I was interviewed by journalist Lindsay Beyerstein on the subject of homebirth and the recent publication of statistics by the Midwives Alliance of North America.
You can find the interview here:
http://www.pointofinquiry.org/amy_tuteur_md_-_the_skeptical_ob/
It’s a long interview. There’s just as much after the commercial break as before.
Thanks to Point of Inquiry and Lindsay Beyerstein for the opportunity to share my thoughts!
Would you hire an architect who told you that you could save lots of money building your new house by ignoring all those pesky building codes?
Probably not. As much as you’d like to save money, you recognize that choices have consequences and the consequences of ignoring building codes might be dire.
What if, in response to your concern that such a house might fall down, trapping and killing your family, the architect responded that some houses are just meant to fall down and some families are meant to be buried alive under tons of debris?
Would you be reassured?
How about if the architect told you that your house wouldn’t fall down as long as you believed in yourself and your choice to ignore building codes?
You’d probably be angry that the architect was treating you like a gullible fool.
In other words, you would be capable of rejecting a plan that sounds too good to be true, even if it might make you happier to believe that you didn’t need to spend money to follow those pesky building codes.
That’s the nature of adult reasoning. You don’t determine if a claim is true by whether or not it makes you happy. You apply reason, and conclude that many claims are not true even thought it would make you happy if they were true.
Unless, of course, you are a homebirth advocate.
Homebirth advocates have a toddler level approach to the world: what makes them happy must be true, and if anyone tells them it’s not true, they fall to the floor, weeping, declaring that they hate the truth teller for being so mean.
If you think about it for even a nanosecond, you realize that is how homebirth advocates “reason.” They always want to do what is easiest and least scary for them, so they simply pretend that what is easiest and least scary for them must be true.
Hospitals are scary. Homebirth advocates prefer to believe that hospitals kill countless babies with dread “interventions,” so staying home must be better. And homebirth midwives are happy to support them in their delusion.
C-sections are scary. Homebirth advocates prefer to believe that no woman needs a C-section unless whatever is happening is so scary (massive bleeding, cord falling out of the vagina, a baby with no heart rate), they are more afraid of bleeding to death or having a dead baby than they are of the C-section. And homebirth midwives are happy to encourage this type of thinking.
Obstetricians are mean because they won’t tell you what you want to hear simply because you want to hear it. They won’t praise you for being “educated” when you are actually ignorant. They won’t tell you that you are a “warrior mama” just because you managed to do what most of the mothers who ever existed have already done (or died trying to do). Homebirth midwives make women much happier because they never tell them anything they don’t want to hear.
Dead babies are scary. They prefer to believe that the chance that their own babies might die is barely higher than zero. Therefore, obstetricians are “playing the dead baby card” rather than trying to obtain informed consent when they tell them about risks as well as benefits.
Needles are scary. Therefore epidurals are “risky” and natural childbirth is “safer.”
Childbirth complications are scary. Therefore, they simply don’t exist; breech, twins, VBAC, etc. are nothing more than variations of normal.
Science is scary, and hard. Therefore they create their own “journals” where any crap they dream up will be published because the criterion for acceptance is not scientific rigor, but rather the ability of the paper to make homebirth advocates happy.
Scientific meetings are scary. People might ask questions! They might point out flaws! They might disagree! Therefore, professional homebirth advocates can never speak in any venue where the audience has not been vetted to remove anyone who might make homebirth advocates unhappy.
The truth is scary. Therefore, homebirth advocates, delete and ban to create “safe spaces” for themselves where they will never be confronted by anything that might make them unhappy. Indeed, there is not a single homebirth website that I am aware of, or a single professional homebirth advocate who does not whitewash her website, not merely to remove uncomfortable facts, but to pretend they don’t exist at all.
Debate is super duper scary. That’s why professional homebirth advocates will never be caught in any debate that isn’t rigged before hand. Being made to look like a fool is always a distinct possibility for professional homebirth advocates and that wouldn’t make them happy, would it?
So homebirth advocates, and women contemplating homebirth, need to ask themselves:
Are they adults who can accept the fact that homebirth kills babies who didn’t have to die?
Or are they toddlers who prefer to pretend that whether or not something makes them happy determines if it is true?
In the ongoing discussion about my tone, no one has picked up on what seems most noticeable to me, the dramatic difference between the way that laypeople talk about me and the way that professional homebirth advocates talk about me. Rarely does a week go by that some lay homebirth advocate does not refer to me as mean and explain why no one should listen to me.
What do professional homebirth advocates do? They don’t talk about me at all … which is pretty remarkable if you think about it. They fell all over the Wax study and will tell you in great detail what is wrong with it, but they don’t mention my posts because they CAN’T rebut them. There is nothing factually wrong with what I write and they know it. They don’t dare mention me because they know how very persuasive the truth can be.
Not a single one will publicly debate me because they know they will be eviscerated in short order. They ban me and delete me and they ban and delete anyone who has learned the truth from me, regardless of how nicely those other people tell the truth.
This, to me, is the ethical scandal at the heart of professional homebirth advocacy. Sure there are some professional homebirth advocates who are buffoons, like Jennifer Margulies or Judy Slome Cohain. They don’t understand science and they have toddler level reasoning abilities: if something makes them happy, they believe it. But people like Melissa Cheyney, Wendy Gordon, and Aviva Romm, KNOW that they are hiding hideous homebirth death rates and they simply don’t care. If they put half the energy they use to hide the truth into improving homebirth safety, there would be no need for this blog in the first place.
Professional homebirth advocacy has no safety standards of any kind, because it is not about caring for babies. It is about improving the employment opportunities and reimbursement rates for high school graduates who want to “play” midwife but find it too hard to get a real midwifery degree.
Am I “meen”? I wouldn’t call it that. I would say that I am very, very angry… and I let it show. I feel I have a responsibility to speak out against what I see as the moral corruption at the heart of homebirth advocacy, the willingness to bury dead babies twice. First to put them in little coffins in the ground because homebirth “midwives” can’t be bothered to care as much about safety as about reimbursement. Second, to bury them from the public conscience so as not to affect the economic bottom line of homebirth midwives.
That’s why I came down so hard on Aviva Romm. I deliberately maneuvered her into a position where she had to choose between lying or running away. She chose to run away, and leave those little dead bodies scattered wherever they may fall. It is more important for her to preserve her credibility within the crunchy community, and keep selling quack books about quack subjects, than to speak the truth. Frankly, that willingness to place profits over truth makes me nauseated.
I started this blog because I couldn’t abide the lies from homebirth and natural childbirth advocates, but I keep at it, because I feel I have a responsibility to babies and mothers. Who will speak for babies like Wren Jones, who died of group B strep sepsis on the day he was born, because his parents would hoodwinked by a “midwife” who told them to treat a dangerous bacterium with cloves of garlic in the vagina? Who will speak for Magnus Snyder, who died after a protracted struggle to live because the “midwives” who cared for his mother relished the thought of delivering a breech baby for the first time and were more concerned with their “opportunity” than a baby’s life. Who will speak for Abel Andrews, who cannot speak for himself because the “midwives” who cared for him didn’t know how to perform a resuscitation and left him with a severe brain injury?
I can tell you damn straight who won’t speak for them. Melissa Cheyney won’t speak for them. Wendy Gordon won’t speak for them. Aviva Romm won’t speak for them.
So I ask you, who will speak for Wren, Magnus, Abel and hundreds of others if I don’t? Who will open everyone’s eyes to the suffering and deaths of babies at homebirth if I can’t? Who will rhetorically grab everyone around the throat and force them to look at what they would prefer to ignore if not me?
Am I “meen”? Maybe, but if that’s what it takes to get mothers, homebirth advocates and legislators to look at the truth, I’m proud of it.
Earth to homebirth advocates:
Have you noticed that you are being treated like gullible fools?
It appears that everyone in the universe knows that the MANA homebirth statistics paper shows that homebirth with a non-nurse midwife has a horrific death rate except for you.
Melissa Cheyney, Wendy Gordon and other MANA executives presented the data but simply told bald faced lies about what it means. They figured you are so gullible that you’d willingly lap up the lies and pretend they were truth.
MANA itself cannot find a single obstetrician, neonatologist, pediatrician, epidemiologist, or ethicist who is not directly affiliated with the homebirth movement to support their claims. But they imagine you are too stupid to notice.
Lamaze is so convinced the study is a piece of utter crap that their “references” to support it are The Daily Beast and The Huffington Post, as well as their own blog, Science and Sensibility.
No problem. They figure you guys are such morons that you will Facebook and tweet these links as if they are actual reference.
Now Aviva Romm, MD finds herself in a bind about these MANA statistics.
Dr. Romm is no fool. She received a prize for graduating at the top of her class at Yale Medical School. No doubt she values her reputation for academic achievement and isn’t about to risk it by lying to support MANA in their own prevarications. So when I asked her point blank about analyzing the MANA paper and the Grunebaum abstract, she dithered:
Awww. Statistics are too hard for Aviva. And if you believe that, I have a bridge in Brooklyn I’d like to sell you.
I jumped on her “inability” to analyze the statistics for herself (although I restrained myself from pointing out that if she doesn’t understand statistics, how does she know homebirth is safe?):
It’s not easy to find someone willing to go along with this little charade since, as a variety of math and stats people pointed out to me, there are no statistics involved in the analyses. It’s all elementary school math.
Fortunately, a math PhD did come through and volunteered to analyze the papers. I promptly notified Aviva on Facebook and Twitter and prepared to be ignored. No professional homebirth advocate can afford to be part of an independent analysis of the data because they KNOW the MANA paper shows that homebirth has a perinatal death rate at least 450% higher than comparable risk hospital birth. I never believed that Aviva would go through with an independent analysis and the only reason I suggested it is to show other homebirth advocates the truth … that American women are being taken for chumps and fools by people who know that homebirth kills babies and don’t want them to find out.
After being ignored for more than 24 hours I sent a tweet this morning and got a prompt reply, weaseling out of the agreement, just as expected.
Actually, Aviva, the title of the piece is Stupid is the new black and, in case you haven’t noticed, I’m not interested in papering over the preventable deaths of babies at homebirth with faux “courtesy” even if you are.
And I hardly think that lying about whether you can analyze the MANA paper, which you KNOW shows that homebirth kills babies, was showing me courtesy in the first place.
So thank you, Dr. Romm, for doing exactly what I always expect you quacks like you to do. No self-respecting quack homebirth advocate would ever be caught in a position where she couldn’t delete the truth. It’s nice to know that for professional homebirth advocates, their ability to fool the gullible public is more important to them than whether innocent babies live or die.
So professional homebirth advocates will continue to lie about deaths at homebirth. The only outstanding question is whether lay homebirth advocates will continue to believe them.
It’s no secret that I am strenuously working for the abolition of the CPM (certified professional midwife credential). And it’s no secret that I am confident that the bogus “credential” will be abolished eventually. The only outstanding question is how many babies will die at their hands before they are put out of business.
Why should the CPM credential be abolished?
I have given many reasons in the past including the fact that CPMs have less education and training than ANY other midwives in the first world and the fact that they would be ineligible for licensure in the Netherlands, the UK, Canada, Australia or any other industrialized country. In fact, if you’d like to know all of the many reasons, you can watch the video in the sidebar of this blog.
Today, though, I want to give the simplest possible answer, one that legislators, doctors, public health officials and even homebirth advocates can understand:
CPMs don’t have any safety standards of any kind.
Can you think of any other group of professionals that has never published a single guideline for safe practice? I can’t.
MANA is not a professional organization. It is a special interest lobby and special interest lobbies don’t concern themselves with safety.
It would be bad enough if MANA and CPMs ignored safety, but the truly chilling fact is that MANA and CPMs actually OPPOSE parameters for safe practice.
Consider the recent paper published by MANA executives, Outcomes of Care for 16,924 Planned Home Births in the United States: The Midwives Alliance of North America Statistics Project, 2004 to 2009. Let’s leave aside for the moment the fact that the authors lied about the fact that their data show that homebirth increases the risk of perinatal death by at least 450% and probably a whole lot more.
Let’s look at the appalling death rates that the authors didn’t lie about.
For example:
Of 222 babies presenting in breech position, 5 died either during labor or the neonatal period.
So the homebirth death rate for breech was 20/1000 compared to approximately 0.8/1000 in the hospital. That’s a breech death rate 25X higher (2400%) than the hospital.
MANA has known about this astronomical death rate for 5 years. What have they done to mitigate it? NOTHING!
At no point during those 5 years did the executives at MANA let women know about the extreme risk posed by breech homebirth.
At no point during those 5 years did MANA publish a clinical practice bulletin to inform their own members about the extreme risk posed by breech homebirth.
In fact, homebirth midwives continued to lobby to extend scope of practice to INCREASE breech homebirths.
And even today, in the face of publication of the exact magnitude of the extreme risk posed by breech homebirth, homebirth midwives and their allies are CONTINUING to lobby against an efforts to restrict breech homebirth.
Typical of these efforts in this Change.org petition:
The Arizona State Legislature is considering adopting a new bill that would make it illegal for home birth midwives to attend breech, VBAC, and multiple births (SB1157)…
A recent study published in the peer-reviewed Journal of Midwifery and Women’s Health shows that current science supports home birth for breech and VBAC patients.
I don’t know if the author of the petition is a liar or a fool, but the study showed that science (current or otherwise) does NOT support breech homebirth because the death rate is an appaling 20/1000.
Where is MANA and its executives in this attempt to void any safety regulations in Arizona? They are nowhere to be found. Even though MANA knows that its OWN DATA shows breech homebirth has a hideous mortality rate, they are silent.
The CPM should be abolished because CPMs are not health professionals; they are business women who don’t give a damn about safety and care only about their bottom line. They have literally NO standards for safe clinical practice, which is unfathomable for a purported health care organization, but entirely predictable in an economic lobbying organization.
The CPM credential is a public relations ploy designed to trick legislators and laypeople into believing that homebirth midwifery a profession. It’s not and the sooner the CPM is abolished, the sooner the deaths at their hands will end.
We’ve settled the lawsuit:
The parties have entered into a settlement agreement which has resolved all claims and controversies to their mutual satisfaction.
Geradine Simkins, President of the Midwives Alliance of North America, July 2008.
MANA estimates approximately 20,000 cases will be in the database by the end of 2008.
Peggy Garland, MANA Director of Research, November 2009:
I am pleased to announce the availability of data from the MANA Statistics Project. We have completed review of almost 13,000 records from late 2004 through the end of 2007…
… [W]e expect another 10,000 records will become available for research, spanning 2008-2009.
Melissa Cheyney, August 2011:
The MANA Stats project currently has over 600 active contributors … and our database contains over 27,000 records and counting …
MANA Stats webpage, now:
The MANA Statistics Registry (“MANA Stats”) has gathered has over 24,000 records in the initial (“2.0”) dataset (2004-2009) …
Here’s part of the explanation, accounting for approximately 4,000 women:
In 2004, the Midwives Alliance of North America’s (MANA’s) Division of Research developed a Web-based data collection system to gather information on the practices and outcomes associated with midwife-led births in the United States…
The 2004 to 2009 MANA Stats 2.0 dataset includes data from a total of 24,848 courses of care. The sample for the analyses reported here is restricted to 20,893 pregnancies in which women were planning a home or birth center birth at the onset of labor. These pregnancies included 66 sets of twins for a total sample of 20,959 newborns. Excluded from our sample are 521 women who were not planning a home or birth center birth at the onset of labor, 3434 women who transferred care to another provider prior to the onset of labor for either medical (eg, a complication requiring obstetric specialty care) or nonmedical (eg, woman moved during pregnancy) reasons…
The geographic distribution of the births included 35.7% in the Pacific states (Alaska, California, Hawaii, Oregon, Washington); 23.4% in the West (Arizona, Colorado, Idaho, Montana, Nevada, New Mexico, Oklahoma, Texas, Utah, Wyoming); 14.8% in the Midwest (Illinois, Iowa, Indiana, Kansas, Michigan, Minnesota, Missouri, North Dakota, Nebraska, Ohio, South Dakota, Wisconsin); 10.8% in the Southeast (Alabama, Arkansas, Florida, Georgia, Louisiana, Mississippi, North Carolina, Kentucky, South Carolina, Tennessee, Virginia, West Virginia); 10.0% in the North Atlantic states (Delaware, New Jersey, New York, Maryland, Pennsylvania, Washington, DC); and 5.3% in New England (Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, Vermont). [my emphasis]
The complete November 2004 through December 2009 MANA Stats 2.0 dataset (N = 24,848) includes records from all women receiving at least some prenatal care from contributor midwives. For the purposes of this analysis, we excluded women who transferred care to another provider prior to the onset of labor, women who at the onset of labor had a planned birth location other than home, and women who did not live in the United States. Thus, our final sample for this analysis consisted of all planned home births (N = 16,924).
We already know from the companion paper that 20,959 newborns were left after excluding 521 women who were not planning a home or birth center birth at the onset of labor and 3434 women who transferred care to another provider prior to the onset of labor. Moreover, according to the companion paper, 100% of the women in the studies lived in the US. How, then, could nearly 4000 additional women be excluded for not living in the US?
Unless MANA accidentally misrepresented the number of women in the study or the number of women excluded, they appear to have left out nearly 20% of the patients in their database.
Why?
And what would that data show if it were included?
* A commentor pointed out that the difference may be that the first paper includes birth center births, while the second paper excluded them. That would make sense. However, it doesn’t explain why they claim to have excluded women who lived outside the US even though the first paper indicates that all the women lived in the US.
If the women excluded from the second study were women who gave birth at birth centers, a comparison between outcomes would have been useful. It’s curious that they didn’t include it.
In the world of homebirth, stupid is the new black.
Homebirth advocates proudly flaunt their stupidity and the saddest part about it is that most of that stupidity is willful. They are so sure that their ignorance and transgressiveness are attractive that they willingly suspend disbelief to accept the most outrageous claims and ridiculous lies from professional homebirth advocates and other laypeople.
As any fashion aficionado can tell you, the key to a great look is the foundation garments. Any fabulous dress requires a great bra and shape-wear to accompany it. Whereas a fashion forward woman might start with a properly fitted bra and Spanx, the homebirth advocate starts with ignorance of obstetrics, childbirth and history. The foundational garment of homebirth advocacy is the bizarre belief in the safety of childbirth, despite massive historical and contemporary evidence that childbirth is one of the leading killers of young women and the leading killer of children.
That ignorance allows the homebirth advocate to layer any amount of stupid claims and bizarre denials over it to complete the look.
Obstetricians, pediatricians, neonatologists, anesthesiologists, epidemiologists and ethicists rarely support homebirth and that’s because they start out with knowledge of the fundamentals of childbirth and the history of perinatal and maternal mortality. You might think that the fact that homebirth is opposed as unsafe by the people who know the most about the wellbeing of babies and mothers would cause homebirth advocates to rethink their position, but you’d be wrong. Just as a fashion model wears a slip over her foundation garments, homebirth advocates wear a profound anti-elitism over theirs. Apparently the superior education and training of doctors make many homebirth advocates feel small; the only way for them to feel better about themselves is to deny that experts know anything.
Now for the actual outfit.
Just like there are many shades of black, there are many shades of stupid among homebirth advocates.
Henci Goer says that homebirth is safe and hospitals kill babies. That’s stupid.
Melissa Cheyney, CPM lobbies for laws in Oregon that stipulate any person call legally call herself a homebirth midwife regardless of education or training. That’s stupid.
Judy Slome Cohain, CNM insists that neonatal group B streptococcal sepsis can be prevented by putting cloves of garlic in a woman’s vagina. That’s stupid.
Marian MacDorman claims that the CDC data on which she she based her own published research “aren’t designed for research.” That’s stupid.
Aviva Romm claims that homebirth is safe but when ask to analyze the MANA homebirth paper says:
I’ll tell ya, ladies, I’ve taking medical statistics ad nauseum in my training and still do not consider myself a skilled statistician by any means. Statistics are generally a lot more than meets the eye — there are issues of power, inclusion and exclusion biases, data collection methodology, and even what questions were being asked. So I will be sitting down with someone who can help me to meaningfully review the stats. Not until then can I give a scientifically meaningful response rather than merely my interpretation (another problem with statistics reporting – who’s doing the interpreting!). This is not going to happen fast, but rest assured, when I am confident in an assessment, I will report on this.
That’s stupid and it’s a load of bullshit.
With the exception of Judy Slome Cohain, who appears to have serious problems with logical thought, I would be willing to bet that the others actually realize that their claims are stupid, but they are so confident in the gullibility of their followers whom they figure will believe any garbage they choose to spew.
And all of this would be fine if wearing the wrong color were all that was at stake. Who cares if women who look terrible in black insist that they look fabulous in black? But when it comes to homebirth safety, the lives of innocent infants are at stake. When women dress themselves i ignorance of childbirth, the anti-elitism of the uneducated, and the stupidity of whatever flavor of nonsense their leaders are currently spouting, babies die.
I realize that for homebirth advocates, stupid is the new black … but that doesn’t mean I have to accept it.
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?
Both have executives who lie to preserve market share.