Saturday, July 28, 2007

MANA is unethical in withholding its statistics

As we have seen repeatedly, the amount of data on homebirth is sparse, and most of the studies are poorly done and biased. Even so, the existing scientific evidence shows that homebirth has an excess rate of preventable neonatal death. There is not enough evidence to draw any conclusions regarding maternal mortality.

There is, however, a repository of statistical information that dwarfs all the existing scientific information, even when it is added all together. That repository is the MANA (Midwives' Alliance of North America) collection of statistics for all registered midwives from 2001-2006 and continuing up through the present. The database probably contains somewhere in the range of 30,000 deliveries, perhaps more. We know that the data is available because MANA is offering it to pre-approved individuals who sign confidentiality agreements preventing them from sharing the data with anyone else.

I don't know what the data shows, but I'd be willing to bet a lot of money that it shows a significant excess rate of preventable neonatal death, perhaps even higher than 1-2/1000. I wouldn't be suprised, either, if it included maternal deaths. Why do I think the data shows that homebirth is not safe? The issue of licensing of DEMs is being discussed in several states. If the MANA data demonstrated the safety of homebirth, they would release it publically themselves. The fact that they refuse to release it except to pre-approved individuals, and the fact that they require a legal document preventing disclosure suggests that the data will be very harmful to MANA's interests.

MANA does not seem to realize that it has an ethical obligation beyond serving its members and their professional and economic interests. It has an ethical obligation to patients. If MANA is in possession of a large database that demonstrates that homebirth is not safe, and I believe they are, it is unethical for them to withhold that information and to take legal steps to insure that the public does not learn that information.

MANA should release the information immediately, both in print and on the web. Any state agencies contemplating DEM licensure should insist on a release of the information as a prerequisite for even considering the licensure issue.

There is simply no ethical justification for withholding the safety information in the MANA database.

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