Melissa Cheyney, homebirth, and the GM defense

secret documents

There is a chilling story on the front page of The New York Times this morning, General Motors Misled Grieving Famiies on the Lethal Flaw:

It was nearly five years ago that any doubts were laid to rest among engineers at General Motors about a dangerous and faulty ignition switch. At a meeting on May 15, 2009, they learned that data in the black boxes of Chevrolet Cobalts confirmed a potentially fatal defect existed in hundreds of thousands of cars.

But in the months and years that followed, as a trove of internal documents and studies mounted, G.M. told the families of accident victims and other customers that it did not have enough evidence of any defect in their cars, interviews, letters and legal documents show. Last month, G.M. recalled 1.6 million Cobalts and other small cars, saying that if the switch was bumped or weighed down it could shut off the engine’s power and disable air bags.

In other words, GM absolved themselves of all responsibility for the deaths that occurred as a result of their mistake, even though they knew all along that people were dying as a direct result of the flaw.

The exact same thing is happening in the world of homebirth. Melissa Cheyney and co-authors have a commentary in this month’s issue of Birth: Issues in Perinatal Care, the “journal” published by Lamaze International. I use the term journal in quotes because a real medical journal publishes everything on a topic. Birth is nothing more than an industry mouthpiece; editors have acknowledged that they will not publish papers and reviews that don’t comport with their philosophy.

Cheyney’s piece, A Crusade Against Home Birth, is delightfully and deliberately misleading. Or it would be delightful if babies weren’t dying as a result.

The executives as GM could take lessons in obfuscation, misdirection, and outright lying from Cheyney and her fellow executives at the Midwives Alliance of North America (MANA) the trade and lobbying organization that represents non-nurse midwives (CPMs, LMs, and DEMs, laypeople who awarded themselves the designation “midwife” despite being unqualified to work as a midwife in any other industrialized country).

Cheyney and the folks at MANA are worried. Their little empire (and source of 100% of their income) is threatened by a large and growing body of evidence that homebirth at the hands of a non-nurse midwife has a hideous perinatal death rate. Indeed, their own statistics showed that homebirth with a CPM has a mortality rate 450% higher than comparable risk hospital birth, a fact that they unsuccessfully tried to lie about in another paper that Cheyney wrote.

Cheyney’s commentary is ostensibly about the Grunebaum paper that showed that homebirth increases the risk of a 5 minute Apgar score of 0 by nearly 1000%. The obfuscation starts with Cheyney’s title, A Crusade Against Home Birth. I have to give her credit for encapsulating in a so words the self-pity, conspiracy theories and mendacity that are at the heart of homebirth midwifery.

Instead of responding to a scientific article with a scientific analysis, Cheyney signals from the get-go that she will be using a tactic perfected by the tobacco industry. SourceWatch describes the tobacco industry’s attempt to reframe the debate:

The “reframe the debate” strategy consists of moving the topic of a contentious dispute onto a wholly different topic. This involves making dire predictions of a more extreme outcome, portraying the original action as dangerous, tying activists to the dangerous outcome, linking the originally-proposed action to a fear-inducing outcome …

As the Tobacco Institute explained to its members:

Our judgement, confirmed by research, was that the battle could not be waged successfully over the health issue. It was imperative, in our judgement, to shift the battleground from health to a field more distant and less volatile …

Grunebaum wrote an excellent paper demonstrating that homebirth dramatically increases the risk of a baby being born without any sign of life, and Cheyney almost certainly knows that the paper is true. Therefore, she has reframed the debate to switch attention from the scientific evidence (where Cheyney has less than nothing to stand on) to the dire prediction of an extreme outcome, portraying the paper as part of a conspiracy to deprive women of autonomy. The title is the equivalent of: “Don’t look at the growing numbers of dead infants; look over there where evil men are trying to take away your freedom.”

It is repeated within the text of Cheyney’s piece:

This article was not published in isolation, but is part of a larger effort by senior author Dr. Frank Chevernak from Cornell University, who has published at least six other articles critical of home birth in the past 2 years in major obstetrics, pediatrics, and ethics journals (19– 24). A recent article published in Pediatrics is typical of Dr. Chevernak’s work. In it, he claims to discuss the ethics of home birth, but his discussion runs counter to contemporary democratic principles of free choice and autonomy for the expectant mother, and to women’s control over their own bodies…

It’s a conspiracy to deprive women of their freedom!

That’s the exact strategy from the tobacco playbook, and every bit as unethical.

But even Cheyney knows that she has to address the actual scientific paper, so she copies the same strategy that appears to have guided GM: lie, deny, cover up.

Here’s what GM did:

… [B]y the time Benjamin Hair, 20, crashed into a tree in Charlottesville, Va., on Dec. 13, 2009, while driving a Pontiac G5 home, G.M. had conducted five internal studies about the ignition problem, its records indicate. Though Mr. Hair used his seatbelt, he died after the car’s air bags failed to deploy. His parents were baffled. “The police couldn’t tell us what caused the accident,” said Brenda Hair, his mother. The Hairs contacted G.M., providing accident reports but no vehicle data, because the car’s black box had been destroyed. “They came back and said they’d presented it to their board of engineers, and they couldn’t say it was related” to a defect, Ms. Hair said.

It is difficult to comprehend that anguish of losing a child in an accident. How much greater will that anguish be now that Hair’s parents have learned that GM knew all along that their cars had a fatal defect, hid that defect from consumers, failed to repair the defect, and then lied about it when presented with evidence?

Here’s what Cheyney and MANA have done:

1. First, they hid the death rate of homebirth for 5 years.

2. Then when they finally published the death rate, they refused to compare it to the appropriate comparison group (low risk women who gave birth in the hospital in the same years), and instead compared their data to studies from other countries.

3. Although Cheyney and MANA have known all along that their death rates are hideous (hence the decision to hide them for 5 years), they simply lied in their own paper to claim that their data showed homebirth to be safe when their own data shows homebirth to be dangerous.

In other words:

GM hid the existence of the faulty ignition for 5 years
MANA hid the existence of dramatically higher perinatal death rate at homebirth for 5 years.

In the wake of accidents involving the faulty ignition, GM claimed to grieving families that there was no safety problem
in the wake of homebirth deaths, Cheyney and MANA have claimed to grieving parents that there is no safety problem with homebirth.

While GM’s own data showed that the ignitions were fatally flawed, they went forth and lied about the issue
when MANA’s own data showed that homebirth with a non-nurse midwife is fatally flawed, they went forth and lied about it.

In GM’s defense, they did not go as far as Cheyney and MANA. GM could have said that the claims about the faulty ignition were the work of a conspiracy on the part of Ford who only wants to take away the right to drive GM cars or maybe even ALL cars.

Cheyney and MANA appear to have no problem saying that claims of (and scientific papers about) deaths of babies at the hands of homebirth midwives is a conspiracy on the part of obstetricians to take away the right to have a homebirth, or maybe even ALL of women’s rights.

You know that Melissa Cheyney and MANA have gone to a bad place when a major corporation that allegedly hid a preventable cause of death from the public, looks better than professional homebirth advocates.

The analogy is inescapable:

Cheyney and MANA are no different from any organization that tries to hide safety defects from the American public for no better reason than to preserve market share.

78 Responses to “Melissa Cheyney, homebirth, and the GM defense”

  1. Karen in SC
    April 1, 2014 at 4:18 pm #

    In the news today: “General Motors came under harsh criticism on Capitol Hill Tuesday as CEO Mary Barra went before members of Congress investigating a botched GM recall. Barra, appearing before a House committee, apologized for the 13 deaths that GM says were caused by a faulty ignition switch, as well as GM’s 10-year delay in issuing a recall. That February recall has grown to 2.6 million vehicles worldwide.”

    Barra, appearing before Congress, for thirteen deaths THIRTEEN deaths over a decade.

    Remind me again how many babies died in the five years covered by the MANA study? How many in the 2013 end of year wrap up?


    I am outraged. #notburiedtwice

  2. SNM1
    March 27, 2014 at 1:45 am #

    “large and growing body of evidence that homebirth at the hands of a non-nurse midwife has a hideous perinatal death rate.”
    I did not read the entire MANA “study” as I was very busy with school but I wasn’t under the impression that they distinguished between CNM and CPM attended home births in the study and I have actually wondered what the differences are between the two groups as we know birth center and hospital based CNMs have very good outcomes overall. I am curious whether or not this safety rate would also be seen in homebirths… I would like to see the statistics between the different midwives laid out in this instance because I am one who is not of the opinion that a midwife is a midwife is a midwife regardless of the initials after her name… I have worked damn hard for the initials that I will have and will have very stringent requirements to maintain those credentials.

    • Ash
      March 27, 2014 at 10:54 am #
      Page 20
      Number of deliveries by CNMs vs people who are not CNMs

      • Young CC Prof
        March 27, 2014 at 11:23 am #

        But that study did not examine outcomes for CNMs separately. In fact, the numbers in the MANA study are probably too small to permit that, unless the CNM vs non CNM difference is truly marked. 5,000 CNM births, 12,000 non-CNM births.

        • Ash
          March 27, 2014 at 11:29 am #

          Indeed! But it certainly does show that the majority of homebirths in that studies are by CPMs.

          • SNM1
            March 27, 2014 at 4:37 pm #

            Thanks! I know of two or three CNMs in my area that do home births but the majority of home births are done by CPMs. I would like to see data by region as well and comparing states where CPMs are legal versus where they are not. I am very curious to see if there is a difference in states that CPMs are legal so don’t have to worry about legal ramifications of going to the hospital as well as have a clearly defined scope.

          • Young CC Prof
            March 27, 2014 at 4:39 pm #

            Try CDC Wonder. Look up out-of-hospital midwife-attended neonatal mortality rate by state, and add up all the states where they are integrated vs alegal vs illegal.

  3. Trulyunbelievable2020
    March 26, 2014 at 10:11 am #

    Fantastic post, Amy! I always appreciate when you respond to a concrete demonstration of idiocy, although I realize that it’s not always possible to find an appropriate one given the frequency of updates.

  4. fiftyfifty1
    March 26, 2014 at 8:15 am #

    Good analogy except that it misses the scale of the problem. For every 1,000 healthy moms who choose to birth at home, 1 extra baby will die (more for certain risk factors). Can you imagine the uproar if 1 out of every 1,000 Cobalt owners had had this fatal ignition problem?

    • Young CC Prof
      March 26, 2014 at 8:46 am #

      As I’ve said before, people who compare homebirth deaths to pretty much any car safety issue are missing the scale of the problem.

      The excess death rate at homebirth seems to be about 1 per thousand, like you said. That’s the same as the probability of a (viable) newborn baby dying in a car accident at ANY point in his or her entire life.

      “Well, you’re more likely to die in a car accident!”

      Nope. You’re more likely to die in a car accident than be murdered. Not more likely than killing your baby at home birth.

      • Trixie
        March 26, 2014 at 9:31 am #

        And, the risk of dying in a car accident is steadily falling, due to improvemens in vehicle safety, car seat safety, road design, drunk driving enforcement, etc. So a newborn born today probably has an even smaller risk of dying in a motor vehicle accident than 1/1000.

        • Young CC Prof
          March 26, 2014 at 10:37 am #

          There’s also the fact that, against all logic and all of human biology and history, adolescents appear to be getting less stupid, or at least less disastrously stupid.

          • Trixie
            March 26, 2014 at 11:19 am #

            Or they’re drinking less and have graduated licensing in most states….

      • The Bofa on the Sofa
        March 26, 2014 at 9:39 am #

        “Well, you’re more likely to die in a car accident!”

        I’ve mentioned before that the problem with drunk driving is not the risk, but the prevalence. US DOT stats suggest that everyone in the US drives drunk on average once a month. That means for every 30 people who never drive drunk, there is someone who drives drunk every day.

        Something like 25 billion miles driven drunk each year in the US. Assuming that the average length of a drive is 8 miles, that would be 3 billion drunken drives a year. No surprise that there are 10K drunk driving deaths.

      • Mr.G
        March 26, 2014 at 10:17 am #

        26 deaths and 1.500.000 Cobalt cars, or 1 death in 57,692 cars. In 57,592 homebirths you have 57 excess neonatal deaths (1 in 1,000), 57 times the deaths compared to driving a Cobalt.
        The average car drives 15,000 miles a year. So 1.5 Million Cobalts drove 22.5 Billion miles last year. With 26 deaths that is one death in 750 Million miles driven. And they recall the car for this low death rate but not the neonatal deaths with homebirths?

        • Trixie
          March 26, 2014 at 11:21 am #

          The CPSC banned all drop side cribs over a much lower death rate.

    • The Bofa on the Sofa
      March 26, 2014 at 9:13 am #

      But this is kind of the point.

      Consider that there IS an uproar about things like fatal ignition problems or even something like drunk driving, despite the fact that the “absolute risks” of these things are way less than childbirth. Yet, despite the (justifiable) concern over things like fatal ignition problems, drunk driving or car seats, increases in childbirth risks get blown off as insignificant on the grounds that the absolute risk is low.

      • Young CC Prof
        March 26, 2014 at 10:13 am #

        Of course, your risk of dying in a motor vehicle accident on any given day is roughly 1 in 3,000,000 (since just under 100 Americans do so every day.)

        A 1 in 1000 fatality rate PER ATTEMPT is absurdly dangerous in a world as safe as the one we live it.

        • The Bofa on the Sofa
          March 26, 2014 at 12:18 pm #

          So 1 in 3 million on a given day turns into 1 in 8 000 per year, and 1 in 275 (4/1000) over the course of 30 years.

          That means that the risk of a woman dying in a car accident during her fertile years (call it 15 – 45) is 4/1000.

          That’s the same risk as is losing one of the babies if you have 2 MANA homebirths.

          Alternatively, the risk of one MANA homebirth is the same as your risk of dying in a car accident over the course of 15 years.

  5. Dr Kitty
    March 26, 2014 at 3:32 am #

    A question for Melissa Cheyney.

    If delivery in water is associated with unique risks (umbilical cord avulsion, drowning or near drowning, hyponatraemia, aspiration pneumonia) at what rate would those risks have to occur before a prudent patient ought to be informed of them for her consent to waterbirth to be considered valid informed consent?

    • birthbuddy
      March 26, 2014 at 7:16 am #

      Waterbirth should, and arguably is, illegal.
      The mother’s right to performance art (autonomy) ends at the instant the baby is expelled alive from her body (even earlier in some states).’
      The baby instantaneously becomes a legal person with its own rights, for instance not to be forced into a contaminated pool of urine, blood and faeces. Still being connected by the cord is irrelevant in the definition.

    • attitude devant
      March 26, 2014 at 10:18 am #

      In the States, Dr. Kitty, I believe we have a ‘reasonable person’ standard for disclosure. In other words if a reasonable person would want to know something, she should be informed.

      • Dr Kitty
        March 26, 2014 at 2:17 pm #

        So…would a reasonable person want to know about the case studies currently on record?

        Or would there have to be a specific rate of these adverse event before a reasonable person would want to know?

        Does Melissa Cheyney have a particular rate in mind?

        Current understanding is that if a risk is serious enough, the rate can be very, very low.

        • attitude devant
          March 26, 2014 at 5:45 pm #

          OK, so not a lawyer, so this is a lay person speaking: there isn’t some hard number of events that makes the reasonable man standard come in to play. For something that is fairly common but trivial (“The IV might bruise your arm.”), the reasonable man wouldn’t care. For more dire outcomes, even if uncommon, the reasonable man would want to know. I suppose it all comes down to how well a talented trial attorney could convince a jury that the reasonable man would have wanted to know.

          • Dr Kitty
            March 26, 2014 at 6:03 pm #

            Agree with you.
            BUT the whole push from the NCB community seems to be that the risks are so rare that they aren’t worth noting, carry on as per usual with the water births until we have more data and can advise our clients IF the risk is shown to be high enough to worry about.

            Which, IMO is exactly the wrong way to go.

            Women will understand “we have some data that shows that in very rare cases babies have died as a direct result of waterbirth, so we no longer advise it”.

            Women will struggle to understand “we have some data that shows that in very rare cases babies have died as a direct result of waterbirth. We’re not that bothered

  6. Melissa
    March 26, 2014 at 2:42 am #

    I’m trying to imagine how scholarship must work in a world where publishing 2 papers on the same topic makes you someone who has an ax to grind. Does Cheyney thing that academics should study to learn enough about a topic to write on it, and then take up something new? Actually, that does sound like a very NCB way of thinking. Once you’ve been to Google U to learn about vaccines why follow up on the topic when you can just declare yourself an expert in something else.

    In the real world people who write one paper on a topic will tend to write many more because becoming an expert in a topic is why people publish your papers, and because the more you research the more you know. But I suppose if your knowledge is all about using your gut and Mommy instinct then actual expertise might seem silly.

    • Young CC Prof
      March 26, 2014 at 8:41 am #

      I also recall that one of the absurd antivaxxer “demands” was a wildly unethical RTC, performed by someone with proper qualifications and no previous public stance on vaccines–failing to recognize that the two qualifications are essentially contradictory.

  7. Ob in OZ
    March 26, 2014 at 1:15 am #

    She should be in jail. How does 4 deaths and knowledge that she has ignored the ban allow her to be free to kill more?

    • birthbuddy
      March 26, 2014 at 1:45 am #

      What would Hannah Dahlen and her Midwifery Colleagues have done if the SA Coroner did not push this as hard as he did? The Midwifery Council were far too weak and slow in their response to this serial killer.

  8. LMS1953
    March 25, 2014 at 8:19 pm #

    Dr Amy, would you care to revisit this critique of Dr Chervenak where you excoriated him for not accepting that maternal autonomy is the grand unification theory of all things philosophical? NO RIGHT IS ABSOLUTE. A woman cannot ethically extort several million dollars of NICU care and life-long care of a neurologically impaired offspring on the balance scale of her need for a cleansing HBAC3 of a breech baby. That is irrational lunacy that a rational society should prohibit.

    • Amy Tuteur, MD
      March 25, 2014 at 8:34 pm #

      No. I still think Dr. Chervenak is wrong. You can make a better philosophical argument against homebirth than he made.

  9. Amy M
    March 25, 2014 at 8:02 pm #

    Ugh, has this gone all sideways for anyone else?

  10. Danielle
    March 25, 2014 at 3:52 pm #

    Lamaze might, with some plausibility, discuss a “campaign” against them when referencing this blog, insofar as Dr. Amy’s online presence is entirely dedicated to the issue of home birth, and her blog is the jump off-point for internet-based activism.

    The same argument simply cannot be made to stick when mounted against Amos Grunebaum. He has now published or presented two important academic studies presenting important evidence. There is only one productive response to such research: note any limitations of the data set and try to correct for it; and find additional ways to test the veracity of the findings. The instinct should be to assume a problem is there when data points to it, and that further refinement of our understanding of the risk is necessary. You don’t get to say there’s nothing to see here, move along. Even if you think the CDC data may inflate the risks somewhat, the study is valuable. It should be starting a wider conversation, not causing everyone to rush to debunking the study.

    The way Lamaze and Cheyney are framing their opposition is ultimately self-defeating. They could be arguing for natural child birth as an option to women and discussing how women’s options can be respected within the confines of hospitals or properly equipped birth centers. They could be collaborating. Instead they’ve decided to frame the whole question as a war between doctors and women–and as in any war, “concession” is a sign of weakness, rather than a means of moving forward in a conversation.

  11. LMS1953
    March 25, 2014 at 2:04 pm #

    BTW, the black/white “fix” needs to be toggled to “white”. All the comments are black in my mobile version. The discus designer who thought that feature was at all helpful should be boiled alive in her/his own bile

    • Trixie
      March 25, 2014 at 2:09 pm #

      It’s black for me on iPhone, but white on my Android tablet.

    • March 26, 2014 at 2:26 am #

      Can it be changed? Comments on a black background are almost unreadable for me.

  12. Trixie
    March 25, 2014 at 2:03 pm #

    And also, semi-OT: I had a 1998 Saturn SL. One time I rolled about 12 inches from a dead stop into a low parking berm I didn’t realize was in front of me (I was planning to pull through rather than back out, but hadn’t hit the accelerator yet). Both airbags deployed. No damage to the front bumper. The dealership told me I had to have been going at least 20 mph, and I escalated it to corporate and never got a satisfactory resolution from GM, and ended up having to claim it as a collision because at the time I didn’t have the money to fix the airbags out of pocket. That was the last time I’ll ever buy a GM vehicle. I did not trust those airbags ever again.

  13. LMS1953
    March 25, 2014 at 2:00 pm #

    Precisely the same analogy could be made with Obamacare. And the people who gave you that gem will be more than happy to further enable homebirth and CPM licensure.

    • The Bofa on the Sofa
      March 25, 2014 at 2:10 pm #

      Then again, Obamacare can be modified to address the issues CPM as data becomes available.

      Meanwhile, trying to modify the alternatives to ObamaCare that have been proposed in order to get people with healthcare coverage is impossible, since, well, there are none.

      • LMS1953
        March 25, 2014 at 7:54 pm #

        And there are NO ALTERNATIVES because Senator Harry “They’re lies, all lies, I tell you, all lies” is an obstructionist who has denied ANY and all Republican measures. But that’s OK, in a mere 7 months his bag of senile bones to the curb. Then Obama can be exposed as the complete incompetent as he vetoes bill after bill a united Republican Congress sends up to him. Then the American people might understand how important it is to have an adult in long pants in the White House:

        • CanDoc
          March 25, 2014 at 8:32 pm #

          Just, wow. I thought with the Hippocratic Oath and everything about trying to help others, that my physician colleagues south of the border would be a lot more enthusiastic about Obamacare. It must be an awful feeling to deny patients non-urgent (but still important) care because they can’t pay. Universal healthcare has been working, overall, pretty well for us here in Canada for over 50 years. Oh, and we don’t have any lay midwives getting publicly reimbursed by anyone, anywhere. Nor chiropractors, naturopaths, or other alternative practitioners. Actual, real midwives are reimbursed by a specific schedule with each province (for a while Alberta licensed them but required patients to pay partial costs out of pocket.)

          • LMS1953
            March 25, 2014 at 8:48 pm #

            It must be an awful feeling not to be able, as a country, to train and appropriately compensate interventional cardiologists, radiologists, neonatologists and oncologists and buy all the equipment they need and build all the multi-million dollar specialty centers they need on a per capita basis when you can just dump these patients on your neighbor to the south. And don’t give the lame excuse than Canada pays for the services. Such payment does not nearly cover the overhead needed to provide these services.

          • Certified Hamster Midwife
            March 25, 2014 at 9:49 pm #

            They only dump the ones who can pay cash, though. Everyone else can, literally, eff off and die.

          • Sue
            March 26, 2014 at 11:02 pm #

            Strangely, though, the UK, Australia and NZ can provide universal access public health, including interventional Cardiology, without noticeable penury amongst their medical specialists. Strange, huh?

        • The Bofa on the Sofa
          March 25, 2014 at 8:37 pm #

          (let me you in on a secret: Obama Care IS a Republican alternative)

          What great alternatives are you talking about? Not that “allow selling health insurance over state lines” bullshit again, right?

          Republicans had presidency and congress for like 6 fucking years. They didn’t do ANYTHING for health care. Not a fucking thing.

          They didn’t even try to implement Mitt Romney’s plan (which he ran from immediately as soon as Obama supported it)

          • LMS1953
            March 25, 2014 at 8:52 pm #

            Fuck off, idiot. If you want to have a health program that not a fucking Democrat read before they fucking voted for it and a program the POTUS lies about every time he opens his mouth, be my fucking guest.

          • Young CC Prof
            March 25, 2014 at 8:54 pm #

            Woah. Easy on the language (and the political diversions.)

          • Trixie
            March 25, 2014 at 9:13 pm #

            Seems like if LMS is going to fly off the handle, it happens right around this time of night. Why is that, LMS?

          • March 26, 2014 at 2:18 am #

            Hey Trixie while we’re on the topic, is there any way to stop voyeuristic sycophants rehashing other people’s insults?

        • The Bofa on the Sofa
          March 25, 2014 at 8:38 pm #

          BTW, how many alternatives to Obama Care have come out of John Boehner’s house? Not “repeal Obama” but actual something that does something?

  14. March 25, 2014 at 1:57 pm #

    It’s about a midwife’s right to choose her own practice standards. That’s the women’s right to choose that they are referencing, right?

  15. Mel
    March 25, 2014 at 1:03 pm #

    Correct me if I’m wrong:

    Cheyney et al states :Two detailed studies comparing birth certificate records to medical records … yielded sensitivity rates of .226 and .182 respectively. This means that 80% of neonatal seizures identified on medical records are not identified on birth certificate data.”

    While the authors are using this to discredit birth certificate data, I find it terrifying that the significantly increased risk of neonatal seizures and serious neurologic dysfunction was MISSING 80% of the risk category.

    Plus, it’s disingenuous to shorten neonatal seizures and serious neurologic dysfunction into “neonatal seizures”.

    • Amy Tuteur, MD
      March 25, 2014 at 1:13 pm #

      I don’t really understand the Cheyney defense, “maybe birth certificates are wrong so we should just ignore the issue and not bother to find out if homebirth increases the risk of 5 minute Apgar of 0.”

      It’s like the tobacco industry trying to discredit an individual study on smoking and lung cancer as if that would prove that smoking doesn’t cause lung cancer.

      The really contemptible thing about Cheyney’s behavior is she KNOWS that HER OWN DATA shows that homebirth dramatically increases the risk of perinatal death.

      • Guesteleh
        March 25, 2014 at 2:11 pm #

        Cheyney says “approximately 80 percent of cases of neonatal seizures identified on medical records are not reported on birth certificates,” as if that undermines Grunebaum’s research when what it points to is that he’s UNDERcounting the number of babies with neurological damage. Unless Cheyney thinks that all of the missing neonatal seizures are coming from the hospital size and not the homebirth side? But that makes no sense at all.

        • Trixie
          March 25, 2014 at 2:21 pm #

          It makes sense if your audience is people who are bad at critical thinking and want to believe Grunebaum is wrong. The point is to cast doubt on the results with fancy, academic sounding language.

        • March 26, 2014 at 2:33 am #

          Seizures occur when? Birth certificates are written when? It would seem logical to me that seizures occurring at any time in the neonatal period later than, say, 24 hours after birth, would not be noted on birth certificates .

    • Mr.G
      March 25, 2014 at 2:30 pm #

      Actually. The studies Chaney quotes do NOT mention neonatal seizures at all. Nor do they say Apgar scores are unreliable. More lies.

  16. hmm hmm
    March 25, 2014 at 12:57 pm #

    typo, first sentence point #2 of the Cheyney section. Great post.

  17. March 25, 2014 at 12:40 pm #

    OT – an update on the Ottawa woman – the baby has turned head down without an ECV. Hoping for a happy and healthy outcome soon…

    • March 25, 2014 at 12:42 pm #

      Note: The mother would have been saved a whole lot of anxiety if the OB would have been willing to agree to a planned cesarean if the baby did not move into a good position.

      • Young CC Prof
        March 25, 2014 at 1:17 pm #

        Definitely unnecessary and stupid drama. But glad she has been spared the risk of spontaneous labor with a transverse baby at least!

      • Jessica S.
        March 25, 2014 at 5:06 pm #

        No kidding. Especially when there’s good evidence that stress is not good for mom or baby. Seems very petty.

      • CanDoc
        March 25, 2014 at 8:37 pm #

        WTF? I know the Ottawa OB community. I haven’t found your other posts on this, but anyone with a breech baby who doesn’t consent to a vaginal breech delivery absolutely has the right to request a cesarean section. All the Ottawa OBs I know are strongly in agreement with this (and the older ones tend to think the new-fangled vaginal breech team is valuable but really, there’s good reason why we stopped doing vaginal breech deliveries.) Difficult to imagine that any woman would be forced to have a vaginal breech delivery against her will given the incredible and indefensible medico-legal costs in the event of complications. Suspect there is more to this story (including possibly an OB with terrible communication skills?)

        • March 26, 2014 at 2:41 pm #

          WTF indeed. I’ll grant that the case is complicated, but the approach in my opinion was heavy-handed, and perhaps reflects a need to refine communication skills – both between OB and patient and between OB and the rest of this woman’s team. I’m a little dismayed by some of the things I’ve heard out of Ontario lately though – as it seems to indicate that perhaps shared decision making and communication skills might need be improved upon by some practitioners.

  18. March 25, 2014 at 12:39 pm #

    If they really cared about the freedom of women to make choices – they’d care to ensure that those choices were made in the context of informed consent. They’d care to improve the information on the risks and benefits of all options available to women – home birth, hospital birth and (GASP!) even maternal choice cesarean. They’d care to mitigate the risks to the choice that they support – by actually working to make it safer by identifying problems (like the incredibly inadequate training of some providers) and working to solve those problems (increased training and qualification requirements). All they really want to do is expand access to wholly a inappropriate status quo of home birth.

  19. Trixie
    March 25, 2014 at 12:28 pm #

    Cheyney fails to recognize (or deliberately obfuscates) the difference between a “crusader” and an expert. Dr. Grunebaum and Dr. Chevernak are experts. The reason they continue to do this research is to try to prevent death and disability, and they have the training and experience to do so. Cheyney and her cronies — well, they’re pretty good at knitting, I hear.

  20. attitude devant
    March 25, 2014 at 12:27 pm #

    Thank you for this. I have been thinking of tobacco and Missy Cheney for some time. I hadn’t thought to add in the GM story.

    I confidently look forward to a remake of The Insider, with Judith Rooks in the Russell Crowe role.

  21. moto_librarian
    March 25, 2014 at 12:23 pm #

    “This article was not published in isolation, but is part of a larger effort by senior author Dr. Frank Chevernak from Cornell University, who has published at least six other articles critical of home birth in the past 2 years in major obstetrics, pediatrics, and ethics journals (19– 24).”

    That’s right folks – Melissa Cheyney is whining about the high numbers of solidly researched articles being published in major, peer-reviewed journals while the only avenue for publishing the MANA “data” are the vanity publications “Birth” and “Midwifery Today.”

    Here’s a hint for you, Missy: this is not a crusade, it’s science.

    • attitude devant
      March 25, 2014 at 12:26 pm #

      moto– That’s two remarkably cogent comments in as many days. You are on a roll! Brava!

    • Dr Kitty
      March 25, 2014 at 3:18 pm #

      Cochrane Review…I think you need to do for home births what you did for surfactant…

    • Danielle
      March 25, 2014 at 4:49 pm #

      Cheyney might try to retort that the cited studies both come from two people, both from Cornell – but that’s really not evidence of a conspiracy. It is the sort of thing one sees all the time: a scholar becomes interested in a topic and writes several articles on it, because that is what you do. Write one article or book, then follow what you learned the first time onto another project. That this person may have a colleague at the same institution, or a different one, who also publishes multiple studies is hardly remarkable.

      Conspiracy suggests that someone is fabricating data and foisting a fraud on the public. A peer-reviewed article can not be called a conspiracy: it can be argued against, preferably by better research. So, Cheyney, pony up. Move the conversation forward. That’s the whole point of quibbling in academic journals.

      • Young CC Prof
        March 25, 2014 at 4:57 pm #

        In mathematics, this happens all the time. The topics are very small, as are the groups of people who study them. On average, there are 10 people working in your subfield. There’s a good chance one is your student or your teacher, you personally know three or four others, and you’ve exchanged email with most of them.

        The word they’re looking for isn’t “conspiracy” but “collaboration.”

        • Danielle
          March 25, 2014 at 5:05 pm #

          Indeed. What might well conclude that my dissertation advisor, myself, and 5-6 of my graduate school classmates are all engaged in a vast “conspiracy” to change the way people think about certain aspects of US history. Oh, and it gets better: we’re embedded in an elaborate network of people at other institutions who spend time thinking about the same things! We’re in cohoots! Even this month, I contacted one of these colleagues to join with me in my plot … er, conference panel … and brought in a third person to join us. Our power is clearly expanding.

          And one of us works for the government. THE GOVERNMENT!

          What will we do next? Who will stop us?

          • Danielle
            March 25, 2014 at 5:08 pm #

            *One might well

            Admittedly, my inability to type is an obstacle to my plans for world domination.

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