ICAN, how successful is the VBAC if the baby is dead?

iStock_000027331450Small copy

Call me old fashioned, but when I think of a successful birth, I think of a healthy mother and a healthy baby.

Apparently that’s not the case for the folks at the International Cesarean Awareness Network (ICAN), an organization that appears to think that the only successful birth is one that involved transit through the vagina … whether the baby was dead or alive.

Consider their post New Survey Shows High Success Rate for VBAC’s at Home. They are talking about the results of the statistics paper from the Midwives Alliance of North America:

Within this cohort were 1054 women with a history of cesarean section who were planning a vaginal birth after cesarean – VBAC – at home. (This is also referred to within the birth community as “HBAC” – home birth after cesarean). Within this subgroup, 87% had successful vaginal births, with 94% of those births occurring at home and the remaining 6% occurring after a transfer to a local hospital. This success rate is substantially higher than the 60-80% success rate reported across other large hospital-based cohorts (2) and likely reflects the high level of commitment to and support of natural birth, both from the mothers and their care providers.

If you are old fashioned like me, you might think that meant that there was a high rate of healthy babies who arrived by VBAC (vaginal birth after cesarean).

You would be wrong.

For those at ICAN, who are more concerned to boast about the use of their vagina than whether their baby survives, a dead baby is a “success” so long as a C-section wasn’t involved. It’s not that ICAN is unaware of the dead babies:

In the cohort reported by MANA, the intrapartum fetal death rate was significantly higher for women with prior cesarean compared to those without a history of cesarean (2.85/1000 versus 0.66/1000). For comparison, neonatal death rates for repeat cesarean and hospital VBAC were 1.03/1000 and 0.84/1000 …

Notice that nifty sleight of hand here (committed by MANA and repeated by ICAN), comparing FETAL death rate of the MANA cohort with NEONATAL death rate of the hospital group. The overall death rate in the MANA VBAC group was 5/1000. That’s a death rate 5X higher than comparable risk women giving birth in the hospital.

We at the International Cesarean Awareness Network (ICAN) find these statistics encouraging and applaud the Midwives Alliance of North America for collecting and presenting this data.

Encouraging??!! Anyone who is considering VBAC should take note:

When ICAN tells you that you have a high chance of a successful VBAC, they do not mean that your baby will survive. If you care about whether your baby lives or dies, you should be getting your VBAC information elsewhere.

The folks at ICAN and have nothing on the geniuses at the Midwives Alliance of North America, though. ICAN merely misrepresents the data and includes dead babies among “successful” VBACs. The fools at MANA don’t even understand their own data.

Consider this bit of appalling stupidity, direct from the MANA Facebook page (deleted the following day), in response to the observation that a VBAC death rate of 1/200 is hideous:

MANA Facebook 6-9-14

Here’s the money quote:

…[I]t does show a combined 5 deaths of 1000 (which is not the same as 1 in 200, since 1000 subjects were necessary to find those 5 deaths).

5/1000 is not the same as 1/200??!! 5/1000 is better than 1/200 “since 1000 subjects were necessary to find those 5 deaths”??!!

Those who rely on MANA for their information on the safety of homebirth take note:

If the people at MANA cannot do basic division, you cannot trust them to analyze their own data properly, let alone report it honestly.

It’s pretty clear that you cannot trust either ICAN or MANA to care about the safety of your baby.

Of course if you care about the safety of your baby, you wouldn’t be contemplating a VBAC at home in the first place, would you?

177 Responses to “ICAN, how successful is the VBAC if the baby is dead?”

  1. GuestM
    June 17, 2014 at 11:34 am #

    Every time something like this comes up, I wish I could tell all of these people about my beautiful VBAC. It was peaceful and the doctor was wonderful. Of course, my daughter had passed away in utero days before, but I suppose to some of these people my VBAC would have been a triumphant success. But I would much rather have had 10 c-sections if it meant delivering a living baby. i have to imagine that people who pursue this fanatically have never had to suffer through the loss of a child. Perhaps they’d think differently if they had.

    • Guestll
      June 17, 2014 at 4:49 pm #

      I’m so very sorry for the loss of your daughter.

    • Guesteleh
      June 17, 2014 at 4:58 pm #

      I’m so sorry for your loss.

  2. Laura
    June 16, 2014 at 10:19 am #

    I used to run an ICAN chapter, I stopped because of so many in the organization promoting homebirth. It could be a good resource for so many women if they didn’t promote homebirth. Some of the women that I spoke with were just looking into VBAC’s (there is a ban on our local hospital) , others attempted ones that were failed and needed emotional support. One women that had a failed homebirth and transferred to the hospital had PPD possibly PTSD, I tried to get her into counseling but she was so angry at the hospital and the DR’s that she wouldn’t get help.
    Another women that left an impression on me was one with 4 previous c-sec wanted information on an unassisted birth for her 5th child, all I could tell her was that is not a good idea it is too risky and try the university hospital.
    I had to ask the local CM to stop coming to meetings because I was not promoting homebirths, the information she was giving out was horrible. She was telling women that having a c-sec is like getting your leg operated on. I felt that she was there trying to get business which I never gave her a recommendation.
    I was also kind of frustrated with the local DR’s too I know it is banned but I was hoping to connect with them for information on VBAC’s, I know that I was not liable for anything I said, however that didn’t mean to me that I didn’t feel like I could say the wrong thing and be ok with it either. I started every meeting by saying I am not a medical professional, this is purely information and I recommended that they speak in depth with their healthcare provider, because my information may not be accurate.
    I also want to say it was so frustrating to see the blogs and “information” that made women feel like a rupture could never happen to them, I made sure to state it as there is a high and lower risk group but either way no one can guarantee 100% a rupture will not happen. SO this turned into a rant.

  3. Busbus
    June 16, 2014 at 9:53 am #

    This is slightly OT and certainly not a new thought on this blog (so, sorry for the repetition), but today it just hit me on a personal level more than before: I saw a photo from a homebirth the other day, where you could see the small midwife’s kit in the background of a the bedroom where the mother was laboring. It suddenly came to me that if I saw that picture in a different context, say, a shack in sub-Saharan Africa or even an ill-equipped rural hospital or mobile midwife’s unit in a developing nation, I’d be worried for that mother and baby (and I sure as hell wouldn’t choose to give birth there – just like the mothers who have no other choice would overwhelmingly choose better medical attention if they could). And I know that in many places, even that minimal amount of medical help is more than many women can hope for.

    And then I thought – that is what I chose for my own babies when I decided on a homebirth. How could I not make this connection? Why did I feel “safe” in my own living room, miles away from the next hospital, when I wasn’t affording my babies any more protection than I would have had in a third-world country with only a midwife present? Living in a first world country sure gives me a whole lot of advantages, but it doesn’t make an OR appear out of thin air just because I happen to need one.

    Women who live in worse places than us frequently make a lot of sacrifices to get medical attention – ANY medical attention – when they have a baby. They walk many, many miles, sometimes give up a large part of their family’s savings, accept overcrowding and other difficult conditions at the hospital – all in an attempt to make sure that they and their babies make it through birth healthy and alive. And we sit here wining about IV’s and “annoying” hospital policies in the state-of-the-art medical centers we have access to? Really???

  4. Courtney84
    June 16, 2014 at 9:02 am #

    I haven’t been around much lately, but I really appreciate the level headed blog posts and active comments on VBAC these days. My little boy is just days away from 6 months old, and we are thinking about the next one. Per my OB I need to wait 9 months to conceive if i want to attempt a VBAC (with her as my doctor). I am, unfortunately, significantly overweight. I have recently started on a mission to get down to a BMI of 24, which means losing nearly 50 lbs. I don’t need my next baby to come out my vagina; if I need to have surgery that’s fine. I really do want to do lol that i can to set myself up to be a good VBAC candidate, but not drink the “vaginal at any cost ” Kool Ade.

  5. Tina
    June 14, 2014 at 2:49 pm #

    Interesting article. Thank you for this. I have a question that is pertaining to VBAC’s but a little outside the realm of this article. I have had a C-section. I have read in scholarly journals that research frequently finds that a woman who is having a VBAC is at a huge risk for a full thickness rupture of her uterus if she was given drugs to induce labor or stimulate uterine contractions (such as pitocin or pitocin with cytotec). Why is it that hospitals/doctors are still allowed to practice this way if it heightens the risk of a full thickness uterine rupture which could result in the death of the baby and or mother?

    • Karen in SC
      June 14, 2014 at 3:08 pm #

      I’m not an OB but I’m guessing that if labor doesn’t start on its own and the woman still wants very much to try for a VBAC, she can consent to administration of the pitocin. Sometimes I’ve read this described as a “whiff”. You did not define huge – what have you read?

      In those cases it’s a choice between keep trying with a safe dosage and maybe rush to a c-section, or go directly to a c-section. Each mother will have a different preference and also there are other factors to consider such as position of the baby, ripeness of cervix, time elapsed since the c-section, estimated thickness and placement of the scar, etc.

      Your OB will discuss all this with you. In the ICAN world, the only correct answer for all women is VBAC and that attitude is dangerous.

      • Tina
        June 14, 2014 at 4:42 pm #

        Hi Karen. You asked me to define huge. What I read, aside from abstracts and articles in the American Journal of Obstetrics and Gynecology, was an article in American Family Physician that stated that 77% of women who had uterine ruptures were involved in an induction of labor. I then went on to read the revised ACOG standards from 2010 which lists recommendations on women attempting a TOLAC and it states that women should not be given Misoprostol during induction (I’m not sure but I think that’s the same as cytotec). This recommendation was based on “good and consistent scientific evidence.” However, I was unable to find anywhere where the guidelines ruled out use of pitocin. I have not found where, when labor is augmented with pitocin, there is an increased risk of uterine rupture, only when it is induced. And of course, I believe you are correct in your statement about a trial of labor after a cesarean being dependent upon the position of the baby, definitely the type of scar, etc..

        • araikwao
          June 14, 2014 at 6:24 pm #

          There is an article I’ve cited before (I think Aus Journal of O&G, 2010) which gives the odds ratios for rupture risk with various methods of induction or augmentation. Augmentation with Pit/Synt is unsafe, I think 10x the odds of rupture, whereas induction with the same is 3.5-4x the odds of rupture. Around here, not all ob’s will induce, because everyone has different thresholds of acceptable risk.

        • Mac Sherbert
          June 14, 2014 at 6:38 pm #

          I think it must vary considerably. I thought about a VBAC, but my body just didn’t want to go into labor. My OB said she was willing to admit and try a soft induction,,.she didn’t seem have any issues at all with it, if that was something I wanted to do. She said she was very comfortable trying it at this particular hospital. I was 40 weeks and 3cm…my previous baby was breech, but I had labored some with it before the breech presentation was discovered.

          Anyway, I was a fairly good candidate for VBAC. I had good bishop scores and would have been at a hospital with 24/7 anthiestologist dedicated to OB and a high level NiCU. I turned her down just because I had a feeling that if my body didn’t want to labor maybe there was a reason and I turned out to be right in that thinking.

          • Jessica S.
            June 14, 2014 at 8:46 pm #

            And, if you’re going to need a CS in the end, there’s less risk when you’re not in full blown labor and haven’t been pushing for hours, with a crisis on your hands. It’s a toughie, b/c there’s no way to know ahead of time what’s going to happen. That’s why case-by-case is the only rational way to treat these situations.

    • staceyjw
      June 14, 2014 at 3:26 pm #

      I don’t think inducing VBAC’s is common practice, but only done on a case by case basis. I would think that you would need more detailed history in order to weigh the risks of VBAC induction.

      My VBAC was either induced or augmented, based on how you define the start of labor. I was in the hospital already for pPROM, and had my cerclage removed, but wasn’t actually in labor. Got some pitocin and a few hours later- baby by VB.

    • Medwife
      June 14, 2014 at 5:11 pm #

      Induction with prostaglandin analogues (misoprostol, cervadil, prepadil) is absolutely contraindicated in a VBAC. Rate of rupture dropped significantly after that guideline came out. I haven’t looked lately at stats regarding pit induction or augmentation, as I work in a facility with a VBAC ban, but low dose pitocin induction and or augmentation is definitely not unheard of. I think there are significant differences between individual providers. Last I read, pitocin aug of 1-2 mU/min was not significantly associated to am increased risk of rupture. 1 mU/min is the lowest dose possible.

      • Therese
        June 16, 2014 at 12:23 am #

        Anyone happen to know how often are inductions successful when the pitocin dose is kept between 1-2 mU/min? Just from my experience, my body was really not that responsive at all to it (the majority of 24 hours the pitocin was that low, since the baby did not respond well to higher doses and I pretty much made 0 progress, even though I had given birth twice before.)

    • Paloma
      June 15, 2014 at 12:38 pm #

      My hospital tries VBACs for every woman with 1 previous c-section and some of them are induced. However, since this does elevate the risk of complications they get constant monitoring from the moment they are induced until they give birth. I suppose hospitals are allowed to do this because they are able to monitor correctly and because they are equipped to deal with a rupture (the OR we have is literally next door). And obviously, patients are informed of the risks before the induction and they decide if they want to try or not.

    • Laura
      June 23, 2014 at 11:01 pm #

      I’m not a doctor or anything, but my first child was a c-section and I had 3 successful VBACs after that. They did not do any form of chemical induction, but my second child was late and if I waited any longer, they were going to do a csection. I was only fingertip dilated, so they did a mechanical induction where they inserted a catheter into my cervix, attached it with that rubber tubing to a 2 lb saline bag and slowly inflated it to 3 cm, using the bag as traction. It hurt like nothing I had ever felt before, but after about 20 minutes, I had dilated to 3 cm, and they were able to break my water to get labor going on its own. I’m not quite sure why that’s not done more often to help with VBACs – it did wonders for me 🙂

  6. Amy Tuteur, MD
    June 14, 2014 at 12:29 pm #

    I have a few questions for Carla Hartley in the comments section:


    • Karen in SC
      June 14, 2014 at 12:43 pm #

      I have some too. How does she explain the preventable death of babies when there hasn’t been any interventions? Why do breech babies get head entrapment when no interventions are performed? How does a placenta get to zero amniotic fluid when the mother trusts birth and is under the complete care of a midwife?

      Saying “Birth is as safe as life gets” is a despicable way to explain away these tragedies. Acceptable collateral damage. #notburiedtwice

    • Durango
      June 14, 2014 at 1:04 pm #

      Carla et al never cop to the contradictory notion that “interventions cause bad outcomes” and “if there is a problem, we’ll transfer to the hospital.” That is, if you think intervening will cause problems, then you will be very slow to intervene. No midwife who thinks interventions are evil is going to do anything in a timely way. They are going to wait until things are crashingly bad before they finally decide that maybe, just maybe, intervention might be helpful.

    • Sue
      June 15, 2014 at 8:39 am #

      “The body that knows how to conceive and grow certainly knows how to birth. ”

      Yep – that same body who knows how to do infertility and miscarriage?

  7. Dr Kitty
    June 14, 2014 at 8:02 am #

    It’s almost like there is a recognised complication in VBACs which occurs at a rate of about 1/200 and almost inevitably results in foetal death if it occurs at home…
    You know, I just can’t think what it might be….

    Or, to paraphrase MANA and ICAN

    “Rupture, schmupture, nothing bad will happen to me if I think happy thoughts, and 199 is a much bigger number than 1, so it’s almost like there is no risk.”

    • fiftyfifty1
      June 14, 2014 at 10:17 am #

      And if 199 is a bigger number than 1, just think of how much bigger 995 is than 5!

      • Captain Obvious
        June 14, 2014 at 11:04 am #


      • Mac Sherbert
        June 16, 2014 at 7:15 pm #

        Unless your baby is the one in RED then 1 must seem like a huge number/percent! It infuriates me how they marginalize that ONE baby.

        • Young CC Prof
          June 16, 2014 at 8:57 pm #

          I think the problem is the definition of rare. A 1 in 200 chance is unlikely, but if we’re talking about a specific disaster, it’s a large enough probability to be worth considering and possibly taking action to prevent. A (literally) 1 in a million chance of disaster, however, should probably be disregarded.

    • staceyjw
      June 14, 2014 at 2:11 pm #

      I DID see a blog post that basically said exactly this, she was illustrating how she looks at 199 v 1. There was a graphic that showed 199 little black figures and one red one. The author said “See, the risk is minimal. See how few red figured there are!”
      Really. The odds that shed wouldn’t be the 1 were good enough or her to push HBAC. Because remember, that one will die in the hospital anyway, dontchaknow.

    • yentavegan
      June 14, 2014 at 7:58 pm #

      Well it is only 1/200,and I’m not having 200 babies!

    • Amy M
      June 16, 2014 at 7:55 am #

      No see….cause 5 in 1000 is different than 1 in 200 so you yhave to have 5 babies…or something like that.

  8. Amazed
    June 14, 2014 at 6:32 am #

    And the Most Nonsensical Comment Award goes to Julia Dalton, Idiot Extraordinaire. Enjoy…
    Julia Dalton
    Look, your fried Doula Dani’s interpretation of the results is just that, an interpretation,

    a clearly biased interpretation based on some heavy emotional
    investment she has in being against homebirth. Her results are NOT
    published and peer-reviewed. The MANA study IS published and

    There seem to be a lot of you calling foul on
    the MANA study, but the reality is that you have NOTHING to support your
    assertion that home birth has a higher infant mortality rate than
    hospital births. The flawed Wax study from ACOG was a joke, and deeply

    I stand behind MANA and their stats. And beyond
    that, I stand behind the ability of a woman to choose where she wants to
    birth and to pick the provider she is most comfortable with.
    End of quote.

    Question mine: Are they all really Julia Dalton level dumb, or are they all just fucking bitches who only care for lining their pockets and toeing the party line stepping all over dead babies?

    • Dr Kitty
      June 14, 2014 at 8:05 am #

      Statistical analysis, if done properly, isn’t about opinions. It is simple maths, comparing like with like.

      • Amazed
        June 14, 2014 at 8:40 am #

        Not when it doesn’t suit MANA and their apostates, it isn’t.

        I’d love to see Julia Dalton and Jen Kamel facing each other over the issue of standing behind MANAs stats… or not. Julia hollering, “I trust MANA analysis!” and Jen whining, “But the sample was so smaaallll, the analysis should not be trusted ’cause MANA said so!”

        • Siri
          June 14, 2014 at 5:54 pm #

          Not apostates – acolytes perhaps, or apostles? Apostacy means abandoning the faith.

          • Amazed
            June 15, 2014 at 8:59 am #

            Thanks, Siri, I’ll fix it.

            By the way, amazing post over the Page of Lunacy. I was cheering as I read through.

          • Siri
            June 15, 2014 at 9:17 am #


      • staceyjw
        June 14, 2014 at 2:28 pm #

        LOL, you are such a simpleton, a fool that thinks numbers and the scientific method equate to truth.
        There are other ways of knowing, and they are so much more powerful. Did you never read about how irrationality should be used in MWery?

    • Captain Obvious
      June 14, 2014 at 11:05 am #

      She stands by the MANA press release, not the MANA stats.

    • Young CC Prof
      June 14, 2014 at 11:37 am #

      There is motivated reasoning involved. The midwives have a strong incentive not to understand something that basically says their entire income source should be cut off, and the mothers who have previously given birth at home have an incentive that is perhaps even stronger–unwillingness to admit that they put their children at risk. (Former HB moms out there, I have a LOT of respect for anyone’s who’s made that intellectual journey.)

      That’s probably the origin of the nonsense about how I can safely ignore any essay or article critiquing a peer-reviewed study if the essay itself is not peer reviewed. She’s finding an excuse to dismiss Dani’s work because she doesn’t like what it says.

      However, I also believe that most of them are truly incapable of understanding the math involved. The writers of the MANA STATS paper managed a clever trick–they sliced and diced the death rates into sub-groups, and showed intrapartum, early neonatal and late neonatal separately. The deaths attributed to congenital defects were relegated to a footnote. This was done both to ensure that all numbers were small enough to dodge statistical significance and to avoid printing the total number of deaths anywhere in the paper. I firmly believe the writers knew exactly what they were doing, but the audience would never pick up on it.

      44, MANA. The number you’re afraid of is 44.

      • AmyP
        June 14, 2014 at 12:23 pm #

        “However, I also believe that most of them are truly incapable of understanding the math involved.”


      • Amazed
        June 15, 2014 at 8:59 am #

        Oh I do agree with almost anything you said. I only take issue with them being incapable of understanding the math involved. I hate math wholeheartedly and it hates me back. I often joke that my math knowledge spans over the calculation that 2 + 2 = 5. But even I know that 1 in 200 is quite the same as 5 in 1000. I refuse to believe that they don’t know it. They are just embarrassing themselves by pretending the two things are different.

        And while I do agree that HB mothers do have an incentive not to admit that they took a risk with their children’s lives, I cannot fathom how the urge to protect their future children’s lives can be less of an incentive. I mean… OK, you got lucky once but now you know better – and you still bury your head in the sand and hope you’ll get lucky again? I am really running short of compassion for the women who see the information in its entirety (many HB moms of the past didn’t have this luxury), choose HB to get empowered, and then it’s, “Ebil hospitals made me do it and I didn’t know, and everyone else is to blame that my baby died/was hurt but me.” Personal responsibility, my ass.

    • Jessica S.
      June 14, 2014 at 1:10 pm #

      “I stand behind the ability of a woman to choose where she wants to
      birth and to pick the provider she is most comfortable with [as long she wants to give birth at home and picks a homebirth midwife as her provider].”

      Fixed it for her.

      They talk about “choice”, but they pile on women who give up and praise women who take extreme risks. They want to eat their placenta and have it, too. 😉

      It’s not too dissimilar from the whole “I’m not anti-vaccine, I’m pro-safe vaccine” which of course isn’t true. It just isn’t as fashionable anymore to be openly anti-vax, now that even the media has started to shun them, too.

    • staceyjw
      June 14, 2014 at 2:26 pm #

      They are so wedded to their ideology they cannot see the truth even if its written in blood right in front of them (as it often is). Seeing this stuff would make their worldview come crumbling down, and their psyche protects against this. This is why when a HB loss mom realizes that it IS HB and the lay MWs fault, they usually have so much emotional upheaval (in addition to the loss).

      Think of them like someone in a cult, because NCB and cults share most of the same characteristics. Do you think any of the people in the Sea.org (hardcore Scientology) would see the truth of their organization if 100 people proved it to them? Even 10,000? Of course not. They would never accept the truth, and they they would never accept your evidence. By continually moving the goal posts, they keep their worldview and beliefs intact.

      It IS really threatening, and can be pretty scary, even traumatic, to lose your entire worldview. These people are not just HB defenders. HB is just a part, an integral part, of a larger belief system. This is why most HBers also share other beliefs with each other, and why they fight the basic beliefs of HB so vehemently. This is why they continually parrot things we have proven false “HB is safe or safer!” instead of just admitting “its not as safe or safer, but the odds are good enough for me, and I still want a HB”.

      Admitting it is NOT safe (that MANA is lying, etc) is more than an acknowledgment that you may have risked your own kid, more than admitting you were wrong, or fooled. It is taking a vital piece out of the Jenga like puzzle that supports their whole view on life. Its like a young earth creationist admitting that fossils do show the earth is older than they thought. The wrong answer to a question about something deeply held can lead to a path most fear taking.

      • Amazed
        June 15, 2014 at 9:56 am #

        Oh I do try to imagine the things this way. But the fact that they hold the hospital as a security blanket is quite revealing and reeking of the monstrous hypocrisy their world view is. Sure, hospital is bad but it’ll save me, so why worry? C-section is an instrument of Satan but hey, if I come from home, I’ll get to bump another emergency. Too bad for the sheeple who was stupid enough to trust hospitals in the first place.


      • Busbus
        June 15, 2014 at 10:12 am #

        I wasn’t even that deep in the woo, but my recognition of how I had fooled myself and how I had relied on sources that were not trustworthy without questioning them DID lead me to reconsider a lot of other beliefs I held. (I actually only started to seriously look into the safety of homebirth after I had already started to question my pseudoscientific belief in attachment parenting and looked into the actual science behind the breastfeeding propaganda.)

        I am absolutely a different person now than I was when I was pregnant with my first child and chose my first homebirth. So, I’m convinced that you are right. And for people who are even more into all the related stuff, it must be even harder than it was for me.

      • Busbus
        June 15, 2014 at 10:42 am #

        Sorry, I have to reply again. I’m actually starting to think that this whole natural/homebirth/anti-vax/anti-science subculture is our modern version of strange anti-rational societal strains. It’s more than just the homebirth culture – it’s a whole world view that’s incredibly popular among upper-middle-class today. It has penetrated a lot of other areas of life, too. Natural being “better” has become the truism of our times. I’m also quite sympathetic to Badinter’s argument in “the conflict” that this represents an anti-feminist backlash.

        • Guesteleh
          June 15, 2014 at 12:15 pm #

          If I do everything natural it just reinforces that I naturally deserve all of my economic and social privilege. I wank on this a lot but I’m convinced that’s what it’s all about.

    • Medwife
      June 14, 2014 at 5:27 pm #

      Oh please. Peer reviewed and published by the Journal of Midwifery and Women’s Health. If there was not a strong ideological bent to the reviewers as well as the incestuous nature of the small midwifery community, that article never would have been published as is. The authors of that article include some big, big names. Who was going to hardcore critique Saraswathi Vadam? *snort*

      • Amy M
        June 16, 2014 at 7:56 am #

        yeah, let them send their “study” to Nature and see how far they get…

        • The Computer Ate My Nym
          June 16, 2014 at 8:26 am #

          “Thank you for your submission, but we believe your manuscript would not be of high enough priority to be likely to be published here…”
          Probably, at least. Remember, Lancet published Wakefield. There is no perfect protection…

          • Young CC Prof
            June 16, 2014 at 10:13 am #

            But back in 1998, Wakefield was a respected researcher, and the study sounded like an interesting piece of early evidence. The study did not look like junk, it looked great, the problem was that he flat-out lied about the data, and he knew enough about research to make it look plausible.

            Most of the MW studies, on the other hand, the flaws are quite obvious.

    • Box of Salt
      June 15, 2014 at 9:46 pm #

      “The MANA study IS published and peer-reviewed.”

      It’s still not a study. It’s still a write up about a self-selected survey.

      From their methods section (http://onlinelibrary.wiley.com/doi/10.1111/jmwh.12172/full)
      “Participation in the project was voluntary, with an estimated 20% to 30% of active CPMs and a substantially lower proportion of CNMs

      It’s one step away from completely worthless (internet poll, anyone?).

  9. Sue
    June 14, 2014 at 12:41 am #

    Reminds me of ”the operation was a success but the patient died”

    • Adelaide GP
      June 14, 2014 at 1:19 am #

      Or, “do you want the good news, or the bad news…….”

  10. Beth S
    June 13, 2014 at 11:49 pm #

    I suck at math, to the point where the only reason I passed math in high school at all was because my Algebra and Geometry classes were taught by the football coach who explained things as simply as possible to get everyone through as half the class were his players. However with that said, even I can see these numbers are horrible and how is it people think that five is better than one when it comes to deaths.

  11. Guesteleh
    June 13, 2014 at 9:40 pm #

    It drives me crazy how ALL of these groups delete comments and entire posts. It’s literally Orwellian. And with all of this retconning it is almost impossible for the average person to hear anything negative about homebirth unless they find this blog. The Jan Tritten crowdsourcing debacle is the worst example but it’s just one of dozens that I’ve seen. Until I witnessed it myself, I would never have believed the scale on which the whitewashing is happening.

    • Jessica S.
      June 13, 2014 at 9:58 pm #

      I agree, it’s infuriating. And they try to spin it as not wanting things to be too negative, as if women are a bunch of delicate flowers.

      • Petanque
        June 14, 2014 at 6:55 am #

        Exactly. I am not a delicate flower, I am an adult person with a brain, and the ability to think logically. I don’t need to be told to shut up and listen to my mysterious womanly intuition!

    • Mishimoo
      June 13, 2014 at 10:00 pm #

      It’s not just the censoring either, they have the double-think down pat, along with the regimented exercise + diet, the ostracism of people that speak up or don’t agree, and looking down on the proles for being happily ignorant.

      • Jessica S.
        June 13, 2014 at 10:33 pm #

        I have to say, I do love reading a comment where someone has used the term “proles”. 🙂

        • Mishimoo
          June 13, 2014 at 10:40 pm #

          Thanks ^_^
          I also realised after I wrote that, they (along with anti-vaxxers) also target children with books and toys in an effort to indoctrinate the next generation, just like the kids groups in ‘1984’

  12. OldTimeRN
    June 13, 2014 at 8:15 pm #

    As someone who sucks at math and thinks calculators and IV pumps were invented just for her, even I couldn’t be fooled by these numbers. But I clearly see what they are trying to do. Throw a bunch of numbers confusing wording around hoping that no one notices the trick of hands. Luckily Dr Amy and her minions are around to sort through the lies.

  13. Adelaide GP
    June 13, 2014 at 8:14 pm #

    There’s an almost jokey level of self justification/denial going on in that “explanation” of mortality rates. Sort of how I say to the hubby ” I will have another piece of chocolate, it’s got calcium in it , good for my bones!!”. You can justify anything if you are happy enough to engage in self delusion! I remember the mental gymnastics we went through when my high school debate team got set the topic “that smoking is good for you”. We almost won which was astounding, because of clever-clever sounding, but ultimately false arguments. Unfortunately prospective HBAC mothers might not be able to see through the nonsense, even though it’s probably not all that sophisticated ( the ability to reduce fractions) . Good on you , Dr Amy , for continuing to call them out on it.

  14. doctorex
    June 13, 2014 at 8:06 pm #

    Oh Good Lord. If midwives are only going to need a high school education and some count of times their hands are inside sacred yonis to practice, we definitely need a high school education to be attainable only with pretty solid statistical literacy. These people clearly lack that.

  15. Box of Salt
    June 13, 2014 at 6:19 pm #

    OK, is it just me or is this statement paradoxical?
    “The data show that low-risk women who plan a VBAC at home”

    How can any VBAC be low risk?

    • Young CC Prof
      June 14, 2014 at 2:18 am #

      Easy. Studies show low-risk home birth in the Netherlands and UK has outcomes almost as good as hospital birth. But MANA refuses to define low-risk in any meaningful way, so they can apply those results to anyone.

      • Melissa
        June 14, 2014 at 3:10 am #

        It all makes sense if you consider low-risk as something you determine after the fact. If they are okay they are low risk, if something goes wrong they weren’t, and we won’t count them in our stats.

  16. staceyjw
    June 13, 2014 at 6:18 pm #

    And every time I think they cannot be more stupid and misleading, they are! 1 in 200 not the same as 5 in 1000? Even an elementary kid knows better.

    I would say that I am pretty sure no mom considers her HBAC a success if baby dies, but I have seen a few examples of exactly this.

    What a twisted subculture.

  17. Box of Salt
    June 13, 2014 at 5:22 pm #

    “VBAC’s” ?

    I have stupid pedantry question for those who are more recently educated than I in American English grammar. I was taught by teachers who were old school 30 years ago, and I personally cannot split infinitives, end a sentence with a preposition, nor put a period on the outside of quotation marks.

    Since when did plurals and possessives become the same thing? Is it because “VBAC” is an acromym? Is this actually acceptable usage these days?

    • CognitiveDissonaceHurts
      June 13, 2014 at 5:30 pm #

      So, not only is math a challenge, but English grammar is too?

    • Trixie
      June 13, 2014 at 5:42 pm #

      It should be VBACs. You’re right.

      • Carrie Looney
        June 13, 2014 at 7:28 pm #

        If we’re being pedantic, because it’s the B that takes the plural, shouldn’t singular and plural both be VBAC? Just like RPM…

        • Box of Salt
          June 13, 2014 at 7:37 pm #

          VBsAC, like mothers-in-law?

          The apostrophe is still wrong.

        • Trixie
          June 13, 2014 at 8:36 pm #

          Except, it’s an acronym you pronounce, “vee-back.” So you’d say, ” vee-backs.”

    • MLE
      June 13, 2014 at 8:19 pm #

      ICAN right good.

    • araikwao
      June 14, 2014 at 4:56 am #

      I think it’s okay because it is used to denote missing letters between C and S?

      • Box of Salt
        June 14, 2014 at 3:26 pm #

        What letters are missing? As noted below, it’s Vaginal Births after Cesarean (Section).

        The singular is “VBAC.” No missing letters.

        The C-section does not own anything.

        • araikwao
          June 14, 2014 at 10:05 pm #

          Well, the letters “(a)esarean” are missing… I’ve been taught that an apostrophe is not incorrect in that situation (although being a hater of inappropriately used apostrophes, I rarely do), and that it is used to show ownership or a contraction, e.g wasn’t, I’ve, etc. I remember a super-awesome English teacher telling us that the possessive use actually was a contraction anyway, that in earlier usage, people would say the full version which was, e.g. ” Box of Salt his opinion”, which was subsequently contracted to “Box of Salt’s opinion”. Does that make sense? And has anyone else come across that explanation?

          • Trixie
            June 15, 2014 at 9:27 am #

            Yeah, I think that’s historically correct, and it’s how some other Germanic languages operate.
            Actually in colloquial English spoken by native PA Dutch speakers, you’ll hear this construction used from time to time — “Sam his dog” meaning not a dog named Sam, but a dog owned by a man named Sam — Sam sei Hund.

    • Siri
      June 14, 2014 at 5:02 pm #

      One VBAC, two VBACs. The baby died, and it was the VBAC’s fault.

  18. Guest
    June 13, 2014 at 4:56 pm #

    OMG, it’s obvious that the people writing on behalf of ICAN and MANA are nuclear-grade stupid if they can’t figure out basic mathematical concepts. Heaven help the poor souls who fall for it.

  19. Dr Kitty
    June 13, 2014 at 4:34 pm #

    I get that people see 1 in 200 and think they will be the 199.

    I have 6000 patients.
    I have patients with 1 in a million, 1in 500,000, 1 in 100,000 diseases.
    I have a patient with a condition that, as yet, we cannot find any other cases of in the literature.

    1 in 200 doesn’t reassure me.

    • pinkyrn
      June 13, 2014 at 5:33 pm #

      And when it happens to you personally, it does not matter how rare the condition is.

      • Amy M
        June 16, 2014 at 8:04 am #

        We were the lucky 1:250 to get identical twins, and our odds were even greater to get them from a single embryo transfer via IVF. Of course, the outcome of our freak occurrence is a lot more positive, since we have 2 healthy children, but still….never thought I’d be that mom.

    • Busbus
      June 13, 2014 at 8:06 pm #

      No, 1 in 200 doesn’t reassure me, either. And, quite frankly, I think it would have made me think twice about homebirth even at the time that I was still all into it. THAT’S why they don’t want to say 1 in 200.

    • Who?
      June 14, 2014 at 8:22 am #

      I just think about a crowded train platform-how many hundred people are standing around, just waiting for their train. If one of them, or one of their children, was prone to be ‘struck by lightning’, apparently randomly, I bet there would be a lot of people deciding to catch the bus.

      It’s especially powerful when the risk is that your child, not you, is the victim of this chance. Or at least for me it is.

      • staceyjw
        June 14, 2014 at 2:36 pm #

        The crowded train platform is a really good illustrative analogy. I am stealing it!

    • Bombshellrisa
      June 14, 2014 at 10:41 am #

      We are talking about midwives who think attending 150 births is a number sufficient to call themselves “experts” in “normal birth”.

    • June 14, 2014 at 3:03 pm #

      A lot of times, a pretty simple analogy works well for me in explaining this sort of stats, since people deal very poorly with big numbers.

      Say there are 200 candies in a pile. One, and only one, has a deadly poison in it. Will you take a candy and eat it? What if there were only 100 candies? What if there were 1000 candies? At what point do you figure your luck is good enough, your odds are good enough, that you’re willing to risk the poison candy?

      Most people won’t take a candy, even in the thought experiment, at 1:200 odds.

      • staceyjw
        June 14, 2014 at 4:05 pm #

        If a HB MW is asked this, she would say “Go ahead take one. Your wombynly intuition won’t let you pick the poisoned one, and even if you did, I have herbs, affirmations and a car to take you to the nearby hospital!”

    • EastCoaster
      June 14, 2014 at 8:32 pm #

      I have a 1 in 100,000 lung condition! It certainly makes 1 in 200 look foolish when you’re “the” one.

  20. Guestll
    June 13, 2014 at 4:21 pm #

    Come on you guys, the MANA volunteers running that page don’t have all the time in the world blah blah blah! Their job is propaganda, not basic math!

  21. Dr Kitty
    June 13, 2014 at 4:19 pm #

    Dr T…did you specifically pick the memorial sculpture that looked like a foetus protruding through a uterine rupture?

  22. lilin
    June 13, 2014 at 3:42 pm #

    A question: Wouldn’t 5/1000 deaths be more damning than 1/200? Smaller surveys are less powerful, aren’t they? IT seems like there’s a greater chance that one death in two hundred is an anomaly than there is that five deaths in a thousand is an anomaly.

    • DiomedesV
      June 13, 2014 at 3:55 pm #

      Yes. I think that is actually what MANA is trying to say… sort of. I got the impression that they were correctly trying to point out that a survey of 200 families could pick up several or no deaths, just by chance, and that you would need 1000 families to feel more confident in the rate of death.

      Of course, the implications are that their stats are terrible. They’re trying to deflect from that by engaging in quasi-numerate, quasi-literate humbug.

      • lilin
        June 13, 2014 at 4:09 pm #

        So they’re basically saying, “We definitely know that, over a large group, one in every two hundred babies die. But cheer up! You might be part of a relatively lucky group of two hundred in which no babies die!” Of course, that means that a mother might also be part of a relatively unlucky group in which two babies die.

      • Box of Salt
        June 13, 2014 at 6:04 pm #

        DiomedesV “you would need 1000 families to feel more confident in the rate of death”

        This statement needs to be turned around.

        You had to kill 5 babies to find this out.

      • June 14, 2014 at 2:03 am #

        Using that kind of math I can show that the ratio of boys to girls in my extended family is roughly 80% boys in the current generation, therefore, extrapolating from the “tiny sample” I can confidently say that there are 80% more men in the world than women. Sure, one can find a group of 200 women who have not had a single neonatal death, heck, if I choose carefully, I could probably create a group of thousands who wouldn’t have a single death either. One Israeli in 5 over the age of 65 has type 2 diabetes, but I could refute that fact by finding lots of senior citizens who don’t have diabetes and claim they are representative of the entire population of over-65s.

        It’s meaningless.

    • Melissa
      June 13, 2014 at 4:06 pm #

      Exactly. They are arguing that we should say 5/1000 because it’s better than 1/200 when, if anything, 5/1000 is WORSE (although for all practical purposes they are equal) because it is a larger study than 200.

      In reality, this is important to them because 5/1000 sounds less than 1/200 if you don’t think about it.

      • Carrie Looney
        June 13, 2014 at 4:44 pm #

        Yes, the way they talked about it is bizarre. “You have to go through 1000 births to find 5 deaths!” With some odd little implied business that going through 200, you wouldn’t find aaanything (although you _would_ have a good chance of getitng 1 death in those 200, because math, and as mentioned below, we have no idea how many brain-damaged babies and shredded uteruses you’d expect in those 200).

        All of that makes me look at the statement “Our goal is to provide accurate, evidence-based information” and think, well, you might want to lower your expectations around that goal…

    • Young CC Prof
      June 14, 2014 at 2:21 am #

      Yes, that is exactly right. A single example proves almost nothing, 1/200 could have been a fluke. 5/1000 is still a small sample, but it’s large enough to come up with a confidence interval that does not include zero, or any reasonable estimate for the hospital death rate.

  23. MaineJen
    June 13, 2014 at 2:54 pm #

    Basic math skills that most kids learn in the fifth grade. I can’t even.

  24. Trixie
    June 13, 2014 at 12:34 pm #

    MANA was asked multiple times by various other posters to clarify how 5/1,000 was better than 1/200, and also whether 5/1,000 was an acceptable outcome, and they punted each time.
    The next day, they called Dani “inflammatory” for pointing out that MANA’s death rate was twice the rate of the birth center study. Numbers are meeeen. Just like Dr. Amy. https://m.facebook.com/story.php?story_fbid=847396445290401&id=164138070282912

    • auntbea
      June 13, 2014 at 2:53 pm #

      Don’t forget the part where basic math plays no role in statistics.

      • Trixie
        June 13, 2014 at 4:48 pm #

        Right, since the deaths didn’t occur right at 200, 400, 600, 800, and 1,000, it doesn’t really count.

        • Sue
          June 15, 2014 at 8:44 am #

          No, silly! 5 in 1000 means no deaths until 995, then five in a row!

      • Guestll
        June 13, 2014 at 4:55 pm #

        Guise, the volunteers don’t have time for this nitpicky clarification shit! They can’t keep incorrectly answering the same simple questions! They have advice to disseminate, love and light to spread, babies to kill!

  25. Amy
    June 13, 2014 at 12:28 pm #

    This absolutely correlates with my brief experience reading the ICAN email list (which, incidentally, was where I first heard about how “mean and horrible” Dr. Amy was). Just before I left, a woman lost a baby during a home birth but the women on the list were consoling themselves that “at least she got her VBAC.” I was appalled. Around the same time, the women all ganged up on one participant who had had a rupture, lost the baby, and had her next two children via schedule cesarean. They said she wasn’t supportive of VBAC, even thought she repeatedly asserted that she did support other women’s choice to give birth how they wanted.

    • Gene
      June 13, 2014 at 1:35 pm #

      That’s obscene.

    • Ann
      June 13, 2014 at 2:44 pm #

      This is how the TSA spun airport security to it’s troops. So what if 65% were dissatisfied with how the terminals were run, it’s the 35% that appreciated it that counted. No wonder this country is so screwed up.

    • Sue
      June 14, 2014 at 12:46 am #

      I sort of understand “See Rome and die” but “Get your VBAC and die”??

  26. Karen in SC
    June 13, 2014 at 12:21 pm #

    Doula Dani did an excellent blog post on the MANA HBAC data. It’s very thorough. http://whatifsandfears.blogspot.com/2014/04/mana-study-part-4-vaginal-birth-after.html

    • Karen in SC
      June 13, 2014 at 12:22 pm #

      I was going to post that on the ICAN blog but comments are closed!

  27. The Bofa, Being of the Sofa
    June 13, 2014 at 12:12 pm #

    I guess I don’t accept their premise, that an 87%VBACs success rate is substantially higher than a 70% success rate in the hospital.

    Higher, sure, but at a cost.

    Let’s use their numbers of 2.85 per thousand at home and 1/1000 in a hospital.

    So 1000 women in the hospital, 700 will have successful VBACS, and only 1 child will die.

    However, at home, 870 will have success, but with 1.85 additional deaths. There are 170 VBACS that would be successful at home that are not successful in a hospital, and they account for 1.85 deaths . That means 1%.of the additional successes result in death.

    That isn’t encouraging, that actually shows the point! The reason why the hospital’s “success rate” is lower is because they don’t accept a 1% chance of death!

    This is what ICAN’s numbers are telling us. The mortality rate for women that hospitals don’t let do VBACS that can do it successfully at home is 10 times higher than that for the ones that are successful!

    Sounds to me like the hospital is doing a really good job of identifying the risky situations.

    • PrimaryCareDoc
      June 13, 2014 at 12:13 pm #

      This is a great point.

    • Paloma
      June 13, 2014 at 2:34 pm #

      Also, these numbers only show mortality, no morbidity numbers on those extra successful VBACs. If I were attempting a VBAC, my concern would not only be a live baby, a healthy one too.

      • Amy M
        June 13, 2014 at 5:13 pm #

        And the mom too…if there is a rupture and everyone lives but mom loses her uterus and more than half her blood volume, that’s not good either.

      • staceyjw
        June 13, 2014 at 6:23 pm #

        Well, you have to figure that HB has a 18x higher rate of brain damage (HIE) and use of cooling cap therapy. I bet many of those were HBAC’s (and breech).

        • Young CC Prof
          June 14, 2014 at 2:27 am #

          I just noticed one more freaky fact from the MANA study: Of intrapartum transfers, 9.5% had a five-minute APGAR below 7. How does that compare to, say, babies born by emergency c-section in general?

    • Anne
      June 13, 2014 at 9:31 pm #

      This is exactly the point.
      The number needed to harm (NNH) implicit in the increased perinatal mortality, to achieve those extra few births is unacceptable to most people.
      Of course if you wait longer, more women will have vaginal births.
      But more will lose their babies, at a rate which is orders of magnitude higher than the conservative approach.
      And from a clinician’s POV, this exactly reflects standard of care- once a multigravida’s labour becomes dysfunctional, there is an exponentially increased risk of rupture- with our without a scarred uterus.
      Why don’t we augment MG?
      Because their failure to progress is telling us something. And we ignore this at our peril.

    • Sue
      June 14, 2014 at 12:47 am #

      All of this fits in with their known priority – which is to maximise the chances of the birth occurring according to their ideology, not to maximise the safety for mother and baby.

      • Young CC Prof
        June 14, 2014 at 2:24 am #

        That would explain why iCAN is anti-induction, even though there is ample evidence that judicious use of inductions can prevent many c-sections. (Example, my friend who delivered a healthy son TODAY!!!!! after being induced due to PROM)

        It’s ideology, not safetly.

  28. Empliau
    June 13, 2014 at 12:00 pm #

    Holy wackadoodles, Batman. It’s (as has been often said) all about them. If they aren’t broken, their bodies aren’t lemons, then they can give birth vaginally – sometimes to a dead or dying baby, but these things happen. I’m incoherent with rage that they don’t seem to give as much emphasis to what shape the baby is in when they’ve triumphantly proved themselves. They’ve got their healing VBAC, and maybe the next baby will live, right? When my brothers played a hostage rescue video game as teens, they considered a 90% casualty rate ‘acceptable collateral damage’. That was a video game. These are babies – and their own babies. I can’t even imagine their mindset.

    • Young CC Prof
      June 13, 2014 at 12:03 pm #

      Except the MANA study didn’t bother to count uterine ruptures. There’s no next baby after the surgeon pieced your uterus back together like a jigsaw–or performed a hysterectomy because, by the time you got to the hospital, there was no other way to stop the bleeding.

  29. Anna T
    June 13, 2014 at 11:50 am #

    I just don’t get how they can boast of doing HBAC?! I mean, all studies that show home birth is safe (or rather, could be safe under certain conditions) refer to LOW-RISK women. You can’t take that data and apply it to someone who is not low-risk. A woman with a history of a Cesarean is automatically NOT low-risk, and therefore should never attempt a birth at home.

    Why is this legal??? Why aren’t homebirth midwives banned from taking on VBACs?

    • Young CC Prof
      June 13, 2014 at 12:48 pm #

      That’s one of their classic fallacies. They like to quote studies that show reasonably decent outcomes, like de Jong and UK birthplace, both of which rely on conditions that the most skilled and careful midwife in the US cannot provide, like easy transfer. Then they use these studies to claim low-risk women are good candidates for home birth in the USA. Then, they refuse to define low risk, set up a big umbrella, and welcome twins, VBAC and other disasters waiting to happen.

      Unfortunately, reality is a honey badger and doesn’t care about their semantic tricks.

    • Melissa
      June 13, 2014 at 3:41 pm #

      Sadly, I think that most states are going to just not care about this issue because it is such a small amount of people. I work in policy, and I saw a bill that would allow domestic violence protections in cases of children who abuse their parents physically take 17 years to get passed. It wasn’t a controversial bill. People weren’t out protesting it. It’s just that there were only a handful of cases every year of people who were being abused by their older teen or adult children but who had trouble getting support because it wasn’t classified as domestic abuse. And the lawmakers had bigger issues to deal with.

      My state lawmakers are only in session for 60 days each year.Any legislation needs to be passed in those 60 days or you have to start over the next year. Some state legislatures have even shorter sessions. Things like homebirth and midwife regulations simply don’t get high enough priority to make it in that time, not until there is a huge tragedy in the media or something.

      And, probably most upsetting, is the fact that many people have a “buyer beware” view of those who pick homebirth. When I was working on a paper about midwife regulations for my MPA degree people flat out told me that nobody should care since if women got hurt by homebirth it was their fault for wanting one in the first place. Instead of getting angry at the midwives they placed it back on people who were the victims. Some of it is sexism and a total lack of understanding about the NCB movement. Some of it is the current move towards deregulation and the idea that civil courts can take care of everything.

      I’m not sure what it will take to get it on the radar of state legislators. I’m afraid it will have to get worse before they will act.

      • T.
        June 13, 2014 at 5:49 pm #

        Well, it is a bit of a choice to get a homebirth. Yes, the NCB lies are appealing, but you can chose to believe in them or not. Googling “homebirth safety” get you both the MANA faulty paper and the skeptical ob, and others who said that MANA is wrong.
        It is like anti-vaxer. Sure, there are people out here spewing lies and nathuropaths and quacks promoting anti-vax agenda, but really, there are also good sources that shows how anti-vaxers are idiots.
        So if you don’t get vacinate and have an adverse outcome, it IS your fault. Sorry. Suffering from the conseguences of a choice doesn’t eliminate responsability.

        It doesn’t, however, means that midwifery shouldn’t be better regulated. It indeed should. But it is a general problem: naturopaths get called MD in some places, for goodness sake.

        • Box of Salt
          June 13, 2014 at 6:02 pm #

          The problem here, however, is in both cases (homebirth and antivax) is that it’s not you who will do most of the suffering.

          It’s your child.

          Is that really what you want? Can you think this through?

        • staceyjw
          June 13, 2014 at 7:01 pm #

          At the core, this is a consumer protection situation. We do not allow drop sided cribs anymore, even if mom wants to buy them, right? We do try to protect the public from the unscrupulous HCPs and dangerous products.

          Unregulated, unaccountable, uninsured maternity providers have no place in the modern world. At all. Whether people want to hire them or not, they should never be allowed to present themselves as MWs.

          IMO, if they weren’t out there advertising, and going after the general public, while making the false claims of safety, it would be less egregious. They demand insurance reimbursements, and are even fighting for the ability to take Medicaid, as if they are actual HCP’s.

          I cannot believe they have the nerve to do this, and they still expect to remain autonomous, with no rules and no insurance! This also costs taxpayers, short and long term, as half of all births are paid by Medicaid.

          • Busbus
            June 13, 2014 at 8:00 pm #

            That is the main reason I’m against Medicaid reimbursement for non-nurse midwives. It gives them an air of respectability they have never earned in the slightest.

          • OldTimeRN
            June 13, 2014 at 8:30 pm #

            Good post. The states and public figures shouldn’t get to have it both way. Meaning hospitals and Doctors have to be regulated with laws, fines, malpractice suits, and ability to take away licenses. Yet have these unlicensed midwives running around not having to answer to anyone. OBs and hospitals can be sued for birth injuries for 21 years? Can you sue for your home birth in 20 years?

          • staceyjw
            June 14, 2014 at 3:05 pm #

            Exactly! In Oregon, these frauds had found a LOOPHOLE that let them take OHP (Medicaid). When ACA came in, they lost their loophole, and have been fighting incessantly to get the rights to charge Medicaid. And stay uninsured. And charge MORE than OBs get, but a factor of like 3.

            They expect to be invited to the table during any, and all, discussions on future ACA implementation, but refuse to give anything in return. They also expect to be invited into these CCO’s (how HCPs are organized here), but want none of the responsibilities. TYPICAL My OB jumps ridiculous hoops, pays an exorbitant amount for insurance, just to qualify. These frauds think getting a CPM/OR LDEMis good enough.

            I think they ought to be disclosed entirely. If they get a CNM, they can add their 2cents. Why people tolerate this is way beyond me.

          • Beth S
            June 13, 2014 at 11:42 pm #

            I was debating homebirth on Baby Center last night and while I could get these women to agree to a better education standards for HB midwives, continuing education for HB midwives, as well as stricter licensing standards. The two things I was pushing for that I couldn’t seem to get past their own prejudices were a risk in/risk out assessment with an OB/GYN as well as mandatory med-mal for all health care practitioners. I just don’t understand why they seem to think unaccountable and uninsured providers have a place anywhere in this world.

          • AmyP
            June 14, 2014 at 1:00 am #

            Drop-side cribs are way less dangerous than HBAC.

          • araikwao
            June 14, 2014 at 5:21 am #

            Does a drop-side crib have one side that can be released to slide down to a lower level? If so, we still use them in Aus (ahem, my son is sleeping in one as we speak). What was the safety issue that changed things in the US?
            (And on that note, despite the safety issues and warnings against their use, cot bumpers and baby walkers are still sold here – grrr.)

          • Young CC Prof
            June 14, 2014 at 11:13 am #

            Actually, drop-side cribs aren’t inherently dangerous. They were sold for decades without problems, then certain manufacturers started cutting corners that should NOT have been cut, so that the drop side occasionally fell off, often when a bigger baby or toddler was leaning against it. The easy solution was to ban all drop-sides.

          • Trixie
            June 14, 2014 at 12:30 pm #

            It didn’t fall off — that would’ve been less dangerous. They detached just a little, enough for the body to slide through the gap between the side and the mattress, but not the head.

          • Trixie
            June 14, 2014 at 12:33 pm #

            It’s actually illegal to resell or gift any crib made before 2011 in the US. The CPSC didn’t just ban drop sides, they also strengthened all the safety standards around crib construction. You can’t even resell a non drop side that’s more than 3 years old.

          • Lion
            June 14, 2014 at 1:18 pm #

            Same here in South Africa on all the points you mention.

      • staceyjw
        June 13, 2014 at 6:34 pm #

        The work it takes to change even a most egregious law that is obviously dangerous, with lots of experts and victims, is ridiculous. If there is push back- it can take forever with no promise of a good law actually being passed. If moneyed interests or the powerful are opposed to it, might as well bang your head into the wall.

        Lobbyists REALLY do help. Money REALLY does help. And loud people help a lot ONLY if it’s a bill that no one carter about, that is an easy victory for the politician.

        That is how it is here in Oregon. The MWs got all they wanted for years because no one really cared and opposed them in an organized way (or at all). Sure, the MWs are loud and their followers are true believers that show up to protest, but they only get what they want because the public doesn’t care, so the politicians can make a whole group happy without any blowback or chance of negativity.

        Now, there are counter protests, even if they are small they exist. There is organized push back and the stats to back it. We did not get all we wanted, but we did have some success considering it was the first time anyone went up against them.

        People that get mad when their senator or whomever doesn’t do all the things they said they would have obviously never had to try to get anything passed.

      • doctorex
        June 13, 2014 at 7:52 pm #

        Yet state legislatures seem totally on board with passing bill after bill after bill limiting abortion. It seems like dead babies is an important issue for them at least some of the time…

      • Who?
        June 14, 2014 at 7:28 am #

        And people with power/money have to care-not to start a pro vs anti arming yourself argument here, but how many gun incidents resulting in death have there been in the US since Newtown, and Americans can’t get anything done about it.

        In that case, the forces who want things left alone are more powerful. If only all the gun control people would joint the NRA, vote the gun lobby off and carry on, who knows what might be possible…

        Point is, money gets stuff done. Find money for controlling home birth, and it will be easier to get done, legislatively at least. You’ll still have the outliers, like Mrs Lovell from an earlier post, but you could take a lot of unsure people out of the mix.

  30. auntbea
    June 13, 2014 at 11:49 am #

    Can someone tell me how to post a screenshot here? I fail.

    • Trixie
      June 13, 2014 at 12:29 pm #

      There should be a little box with a picture icon in the lower left corner when you’re typing a response.

      • auntbea
        June 13, 2014 at 2:50 pm #

        Oh. That’s really obvious.

  31. Meg @ Adventures with Jude
    June 13, 2014 at 11:47 am #

    If my fourth grader was told to never, ever, ever, leave a fraction unreduced, you’d think a statistician would be doing the same.

    Plus, in order for statistics to be truly valid, you need large groups of people. In our house, 3 out of 5 kids are autistic. Does that mean 60% of the kid population in the US is? No. (Thank God.) But that’s why the numbers need bigger sample groups to be valid, and then the fractions get reduced to manageable numbers (the current 1 in 68 figure). Is it possible you’ll get a group of 68 kids and have none with autism in the group? Not likely, but depending on luck and your sample group, it’s possible…but that means to average things out there is another group of 68 with 2 kids. Sure, you might have to get to 136 kids to find two with autism, but that doesn’t mean that suddenly the overall fraction drops. We’re talking 4th grade math here…and you want to convince me of a medical decision?

    • Dr Kitty
      June 13, 2014 at 4:26 pm #

      Do you know how many people you need before you have a 50/50 chance of two sharing a birthday? Bearing in mind there are 365 days.


      People’s gut feelings about statistics are generally very, very wrong.
      You have to work the numbers.

      • Meg @ Adventures with Jude
        June 13, 2014 at 5:20 pm #

        LOL…seems we’ve hit jackpots then, because two of my boys are born on the same day (9 years and 92 minutes apart). DH’s family also have other sibling sets, multi-generational sets…and really big cakes to fit all the names. 😉

      • Box of Salt
        June 13, 2014 at 5:58 pm #

        We tested this in Algebra II when I was in 11th grade, in a class of about 30. We went through about 90% of the room, month by month, before we hit a match: It was me, and the math teacher.

        Yeah, that all makes sense statistically, but man! Sharing a birthdate with the math teacher does not score popularity points.

        • Trixie
          June 13, 2014 at 8:45 pm #

          I shared a birthday with my astronomy prof. That was how I learned I don’t have a zodiac sign.

          • Busbus
            June 14, 2014 at 3:10 pm #

            How does that work?

          • Amy
            June 14, 2014 at 11:50 pm #

            It’s actually not that weird when you think about it. Here’s how it works. If you walk into a room full of 22 people, not only are we looking at whether you share a birthday with any of them, but also whether any of them share a birthday with each other. When we’re looking at *any two people* sharing a birthday, we’re in the realm of compound probability, which involves a lot of multiplication, particularly factorials.

            So let’s say there are two people in the room. The odds of the two of you sharing a birthday are 1/366 (we have to include February 29th)– pretty low. Assuming you don’t,which has a probability of 365/366. and a third person walks into the room, the odds of Person 3 NOT sharing a birthday with either of the first two is 365/366 * 364/366 (which is how we mathematically calculate the probably of both the first two not sharing AND the third sharing with neither of the first two). If you continue this by imagining a fourth person coming in, you multiply the current running product by 363/366, a fifth person by multiplying the total by 362/366, and so on. When the running total gets below .5, then what we’re talking about is a less than 50% chance that nobody shares a birthday with anybody else.

          • Busbus
            June 15, 2014 at 12:35 am #

            Amy, that was a great explanation of the birthday experiment! But I was actually wondering about not having a zodiac sign… Sorry, I should have been more specific! 🙂

          • Trixie
            June 15, 2014 at 8:22 am #

            When they set up the Zodiac thousands of years ago, there was a constellation in each of the 12 30° divisions of the sky which pretty much corresponded to 12 month-ish long stretches of zodiacal signs (although it was never exact). But due to precession of the earth’s axis, those positions have shifted over time. From 11/30-12/17, none of the 12 Zodiac signs are in the Zodiac. A constellation called Opiochus is, however.

          • Busbus
            June 15, 2014 at 10:26 am #

            Wow, that’s interesting! Is that true in every year, or just in the year you were born in? Also – not that the unscientific nature of astrology was ever in question – but that should just really drive home what BS it is, no?

          • Trixie
            June 15, 2014 at 1:37 pm #

            No, every year, the same thing happens, although it is very gradually shifting due to precession. The Wikipedia article on the Zodiac has a good explanation.
            I’ve tried explaining this whole thing to someone who believes in astrology, and they were like, “but you’re a Sagittarius so of course you’d say that.” I tried.

          • Sue
            June 15, 2014 at 8:48 am #

            I don’t have a Zodiac sign either!

            What are the odds of two people without Zodiac signs both posting on the same thread of the same blog?

  32. Young CC Prof
    June 13, 2014 at 11:45 am #

    To explain the comment thread weirdness on the ICAN post, yes, that was me, no, I didn’t delete my own post, yes, I was polite. Their rank-and-file has no idea how censored their site really is.

    And yes, comparing intrapartum deaths, which in term infants are almost invariably cause by L&D problems, to neonatal deaths, which are frequently caused by totally unrelated issues like SIDS or suffocation, is completely absurd.

    • Trixie
      June 13, 2014 at 12:35 pm #

      Great work on the MANA page, too. You had them squirming.

    • Jessica S.
      June 13, 2014 at 9:54 pm #

      Yeah, that was what bothered me the most – there’s no way they want to place the intrapartum death rates in home birth next to those in hospital.

  33. auntbea
    June 13, 2014 at 11:29 am #

    That MANA thread was just gold. So much glaring idiocy right out there in the open. I’m sorry it got deleted.

Leave a Reply

You must be logged in to post a comment.