Wait, what? The “unreliable” CDC homebirth data is suddenly reliable?


I am not a shy and retiring person. Indeed, my aggressive online persona is the subject of frequent comments of the web (“Dr. Amy is so meen!”) But when it comes to brazeness, professional homebirth advocates leave me in the shade.

You have to be pretty brazen to tell a bald faced lie and then turn around a month later and say the exact opposite.

Case in point, the homebirth data from the CDC Wonder database. The Midwives Alliance of North America (MANA), the organization that represents homebirth midwives, published a study in which they claimed that their analysis of nearly 17,000 births attended by homebirth midwives found that homebirth is “safe.” There was just one teensy, weensy problem. The authors of the study never compared homebirth in the years 2004-2009 for comparable risk women who gave birth in the hospital in the same time period. Had they done so, it would have been obvious that their own data showed that homebirth increased the risk of perinatal death by a whopping 450%.

When I and others pointed out that MANA had not compared their death rates to the only relevant comparison group, they responded by claiming that they couldn’t make the comparison because the CDC birth certificate data on homebirth is inaccurate.

According to MANA:

Why doesn’t the Cheyney study compare home birth to hospital birth mortality rates?

It makes sense to want to draw these comparisons. However, hospital rates in the U.S. are derived from vital statistics data (birth certificates and/or death certificates). A number of organizations, including the American College of Nurse Midwives and Citizens for Midwifery have spelled out the limitations, which include a failure to capture the intended place of birth and inaccurate reporting of some outcomes (my emphasis).

CDC Statistician (and Editor-in-Chief of the Lamaze journal Birth: Issues in Perinatal Care) Marian MacDorman went so far as to tell The Daily Beast:

Most of the alarmist studies come from data pulled from vital-statistics data, from birth certificates and infant death certificates that are linked together. These administrative records “aren’t designed for research… There are quite a few limitations in using that data for that kind of analysis.

First, the researchers aren’t able to follow women who intend to deliver at home but later transfer to the hospital, which removes trauma patients from home-birth statistics. Then home-birth data fail to account for planned vs. unplanned births. (my emphasis)

Other media outlets, including Time, published these claims.

Imagine my surprise, then, when I woke up today to find professional homebirth advocates touting the latest report from the CDC that shows the rate of homebirth in the US has increased to its highest level since 1990.

For example, Jill Arnold of the Unnecessarean and Cesareanrates.com is promoting this graphic on her Facebook page and Twitter feed.

Homebirth rates

Where did she get the data for that claim? From the CDC! The new Data Brief Trends in Out-of-Hospital Births in the United States, 1990–2012. The authors of the Data Brief note:

In 2012, 1.36% of U.S. births were born outside a hospital, up from 1.26% in 2011.

Not all of these are planned homebirths:

88% of home births … were planned in 2012

How do they know?

This report is based on data from the Centers for Disease Control and Prevention’s National Center for Health Statistics National Vital Statistics System, Birth Data Files for 1990–2012. These data files include data for all births occurring in the United States and include information on a wide range of maternal and infant demographic and health characteristics…

Reporting of separate data on home and birthing center births began with the 1989 revision of the U.S. Standard Certificate of Birth. Prior to 1989, births were reported as occurring in or out of a
hospital, with no detailed breakdown of type of out-of-hospital birth.

The 2003 revision of the U.S. Standard Certificate of Birth added a data item on planning status
of home birth…

Wait, what? I thought that Marian MacDorman, MANA, the American College of Nurse Midwives and Citizens for Midwifery said that birth certificate data is unreliable for place of birth.

Who dared to based a study on that exact same data?

The lead author of the new report is … Marian MacDorman!

See what I mean? You have to be pretty brazen to claim, with a straight face, in early February that MANA couldn’t and shouldn’t compared its death rates with CDC data because birth certificates are unreliable for place of birth, and then, less than a month later, publish a report touting an increase in the number of homebirths in the US based on THE EXACT SAME birth certificate data.

One of those claims is a bald faced lie. Considering that Marian MacDorman has published a CDC report BASED on the data she claimed was “unreliable” only a month ago, she must believe that it is quite reliable indeed.

MANA knows that, too. But the only way they could think of to hide their hideous death rate was to avoid comparing it to the CDC data. And when they were called on that deception, they responded with an even bigger deception, the claim that the CDC data is unreliable for place of birth.

I’d be curious to know what those who call me too aggressive in pointing out the dangers of homebirth call people who lie to them one month and turn around and expect them to believe the exact opposite the following month. How about aggressive in hiding the dangers of homebirth, and brazen in their belief that their followers are so foolish and gullible that they won’t remember what professional homebirth advocates have said from one month to the next?

My online persona may be aggressive. It may be “meen.” I may really be an SOB. But at least I respect the intelligence of my readers, both those who agree with me and those who disagree. That’s a lot more than you can say for professional homebirth advocates.