Let me take you on a trip down memory lane.
I started writing about the Midwives Alliance of North America and their campaign to hide their death rates more than 5 years ago, back in August of 2006. My first major post on the issue was Research and special interests/the BMJ 2005 study in which I began an exploration of the fact that Johnson and Daviss were not forthcoming about their connections to the homebirth industry. Over the following year, I proceeded to analyze the BMJ 2005 study and demonstrate that it actually shows that homebirth with a CPM in 2000 had a death rate nearly triple that of low risk hospital birth in the same year. It took nearly 2 years, but Johnson and Daviss ultimately acknowledged that I had been right all along.
I first wrote about the fact that the Midwives Alliance of North America (MANA), the organization that represents homebirth midwives, was hiding their own death rates back in January of 2007. MANA has fought me every step of the way, denying, lying and doing whatever it takes to hide the fact that not only does the evidence show that homebirth with a homebirth midwife has a hideous death rate, but MANA has known that for years and done everything it could to make sure that American women did not find out.
That hideous death rate has been confirmed by 5 years of CDC statistics on planned place of birth, and most spectacularly by the horrific perinatal death rate of licensed Colorado homebirth midwives.
The mountain of statistics confirming the increased risk of death at homebirth is continuing to grow, and, as a result, it appears that 5 years of lying and denying on the part of MANA and homebirth midwives and their supporters is about to end. That’s the message I take away from the proactive attempts of the homebirth industry to minimize the significance of those deaths. Consider today’s post on Science and Sensibility by by Wendy Gordon, CPM, LM, MPH, MANA Division of Research, Assistant Professor, Bastyr University Dept of Midwifery (and placenta encapsulation specialist!), a woman who has been arguing with me in print about the data for more than 5 years.
The post talks about last week’s Institute of Medicine conference on birth settings and specifically addresses data that shows that planned homebirth has an increased rate of death. Instead of denying it, as Wendy Gordon has done in a variety of venues for more than 5 years, she actually acknowledges it and then counsels everyone to ignore it.
Gordon references the presentation by Dr. Frank Chervenak on CDC data:
Chervenak used his 12 minutes (out of 10) that were to be devoted to the hospital provider perspective for, instead, a rapid-fire display of “back-of-the-envelope” bar graphs attempting to show home/hospital differences in 5-minute Apgar scores using raw data drawn from birth certificates.
Gordon helpfully telegraphs the response that I suspect will accompany MANA’s defense of its horrific death rates:
1. It hasn’t been published!
Since it appears that some doctors are having a hard time getting their “research” on this topic published in peer-reviewed journals, they are presenting their data in settings that do not require peer-review, such as last year’s annual conference of the Society of Maternal-Fetal Medicine (the study still hasn’t been published) and this IOM workshop.
Of course, CDC data is published. It’s published by the CDC. It is valid even before it is included in a peer reviewed scientific paper. When the CDC publishes the number of people who died of lung cancer last year, that number is accepted, regardless of whether it ever appears in a scientific paper.
2. So what if the death rate at homebirth is much higher? The absolute number of babies who have died is small.
Let’s say that a person’s odds of getting struck by lightning in a heavily populated city are one in a million, and those same odds in a rural area are five in a million. These odds are called your “absolute risk” of being struck by lightning. Another way to look at this is to say that a person’s odds of being struck by lightning are five times higher in a rural area than in a densely-populated area; this is the “relative risk” of a lightning strike in one area over another.
A common approach of anti-homebirth activists is to use the “relative risk” approach and ignore the absolute risk, because it’s much more dramatic and sensationalistic to suggest that the risk of something is “double!” or “triple!” that of something else …
So after years of lying about the increased risk of death at homebirth, the homebirth industry is finally acknowledging that what I’ve been writing about the death rates has been true all along.
I find it quite amusing that Gordon and other homebirth advocates have suddenly discovered the difference between absolute and relative risk. The same people who have been howling about the “dangers” of epidurals (the risk of death from an epidural is less than the risk of being killed by a lightening strike), are suddenly insisting that the risk of death at homebirth, which is anywhere from 100 to 1000 times higher, is actually so small that you should ignore it.
3. Birth certificate data is unreliable!
Epidemiologists in the room were quick to step to the microphone for the open discussion part of the panel, pointing out the many flaws in Chervenak’s presentation. Marian MacDorman, Ph.D., senior statistician and researcher for the CDC’s National Center for Health Statistics, reminded everyone that birth certificate data is notoriously unreliable for neonatal seizures and low Apgar scores; this has been shown time and again for decades and had indeed been discussed earlier in this very workshop. More importantly, McDorman stated that data from birth certificates cannot be used to make comparisons between settings or providers…
I find that absolutely hilarious. Marian MacDorman, an editor of the Lamaze sponsored “journal” Birth, has published a number of papers based on, you guessed it, birth certificates. Infant and Neonatal Mortality for Primary Cesarean and Vaginal Births to Women with “No Indicated Risk,” United States, 1998–2001 Birth Cohorts is widely quoted in the homebirth community as demonstrating a 3X higher neonatal death rate (triple!) for elective C-section as compared to vaginal delivery. MacDorman and colleagues publicly revised the relative risk after others pointed out serious methodological flaws, but they still ended up claiming that C-section without medical indication has a 1.5X higher risk of neonatal death (nearly double!) than vaginal delivery. But birth certificates are notoriously unreliable for reporting risk factors, as I pointed out at the time.
Apparently MacDorman is trying to set a new standard for hypocritical behavior. She published at least 2 studies relying on birth certificate data, and in both studies, although the relative risk of neonatal death at C-section was supposedly nearly double or triple, the absolute risk was very small. Those studies are supposed to be valid, but the homebirth death rates are not?
After years of lying and denying, homebirth advocates are being forced to acknowledge the dramatically increased risk of death at homebirth.
There are two important messages to take away from this:
Homebirth (particularly homebirth at the hands of grossly undereducated and undertrained CPMs) dramatically increases the risk of perinatal death.
More importantly, professional homebirth advocates have steadily and repeatedly lied about the increased risk of perinatal death. They should never have been trusted before, and cannot be trusted now.
This is yet another reason why the CPM should be abolished. In addition to being undereducated and undertrained, the entire CPM industry is unethical, putting their desire for income ahead of their obligation to obtain informed consent. Not only have they let babies die, they’ve lied about it, too.
