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.