Are homebirth advocates as stupid as Melissa Cheyney and MANA imagine?

Dictionary definition of word stupid

Melissa Cheyney is the Donald Trump of homebirth midwifery. Both think they can trick their followers and get away with it.

Trump has nothing on Cheyney and the Midwives Alliance of North America (MANA) when it comes to treating their followers with contempt. They appear to think that their followers are both stupid and gullible.

The only thing that is more amazing than their contempt is the fact that it is justified. It doesn’t matter how often Cheyney and MANA (or Trump) obfuscate, their followers slurp it up and then lick the floor looking for more.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]In a more than 3000 word piece ostensibly explaining the relative risks of homebirth, Melissa Cheyney refuses to tell women the actual risks.[/pullquote]

Last week I wrote Cheyney and MANA have finally acknowledged the hideous homebirth death rates that they’ve been hiding for years. The paper is Perspectives on risk: Assessment of risk profiles and outcomes among women planning community birth in the United States published in Birth: Issues in Perinatal Care, the journal owned by Lamaze International.

How hideous are they?

IMG_2167

As you can see, in every category — with risks or without — homebirth increases the risk of fetal/neonatal death substantially and often enormously.

Even uncomplicated births to women who have given birth before are 3X more deadly than hospital birth; first births are 8.8X more deadly. It only gets worse from there, culminating in breech homebirths that are 56X more deadly than a planned C-section.

The REAL risks are almost certainly higher because these risks are based on a small subset of MANA members who voluntarily reported their outcomes.

So Cheyney and MANA have publicly acknowledged their hideous death rates, but — and this is the truly astounding part — they have so little respect for the intelligence of homebirth advocates that they think they can hide these death rates from them.

MANA has published Understanding Relative Risks In The Community Birth Setting: An Interview With Researcher Melissa Cheyney. There is not a single number in the piece. In a more than 3000 word piece ostensibly about the relative risks of homebirth, Melissa Cheyney refuses to tell women the actual risks.

Instead, she attempts to baffle them with bullshit.

Following the tactics of Trump, the piece starts with a brazen effort at misdirection:

Community birth (planned home and birth center births) has been demonstrated to be a safe option for low-risk women.

Yes, but NEVER in the US.

There has never been a single study — not even one — that has showed American homebirth to be as safe as comparable risk hospital birth.

According to Cheyney:

We started with the premise that given the larger literature on planned home and birth center births with trained midwives in high-resource countries, home birth clearly can be safe and for some outcomes safer than hospital births for a certain segment of the population. The Dutch, UK, and Canadian studies have clearly shown us this.

That sounds so familiar. It’s almost exactly what I wrote in my New York Times Op-Ed on homebirth Why is American Home Birth So Dangerous.

…[T]here are places in the world where home birth is relatively safe, like the Netherlands, where it is popular at 16 percent of births. And in Canada, where it appears safest of all, several studies have demonstrated that in carefully selected populations, there is no difference between the number of babies who die at home or in the hospital.

In contrast, home birth in the United States is dangerous…

According to Cheyney:

This caused us to question whether we were asking the right questions. Instead of asking, is home birth safe?, we argued that we should be asking, safe for whom?, under what circumstances?, and using whose definition of safe? This study was born out of a commitment to maternal autonomy and informed, shared decision making.

A commitment to informed decision making? How can American women be informed if Cheyney refuses to tell them the actual risks?

Instead:

I would group findings into three categories.

For example:

…[T]here is a third category, which was associated with much higher than anticipated fetal and neonatal mortality and morbidity: women presenting with a breech infant, multiparous women with a history of cesarean but no vaginal birth, and preeclampsia. The breech and preeclampsia findings were not surprising to us, but one of the outcomes we are really grappling with is the risk associated with a labor after cesarean in the community setting when there has been no previous vaginal birth. That is higher risk than we anticipated going into the study.

How much higher? Cheyney won’t say and then offers this:

The practitioner will always need to nuance these findings in their discussions with an individual family. Practitioners can begin by giving families a broad sense of the risk landscape. But then the conversation will have to narrow back in, not only to the mother’s individual risk profile, but also to her value system. It is her body, and until the baby is born, she has full autonomy in decision making. She will need to make choices about her care that fit with her worldview and her value system, because she is the one who will live in that body and raise that baby afterwards.

But how can she make an informed decision if she doesn’t know the actual risks?

My favorite quote, though, is this one:

…[W]hat studies like this do is they offer us the opportunity to be self-critical and reflective. They enable us to turn the lens inward and look at our practice as midwives and say, “Where do we need to improve?”

That’s hilarious — or it would be if American homebirth midwives weren’t presiding over so many deaths.

Cheyney’s study shows beyond any doubt that American homebirth midwives are grossly undereducated, undertrained and deadly. American homebirth is not safe and can never be safe until we abolish the second, inferior class of midwives known certified professional midwives (CPMs). We must mandate that — as in The Netherlands, the UK and Canada — no one should be allowed to call herself a midwife unless she meets the international standards of midwifery.

Only the stupid and the gullible could draw any other conclusion. So the only question that remains is whether American homebirth advocates are that stupid and that gullible.

  • RudyTooty

    Stupid. Stupid?

    Gullible? Brainwashed?

    Bias-confirmed?

    A whole bunch of people buy into this type of thinking.

    “…no one should be allowed to call herself a midwife unless she meets the international standards of midwifery.”

    You are aware that the ACNM believes that enforcing MERA guidelines fulfills the International Confederation of Midwives standards for midwifery?

    And that these guidelines are woefully insufficient.

    I think it requires 50 hours of CEUs in whatever NARM or MEAC Accredited hogwash (crystal therapy for hemorrhoids, essential oil postpartum hemorrhage first aid) on top of the CPM for someone to meet these standards.

    ACNM supports this.

    http://www.midwife.org/US-MERA

    Are they stupid, too?

    Or are they just not paying attention?

    Or do they just want to believe in magical beautiful empowering healing homebirth?

  • Vulcan Has No Moon

    “Trump has nothing on Cheyney and the Midwives Alliance of North America (MANA) when it comes to treating their followers with contempt. They appear to think that their followers are both stupid and gullible.

    https://uploads.disquscdn.com/images/00a540da468488a25ffc413e2ace9a856c332b7006a15340495988c223695e65.gif

    https://s-media-cache-ak0.pinimg.com/236x/c4/64/ed/c464ed8f58452867ebca66942ad980ad.jpg

  • Amazed

    I’d love to see a measure they seem to have left out: the arrangement of midwife’s payment. How many demanded full payment in advance? How many contracted partial payment before and after their client gave birth? How many would have lost the second installment if the client was transferred? And how this transfer/transfer-should-have-been corresponds to the number of VBACs, pre-eclamptic mothers, breech, multiples, and so on?

    Pity that they left this part out, eh?

    • swbarnes2

      The earlier MANA paper had some stats on that…they had 401 newborns for whom the 5 minute Apgar score is missing. Number of babies whose method of payment was undocumented? 7.

      There’s no breakdown on how payments were made, just whether it was self pay, or private insurance, or government insurance

      • Amazed

        I remember how impressed I was that the most well documented measure was payment. Says a lot, methinks.

  • Sheven

    Midwifery and big tobacco: two industries that should have nothing in common, but do.

  • EllenL

    The word “relative” is the tipoff that someone is trying to minimize the seriousness of a situation. In the context of homebirth, Relative Risk
    means “but it won’t happen to you.”

    Here’s the rub: it’s going to happen to someone, and it’s just as likely to be you.

    • Gene

      The chance of a bad outcome is zero until it happens to you…

      • Amazed

        There’s this poster on Gavin’s mom’s page who keeps asking questions about safety because she’s condsidering a homebith with CNMs who she feels are giving her some great information. The rub is, she didn’t understand why deaths before labour are included in some of the studies. What info are they feeding her?

        She asks for info and then promptly dismisses it because she’s slender and low-risk, according to her. She keeps talking about unnecessary interventions and miwifery care without acknowledging even once that Gavin died because necessary interventions were avoided in midwifery care. She didn’t even express sympathy to Danielle before pressed.

        I can’t even.

        • maidmarian555

          I saw that yesterday. I mean, of all the utterly inappropriate places to start saying the crap she was spouting (like how concerned she is about c-section rates)…. I just don’t get what goes through their heads. I was really shocked by that, why on earth would you pick a memorial page to say those things? On Facebook no less so your friends will probably have your shitty, thoughtless comments pop up on their feeds too.

      • RMY

        It’s like fertility, that the odds 20% a cycle don’t matter, your either pregnant or not at the end of the cycle.

  • lawyer jane

    The problem is that we can’t trust them to actually, objectively discover what the woman’s values are. Saying “it is her body, and until the baby is born, she has full autonomy in decision making” is true legally, and I think we all agree that is true. But the vast majority of mothers do not make choices about childbirth in a way to maximize their own bodily autonomy — they want their baby to be born safely more than anything! We’re not choosing here between the life of the mother and the life of the baby, but the fact that most women are going to value the life of their baby far over the mode of delivery, when it comes down to it.

    • Actually, I don’t think women should have unlimited power over their method of birth if it has a sufficiently significantly higher risk of death or injury to the fetus than standard hospital policies. I think someone has to be an advocate for the unborn once the fetus is viable outside the uterus.

      • I get very, very antsy about that, because of how dangerous a precedent that sets. I don’t disagree that a viable fetus has some ethical weight, but I really, really disagree that a woman’s bodily autonomy should be compromised because of it.

      • Young CC Prof

        Ethically, I agree with you. I think that deliberately allowing your term or near term baby to die rather than consent to reasonably safe interventions is abhorrent. But legally, forcing consent for the sake of a fetus goes to some pretty bad places.

        • Sarah

          I also always wonder what people actually think this should look like, when they advocate for limits on a woman’s right to choose birth method and advocating for the foetus.

          If you just mean you really don’t like it when a woman chooses a stuntbirth and you’re not going to refrain from saying so even if she and/or the baby die in the attempt, well and good. Sometimes that is what people mean. Like when people say they judge women for having abortions but wouldn’t make it illegal. However, on other occasions they’re also talking about methods of coercion, punishment or both. Which as you say, leads us to some pretty bad places.

          I think if people are advocating for coercion and/or punishment, they ought to spell that out clearly.

          • Who?

            I agree with you.

            The woman has the final say.

            I get lost when medical advice is considered scary or an attempt to intimidate, not a disinterested communication of the likely outcome of a choice or set of choices.

            And I really lose it when a woman allows her unborn baby to die for want of medical care but seeks out and accepts care for herself in the aftermath.

          • Valerie

            I’m absolutely against coerced CS, even if the baby dies. CS increases risks for future births, and it’s up to mothers if they want to prioritize their future fertility and risk the survival of their current pregnancy. Also, hospitals shouldn’t be operating on competent people against their wishes.

            And that’s what we’re talking about, right? Isn’t CS the main tool that ultimately makes birth in a hospital safer for babies? Obviously there are other factors, like people trained in resuscitation, drugs to manage labor, etc, but isn’t CS the biggest life-saver?

          • Sarah

            Usually.

      • Sarah

        I find that attitude horrifying, and something that must be fought at all costs.

      • Eater of Worlds

        You know, I check up on this woman I knew in the mid 90s who went nuts over pregnancy. She couldn’t get pregnant, did an awful private adoption with someone she met online. Awful to the parents. I won’t state why because I don’t want to get sued.

        Then she managed to get pregnant and had a bunch of her own kids. Decided against vaccination, became a midwife, etc.

        Anyway, 2 years ago she was at risk of getting her license suspended because she let a birth go beyond 42 weeks. She said that it’s wrong to determine when the birth is when you go by the last period and going by ultrasound is better. The law in her state says it goes by last period. The baby was born healthy and I can’t find if she got suspended or not (so I assume not?) but her go fund me is still up for legal fees https://www.gofundme.com/v6ed63kk

        She apparently has a really popular clinic in Arizona. So, while I agree that the mother has the right to give birth at 46 weeks if she wants, do people here think the midwife failed in her care by going over 42 weeks? If you feel she failed, how does that mesh with the patient’s desire to go over the limit that is set for safety of the baby?

        Her clinic https://www.nurturingheartsbirthservices.com/

        Six years ago she wrote that pitocin is “pit of dispair”, like it’s some fucking Princess Bride joke. Besides only listing the scary side effects, she brings up a paper about how the preservative in pitocin seems to kill people when you give IV methadone by cardiac toxicity, when methadone alone has big issues with respiratory depression. Just scaremongering bullshit http://pathwaystofamilywellness.org/Pregnancy-Birth/pit-of-despair.html

    • Mel

      I agree. Women in developed nations expect that their infant will be born healthy and that they will have no more than the usual aches and pains left over from labor after birth. This expectation is so deep that a subset of women can’t conceptualize that home-birth (or the even more terrifying stunt of unattended childbirth – because THAT’S a good idea) places you back in a time period where babies died frequently during or immediately after birth and women were routinely injured or killed during pregnancy and delivery.

      That’s the trick that NCB works on. Informed consent is easier to get when both parties have the wrong control group. NCB isn’t promising a hospital birth risk rate with the comforts of home; it’s offering the risk rate of women pioneers with the comforts of home.

      Added bonus – the practitioners themselves are drinking the Kool-Aid as well. At the rate that most CPMs practice midwifery, they can go years between serious accidents if all of their clients deliver at home. With a high rate of transfer due to maternal request for pain medication, they can go even longer. Add a natural dose of human hubris – e.g, “This went well because I am an amazing midwife” – and you get Ina May and her ilk.

  • moto_librarian

    This bullshit might pass muster in anthropology, Melissa, but we aren’t talking about theory here but the actual lives of infants. Do you have any moral compass whatsoever? Because I cannot read this self-serving drivel and believe that you can possibly be working within an ethical framework. The answer to your question is glaringly obvious: develop and mandate criteria for risking out women once they are no longer low-risk. Quit delivering multiples, breeches, and VBACs at home. Women can refuse any and all interventions in the hospital. Yes, they will be warned about the real consequences of their refusal and will see it documented, but this idea that women lose their autonomy the moment that they enter the hospital is ridiculous. You also know damned well that fewer women would decide that homebirth is a good idea if they are uniformly risked out by all midwives. You have a responsibility as the head of MANA to provide women with informed consent. If you are incapable of doing that, I hope that your university considers whether or not you are adhering to the ethics of your profession.

    • lawyer jane

      Exactly. Women deserve health care professionals who use objective criteria based on the risks and benefits of treatments and procedures, while respecting patient autonomy. We can go to religious authorities or psychologists if we want to understand our “values.” That’s not what medicine is for.

  • Dr Kitty

    “She will need to make choices about her care that fit with her worldview and her value system, because she is the one who will live in that body and raise that baby afterwards.”

    Agreed, but more to the point, she is the one who might not raise the baby afterwards, if they die a preventable death at homebirth.

    She will be the one who will shoulder the grief and the guilt, because sure as eggs is eggs the NCB “community” will tell her that she “knew the risks”, “did her research” and “the absolute risk is low”.

    She is the the one, even if there is clear evidence of midwifery malpractice and/or negligence, who won’t get a penny in compensation, or any professional disciplinary action, never mind a genuine apology and steps to prevent anyone else suffering the same fate.

  • MaineJen

    “The breech and preeclampsia findings were not surprising to us…”

    Then why have midwives been perfectly okay with delivering breech babies at home for all these years, arguing that breech is just a variation of normal?

    And I love the totally disingenuous tone of discovery about the whole piece. “We simply had no *idea* that the risk profile for VBAC at home was so bad!” Fool, please.

    These people really have some nerve.

    • myrewyn

      Like our commenter from yesterday or the day before, (was it Kathy??), they are blind to what’s being put plainly in front of them. Kathy kept saying “but why do you not figure out what would make it SAFER?” when people were listing over and over the testing and risking out criteria midwives could use to help ensure their home birthers are the lowest possible risk.

      • Empress of the Iguana People

        Safer is having a nice room to yourself in the L&D section of the hospital. Which is pretty common in the US.

      • EllenL

        What do they expect, that we could move a surgical suite into their house? (Even if we could, they wouldn’t like it. All those lights and that scary equipment! And doctors and nurses actually doing things.)

        • moto_librarian

          And here’s the thing. On some level, I was aware that the pediatric nurses had entered the room when I was having my “natural” labor and delivery, but I was so out of it that it barely registered and it certainly wasn’t a distraction. When I had an epidural with my second, I was so focused on meeting our baby that I also didn’t care. I was glad that the NICU team was there because our son had passed mec, but it didn’t harsh my mellow or anything. So many of the complaints by NCBers are just spoiled umbrage.

          • Amazed

            The other day, Little Miss Impatience’s mother told me that she never felt she was in mortal danger when her placenta detached. She still doesn’t feel that she dodged a bullet there. Good for the medical professionals! In the face of emergency, they calmly and competently took care of the situation without scaring the mother and made sure she left the hospital on her own two feet, with a healthy baby in her arms. (Who was running in panic from Amazing Niece because Aunty’s Little Treasure is scary in her expansive love for other babies. The fact that she can’t walk yet was no problem for her – she crawled after Little Miss Impatience to smother her with hugs and kisses. Imagine to have missed this scene because my friend had chosen to try having little missy at home!)

            Compare this to the chaos and panic of a possible emergency transfer. Why on earth would someone take the risk?!…

          • Mel

            In defense of LMI’s mom, medical emergencies cause a weird level of denial in people.

            When I was in the hospital before Spawn was born, I was very, very concerned about his health with his pending emergency delivery. I was really worried that if my HELLP got worse, he’d be delivered before I could get steroids and he’d have a more complicated recovery – or die.

            I never put together that I was in genuine acute danger myself from my high blood pressure or having internal bleeding start. I mean – I know that severe pre-e can cause severe seizures and strokes while low platelets means bleeding can be torrential – but my brain put up a huge block titled “Nah, the doctors and nurses totally have this under control. You’ll be fine.”

          • Amazed

            Oh, I am not saying she got it wrong. I’m talking about how she doesn’t feel she had been in danger. That’s a credit to her doctors, midwives, and nurses, not accusation that she doesn’t understand. She does. But just like I don’t FEEL I was almost molested as a child because I was too young to know where babies came from (really, why else would the teen neighbout drag me to his room, lock the door, throw me on the bed and start opening my jeans if not for this?), she doesn’t FEEL they were in mortal danger. It isn’t denial on her part. No one panicked. She got a calm emergent c-section that bumped her roommate’s planned one. She recovered and LMI is a cutie. How could she know at the time when no one acted like she was dying? And they shouldn’t have.

          • Mel

            I didn’t take as an accusation; I was simply reflecting on how our minds work.

            Plus. doctors and nurses have a rather different way of responding to emergencies thanks to extensive training.

            I was more concerned about Spawn when he was surrounded by calm but intensely focused people compared to when a nurse was showing some natural impatience with a baby who was freaking out because his elbow was uncovered – and also refused to unlock said elbow to get it back in his Snuggaroo…..

          • Amazed

            Hehe! What kind of monster was she? To deny a preemie the little fun he can find in his Snuggaroo! From what you’ve been writing here, I think he must have been bored as hell in there.

            I can see why this wouldn’t bother you, though, unlike the calm intense focus.

          • I honestly didn’t see the NICU team waiting in the corner when I delivered my son. I didn’t know they were there until the OB handed the floppy (1 min Apgar of 3) baby to the waiting team.

            They worked on him, and he’s fine. But I think the hospital birth definitely damaged his ability to DO HIS DARN HOMEWORK!!!!!!

        • myrewyn

          Like the stories below, I guess I had minor complications with both of my deliveries but the medical professionals were always so calm I never knew or was worried. Knowing what I know now I think my first was a mild shoulder dystocia and I had a PPH with my second, all resolved with no drama or fear.

      • myrewyn

        I have just reread some of Kathy’s comments because there were new replies below them and I have to add that they are also very, very bad at math.

        • Dr Kitty

          “But 0.15% is a very small number!!!!”

          I want all of them to read Greenhalgh’s How to Read a Paper and get back to us afterwards.

        • Heidi_storage

          Yes, Kathy’s innumeracy would have been hilarious if it weren’t so scary.

    • fiftyfifty1

      “”The breech and preeclampsia findings were not surprising to us…”

      They knew the risks and yet “breech is a variation of normal” and “doctors just order a bunch of lab tests to cover their asses” and “preeclamsia only happens to women if they don’t eat right.”

    • kilda

      their statement that the breech findings weren’t a surprise is pretty damning. So they were unsurprised that breech birth at home carries 13x the mortality, but have not been telling women this and have not risked them out of homebirth for it. Wow.

    • Mel

      That sentence made me honestly question their intelligence.

      You didn’t expect a horrible adjusted odds ratio for home VBACs without a previous vaginal delivery?

      What part of applying high amounts of pressure to a surgical scar in a muscle against an irreducible fetus trapped against an immobile pelvis did you think was going to end well? The uterine rupture, the extremely stressed fetus, or the car ride to modern medical facilities with an internally bleeding woman and a suffocating infant?

      Hmm?

      • Merrie

        To be entirely fair, it’s reasonable to expect a difference in VBAC outcomes based on the reason for the previous c/s. If it was done for a breech baby and the next one is vertex, or for twins and now she’s pregnant with a singleton, or some other thing that hasn’t repeated, probably better results versus one done for arrest of descent, mom’s recurring health problem, or whatever, that is likely to be a problem in the current pregnancy as well. I doubt this data has that level of detail, though, or that these lunatics are trying to figure out if it does.

        • Amazed

          What they’re trying to do is to present themselves as capable providers – and now, that includes knowing that certain risks would lead to worse outcomes at population level because, honestly, the alternative is bound to make them look like dangerous loons. I suppose it was all because good, responsible midwives were trying not to push selfish mothers into having the much more dangerous unassisted homebirths, now.

        • Dr Kitty

          Even the very *best*candidate for VBAC with no previous VB still has a greater than 20% chance of needing an emergency CS in a future TOLAC.

          If you wait until you’re absolutely *sure* she’s in that 20% before you transfer, for example waiting for SOL beyond 42+weeks, ROM > 48hrs, allowing first stage to continue for over 24hrs and 4hrs of pushing etc as we know CPMs are wont to do, well, is it any wonder babies drop dead into their hands or can’t be saved when that CS finally happens?

          • Eater of Worlds

            My SIL did a VBAC because she wanted to experience vaginal birth. Her first baby was breech and 11 pounds, he probably got too big to turn when he was supposed to and was way to big to even consider physically maneuvering him prior to birth. My family has big boy babies and average sized girls. Her doctor had very very strict rules for VBAC. The baby could not be over a certain size, mom had to go into labor naturally by a certain time, mom could not be induced, mom had to be a healthy weight, mom could only be in labor for a certain amount of time. So SIL got lucky and had her 7.5 lb daughter that way.

            People always ask me about the big boy/average girl so here’s the family history:

            Great-grandfather to these kids 13 pounds, grandfather 12 pounds (from a starving 4’10” woman in WWII) and his sisters were 7 lbs, father 6 lbs at almost 6.5 weeks premature, breech and 19″, I was a week late, 6 lbs, 19″ and breech until labor started (our mom apparently grows 19″ babies, and doc said her uterus just had no more room), his son couple ounces shy of 11 pounds and…23? 24? inches, his daughter 7.5 lbs 20″.