Sunday, June 29, 2008

Goer cannot rebut the claims

To her credit, instead of deleting my post, Henci Goer boldly tries to address it:
The link you inserted for the WHO quote did not work, but I tracked down the quote by searching on the terms "World Health Organization" "April 2006" and "home-like." Those who know you will not be surprised to hear that you misinterpreted the WHO statement, which is about "home-like settings" in hospitals not home births. The WHO sources its statement to

Hodnett ED et al. Home-like versus conventional institutional settings for birth. The Cochrane Database of Systematic Reviews, 2005, 1, article number CD000012.

Without a source for the NICE statement, I will not venture to comment on what you are likely to have taken out of context or misrepresented except to say that it hardly seems likely that U.K. health care policy would promote home birth if it posed excessive risk, which, of course, it doesn't.

Finally, the blanket accusation that U.S. direct-entry midwives have less training than other midwives in industrialized countries requires no denial because it is fatuous. The person who made it offered no comparison data to substantiate the claim. In fact, it would have been impossible to do so. Midwifery training varies from country to country as does scope of practice. In many countries, midwives do not function independently but under the supervision of obs who set policies and make medical decisions. In some countries, they function the way intrapartum nurses do here and don't even catch babies. The training needed for practice in these situations is different than that needed by a midwife working independently who takes full responsibility for her clients. What is more, other than in the Netherlands, midwives are almost always trained to conduct hospital births exclusively, which is a whole different animal from home birth. To sum up, there is nothing to "deny" because the accusation has no substance. The real question is, "Do certified U.S. direct-entry midwives receive adequate training to properly care for women intending home births and their infants in the antepartum, intrapartum, and postpartum periods?" To answer it, one has only to show that the NARM certification process for midwives is rigorous and thorough and that to achieve certification, a midwife must demonstrate that she has the requisite knowledge, skill, and experience to care for women appropriately at out-of-hospital births. End of story.
End of story? I don't think so. Here's my response, posted to her website:
Those claims were mine. Maria quoted them here without attributing them to me.

Ms. Goer, you did not manage to rebut, either claim, both of which are quite simple:

1. The WHO says homebirth increases the risk of neonatal death

2. US DEMs (including CPMs) have less education and less training than ANY midwives in the industrialized world.

Marsden Wagner himself acknowledges that the WHO strong disagreed with him on his personal opinion that homebirth is safe. He writes about it proudly in his chapter, Confessions of a Dissident, in the book Childbirth and Authoratative Knowledge by Brigitte Jordan.

Moreover, you did not even address the latest CDC statistics from the linked Linked Birth/Infant Death 2003-2004 dataset. The data show that homebirth with a direct entry midwife has double to triple the neonatal death rate as hospital birth for low risk women.

And as long as we are discussing this issue, I will mention two additional points that you have never addressed:

1. MANA (the Midwives Alliance of North America) has been collecting safety data on homebirth since 2001. They have publicly offered the data to those who can prove they will use it for the "advancement" of midwifery. Even those people must sign a legal non-disclosure agreement preventing them from revealing any data to anyone. In contrast, the US and state governments make all birth data available each year on the internet. MANA's data almost certainly show that homebirth with a CPM has a much higher neonatal death rate.

2. Over a year ago, we argued about whether Johnson and Daviss used the correct comparison group in the BMJ 2005 study. I said that the correct comparison group was low risk hospital births in 2000. With that comparison (which Johnson and Daviss left out of the paper), they had ACTUALLY showed that homebirth with a CPM had a neonatal death almost triple that of hospital birth. You gave all sorts of excuses as to why they didn't need to use that group. Johnson and Daviss have since publicly acknowledged on their onw website that I am correct. You have not acknowledged it, and instead (as far as I can tell) deleted the posts you wrote in support of the wrong control group.

3. Maria pointed out to you in another post that the World Health Organization 2006 report on perinatal mortality (which shows that the US has a lower rate of perinatal mortality than Denmark, the UK and the Netherlands) and that this cannot be reconciled with your public claims that the US has a higher rate of perinatal mortality than other first world countries. Fortunately, you now acknowlede that the US perinatal mortality rate is comparable to other developed countries.

Finally, I would appreciate it if you would stop insinuating that I am not who I say I am, that I do not have the credentials I list in my CV (Harvard '79; BU School of Medicine '84; Boston's Beth Israel Hospital internship, residency, staff appointment OB-GYN, Brigham and Women's Hospital staff appointment, Harvard Medical School Instructor in Clinical Obstetrics and Gynecology) or that I am in the employ of ANY organization. A public apology for your completely baseless, fabricated accusations would be appropriate. If you promote such obvious and easily checked falsehoods about me, people might begin to think you are using the same tactic to promote homebirth.

In case you decide to refuse to post or to delete this entry, readers can find it on my website.


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