Jennifer Block makes a big mistake

Jennifer Block made a big mistake this time. No, I don't mean her habit of offering mistruths, half truths and outright lies, nor her propensity to ignore facts that she doesn't like, not even her pathetic substitution of ad hominem attacks against me in place of addressing the data that I presented. In her recent Slate piece, she questioned the integrity of another journalist, Michelle Goldberg, and it has blown up in her face.

Block didn't know about Goldberg what I learned about her. She is the most thorough, in depth reporter I have ever dealt with. She immersed herself in the topic over a period of weeks, interviewed dozens of people and followed up on everything. When I told her about the Johnson and Daviss paper and the bait and switch they perpetrated to make homebirth look safe when their data showed it wasn't, she called them and offered an opportuntity to explain. Apparently, they weren't able to explain away the bait and switch.

When I told her about women who lost babies at homebirth, she spoke to nearly a dozen of them. She talked to other obstetricians, a pediatric emergency room chief, and many more people who are directly and indirectly affected by the homebirth issue. The article that she eventually produced only hinted at the tremendous amount of research that went into it, as well as the strenuous efforts to follow through on every claim, and the opportunities given to homebirth advocates to explain their previous actions.

Goldberg draws on this research in a published response to Block's accusations:

... I’m grateful for Block’s piece, since it gives me a chance to wade into some of the disputes that I elided, for reasons for space and readability, in my original article...

Block presents two arguments for why we shouldn’t take Tuteur seriously. The first is that she is no longer practicing ...Block offers no evidence to dispute her interpretation of existing data. Nor does she explain why Tuteur’s retirement renders her impressive medical background irrelevant.

It was Tuteur who found serious flaws in a widely-cited study published by home-birth advocates Kenneth C. Johnson and his wife, Betty-Anne Daviss, in the British Medical Journal, that purported to show home birth’s safety. In response, Johnson and Daviss self-published a new analysis with updated data—a tacit admission that Tuteur’s criticisms were valid. (Tuteur, as I explained, disputes the methodology of their new, non-peer reviewed analysis as well.) She is an important voice in this debate, whether Block likes it or not.

Moreover:

... I also quoted Martha Reilly, chief of Women’s and Children’s Services at McKenzie-Willamette Medical Center near Eugene, Ore., a place where home birth is particularly popular. Reilly told me that every ob-gyn she works with has treated a woman rushed in after a home birth gone awry, her baby dead or severely injured. Block essentially accuses her of lying, though according to Reilly she didn’t bother to call her. “The Department of Health reports 102 planned home births in Lane County in 2010,” writes Block. “Reilly’s claim is improbable given that the odds are in the per-thousand range, though it’s perhaps indicative of how polarized some providers are on this issue.” But Reilly didn’t claim that all these disasters happened in one year. Nor is there any reason to assume, as Block does, that none of them came from surrounding counties.

And typical of Block's "bad faith approach":

... She quotes one “Melissa Cheney,” an “anthropologist at Oregon State,” who claims to have found that doctors spread unsubstantiated rumors about home-birth deaths. In fact, the anthropologist’s name is spelled Melissa Cheyney, and in addition to her post at Oregon State, she is a licensed midwife and head of the division of research at the Midwives Alliance of North America. Cheyney is a major figure in the pro-midwifery community, not an objective academic observer.

In addition:

...[Block] cites studies from Canada, the U.K., and the Netherlands ... I explained, in my original piece, why it doesn’t make sense to compare home-birth midwifery in the United States, where training and regulation are incredibly lax, to the practice in countries where it’s deeply integrated into national health services. For the sake of brevity, I didn’t go into detail. Let me do so now, focusing on Holland, a country American home-birth advocates love to reference. (You may also want to read Lindsay Beyerstein of In These Times on the same subject.)

... [I]t’s not entirely clear just how well the Dutch system really works. A 2010 study of Holland from the British Medical Journal found that the babies of low-risk mothers cared for by midwives had a higher death rate than the babies of high-risk women who delivered in hospitals. The study also pointed out that the Netherlands has one of the highest perinatal morality rates in Europe. “Whether the Dutch obstetric-care system contributes to this relatively high mortality remains unclear,” it says.

Goldberg offers a powerful indictment of homebirth advocates:

... The home-birth movement seems to be driven by a quasi-religious naturalist ideology that denies the danger that’s been inherent in childbirth for most of human history. It cherry-picks studies, distorts facts, and attacks its critics in a way that reminds me of my many years reporting on the Christian right. (my emphasis)

As to the charge that those who report on the data about the risk of neonatal death at homebirth:

Women have a right to adhere to the home birth movement’s ideology, and as far as I’m concerned they have a right to have their babies anywhere they choose. But they also have a right to know that giving birth at home has the potential for as much danger and trauma as anything in Block’s book about the horrors of hospitals. They have a right to weigh the very real risk of an unnecessary C-section against the risk of a dead baby, which is much smaller but, to many mothers, much more grave.

That’s not trying to scare women. It’s being honest with them.