More mendacity from the Midwives Alliance of North America

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As the author Stephen King once explained:

The trust of the innocent is the liar’s most useful tool.

If anyone ought to know, it’s the folks at the Midwives Alliance of North America (MANA), the organization that represents homebirth midwives.

Apparently emboldened by the fact that journalists have not questioned their lie that their paper shows homebirth is safe when it actually shows homebirth to have a death rate 450% higher than hospital birth, they are now telling more lies to defend the paper.

The new lies are from their latest blog post Homebirth Research Q & A.

According to the folks at MANA:

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.

That is nothing but a lie.

Where does this supposedly inaccurate hospital data comes from? It comes from the linked birth-infant death files of the CDC (publicly available at the CDC Wonder website). MANA and ACNM insist that birth certificates are unreliable for both place of birth and outcomes. Since 2003, birth certificates have included a question about intended place of birth. Moreover, birth certificates must legally be signed by the person who delivered the baby. If a homebirth midwife delivered the baby, then the birth was a planned homebirth. There is simply no question about that.

As far as outcomes are concerned, the linked birth-infant death files are highly reliable because they cross reference both birth and death certificates. There is simply no question that when a death certificate exists for an infant, that infant has died, and it is simply ludicrous to claim otherwise.

But what may be a more compelling refutation is that both the ACNM and MANA have publicly promoted other studies that were based on THE EXACT SAME DATA.

For example,a press release from September 2013 touting a study that showed an increase rate of homebirth in the US, the ACNM explained:

Analyzing national birth certificate data from 2004 to 2010, the report authors Marian MacDorman, PhD, Eugene Declercq, PhD, and T.J. Mathews, MS, found a 41% increase in the proportion of home births and a 43% increase in birth center births, with 10% of the home birth rise and 14% of the birth center rise occurring within the last year.”

The birth certificate data was apparently reliable then.

MANA frequently bewails the US infant mortality statistics. Wendy Gordon, CPM did so in a MANA bulletin of May 2013. Writing in the Huffington Post, MANA Director of Research Melissa Cheyney spoke disparangingly of the US infant mortality. Where do those statistics come from? You guessed it, the same CDC data that MANA is now disparaging.

Indeed, MANA and the ACNM have repeatedly quoted the CDC data, and never questioned it … right up until I pointed out that the CDC mortality rates are far lower than those quoted by MANA.

The CDC linked birth-infant death data set is the benchmark for infant and neonatal mortality in the US. No one, let alone the ACNM or MANA, has previously questioned the validity of the data. There is no remotely plausible scientific reason for not comparing MANA mortality rates to the CDC data. But Cheyney and MANA refused to compare their death rates to the CDC hospital rates because the MANA mortality rate is hideous in comparison.

Both MANA and the ACNM are lying about the validity of the CDC database, a database they have repeatedly quoted, because that’s the only way to convince the innocent that the MANA death rates are anything other than deplorable. Their behavior is self-serving, unethical and immoral, but apparently for them, anything that might increase their market share is allowed.

  • MrG

    And the ACNM also advertises the MacDorman paper which is based solely on birth certificate data http://bit.ly/1eGrItG among “best available studies”….. Now in addition to MANA the ACNM is really embarrassing themselves. What do you think the hard-working CNMs that do nearly 300K hospital deliveries a year think about their ACNM defending the horrendous home births statistics by MANA?

  • manabanana

    When the Declercq article was published, I’d had the same.

    “Waitaminute… isn’t birth certificate data bad? Oh, right, it’s only bad if you don’t agree with the conclusion drawn from that data.”

    Funny how the birth certificate data was plenty good enough in Declercq’s study.

    But… no one really cares what I think. Thanks for airing these concerns more publicly. I hope eventually this gets heard.

  • Young CC Prof

    You know who one of my personal heroes is? Kepler. He had this theory about circular planetary orbits and the platonic solids. He spent nine years calculating the orbit of Mars, only to discover that not only did it fail to match his theory, it wasn’t a circle at all.

    Did he give up? Did he twist the data to fit his preconceptions? Nope, he wrote up a beautiful theory about elliptical orbits, and then he published it. THAT is what science is about.

    • Anj Fabian

      [sniff!}
      That was so beautiful!

      Needs a picture meme.

  • fiftyfifty1

    CNMs. So blinded by the woo and the mythology of a heroic granny midwife past that they can’t see to cast out the fakes that will destroy their good name.
    At this point, as I see it, they are complicit in the deaths.

    • R T

      I guess it’s all about money. If CNMs become more sought after for hospital and homebirth they will make a lot more money! If homebirth in US becomes a service covered by insurance they stand to make a lot more money. I don’t know if they’re blinded by the woo or pretending they believe all that to increase their business? I really hope we aren’t headed to an era of home births paid by health insurance attended by midwives with no malpractice insurance. I few of my friends have been able to get homebirths and freestanding birth center births paid for by their spouses military health coverage where I live.

      • LMS1953

        @RT: Precisely. I have been chastised for bringing in “my political views”. I hope we are not turning this into a safe zone from a rational format to pursue the truth. FACT: Obama has shown nothing but disdain and antipathy towards doctors. FACT: The ACA aims to expand the role of “physician extenders” and alternate mediicine. I will be happy to provide the citations for anyone who cares to debate this. Combine those two, and the only reasonable deduction is that there will be tremendous political pressure to facilitate home birth by unqualified providers. Home birth has all the characteristics to be the darling of the ACA: it is a “fundamental change”, it disparages the role of the penocratic medical establishment; it is “cost saving”; it redistributes wealth away from got rocks docs who have done nothing to earn such status except take advantage of their “privilege”. This is exactly why midwives of all ranks are trying to pull the cover over deplorable home birth neonatal death rates. Most Americans would be able to see through all the bullshit if it were made clear that home birth disproportionately kills babies. Chastise me for expressing these “political views” at your own peril.

        • Trixie

          “At your own peril?”. Lolz.

        • AlisonCummins

          Straw man.

          Concern about the role of physician extenders is one thing; it can be debated no matter who is president. TIN FOIL HAT BIRTHER (as you so eloquently put it) rants have nothing to do with physician extenders and no place on a blog about obstetrics.

          And if you are threatening me I don’t take kindly to that. I post under my real name.

        • Elizabeth A

          I’m chastising. It’s generous to say that it’s merely tangential to the conversation, and it’s tedious. You want to complain about the ACA, fine, but either wait till it’s relevant or make your own space for it.

        • NoLongerCrunching

          Ok, I voted for Obama twice and I think we should have socialized medicine like every other freaking industrialized country in the world. But I do worry that in efforts to save money, we could go the way of the UK and start pawning women off on less educated cheaper practitioners, with resulting morbidity and mortality.

          > Chastise me for expressing these “political views” at your own peril.

          Not cool.

        • AlisonCummins

          It just occurred to me — do you issue threats in male-dominated spaces? Or just when you think women aren’t showing your penis enough deference?