Karma is a bitch.
Jen Kamel of the loosely named blog VBACFacts, a lay person with a very poor grasp of obstetrics, decided to do a hatchet job on a wonderful post by Doula Dani.
Danielle wrote about vaginal birth after cesarean (VBAC), Jen’s supposed area of “expertise.” Being the deeply conscientious person that she is , she gave Jen the opportunity to participate in the post. Jen turned her down, but when the post was published, she savaged it, first in private and then publicly by reprinting the private conversation without permission.
Jen titled her acid post The Dangers of Birth Blogs, and had this to say about Danielle:
Every practitioner and birth professional reading this has likely witnessed the problems that occur when lay people cross the line of giving information and feel competent to dispense actual medical advice despite the absence of any clinical training or education. (For specific examples of what this looks like, click on the third Facebook post above.) A doula is a childbirth support specialist, skilled at helping families navigate labor and birth in a way that fits each family’s needs, values and risk tolerance. A doula is not a medical expert, and medical advice is outside a doula’s area of practice.
Now I don’t name this doula or link to her blog because my objective is not to publicly shame her or to direct people to her blog. While I use my experience with this doula as a example, this is about the bigger picture.
My objective is to issue a warning: There are a lot of people out there who have no idea what they are talking about. And it is downright shocking to me how many parents and professionals are willing to just accept something as truth simply because they read about it on a blog … or writes about it on Facebook … A little bit of knowledge is not enough to understand any complex subject including post-cesarean birth options.
The irony, of course, is that Jen is describing herself. She is a lay person who “routinely crosses the live of giving information and feel competent to dispense actual medical advice despite the absence of any clinical training or education.” She has a little bit of knowledge about VBACs but “not enough to understand any complex subject including post-cesarean birth options.” And like Jen, I marvel at “how many parents and professionals are willing to just accept something as truth simply because they read about it on a blog” … like, say, VBACFacts.
Jen’s post is as clear as mud. It is extremely difficult to read and understand. But I did understand this, which Jen posted in the comments and on the associated Facebook post:
If there is something that I have said above that is inaccurate, please let me know.
So I let her know.
Jen criticized the use of the appalling MANA HBAC data to demonstrate that attempting a VBAC at home has a hideous death rate:
… You have to know that issues with the MANA mortality data. That collection of data is insufficient to accurately measure mortality. 1000 TOLACs [trial of labor after cesarean].
When Danielle points out that the data is not insufficient, Jen doubles down:
It is laughable that she makes this statement. Anyone who claims that 1000 labors is sufficient to measure maternal or neonatal mortality rates in America has no idea what they are talking about. It is simply too small of a sample size.
Jen is withering:
how much of my time should I give you to work on your piece?
I mean… I want to help you, but…
And I’ve already given you a line by line feedback.
As someone with a website, you are under an obligation to be ethical, clear, and transparent. When you make conjectures like that, when you make leaps or tie two events together that have not been clearly connected per research, you are not being clear. It certainly makes for pretty dramatic reading but it’s not accurate.
So the question is: do you want to go for dramatic or do you want to go for factually accurate? Because sometimes factually accurate is a little bit more boring, frankly. All depends on what your objectives are. The truth? Or some other agenda?
Is it good science to take an pretty solid figure (hospital mortality rates) and compare it to a figure found in a study that is not powered to measure mortality rates and then make a conclusion? Perhaps for someone reaching for an agenda, yes. But we have to be honest. And the honest answer is, the MANA data is not powered to measure mortality. They acknowledge that in the narrative. End of sentence. You cannot take this data and wave it around as a strong piece of evidence on the mortality rates of home VBAC.
Too bad Jen is completely, totally, utterly wrong.
I explained to Jen on her Facebook page why the MANA data is adequate to draw conclusions. I explained why you can’t just eyeball the data to determine if it is adequate (as she acknowledged that she did), and there is a statistical test for power. I explained that both sample size AND effect size determine power, meaning that a large effect requires a much smaller dataset to be adequately powered than a small effect and the difference between the HBAC death rate and the hospital death rate is quite large. She countered by claiming that MANA thinks the data is underpowered, as if that means anything.
But apparently, the more she thought about it, the more she realized she had made some serious errors. So she did what any natural childbirth blogger does when confronted with an error: she deleted the evidence. She deleted her blog post (the link above is the cached version) and she deleted the Facebook post where she is shown to be wrong, as well as multiple other Facebook posts that referred her withering hatchet job.
She forgot to take down one of her Facebook posts, the most ironic one of all.
The text on the illustration is cut off. It reads:
If you don’t make mistakes, you’re doing it wrong.
If you don’t correct those mistakes, you’re doing it really wrong.
If you can’t accept that you’re mistaken, you’re not doing it at all.
I propose that we add the following line just for Jen:
If you hide the evidence that you were mistaken, you are a very dangerous birth blogger.
And, Jen, one more thing:
If you don’t apologize publicly to Danielle for that underhanded, vicious, ignorant hatchet job, you are contemptible.