http://www.blogher.com/ama-ricki-lake-no-more-babies-born-bathtubs-please-ricki-lake-ama-stuff-it#comment-46556

I have multiple problems with this (white women only, assuming all of the nurse-midwife and midwife attended births were low-risk, etc.). Can you address it?

If you will head on over to the "two questions" thread under the "home birth & birth centers" topic, and read through to the end, especially my post on p. 4, it will explain why I am not going to spend any more time refuting Tuteur's claims. In a nutshell, her original failure to understand that perinatal mortality rates cannot be compared to neonatal mortality rates is so fundamental that there are only two possibilities: she is grossly unqualified to argue statistics or she is deliberately trying to mislead. Her refusal to correct that crucial error after having it pointed out to her argues for the latter. In either case, she has no credibility and is therefore not entitled to the time or effort it would take for the refutation.

-- Henci

Henci, please tell me if I'm off my mark here . . .

Notwithstanding the perinatal/neonatal equivocation . . . The chart that she generated refers to DEMs when the CDC refers only to "Other Midwives."  From my understanding, the CDC gathers this data from birth certificates.  A number of states are still using the 1989 birth certificates, which do not specify birth attendants or whether or not a home birth was planned or unplanned.  (The notorious but well-debunked Pang study of Washington State home births attempted to extrapolate the same homebirth-is-dangerous conclusions from the same data).  Even with the newer 2003 birth certificates, the CDC is still getting limited data.  The category of "other midwives" is not a guarantor of planned out-of-hospital births overseen by NARM-certified midwives.  Just some thoughts . . .

You are on the money. Home birth midwives come in all kinds of flavors. Some are certified nurse-midwives (CNMs), some are certified direct-entry midwives by NARM (CPMs), some are licensed midwives (LMs), and I don't know what their training may be or who is the licensing body, although perhaps someone else who follows this board does. (If so, please educate us.) Some, as you say, are not certified by any organization so who knows what their qualifications are. In a few states direct-entry midwives are still illegal. I have no idea what people put down on the birth certificate in those states. I don't know what the unassisted home birthers put down either. I don't know what midwives do in cases where identification could mean big trouble for the midwife, for example, home VBACs. In short, as any objective person would understand, no conclusions can be drawn from a CDC-generated chart about the relationship between direct-entry midwives and home birth outcomes, especially these days when the only option for a woman with a prior c/sec, breech baby, or twins who doesn't want to be forced into cesarean surgery against her wishes is to have her baby at home.

-- Henci

That reminds me of the "thought for the evening" I used to put up back when I was teaching Lamaze classes out of my home: "Doctors don't deliver babies. Women give birth."

-- Henci