Saturday, June 28, 2008

Henci Goer and the truth

Henci Goer continues to have great difficulty with the truth. She is putting her own credibility with laypeople in jeopardy when she makes misleading claims about facts that are so easy to check.

Someone wrote the following on the Lamaze message board:
1. Homebirth increases the risk of neonatal death. This is accepted and acknowledged by the WHO, the CDC, NICE (The National Insitute for Health and Clinical Excellence), a healthcare watchdog in the UK, among other major health organizations.

2. American direct entry midwives have less education and training than any midwives in the industrialized world.

Henci, do you have more information about this? Thanks!
Here's Goer's disingenuous response:
Both statements are gross falsehoods. Here is a quote from Care in Normal Birth: A Practical Guide, which is published by the WHO:

So where then should a woman give birth? It is safe to say that a woman should give birth in a place she feels is safe, and at the most peripheral level at which appropriate care is feasible and safe (FIGO 1992 [FIGO is the international Ob/Gyns professional organization]). For a low-risk pregnant woman this can be at home, at a small maternity clinic or birth centre in town . . . (p. 12)

World Health Organization. Care in Normal Birth: A Practical Guide. Geneva: World Health Organization; 1996.

And here is a quote from Sheila Kitzinger, writing in this year's March issue of Birth:

In September 2007 the UK National Institute for Health and Clinical Excellence (NICE) issued clinical guidelines on intrapartum care of healthy women and their babies during childbirth. Under "key priorities" it stated: "Women should be offered the choice of planning birth at home, in a midwife-led unit or in an obstetric unit." Information suggests that for "women who plan to give birth at home or in a midwife-led unit there is a higher likelihood of a normal birth, with less intervention" (p. 77).

Kitzinger K. Letter from Europe: home birth reborn. Birth 2008;35(1):77-8.

As for the canard that U.S. direct-entry midwives are poorly trained, a perusal of the North American Registry of Midwives (NARM) website gives the lie to that.
Goer's quote from the WHO is out of date. The WHO said in April 2006:
Home-like settings for childbirth are associated with reduced likelihood of medical intervention. The evidence shows that the number of spontaneous vaginal births is higher, breastfeeding initiation more common and maternal satisfaction better in home-like institutional birth settings compared to conventional institutional settings. However, the evidence shows an increased risk of perinatal mortality, the reasons of which are not fully established. Thus, there is an increased need for monitoring early signs of complications in these home-like settings. (my emphasis)
As far as the NICE report is concerned, Goer didn't even answer the question. She was asked if NICE reports a higher rate of neonatal mortality at homebirth, and they do. From the same report that Goer quoted:
... intrapartum-related perinatal mortality (IPPM) for booked home births, regardless of their eventual place of birth, is the same as, or higher than for birth booked in obstetric units.
* If IPPM is higher, this is likely to be in the group of women in whom intrapartum complications develop and who require transfer into the obstetric unit...
* When unanticipated obstetric complications arise, either in the mother or baby, during labour at home, the outcome of serious complications is likely to be less favourable than when the same complications arise in an obstetric unit.
Goer tried to sidestep the direct question that she was asked about DEM qualifications. American DEMs have less education and training than ANY midwives in the industrialized world. There's no denying it and she didn't deny it.

Obviously, neither claim is a falsehood, so why did Henci Goer say they were?


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