Kudos to the more than 400 people who have signed the online petition demanding that the Midwives Alliance of North America (MANA) release the death rates for the 27,000+ homebirths in their database. It has been swiftly and remarkably successful.
I created the petition on October 1.
On October 4 MANA began censoring comments on their blog after refusing to reveal the death rates.
Also on October 4th, after learning that both Melissa Cheyney CPM and Wendy Gordon CPM (and placenta encapsulation specialist!) were feeling pressured by my “attacks,” I offered this challenge:
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.
On October 24, ahead of the MANA13 national conference taking place this weekend, Cheyney felt compelled to spew more BS in an effort to justify the fact that MANA has been hiding their death rates for nearly 5 years.
They say that when you can’t dazzle them with brilliance you can always baffle them with bullshit and apparently that’s Cheyney’s motto, too. Cheyney employs a lot of words to tell us nothing. Well, not exactly nothing. She can’t resist yet another whopper.
Cheyney claims that the MANA statistics cannot be released without the approval of an IRB (institutional review board).
The code of federal regulations # 21 part 56 requires it, and researchers cannot submit findings for publication unless they have gone through appropriate procedures to access data. You must have IRB clearance before you analyze data for publication.
First, MANA itself has published almost all the data from the database EXCEPT the death rates.
Second, while IRB approval could be required for publications based on the data, IRB approval is not required to read and review the data.
Finally, Federal regulations #21 part 56 concerns studies leading to FDA approval of drugs or devices and has nothing to do with the MANA data.
Cheyney also has this revelation for us:
I’m excited to report that a group of researchers and I have two papers on the MANA Stats 2.0 dataset coming out in the Jan/Feb 2014 issue of the Journal of Midwifery and Women’s Health…
M: This article looks at the demographics of the MANA Stats data set 2004-2009, including the intended place of birth and the type of midwife in attendance …
It also looks at standard maternal-child health outcomes and home birth indicators, like transfer rates, i.e. intrapartum transfer, neonatal transfer, maternal postpartum transfer, and it looks at reasons for those transfers. It also examines cesarean section rates and spontaneous vaginal birth rates. It also examines intrapartum, early neonatal, and late neonatal mortality. Finally, it explores rates and type of tearing, hemorrhage, and NICU admissions.
That’s funny. As recently as September 29, Wendy Gordon claimed that there were no articles in press, and now there are suddenly two that will be published in less than two months?
So nearly 5 years after the data was analyzed, MANA has decided to publish it. Johnson and Daviss took 5 years to figure out how to spin the CPM death rate in the 2005 BMJ homebirth study. They finally decided to compare homebirth in 2000 to hospital birth in a bunch of out of date papers extending back to 1969. That’s how they concealed the fact that homebirth had a death rate nearly triple that of low risk hospital birth in the same year.
I expect a similar attempts from Cheyney at burying the deaths of homebirth babies. She should report how many homebirth babies died compared to how many homebirths were intended. What might she do instead?
Here are just a few possibilities:
Compare homebirth to high risk hospital birth including premature babies
Exclude breech, twins, VBAC and postdates from the homebirth deaths as “high risk” even though Cheyney has spent years trying to convince the state of Oregon that they’re not
Follow the lead of Colorado homebirth midwives are report the result in an incomprehensible way like deaths per midwife
Take a page from Oregon homebirth midwives and obfuscate the data by adding in all prenatal stillbirths thereby dramatically diminishing the impact of homebirth deaths.
I’m sure that Cheyney will do something to hide the hideous death rate at CPM attended homebirth. I’m so sure, in fact, that if I’m wrong, I will publicly apologize to Cheyney and donate $100 to the MANA stats project.
It’s a win-win for me. If I’m wrong, and Cheyney publishes the number of homebirth deaths compared to the total number of attempted homebirths, I’ll finally have access to the data. If I’m right, I’ll save $100 and I’ll be able to say that you heard it here first that MANA would try to hide the many homebirth deaths at the hands of their members.
No matter what, though, we’ve already shown the power of a public petition. In less than one month, MANA has already been forced to release data to counteract the charge that they’ve been hiding their death rates for nearly 5 years. It’s a small, but real victory.
If you haven’t signed the online petition yet, please do so. We can’t let up the pressure on MANA to release the data that will allow women to make an informed decision about homebirth.
“Johnson and Daviss took 5 years to figure out how to spin the CPM death rate in the 2005 BMJ homebirth study.”
Creativity is everywhere! Must be all those magical vaginas, as you quoted, Dr. Amy. Why use stats from 1969? What about 1949?
I am at work today. A coworker told me she wanted a homebirth midwife until she found out about the atrocious outcomes and lack of any real skill and accountability. She said ” MANA won’t even release their death rates!”
The message is beginning to get through!
My niece (who is a decade away from childbearing at least) happened to mention to me that one day, she wants a homebirth in the water. I asked her please not to do that because babies have died. She said, “Oh. Never mind, then.”
See? My teenage niece gets it. It really shouldn’t be this hard.
Did you ask her if she read here? I bet you anything she does.
I was going to but it was part of a larger conversation about our pregnancy losses. I might ask next time we chat!
Gee, i wonder who has a lower infant/newborn mortality rate, planned repeat c/sec or hbac?
“There’s no place to give birth that will have a mortality rate of zero.”
Wait … but I thought birth was a normal physiological process? How can it be safe but not carry a mortality rate of zero-or-very-close? I mean. I blink lots all day every day. That’s a normal physiological process. Far as I know, it has a mortality rate of zero. Wait, can someone check that? Has anyone ever died from blinking?
Eating is a natural physiological process, but people choke to death.
Sure. But I wouldn’t go to a hospital to eat just for the choking factor. So maybe they have a point! Some people are meant to choke to death! There is no place where you will eat that has a mortality rate of zero!
Birth IS a normal physiological process. Just like hunting bears with rocks and sticks. Or being hunted by bears, you know. It’s all part of nature.
You can check out the VT data, which is UG-LEE. VT, like OR, required MANAstat collection for the state.
https://leg2.vermont.gov/sites/legislature/Committees/HCommittees/HealthCare/Witness%20Handouts/Act%2035%20Testimony,%202012%20data%20Midwifery%20Services%20and%20Home%20Births.pdf
I would really like to know what the ‘congenital anomalies’ were, for the “1 intrapartum death”. Congenital anomalies are really fairly uncommon. 1 intrapartum death in only 110 births, btw, for whatever reason, is high, IMO, but the sample is very small [assuming, of course, that there really were only that number of homebirths in VT during that year. Since statistical reporting to MANA is voluntary, who knows?
Not impressed, Ms. Cheyney. This dodging and manipulation is why I lost faith in the natural childbirth community as a self policing entity dedicated to providing safe and ethical care.
Ok, let’s vote on the method they’ll use. Here’s my idea: they will exclude their breech, twins and VBAC outcomes and then they will compare their remaining births to hospital stats that have breech, twins and VBAC excluded but that have NOT excluded other important risk factors that are found almost exclusively in hospital-birthing populations e.g. pre-term, non-white race, low-income, pre-eclampsia, chronic health conditions of mother, known deformity of fetus.
So basically a combo of Dr. Amy’s #1 and #2
I figure they’ll remove the congenital anomalies from the OOH group but not the hospital group, a la Johnson and Daviss.
They may do that, but that alone won’t be enough. Or at least it wasn’t enough in Oregon.
Off-topic but hilarious: Parachute use to prevent death and major trauma related to gravitational challenge: systematic review of randomised controlled trials
Conclusions As with many interventions intended to prevent ill health, the effectiveness of parachutes has not been subjected to rigorous evaluation by using randomised controlled trials. Advocates of evidence based medicine have criticised the adoption of interventions evaluated by using only observational data. We think that everyone might benefit if the most radical protagonists of evidence based medicine organised and participated in a double blind, randomised, placebo controlled, crossover trial of the parachute.
Ah, the Christmas edition of the BMJ, almost worth the membership fee by itself.
The sad thing is that’s not all that off-topic for this blog.
Here’s what I don’t get – why not have the data publicly available with an extensive documentation about what it includes or doesn’t include?? Let the data be free – keeping data hostage serves nobody, not even MANA (to the extent that withholding it “dirties their hands” with respect to the harm that occurs and might have been prevented).
I would love to get my hands on their raw data.
I guess they forgot that they bragged about the Cs rate already……
I am sure their data is crap. It is voluntary, and MWs are encouraged to send data in only on the good cases.
Can’t wait to see the newest lies.
And bragging about a CS rate is not something any organization should do – it just doesn’t mean anything without knowing about morbidity and mortality….
Or the composition of the population you are dealing with.
Cheyney’s argument is that, because death is such a rare event compared to c-section, you need a far larger dataset to get anything meaningful about the former. Which is true, except that Wendy Gordon bragged about the c-section rates just this July–presumably based on the same data Cheyney was using to write her upcoming papers. There was no reason they couldn’t have released the mortality rates at the same time.
Hang on — re the VT data: if there were 4 attempted HBACs, and one wound up as a C/S in hospital, then the C/S rate is a whopping 25%!
Actually, isn’t 25% C/S reasonable to low for attempted VBAC? Especially if you haven’t specifically screened out women whose reasons for needing a c-section the first time are very unlikely to recur?
The point i was trying to make is that homebirth midwives typically claim extremely low C/S rates, even lower than the “WHO rate” of 15% which is a joke anyway.
NO ONE who has had a previous C/S should be delivering, or attempting to deliver, at home anyway, no matter what the reason for the primary C/S was.
If they don’t hide the results with statistical sleight-of-hand, but simply lie outright, do you keep or lose the $100?
I wondered that. There is no doubt that the statistics she has in hand are going to be horrifying, but I am also certain that there are even MORE deaths that were never even reported, as there is little to no oversight or accountability.
I’m not too worried about losing the money. If the death rate had been remotely acceptable, it would have been reveal nearly 5 years ago. It has taken Cheyney the intervening years to figure out how to hide the terrible reality.
Of course she could simply lie outright, but I could call her on that since I have some idea of what the data actually show. I suspect she will try some sort of sleight of hand.
Cheyney may be tipping her hand with this:
We’ve seen this claim and the call for “more nuanced” discussion before. It seems as if they’ve been trying to pave the way for less-than-stellar stats by trying to reframe the debate to say that safety isn’t the only issue–a strawman, if ever there was one.
I’d hazard a guess that the second paper Cheyney submitted to the journal is a discussion that tried to do exactly that kind of reframing.
“there’s no place to give birth that will have a mortality rate of zero.”
Nirvana Fallacy: Insisting that only perfection is acceptable.
http://tvtropes.org/pmwiki/pmwiki.php/Main/PerfectSolutionFallacy
If you look at the questions she lays out in the next few paragraphs as examples of what you should look for in the MANA data, it is OBVIOUS that she is laying the groundwork for, “Yes, yes, there is higher neonatal mortaility, but that’s not the important question!”
” There’s no perfect place to give birth, and there’s no place to give birth that will have a mortality rate of zero.”
Wait … but I thought birth was a normal physiological process? How can it be safe but not carry a mortality rate of zero-or-very-close? I mean. I blink lots all day every day. That’s a normal physiological process. Far as I know, it has a mortality rate of zero. Wait, can someone check that? Has anyone ever died from blinking?
I thought birth was as safe as life gets! Guess not.
Here’s the comment I submitted:
OT Crazy HB mother alert. I would love to hear the story behind this news article: http://blogs.seattletimes.com/today/2013/10/amber-alert-issued-for-missing-mill-creek-newborn/
This alert showed up on my Facebook newsfeed (I have “liked” a news station from the area) and the comment thread was astounding. 90% of the people were wondering why we should be concerned since the one day old infant with difficulty breathing was with her mother. I was a little taken aback by the total distrust of the medical system/police and total reliance that “mom knows best” is applicable in this situation. By the way, it was the midwife who called 911 because the baby was in distress, but the mom cancelled it and said she would take the baby in herself.
The young woman has been arrested a few times and has struggled with substance abuse (and some of her arrests had to do with drugs). So yeah, I can see that she wouldn’t want to have the baby going to a hospital and wouldn’t want to be treated by medical professionals herself, since she might have been afraid her baby would be taken away from her. It’s just interesting that everyone jumped on the “mama knows best” bandwagon without thinking about what a mother who might have a newborn struggling with withdrawal and what that means for the newborn. Who could ever sympathize with a woman whose newborn baby was having trouble breathing and the mom not wanting the baby to be checked out NOW.
Okay, if I said I was driving my child to the hospital, and then we disappeared, I’d WANT people to be looking for us! What if we were in a ditch somewhere? Hasn’t that occurred to those commenters?
But yeah, it sounds like she decided to take the baby and run rather than seek urgently needed medical care.
Hell, Cheyney was boasting about things like c-section rates from the data on Twitter back in July. Guess she didn’t need IRB approval for that.
Strangely, there are no comments on the post.
Liar! There is TOO a comment:
“Thank you for this informative interview and the background on the
research. I so look forward to the research studies that are in line
for publication!”
Well, yes. This is exactly the kind of robust discussion they want.
These women seem like idiots. I love their nonsensical statistics gabble in which they try to justify why they won’t release the numbers.
Just release the numbers.
How does MANA expect to be taken seriously if this is what they discuss at their annual meeting?
Oh, the jokes I could have with that tweet. It does remind me of one, though. I promise it’s not too bad. A man showed up at a flower show for exotic cross-breeds. The most creative hybrid would win. He had a red rose bush and the person taking the entries looked at it rather doubtfully, saying that it didn’t look different to any other common red rose.
“Oh,” the botanist said, “This isn’t an ordinary rose. This rose has the scent of a vagina!”
“All right,” said the official. “You may enter it, but I doubt you’ll win. However, if you could invent a vagina that smells like a rose, you’d be a billionaire!”
If that offends anybody, I apologize in advance. I’d love to say it into the open mic at the MANA convention, though.
I laughed. But I hate the smell of roses.
Not offended, mildly amused.
Well, that did it. I’m actually speechless
“Second, while IRB approval could be required for publications based on the data, IRB is required to read and review the data.”
Confused by this part, is it meant to read “IRB is NOT required to read and review the data.”?
Sorry. Fixed it.
Great! I can’t wait to see the numbers (and how they spin them) when they come out. One typo: “hiding their death rates for nearly 5 year.”