and a big pack of lies. And no accountability. I call that evil.

    Also, the number of successful home births is likely also augmented by the “unplanned” home births. Usually those births are fast and uncomplicated (which is why they didn’t make it to the hospital). Add to this the fact that a huge majority of those unplanned deliveries will then go to the hospital, where mom and baby can be examined and observed and where post-birth complications (such as Group B Strep infection) can be caught and treated. So those “unplanned home births” also likely make the home birth stats look even better than they are.

    Dr. Amy, please keep fighting the good fight! There is no reason babies should have to suffer and die because of selfish, evil people.

    • Trixie

      What Dr. Amy is saying is that unplanned homebirths aren’t counted in the CDC stats if you sort by birth attendant. If a home birth midwife signed the birth certificate, the baby was clearly a planned home birth, not an accidental home birth.

      • KerBearRN

        Ah, got it. I am just thrilled that people are out there pushing those numbers.

      • Elaine

        Do all planned HBs show up in the stats that way? I interviewed with a CPM group. In my state CPMs are alegal. If I had birthed with them they would not have signed the BC. Wouldn’t my birth have then looked in the stats like it was unassisted? Or can you list ‘other midwife’ if the midwife doesn’t sign it?

  • Mel

    Rather OT: How do midwives convince themselves to keep up the pretense of safety after emergency transfers and/or bad neonatal outcomes?

    This comes to mind for me after being present for horrible, horrible cow birth yesterday. We had a 2nd calf cow present with a set of still-born twin bulls – the first was a true breech – tail first with both legs extended towards the head of the cow. None of us including the vet could get a hold of either leg of the calf and so needed to “disassemble” the dead calf to deliver it. The second calf was face-first but upside down and so took all three of us to get the position right to deliver it. My husband and I spent two hours giving calcium, dextrose, steroids and fluids to the dam in hopes she’ll recover. The vet spent about 30 minutes with us after the calves were born comforting us – showing us the signs that showed that the calves had died about 12 hours beforehand, that the membranes had been intact, the fluids had been clear…pretty much anything he could to help us see that we hadn’t missed something. In fact, I asked about 10 times if there was anything we could have done differently. The vet told me “No, you did everything you could have. ” many, many times. (Actually, he thanked my husband and I for staying there to help him – not everyone does or can.)

    I know I will be able to keep being around dairy births as long as the vet can keep telling me we’re doing everything we possibly can. I couldn’t do it if I knew that we were running risks that could be avoided – like giving birth at home instead of a hospital.

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

      They convince themselves that the hospital would not have saved anyone. Or they minimize it. It takes a huge amount of integrity to say “wow my whole career is based on lies, I should quit!”. Its a lot easier to rationalize the hell out of whatever you are responsible for. That’s what I’ve experienced in the utah midwifery community so far- wrongdoing either didn’t happen or it was acceptable somehow. That’s the mantra of cpm’s and other quacks.

      • fiftyfifty1

        “It takes a huge amount of integrity to say “wow my whole career is based on lies, I should quit”

        Yes it does, and I respect that a lot.

        “Bittersweet and strange,
        Finding you can change,
        Learning you were wrong”

        Alan Menken

    • no longer drinking the koolaid

      This midwife can no longer justify it. There are very, very few women who fit the criteria as normal (no identifiable risk factors), and this meant that I was transferring a lot of the time. A bit of bright red vag bleeding (possible marginal abruption), a slight dip in the baby’s heat beat, back pain out of proportion with expected labor, non-progressing labor, mom seems hestitant about laboring OOH; all those things meant a transfer.
      It got to the point where the last 3 months almost everyone ended up at the hospital, and I was okay with that. However, it also showed me that OOH has an extremely small population of women that qualify.

      And about those midwives who keep practicing after something awful has happened. I’ve sat through peer reviews with those midwives. Seldom does any other midwife suggest that maybe the attending midwife took a risk she shouldn’t have. It’s more a case of “You poor thing. I’m sure you did everything you could.” If you are surrounded by people who agree with your line of thinking in taking the risk in the first place, then why would you bother disagreeing with them and changing the way you practice. Obviously, it was in some way the mother’s fault. She left out information you needed to know, she refused to transfer, she didn’t want the birth bad enough, etc.

      • Guesteleh

        The mother blaming is horrifying. This is straight out of the cult handbook.

      • CognitiveDissonaceHurts

        I know that it is hard for most of you to understand this but when you surround yourself with enough resources and people that support your position, it is oh-so-easy to dismiss the naysayers. I did that for 30 years. The term “falling on deaf ears” sums it up nicely.

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

          This is why I consider NCB a cult (as a cult survivor)

      • R T

        Poor mama cow :’(

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

        When I was in the UK, because the criteria for homebirth were so strict, it actually was difficult for students at my hospital in Cambridge to have the required minimum within the 3 months set aside for community midwifery, and some of us had to be on call for a further period.

    • Spamamander

      OT I wish there was a way I could buy specifically from your dairy- every post I have seen of yours describing things in your barns sounds like you guys care very, very much about the welfare of your animals. It is wonderful to see.

      • Mel

        Thank you

    • fiftyfifty1

      some calves just aren’t meant to come earthside…..

  • Lawyer Jane

    Can someone help me with some basics here?

    Does the CDC birth/death certificate data for homebirths include a category for planned vs unplanned? Is it true you cannot exclude unplanned homebirths from the dataset?

    Can you at least filter the CDC data type of attendant – so if it’s not a health care professional of some type for a homebirth, then you can assume it was unplanned/unattended and exclude it?

    Does the CDC dataset include a field for homebirth transfers?

    If homebirth transfers are coded as hospital, doesn’t that make homebirth look BETTER, since transfers would probably include deaths & birth injuries?

    • Kazia

      Homebirth transfers are included in the hospital data, so it undercounts hombirth deaths.

      You can’t *exactly* filter homebirths by planned/unplanned, but you can filter by birth attendant. I think the categories are MD, DO, CNM, Other Midwife, and Other. All but the Other imply planned homebirth.

      Dr. Amy did a post about how to use the CDC Wonder database last week. It’s very informative!

    • Young CC Prof

      Yes, assuming there are significant numbers of homebirth transfers who are born and die in the hospital, the inability to track transfers with CDC data makes the home birth numbers look better than they really are, and the hospital numbers slightly worse.

    • Guesteleh
    • Guesteleh

      Copy-pasting a comment from Trixie below because it’s relevant to your question:

      What Dr. Amy is saying is that unplanned homebirths aren’t counted in the CDC stats if you sort by birth attendant. If a home birth midwife
      signed the birth certificate, the baby was clearly a planned home birth,
      not an accidental home birth.

    • C T

      Didn’t the Oregon stats take intended place of birth into account? And didn’t they show an even worse death rate than one gets using the CDC? Homebirth advocates act as though this weakness in the CDC data might work in their favor, but that seems entirely unwarranted in light of what they found in Oregon. They play at obfuscation and denial, but logic is against them.

      • areawomanpdx

        Yes, Oregon is one of the only states (maybe the only one?) that includes intended place of birth on the birth certificate, and only started doing so in 2012, precisely to track this.

  • Mel

    As a public school teacher, I find it a bit odd that MacDorman is mixing her job as a CDC statistician AND disproving the accuracy of the CDC stats for an outside interest group. It’d be like me working as a public school teacher AND working in my spare time to disband the public school system. At best, it shows a questionable sense of professionalism. At worst, it makes you look like a plant for one side or the other…..

    • Trixie

      She’s the Ron Swanson of the CDC.

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

        but ron is endearing and means well!

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

          And probably has the better mustache.

    • fiftyfifty1

      Yep, Marian MacDorman is committing a major ethics breach. She should ideally remove herself from doing statistics on and commenting on her area of activism. At a minimum she needs to declare her conflict of interest.

  • Young CC Prof

    “Most of the alarmist studies come from data pulled from vital-statistics
    data, from birth certificates and infant death certificates that are
    linked together. These administrative records “aren’t designed for research,””

    If they aren’t for research, why exactly does the CDC bother to compile the data in such a useful format? Just for fun? Nope, sorry, it’s there to be analyzed.

    • auntbea

      So that the government knows just how minions it has available when the alien invasion strikes and they turn on the secret, implanted microchips that turn us all into mindless fighting machines.

      • Trixie

        Hint: They inject the nanobots into your spine during the epidural. From there they swim to your brain so the government can control your thoughts forever because chemtrail.

        • auntbea

          Don’t be silly. That would limit the army to women who had borne children. Clearly, they inject it with the “Vitamin K” shot. (I mean, seriously, did they think we were going to fall for Vitamin K when there isn’t even a Vitamin J?)

          • Young CC Prof

            It’s the fluoride in the water that keeps it charged up. And of course, all the water has fluoride, tap and bottle both. If your municipal water supply claims to be unfluoridated, then that’s just proof They run particularly deep in your town.

          • Trixie

            It’s actually Vitamin I. For Illuminati.

          • Mishimoo

            They also insert mind-controlling microchips and a killswitch with the vaccinations. You see, the ‘c’ in Meningococcal C is actually little cancer-causing nanoparticles; you can tell by the capitalisation. That’s how They are limiting the lifespan and population of the human race. Autism is just proof of malfunctioning mind-control chips. If you take away their powersource with a certain diet, they go into a a sleeping mode designed to save power.

          • auntbea

            Wow. That explains SO MUCH.

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

    I love the internet. It makes it so much harder for people to lie. Someone will always find out and point it out. Thanks for your perceptive coverage of the MANA stats release, Dr Amy!

    • Karen in SC

      I would think a statistician would double and triple check reports for accuracy. And if an underlying parameter changes, fully document and explain. But that’s just me.

  • Amy Tuteur, MD

    Someone just informed me that MacDorman is the new Editor-in-Chief of Birth! I edited the post to reflect that.

  • Captain Obvious

    I just don’t get it. I have been an employer and I review my employee’s performance. Talk about damage control needed for MANA and other Homebirth advocates. The lies, the fraudulent boasts of Homebirth safety, the omittance of the truth, the publishing of a press statement knowingly it doesn’t represent the truth, the delay in publishing the data when the results could have affected the lives of babies. Any other business would have to go through their employees and terminate them for such bad performance. But of course, the employor or administration has to want the truth publicized. So I guess the whole organization from the top representatives down to the lowly junk journal blogger like Brandy from the Daily Beast needs a revamping. What organization can hold them accountable? ACOG has no say on midwives. I guess it’s up to the politicians? Good lord.

  • PoopDoc

    I was planning on going to the hospital. No really, I was… But I went in to labor. And this midwife… She happened to be going door to door collecting signatures for something or other. It was like, amazing… How she just, ya’ know… just happened to be there. So I decided right there on the spot to have my baby in this kiddie pool that was just in the living room. What? You don’t keep a kiddie pool filled in your living room? Seriously.

    • Dr Kitty

      There is just no way I can see to undercount planned HB and turn them into UC or hospital births where MWs aren’t accountable for the bad outcomes unless a huge proportion of MWs don’t actually show up during labour and the woman ends up as an unintentional UC OR a high proportion of women decide at the last minute to have their babies in hospital instead of at home.

      Neither of which suggest a great standard of care by MWs either.

      The only way you can make the dead HB babies disappear is to get them counted as hospital births or UC, or decrease the HB death rate by getting hospital births or UCs with good outcomes reclassified as HB.

      Unless Marian MacDorman has knowledge that the misclassification has caused a statistically significant error in the data…in which case she needs to publish her evidence. Otherwise it is just a “feeling” that the data isn’t telling you what you want it to.

      • Elaine

        “There is just no way I can see to undercount planned HB and turn them into UC or hospital births where MWs aren’t accountable for the bad outcomes ”

        Easy. CPM doesn’t sign the BC. CPMs are alegal in my state. I interviewed with some and they straight up told me that they don’t sign the BC. And I bet this isn’t limited to this one particular group. It would be interesting to know how widespread this is. Obviously in states where CPMs are actually ILlegal they won’t be signing them either.

        So the question is, without the attendant’s signature, does mom’s reporting of the attendant count, or does it get put in as no attendant?

        • Amy Tuteur, MD

          It gets put into “other,” a group with a much higher mortality rate, meaning that the homebirth death rate is probably artificially lowered even further.

          Moreover, MacDorman and MANA’s criticism is that they can’t use the CNM hospital birth group as a comparison for the MANA death rates, when there is no evidence that CNM hospital births have any errors at all.

          They are simply lying and hoping that the gullible will be fooled.

          • theNormalDistribution

            I don’t understand the argument. It sounds like all of the objections to the data, even if legitimate, are problems that would undercount the home birth deaths. How is that relevant at all when the homebirth death rate is substantially higher? It’s like saying you can’t trust a conservative estimate because you don’t have the precise numbers therefore anything is possible.

          • Young CC Prof

            To use the chess notation, it’s a variant on the “science doesn’t know everything” gambit, in which the player insists that since science doesn’t know everything, science in fact knows nothing, and his thoroughly and specifically debunked theory could be true!

            Here, it goes, “There are some sources of bias in the data, (all of which would probably make me look even worse if they could be resolved) but still, it’s bias therefore the entire data set is unreliable and should be discarded and ignored.”

          • theNormalDistribution

            I know exactly what you’re talking about. I’ve seen people say things like this over and over again and yet every time they do, I’m shocked by it and assume I must have misunderstood.

          • auntbea

            I know some data that are that so biased it would impossible to get a right answer no matter what statistical trick you use, and I DO make concerted efforts to get my colleagues to not use those data at all. But these data are not that.

          • Young CC Prof

            Oh, definitely. A voluntary-response survey with a 1% response rate, for example. But yeah, not the CDC vital stats reports!

    • AllieFoyle

      Yeah, how is unplanned HB at all relevant to the MANA data? It’s voluntary data reported by midwives, who were presumably hired prior to the delivery in preparation for a HB. It’s not as if precipitous HBs that were planned hospital births are included in that data.

      I can see how using birth certificates without intended place of birth would undercount the number of HB deaths and complications because transfers would be considered hospital births, but how could that possibly be used to argue that HB is safe?

      I really believe they think that if they just keep talking, women will be convinced by the strength of their convictions, or at least too confused to look into it further.

      • no longer drinking the koolaid

        In my own practice I remember at least 3 women who planned to birth at the birth center but ended up at home (n=400). Two were first babies and the labors went way, way faster than anyone thought. Piddling irregular contractions to pushing in under an hour. I scrambled my stuff and headed to their home to do the deliveries. Not planned, but safer than having the baby in the car trying to get to the center. Yes, they were all told that they should call EMTs and an ambulance to be their in case the baby came first.
        And except for a half dozen women, I no longer do home birth. All of these women know that if the least little thing seems amiss during pregnancy, labor, postpartum, or for the newborn, we will be on our way to the hospital. Never had much tolerance for things outside of completely, totally normal and even less so now.

        • areawomanpdx

          But birth center births are considered OOH for the purpose of CDC stats, so in this case, your patients would not have changed categories anyway. They planned OOH births with a midwife and they got OOH births with a midwife. Whether it happened in the birth center or at home is irrelevant.

          • C T

            The CDC Wonder database only tracks whether a birth is in the hospital, out of the hospital, or unknown.

          • areawomanpdx

            Exactly. So a birth center birth falls into the same category as a homebirth. (Out of hospital)

          • no longer drinking the koolaid

            So to sort those out, you need to look at something like the birth center study. Although it is better done, it has some of the same problems as the MANA study in that participation is voluntary, but they take the reports much more seriously. When it was brought up to Susan Stapleton that some midwives may be risking women out of the birth center and doing them as home births so it would not effect their accreditation, AABC was quite concerned and investigated those claims. I am disappointed that they have not published anything about the outcome of that investigation.

          • areawomanpdx

            Yes, that would be very interesting to read. An insight into OOH birth culture for sure — that seems to be a pretty common mindset. I personally know someone who was risked out of a birth center birth into a homebirth with disasterous consequences.

          • fiftyfifty1

            “some midwives may be risking women out of the birth center and doing them as home births so it would not effect their accreditation”

            Holy shit! basically this amounts to saying “we are so worried that your anticipated poor outcome may make our stats look worse that we suggest you deliver your baby in an environment with even fewer resources.”

          • Staceyjw

            What they say when they want to do a birth that cannot be done in the BC: “those rules are silly, and just red tape. You can still have the birth you want, lets just do it at home!”

          • KarenJJ

            Yeah WTF? It’s like taking a left turn instead of a right. If you risk out of the birth centre you need to move UP the chain to a hospital and obgyn.. That’s how they do it in Europe, where homebirth is safe….

          • Staceyjw

            Also, the Birth Center study was misleading to consumers, because it was only accredited centers, but the non accredited centers used it as proof of safety.

            There are 8-10 in this region, but only ONE is accredited. and its owned and operated by the local hospital chain (though free standing).

          • no longer drinking the koolaid

            The birth center study included both accredited and non-accredited birth centers. Any center that is a member of AABC was encouraged to participate.

          • no longer drinking the koolaid

            As far as the CDC is concerned, yes, they were OOH births. For MANA stats (I participated, but then asked them to delete my 400 births), there is a difference between home and birth center. The state also tracks whether it was home, birth center or hospital. For 2014, this state (MI) as well as several others are now asking the intended place of birth and the intended attendant.

  • auntbea

    Daaaaaaaaamn. What a burn. I hope people read it.