better birth lies about the safety of out of hospital birth

I was poking around better birth’s website the other day, and I was perplexed to find this pdf on their website (titled “The Advantages of Out of Hospital Birth”, by Suzanne Smith LDEM). the very first claim is a whopper:

Out-Of-Hospital Birth is Safer than
Hospital Birth
Yes, that’s right, safer. Scientific studies
from around the world show birth outside
a hospital with a competent midwife to be
the safest way for normal, healthy
pregnant women.

She bases this conclusion off of the fact that the vital statistics for Utah lists out of hospital birth as having a perinatal death rate that was lower than that in the hospital. She bases it off of only two years of data. Here is the table:

table

If you didn’t think about it for more than a few minutes it would seem a plausible claim, until you realize that hospitals take all patients, including high risk patients. Births that were undoubtedly going to end in perinatal death were presided over in a hospital setting, and get put into the ‘hospital’ column.  Patients with developmentally abnormal babies, or extremely premature babies, factor into the hospital perinatal death rate. They do not factor into the rate for home birth midwives.

One question I have is that if a baby dies after a homebirth transfer, which column does it get counted in? What does a free-standing birth center birth count as? These are questions not answered in the PDF.

I also happen to know that the years listed here were before midwifery became legal in the state of Utah. How can we be sure that planned home births were accurately reported when midwives could face prosecution for attending to them? The number of home births is so small compared to hospital births, so missing a single death would throw off the percentages greatly (where as missing a hospital death would have a much smaller effect).

I know for a fact that these numbers aren’t complete to begin with. The FLDS (which runs its own birthing center with midwives) has a huge graveyard filled with dead babies. These deaths aren’t reported. There is speculation that inbreeding may have caused many of these stillbirths, but we can never know for sure. There are even more unreported perinatal deaths in the utah compound:

Pam Black, a former member of the FLDS says that not all of Colorado City’s dead infants are buried in the cemetery. While she was still a member of the FLDS, Warren Jeffs declared, “Babies, born stillborn, are born ‘without souls’ and do not require burial in consecrated ground.” When Pam Black gave birth to a stillborn infant in the FLDS-run clinic, they wanted to bury her dead baby boy, wrapped in the afterbirth and shoved into a plastic trash bag, in the back yard of the clinic, like a dog. Only after much crying and begging did staff finally relent and allow her child to burial in the “Babyland” cemetery.

It is impossible to know how many (if any) stillbirths belong on the chart Suzanne Smith holds up as proof that homebirth is safer than hospital birth.

Suzanne Smith references a study that said it had the same conclusion, but that shared many of the same flaws (comparing hospital births of high risk pregnancies to low risk pregnancies). There were other problems with the studies- such as midwives being able to opt out of participating in the study. That would no doubt tweak the numbers. The responses are worth a read. Its nothing but actual health professionals pointing out the flaws of the study and a bunch of lay midwives praising the study for ‘proving’ that home birth is safer.

What the study actually shows is that, in the best case scenario (meaning with data that can be cherry-picked to favor home birth) the death rate for healthy pregnancies is very similar to the death rate for hospitals (including high risk pregnancies). This does not prove that home birth is safer than out of hospital birth- quite the opposite, in fact. The death rate for low risk women should not be at all comparable to the risk of the general patient population, and they are no where near being able to match the hospital’s rate for low risk women.

Some of it is just outright bullshit:

The safest (and usually most rewarding)
way to have a baby is naturally, without
drugs to interfere with the birth process
and the body chemistry of you and the
baby.

-Suzanne Smith, LDEM and owner of Better Birth LLC

Natural meaning no epidural, IV, or surgery (among other things). safest for who? the baby with a chord prolapse? the baby who is in fetal distress? the mother who has a metal bar in her sacrum? the mother who has a bleeding disorder? an active case of genital herpes? 3 previous c-sections? The baby whose mother has a group b strep infection? You cannot say “the safest way to have a baby is ____” when c-sections are safer for some and vaginal birth safer for others.

This is something I find completely unacceptable. I don’t have a problem with women choosing out of hospital birth, as long as they are informed of the actual risk involved with their choice. This is flagrant false advertising on the part of Better Birth LLC. Patients cannot meaningfully consent to services from women who are either unwilling or unable to understand the data available regarding out of hospital birth. The PDF isn’t something better birth simply linked to, its something the owner authored. I can’t decide if she is deluded, very stupid, or cravenly dishonest. Regardless of the motivation, there needs to be legislation in place to protect mothers from midwives like her who are willing to sell this fiction with a straight face.

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4 comments

  1. Reblogged this on Safer Midwifery in Utah and commented:

    Utah midwives should not be allowed to get away with lying to patients. We deserve informed consent.

  2. Elizabeth Clark · ·

    Your right many of the planned homebirths that went wrong pre-2005 were frequently recorded as a precipitous birth gone wrong.
    It always seems fascinating to me how few women seem to be bother by it when these midwives say they’ve been practicing since 1984 or 2000 even after they’ve been told that it was illegal.

  3. Actually, the neonatal death rate in the hospital for babies of all risk levels is 4.5/ 5 out of 1000 for white and hispanic babies and up to 10/1000 for black babies. Point being: the stats you posted are for low risk babies and women in both the home and hospital setting.

  4. I went looking for information on perinatal mortality in 1990 in utah, and the state has a figure of 3.78/1000. There is no information provided about the report that better birth is citing or why their percentages differ from the official record. If you are comfortable saying its because they identified low risk women for hospital birth, go ahead. I’m really not. Even if they were only low risk patients, it would not negate all the other problems I identified (such as midwifery being illegal during the time that this information was gathered, transfers, FLDS births, etc).

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