Friday, February 22, 2008

Homebirth advocates are not honest with themselves

Kneelingwoman has written another thought provoking post, What Have We Got To Lose?. The part that I found most compelling is this:
There is an effort being promoted; "The Big Push for Midwives" and ... for me, all of this is very akin to the issue of "risk assessment" -- in increasing numbers, neither parents' nor midwives want to explore the real risks of a course of action, or inaction, and then have to scramble to fix the resulting diseaster ... Midwifery, for many years, has simply not wanted to deal with the reality on the ground because we have listened only to ourselves; not to the women we say we want to stand in solidarity with. We have then been forced into accepting a limited role in the health care system out of stubborn adherence to an educational path that has rapidly outlived it's ability either to reproduce practioners or ensure a viable working life for it's current proponents.
Kneelingwoman describes this as an issue of "risk assessment", but I think the problem is more general. Homebirth advocates are simply not honest with themselves and each other about the inherent risks of childbirth, the serious safety limitations of homebirth, and the woefully indequate education and training of homebirth midwives.

A brief tour around the internet on any given day will illustrate what I mean:

Newsweek is currently running an article on The Delivery Debate. As part of the article, Katie Prown, campaign manager of The Big Push for Midwives, is quoted:
Prown rejects ACOG's claims that CPMs are less qualified than CNMs. "If those accusations were true, then we would see a different trend than what we are looking at right now," she says. "In the last five years Utah, Wisconsin, Virginia and Minnesota have licensed certified professional midwives … These states are seeing good results. If they were seeing bad results, states would be outlawing CPMs."
I posted a comment that pointed out that her claim is false. Wisconsin's birth statistics demonstrate that neonatal mortality for homebirth attended by a DEM is consistently TRIPLE the rate of neonatal mortality for CNM attended births. Prown responded:
The Wisconsin statistics that Dr. Amy cites are irrelevant. One, they were compiled before Certified Professional Midwives in the state attained legal status (which happened in May, 2007) and two, they make no distinctions among babies who were delivered by CPMs, family members, taxi drivers or anyone else who may or may not have been adequately trained for the task at hand.
Prown is not even honest with herself about the statistics, so she can't possibly be honest with anyone else: She encouraged people to look at Wisconsin for evidence of homebirth safety without knowing that the statistics show that homebirth is not safe. Now she is furiously backpedaling by claiming that the statistics are "irrelevant" and by falsely claiming that they include non-midwives.

Homebirth advocates are not honest with themselves because they attempt to reason backwards from false conclusions. They are sure that homebirth is as safe as hospital birth, so they insist that it is without even bothering to check. They are completely unaware that the low rates of perinatal and maternal mortality in first world countries are the result of modern obstetrics, so they falsely claim that homebirth is as "safe as life gets". They are so isolated from the reality of obstetrics and even the reality of midwifery (CNMs and the US, and European midwives) that they don't know how poorly the grossly inadequate education and training of American DEMs compares to real midwifery training.

I think that Kneelingwoman is entirely correct on this point. Although it may appear that state licensing of DEMs represents a victory, it is the beginning of the end of American direct entry midwifery. When states get involved and start collecting statistics, it will be impossible to sustain the falsehood that homebirth is as safe as hospital birth. It will also be impossible to defend the grossly inadequate education and training of American DEMs. They, like Canadian DEMs and European midwives, will be forced to adhere to higher standards of education, training and practice.


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