You have to give MANA (the Midwives Alliance of North America) credit. Their motto appears to be: if at first you don’t succeed, lie, lie, again.
Clearly MANA is very worried in the wake of publication of the Grunebaum study that shows that homebirth increases the risk of a 5 minute Apgar score of 0 by nearly 1000%. Therefore, they’ve sent Wendy Gordon, CPM (and placenta encapsulation specialist!) to do what she can to discredit it.
No matter that it comports with the data from Oregon that shows that PLANNED homebirth with a LICENSED homebirth midwife has a death rate 9X higher than comparable risk hospital birth or that MANA has found that its own members have such hideous death rates that they have been desperately hiding them for years.
This is not about the truth, obviously. This is about tricking American women into ignoring horrific homebirth death rates, so any research that demonstrates the danger of homebirth must be discredited.
Wendy’s first attempt didn’t go so well. She was caught (by me) in a bald faced lie. MANA did not attempt to deny it, but, as it typical for them, they didn’t correct it, either. Apparently the entire attempt was not as successful as MANA would have liked. How can I tell? Within less than 24 hours, MANA felt the need to censor comments since the comments raised questions that MANA could not or would not answer.
Wendy’s second attempt, on the Lamaze blog Science and Sensibiity, tries to avoid the pitfalls of the first attempt. Instead of including the bald faced lie about the accuracy of Apgars on birth certificates, she simply linked to it.
She’s also made the smear considerably more vague, starting with the title itself, Flaws In Recent Home Birth Research May Mislead Parents, Providers. A more accurate title might be We hope that vague, unsubstantiated “flaws” that we’ve made up might be used to mislead others about the real dangers of homebirth.
The Grunebaum paper is well done and extremely difficult to undermine. There is simply no question that the data shows that homebirth raises the risk of a 5 minute Apgar score of 0 by nearly 1000%. The authors’ decision to use the 5 minute Apgar score of zero is truly inspired. Other research shows that homebirth has an appalling rate of intrapartum death, and not just any intrapartum death, but totally unexpected (“the heart rate was normal right up until the baby was born”) death. This is almost certainly due to failure to monitor babies appropriately during labor. The decision to use the 5 minute Apgar score of 0 means that we are looking at severe intrapartum compromise, almost certainly resulting in death.
Though the lay press has reported the results as an increased rate of stillbirth, and though the findings almost certainly do reflect an increased rate of stillbirth, the key point is that they reflect INTRAPARTUM stillbirth, not stillbirth before labor begins. How do we know that? Babies who die before labor begins don’t get birth certificates and they certainly don’t have 5 minute Apgar scores assigned, because Apgars are given only to babies believed to be alive prior to the moment of birth.
But rather than acknowledging that the decision to use the 5 minute Apgar score of 0 is one of the primary VIRTUES of the study, Gordon insinuates that it is a flaw.
When we examine a little more closely what it means to have a 5-minute Apgar score of zero, we might find that it does include some babies who died shortly after birth. We might also find a number of babies who had lethal congenital anomalies, who would not have survived no matter where they were born or who attended the birth; there may be important differences between home and hospital populations with regard to whether these anomalies were detected prenatally and whether parents changed their birth plans because of it.
The babies might have had anomalies! Duh! Of course they “might” have had anomalies. That doesn’t mean those anomalies were incompatible with life if the babies had access to lifesaving technology.
There may be important differences between home and hospital populations regarding anomalies! But there is NO EVIDENCE that there are important differences, so attempting to dismiss the findings on that basis has a whiff of desperation about it.
Wendy claims:
A rigorous study that actually examined deaths would have excluded births with outcomes that had nothing to do with place of birth or attendant.
No, rigor does NOT require excluding births with outcomes that have nothing to do with place of birth or attendant (“the baby would have died in the hospital, too”). Why? Because we are looking at the DIFFERENCE between outcomes BASED ON place of birth and attendant. If we subtracted all the deaths that “would have happened in the hospital, too,” the DIFFERENCE between home and hospital could be EVEN GREATER than if we didn’t subtract outcomes that were independent of place of birth or attendant, because the hospital death rate would be ZERO, since all the deaths in the hospital group “would have happened in the hospital, too.”
Either Wendy is hoping that homebirth advocates have poor basic logic skills or she herself has poor basic logic skills.
Here’s another whopper:
On the other hand, even a small percentage of misclassified outcomes in the home birth category have a dramatic impact. Because the number of home births in the U.S. is small, the inclusion of prenatal stillbirths, congenital anomalies and unplanned, unattended home births in the “home midwife” category is likely to have an appreciable effect on the negative outcomes examined here.
Is there any evidence that ANY of the 5 minute Apgars of 0 at homebirth were not 0? Is there any evidence that homebirth midwives signed birth certificates of patients who had unplanned homebirths? No, of course not. There’s isn’t a shred of evidence that even one midwife is accidentally recording that the baby she delivered had a 5 minute Apgar of 0 when it did not. Claims like these positively reek of desperation.
And yet another whopper:
I wrote my initial reaction to Grunebaum et al’s study last week when their press release came out. I expressed concerns about the low reliability and validity of birth certificates for drawing conclusions about rare outcomes. Grunebaum’s own data shows that over 10% of “home midwife” deliveries had no information on the birth certificate about the mother’s parity and had to be excluded from their calculations, while only 0.2-0.5% of hospital or birth center deliveries were missing parity data; this strongly suggests that something is amiss with the “home midwife” data.
No, Wendy didn’t express her concerns, she LIED about the reliability of Apgars scores on birth certificates, and supplemented that lie with a deliberate misrepresentation of a paper on birth certificate reliability that shows THE OPPOSITE of what she claimed it showed. Her misrepresentations were publicly pointed out in the comment section and she NEVER DENIED them.
Wendy is so desperate to smear the paper that she cheerfully smears homebirth midwives along with it. They are such slobs that they didn’t include parity on the birth certificate. I don’t doubt that midwives are sloppy in their record keeping, but that doesn’t mean that they sloppily wrote that the 5 minute Apgar score of the baby they just delivered was 0.
Wendy can’t resist logical fallacies, either. She trots out a loaded question just like the classic “have you stopped beating your wife?”, a “question” based on a foregone conclusion that may be completely false.
The fact that these authors were clearly warned about the low quality of their data regarding both low Apgar scores — and especially seizures — but chose to push ahead with publication without addressing them, suggests other motivations.
The authors were never warned about the low quality of their data since their data is high quality. To the extent that they were warned about anything, they were warned that homebirth advocates were fully prepared to LIE about the quality of the study’s data. True to the warning, Wendy is lying about it now.
Give it up, already, Wendy. At this point, you are just destroying your own reputation and that of MANA. The Grunebaum paper is a high quality paper that presents accurate data on an excellent metric (the 5 minute Apgar score of zero). It comports with the CDC data, the Oregon data, and the fact that MANA has refused for years to release their own death rates.
Homebirth kills babies who didn’t have to die. I know it, you know it and MANA knows it. Your desperate attempts to hide the truth from American women don’t smear the papers you criticize; they smear the organization that you represent.
