When I first read about Dr. Fischbein’s improprieties I thought about the tenuous situation that midwives find themselves in where, even if they’re impeccably trained and doing everything they ought to do, their practice can be put in jeopardy because some other practitioner sleeps with a patient. The right thing to do is to oppose patient exploitation wherever it occurs, but maybe it’s also time to look at the system. If the state of California has decided that midwives should be able to practice, their practice shouldn’t be threatened by external events like Dr. Fischbein’s misbehavior or the untimely death of Dr. Gregory Dantzler.

I gathered data for several big studies and observed several others while at Parkland and I’m not sure I even believe in research anymore. There were so many flaws, so much imperfection, and such a willingness to accept it that the foundation I was educated on is shaken.

Sherry, would any of those flaws be sufficient to materially bias neonatal mortality figures? If so, please specify what and how. I just can’t see mortality being miscategorized as, say, “exceptionally low respiration and failure to thrive…”

What does Tutuer cite to discredit it . . . . the execreble Pang study and some unpublished searches on CDC databases?

Given that no credible empirical evidence establishes clearly the superiority of one method over the other (as far as neonatal, perinatal mortality) but ALL studies show dangerous medical intervention are lower with home births, why does Amy Tutuer demonize the home birth advocates? Home birth seems a reasonble reaction to the evidence we have

The comments also demonstrate the fear and misinformation that accompanies almost any discussion of home birth with a physician. Home birth can be so safe with the proper skills and preparation. Yet most doctors respond almost hysterically in opposition. Because home birth is a viable alternative, I can only conclude the rage is based on economics and potential lost income.

And by the way, there is no such thing as what Dr. Tuteur refers to as an “American homebirth midwife”. There are CNM’s and there are lay midwives. Most, if not all, states, in response to intense pressure from the medical profession, no longer qualify or recognize lay midwives. There are many lay midwives who now practice underground because they have no recourse to legal status. This in itself does a tremendous disservice to birthing women. Lay midwives with appropriate training and supervision can be excellent birth attendants. But with no regulation you have a mixed bag, with some very dangerous people indeed doing damage out there.

This is definitely an area that needs more exploration and civil, reasonable discussion among professionals who need to respect each other, not deride each other. That should be easy if we have nothing but the safety of mothers and babies at heart.

But if it is something else driving the animosity, that sort of impartial dialogue will never happen.

I’m also concerned about this statement:
“the North American Registry of Midwives made participation in the study mandatory for recertification and provided an electronic database of the 534 certified professional midwives whose credentials were current.” Does that mean that they were required to participate in this study in order to have a job? It’s unclear to me from the text but if true that would be a major breach of research ethics where dispassionate objectivity is vital.

I’ve been very disappointed in the quality of publications from the BMJ over the last 5 years and approach any paper published in it more cynically than others. That’s my personal bias.

I will admit that I don’t know much about this issue and, not to be rude or dismissive, I really don’t care. (I’m sure most of you don’t care about ANCA vasculitis ) I say that to mean I’m not trying to get into an argument one way or another, I just take issue with poorly designed studies being misrepresented as other than what they are because that makes for those observers like myself to really be able to trust the positions being put forth.

Oh, and I think you meant “libel” not “slander” earlier.

I fear you are truly disseminating false information.

First, from an epidemiological perspective, prospective cohort studies are far more valuable than retrospective descriptive. All yr studies are the former, not the latter. The ONLY prosective cohort study so far discussed is the Johnson/ Daviss report.

Second, u absolutely distort their results. They was a slightly higher rate of natal death in the homebirth group–of a few percentage points. If there had been 1 death fewer, the hospital deaths would have been greater. In other words, the rates were ridiculously close on an absolute level–leading to the conclusion that there was no statistical difference.

Third, you vicious, ad hominem attack on Johnson/Daviss is absurd. By your logic, no OB study would be credible because OBs have an interest in keeping their turf.

Third, do you have a citation for the Malloy study–has it been published in a peer reviewed journal. I’ve worked with CDC data. IT has the same problem as the Pang data–groups all home births (including accidental ones) together. And, again, it’s a retrospective study–kind epidemiological sludge.

Amy, you are a doctor. You are granted great privileges and wealth by the state in the hope that you will use your status responsibly for the benefit of all–not just the financial interest of your profession. Please remember that next time you post something publically!!! All the women who have been cut and mangled by c-sections, contracted hospital-borne infections while giving birth, has unnecessary episiotemies–or more broadly died from OB-transmitted puerpel fever–would want you to remember that too.

Second, your outrageous claim “American homebirth midwife has triple the neonatal mortality rate of homebirth in Canada or The Netherlands”

Those studies come from other countries where midwifery education is far more rigorous than the post high school certificate of American homebirth midwives, and where eligibility requirements for having homebirth are very strict.

Indeed, those studies show that homebirth with an American homebirth midwife has triple the neonatal mortality rate of homebirth in Canada or The Netherlands.

Has anybody conducted a broad literature search in the last five years, looking at empirical results of comparisons between home/midwife and hospital/MD birth?