Disappointed in the journal Nature

Yesterday I wrote about the fact that I comment I posted in response to a Nature News piece on the Wax study was removed. I wrote to Philip Campbell, the Editor of Nature and, as promised, I am updating readers on what has happened.

This was my original comment:

It is rather ironic that while homebirth midwives attempt to discredit the Wax study, they steadfastly refuse to publish the safety data that they have collected.

MANA (The Midwives Alliance of North America) the trade organization for homebirth midwives (certified professional midwives, CPMs) spent the years 2001-2008 collecting a tremendous amount of data. Over the years MANA repeatedly told its members that more extensive safety data was forthcoming, encompassing approximately 18,000 CPM attended planned homebirths. MANA has announced completion of the data collection and publicly offered the data to others.

So why haven’t we seen the death rates for CPM attended homebirths? MANA will only reveal the data to those who can prove they will use it “for the advancement of midwifery” and even these “friends” of midwifery must sign a legal non-disclosure agreement providing penalties for those who reveal the data to anyone else.

In other words, MANA’s own safety data shows that homebirth increases the risk of neonatal death, possibly quite dramatically.

Complaints about the Wax study are a red herring. The organization that represents American homebirth midwives KNOWS that homebirth increases the risk of neonatal death. Their own data is so compelling on this point that they don’t dare release it.

The Midwives Alliance of North American has an ethical duty to release its own neonatal death rates. There is absolutely no justification for keeping this information from the American public. Rather than questioning the Wax study, we should be asking what MANA is hiding and why.

Today I heard back from Tim Appenzeller, Chief Magazine Editor:

Philip Campbell has asked me to respond to your concerns about the removal of your comments. It comes down to this: Anyone posting to our site agrees to our community guidelines http://www.nature.com/info/community-guidelines.html. They specify among other things that comments should not be defamatory. Your posts asserted that MANA is hiding evidence that home birth increases infant mortality. That’s a serious accusation, and after reviewing your posts we decided that our community forum is not the place to explore it.

Here is my reply:

Dear Dr. Appenzeller,

I’m deeply disappointed.

It may be a serious accusation, but it is undeniably true. There is no question that MANA is hiding the death rates from its database of 18,000 planned CPM attended homebirths.

And while I see some merit to your explanation, it seems that it is applied inconsistently. After all, you left the up the comment that defames me:

We all know that Dr. Amy lurks on the internet to add her negative comments to any article or report about home birth. Her agenda is to discredit the CPM credential regardless of the research.

As a CPM with 17 years of home birth experience and like Faith and Susan, actively participating in the MANA Statistics Project, I know the commitment and hard work that we are all doing to provide quality maternal/infant care. Safety is first. Informed Consent is one of the hallmarks of the Midwives Model of Care
.
Dr. Amy will not go away. She will continue to spew her venomous agenda time and time again because blogs and boards and comment sections on the internet is all that she has left. Those of us who work in the home birth community understand this and carry on despite her. Sad that she spends her time in such negativity. It says a lot for how sorry and pitiful her life is.
Kim L. Mosny, CPM

My concern is that Nature is letting consumers dictate what scientific evidence is allowed to appear and what commentary on that scientific evidence is allowed to appear.

The investigation detailed in the original piece appears to be the result of lobbying pressure brought to bear on the American Journal of Obstetrics and Gynecology by homebirth advocacy groups. The merits of the Wax paper should be determined by the scientific community, through open and unimpeded discussion, not by consumer or lobbying pressure. The flagging of my comment and its subsequent removal appears to be part of that same consumer and lobbying pressure. As I said above, I am deeply disappointed that Nature has bowed to it.

Sincerely,
Amy Tuteur, MD

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