To Maria:  Apologies, but Amy's stats have been rebutted ad nauseum in both this thread and at least one other thread on this Forum. She has shifted her ground now to the CDC data, but she lost all credibilility permanently when her initial accusation compared Johnson & Daviss' perinatal death rates (stillbirth + neonatal death) to neonatal death rates, and she refused to acknowledge this error when pointed out to her and went on repeating it. That tells you all you need to know about the honesty of her intentions and whether any more time should be spent trying to establish the validity of her claims. As the saying goes, "Fool me once, shame on you. Fool me twice, shame on me." If you want any further data from Amy, you will have to review this thread and the others (a search on "tuteur" should bring them up) on the Forum or go over to Amy's own blog.

Maria's confusion illustrates the serious problems someone like Tuteur causes for people who want to understand an issue outside of their sphere of expertise. They fall into the trap of thinking they are hearing a legitimate difference of opinion by experts of similar standing when they are not. You know this is so in Amy's case because of her continuing to repeat the same accusation after her basic error was pointed out to her--more than once, I should add. However, the result of her tactics is that those wanting to understand the issue may end up throwing up their hands in frustration, thinking neither side has the right of it or it's just too complicated for the nonexpert to understand. That's a win for the Tuteurs of this world. 

Her mud slinging also serves a purpose. Even if you try to ignore it or understand that it applies to her, it plants the pernicious idea that you can't trust anybody: everyone in the debate has an agenda and will cherry pick or distort data to support their position. Ernst's post suggests this. That's another win for the Tuteurs of this world.  

Amy's tactics achieve another purpose as well. They misdirect attention from much bigger issues with much greater impact on childbearing women. While everyone is in an uproar over the baby's safety in the tiny percentage of women who plan home birth, the focus is off the far greater dangers posed to the health and wellbeing of the millions of mothers and babies who undergo conventional obstetric management. You saw another example of this strategy in the Amer. College of Ob/Gyn's anti-home birth statement (no supportive data, of course) that came out after laceName w:st="on">RickilaceName> laceType w:st="on">LakelaceType>'s movie, the Business of Being Born, began making a splash. The point of the movie wasn't that every woman should birth at home, but the systemic problems with hospital birth that made home birth a good, if not a better, option for low-risk women. However, by shifting the ground to the irresponsibility of home birthers, they took control of the message and the grounds of the debate.

This brings me to one more related thing:  I moderate this Forum parttime. While my time and attention have been taken up with this discussion, I have been neglecting others who are posting on different topics. You all are free to continue the discussion, but I need to turn my attention to them.

-- Henci

Just in case anyone is unclear on what the initial claim Dr. Amy made was and that she continues to make...I believe what Henci is referring to is Dr. Amy's repeated claim that homebirth has a 3 times greater neonatal mortality than hospital birth.  She got this from her calculation of a perinatal mortality rate of 2.7/1000 for homebirth vs. a neonatal mortality rate of 0.9 for hospital birth.  If someone were to challenge her to provide stats now to support the "3 times" allegation, I'm guessing she would cite the CNM in-hospital neonatal mortality rate (around 0.3?) from the CDC Wonder website. 

However, I'd counter that she does not have a fair comparison group because most CNM's are so very stringently controlled on the risk level of patient that they can accept (for example, many can not attend VBACs, or babies over a specific predicted size), so that the CNM patient risk profile does not match the the DEM patient risk profile at ALL.  There is also the issue with the CDC Wonder website that the data is reported as how the birth ended up, not how it was planned...which can really skew the data.  Specifically, many "out of hospital" births are planned hospital births--and these can be pretty high risk because they are often unattended and include people who really doesn't know what to do (just last week a story on the front page of my local paper reported on one such case where a mother birthing her 4th child while standing in a parking lot was assisted by a former maintenance man and another mother of 4...you'd think between 7 prior births those women would have a clue...but NO, they let the maintenance man tie off the umbillical cord with a scrap from a shirt--not necessarily a clean shirt!  And let me guess...in his haste to rip the fabric, he most likely bit it to start the tear rather than finding scissors...) if a risk were to develop during labor with a CNM, care would be transferred more quickly to an MD resulting in many poor outcomes getting shifted out of the CNM data (I had a client who THOUGHT she was going to birth with a midwife, but at the last minute the midwife called in an OB without consulting the mother to catch--or rather to use a vacuum that he barely got out of the package before the baby came out by maternal efforst alone after less than 10 minutes of pushing--because she suspected problems from a suspected big baby--despite the mother's previous history of not having a problem birthing a big baby--so that birth was listed as an MD birth).  This kind of transfer would be less likely to occur with out-of hospital DEM birth...but it does happen, so even for them, we are loosing the data on births that were intended homebirths, but transferred to the hospital. The CDC Wonder website...while intriguing...I feel has a lot of significant drawbacks when it comes to trying to compare different types of care providers.  But oh heck...lets have some fun here...

Using Dr. Amy's cherry picked "low risk" women--20-45 years old, white, singleton babies 37+ weeks, 2500+ g...here are some comparisons of neonatal mortality risk (per 1000) for the 2003-2004 data set:

MD in hospital: 0.61

"Other Midwife" in hospital: 0.36

MD out of hospital:  2.89

"Other Midwife" out of hospital:  1.15

OMG!  Look at that...it doesn't matter where the birth occurs, match the Dr. to the midwife, and the midwife has better outcomes!  We need to ban Dr's!  All births should be in the hospital with "other midwives" to acheive optimum neonatal mortality.

Ridiculous, right?  ;-)

Angela and Jenn: I moved the exchange of posts on the Grobman VBAC study from here to under the VBAC topic.

-- Henci

Henci,
I didn't include the quote to what I was replying to in my last post.  I'll post again. 

Henci,

I'm not sure exactly why you are so offended.  Getting statistics from MANA who isn't exactly an objective party in the matter doesn't make much sense.  People don't like Dr. Amy because she wounds their pride but that doesn't mean what she says isn't worth heavy consideration.  I think she is completely straight forward and people don't like that and people would rather be flattered than know the truth.