Apparently Melissa Cheyney, CPM, head of the Oregon Board of Direct Entry Midwifery and and Wendy Gordon, CPM (and placenta encapsulation specialist!) are feeling pressured by my “attacks.”

Hallelujah!

I didn’t think that either my exposure of Gordon’s lies, or my exposure of MANA’s attempt to hide their own death rate could exert any pressure on them since they don’t seem to be the least bit pressured by dead babies. From my perspective (naive, I know), there could be no greater pressure than the fact that babies are dying preventable deaths for no better reason than preserving the ability of lay people to get paid for pretending to be midwives. Every REAL health care provider that I know (physician, house officer, medical student, CNM, student CNM) would be utterly devastated by even a single preventable death, let alone dozens of them.

I find it truly mind boggling that both Cheyney and Gordon could engage in such utterly reprehensible, totally unethical efforts to keep critical information from American women. Don’t they care at all about the dead babies?

Evidently not. They have progressed from lying by omission, refusing to release the MANA death rate while simultaneously boasting about the low C-section rate that resulted in those babies’ deaths, to straightforward bald faced lies like Wendy’s whopper appearing in her MANA blog post:

This research, which claims to be the largest study of its kind, relies on data from birth certificates (known as “vital records”). What we know about using information drawn from birth certificates is that they are pretty good for capturing information about things like mother’s age and whether she is carrying twins. They are not very accurate when it comes to rare outcomes like very low Apgar scores, seizures, or deaths (Northam & Knapp, 2006).

What does the Northam & Knapp article actually say? The exact OPPOSITE.

Birthweight, Apgar score, and delivery method agreed 91.9% to 100%. The high-percent agreement supports the reliability of those variables …

Before MANA started blocking comments, I managed to ask:

So the heart of Gordon’s argument is completely untrue. And Gordon referenced the mistruth with a citation that showed the opposite of what she claimed it showed.

Do you plan to correct that misinformation?

No one denied that Gordon deliberately misrepresented the data on the reliability of Apgars and deliberately misrepresented the North & Knapp paper. How could they? Anyone who can read can see the lie for themselves. But they didn’t correct it, either, because the truth is the last thing MANA wants women to know.

Cheyney and Gordon are downright pathetic. They are far feeling far more “pressure” about being exposed as liars than they feel about behaving grossly unethical and letting the deaths of innocent babies count for naught.

I’d like to address Cheyney and Gordon directly, since they obviously read this blog:

Stop lying! Stop hiding! Stop trying to bury dead babies twice, once in the ground and the second time in our collective memories.

How dare you two lie to American women by omission or commission? I never had any doubt that you aren’t healthcare providers; I’ve always known you are lay people trying to get paid while you get your birth junkie fix, but really??!! Have you no decency at all?

Release the MANA death rates. Stop lying about existing research. Start acting like the healthcare providers you claim to be and not a bunch of selfish, self-absorbed women who casually step over the tiny bodies of babies who didn’t have to die on your way to picking up a check.

And, one more thing: If you think this is pressure, you ain’t seen nothing yet!

 

If the behavior of Cheyney and Gordon makes you angry, please sign the petition to force MANA to release its own death rate.

Thank you to the folks at ACOG for inviting me to address the district meeting in Maui.

It was a privilege and a pleasure to speak to nearly 300 obstetricians, medical students and CNMs, all of whom were eager to learn what they could do to prevent homebirth tragedies. As I told the group, I wish I could have taken a picture from the podium. I think many homebirth advocates would be surprised. They’d be surprised that the group was 50% women; they’d be surprised that the group was anxious to learn all they could; and they’d especially be surprised that the question I heard repeatedly, both during my talk and afterward was: “How can we convince homebirth midwives to transfer a higher proportion of their patients, earlier in labor, before it is too late to save the baby?”

Homebirth advocates also would have been surprised by the straightforward nature of my talk. All I did was tell the truth: the truth is ugly enough, and there was hardly a soul in the room who was not aware that homebirth leads to preventable deaths, because they had seen if for themselves.

The talk was not recorded, but I have posted my Powerpoint slides:

[gview file=”http://www.skepticalob.com/wp-content/uploads/2013/10/The-Homebirth-Midwife-said-What.pptx”]

You can read my notes for the talk (complete with typos) here:

Dr. Amy’s ACOG talk

The talk took over an hour plus time for questions from the audience.

My questions to the audience were these:

How many babies have to die preventable deaths before we address the misinformation spread homebirth advocates and homebirth midwives? How many babies have to die before we abolish the pathetically inadequate CPM credential?

I don’t know, but every death is a tragedy too many.

I’ve been somewhat remiss in posting updates, but I’ve had good excuses. Last week I was in Maui, speaking at the ACOG district conference. Then I took the red-eye to the West Coast to attend my son’s wedding, which was awesome.

In the interim, there have been multiple articles about the lawsuit. Mass Lawyer’s Weekly featured it on the front page, in conjunction with a similar lawsuit brought by Harvard Law Professor Lawrence Lessig, a noted authority on copyright: Cases Promise Clarity on Takedown Notices.

Two federal suits in Boston … are expected finally to answer the question of how much good faith a copyright owner must have before issuing a takedown notice under the Digital Millennium Copyright Act.

Lessig’s complaint, which is pending before U.S. District Court Judge Nathaniel M. Gorton, raises the same issues of first impression addressed last week by U.S. District Court Judge Richard G. Stearns in Tuteur v. Crosley-Corcoran, a copyright case brought by a former clinical instructor at Harvard Medical School.

Why did Prof. Lessig file his lawsuit?

Lessig’s suit concerns a keynote address he delivered in 2010 at a conference in South Korea. The lecture was about cultural developments in the age of the Internet. During the discussion, Lessig showed portions of a copycat video phenomenon that involved computer users around the world posting music videos of the song “Lisztomania” by the French rock band Phoenix. Lessig, the founder of the Stanford Center for Internet and Society who is an outspoken advocate for fewer copyright restrictions, put the lecture on YouTube. In response, the band’s Australian record company, defendant Liberation Music, sent him a takedown notice threatening to sue him for violating its copyright. YouTube took the video down, but Lessig and his lawyer … responded by filing suit under Section 512(f) of the DMCA. Co-counsel Daniel Nazar of the Electronic Frontier Foundation said Lessig’s academic lecture was “so clearly a fair use” that the record label’s takedown notice amounted to a knowing misrepresentation.

Daniel Nazar of the Electronic Frontier Foundation explains why they filed an amicus brief in support of my position:

Although Tuteur’s case involves a dispute over home-birthing, Nazar said, it raises important questions about the standard of proof needed to issue takedown notices, which is what prompted his brief and an opposing one from the Motion Picture Association of America.

“The MPAA doesn’t want to have to consider whether something is authorized by law before they seek to remove it from the Internet,” he said. “That’s a really big problem for free speech because placing the onus on the speaker to defend their critical content is not how it should be, and it is not what the law requires.”

On Monday, September 30, Mass Lawyers Weekly published an editorial on the cases, Takedown cases provide opportunity to clarify law:

The cases have received a significant amount of media attention because the objects of the takedown requests are well-known individuals with the wherewithal to fight back. Most people hit with such a notice can’t afford to get into a legal battle and simply cave.

Unfortunately for Liberation Music and Crosley-Corcoran, Lessig and Tuteur are not only prepared to litigate, they’re also prominent enough to attract amici support. In Tuteur’s case, a joint brief was submitted by the Electronic Frontier Foundation, the Digital Media Law Project in Cambridge and Harvard’s Cyberlaw Clinic.

The bad news for these defendants is good news for attorneys seeking to know where the lines should be drawn in a complicated area of the law. Currently, the correct standard is unclear: While
copyright holders must have a reasonable and articulable basis for sending a takedown notice, there’s a lot of uncertainty over what constitutes sufficient cause.

Now, because Lessig and Tuteur have stepped up, the end result could be welcome clarity where there has been little guidance.

The next step in my lawsuit is discovery, which involves reviewing documents and taking depositions. That phase must be complete by February 7, 2014.

Oregon homebirth midwives have a very serious problem. A recent analysis prepared by Judith Rooks, CNM (a homebirth supporter) showed that for a baby alive at the start of labor, homebirth increased the risk of death by 800%.

That required action on the part of homebirth advocates. No, silly, not tightening requirements for the education and training of homebirth midwives. How about restricting their scope of practice? Are you nuts? Just because babies are dying left and right at Oregon homebirths is not reason to interfere with the income stream of homebirth supporters.

Instead, homebirth partisans have moved to bury dead homebirth babies twice. First they buried them in pathetically tiny coffins. Now they are burying them in report about homebirth that includes a blizzard of numbers, all the numbers EXCEPT the most important one, the death rate of babies who started labor alive.

You can find the unabridge document here.

It is 7 complete pages and includes a variety of pages, but search for any mention of “death rate” and you will find there is NOT A SINGLE MENTION of the deaths rates.

Why does that sound familiar? Maybe it’s because it’s just like the most recent report from Colorado homebirth midwives that ALSO neglected to mention the death rates. Maybe because it’s strikingly reminiscent of MANA’s decision to publicly proclaim the C-section rate, intervention rate, transfer rate, prematurity rate, and many other rates, and in a striking coincidence, they ALSO neglected to mention the death rates. It’s almost if there is a conspiracy among homebirth midwives and their supporters to hide the death toll of homebirth from American women!!

The abridged version tries another tactic: adding in stillbirths to dramatically soften the impact of the homebirth deaths.

The term perinatal mortality rate§ for planned out-of-hospital births (4.0/1,000 pregnancies) was nearly twice that of in- hospital births (2.1/1,000).

Doesn’t that sound so much better than an 800% increased death rate for babies who were alive at the start of labor? And it’s so much less informative, too, which comports with the efforts of MANA and homebirth midwives to obtain “misinformed consent.”

The folks at the Oregon Department of Health should be ashamed of themselves for agreeing to participate in a patently unethical whitewash.

The fact remains (even if they won’t include it) that for babies alive at the start of labor homebirth increases the risk of death by 800%. That is an appalling number, only slightly less appalling than the fact that homebirth partisans are desperate to hide the number by any means at their disposal.

Homebirth kills babies. Homebirth midwives and their partisans KNOW that homebirth kills babies and they are doing everything they possibly can to hide that information from American women.

When it comes to homebirth midwives, their lack of ethics is nearly as appalling as their lack of education and skill.

Homebirth advocates in general, and the Midwives Alliance of North America in particular, love the “big lie.” They have no intellectual respect for each other and operate on the assumption that homebirth advocates will believe anything, no matter how ridiculous or outrageous, if you just say it loud enough and long enough.

For example, MANA executive Wendy Gordon CPM (and placenta encapsulation specialist!), writing in the comment section of her Science and Sensibility piece, which has been ripped to shreds. is still telling lies as fast as she can make them up.

But what seems to be clear, time and time again in the most rigorous studies on homebirth safety, is that for women with healthy low-risk pregnancies, there is no increased risk of death (however that is defined in those studies) …

That, like most of what comes from Wendy Gordon and MANA is bullshit!

Why? For a very simple reason.

Prior to the recent Grunebaum paper showing that homebirth increases the risk of an Apgar score of 0 by nearly 1000%: THERE HAS NOT BEEN A SINGLE HIGH QUALITY STUDY OF NON-NURSE MIDWIFE ATTENDED HOMEBIRTH IN THE PAST 8 YEARS!

In fact, the has only ever been ONE STUDY that specifically addressed non-nurse midwife attended homebirth, the Johnson and Daviss study, which claimed to show that homebirth with a certified professional midwife (CPM) in 2000 were as safe as hospital birth. There’s just one teensy problem. The authors didn’t compare homebirth in 2000 with low risk hospital birth in 2000 because that would have shown that homebirth with a CPM had a death rate nearly 3X higher. In order to hide that fact, Johnson, the former Director of Research for the Midwives Alliance of North America, and Daviss, his wife and a homebirth midwife, compared CPM attended homebirth in 2000 with a bunch of out of date papers extending back to 1969 when (conveniently) the perinatal death rate was much higher than 2000.

All the other homebirth papers that Wendy Gordon and MANA like to quote come from different countries where there are NO CPMs because CPMs are considered to have too little education and training to qualify for licensure in the Netherlands, the UK, and Asutralia. As it happens, those studies from the Netherlands, the UK and Australia ALSO show that homebirth increases the perinatal/neonatal death rate, too. There have been several studies of homebirth in Canada that showed that — with strict eligibility criteria, and a massively high transfer rate — deaths as homebirth could be avoided. There were no CPMs in that study, either, as Canada, which used to recognize the CPM, abolished it several years ago on the grounds of inadequate education and training of CPMs.

Of course, that doesn’t mean there has been no data on non-nurse midwife attended homebirth in the US. The CDC has noted both place of birth and attendant since 2003. They looked at birth certificates signed by non-nurse midwives certifying that they were the attendant who delivered the baby. That means they looked only at PLANNED homebirths and they found, in each and every year, that homebirth had a neonatal mortality rate from 3-7X HIGHER than comparable risk hospital birth. You can see a chart of the results below:

Moreover, the state of Oregon collected their 2012 data of planned homebirths attended by licensed midwives and had it analyzed by Judith Rooks, CNM. It showed that homebirth has a mortality rate than is 9X higher than comparable risk hospital birth.

There is ANOTHER source of data for the death rates of homebirth attended by non-nurse midwives. That’s the database of approximately 27,000+ planned homebirths assembled from 2001-2009 by MANA itself. What’s the death rate for those births? MANA REFUSES TO RELEASE THE DEATH RATE!

At this point, EVERYONE understands that the MANA death rates are hideous, even homebirth supporters. They spend their time spinning absurd reasons why MANA should release the hideous death rates, claiming that they must be “flawed” in some unspecified way that justifies hiding them.

So let’s review why Wendy Gordon’s claim that studies have shown that homebirth is as safe as hospital birth is nothing but a bald faced lie:

1. There have been NO high quality studies of non-nurse midwife attended American hospital birth in the past 8 years.

2. The ONLY study of CPM attended homebirth shows a mortality rate nearly 3X higher than comparable risk hospital birth in the same year.

3. Studies from other countries are not applicable since their midwives are far more highly trained.

4. The CDC data shows that homebirth, in every year from 2003-2008, had a neonatal death rate at least 3-7X higher than comparable risk hospital birth.

5. The Oregon data fro 2012 shows that planned homebirth with a licensed non-nurse midwife has a mortality rate 9X higher than comparable risk hospital birth.

The recently published Grunebaum study merely confirms what we (and MANA) already know: homebirth dramatically increases the risk of perinatal death.

The data is pretty clear and the MANA statistics would merely provide the coup de grace. That’s why it is important for MANA to release their own death rate.

Nearly 300 people have signed the petition to MANA demanding the release of the death rate. Please sign the petition now and urge your friends (real and virtual) to sign, too.

Let MANA know that the time for lying and hiding has passed. American women deserve to know what MANA executives know: how many of the babies in their 27,000+ database died at the hands of homebirth midwives?

I created a petition on Change.org with the (probably vain) hope of publicly embarrassing the Midwives Alliance of North America into releasing the death rate of the 27,000 homebirths in their database.

You can find the petition at Release the Homebirth Death Rate!

To:
Midwives Alliance of North America
Release the Homebirth Death Rate!

American women need accurate information to make an informed decision about homebirth. Until MANA releases the number of babies who died at the more than 27,000 homebirths attended by their members, women will lack access to critical information that they deserve.
Sincerely,
[Your name]

Several of the people who have already signed have done so in memory of babies they have loved and lost, unwittingly trusting “midwives” who never told them the real risks, the actual death rate, of homebirth.

I read yet another story of a preventable neonatal death yesterday on message board. The mother introduced herself back in March:

I’m a FTM and doing home birth as well. We made that decision when we saw the documentary “The Business of Being Born.”

My midwife said that these “complications” can be foreseen way in advance and can be fixed as long as the signs are noticed. With hospitals, they don’t keep an eye on you so they miss those signs and then rush you to get a c-section…

Last Thursday, baby Natalie died during labor, fatally compromised most likely during the pushing phase:

After 6 hours of pushing, not only was I in pain and tired but she hadn’t moved and there was meconium running down my leg which indicated that she was in stress. My midwife was still checking her heartbeat and it was a little slow. They had me lay on one side and have oxygen and that seemed to help her heart but it wasn’t helping anything else. At that time I told my midwife I was done. I couldn’t do it anymore. She tried to lift my spirits and say I COULD do this but I told her I did not want the encouragement. I was tired and I didn’t want to be in pain anymore. I wanted the hospital.

Now Natalie’s mother is left bereft and bewildered:

… By the time they opened me up, she didn’t have a heartbeat. She was covered in meconium and the umbilical cord was wrapped several times around her neck and body. They tried resusitating her for 15 minutes but she never made it.

I was in disbelief. Wait, what? But this wasn’t supposed to happen. None of this was. I was supposed to have my little baby girl at home, she was supposed to be in our arms, we were supposed to be happy. That was the plan. How could she die?

Yet another mother is left in agony for no better reason that because homebirth midwives want to preserve their ability to earn money from their birth junkie hobby, dead babies be damned.

… I want a do-over. Why can’t I have a do-over? I’ll do it right this time, I promise.

I’m sorry, baby girl. I’m sorry you were in stress. I’m sorry I didn’t know. I’m sorry you didn’t have a chance to be held and to be loved by us. All we wanted was you.

Please sign the petition to prevent tragedies like these. I have arranged it so that Melissa Cheyney, Director of Research at MANA will get an email every time someone signs.

Sign in memory of baby Natalie … and Aquila, and Marybeth, and Shahzad, and Wren and the many other babies who died because their mothers never gave informed consent to homebirth, because they never knew the death rate. Even the Midwives Alliance of North America knows that homebirth kills babies who didn’t have to die. They’ve done everything in their power to make sure that American women don’t find out the truth. Let’s end the needless, senseless deaths NOW!

There are times when I could almost feel sorry for Wendy Gordon. Her desperation to fool her followers has become thoroughly pathetic. But then I remember that it takes a special kind of unethical to trick people into ignoring a growing pile of tiny dead bodies for no better reason than that she and her cronies make their money from it.

How desperate is she?

As I’ve noted before, Wendy’s efforts to discredit the Grunebaum study that showed that homebirth increases the risk of 5 minute Apgar score of 0 by nearly 1000% are not going well. As I pointed out, the Grunebaum study comports quite well with the data from Oregon that showed that homebirth increased the risk of death by more than 800%. Others have pointed that out to Wendy, and she has tied herself into a knot trying to explain why we should ignore the correlation.

Here is her pathetic effort:

The Grunebaum study does not examine deaths, so there is no correlation to be made here.

What breathtaking bullshit! The Grunebaum study most certainly looks at deaths since only a vanishing percentage of babies with 5 minute Apgar scores of 0 will survive. Think about it: a 5 minute Apgar score of 0 means that the baby had NO HEARTBEAT for at least 5 minutes. Moreover, the Grunebaum study excludes babies who died in the hours or days after birth so it actually UNDERCOUNTS early neonatal deaths.

A 5 minute Apgar of 0 is a terrible outcome regardless of whether in rare circumstances the baby might survive with significant brain damage and/or cerebral palsy. Wendy is insisting that the two studies have nothing to do with each other because one looks at the almost certainly dead and the other looks at the definitely dead.

The Wendy proceeds to recycle her original crap:

A misclassified death in the homebirth group causes the mortality rate to swing dramatically, while a similar misclassification on the hospital side has essentially no effect.

You’ll get no argument from me that homebirth midwives are ignorant clowns, but even I don’t think they are so incompetent that they can’t tell the difference between a dead baby and a live one.

I believe that midwives are eager to understand what the evidence has to say about the safety of our model of care and the location of birth …

Oh, please, Wendy. You won’t even acknowledge that the studies are true, let alone understand why the events described actually happened.

And guess what? You know those articles “in press” that will reveal the MANA death rates next year. Well it turns out they’re not really “in press” at all.

… When I say “in press”, that means that the research articles are in the hands of the editors and reviewers of the journal to which they have been submitted.

That’s bullshit, too. “In press” means just what it sounds like: the article has been accepted for publication and is being formatted and printed. The MANA “articles” aren’t in press; they haven’t even been accepted for publication and they may NEVER be published.

But Wendy, like the rest of MANA’s homebirth stooges, is so desperate that she is willing to say ANYTHING in order to direct your attention away from the growing pile of tiny dead bodies. The entire executive board of MANA are breathtakingly unethical. The stooges who publicly lie and mislead on behalf of MANA are more concerned about protecting the income they make from pretending to be midwives than whether babies live or die. They literally do not care WHO dies in order to preserve their ability to make money from their birth junkie hobby.

Wendy and MANA’s goal appears to be making stooges out of their followers. They don’t expect to be taken seriously by anyone in the mainstream medical or scientific communities. They’re merely hoping to provide plausible deniability so their gullible followers will continue to pay them for risking their babies’ lives.

Wendy Gordon and the other MANA executives should be embarrassed at their profoundly unethical behavior, but, apparently, nothing embarrasses them. They are stooges, attempting to preserve their income in any way they can, dead babies be damned.

You have to give MANA (the Midwives Alliance of North America) credit. Their motto appears to be: if at first you don’t succeed, lie, lie, again.

Clearly MANA is very worried in the wake of publication of the Grunebaum study that shows that homebirth increases the risk of a 5 minute Apgar score of 0 by nearly 1000%. Therefore, they’ve sent Wendy Gordon, CPM (and placenta encapsulation specialist!) to do what she can to discredit it.

No matter that it comports with the data from Oregon that shows that PLANNED homebirth with a LICENSED homebirth midwife has a death rate 9X higher than comparable risk hospital birth or that MANA has found that its own members have such hideous death rates that they have been desperately hiding them for years.

This is not about the truth, obviously. This is about tricking American women into ignoring horrific homebirth death rates, so any research that demonstrates the danger of homebirth must be discredited.

Wendy’s first attempt didn’t go so well. She was caught (by me) in a bald faced lie. MANA did not attempt to deny it, but, as it typical for them, they didn’t correct it, either. Apparently the entire attempt was not as successful as MANA would have liked. How can I tell? Within less than 24 hours, MANA felt the need to censor comments since the comments raised questions that MANA could not or would not answer.

Wendy’s second attempt, on the Lamaze blog Science and Sensibiity, tries to avoid the pitfalls of the first attempt. Instead of including the bald faced lie about the accuracy of Apgars on birth certificates, she simply linked to it.

She’s also made the smear considerably more vague, starting with the title itself, Flaws In Recent Home Birth Research May Mislead Parents, Providers. A more accurate title might be We hope that vague, unsubstantiated “flaws” that we’ve made up might be used to mislead others about the real dangers of homebirth.

The Grunebaum paper is well done and extremely difficult to undermine. There is simply no question that the data shows that homebirth raises the risk of a 5 minute Apgar score of 0 by nearly 1000%. The authors’ decision to use the 5 minute Apgar score of zero is truly inspired. Other research shows that homebirth has an appalling rate of intrapartum death, and not just any intrapartum death, but totally unexpected (“the heart rate was normal right up until the baby was born”) death. This is almost certainly due to failure to monitor babies appropriately during labor. The decision to use the 5 minute Apgar score of 0 means that we are looking at severe intrapartum compromise, almost certainly resulting in death.

Though the lay press has reported the results as an increased rate of stillbirth, and though the findings almost certainly do reflect an increased rate of stillbirth, the key point is that they reflect INTRAPARTUM stillbirth, not stillbirth before labor begins. How do we know that? Babies who die before labor begins don’t get birth certificates and they certainly don’t have 5 minute Apgar scores assigned, because Apgars are given only to babies believed to be alive prior to the moment of birth.

But rather than acknowledging that the decision to use the 5 minute Apgar score of 0 is one of the primary VIRTUES of the study, Gordon insinuates that it is a flaw.

When we examine a little more closely what it means to have a 5-minute Apgar score of zero, we might find that it does include some babies who died shortly after birth. We might also find a number of babies who had lethal congenital anomalies, who would not have survived no matter where they were born or who attended the birth; there may be important differences between home and hospital populations with regard to whether these anomalies were detected prenatally and whether parents changed their birth plans because of it.

The babies might have had anomalies! Duh! Of course they “might” have had anomalies. That doesn’t mean those anomalies were incompatible with life if the babies had access to lifesaving technology.

There may be important differences between home and hospital populations regarding anomalies! But there is NO EVIDENCE that there are important differences, so attempting to dismiss the findings on that basis has a whiff of desperation about it.

Wendy claims:

A rigorous study that actually examined deaths would have excluded births with outcomes that had nothing to do with place of birth or attendant.

No, rigor does NOT require excluding births with outcomes that have nothing to do with place of birth or attendant (“the baby would have died in the hospital, too”). Why? Because we are looking at the DIFFERENCE between outcomes BASED ON place of birth and attendant. If we subtracted all the deaths that “would have happened in the hospital, too,” the DIFFERENCE between home and hospital could be EVEN GREATER than if we didn’t subtract outcomes that were independent of place of birth or attendant, because the hospital death rate would be ZERO, since all the deaths in the hospital group “would have happened in the hospital, too.”

Either Wendy is hoping that homebirth advocates have poor basic logic skills or she herself has poor basic logic skills.

Here’s another whopper:

On the other hand, even a small percentage of misclassified outcomes in the home birth category have a dramatic impact. Because the number of home births in the U.S. is small, the inclusion of prenatal stillbirths, congenital anomalies and unplanned, unattended home births in the “home midwife” category is likely to have an appreciable effect on the negative outcomes examined here.

Is there any evidence that ANY of the 5 minute Apgars of 0 at homebirth were not 0? Is there any evidence that homebirth midwives signed birth certificates of patients who had unplanned homebirths? No, of course not. There’s isn’t a shred of evidence that even one midwife is accidentally recording that the baby she delivered had a 5 minute Apgar of 0 when it did not. Claims like these positively reek of desperation.

And yet another whopper:

I wrote my initial reaction to Grunebaum et al’s study last week when their press release came out. I expressed concerns about the low reliability and validity of birth certificates for drawing conclusions about rare outcomes. Grunebaum’s own data shows that over 10% of “home midwife” deliveries had no information on the birth certificate about the mother’s parity and had to be excluded from their calculations, while only 0.2-0.5% of hospital or birth center deliveries were missing parity data; this strongly suggests that something is amiss with the “home midwife” data.

No, Wendy didn’t express her concerns, she LIED about the reliability of Apgars scores on birth certificates, and supplemented that lie with a deliberate misrepresentation of a paper on birth certificate reliability that shows THE OPPOSITE of what she claimed it showed. Her misrepresentations were publicly pointed out in the comment section and she NEVER DENIED them.

Wendy is so desperate to smear the paper that she cheerfully smears homebirth midwives along with it. They are such slobs that they didn’t include parity on the birth certificate. I don’t doubt that midwives are sloppy in their record keeping, but that doesn’t mean that they sloppily wrote that the 5 minute Apgar score of the baby they just delivered was 0.

Wendy can’t resist logical fallacies, either. She trots out a loaded question just like the classic “have you stopped beating your wife?”, a “question” based on a foregone conclusion that may be completely false.

The fact that these authors were clearly warned about the low quality of their data regarding both low Apgar scores — and especially seizures — but chose to push ahead with publication without addressing them, suggests other motivations.

The authors were never warned about the low quality of their data since their data is high quality. To the extent that they were warned about anything, they were warned that homebirth advocates were fully prepared to LIE about the quality of the study’s data. True to the warning, Wendy is lying about it now.

Give it up, already, Wendy. At this point, you are just destroying your own reputation and that of MANA. The Grunebaum paper is a high quality paper that presents accurate data on an excellent metric (the 5 minute Apgar score of zero). It comports with the CDC data, the Oregon data, and the fact that MANA has refused for years to release their own death rates.

Homebirth kills babies who didn’t have to die. I know it, you know it and MANA knows it. Your desperate attempts to hide the truth from American women don’t smear the papers you criticize; they smear the organization that you represent.

Aloha from Hawaii! Above is the view from the pool where I am writing this post.

I’m here for the ACOG district conference and I’ve been reviewing my notes for my talk on Friday. I’m struck by the fact that everything I plan to talk about — homebirth and, to a lesser extent, natural childbirth — is premised on a fundamental and erroneous belief, that there is a problem that exists with childbirth and that homebirth and natural childbirth can fix it.

The problem is that childbirth has been (dare I say it) …. medicalized. Oh, the horror!!

It’s horrible because … wait a second … what’s horrible about medicalizing childbirth?

The underlying belief of natural childbirth advocates is that childbirth has some kind of pristine essence that should not be changed in any way except, possibly, in the most dire emergency. The major efforts of professional homebirth and natural childbirth advocates are forcefully directed toward “problematizing” any medicalization of childbirth and then offering homebirth and natural childbirth as the solution to this “problem.”

But childbirth is a function just like any other bodily function and we don’t consider medicalizing other bodily functions to be a problem, so why should medicalizing childbirth be considered a problem?

For example:

Women routinely and deliberately medicalize fertility by using a variety of different forms of birth control. Most women highly value the ability to regulate their own fertility and very few people are singing the praises of having 10 children as a result of “unhindered” fertility.

Both men and women routinely medicalize aging. Instead of letting their blood pressure rise “unhindered” and end up with cardiovascular disease, they routinely visit doctors and take medications to lower the nearly inevitable high blood pressure that comes with the natural stiffening of aging arteries. And no one seems to have a problem “medicalizing” eyesight by using glasses to compensate for the entirely natural deterioration of near vision that occurs as a result of aging.

Or how about something even more basic still? We routinely medicalize body odor by regular bathing, using soap, shampoo and even deodorant. No one seems to think that is a problem. either.

In fact, I’m hard pressed to think of anybody complaining about “medicalization” of any other bodily function, so why complain about medicalizing childbirth?

Why? Because homebirth and natural childbirth completely depend on creating this faux “problem” in order to save us from it. They are committed to romanticizing childbirth, ignoring history, and ignoring science, all the while pretending that they are promoting “evidence based” practice.

Nothing could be further from the truth. Natural childbirth is based on no evidence of any kind. The white men who promulgated it simply made it up to comport with their personal views about the role of women in the world (specifically that the world would be a better place if women stopped agitating for political and economic rights, and, instead, stayed home and had babies as “nature intended”).

Indeed, homebirth and natural childbirth advocates implicitly recognize that scientific evidence is not on their side by routinely deleting comments that contain real scientific evidence and banning commentors whose knowledge of science extends beyond the “alternate world of internal legitimacy” created by the “journals,” conferences and “credentials” conjured into existence by themselves.

Nature is neither benign nor perfect. We seem to be able to recognize that in every other area of human health. No one complains that middle aged people who use reading glasses are “medicalizing” the vision experience. We don’t problematize reading glasses. No one complains that the elderly medicalize the cardiovascular experience by taking steps to control their blood pressure. We don’t problematize blood pressure medications. And no one is complaining that we have medicalized the body odor experience by bathing regularly with soap and shampoo.

So the next time you encounter homebirth and natural childbirth advocates fretting about medicalized childbirth, consider that there appears to be nothing wrong with medicalizing any other bodily process. The faux “problem” of medicalized childbirth isn’t a problem at all; it is simply the way that homebirth and natural childbirth advocates justify their existence.

And consider, too, that when you recognize that there is nothing wrong with medicalizing childbirth, there is no reason to feel guilty about giving birth whatever way works best for you.

Imagine going to the doctor because you hadn’t been feeling well for several days.

Dr. Knowitall: What seems to be the problem?

You: Well, Doctor, I have a pain in my lower right side and it’s been getting worse. I’m afraid I might have appendicitis.

Dr. Knowitall: No, you don’t.

You: Pardon me. I don’t have appendicitis?

Dr. Knowitall: No, you don’t have pain in your lower right side.

You: No, really I do have pain and my pain is getting worse.

Dr. Knowitall: You just think you have pain because you’ve been culturally conditioned by surgeons to expect that you will develop appendicitis.

You: But, Doctor, my pain is so bad that I can’t lie flat on your exam table.

Dr. Knowitall: Sigh. Obviously the pain is your fault. You must be walking wrong.

You: Look, you can see me walk. I’m not walking wrong; I’m walking just like everyone else, but I have pain in my lower right side, and I’m constantly nauseated.

Dr. Knowitall: If you just trusted your body, you wouldn’t be nauseated. Appendicitis is extremely rare, so you don’t have pain or nausea.

You: But I’m vomiting, too.

Dr. Knowitall: Please, it’s obvious that you are selfishly looking for an excuse to have surgery. If you were educated like I am, you would understand that it is absolutely critical for you to avoid surgery under any but the most extreme circumstances. Do you have any idea of the risks of surgery? You could end up brain damaged, with allergies and autism.

*****

Sounds ridiculous, right? Who would continue to consult a doctor who refused to believe you when you described your symptoms, or, worse yet, blamed you for your own pain? Most people would be outraged.

Yet lactivists feel no compunction about behaving like know-it-alls and doing the exact same thing. Tell them you have pain when nursing and they “know” that you don’t. Insist that you have pain and they’ll insist that you are breastfeeding your baby all wrong.

Tell them that your baby is screaming with hunger and they’ll tell you that it’s normal. They “know” you’ve been culturally conditioned to believe that you aren’t making enough milk.

Tell them that your baby has gained no weight in the 4 weeks since birth and they “know” that you are lazy and looking for an excuse to stop breastfeeding. Just pump in between feedings to increase your milk supply.

Tell them that you can’t pump enough to nourish your baby while you work and they’ll tell you that you are depriving your baby of multiple IQ points and sentencing him to a lifetime of allergies, obesity, diabetes and cancer.

No one would tolerate a doctor who refused to accept the patient’s description of her own symptoms. Why do lactivists think they are entitled to dismiss the symptoms of women having difficulty breastfeeding?

Would anyone think a doctor could diagnose and treat ANYTHING if she refused to listen or completely dismissed what patients were telling her? Why do lactivists think they can improve breastfeeding rates if they refuse to listen and completely dismiss what women are telling them?

Why? Because they don’t care about improving breastfeeding rates nearly as much as they care about hectoring mothers who don’t model their own choices back to them.

If lactivists really cared about increasing breastfeeding rates, they’d stop talking and start listening, but instead they just keep yammering away.