Wait, what? The “unreliable” CDC homebirth data is suddenly reliable?

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I am not a shy and retiring person. Indeed, my aggressive online persona is the subject of frequent comments of the web (“Dr. Amy is so meen!”) But when it comes to brazeness, professional homebirth advocates leave me in the shade.

You have to be pretty brazen to tell a bald faced lie and then turn around a month later and say the exact opposite.

Case in point, the homebirth data from the CDC Wonder database. The Midwives Alliance of North America (MANA), the organization that represents homebirth midwives, published a study in which they claimed that their analysis of nearly 17,000 births attended by homebirth midwives found that homebirth is “safe.” There was just one teensy, weensy problem. The authors of the study never compared homebirth in the years 2004-2009 for comparable risk women who gave birth in the hospital in the same time period. Had they done so, it would have been obvious that their own data showed that homebirth increased the risk of perinatal death by a whopping 450%.

When I and others pointed out that MANA had not compared their death rates to the only relevant comparison group, they responded by claiming that they couldn’t make the comparison because the CDC birth certificate data on homebirth is inaccurate.

According to 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 (my emphasis).

CDC Statistician (and Editor-in-Chief of the Lamaze journal Birth: Issues in Perinatal Care) Marian MacDorman went so far as to tell 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… 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)

Other media outlets, including Time, published these claims.

Imagine my surprise, then, when I woke up today to find professional homebirth advocates touting the latest report from the CDC that shows the rate of homebirth in the US has increased to its highest level since 1990.

For example, Jill Arnold of the Unnecessarean and Cesareanrates.com is promoting this graphic on her Facebook page and Twitter feed.

Homebirth rates

Where did she get the data for that claim? From the CDC! The new Data Brief Trends in Out-of-Hospital Births in the United States, 1990–2012. The authors of the Data Brief note:

In 2012, 1.36% of U.S. births were born outside a hospital, up from 1.26% in 2011.

Not all of these are planned homebirths:

88% of home births … were planned in 2012

How do they know?

This report is based on data from the Centers for Disease Control and Prevention’s National Center for Health Statistics National Vital Statistics System, Birth Data Files for 1990–2012. These data files include data for all births occurring in the United States and include information on a wide range of maternal and infant demographic and health characteristics…

Reporting of separate data on home and birthing center births began with the 1989 revision of the U.S. Standard Certificate of Birth. Prior to 1989, births were reported as occurring in or out of a
hospital, with no detailed breakdown of type of out-of-hospital birth.

The 2003 revision of the U.S. Standard Certificate of Birth added a data item on planning status
of home birth…

Wait, what? I thought that Marian MacDorman, MANA, the American College of Nurse Midwives and Citizens for Midwifery said that birth certificate data is unreliable for place of birth.

Who dared to based a study on that exact same data?

The lead author of the new report is … Marian MacDorman!

See what I mean? You have to be pretty brazen to claim, with a straight face, in early February that MANA couldn’t and shouldn’t compared its death rates with CDC data because birth certificates are unreliable for place of birth, and then, less than a month later, publish a report touting an increase in the number of homebirths in the US based on THE EXACT SAME birth certificate data.

One of those claims is a bald faced lie. Considering that Marian MacDorman has published a CDC report BASED on the data she claimed was “unreliable” only a month ago, she must believe that it is quite reliable indeed.

MANA knows that, too. But the only way they could think of to hide their hideous death rate was to avoid comparing it to the CDC data. And when they were called on that deception, they responded with an even bigger deception, the claim that the CDC data is unreliable for place of birth.

I’d be curious to know what those who call me too aggressive in pointing out the dangers of homebirth call people who lie to them one month and turn around and expect them to believe the exact opposite the following month. How about aggressive in hiding the dangers of homebirth, and brazen in their belief that their followers are so foolish and gullible that they won’t remember what professional homebirth advocates have said from one month to the next?

My online persona may be aggressive. It may be “meen.” I may really be an SOB. But at least I respect the intelligence of my readers, both those who agree with me and those who disagree. That’s a lot more than you can say for professional homebirth advocates.

  • Karyn Croushore Hodgins

    As my husband likes to say…. 87.357% of statistics are made up…. looks like MANA is just paying attention to the stats when it suits their needs

  • MaineJen

    …so NOW fractions of a percent are incredibly significant, MANA? …Oh, okay.

  • MrG

    Today, GM recalled 1.6 Million cars sold over the last 10 years because of 31 deaths. Only 31 deaths! Imagine the incidence of deaths. Really low considering how many miles were driven during that time. Then compare that to homebirths were over the last 10 years likely over 100 babies died because they were delivered at home. About 150,000 homebirths and 100 additional deaths. A much higher chance of dying than driving a GM car. At GM recalled their cars. Don’t you think we should recall homebirths so called “CPMs”?

  • CanDoc

    Wait a second. Marian MacDorman is a “CDC STATISTICIAN”??? Wow. Disappointing. (Confused).

  • WhatPaleBlueDot

    I lolled.

  • Renee

    WOW. That is BRAZEN as can be.

    • Dr Kitty

      Marian MacDorman certainly has chutzpah!

  • Deena Chamlee

    Manipulation of other’s REALITY…..Classic Co-Dependency . The one who’s SHAMECORE is so LARGE THEY HAVE NP SHAME BECAUSE THEY DISPLACE IT ONTO OTHERS. Then manipulation of realities ensues…..
    Pia Melody
    FACING CO DEPENDENCY

    • Julia

      Huh?

      • Deena Chamlee

        Lol the dynamics are classic co dependency. Abusers who are abuse survivors themselves , such as sociopaths. They have no shame, no conscious, no morals, no ethics, no attachment ability. Only narcissism and getting what they want at any cost.

        For instance although homebirthers do less than 1-2% of births the narcisstic belief they are appropriate attendants for breech, twins and vbacs with less to no education in a higher risk setting.

        Then they manipulate the public’s reality by telling them these type births are safe being attended ay home by fraudulant individuals who arent midwives.

        Once again the battle over statistics, why even read the rubbish knowing who one is dealing with? It is lie after lie!

    • fiftyfifty1

      I was totally with you until the part where you ranked homebirth midwifery as one of the most abusive schemes in U.S. history. It is bad, but slavery and genocide of native populations must have been far more abusive, no?

      • Deena Chamlee

        Ha yes fifty you are right.

    • Renee

      HB STILL is not SAFE, even when attended by better trained people. It is SAFER than with a CPM or LDEM, of course, but still has a death rate 2x, or more, than comparable risk hospital birth by same practitioner.

      NO study shows HB as safe, as widely practiced.

      The Birthplace Study shows good stats, but a lot of common practices were left out to get this result:
      -first time moms were barred,
      -anyone with any health related risks was not allowed (No high BP, no diabetics, no one w heart conditions, etc)
      -typical high risk cases were not allowed (NO HBAC, multiples, breech, post dates, etc)
      -no one with past high risk pregnancies (history of GD, history of premature birth and on and on)
      -evidence based prenatal care was required
      -any developing risks disqualified mom
      -no women having baby # 4 and up
      **And STILL a whopping 44% were transferred during labor!

      What does this tell us?
      Rigorously screened moms, on their 2 or 3rd babies, with a prior history of an uncomplicated VB, with zero health or pregnancy related risks, that were transferred at any sign of trouble, with well trained MWs integrated into the system, that lived within 5 miles of a hospital where the MW had privileges, with dedicated transport available, in a nation where everyone has health coverage from birth and SES is not as varied, were able to have a HB that was about as safe as in the hospital.

      Same can be said for the AABC Study of US ACCREDITED BC’s- they had good rates of safety because they were very restrictive, used mostly CNMs, followed lots of rules, and had a high transfer rate, and cared for a population of mostly white, middle class women. Some of these centers are hospital owned, and those ones did the majority of births (like the Nurse MW BC operated by the local hospital chain here). There are like 8 BC in my region, but only the hospital owned one was accredited, and it did more births than all the others combined.

      NOT A SINGLE OTHER PAPER WORLD WIDE SHOWED ANY GOOD RESULTS FOR OOH BIRTH. These 2 are the ONLY ones, and the restrictions are just too many to make this a practical comparison.

      I also feel that many of the CNMs willing to, or doing, HB are often ideologically similar to LDEMS. They take the same risks, and other than access to some meds, offer little to no improvement in care.

      If you wanna say CNMs are better, fine. IF you wanna say, you can make HB safer, fine. If you wanna stop fakers from using the term MW, fine.
      But do not claim HB is safe.

      • Young CC Prof

        As for those studies that show HB can be made reasonably safe with sufficient pre-screening, what percentage of US births do you think would qualify? Not terribly many.

      • Deena Chamlee

        Renee,

        Is OOH anti social in nature? Radical feministic say so. Nowhere in the world is OOH birth not infiltrated with the movement that started on the FARM. Nowhere Australia is infiltrated, England is infilitrated and midwives are leaving the profession nationallt and internationally because of abuse/ bullying.

        Either my profession faces this without fear and gets to the other side or it is my belief we are doomed for failure.
        I do not think anyone can say that OOH birth has been adequately studied regarding SITE. Too many co factors presently make this impossible. Until midwifery CLEANS HOUSE and makes apprppriate amends and restitution to colleagues, MDs and the public at large I dont see any of us getting anywhere with this debate.

        OOH BIRTH is going to occur. I believe it is my ethical responsibity to protect the public and I believe in informed choice/ shared decision making where the client selects site of birth with shared decision making.

        That doesnt mean only hospital. It means doing everting within my power to improve the system. And I believe it starts with an overhaul of my profession. I have hope and belief we are in the beginning stages. To overthrow a type of culture that has dominated midwifery for at least 40 years if not more doesnt happen overnight because it tales years to understand WHY. Now that many know WHY change will begin I believe.

        • Deena Chamlee

          And it not only takes midwives to do this it takes evetybody. And I mean everybody: OSHA, JOINT COMMISSION, ACOG, WHO….EVERYBODY. SOB, YOU, ME , THE PUBLIC, THE POOR HARMED FAMILIES MAKING THEIR VOICES HEARD ect ect. We are making a difference because I have personally witnessed this in my professional life.

      • Medwife

        Any provider who I would trust at a home birth, refuses to attend home births. That says it all.

      • fiftyfifty1

        You have some facts about the Birthplace study wrong IIRC: First time moms were NOT barred (they were, however analyzed separately. They had a 2x + increased risk of death).
        I believe they allowed moms on baby #4, just not grandmultips (5+). Transfer rate during labor was in the 40% range for *first time moms* but much lower for low risk women with a proven pelvis.

        Homebirth for a completely low risk mom under ideal conditions (2 CNM-level providers or higher, proven pelvis, all prenatal labs, very close to hospital.etc) has been found to be safe enough that I don’t think it is unethical for a mom to choose it. Still not something I would want for myself or my own baby but not unreasonable either.

  • Dr Kitty

    People always forget the unintended HB.
    A wonderful mix of concealed pregnancies, precipitous labours and going into labour in the middle of various unpredictable adverse events which either prevent you getting to hospital or an ambulance getting to you.

    One of my old school friends ended up having an unintended HB the other week. She thought she had time after her water broke for her mother in law to drive 30 minutes to take care of her older child. As it turned out baby was born while granny was still on the road, shortly after the ambulance arrived. Her husband got her call that he should leave work and take her to hospital after his mum got there, and found her in their bathroom, about to deliver the baby as their toddler looked on!
    Thankfully all was well, but talk about well laid plans going awry…

    • Young CC Prof

      My old school friend delivered his second daughter a couple weeks ago. In a car! They’re both OK, though I didn’t get the whole story.

      • Awesomemom

        I have a friend that delivered in a car too.

        • prolifefeminist

          Me too – on her way to have a HB at someone else’s house (don’t get me started). Primip, 9 lb baby, precipitous delivery, BAD tearing, side of the road in the middle of nowhere. Ugh.

          • Young CC Prof

            In 2010, roughly one birth in 2,000 took place in location: Other. Apparently, it isn’t THAT uncommon.

      • Lion

        This happened to a friend of mine last year too. Second baby. Her fisrt had been a very long and difficult labour, so she was expecting the same. They had barely left home for the hospital when they pulled over on the side of the road as baby was arriving.

    • Karma Kidney Stone

      A friend of mine didn’t even know she was pregnant. She went to the ER with stomach pain, and delivered a baby in the ER bed. They estimate she was 25 weeks. Baby is doing very well, given how premature she is.

      • realitycheque

        I always wonder how these pregnancies go unnoticed, particularly those of women who end up having full term babies.

        When I was in third trimester, there was absolutely NO ignoring my son’s kicks/somersaults. Some of them would stop me in my tracks, they were so powerful.

        If no other signs and symptoms were to give the pregnancy away, surely that would?

        ETA: Not trying to imply that your friend, or other women with unnoticed pregnancies are being untruthful, just that it’s baffling to me.

        • Karma Kidney Stone

          Her periods are irregular, but I agree. I’m so miserable when pregnant that I could not over look it. Irregular periods or not. I get nausea so bad I live in the bathroom, and I have a damaged pelvis from a botched midwife delivery, so I spend the entire pregnancy in terrible pain. I envy women who sail through pregnancy feeling great.

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

            Me too. Couldn’t miss pregnancy because of the puking and pain. My mother always said she never felt better in her life than when she was pregnant with me. Talk about a letdown.

            I also have a close friend who went full term without knowing she was pregnant. Same deal. She also was irregular and didn’t gain much – but she’s the first to tell you there was plenty of denial going on.

          • anion

            My first pregnancy was miserable; I gained a ton of weight (that “best Odds” diet from WHAT TO EXPECT made me gain like a mofo), I was exhausted all the time, my skin was bad, my hair was dry and weirdly curly, I had digestive issues…very little morning sickness, but just miserable in general.

            With my second I had morning sickness until three every day (and for months all I could stomach in the afternoon was spanakopita appetizers and Friday’s potato skins), but I gained exactly 35 pounds and felt and looked fantastic, with tons of energy.

            So maybe another pregnancy would be different for you? :-)

            And I knew a girl in high school who didn’t know she was pregnant until her eighth month. She was six months along on spring break, wearing a bikini, and had the tiniest little pooch, and she had several very faint “periods” along the way–she’d never been particularly regular, so didn’t notice any difference.

          • Karma Kidney Stone

            I’ve had 8 pregnancies (4 losses), and yeah, miserable every single time. It actually got worse as I started collecting health problems. We aren’t having any more children.

          • The Computer Ate My Nym

            None of my business, but have you been checked for hypercoaguable states? It’s a treatable cause of miscarriage and has consequences extending beyond pregnancy…

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

            Eh, I got sicker with each pregnancy (3rd one was the charm) and we immediately closed the factory. :) One and DONE.

          • Young CC Prof

            Actually, I’ve heard that nonviable pregnancies sometimes (depending on the reason they are nonviable) produce less nausea.

          • Lion

            I had near constant vomiting with my two pregnancies where I now have children to show for the horror, and with the one I miscarried (9 weeks), I had milk nausea when I smelled raw meat or coffee. With the two healthy pregnancies, nothing in particular set me off, I just vomited 8 or 9 times a day until I was put on Zofran. I vomited all other prescribed medicines up, but the ondansetron (zofran) stayed down, though it didn’t stop the nausea. The cost gave my husband heart burn though :). I think the vomiting and nausea might be to do wtih the hormone levels, which I assume are higher in viable pregnancies. Wi th my ectopic pregnancy, which was discovered at 6 weeks, I did not have any nausea. The hormones levels fluctuated – one blood test would show pregnant, then the next not and the one after pregnant again.

          • Karma Kidney Stone

            My mother, too. She said she felt like a “flower in bloom.” I felt like a zit about to pop.

          • LION

            I had horrendous vomiting from about 5 weeks with both my pregnancies. I couldn’t miss that something was unusual. I have a few friends with irregular periods and who only with hindsight realised that their vaguely tender breasts and minor “offish” feelings were pregnancy. All of them discovered their pregnancy by about 20 weeks though. We did have someone in our antenatal class who was quite tall and didn’t show until nearly 35 weeks – wore her usual clothes (and hse was a slim gym bunny type) – but she knew she wsa pregnant from 4 or 5 weeks. But after that I realised some people don’t look pregnant when they are. My aunt talks about how she saw her optometrist onewednesday and then went to collect her glasses the next wednesday to be told she’d left and had a baby the day before. My aunt said she had not looked pregnant at all and hadnot been wearing a jacket or loose clothing, but a pair of trousers and button up shirt. There is no way I could have mistaken my pregnancies. Even the one I miscarried and my ectopic pregnancy I knew some thing ws up very early on.

        • Dr Kitty

          The constant puking until 16 weeks, the fact that I looked like I had shoved a beach ball up my jumper from 20 weeks, and an active baby whose kicks were visible through my clothing…no denying that pregnancy.

          There is some evidence that concealed pregnancies are a psychological issue, in which the woman’s body sort of plays along with the “I’m not pregnant” script, and denial is a serious factor.

          The lady I encountered who was very heavily pregnant (38weeks) before seeing a GP clearly did know she was pregnant on some level, and looked obviously pregnant to me, with easily palpable foetal parts and kicks when I examined her. It was her fourth baby, so no, I don’t think it was a “complete surprise”.

        • MaineJen

          I, too, know someone IRL who ‘didn’t know she was pregnant.’ She’s a tiny person (5 feet, maybe 105lbs), and I knew her years after the fact, but…she said she mysteriously gained 10 lbs over the course of a year, but not all in her abdomen as you’d expect (all of her clothes still fit), and she was on birth control the whole time and still got periods regularly. She went to the ER one day with what she thought was appendicitis…only to deliver a 34-week little girl a half hour later!! She was young (early 20s), totally unprepared, and her lifestyle was definitely not condusive to children, so she didn’t even know at first if she wanted to keep her daughter or give her up for adoption. She ended up keeping her and raising her with the ex-boyfriend who was the father (by that time they weren’t together any more); their relationship is great and she’s a good mom to a wonderful child who is about to start high school. So…it can happen?

        • Karyn Croushore Hodgins

          I have always wondered about that as well. We were appalled when my daughter came home pregnant at 15. And by the time we found out she was 34 weeks. Please no comments about what kind of mother am I that my daughter had a baby that young… I am the kind who is a nurse… who had the talk with her…. who encouraged her to come to me and talk to me about sex…. all to no avail.
          Long story short (or not so short lol), In June of 2010, she was getting dizzy and passing out every time she stood up… took her to the PCP who asked her if she could be pregnant. OF course her answer was no… so no one thought to test her. 3 months of PCP appts, labs, neurologists, tilt table tests and no one thought to do pregnancy test!.
          FF to November… 2 days before Thanksgiving…. watching TV.. my teenager wearing her hoodies and sweatpants, stands up and stretches. Her shirt pulls up and my jaw hits the ground.
          She denies, denies, denies, I finally say you are either pregnant or you have not pooped in MONTHS. We ended up buying a test just to convince her.
          Her US had her at 34 weeks! And she swears she didn’t know… both the doc and I were skeptical… but she did have periods right up through October.
          My beautiful granddaughter was born at 37 weeks and 1 day with no complications or issues in spite of no prenatal care thank the lord.
          And I still think that some day she is going to say to me… ok mom… I knew… I was just afraid to tell you….

          • An Actual Attorney

            The kind of mother whose kid might get pregnant / get someone pregnant at 15? The kind of mother who has 15 year olds.

            It happens. It’s always happened. And it probably always will. You hope you give them enough knowledge and they get enough luck, and then life happens.

  • Young CC Prof

    Fox 5 is talking about home births in like 2 minutes. Let’s see what they say…

    • Amy M

      Ooh fill me in, I’m at the table with my children, and not turning on tv until they go to bed.

      • Young CC Prof

        They cited this exact study, about how home births are rising. Dr. Manny on the TV said approximately: “Safe, if your midwife screens you but if you do not qualify, do not push the issue.”

        He also said midwives know how to screen for risk factors. Major fail, Dr. Manny! (Of course, it was about 45 seconds of screen time, in between why eating too much bacon is unhealthy and the weather forecast.)

        • Certified Hamster Midwife

          False news story. There is no such thing as “too much bacon.”

    • Young CC Prof

      And here’s the “full story.”

      http://www.myfoxny.com/story/24883441/us-home-births-continued-steady-increase-in-2012-cdc

      Pretty awful, really. I especially liked: “Byrne said some women should rule out home delivery out-of-hand — those with prior C-sections, women who are morbidly obese and women at risk for breach birth.” The first part makes sense, but breech births can’t be reliably predicted before about 35 weeks. And that’s not how it’s spelled, either.

      The rest is pretty basic NCB apologist BS regurgitated by a reporter who didn’t understand it.

      • Amy M

        Bleh. Science news is always disappointing.

      • fiftyfifty1

        Hold it! NCB apologist BS on FOX News?! I thought LMS1953 said Fox news was going to be our salvation! Turns out the libertarians and conservatives aren’t the infallible geniuses he claimed they would be.

        • anion

          I hate to say it, though, but Fox’s running this story may provide a perfect opportunity to send them Gavin Michael’s story and the stats about homebirth in general; it can be sent to them as feedback, and having just reported on the topic they may be interested in carrying the story further.

          I’m not commenting on the political stuff, and I agree that Fox isn’t the demographic we want to reach, but it still might be worth sending them an email.

          • Young CC Prof

            I looked for contact info on their website, then got distracted by my baby. Anybody find a link or address?

          • anion

            http://www.myfoxny.com/category/235904/contact-us

            It’s really hard to find, just a tiny envelope icon in the upper left of the homepage; I clicked it and this is what I found.

          • anion

            The story came from a site/service called Healthday, which seems to be sort of like an AP for health news; news stations/papers/whatever can license their content. I don’t know enough about newswires to tell how legit it is, but it feeds to some big news channels/sites and has a solid, ethical editorial policy.

            It’s here: http://www.healthday.com/

            Their editorial policy is here: http://www.healthday.com/healthday-editorial-policy.html

            and it implies that they’ll seriously look into any factual errors or problems with irresponsible reporting/editorial bias.

            And you can contact them here: http://www.healthday.com/contact-healthday.html?f=editors

          • Jessica S.

            I read the same thing on WebMD yesterday, sourced from Healthday, too: http://www.m.webmd.com/baby/news/20140304/us-home-births-continued-steady-increase-in-2012-cdc

            Not that I think WebMD is all that reliable, in regards to being woo-free.

          • RebeccainCanada

            What is the demographic you want to reach? I tend towards being Conservative. Conservatives I feel are increasingly using midwifery care, not vaxing and trusting woo for health issues. There’s so much ” Dr. Mercola said this…” Everywhere. MDC is full of Conservatives.

            Just curious, trying to follow the convo.

          • Certified Hamster Midwife

            Conservatives tend to start having children earlier and have more of them, from what I’ve seen.

        • Jessica S.

          I don’t think she’s talking about FNC (FOX News Channel) but rather the local channel. In my experience, there’s quite a difference between local affiliates and FNC, or even
          FOX as a content producer, e.g. The Simpsons. I’ve been (very pleasantly!) surprised at how much the writers have gotten away with direct pokes at FNC. One of my favorites is was in the intro, a FOX News Channel chopper drops off someone (can’t remember who) at the Statue of Liberty’s torch and in the process, it unbalances the helicopter. As the copter spirals down, the pilot yells out the side “WE’RE UNBALANCED! IT’S NOT FAIR!” :-D

          • deafgimp

            When the Simpsons were bought, Fox was a brand new channel. They needed the Simpsons desperately, and therefore they got away with a TON on their contract. The ability to make fun of Fox was explicitly written into the contract. Otherwise the Simpsons wouldn’t have gone with them because it wouldn’t have allowed them to do the type of humor they wanted. The making fun of Fox isn’t just specific, it’s also a way of generically allowing them to be more wild.

          • Jessica S.

            Very interesting! I didn’t know that.

      • Renee

        Don’t tell Plus Sized Mommy Memoirs! She tells everyone that weight is not a risk at all, and HB is great, as is HBAC. Anyone that disagrees is a HATER.

  • prolifefeminist

    Again and again I have to ask, what the hell is wrong with the American College of Nurse Midwives? I can’t believe they go along with this garbage spewed by MANA, et al. Makes me sick.

    • Deena Chamlee

      Imagine common denominators

      • prolifefeminist

        I know – I get that and I guess that’s what it is. I just cannot believe that years of working through nursing school and graduate school is eclipsed by these common denominators that “birth is safe” and natural is better. It’s just insane.

        I’m currently in school full time working on the last of my prereq’s for nursing school. I’m at the very beginning of my education as a nurse, and I just cannot imagine going through years of this and then turning around and equating my expertise with someone with a high school diploma and a mail order certificate. Why does the ACNM lower themselves to CPM standards when their educational backgrounds are night and day? Does the “bond of sisterhood” and exultation of all things natural really trump everything else, including common sense?

        ETA: It’s like the AMA welcoming NDs and Chiros into their fold, as if they have equal qualifications!

        • fiftyfifty1

          “Does the “bond of sisterhood” and exultation of all things natural really trump everything else, including common sense?”

          Apparently yes. That’s why I no longer refer my patients to CNMs.

          • Deena Chamlee

            Fifty not all of us are, in fact majority probably would not be if they knew the truth.

          • The Bofa on the Sofa

            Unfortunately, the problem is that far too many are like that, regardless of why, which makes it too risky, according to fiftyfifty1. I am not a provider, so my opinion doesn’t matter, but I absolutely endorse her position.

            If more doctors took that attitude, it would help create change.

          • prolifefeminist

            That’s exactly it, Bofa. The ACNM has not only allowed a level of bullshit to creep in but has openly encouraged it, and the result is that this woo bullshit is taught, tolerated, and practiced by more and more CNMs. They should be eradicating it from their ranks, but instead they encourage it and give it a veneer of credibility.

            Meanwhile, the CNM credential is steadily losing respectability. The ACNM has failed to protect its “brand.” It would be like McDonald’s allowing any old burger joint to slap up a MickyD’s sign – eventually, people will stop going to places called McDonald’s because they can’t predict whether they’ll get a tasty artery-clogging Big Mac, or a pile of crap on a bun. You ruin the brand doing that because people don’t know what they’re going to get. The ACNMs failure to protect the brand of “midwife” is having the same effect – now providers like fiftyfifty and others aren’t referring to them because there’s no quality control – you might get lucky and get an evidence-based CNM, or you might get one who specializes in Wooology. It won’t be long before the bad rep spreads, and it doesn’t matter if there are “some” or even “many” good CNMs, because the shitty ones will have destroyed their good reputation.

          • Amy Tuteur, MD

            I suspect it may be related to the problem with women and skepticism. The ACNM values “sisterhood” over safety.

          • The Bofa on the Sofa

            The ACNM has not only allowed a level of bullshit to creep in but has openly encouraged it, and the result is that this woo bullshit is taught, tolerated, and practiced by more and more CNMs. They should be eradicating it from their ranks, but instead they encourage it and give it a veneer of credibility.

            Of course, the reason the ACNM (and the membership) allows the bullshit to be taught is because deep down, a large fraction agree with it.

            Being a nurse doesn’t mean one isn’t woo. Nurses are the ones who push “therapeutic touch” for example, something so obviously wrong that it can be shown so by an 8 year old.

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

            I think there is a major difference between women who go into CNM education with their ideology already in place, and those who don’t. It’s like having a theory and then looking for facts to support it, rather than doing research and then interpreting it to create a theory. Sort of similar to going to med school to become a doctor so one can prove that Laetrile cures cancer. Think of Andrew Wakefield and his shenanigans.

    • fiftyfifty1

      CNMs have been hoodwinked by CPMs into believing that CPMs are actually midwives rather than uneducated birth junkies. CPMs have played right into the Achilles Heal of CNMs: the strong streak of woo they harbor and the bullshit romantic stories about their heroic granny midwife heritage that they tell each other.

    • Vera

      If the ACNM is anything like their Australian equivalents, there is an unbelievable level of politics behind every word that they put out or don’t say. Someone high up has probably decided that they will gain more from allowing MANA to talk crap than from risking their own neck. It’s shameful.

  • Danielle

    “The 2003 revision of the U.S. Standard Certificate of Birth added a data item on planning status of home birth…” Wait, so we can actually run searches for the outcomes of planned home births? I thought we could just get really close by assuming that home births attended by midwives must have been planned.

    • Squillo

      No, not using the public database. The MANA claim is in direct response to Amy’s analysis, which uses the publicly available stats. They have a point, in that you can’t use planned place of birth as a search parameter. What they don’t say, but Amy et al. have pointed out, is that this limitation almost certainly makes homebirth stats look better than they actually are. By restricting the search to births only attended by “MD,” “DO,” “CNM” or “other midwife,” you eliminate virtually all the unattended births (whether intentional or unintentional). However a subset of those in the hospital column will actually have been planned homebirths that transferred intrapartum. Thus, Amy’s analysis almost certainly undercounts homebirth deaths.

      Presumably, researchers can get access to a much more detailed dataset that includes planned place of birth, Apgars, etc.

      • Young CC Prof

        Not all states are recording planned place of birth yet, but many are.

        • Squillo

          Those using the new standard certificate of live birth, I think. I’m not certain how many states do, though. I also don’t know how many states that use their own forms include intended place of birth.

          • Renee

            Oregon has this on the birth cert, and that is how we got high quality data that shows an 8x higher death rate.
            Other states are following suit.

  • Deena Chamlee

    One of the direct entry board midwives in Oregon, CPM, works for the CDC. Now do you think she may have a relationship of some sorts with MacDorman? Maybe MacDorman can answer this ETHICAL question…..

    • Anj Fabian

      She works for the FEDS?
      Zomg, she is totally in bed with The Man.

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

    I feel for homebirth advocates – it must be terribly difficult to live a life with such a large amount of cognitive dissonance in it.

    • anion

      I suspect that’s the reason for the love affair with woo; it’s all based on energy and feelings, not facts, so it’s less jarring. And if it fails, it “wasn’t meant to be,” or “wasn’t what the Universe wanted for [me],” so there’s no need to face any hard truths or admit that one was wrong.

      (And I say that as someone who has actually dabbled/does still occasionally dabble in woo, and is still fairly superstitious about some things. Just, my woo and superstition don’t relate to life-or-death situations or anything that matters to anyone but me. It doesn’t harm anyone or anything if I like to start new projects at the new moon or full moon, you know, or if I open the back door at midnight on New Year’s Eve to let the old year out. And I’m aware even as I do it that it’s silly and doesn’t change a thing. It’s a combination of “Who cares, it’s fun to believe in magic sometimes,” and hedging my bets.)

      • Mishimoo

        The Ob/Gyn that was on shift when I went in for my last was very cutely superstitious – “I know you’re having CNM care, but hi, I’m X the Ob/Gyn on tonight. I probably won’t be working with you, I’ve just found that if I introduce myself, then I’m not needed. Wait, I get doughnuts too? Yay!”

        • Dr Kitty

          There are some definite medical supersitions.
          Just try saying the word “quiet” in an ER…
          Psych and ER nurses believe that the full moon sends them more work.
          There are some people, “scuds”, who are famous for having terrible shifts because they get all the sick, complicated or crazy cases. No-one wants to work with them.

          For example, in my four months in A&E I had relatively peaceful night shifts, bar the usual drunks and heart attacks and so on.

          My friend (the scud) got the self inflicted partial decapitation, the “interesting” reaction to illegal drugs, a surprise birth in the ED, a paramiliatry punishment beating, a tension pneumothorax, a defenestration and various foreign bodies lodged in unlikely orifices.

          If it was something that should be written up in a Journal or feature on an episode of ER, it happened on his shift. EVERY TIME.

          I think the nurses were considering getting him an exorcism.

          • Young CC Prof

            Like I always say, the human brain is designed to understand the world by finding patterns, and in the rare situations where things really are random, we just can’t handle it. The mind will search and cherry-pick and selectively recall until it FINDS a pattern, and then seize on it.

            No one can totally avoid superstition, I have some myself. The best you can do is make sure you don’t put superstition above real evidence when the decision is important and real evidence exists.

          • The Computer Ate My Nym

            Re superstitions and patterns…I think people are more apt to be superstitious in situations where they’re utterly helpless and have no control whatsoever over the situation. Residents develop all sorts of rituals to keep the ER quiet because it’s a situation that they truly have no control over. People don’t like having no control and, often, would rather blame themselves than chance (i.e. “I shouldn’t have said it was quiet. I knew that was just asking for an acute leukemic with a count of 150K, a TTP, and a hemophiliac with head trauma to walk through the door at the same time. That time, of course, being 4:49 pm.”)

          • The Computer Ate My Nym

            Ah, your word for it is “scud”? We call those people “black clouds”. I’m a black cloud. My colleague is a permanent el nino year with global warming in hurricane season.

            Did the partial decapitation survive? I can think of several ways that s/he could but quite a number more where s/he couldn’t…

          • Dr Kitty

            The partial decapitation had managed to sever most of his large neck vessels and was pretty much DOA.The ambulance crew had a literal bucket full of his blood with them (I’m not sure what they thought we might need it for, but I guess waste not, want not).

            Scud as in the missile…as in the department resembles a warzone when they are on.

            Our scud was the nicest, most easy going, sweet guy…and he just got all the disasters of the day.

          • The Computer Ate My Nym

            Yow. I imagine that the ambulance crew didn’t know either, except maybe that they didn’t want to have to clean the blood out of the ambulance afterwards. Or maybe just hoping that you could pull something off…

            I heard about (didn’t see) a case of a man who was in a bar fight and had gotten stabbed in the neck. The person stabbing him must have been the world’s least competent knife fighter because he missed all the great vessels, the spine, and the esophagus. The victim lived, astonishingly enough.

            It’s always the nicest, most easy going people who end up with the worst disasters while they’re on. Sort of like the “only nice people get cancer” rule.

          • Mishimoo

            I can certainly understand why!

            My husband swears that the new moon is when he gets the most frustrating and illogical customers, along with the strangest mechanical faults.

      • Rochester mama

        A veterinarian friend of mine does trap neuter return clinics for feral and farm cats. She will only schedule them when the Farmers Almanac says it’s ok to do castrations.

        • anion

          See, that’s adorable (IMO).

  • Amy M

    Wow, that’s impressively obnoxious. The NCB crowd loves the CDC and the AMA when they support the NCB party line (breast is best), but decide they don’t know what they are talking about whenever CDC/AMA say something NCB doesn’t agree with (vaccinate your damn kids). In this case, when the methods of data collection validate homebirth–yay! When they help show homebirth is dangerous…well, then clearly the CDC is run by drunk chimpanzees. People are welcome to their own opinions, but they aren’t welcome to their own science….no matter what they want to think, the apple still falls down.

    • Mishimoo

      And the Turtle moves.