A public challenge to Henci Goer
Dear Ms. Goer,
As I have already written, the true spirit of science is the
willingness to present, and the ability to defend, your positions
publicly. So I am offering a public challenge to debate and defend
your positions and the scientific papers you depend on for those
positions. You may not wish to hold it within the context of a
support forum on the Lamaze site. In that case, we can hold it
here, or you can create a new forum on the Lamaze site, or your
personal site, or we can hold it jointly on two sites so there is
no chance of one person changing the other person's comments.
You write for lay people who cannot really evaluate the scientific
validity of your arguments. If your claims are really true, it
should not be difficult to defend them in a debate with me. Indeed,
it could only increase respect for your point of view, if you could
defend your positions.
I look forward to your response.
Amy Tuteur, MD By: ATuteur
Well, at least we agree on something: The true spirit of science
does, indeed, include willingness to defend one's position
publicly, as I have been doing here and have said I am willing to
continue doing. To repeat what I have written before, you are
welcome to post a criticism to any analysis of mine. I will
respond. That will make our positions both clear and public.
Readers will then have everything they need to decide which one of
us suffers from a case of "my mind is made up; don't confuse me
with the facts." But I won't be baited. Your posts on this
Forum--including this one--and the Lamaze blog make it abundantly
clear that you want a fair, fact-based debate on birth issues about
as much as Bill O'Reilly wants one on political issues. I won't
play that game. You have your own blog for your rants. You will get
no platform for them here or from me.
-- Henci By: Henci Goer
Great job managing Amy’s assault. I think your remarks show a
much higher degree of professionalism than Amy displays. Well done!
I would be worried about her being my ambassador if I were an
I was hoping to pulse your thoughts on a topic that Amy would not
engage after I suggested it to her on a number of occasions. As I
have observed and participated in the debate of the safety of
homebirth, I have seen several fundamentals:
- The Industrial Medical Complex’s (Amy’s) point of
view is that there will be an excess of intrapartum fatalities with
homebirth. In fact, it is Amy’s mission in life to try and
illustrate that the hospital (intrapartum+neonatal) mortality rate
is lower than Johnson and Daviss established in their fine study of
- The rate of excess interventions is considered as residing in the
category of inconvenience unless there is a fatality to be
- Our side tends to argue that the (excess) interventions in
hospitals degrade safety when safety is viewed beyond counting dead
babies and dead moms.
So, the engineer in me says we need a common currency to roll up
all of the (technical) issues related to the safety of the birth
setting (or the birth model). It seems to me we need a Composite
Safety Index (CSI). This is a thing I have not seen. I have not
thought this through entirely, but I think this metric might have
the following attributes:
- There is a single numerical value representing the safety of the
- Every defect associated with an intervention is identified.
- The rate of interventions is reasonably established.
- There is a reasonable transfer function that relates the defects
associated with hospital birth to an intrapartum fatality. In other
words, a single maternal mortality per 1000 births might have a
score of 2 while a neonatal fatality might have a score of 1 (lower
is better). Now…an inadvertent hysterectomy due to a C/S may
score equal to an intrapartum fatality (i.e. a lost opportunity
dead baby). Similarly, excess miscarriages due to excess C/S count
equally as an intrapartum fatality. A long term, but not fatal
injury (e.g. skeletal damage associated with forceps), would carry
a lower score (perhaps 0.5 or 0.1). Moderate issues (i.e. pneumonia
acquired in the hospital that is adequately addressed) carry a low
score (perhaps 0.01 to 0.1).
- Inconvenience carries no penalty.
- So, this safety index could be a summation of the following
CSI = ?? (Cij*Ri*Dij)
i = Intervention or event
j = Defects (e.g. intrapartum fatality, miscarriage due to C/S,
Cij = Defect Score (e.g. 2 for maternal mortality, 1 for
intrapartum mortality, etc…)
Ri = Intervention Rate (e.g. 5% C/S rate for home birth and 30% for
Dij = Probability of a Defect per intervention
For every intervention (i) there could be a number of defects (j).
While I’m sure that the Defect Score would be meat for lots
of argument and it would be a lot of work to survey the studies to
estimate the probability of a defect, it seems to me this could be
helpful in setting policy (which is why I have been arguing with
Amy for some months – my wife is a CPM and we live in one of
the few states left that does not license non-nurse midwives).
Has such a thing been attempted?
Please keep up the effort. Amy will likely continue to growl at
you. If she continues to make her case on your forum, I am very
confident that our point of view will be shown in a favorable
As it turns out, what you have proposed is an example of "great
minds thinking alike." The American College of Nurse-Midwives has
developed the Optimality Tool, a method for measuring the quality
of maternity care systems. An optimal birth is one in which the
best outcomes have been achieved with the least use of medical
intervention. It has a yes/no scoring system for labor events and
outcomes that incorporates obstetric history and current health so
that apples can be compared with apples. All items are based in the
research evidence. For more information, go to Optimality Index
. My boss
at Lamaze, a nurse midwife herself, envisions a day when women will
compare their Optimality scores the way they sometimes compare
Apgar scores today.
-- Henci By: Henci Goer
I am offended by your comment that we as lay people can not
"evaluate the scientific validity" of what Henci may have to say. I
am a lay person and am quite capable of reading scietific journals
or medical research. If I come across something I don't understand
I get out the dictionary or do a online search. Maybe it is the
hope of OBs that we can't understand and that we don't seek out our
own information. What you have said in your post is why there is
such a backlash. The total arrogance is unbelievable. In all the
postings I've read Henci always gives references and links to
helpful information. It's not as if she is telling us "lay people",
who can not think for ourselves, that what she says is absolute
truth, and just blindly follow it. Can that be said for OBs?
Heather By: Heather
So not only do our bodies not work properly, our minds don't
I had the same thoughts, Heather. Thank you for standing up. I feel
quite capable of reading the research myself too, and I applaud
Henci for pointing people who are looking for information in the
right direction, enabling them to be autonomous.
maria. By: maria
Scientific validity. Our neonatal and maternal mortality
rates run well outside of the top ten in the world, all the top
spots are held by countries who have midwife guided
If I may correct some of the information in your post, it is
true that countries with the lowest mortality rates have midwives
in charge of most births, but only one developed country: the
Netherlands, has a substantial proportion of women birthing at
home. And just to clarify, it is also true, but often not
understood by people unfamiliar with international maternity care
systems, that in many countries, midwives function as labor and
delivery nurses do here, and in other countries, midwives catch
babies, but obstetricians set policies. Under these
circumstances, women may be treated just as abysmally as they may
be treated here.
Dear Ms. Tuteur,
I am offended by your notion that lay people are incapable of
understanding the results of scientific studies. For the
sake of fellow "lay people", I sincerely hope you are not still
practicing medicine. You seem to have an over-active ego
which goes untempered by even a minimal degree of
humility or respect for those you are supposedly serving.
All Times America/New_York
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