Melissa Cheyney and MANA lied for years about the death rate at home VBAC; how can they ever be trusted?

Concept of lies. Lie detector with text.

Last week the healthcare news was dominated by a new study investigating treatment of high blood pressure:

The NIH was so eager to get the news out that it decided to stop the study early, evaluate the preliminary results and make recommendations to doctors…

Preliminary results showed a third fewer cardiac events such as heart attack, stroke, and heart failure and a quarter fewer deaths in those with the lower blood pressure, according to the NIH.

The study was ended early because the number of lives saved was so impressive that investigators felt it would be unethical to keep that information to themselves for an additional year. Many might die if patients and their doctors were unaware of the new data.

Contrast that with Melissa Cheyney’s acknowledgement of the hideous death rate at home VBAC also known as HBAC (homebirth after Cesarean) in the MANA Stats study. The data was collected between 2004-2009 and the terrible results were known in 2010. Cheyney, the Director of Research for the Midwives Alliance of North America (MANA), and MANA executives have known for 5 YEARS that home VBAC kills babies who didn’t have to die, but they hid that information and repeatedly acted as if it did not exist.

[pullquote align=”right” color=”#e85b5b”]When homebirth midwives weigh profit against infant lives, profit wins and babies die.[/pullquote]

I wrote recently that Cheyney had acknowledged the high death toll of home VBAC.

She didn’t merely acknowledge that the death toll at home VBAC is 330% higher than hospital VBAC, she admitted that she expected it:

This is expected in a setting where decision-to-cesarean delivery time in the event of a uterine rupture is presumably greater than the 18- to 30-minute interval at which evidence suggests neonatal risk increases.

Cheyney amplified her admission in a piece for the Lamaze blog Science and Sensibility:

…[I]t is also important to think about the likelihood of an intrapartum transfer, distance from the hospital, and a variety of other factors that are unique to each person. I actually think that looking at the cases that did not have good outcomes can be very informative. They help us to see who might be a reasonable candidate for an HBAC and who might not be. For example, in our dataset there were five deaths overall—three during labor … So for the combined intrapartum and neonatal mortality rate, the total is 4.75 out of 1000.

When we look at these cases more closely, we see that two of the cases were very likely uterine ruptures, based on the heart tone patterns that the midwife was able to distinguish at home. The three other ones were deaths that were totally unrelated to the TOLAC [trial of labor after Cesarean] status of the mother. One involved known risk factors related to giving birth to a twin, the second one was a surprise breech with an entrapped head, and the third one was a cord prolapse.

In other words, not only is HBAC dangerous, but twins and breech are NOT variations of normal, they are potentially deadly.

Indeed, Cheyney admits that “trusting birth” isn’t enough:

I think these findings have ramifications for everyone who’s considering a home birth, not just women who are considering a home birth after a cesarean, because one of the most interesting things that we’ve found is that that risk within our sample varies considerably by obstetric history and parity…

But Cheyney has known about these findings since 2010 (I first heard leaks of the findings in early 2011). Unlike the NIH blood pressure study that was ended early to save lives, Cheyney and MANA hid their data, and let countless additional babies die. They did not share the information with the public until August 2015.

In February 2014, I asked Cheyney in an open letter, how she could sleep at night knowing that she was hiding and misrepresenting the death rate at homebirth. I warned her:

You are going to lose this battle to hide accurate information from American women. Maybe not in the near future, but definitely in the not too distant future. It is inevitable that people are going to ask MANA why you hid those death rates in the first place…

Cheyney lost the battle to hide the VBAC death rates and finally acknowledged them. In so doing she provided not one, but two valuable pieces of information:

1. Cheyney, MANA and its executives hid critical information from women for 5 years, depriving them of the opportunity to make informed decisions and letting babies die preventable deaths as a result.

2. Cheyney, MANA and its executives demonstrated that they have no compunction about misleading women in order to increase their employment opportunities and profits. They hid the death rate in order to convince women that home VBAC was safe, so they could attend home VBACs. If they can hide deaths at home VBAC for 5 years, we cannot trust anything they say about the safety of homebirth. Indeed, the MANA Stats paper from which the VBAC deaths were abstracted actually shows that homebirth itself has a death rate 450% higher than comparable risk hospital birth, but Cheyney and MANA lied about that in the paper itself and in comments they made on their website.

I told everyone for the last 5 years that Melissa Cheyney and MANA were aware of the hideous death rate at homebirth and were hiding that information. Now they’re admitting it, but that doesn’t mean that they’ve stopped hiding deaths and misleading women.

It only means that you can never trust them to tell you the truth. When they weigh profit against infant lives, profit wins and babies die.