How do homebirth midwives handle mistakes?

How do homebirth midwives handle mistakes? They bury them, of course.

They literally bury the babies who die under their care in achingly tiny white coffins. But that isn’t enough. They completely obliterate their existence by refusing to report the neonatal death rates at homebirth.

Finally, an official body has noted that homebirth midwives, organized as Midwives Alliance of North America (MANA), have refused to release their own data on babies who have died at homebirth.

The state of Oregon is currently considering enlarging the scope of practice of direct entry midwives. This is occurring despite the fact that there is no data demonstrating that direct entry midwives are safe practitioners with the limitations currently in place. Apparently, when this data was sought, some midwifery advocates suggested relying on the safety data collected by MANA over the past decade, which, remains hidden. The hearing officer pointedly noted MANA’s conflict of interest (Summary of Public Hearing Testimony and Written Comments, With Recommendations of Hearings Offucer: October 28, 2010).

… [T]he Hearings Officers has reservations about the Agency relying on the Midwives Alliance of North America (MANA), a private organization with a stated goal of promoting midwifery, with the task of receiving, reviewing, archiving, and disseminating data…

From the legal perspective, the Hearings Officer also has concerns that having the State rely upon a private organization to archive data could run afoul of the State’s public records laws…

In addition, though the report does not mention it, the Director of the state’s Board of Midwifery is Melissa Cheyney, the same person who is hiding the MANA data (Homebirth midwife Melissa Cheyney has a conflict of interest).

The hearing officer also notes that MANA has withheld its data from the public, put insurmountable barriers in the way of researchers attempting to gain access to the data, and has insisted that the data could be used only in ways in which MANA approves.

… MANA appears to make data available to researchers in the context of an application and payment of an application fee. The application process appears to rely on committees which examine the structure and nature of the proposed research. In addition, persons desiring access to data must agree to agree to conduct their study in accordance with a Community-Based Participatory Research model in which MANA would be entitled to have a participatory role in the research. MANA also charges a fee of $250 for individuals and $1000 to institutions for access to the data base…

It’s not really surprisingly that MANA is withholding their data. Colorado licensed midwives are required to submit their outcome data directly to the state and the death rate is appalling (Inexcusable homebirth death toll in Colorado keeps rising).

… In 2009 Colorado licensed midwives provided care for 799 women. Nine (9) babies died for a homebirth death rate of 11.3/1000! That is nearly double the perinatal death rate of 6.3/1000 for the entire state (including all pregnancy complications and premature births).

The data is conveniently broken down by type of death and place of death. For example, there were three intrapartum deaths for an intrapartum death rate of 3.8/1000, more than ten times higher than the intrapartum death rate commonly experienced in hospitals. There were 4 neonatal deaths for a neonatal death rate of 5/1000. That’s ten times higher than the national neonatal mortality rate for low risk hospital birth with a CNM (certified nurse midwife)…

And the homebirth death toll in Oregon will include stories like this one reported in the Register Guardian:

The call to paramedics came at 8:10 p.m., the instant midwife Anita Rojas realized the head of the breech baby she was delivering was stuck.

Twenty-one-year-old Kelsie Koberstein was swept up by medics in a blur of pain and fear.

Rojas rode in the front of the ambulance, with Koberstein’s mother and best friend rushing behind in their car…

On her back, her legs pushed up as high as they could go, she clutched the hand of a paramedic as if he were her only anchor to reality…

At Sacred Heart Medical Center, the on-call emergency room obstetrician-gynecologists, Drs. Elizabeth McCorkle and Brant Cooper, wasted no time.

As they instructed paramedics over the hospital radio, they learned this birth was going to be as difficult as they come: It wasn’t just a breech birth, but a “footling” – where a foot emerges first.

Just a few centimeters in width, a tiny foot might not open the cervix wide enough to allow the baby’s head and umbilical cord to pass through. If the head becomes trapped, the baby could quickly suffocate.

When medics pulled up to the doors, the doctors leapt into the back, refusing to squander precious seconds bringing Koberstein inside. The doctors had to turn Lucian’s head 180 degrees in order to free him, a move that took at least 20 minutes.

By then it was too late.

The infant was dead.

It’s about time that those charged with regulating direct entry midwifery have noted that homebirth midwives are hiding their own safety statistics. It doesn’t take a rocket scientist to imagine that MANA’s own data shows that homebirth with direct entry midwife dramatically increases the risk of neonatal death. Now it is time that those charged with regulating direct entry midwifery demand that MANA hand over that data. It is always possible that, as detailed in the report, MANA may manipulate the data in ways that will hide the true dangers, but at least the data itself will be a start in the right direction.

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