Colorado homebirth midwives have a serious problem.
No, I’m not talking about the fact that licensed Colorado homebirth midwives attending planned homebirth have a hideous perinatal death rate, nearly 2.5 times that of the state as a whole (which includes premature babies and high risk deliveries). They apparently don’t consider that a problem at all. To my knowledge, not a single conference, Board Meeting or legislative session has been held to address the hideous death rate.
The problem is that Colorado homebirth midwives are required by law to report the deaths at their hands. At first this wasn’t a problem since no one seemed to read the data or do the necessary calculations. Then I discovered the data.
I first wrote about it back in December 2009 (The horrifying death toll of homebirth in Colorado). I noted at the time that Colorado homebirth midwives were aware of the appalling number of deaths at their hands. In the newsletter of the Colorado Midwives Association, President Karen Robinson reported:
In looking back over the past couple years of statistics, I see that there were 5 perinatal deaths reported each year for 2006 and 2007. This represents a perinatal death rate of 8 per 1000 for those two years, and that is too high for the low-risk population we serve. The state perinatal mortality rate for all births from 2003 to 2007 was 6.4 per 1000.
She then explained why she ignored this huge red flag:
I don’t believe we have a poor perinatal mortality rate, but if solid data shows we do, then I will be at the forefront of the effort to improve our practices and lower the perinatal mortality rate for homebirth in Colorado.
Guess what? The death rate continued to rise. In 2008, 7 babies died. In 2009, 9 babies died. I reported on the rising death rate each year. As far as I can determine, the Colorado homebirth midwives did absolutely nothing. No investigation, no modification of practice standards, no restriction of midwives’ scope of practice, nothing.
Then, the Colorado Midwives, in violation of state law, stopped reporting their death rates. I reported on that, too, and then I obtained the raw data for 2010 and 2011 from someone who had filed a Colorado Open Records Request and found that in calendar year 2010 there were 15 deaths and in calendar year 2011 there were 14 deaths. In those years, the death rate for homebirth were more than double the terrible death rate that had moved Karen Robinson to pledge action were that death rate to continue. But, of course, as far as I can determine, no action was taken at all, and homebirth midwives managed to have their scope of practice expanded slightly.
Colorado homebirth midwives have produced a statistical report this year, and it is a masterpiece of obfuscation. Not only did Colorado homebirth midwives bury an extraordinary number of babies in the past year, they buried them again in an avalanche of extraneous statistics and graphs that are completely nonsensical.
What do we need to know to determine if planned homebirth with a licensed Colorado midwife is safe? We only need one figure: the perinatal death rate. What was the perinatal death rate for the period 10/01/2010 through 09/30/2011 (the period covered in the report)? It doesn’t say. It literally does not mention the single most important safety metric for Colorado homebirth. Not only that, in years past, the number of deaths and the total number of births were reported so that the perinatal death rate could be calculated by simple division. This iteration of the Colorado homebirth midwives buries that information, too.
Instead of reporting that the midwives did 719 deliveries, they presented this:
If you work at it, you can calculate the number of deliveries, as I did, but it is difficult to imagine a less clear way to present the information. Indeed, there is no possible reason to present a graph like this. Who cares how many midwives reported that they did 11 deliveries and how many 12? No one. But if you wanted to make it extremely difficult to calculate the perinatal mortality rate, it would be hard to find a better way to misrepresent the data.
Using a similar graph, I calculated how many transfers the midwives reported: 186. When you add 719 and 186, you get 905. Using other similar graphs I calculated the number of perinatal deaths as 14. 14 deaths in 905 births means that the perinatal mortality rate during the reporting period was an astounding 15.5! That would be an embarrassingly unacceptable rate for the state as whole, representing as it does a perinatal mortality rate almost 2.5 times the actual Colorado rate of 6.4 for all deliveries including premature babies and all possible complications. For a group of low risk women, it is horrific.
Back in 2007, the perinatal mortality rate that Karen Robinson deplored and refused to believe was 8/1000. Now it is 15.5/1000.
So in addition to being grossly unqualified practitioners, Colorado homebirth midwives are shockingly unethical. They are doing everything in their power to hide the deaths at their hands. Indeed, they are so desperate to keep the information from the women of Colorado, they have buried the death babies twice: once in coffins in the ground, and then again in reports and graphs that hide the relevant information instead of reporting it.
