I have written repeatedly about the fact that the Midwives Alliance of North America is hiding the death rates for certified professional midwife (CPM) attended homebirths. Not only does this deliberately deprive American women of critical data about the safety or lack thereof of CPMs, but it also deliberately deprives women of critical safety data about the typical claims of homebirth midwives.
When MANA is forced to release these statistics, as they will eventually be required to do, here are some questions that we can expect to have answered.
What are the death rates for breech deliveries attended by CPMs?
Homebirth midwives like to insist that breech “is a variation of normal,” that obstetricians are no longer appropriately trained in the delivery of the breech infant, and that homebirth midwives have the education and experience needed to safely deliver breech babies. MANA is in possession of the data that will answer the question, and, I suspect, demonstrate beyond a shadow of a doubt that homebirth breech delivery has appalling death rates.
What are the death rates for postdates deliveries attended by CPMs?
Homebirth midwives like to say that “babies are not library books,” due on a certain date. They conveniently elide the mass of scientific evidence that shows that the stillbirth rates begins to rise even before the due date and continues to rise dramatically after 42 weeks gestation. There is a growing body of scientific evidence that even earlier induction for postdates at 41 weeks is effective in preventing stillbirth. MANA is in possession of data that will address the question of expectant management of postdates pregnancy, and, I suspect, demonstrate beyond a shadow of a doubt that postdates homebirth results in an extraordinarily high perinatal death rate.
What are the rates of intrapartum stillbirth for CPMs?
In the hospital setting, intrapartum stillbirth in a term infant is an exceedingly rare event. Is it as rare at homebirth? It is axiomatic in the homebirth community that electronic fetal monitoring is literally worse than useless, failing to improve outcomes but increasing C-section rates. MANA is in possession of data that will address the question of whether intermittent monitoring at homebirth is safe, and I suspect that the MANA data will demonstrate and appalling level of intrapartum stillbirth.
What is the rate of uterine rupture and perinatal death at homebirth VBAC?
It is an article of faith in the homebirth community that VBAC is safe and that virtually any woman, regardless of how many C-sections she has had in the past and regardless of previous obstetric outcomes, is an excellent candidate for VBAC. MANA is in possession of data that will address the issue of uterine rupture at homebirth VBAC, and, I suspect, will show that homebirth VBAC results in disaster and death in an unacceptably high number of cases.
The MANA database is a treasure trove of information, not merely on the safety of homebirth with a CPM, but on the safety of a variety of empirical claims made by homebirth midwives. Of course, if the data shows, as I suspect, that those empirical claims are utter nonsense, it would hardly serve the “advancement of midwifery” to release them.
In fact, I’d be willing to bet a considerable sum that the MANA database represents a major blow to homebirth midwifery. When the data are released, and there is no doubt that eventually they will be released, it will show that MANA is deliberately withholding the death rates because they will establish, once and for all, that homebirth midwives are grossly undereducated, grossly undertrained, and purveyors of preventable perinatal deaths.
