You could practically hear the collective sigh of relief from the homebirth world.
The NYTimes solicited the medical opinions of 4 obstetricians to explain the increased risk of death at homebirth. But look, up in the sky, it’s Superbirther; faster than a snake in the grass, more powerful than an actual education, able to ignore mountains of scientific evidence in a single bound.
Henci Goer has arrived to give homebirth advocates permission to ignore actual scientific experts in favor of … herself!
The message of the obstetricians was clear and consistent:
Drs. Grunebaum and Chervenak: “In the United States, those who support home birth as safe are propagating junk science.”
Dr. Caughey: “Even in Europe, the fetal and neonatal risks are higher with home birth.”
Dr. Jennings: “The ability of a physician to rapidly provide care can be the difference between life or death for both mother and baby.”
Now Henci Goer “fact checks” the New York Times homebirth debate, and the sheeple in the homebirth community rush to embrace it. There is no independent thinking in the homebirth community; there are only celebrity homebirth advocates who spew nonsense and credulous homebirth advocates who lap it up.
Who is Henci Goer and what are her qualifications to critique Drs. Grunebaum, Chervenak, Caughey, and Jennings?
Actually she has no expert qualifications. As she herself has written:
You may be wondering about my credentials … since I am not a doctor — either M.D. or Ph.D — a midwife, or a nurse. I am a certified childbirth educator with a degree in biology from Brandeis University. Beyond that, I am self-taught.
So Henci Goer is not a medical professional and has no experience in the field of obstetrics. That, in itself is not a complete bar to understanding the obstetric literature if it is replaced by a PhD in a hard science or statistics. But, Goer doesn’t have those qualifications, either. In other words, Goer is a teacher of childbirth classes who reads the scientific papers that she likes, but has no independent way of assessing the full depth and breadth of the obstetric literature.
In response to a someone questioning the basis for her self-described expertise, Goer offered this cringe worthy response:
… I have a library of books and a collection of several thousand papers, including books and papers on how to analyze and interpret medical research; and I have been writing and speaking about what the consensus of maternity care research establishes as best promoting safe, healthy birth for over 20 years. That being said, my preeminent credential is illustrated by this anecdote: Penny Simkin was once called on the carpet by an anesthesiologist, irate that she had written a handout listing the potential trade-offs of epidural anesthesia when she was not a doctor (although he did not dispute her accuracy). “What are your credentials?” he demanded. “I can read,” she mildly replied. So can I.
Curiously, though Goer presents herself as an “expert” on the obstetric literature, no real experts agree with her grandiose self-description. She is not called for expert testimony in court cases that turn on the obstetric literature. The government does not invite her to join expert panels on obstetric topics. In fact, the only people who consider Goer an “expert” on the obstetric literature are lay people who have no way to evaluate her self-proclaimed expertise.
Ms. Goer never appears in any venue where she can actually be questioned on her supposed expertise. She knows that her claims would be eviscerated in short order. She just continues to spread misinformation by flattering homebirth sheeple into believing that accepting her nonsense means that they are “thinking.”
I am surprised by this piece, however. In the past, Goer has carefully avoided basing her claims on indefensible propaganda, but this time she goes all in, quoting a comment by the American College of Nurse Midwives and the MANA “study” on their own dismal homebirth death rate that she surely knows is an amalgamation of mistruths, half truths and outright lies. I view this as a sign of her increasing desperation. She knows that the evidence on the increased perinatal/neonatal death rate at homebirth is remarkably robust, has been repeatedly reproduced (including by Judith Rooks, CNM MPH in Oregon showing that PLANNED homebirth with a LICENSED homebirth midwife has a death rate 800% higher than comparable risk hospital birth), and is reflected by a growing number of homebirth deaths in the news. There was a time when her critiques were plausible, even if they were wrong. Now she’s been reduced to relying on drivel produced by her allies, most of whom are poorly educated laypeople such as herself.
But, of course, this has never been about the truth; this is about obscuring the truth.
Goer is painfully honest about her intentions:
Hopefully, I’ve helped to provide a defense for those who may find themselves under attack as a result of the NY Times article.
Because that’s what’s at stake for her and her colleagues, defending themselves and their profits from scientific evidence and expert opinion. Henci Goer makes her livelihood by promoting homebirth; she literally cannot afford to acknowledge the truth of the scientific evidence. The babies who die as a result of homebirth are apparently acceptable casualties of homebirth advocates’ strenuous efforts to protect their incomes.
She argues that the death rate is 53 in 10,000 (like we don’t know that is really 5.3/1000) and not 12.6/1000 that Grunebaum thinks it is. But I had a profound moral conflict about HomeBirth when I thought it was 2.7/1000 . . . It is like she is arguing: yeah it is *really* dangerous, but it isn’t really really dangerous.
Isn’t Grunebaum’s value taken from one of his publications? If so, it has gone through peer review. Her value?
OT – there’s a mom in Texas who suffered a loss at a birth center asking for help on this post:
http://www.skepticalob.com/2014/04/what-are-the-odds-that-the-peer-review-of-texas-homebirth-midwife-gina-phillips-will-be-a-whitewash.html#comment-1880704254
I haven’t heard anything good about the review process here in TX, so anyone who has advice, please jump in!!
OT: anyone know the current (as of 2/28) number of measles cases in the US since the Dec outbreak/s? I am just curious, but the cDC website hasn’t updated since 2/20.
It’ll update on Monday.
Four new measles cases, unconnected to the Disneyland outbreak, have been traced to a Las Vegas restaurant.
http://www.cnn.com/2015/02/27/us/measles-in-nevada/
OT but this is really interesting: Amos Grunebaum instituted an obstetrics safety initiative at his hospital. http://www.wapm.info/Home/FeaturedMember/AGrunebaum/tabid/159/Default.aspx
Here are the results: In a landmark study published in the February 2011 issue of the American Journal of Obstetrics & Gynecology, Dr.Amos Grunebaum reported that obstetric safety initiatives initiated in 2003 at the New York Weill Cornell Medical Center reduced so-called “sentinel events”—such as avoidable deaths and serious injuries—to zero in 2008-09, down from five in 2000. In addition, the safety changes resulted in annual medical malpractice payouts dropping from an average of a $28 million from 2003 to 2006 to $2.6 million a year from 2007 to 2009. With no sentinel events reported in 2008 and 2009, those totals are expected to drop still further.
Among the changes implemented were a uniform oxytocin policy, limiting misoprostol to a non-viable fetus, hiring a safety nurse, implementing team training for all staff and fetal monitoring certification for doctors and nurses. In addition, the labor and delivery unit replaced the unit’s dry-erase whiteboard, which staff used to communicate patients’ progress, with an online status board that was developed in-house, and which can be accessed through any Internet browser.
No paper charting is allowed, both for improved communication and with an eye to leaving a clear legal record in case of a poor medical outcome. The new measures reduced errors and helped ward off unwarranted suits by clearly documenting everything doctors did right in cases where a bad outcome was not their fault. Weill Cornell also hired three physician assistants and a “laborist,” who works full-time, and who works nights and weekends, reducing the time other obstetricians need to be “on call” in their off hours.
The authors concluded that the savings in medical malpractice payments “dwarf the incremental cost of the patient safety program.”
Meanwhile. those twats at MANA won’t even make practice suggestions for their oh-so-professional midwives. Twats.
Look at what they changed because of 5 deaths. FIVE. Such a small number, and yet more than enough reason to strive for better outcomes.
Exciting! Can’t wait to read it.
And here’s where I feel funny saying this because I’m a CNM and I get the feeling I’m “supposed” to see miso as the devil, but- I’ve read a lot about it, and in my initial training environment we induced with it often, and it just does not seem that bad. Right now my hospital doesn’t have an official policy but the culture is to only use miso with a dead fetus, and cervadil is a joke.
Very cool. How does it work with a laborist? Do you get to meet them ahead of time in case your own doctor is off when you go into labor?
The laborist is a hospitalist obgyn, basically, so they only work with inpatients during scheduled shifts. No real opportunity to meet with the laborist staff prior to being an inpatient.
Only if you are in triage before labor and come back and they are on call. That is how I met the doctor that delivered my son : )
Pop quiz: Have the words “improving” and “safety” ever appeared together in any MANA or NARM publication?
It does make it sound as if the poor labourist is actually working 24/7…I assume not, just a very unsocial rota.
The most frustrating thing about this is that almost all of the bad stuff about HB could be fixed with such minimal effort, even without banning HB. But it all comes down to hubris, and because of it, these types won’t allow for the basic things needed to stop (or even slow) the endless flow of disasters.
Henci is a perfect example of this arrogance, and how it limits the NCB crowd to the point where they are either too ignorant, or too unwilling, to share the HB safety info. They are so sure they are right, they are willing to stick their heads in the sand and let deaths pile up. Worse yet, are those that don’t hide, but aggressively continue promoting lies, even when they know better.
Their over confidence leads them to refuse to acknowledge where they belong in the world of maternity care, and leads them to make deadly choices. Because there is a place for the self taught, apprentice based, MW, and her ideological supporters. There is a place for those willing to boldly question the status quo.
But that place is NOT making expert claims on topics they know nothing about, writing entire books of poorly researched lies, refuting factually true claims, and delivering babies with zero restrictions or responsibilities. They overstep what they could actually do well, and head straight into areas where they have no business.
Imagine what the HB stats would look like if these “thought leaders” posed NCB as one choice among many, one way of birthing, instead of the only proper way? If they stopped lying about the facts? If they instead kept fighting, but for true maternal choice, informed consent, respect for birthing women, even for consideration of the “spiritual dimension” of birth?
What if they accepted the numbers, and instead of fighting to hide/deny them, took steps to change the factors making them so high. What if they decided to push to have US HB MWs follow a standard of care, and have strict risk out criteria?
They could easily challenge the current authorities, and demand they do better, while supporting NCB/Hb moms. It would be easy to continue to advocate for NCB, without perpetuating a cult mentality that hurts moms and leads them to make high risk choices.
I repeat- such *little effort* is needed to lower the death toll; even if HB would never be as safe, the gap could be much narrower. Sadly, they won’t do it. They can’t.
Goer makes home birth appear unfairly attacked, and that unfortunately helps the CPM’s gain a lot of sympathy from legislators. In our culture, “midwife” resonates like “mother.” How do we turn that one around?
Henci is a cherry picker for sure. When I read her book “the thinking woman’s guide to birth” it felt a bit off. So I flipped to the FB on pain relief in labour because I know that literature very well. And I was shocked. She gave full credance to old studies with poor methodology that supported the view that epidurals are bad for labour and bad for the baby and ignored all the newer studies with more robust methodology that showed the opposite or neutral effect. I took that book and destroyed it and then left some nasty reviews on Amazon.
She also didn’t bother to update newer editions with the research that ha d come out in the interim. Which is pretty lazy but I guess if nothing comes out that supports your viewpoint you better cling to a bunch of studies for I’m the 1970s and 80s and hope no one checks your refs
I haven’t read the book, but even the name (“The _Thinking_ Woman’s Guide to Birth”) is condescending and judgmental. I guess those of us who haven’t read her book are unthinking, ignorant fools.
Henci Goer claims “we have a study that is accurate,” citing the MANA paper which openly admits that:
“Participation in the project was voluntary, with an estimated 20% to 30% of active CPMs and a substantially lower proportion of CNMs contributing.”
What accurate study?
Hello, Ms Goer: you are citing a self-selected survey. No amount of hand waving will transform it into an “accurate” study.
And even with that, the results are damning. Think of what the study would have shown if reporting had been mandatory.
“I can read” is her credential for evaluating complex scientific research?
I am a medical specialist, have conducted and published original research, evaluated research for grants and assessed trainees’ research. In order to keep up my skills, I go to workshops, courses, journal clubs, conferences – and that gives me a degree of confidence.
This woman can just READ? The hubris!
The most obvious problems with her numbers:
She compares MANA’s numbers, which exclude deaths attributed to congenital abnormalities, to Gruenbaum’s, which do not.
She disparages Gruenbaum’s use of hospital CNMs as a comparison group on the grounds that, “hospital-based midwives would transfer care to an obstetrician when complications arose.” This is a pretty silly excuse, because home birth midwives should also be transferring in case of complications. It’s also a complete red herring, because MANA’s death rates are worse than the death rate for ALL full-term babies born in the hospital.
She also spouts the usual ridiculous excuse that birth certificates do not track planned place of birth. Yup, accidental home births attended by midwives happen all the time! Hidden pregnancies, or accidental out-of-hospital birth due to transportation obstacles or precipitous labor, those are generally not attended.
OT: Did anyone see the article about the Arizona mom whose unvaccinated family developed measles? The kicker to me is her comment: “Yslas-Roach says she “feels horrible” that his daughter was exposed to the measles, adding, “it completely broke my heart. We didn’t do this intentionally.”
WTF? Yes, you did. YOU chose to ignore medical recommendations and keep your kids unvaccinated. How the f*** is that not intentional?
http://www.azcentral.com/story/news/local/arizona/2015/02/26/kearny-mom-speaks-measles/24041541/
How sad is it that I’m reading that, knowing he’s bummed about the measles, but still not entirely sure that he actually learned anything?
That was my take, too. It’s nice that she’s “considering” getting the rubella and mumps vaccines, but why on earth isn’t she running to the doctor as fast as possible to get them!? Wake up, lady. You had a good wake-up call that thankfully wasn’t fatal. Don’t tempt fate again.
“But what are the odds that he’ll get ANOTHER VPD?”- her reasoning probably. (Also why my brother refuses to get renters insurance even though a flood ruined his apartment. Hey, what are the odds that something else will happen. Once one bad thing happens to you then you can’t ever have one happen again!)
My parents’ house was struck by lightning twice in a year. (Well, sort of. Long story. But yeah.)
Getting measles does not reduce the odds of getting mumps. Getting an MMR does.
Ah, it broke her heart And then, if only everyone ELSE had done what they were supposed to do, poor kid wouldn’t have been exposed!
The disgusting woman is still not getting it. Still trying to shift the blame. An uncle had a “severe” reaction to vaccine, so her own mother decided not to vaccinate her and she faithfully followed in mom’s footsteps. Giving the fact that she’s complaining of the “hell” poor she and her poor family went through because people didn’t understand that they weren’t INTENTIONALLY running around exposing people and not, say, the hell Maggie’s family and those who have children too young to vaccinate went through, I’d stake a guess that the severe reaction was a fever that lasted three days. This woman seems unable to rank anyone’s worry higher than her own, fuckingly deserved troubles and I have no reason to think her mother is better.
Yep. The only good part is that a lot of the commenters are calling her out on her poor attempt to shift the blame. Tolerance for anti-vaxxers has definitely waned, at least around that community.
An Uncle had a severe reaction to a vaccine that probably has nothing in common in terms of actual formulation with the one available for her son? I mean, my grandmother had a very bad reaction to penicillin, doesn’t mean that I’m allergic to all antibiotics!
I have a friend whose younger sibling died as an infant shortly after receiving a set of vaccinations. Her (friend’s) mother and the rest of her family are adamant that the vaccines killed the baby. Friend also believes this, but is a nurse, and says that even with that experience, she believes her kids are better off vaccinated than not. She spends an anxious few days following a set, but they are all vaccinated.
Good for her, though that must really suck. I can relate slightly. I grew up in some pretty anti-vax circles, so while I now, as an adult, accept the science behind vaccines and get DD vaccinated as per schedule, I still can’t help but worry for a night or two after she gets them. Totally illogical and unreasonable, but our human minds aren’t always the picture of logic and reason. 😉
It’s definitely a heart vs. head battle, isn’t it? I always worried too.
One of the Facebook comments on the story; absolutely priceless.
“‘I never in a million years thought this would go as far as it has,’ Yslas-Roach says. ‘I’m a believer that if you do not vaccinate your children, you have a responsibility to keep your kids out and away from others, if they’re sick.’
-Goes to disneyland”
This is OT but can we talk about Feminist Breeder’s cancer comments?
These ones?
http://pandce.proboards.com/thread/423737/feminist-breeder-thinks-cancer-school
Yikes. Not even sure they warrant a response. The only thing I could hear when reading it was “Me, me, me!! Look at how horrible MY life is!!!”
Right?! I thought she couldn’t top the strong black woman fiasco, then she’s envying cancer patients.
I certainly didn’t feel envy when my strong Black mother died of cancer.
I hope it’s of some small consolation to you that at least she didn’t have to deal with a hectic schedule like poor, brave FeministBreeder.
The fact that that monumental cunt wouldn’t have that little voice in the back of her head telling her “Hey, saying this will probably make a lot of people feel like I’m telling them their life-threatening problems aren’t actual problems” is amazing. Even if she didn’t mean it, it was out of context, WHATEVER, she should have had that sense of empathy. Ugh. :/
What an awful bitch. A person cannot be that oblivious, it has to be considered deliberate at some point.
The only thing I can think of in response to her is what my grandmother always said–consider the source.
Did you see that someone got a hold of the password for GOMI and posted a threatening message to the blog admin for writing about Gina? http://i.imgur.com/Mvp5TFY.png
How immature can they be?
Oh my God.
Holy shit! D:
Wow, that’s some real feminism right there. /snark
That is horrific, what the hell is wrong with them and how on earth is is ‘feminist’ to threaten another woman?
Strange also because all of the (*ahem*) computer security specialists that I know are very science literate and wouldn’t ordinarily side with someone like TFB.
There’s always the darkweb mercenaries though.
FBI’s cybercrime division is an option.
She’s special isn’t she?
Trust me!
My entire reputation is based on these assumptions which are being torn down by high quality, statistically significant research by experts, but I’m self taught, and I don’t buy it!
You, however, should definitely buy my books, come to my classes and listen to what I say!
Why isn’t she selling used cars?
Apparently, thanks to years of stereotypes warning them and car buying websites allowing them to avoid such things, car shoppers don’t put up with that shit anymore.
If being able to read is all it takes, then why should anyone buy her books, etc.? If they can read her books then surely they could read the sources themselves and don’t need her.
I looked at the comments–Another Liz–is she a regular here? Whoever she is, she wrote an excellent comment. Kind of surprising that it got past the censors—someone (who is not on a work computer) should screenshot it before it goes away.
I put a comment on her site. What do you bet me it’s “awaiting moderation” forever?
Well, betting its awaiting moderation is better than betting on statistical significance of homebirth deaths.
To give credit where it is due, the comment was published. Not responded to, but published.
I have a library full of romance novels, does that make me a expert in sexual dysfunction?
*snorts coffee through sinuses*
Bless you?
It’s what happens when you laugh really hard while drinking coffee. 😉
There are coffee enemas (heaven help us) – perhaps you can market the coffee neti! (/sarcasm) I see riches in your future …
Speaking of coffee enemas, check out Orac’s post yesterday about “the Health Warrior” or whatever her name is, who died of cancer while peddling woo treatments. She was doing something like FIVE coffee enemas A DAY!
The most interesting part of the post is how a bunch of parachuters jumped in with the “You are so mean to do this post right after she died! Her family is grieving and this post is MEEEEEEEN!”
I wish Dr Amy and Orac would put their crap behind them and work together. They have so much in common.
*sigh* If it weren’t for these blasted ethics, I SO could do that.
Repeat after me kiddies “Access to information is not equal to a quality education”
Seriously! I don’t speak Spanish. I took Spanish classes in high school, but never used it outside those classes, so I don’t remember any of the high school Spanish I may have learned at one point. However, I can READ Spanish. Give me any book in Spanish and I will read the crap out of it. Won’t be able to tell you what it was about, but I can read the words. That’s what Ms.Goer’s claim reminds me of.
No doubt. My husband has color chip books galore and I am always looking at all the colors. I know most of the toners used to create the paints even though the system he uses is German so they are all German words. I have used the formula retrieval system online more times than I can count. So yeah, I can read and even quote parts of the literature that helps my husband do his job. That doesn’t make me proficient in mobile auto body paint repair. I can’t use the airbrush sprayer. I don’t give attention to detail the same way because I don’t know what details I should be looking for and while I could theoretically tell someone the steps involved with fixing the job at hand, I have little experience with the process that can cause a bad outcome (fish eyes, poor adhesion, less than ideal color match, ect).
“I have a library of books and a collection of several thousand papers, including books and papers on how to analyze and interpret medical research; and I have been writing and speaking about what the consensus of maternity care research establishes as best promoting safe, healthy birth for over 20 years.”
Notice she never cops to READING those books or papers. I have access to a massive library of science fiction and fantasy thanks to my husband and in-laws, but you don’t see me writing about how to become a sci-fi author phenom…..
And my dozen eggs in the fridge doesn’t make me a chicken…
OT but not really. This is a great bit from Jimmy Kimmel on vaccines, but the best part comes after his intro:
A Message for the Anti-Vaccine Movement: http://youtu.be/QgpfNScEd3M
I was just going to post this. I loved it!
Fabulous!!
1. Go to ANY homebirthing blog. ANY of them.
2. Take a shot when you see the words “research”, “personal choice”, and “uncomfortable”.
3. Die of alcohol poisoning.
Oooo, she has a library of books and thousands of papers. I’m wondering, does she think that Amos Grenebaum doesn’t?
I like how she’s an “International Speaker”. Which means she presented a workshop at a Midwifery Today conference at some German Hyatt.
Or maybe she just went to Canada and Mexico a couple times.
Yeah, what about the people who have the massive library PLUS up to 12 years of post grad education on these subjects? They are out there! And they disagree with Ms Self Taught!
“I can read.” Does that mean that if she needed surgery, she would be comfortable with someone who had read about anesthesia administering it?
Penny “don’t clamp the cord, you are robbing the baby of it’s blood” Simkin. If you don’t believe that these women are birth junkies, take a doula or birth class from her. She is the most dramatic woman. She was the one who suggested singing a song to your belly because once the baby is born if it’s having a crying fit, singing the song will make the baby stop and pay attention. There was a baby who was born not breathing and the dad and midwife were singing trying to get the baby to “wake up”. The parents had taken Penny’s class. The midwife is colleagues with Simkin,
This makes me think of the TV commercial (I think maybe for an insurance company?) with the older women and the wall of photos, and when one of them says to the other, “I unfriend you!” the response is “That’s not how it works! That’s not how any of this works!”
I love that commercial!!
I do too! It’s funny every single time!
The esurance commercials – there’s also one with Candy Crush. I love them, even though I will never use esurance. 😀
https://www.youtube.com/watch?v=K5fn087Jk4I
She probably thinks since all those people have to still do CEs that they must be really stupid.
Plus hundreds of hours spent on the job, hands-on patient care, real world scenarios with many other highly educated, formally trained, very experienced health care professionals to educate, enlighten, demonstrate and TEACH you on the job all the nuances and critical thinking that go into patient care in the most mundane to the most complicated cases. All that knowledge is only valuable when you put it to good use and you can only do that properly when you work with and learn from others.
And Amos Grunebaum actually wrote some of his papers….
I think a better one is that Amos Grunebaum actually wrote some of the papers that she has in her extensive library…
But since he was busy writing them, he probably didn’t have the time to read Ina May extensively!
That is so sad and it makes me angry. I know the crunchies will not listen to the experts, but that self-appointed illusionist. It makes me angry that a magazine is willing to publish that crap.
I’ve never been to that site. Are the comments going to shake out if someone calls her on her “facts?”
Science and Sensibility has yet to delete any of my comments. They have closed the comments, but they generally don’t delete them.
Maybe they changed after that debacle where the lead author of one of the papers they were discussing came into the comments to correct some misunderstandings and was getting deleted, then when it was pointed out that they were deleting the comments they reinstated them (all of them? not sure?) but left some of the other comments deleted and nothing much made sense after that.
I think that also happened to Gilbert grant (epidural without guilt)
They moderate comments and only post what they want.
It confirms already held biases, which is also the convenient reason why every white gun nut shooting up a crowd was a false flag operation but every brown guy doing it is a terrorist.
Does anyone watch The Americans? Reminds me of Stan saying how people just love to be told over and over that they are right.
And they get to hear that while under the assumption that it’s being told to them by rational and intelligent people.
Just sad. Her references are even worse.
I like how she glossed right over the awful death rate of the MANA paper by insisting it wasn’t as high as Grunebaum said, even though her made up number was still almost twice that of hospital midwives, as reported by Grunebaum. See! 53 isn’t as bad as 126, so homebirth is safe!
She bets it’s not even statistically significant.
“bets”
Snort.
Sigh. One does not simply bet that a number is not statistically significant. One tests it.
I can see Boromir making this point.
Oh, good. I was hoping I got the reference right…
Would you have a moment to address her assumptions about the newborn death rates of lay midwives and hospital based CNMs?