Ricki Lake: Please stop lying about homebirth

Following up on her film “The Business of Being Born.” self proclaimed childbirth expert, actress Ricki Lake has published a new book. Hopefully, it is more accurate than her movie, but I have my doubts, given her deceptions and misrepresentations about homebirth.

Childbirth is and has always been one of the leading causes of death of young women and babies in every time, place and culture. Finally, for the first time in human history, that has changed if you happen to be living in the right place. American obstetrics has been spectacularly successful in lowering the neonatal mortality rate 90% and the maternal mortality rate 99% in the past 100 years. In response, homebirth advocates like Ricki Lake have suddenly discovered the joys of giving birth at home.

Homebirth advocacy is supposed to be about “empowering” women to make “informed” health care decisions. How that could happen when homebirth advocacy is based almost entirely on mistruths, half truths and outright lies? Ricki Lake is out front in spreading these deceptions and she ought to stop. In a recent piece on the Huffington Post (Docs: Pay No Attention to Ricki Lake’s Homebirth), Lake claimed:

“In fact, the largest and most rigorous study of home birth internationally to date found that among 5,000 healthy, ‘low-risk’ women, babies were born just as safely at home under a midwife’s care as in the hospital.”

That’s flat out false. All the existing scientific evidence shows that homebirth increases the risk of neonatal death. Sure, there are papers that claim that homebirth is a safe as hospital birth, but they do so by comparing homebirth to high risk hospital birth (instead of low risk hospital birth) or by comparing homebirth in one year to hospital birth decades before (as in the Johnson and Daviss BMJ 2005 study that Lake mentions).

Johnson and Daviss claimed to show that homebirth with a CPM in 2000 was as safe as hospital birth, but they compared it to hospital birth in a bunch of out of date studies extending back to 1969. Johnson and Daviss simply left out the fact that homebirth in 2000 had almost triple the neonatal mortality as moderate risk hospital birth in 2000.

In an interview on the Today Show, Lake declared:

“The fact that we have the second-worst infant mortality rate in the developed world is a statistic that I think people need to know about”

However, infant mortality is not the correct statistic to evaluate obstetric care since it includes deaths up to one year. According to the World Health Organization, the correct statistic to evaluate obstetric care is perinatal mortality, death from 28 weeks of pregnancy to 28 days of life. The World Health Organization 2006 report on perinatal mortality shows that the US has one of the lowest rates in the world, lower than Denmark, the UK and the Netherlands.

Lake continued:

“Home births and midwives are more common in Japan and Europe than in the United States …”

What Lake neglects to mention is that American homebirth midwives belong to a second, inferior class of midwives with less education and training than ANY midwives in the industrialized world. American CNMs and European midwives deservedly have excellent reputations. They have rigorous educational requirements and extensive hospital based training in the diagnosis and management of childbirth complications.

Homebirth midwives (direct entry midwives including CPMs) try to trade on the reputation of other midwives. However, homebirth midwives have grossly deficient education requirements (they can obtain their education by correspondence course) and grossly deficient training, lacking any training in the diagnosis and management of complications. American women need to understand that American homebirth midwives cannot meet the requirements to be licensed in ANY first world country.

Lake also neglects to mention that American homebirth midwives are currently hiding their safety statistics from the public. The Midwives Alliance of North America (MANA) the trade union for direct entry midwives has been collecting extensive statistics on the safety of homebirth since 2001. Those statistics have been publicly offered to anyone who can prove they will use them for the “advancement of midwifery”. Even then you must sign a legal non-disclosure agreement preventing you from revealing any data to anyone else. It does not take a rocket scientist to suspect that MANA is suppressing its OWN data because it shows that homebirth with a direct entry midwife increases the risk of neonatal death, and possibly the risk of brain damage as well.

In order for women to make an informed decision about homebirth, they need to know the truth about homebirth. And the truth is that all the existing scientific evidence to date shows that homebirth increases the risk of neonatal death, that American homebirth midwives cannot meet the licensing requirement for any country in the industrialized world, and that the homebirth midwives trade union is hiding 7 years of their own data on the safety of homebirth.

Ricki Lake should stop spreading misinformation about homebirth, should stop claiming that homebirth is as safe as hospital birth, and should use her influence to demand that homebirth midwives release the safety data that they are hiding.