Last week the healthcare news was dominated by a new study investigating treatment of high blood pressure:
The NIH was so eager to get the news out that it decided to stop the study early, evaluate the preliminary results and make recommendations to doctors…
Preliminary results showed a third fewer cardiac events such as heart attack, stroke, and heart failure and a quarter fewer deaths in those with the lower blood pressure, according to the NIH.
The study was ended early because the number of lives saved was so impressive that investigators felt it would be unethical to keep that information to themselves for an additional year. Many might die if patients and their doctors were unaware of the new data.
Contrast that with Melissa Cheyney’s acknowledgement of the hideous death rate at home VBAC also known as HBAC (homebirth after Cesarean) in the MANA Stats study. The data was collected between 2004-2009 and the terrible results were known in 2010. Cheyney, the Director of Research for the Midwives Alliance of North America (MANA), and MANA executives have known for 5 YEARS that home VBAC kills babies who didn’t have to die, but they hid that information and repeatedly acted as if it did not exist.
[pullquote align=”right” color=”#e85b5b”]When homebirth midwives weigh profit against infant lives, profit wins and babies die.[/pullquote]
I wrote recently that Cheyney had acknowledged the high death toll of home VBAC.
She didn’t merely acknowledge that the death toll at home VBAC is 330% higher than hospital VBAC, she admitted that she expected it:
This is expected in a setting where decision-to-cesarean delivery time in the event of a uterine rupture is presumably greater than the 18- to 30-minute interval at which evidence suggests neonatal risk increases.
Cheyney amplified her admission in a piece for the Lamaze blog Science and Sensibility:
…[I]t is also important to think about the likelihood of an intrapartum transfer, distance from the hospital, and a variety of other factors that are unique to each person. I actually think that looking at the cases that did not have good outcomes can be very informative. They help us to see who might be a reasonable candidate for an HBAC and who might not be. For example, in our dataset there were five deaths overall—three during labor … So for the combined intrapartum and neonatal mortality rate, the total is 4.75 out of 1000.
When we look at these cases more closely, we see that two of the cases were very likely uterine ruptures, based on the heart tone patterns that the midwife was able to distinguish at home. The three other ones were deaths that were totally unrelated to the TOLAC [trial of labor after Cesarean] status of the mother. One involved known risk factors related to giving birth to a twin, the second one was a surprise breech with an entrapped head, and the third one was a cord prolapse.
In other words, not only is HBAC dangerous, but twins and breech are NOT variations of normal, they are potentially deadly.
Indeed, Cheyney admits that “trusting birth” isn’t enough:
I think these findings have ramifications for everyone who’s considering a home birth, not just women who are considering a home birth after a cesarean, because one of the most interesting things that we’ve found is that that risk within our sample varies considerably by obstetric history and parity…
But Cheyney has known about these findings since 2010 (I first heard leaks of the findings in early 2011). Unlike the NIH blood pressure study that was ended early to save lives, Cheyney and MANA hid their data, and let countless additional babies die. They did not share the information with the public until August 2015.
In February 2014, I asked Cheyney in an open letter, how she could sleep at night knowing that she was hiding and misrepresenting the death rate at homebirth. I warned her:
You are going to lose this battle to hide accurate information from American women. Maybe not in the near future, but definitely in the not too distant future. It is inevitable that people are going to ask MANA why you hid those death rates in the first place…
Cheyney lost the battle to hide the VBAC death rates and finally acknowledged them. In so doing she provided not one, but two valuable pieces of information:
1. Cheyney, MANA and its executives hid critical information from women for 5 years, depriving them of the opportunity to make informed decisions and letting babies die preventable deaths as a result.
2. Cheyney, MANA and its executives demonstrated that they have no compunction about misleading women in order to increase their employment opportunities and profits. They hid the death rate in order to convince women that home VBAC was safe, so they could attend home VBACs. If they can hide deaths at home VBAC for 5 years, we cannot trust anything they say about the safety of homebirth. Indeed, the MANA Stats paper from which the VBAC deaths were abstracted actually shows that homebirth itself has a death rate 450% higher than comparable risk hospital birth, but Cheyney and MANA lied about that in the paper itself and in comments they made on their website.
I told everyone for the last 5 years that Melissa Cheyney and MANA were aware of the hideous death rate at homebirth and were hiding that information. Now they’re admitting it, but that doesn’t mean that they’ve stopped hiding deaths and misleading women.
It only means that you can never trust them to tell you the truth. When they weigh profit against infant lives, profit wins and babies die.
What surprises me about these nutties… if they actually care so little about the babies why get pregnant at all? To endure nine months of pregnancy only to knowingly loose the baby in the final effort, this apart from being questionable from the moral point of view, is simply irrational. Just don’t get pregnant any more and you will have no more c-sections. 100% warranty. And nobody will bully you at no hospital. Just that simple.
I’m not going to give Melissa Cheyney any credit for this. It’s far too little, far too late. She has known about this for years, yet willfully misled the public. Her decision to focus on the low intervention rates at home birth has cost lives. Her selective release and interpretation of home birth data is patently unethical. Cheyney should face professional consequences for her behavior.
Henci Goer’s comment on the Science and Sensibility blog states that increased risk of newborn death is worth it, because there’s a higher rate of vaginal birth in OOH settings. WHO ARE THESE PEOPLE!!??!!
http://www.scienceandsensibility.org/home-vbac-safety/#comments
“I would add, too, that the increased likelihood of vaginal birth at home should weigh into the equation in this population. Women with no prior vaginal birth may be at slightly increased risk of perinatal loss with planned HBAC compared with women planning hospital VBAC, but they also may be much more likely to birth vaginally, thereby avoiding the serious and life-threatening risks …” Henci Goer
What the HELL is she thinking??? You ask any rational pregnant woman (no, those two words are not mutually exclusive) if she would do something that knowingly increases the risk of DEATH of her baby and she will look at you like you asked her to BASE jump while mainlining heroin and chugging Everclear.
I do not understand the cult of the almighty vag. How can anyone place a higher priority on how a baby is born than whether or not it survives the process unscathed?
I suppose it depends on which you want more: a birth or a (live) baby. I am thankful all the women I’ve known have preferred the live baby. I seriously wouldn’t know what to say to anyone else.
I think it’s more that they’re aware bad things happen, but don’t imagine that those bad things will happen to them.
But do the women buying into this line of thinking believe the risk is real? Their view seems to be that it’s small; they are led to believe that most perils can either be managed at home by their ‘midwife’ or she will call for help in time for everyone to be saved.
Particularly if you are a white, well educated and affluent woman-as many home birthers are-life’s essential unfairness has likely operated entirely in your favour your whole life. Possibly to the point you actually don’t recognise it. Why would that suddenly stop?
Very religious people seem to take the view that whatever happens is God’s will, and that tragedy is therefore a trial to be borne.
What do you expect. She’s in a cult.
Sooo…let me see if I have this right. Goer’s position is that vaginal birth reduces serious and life-threatening risks, so it’s acceptable to have more deaths in order to achieve a reduction in these risks? And we know the risks are reduced despite the increased deaths because…unicorns and sparkles or something?
The word “risk.” I do not think it means what she thinks it means.
Add to all of that, even if your kid doesn’t die at an HBAC attempt, emergency screaming-ambulance CS involves more risk to both parties than a planned, relaxed, non-emergency CS…
I think it’s not HBAC vs cesarean section, but HBAC vs VBAC in a hospital. Henci is saying that women will find the risk of HBAC acceptable over VBAC in a hospital, because having a HBAC increases the odds of a vaginal birth.
I think midwives spend too much time minimizing the REAL risks of VBAC at home – and their complete impotence in dealing with an emergency such as uterine rupture in an out-of-hospital environment, and clients shopping for VBAC options really believe that there really is no increased risk. “Uterine rupture is rare, it is rarely catastrophic, midwives monitor closely and transport if there is *any* sign of trouble, and we’re *trained* in handling complications and emergencies.” Isn’t that the spiel? Isn’t this what Cheyney is still saying … “as long as midwives monitor labor progress and heart tones properly , and do the right thing prenatally – like have an ultrasound, then there really isn’t a significant risk and HBAC is OK.” Cheyney et al are STILL saying HBAC is OK. Still. Whatever.
So I guess this is a milestone for these nut jobs. They’re at a point of admitting that there is an increased risk, but they’re saying that risk (of a baby dying) isn’t really that big of a deal. At least Goer is.
“I actually think that looking at the cases that did not have good outcomes can be very informative. They help us to see who might be a reasonable candidate for an HBAC and who might not be.”
Is this woman really SO FAR BEHIND the quality and safety culture in health care? She is only just discovering about learning from deaths?
Word.
OT: I am taking some classes at a community college because my BA in literature was earned in Europe and I don’t have ‘credits’ in mathsy, sciencey or political subjects. in order for my degree to be accepted here I have to brush up on subjects I haven’t studied since high school.
atm I’m taking this international comparative politics class and the subject of health outcomes and infant mortality came up yesterday when another student was comparing Cuban IM rates to ours and expressed pretty passionate moral outrage about the alleged disparity.. I was sure the instructor was going to tell my classmate we need to be wary of reported statistics and maybe talk about, as I have read here, how different countries compile their stats and have differing definitions of infant/neonatal death but instead he agreed with the student and tsk tsked about our abysmal rates in the US! I raised my hand and questioned the veracity of the stats my classmate cited and asked the instructor if he knew anything about the conflation of perinatal/neonatal and infant mortality and that the US counts premature babies who die as deaths while other countries won’t spend resources on very sick pre-term babies and exclude them from their data but I got shut down very quickly and he insisted that their results have been verified and found to be ‘completely accurate’ and their IMR is definitely lower than ours. He said this was because they have more doctors per thousand citizens while our physicians cost so much more but deliver worse results.. He was very testy with me.. I know I’m risking aggravating the ‘professor’ but I’m trying to gather some evidence that cuba and other countries measure their rates differently and that if we used the same criteria for determining an infant death it would show that our doctors are actually doing an outstanding job. I’ve found a couple studies/articles that explain it quite well (though most things I’ve read accept their claim of four point something per 1000 at face value) but I would like to take in as much compelling evidence as I can to class so he can’t dismiss me completely. So if any of you could point me in the right direction I would be grateful
Sounds like a great research paper for the class….. This sort of thing is VERY tricky, and yes, your argument has all the merit, but seriously, you’re not going to win with this guy, and what do you care? Just ace your class, and assign that guy to your ‘obnoxious idiot’ file.
Have you seen this one?
http://www.bmj.com/content/344/bmj.e746
So, I was surfing around, trying to see what Melissa Cheyney is up to these days, and 1) I can’t find any sign that she’s doing midwifery any more and 2) her so-called Reproductive Health Lab seems to have disappeared off the web and off of Oregon State University’s website. Does this mean she’s backing off her pro-midwifery stance? I remember how she guarded the Manastats when everyone wanted to see them, even when she was the chair of the Midwifery Board in Oregon. Hmmmmm…. Is she perhaps planning to re-cast herself as a midwifery critic?
MANA Stats:
“Funding.
This study receives
ongoing internal funding from the Midwives Alliance Board of
Directors, and varying sources of external funding,
including the Foundation for the Advancement of
Midwifery, Transforming Birth Fund, other foundations, and
federal agencies.”
From reading the “MANA Stats paper”, grad students were the data cleaners (“data doulas” as they called them). So are OSU students still coordinating the project data collection?
If she does, it will solely be to save her own sorry ass.
Dr. Cheney often collaborates with Dr. Paul Burcher who is Associate Professor of Bioethics at SUNY Albany. I wonder how in the hell he justifies sitting on that data for all that time…..
The same way Athene Donald throws all her support behind Tim Hunt. It’s a bad thing to do unless it’s one of my friends doing it, at which point I’ll just scream “Witchhunt!”
Albany Medical College, which is a private medical school and not affiliated.
SUNY Albany has its fair share of problematic professors, like the one running a study putting veterans through Scientology “detox” protocols, but Burcher isn’t one of them.
Thank you, CHM… I found this reply oddly comforting.
A “surprise breech” HBAC. A twin HBAC. Who the hell do these midwives think they are, Jesus? And can we please stop with this “surprise breech” crap. They’re not fooling anyone. Own your stupid, stupid decision.
Narcissists. They think they’re invincible. They are like drug addicts who will do anything to get that high. The riskier the situation, the better. Sadly, unlike drug addicts, they aren’t the ones who suffer in the end. It is the families who have to bury their babies; the babies with brain damage, the ones who will require lifelong care.
If only midwives in this country were held accountable.
I could have spit reading that part. I VBAC twins if mom desires. In a hospital, with monitoring and emergency c/s available if needed.
It’s kind of interesting that I’ve never heard an OB use the term “surprise breech.” Ever.
I remember with our first, we had an appt with not-our-regular-doctor in the same practice to meet him, so that if we were in the situation where he was on-call, we would know him.
He took one look at my wife and a short palpation and said, “This baby is breech, isn’t it?” Yep. He could tell by feeling it, and it wasn’t hard.
Now with the other not-our-regular-doctor was younger, and when we saw her and told her the baby was breech, she was like, “Let’s double check”, and ran a quick US to confirm it.
And then when my wife’s water broke and we went to the hospital, they brought in portable US to confirm he was still breech before the c-section.
No surprises there.
It shouldn’t be a surprise. I’ve had much the same thing happen to me. The first thing the examiner should do is look at the entire woman. Lots of clues there [I don’t want to write an essay]. The shape of the abdomen, the size, whether a woman is carrying high or low, can give the examiner, if not a lot of information, can raise a lot of questions that need to be answered. Is the woman unusually short? Foot size [can be indicative of pelvic size occasionally], scars, edema, mask of pregnancy…so far, I haven’t even touched the woman. Leopold’s Maneuvers, done properly, should alert the examiner to the possibility of malpresentation, or possible multiple pregnancy, [especially if dates and size do not correlate]. Assess for poly- or oligohydramnios and be aware of the implications…
I trained before ultrasound was invented, and I learned to trust my hands and my instincts. It’s great to be able to get confirmation with technology, but the competent midwife can know when she needs to get it, sometimes as soon as the patient walks in the door, if she’s got her eyes open.
Yep. My OB now palpates (do I have the correct word?) my uterus at each appointment to confirm that little guy is still heads-down. It seems to me like most midwives would also be trained in that, at the very least.
My doc always does Leopolds maneuvers and is so skilled she can often guess the weight of the baby by feel pretty accurately at term. I think it is a shame it’s such a lost skill.
In both my pregnancies my skinny babies have given the false impression of being breech when they were cephalic, because they both had bony little bottoms that fooled the OBs and Midwives into thinking that they were feeling heads.
Palpation is not 100% accurate.
However, when I said “but I’m feeling all the kicks at the top” and the FH was audible lower down, it was apparent that the initial impression was wrong, and US confirmed cephalic positions for us.
That’s a good point. I should have clarified that we’ve also had 2 u/s in the past 3 weeks showing that little guy is head down – my OB palpates more for confirmation that his position from them hasn’t changed.
I could even tell by feeling my own belly the exact position of my own baby, usually ROP (or LOP, I can’t remember anymore what she preferred). I knew with enough certainty to tell my doc she was OP almost all the time and before she turned vertex I could always easily feel she was breech. I think these midwives don’t even try to feel.
I’m impressed! I could never tell at all. I thought both my babies felt transverse because I could feel a lump on either side of my abdomen but they were always head down according to U/S and when doctor palpated. Don’t know what I was feeling!
I would never expect every mom to be abLE to feel. I have training in OB including palpating for baby’s position. My point is that these midwives (not patients) ought to be able to do that too and if they can’t they shouldn’t be forgoing routine prenatal ultrasound. Also, when a woman came on the floor in labor we always used the bedside ultrasound to quickly make sure head was down. Very easy to do and took 30 seconds, if that. My doctors office has a handheld US that she uses every visit so a “surprise breech” just wouldn’t be an issue. Midwives could use this tool as well but choose not to. They are surprised by breech babies because they don’t look.
I’m amazed at how small and portable US machines can be these days. They brought one in yesterday to guide my IUD insertion (lordy, that was painful), and it was so dainty!
I think this is the most important point. Midwives claim to be able to do things that OBs can do, and they can do it without all those evil nasty interventions, and are supposed to be great in the old-fashioned techniques like how to deliver breech babies. Yet here is an example where OBs even without technology can do things where midwives fail.
So what CAN they do?
“So what CAN they do?”
Kill babies that didn’t have to die (and then pretend it wasn’t their fault)?
Hold the space, silly.
Knit.
Knit?
Spout affirmations. Spray essential oils. Discourage Mom from calling for help. Knit.
Ooooo she has a vscan? Those things are fantastic. Also quite pricey. My office can’t afford one but they’ll be all over the place within 10 years, I’m sure.
Yes and it’s awesome! Our family practice does a lot of OB so it was worth the cost for our office. On days I work there, I sometimes sneak off to an exam room to have a quick peek and my current uterine tenant. I wish I had one at home!!
Just think if you were paid in cash for every birth and never had to pay for malpractice? Might be easier to pay for, I would think.
Yes, I could always tell exactly in what position both my babies were lying.
With my twins, it was tough for me to tell, but I definitely felt it when one managed to turn a total 180 about 2 days before they were born. That felt weird. And since we had an idea of how he was facing due to a u/s shortly before that, I had a reasonable guess as to which way he was facing after.
Sorry, I read your Nom de Net as FEDEX MD, and wondered if FedEx was now employing doctors…to deliver packages…
Believe me, I can thoroughly understand your choice of moniker.
I’m not sure CPMs are even properly taught Leopold’s Maneuvers. I must confess that this is one of the downsides of easy access to ultrasound . When the only alternative was X-ray, which no one wanted to use if avoidable, one’s hands became very skilled. Those skills [like doing vaginal breech extractions] are vanishing because there are better options available. But I contend they are necessary skills for all that.
Does foot size really relate to pelvis size? Was told today during a debrief that I most likely have a pelvis unsuited for childbirth as my six pound nine ounce son was in the optimal position by the time I tried pushing him out and he didn’t descend, even with the assistance of forceps and my little (for my height) feet were commented on at the time but I just had it down as an old wives tale.
Amusingly enough I’ve already had one “friend” tell me that I should try a hbac or a water birth next because “your body doesn’t grow a baby it can’t birth….” and it’s just the patriarchy trying to stop me doing womanly things (whatever they are). Apparently wanting a repeat section which I wanted for any subsequent babies even before today is letting down the sisterhood.
I mean, I have a pretty wide pelvis but tiny feet, but I don’t know if that makes me weird haha
This “sister” fully supports your repeat section if that’s what you want. 🙂
I have size 7 feet and have had 10 and 9 lb babies easily!
“your body doesn’t grow a baby it can’t birth….” Well, a C-section is a birth, so that’s technically true!
This was the best I could find:
http://www.ncbi.nlm.nih.gov/pubmed/21895610
This “your body won’t grow a baby it can’t birth” totally neglects genetics (of the father).
Another way NCB ideology completely sidelines the fathers.
If you are of average height, but wear a very small shoe size, it MAY be a HINT that your pelvis is also small — and it’s a good idea to check out, but there is no absolute, direct correlation. Quite a few things which raise a “!” in one’s examination prove to be completely innocuous. It is just the off chance…once in a while one of these “!” moments can be significant.
Foot size, like wrist size, can be an indicator that you really are big or small boned. It isn’t a perfect correlation, but it can be a helpful pointer to investigate further.
I’m five feet tall with UK size 2 feet. The general consensus was that whatever the opposite of childbearing hips are, that’s what I have.
Did the debrief help at all? I know you had been dreading it.
It sounds like genuine CPD, which means that there wasn’t really anything that could have changed the outcome.
It did help. I nearly blacked out in the car park with nerves but took several deep breaths, promised myself a trip to Paperchase and forced myself inside. They were all really nice, went over everything that had happened and weirdly enough having someone describe in detail what actually happened physically helped me separate that from what I experienced mentally which is a very good thing.
They also went over options for another pregnancy, pointing out stuff I hadn’t thought of, like the need to plan for pre-term labour just in case and said that if I still felt I would need a general anesthetic that absolutely would be my choice and that I wouldn’t have a problem getting it based on my history but in the same breath they did try and sell the benefits of being conscious including an earlier release from hospital and getting to see the baby being born so not convinced we are totally in agreement there but not a problem for today.
I do have small for my size (5’8) feet and slender wrists/fingers but it never crossed my mind that there might be an issue with my pelvis. Wish I’d got a pound from everyone who has told me since puberty that I have “childbearing” hips, although I suppose they are pretty good to balance him on now so at least that cloud has a silver lining.
I’m glad that the meeting helped and that your wishes were respected.
Talking about the risks/benefits of GA vs regional anaesthetic probably isn’t so much about trying to change your mind, so much as making sure you’re fully advised of the pros and cons. The recent Supreme Court decision means that you have to be informed more thoroughly about all treatment options and their risks.
I’m glad you were able to relax with stationary afterwards!
Paper chase is, unfortunately, a very rare treat, I find it far too easy to spend money there.
I have big feet and tiny wrists. I must be a mutant. Still waiting on my powers, though.
Wrist size, really? Interesting. I can’t even wear adult watches. Back before cell phones, when you actually needed watches, I wore a plastic Thomas the Tank Engine watch for years. And my feet are small, though not so small as yours (UK size 4 I think). Thank you for alerting me to yet another reason I’m glad I chose a c-section.
Those are officially Cinderella feet.
Well, I’m part of the sisterhood, and I’m all for your getting the repeat section you want. It’s what I would choose too.
They used to say that ‘ponies don’t have elephants’ which back in the day probably really meant ‘ponies don’t survive birthing elephants’.
But Antigonos – you’re talking about CLINICAL skills. These people aren’t clinicians, they’re childbirth entertainers.
“No surprises there.” – well, of course. Your doctors had no financial incentive to ‘not see’ breech.
Some MDs here have reported attending a labor where the baby turned breech during labor but it’s SUPER rare. IIRC for 1 baby they had broof that the baby turned breech, as they used a scalp clip at the beginning of labor. But yeah, these random “surprise” breeches at home are not so random…
I have only seen it in twin births, and after the birth of the first twin.
Well, you know, if you don’t do any ultrasounds, then the baby won’t be breech. Unless its a surprise.
The only time I believe it’s a real “surprise breech at home) is when they transfer after the discovery, but before there’s a critical emergency.
Ah, if only all the “surprise breech at home” transfers were transferred BEFORE the critical emergency. Too often it’s the here’s the train wreck, fix it approach.
Here’s a “surprise breech” from my local birth center. But don’t worry, they’re experts in breech birth even though they can’t even diagnose it and aren’t legally allowed to attend except by accident.
How can they have “extensive training” in breech birth if they’re never allowed to do it (except for the “surprise” ones)?
Silly, Doc! You just never check for breech before birth and then you get a decent set of practice on the unfortunate moms who don’t even get a chance to decide if they want to risk an even higher chance of perinatal death.
You and your ridiculous belief in patient autonomy…..
They were highly trained with a master’s degree through Google University.
Let me guess: this “Extensive Training” of which they speak consists of a weekend seminar in the Hamptons and a YouTube video.
We never attend a breech birth intentionally, which is why we intentionally don’t check to see whether the baby is breech.
In other words, four of the five babies died from complications that should have been known (2 uterine ruptures after known CS; “surprise” breech, and twin delivery) and the fifth baby died from a prolapsed cord which would probably be survivable if in a hospital with monitoring.
Yes. Not only are chances of baby surviving the rupture detected by awesome MANA midwives at home zero, babies are at risk of dying preventable deaths from other causes too.
But she boasts about success rates and avoiding CS. Here is a fictional quote that mimics their psychopathic conclusions based on real numbers from this study:
“Women who suffer uterine rupture at home with MANA qualified midwives have 100% success rate when it comes to VBAC.”
Because those babies that died in that study were, by the time real medical help became available, so long gone that no one even attempted to save them with a CS. 🙁
Well, except those mothers whose pelvis just plain can’t deliver a baby. Those lucky ducks get an emergency CS and a dead baby.