AmyTuteurMD | Indy Week

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Re: “Midwives seek autonomy in N.C.

"here is a link that addresses dr. amy's misstatements about maternal mortality"

Just keep in mind that when I pointed out all the factual errors and deceptions in Ms. Gaskins post, in a post that followed it, amygeekgirl removed it because it showed that Gaskin was flat out wrong and deliberately deceptive to boot.

Imagine if someone created a publicity campaign to highlight lung cancer mortality and never mentioned smoking, but only referred to deaths associated with chemotherapy. That would make no sense. Yet that is just what Ina May Gaskin has done with the "Safe Motherhood Quilt", which purportedly exists to highlight maternal mortality, but never mentions pre-eclampsia, hemorrhage or pregnancy complications, and instead refers almost exclusively to deaths associated with obstetric interventions.

Look at the page of "related articles". There are no scientific papers about maternal mortality. There is nothing about the epidemiology of maternal mortality. Twelve of thirteen articles are about medical mistakes. Gaskin wants to leave the impression that maternal mortality is caused by obstetric interventions. Indeed, in her public discussions of the quilt, she is quite explicit. In reality, as Gaskin almost surely knows, iatrogenic deaths represent a tiny fractions of maternal mortality.

The Safe Motherhood Quilt is not about maternal mortality. It is a quilt designed to publicize bad outcomes associated with obstetric interventions. Anyone who ACTUALLY cared about maternal mortality would not be criticizing obstetric interventions, since interventions save tens of thousands of maternal lives each year. Anyone who cared about maternal mortality would be drawing attention to the causes of maternal mortality, and to the social and economic conditions that prevent some mothers from getting the interventions that they need.

Posted by AmyTuteurMD on 06/09/2008 at 7:05 AM

Re: “Midwives seek autonomy in N.C.

"Pregnancy outcomes of 1707 women, who enrolled for care between 1971 and 1989 with a home birth service run by lay midwives in rural Tennessee, were compared with outcomes from 14,033 physician- attended hospital deliveries derived from the 1980 US National Natality/National Fetal Mortality Survey."

And what is the 1980 US National Natality/National Fetal Mortality Survey? You don't know and the author is couting on the fact that you don't know and would not bother to check. The US NN-FMS is a group of HIGH risk births.

The NN-NFMS was not designed to yield mortality data for 1980. It had an entirely different purpose. The NN-NFMS was designed to obtain health data that was not on the original birth certificate in order to analyze that data. So, for example, the NN-NFMS asked about the use of ultrasound during pregnancy, which does not appear on the birth certificate. The investigators also collected data that did appear on the birth certificate in order to determine the accuracy of the NN-NFMS data.

The NN-NFMS deliberately oversampled high risk births. This fact is acknowledged within the Farm paper, but it is not explained. It means that the sample used in the NN-NFMS has a higher risk level than the population in general, and is much higher risk than any lower risk group. As expected, the neonatal mortality rate in the NN-NFMS sample is HIGHER than the overall neonatal mortality rate for the entire country in 1980.

The NN-NFMS is known to be a tiny (0.3% of births) NON-REPRESENTATIVE fraction of the deliveries in 1980. That is deliberate on the part of the authors because they were using it for something entirely different, but it means that under no circumstances can the NN-NFMS mortality data be substituted for the 1980 birth certificate data.

Homebirth advocacy is based in large part on mistruths, half truths and outright deceptions. This is one of the outright deceptions. The author deliberately used a HIGH risk group for comparison because the comparable low risk group had a mortality rate 1/2 the mortality rate of homebirth at the Farm.

Posted by AmyTuteurMD on 06/07/2008 at 8:52 PM

Re: “Midwives seek autonomy in N.C.

"Notice that Ina May Gaskin, the founder of the clinic, has no nursing degree. Nonetheless, the outcomes at the Farm should be model for birth in the United States."

The outcomes at the Farm were terrible. The perinatal death rate at the Farm was 10/1000. The neonatal death rate for white women at the same time was in the range of 6/1000 and that includes high risk women.

Of course the authors of the Farm study don't mention that. Instead of comparing homebirth at the Farm with hospital birth for low risk women during the same year, they compare homebirth at the Farm with a study of HIGH RISK hospital birth for the same years.

I notice that you have avoided giving a direct answer to my question: "It's okay for some babies to die so that a few women can have the birth "experience" that they want?"

I guess that you do think it is acceptable for some babies to die so their mothers can have the birth "experience" that they want. You are entitled to your opinion, but I can assure you that most mothers are much more interested in the health of their baby than the quality of their "experience".

"Piles and piles of neuroscience and other areas of research are proving this old way of thinking completely out of step with what we now know about babies' first memories."

No, there is no scientific evidence in neuroscience or neonatology that shows that babies remember or are affected by mode of delivery.

Posted by AmyTuteurMD on 06/07/2008 at 4:03 PM

Re: “Midwives seek autonomy in N.C.

"And YES, please, let's have (independent) midwives have hospital privileges in the United States so they can follow their patients and provide continuity of care. We finally agree on something."

We already have midwives in the US who have hospital privileges. They are called certified nurse midwives and their outcomes are dramatically better than those of the poorly trained direct entry midwives.

As for the "independent" part, no midwife is truly independent of obstetricians, otherwise a substantial portion (4-5% or more) of their patients would die. The difference between CNMs and DEMs is that CNMs recognize that dependence and interact professionally and collegially with obstetricians. In contrast, DEMs like to pretend that they don't "need" obstetricians. Their attitude is just another factor that contributes to homebirth with a DEM being the most dangerous type of planned birth in the US. As long as direct entry midwives require obstetricians to save the lives of a substantial proportion of their patients, they are not "independent" and shouldn't waste time and energy pretending otherwise.

"What does it say about our culture that the vast majority of our children are quite literally born into violence?"

It says that some people are so misguided as to actually believe their own ridiculous hyperbole. The are so self-involved and so blind to real suffering in the world that they dare to claim that operative delivery (which they don't remember and might have saved their life) is in some way equivalent to the real violence that people actually suffer.

"Revering life means more than everybody lives."

Says who? Are homebirth advocates now the arbiters of which babies deserve to live?

What are you trying to say? It's okay for some babies to die so that a few women can have the birth "experience" that they want?

Posted by AmyTuteurMD on 06/06/2008 at 8:41 PM

Re: “Midwives seek autonomy in N.C.

"Because homebirth is so rare in the U.S., I think it's wise to look to other countries where it is more common, and thus have greater sample sizes, for guidance. So I am going to just type word-for-word the abstract of a study of homebirths attended by direct-entry midwives in Holland, as it appeared in Obstetrical Myths Versus Research Realities"

Thank you. That gives me the perfect opportunity to show how Henci Goer and other homebirth advocates mislead lay people with "scientific evidence".

According to the World Health Organization 2006 report on perinatal mortality, the Netherlands has a HIGHER perinatal death rate than the US.

Second, direct entry midwives in Holland are midwives who have been through a 3-4 year university based program that includes hospital based experience and training. Dutch midwives have extensive training and experience in the management of complications. Dutch midwives manage their patients in the hospital and at home. If they transfer a patient to the hospital, they can care for them in the hospital.

In contrast, American direct entry midwives are high school graduates that attend storefront midwifery "schools" often by correspondence course. They have no experience in managing complications because they do not train in hospitals. American DEMs have a fraction of the education and training of Dutch midwives, and would not be considered qualified in the Netherlands.

Third, any comparison of outcomes between MDs and midwives and between home and hospital must adjust for risk, which this study (deliberately) did not do. It's hardly a suprise that higher risk patients had higher perinatal mortality rates. That group includes premature births, complications of pregnancy and pre-existing medical conditions.

Homebirth advocacy is based on mistruths, half truths and outright deceptions. This is one of the most common deceptive claims.

Posted by AmyTuteurMD on 06/06/2008 at 1:28 PM

Re: “Midwives seek autonomy in N.C.

John D:

"Amy, that CDC Wonder website is pretty cool. But I wasn't able to "torture" the data to get the results you got."

Direct entry midwives (referred to as "other midwives" in the CDC database) care for only low risk women at term. In addition, the overwhelming majority of DEM patients (more than 90%) are white, which is a lower risk group than other races. To make the comparison as close as possible, I restricted the dataset to white women at 37+ weeks. I also looked only at neonatal mortality (deaths from birth to 28 days) not infant mortality, which includes deaths from 1 month to 1 year.

I ordered the results by place of delivery and by birth attendant.

The neonatal mortality rate for MD attended hospital birth (all risk levels) was 0.61/1000, for CNM attended hospital birth (low risk) 0.38/1000, and for DEM attended homebirths 1.15/1000. Keep in mind that in reality the MD statistics are lower and the DEM statistics are higher than these. That's because homebirth transfers who gave birth in the hospital are included in the MD hospital group and should actually be in the DEM group since they intended to deliver at home.

Posted by AmyTuteurMD on 06/04/2008 at 10:59 PM

Re: “Midwives seek autonomy in N.C.

"For those who want to read the scientific research for themselves, presented in an easy-to-read format and heavily referenced, check out Obstetrical Myths Verses Research Realities." No, that book is filled with the mistruths, half truths and outright deceptions of homebirth advocacy topped off with "bibliography salad," a mishmash of scientific citations that don't actually support Henci Goer's points. If you want to know what the scientific research really shows, you need to read the research itself. Homebirth advocates are hoping that you don't.

Posted by AmyTuteurMD on 06/04/2008 at 10:46 PM

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