Everything you always wanted to know about the MANA Stats EXCEPT the death rates

MANA (the Midwives Alliance of North America) has taken hit after hit over their refusal to release their own death rates.

Last fall, stung by my piece MANA on Time.com What Ricki Lake Doesn't Tell You About Homebirth, MANA responded:

Our dataset is currently available to researchers, and we welcome applications. There is no stipulation that data must be used for the advancement of midwifery nor is there an agreement promising not to release death rates; this statement is completely false.

It turns out that the data is available to anyone. Indeed, Melissa Cheyney herself, writing in the pages of the newsletter of NACPM (The National Association of Certified Professional Midwives, is responsible for revealing the data. So how many babies died at the hands of CPMs? Funny you should ask that question. That's the one piece of data that's missing.

First Cheyney explains the MANA database:

The MANA Stats project currently has over 600 active contributors ... and our database contains over 27,000 records and counting... Many contributors have told us that data is power, and we certainly agree! In a political and cultural climate where both threats and opportunities for health reform exist, we see the MANA Stats project at the forefront of providing the robust, comprehensive data needed to advance the midwifery profession ...

The analysis of the data from 2004-2007, comprising over 8800 midwife attended homebirths, is quite comprehensive:

Preliminary statistics emerging from the 2004-2007 dataset demonstrate the importance of a midwifery-dominated maternity system and are comparable to other published studies on homebirth outcomes. For example, the rate of low five-minute Apgar scores for all intended homebirths, regardless of actual place of delivery, is 1.37% (118/8611), and the rate of labor occurring before 37 weeks is 1.4% (123/8,758). The spontaneous vaginal vertex birth rate (all births where the mother went into labor intending to deliver at home minus all non-vertex presentations, cesarean sections, forceps and vacuum extraction) is 91.6% (n=8961), the forceps rate is 0.2% (18/8,863), and the vacuum extraction rate is 1.1% (98/8,863). The cesarean section rate for all women who went into labor intending to birth at home is 5.03% (442/8,788), and the rate of low birth weight infants(<2500 grams) is 0.93% (81/8743). In addition, we have also calculated three types of transport rates: intrapartum transports (IP), neonatal transports (NEO), and postpartum transports (PP). The IP rate is 10.6% (933/8,807), the NEO rate is 0.8% (69/8807), and the PP rate is 1.76% (155/8,807)...

Here's a handy chart to help you keep track of it all.



But wait! There's something missing. That's right; it's the death rate. MANA still refuses to tell us how many of those babies died at the hands of homebirth midwives.

Why?

It can't be because they don't have that information; they've clearly analyzed the database extensively. It can't be because the MANA Stats are only available to researchers; they've publicly released just about every other facet of the data. I can think of only one reason why they refuse to release the death rate; they don't want American women to know!

The death rate for those 8800+ midwife attended homebirths is so unacceptably high that Melissa Cheyney and MANA don't dare tell the truth about it. Instead, they naively hope you won't notice the omission. How could we fail to notice, though, when the absence of the death rate makes all the other statistics meaningless?

Look! The homebirth C-section rate was only 5%! How many babies died because the C-section rate was so low? Umm, we can't tell you that.

Look! Less than 15% of women attempting homebirth transferred to the hospital! How many babies died because they or their mothers were not transferred in a timely fashion? Umm, we can't tell you that.

Look! Less than 1% of babies born at home were transferred to the hospital! How many of those babies were dead on arrival? How many died thereafter? How many suffered permanent brain injuries? Oh, we can't tell you that ... or that ... or that.

It puts the mendacious arguments advanced by Jennifer Block and Gene Declercq in an ugly light.

Block quotes Declercq "on why determining the precise risk of home birth in the United States is nearly impossible":

“It's all but impossible, certainly in the United States,” says Eugene Declercq ... But to really nail it down here in the U.S., he says, we'd need to study tens of thousands of home births, "to be able to find a difference in those rare outcomes.” ...

All but impossible to assemble a database of tens of thousands of homebirths? Really? Really??!! Both Block and Declercq almost certainly know that such a such a database ALREADY EXISTS. The MANA database contains "over 27,000 records and counting."

Melissa Cheyney doesn't believe that it is impossible to "nail down" the US homebirth C-section rate. She doesn't think it is impossible to nail down the Apgars scores of babies born at US homebirths. She doesn't think it is impossible to quantify the neonatal transport rate at only 0.8%. She's bragging about them!

There is simply no question that MANA's own data demonstrates unacceptably high levels of neonatal mortality at home. There is simply no question that MANA is hiding that data because they fear (correctly) that if women knew exactly how many babies die at homebirth, they wouldn't choose it.

So let me offer a public challenge to Gene Declercq:

Now that you know a database of tens of thousands of births already exists, it will be possible for you to "nail down" the death rate at US homebirths. When can we expect you to call MANA and find out the death rate and share it with the rest of us?