Homebirth midwives don’t want you to know

What would you think if the package insert for your new medication said the following?

Our company, Drugs4All has tested this medication in 20,000 people and collected copious data about its effects. But we made a promise to Drugs4All shareholders that we will not let anyone see that data unless they can demonstrate that they will use it to promote the well being of our company.

Therefore, we’ve created a two-step process for access to the data. If you’d like to learn about the safety of this medication please complete the application attached and explain your commitment to the well being of Drugs4All. Please include the your name and the names of anyone you have ever associated with. A committee will review your ideological commitment to the well being of Drugs4All to be sure that you will not use the data to harm our interests.

If you meet with our approval you will be eligible to see our safety data. That’s step 1. In step 2 you must sign our non-disclosure agreement promising not to share the data with anyone else under the pain of legal penalties.

We’re sorry for any inconvenience, but our first commitment is naturally to our shareholders, not to our customers.

Your first assumption might be that Drugs4All withheld the safety data from the public because it shows that the drug is not safe. Therefore, they must restrict access to the data to those who can demonstrate in advance that they are committed to the interests of Drugs4All and have instituted penalties to be sure that no one else sees it.

Crazy, right?

Evidently not. This the procedure that the Midwives Alliance of North America (MANA), the official organization of homebirth midwives, has instituted to protect the safety data they have gathered in the past decade. In periodic public announcements over the past few years, MANA has announced the existence of the data and promised that it will be the largest and most extensive database of its kind.

Unfortunately for MANA, though, it does not show what they want it to show. Since their first commitment is to homebirth midwives, not their patients, they have publicly announced that only those who pass an ideological litmus test and sign a legal non-disclosure agreement will be allow access to the data.

According to the MANA Handbook for Researchers Interested in Obtaining Access to the Manastats Database:

[MANA} is responsible for representing the midwifery community in its relationship with investigators…Therefore [MANA] expects all investigators interested in collaboration with this community to consider how they can cooperate … and to describe how they intend to do so in their request for data access.

Upon approval of a research application, access will be predicated on the signing of a … a Confidentiality and Non-Disclosure Agreement…

It is difficult to imagine a more unethical procedure for gaining access to the database. MANA has made several things clear.

1. It’s first priority is the benefit of its shareholders.
2. MANA does not believe that patients have any right to know the truth about homebirth safety
3. The data is potentially so damaging to homebirth midwives that it must not be allowed to get out to anyone who hasn’t been vetted in advance and promised to keep it secret from the public.

It does not take a rocket scientist to surmise that MANA’s own data show that homebirth with an American homebirth midwife is not safe. Withholding that information from patients is both unethical and immoral.

MANA should publicly release all their available safety data immediately. Will that hurt the employment prospects of homebirth midwives? Probably, but that’s just too bad.

No one can make an informed decision about homebirth without access to information. But I guess that’s the point. An informed patient might not become a customer, and as MANA has helpfully informed us, representing the interests of homebirth midwives is its most important priority.

  • Deena Chamlee

    But CNM AAP and ACOG has recommended using only CNM or CMs for homebirths. I don’t think there would be an issue if we addressed that:

    1. CM need to be license in every state just as CNMs are

    2. If any non nurse midwife wants to continue to practice they need to complete the educational pathway that leads to the CM credential.

    And that is what we should be working towards.

  • Deena Chamlee

    Melissa transfers does not have anything to do with such high perinatal mortality rates such as Oregon’s and Colorado’s.

    The problem lies with licensing high school prepared individuals as midwives and that has got to stop. Too many babies have lost their lives because of the mayhem.

  • Deena Chamlee

    Oregon

    2012 5.6/1000 or 4.0/1000 perinatal mortality rate for CPMs ( first is cited by Rooks second by Oregon Midwifery Counsel.) Either way unacceptable and devastating.

  • Carla

    agreed. In my opinion natural is more likely to be risk free if done in a safe place than having drugs pumped into you (those ALAWAYS have side effects). If MDs are so worried about homebirths let’s let natural births happen in hospitals, better yet let’s encourage them, that way we don’t waste money on drugs, NICU and even patient stay… oh wait…

  • Carla

    No they aren’t. As I was going insane with the pain during my first labor, an epidural was offered to me as a way out, a paper was given for me to sign but I was never told about the risks. I’m sure it’s there on the paper but really, do you expect a woman in a lot of pain to read it? I don’t think so. I ended up with an emergency c-section. My child ended up with severe jaundice (which is not necessarily a big problem but still) which now I know is one of the side effects of the many drugs pumped into me without asking for permission during my labor. My second birth was an scheduled c-section also offered by my doctor because it was safer. I was informed of the risks of uterine rupture or of my second daughter getting stuck like the first one. I was never told about the risk of my baby aspirating the amniotic fluid because, since I didn’t go into labor, her lungs didn’t quite get ready to breath. I was told that later while my baby was in the NICU. Not at all a fun experience and if I had known that BEFORE I would’ve certainly considered a VBAC with the risk of another emergency c-section (because then I would’ve suffered not her). I’m sure NATURAL (what is so wrong with that, doctor? You don’t get to use your problem solving skills?) childbirth practiced at home has its risks and I too hope and wish midwives are clear about them. But MDs aren’t always clear about the risks of a hospital birth either. What you are talking about is the ideal that medicine should be practiced which is not always the case (certainly it was not the case with me). True my daughter is fine now, both of them are, but I sure could have used letting my body do its job in its own time (ideally in the safety of a hospital) so that my daughter wouldn’t have to go through 3 days away from me intubated in the NICU. The whole reason why women run for homebirths is usually because of the terror they go through in hospitals created by unnecessary interventions that lead to problems that ask for more unnecessary interventions that make doctors very useful. It would be beautiful if hospitals and midwifery could come together and work for the well being of the patient and not for insurance interests, ego and fear of being sued. Europe seems to do it beautifully. We should learn a thing or two instead pointing fingers at one another.

  • http://twitter.com/UltraVenia Jules

    Out of how many total births?

  • vdl

    This is because OBs and MDs think they are the owners of our body, babies, and decision, they for got that we paid them, and when I pay for something is my decision to do the thing my way, not their way, thats why we choose to home bith because they dont respect us.

    • http://twitter.com/UltraVenia Jules

      So you care more about being “respected” than the health and well-being of your baby?

    • suchende

      Choosing to homebirth because you don’t like how MDs treat you is like trading your BMW with a faulty air conditioning system for a Pinto with faulty brakes.

      It’s not just a matter of who is paying whom. You would understand that if you were a licensed professional who pays malpractice insurance and faces a disciplinary board in the event of bad outcomes.