Wednesday, July 16, 2008

Geradine Simkins explains the MANA statistics

No, she did not respond to my request that MANA release its safety statistics. However, she did give a presentation at a recent conference sponsored by the National Aboriginal Health Organization ( Her presentation included a detailed poster that explains the MANA statistics project. Of note:

MANA has collected data on planned midwife attended home births since 1993.

Data collection includes "evaluation of all aspects of midwifery care in terms of safety, optimal maternal, fetal, and family outcomes,and cost effectiveness.

Data collection "uses a very extensive data form! ~360 questions."

MANA estimates approximately 20,000 cases will be in the database by the end of 2008.

MANA has NO INTENTION of every releasing the statistics to the public. Only "qualified researchers" will be granted access based on "an application process/review."

This information confirms what we already know about the the MANA database. It is the largest database of its kind, it gathers copious information, and its results are hidden from the public. One detail is quite suprising, however, raising questions about whether the content of the database has been manipulated. According to Ms. Simkins, the database is projected to contain approximately 20,000 records collected over the past 15 years. This does not make sense in light of the fact that MANA recorded 5000+ deliveries in the year 2000 (in the Johnson and Daviss BMJ study, which used their data). At a minimum, we would expect AT LEAST 5000 deliveries per year in 2001-2008. Where are those other patient records?

Another puzzling detail is that the dataset is supposed to be "complete" by the end of 2008. What does that mean? Are they going to stop collecting statistics? Are they going to stop analyzing safety statistics? Moreover, MANA has been publicly offering access to the database since at least the summer of 2006, so why are they now claiming that the data won't be available until the end of 2008? Is that simply to silence critics who know about the existence of the database and have already asked for access? I know of several people who have already been refused, although no one was told that the data was not yet available.

Regardless, MANA has an ethical obligation to release the safety data, broken down by year, for all the years that they have collected data. Anything else must be viewed as an effort hide the data from the public and as almost certainly an effort to prevent the public from learning that MANA's own statistics show that homebirth increases the risk of neonatal death.

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