The Midwives Alliance of North America (MANA) is aware and has been aware for some time that homebirth has an unacceptably high rate of neonatal death. Their own data makes that clear and that's why they are hiding it. In fact, there now trying to "reframe the conversation," a classic public relations ploy designed to conceal an unpalatable truth.
I have been pounding away at this point for more than four years. I first wrote about it in January 2007 (Why is MANA hiding its data?):
... The [Johnson and Daviss BMJ 2005 study] included data from the year 2000 only, but MANA (Midwives Alliance of North America) has continued the collections of statistics. This could be a valuable resource for women wondering about the safety of homebirth. There's a problem, though. No one is allowed to see those statistics. Well, that's not quite right. You can have access to the statistics only if you "use the data for the advancement of midwifery".
In fact, as early as summer 2006, MANA had already instituted elaborate procedures to hide the neonatal death rate of homebirth, including a non-disclosure agreement with legal penalties for anyone allowed to see the data prohibiting them from letting anyone else see the results.
In July 2008, MANA President Geradine Simkins explained the database:
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.
It does not take a rocket scientist to speculate that MANA is hiding its own safety data because that data shows that homebirth increases the risk of neonatal death. Indeed, MANA has made it clear that it has no intention of ever releasing homebirth death rates to the public, and has attempted to justify this by invoking, then twisting the meaning of "community based research."
From the MANA Handbook for Researchers Interested in Obtaining Access to the MANASTATS Database
The MANA DOR endorses the principles of Community-Based Participatory Research (CBPR), ... a collaborative approach in which research takes place in community settings and involves community members in the design and implementation of research projects... The MANA DOR is responsible for representing the midwifery community in its relationship with investigators... Therefore the MANA DOR expects all investigators interested in collaboration with this community to consider how they can cooperate with these principles, and to describe how they intend to do so in their request for data access.
But community based participatory research is designed to protect the PATIENTS not the providers. And patients deserve to know how many babies died at the hands of homebirth midwives in the past decade.
I have been hammering away at this issue in the past 4 years in every possible forum and with every professional homebirth advocate I could find ... and the silence has been deafening. I'm not surprised about the silence from MANA. It would serve no purpose for them to openly acknowledge that they are hiding the homebirth death rate, and there is no way they could deny that they are hiding it. I am, however, a bit surprised by the silence of professional homebirth advocates.
At first I thought that professional homebirth advocates were silent because they did not know the truth, but after 4 years and a myriad of on-line encounters, I've begun to wonder if many professional homebirth advocates have confirmed that MANA has found the homebirth death rate to be unacceptably high, and they have joined in the effort to hide that information.
Ina May Gaskin is the founder of MANA and is a very active professional homebirth advocate. I've asked her repeatedly, in a variety of different forums, why MANA is hiding the homebirth death rate and whether she thinks it is ethical for MANA to hide the homebirth death rate. She has never even acknowledged the question.
Amy Romano offered this disingenuous attempt to justify MANA's behavior:
I'm irritated that you don’t seem to have read or tried to understand my post and have just shown up to copy and paste the same comment you’ve been leaving around the web. But I will go ahead and respond just to say that I have no affiliation with MANA other than that when I was practicing I contributed data to the MANAStats database... I have read their policies and procedures governing access to MANAStats data and ... I see a pretty straightforward process that ... the research benefit the community. In general I am an advocate of open access to data on the principle that it accelerates the pace of scientific discovery. But I don't see, from my interpretation of their policies, anything that puts up unnecessary barriers.
As a contributor to the database, Romano actually qualifies for access. Yet she does not seem to have taken advantage of that access. Apparently, she doesn't care about the MANA homebirth death rates, which is inexcusable since she is all over the web claiming that homebirth is safe.
But when it comes to nerve, no one tops Amie Newman of RH Reality Check. When confronted with the fact that MANA is hiding their neonatal death rate, she had this to say:
I 100% believe that women deserve the right to know how safe planned homebirth is with a Certified Professional Midwife. I also 100% believe that we have that information currently.
In other words, it supposedly makes no difference that MANA is hiding their death rates for 18,000 homebirths, because we already know all we need to know.
Curiously, not a single professional homebirth advocate has offered to question MANA about their neonatal death rate, or issued a public plea for MANA to reveal their death rate. Which makes me wonder ... how many of them already know the truth? How many professional homebirth advocates are aware of exactly how many of those 18,000 babies died at the hands of homebirth midwives, and are colluding in hiding that data from the public?
When it comes to the people at MANA, like Melissa Cheyney and Geradine Simkins, I don't know how they can live with themselves. They know that homebirth kills babies and they are working very hard to make sure that American women do not find out the truth. But how about the rest of the professional homebirth advocates? How can they live with themselves, continuing to tout the safety of homebirth, while knowing all along that the single largest database of American homebirth shows precisely the opposite?