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Tuesday, January 18, 2011

DOR : MANA stats

So this is a hot topic of sorts.

I want to know your views on the MANA stats project.

The Midwives Alliance's Statistics Project (MANAstats) collects data on birth and associated perinatal care and outcomes, focusing on out-of-hospital births attended by midwives. This data set is intended to support research on midwifery practice and normal birth with the goal of improving care of women and babies and increasing the choices available to childbearing families.

The project, in essence is attempting to compile a large database of midwifery outcomes.

There are several fundamental flaws I see initially in the reporting:
  • First, where are the checks and balances? What are the controls in place to verify the accuracy of what is being reported?
    • It is great that we can have provide our clients with our personal statistics and to see how we are practicing, but I am not certain how easily our outcomes can be manipulated. I realise that this is a difficult issue, as it is fairly accusatory and perhaps pessimistic. Not having faith in thy sister midwife to report honestly. But the question must be raised.  

  • Secondly, why is this information not made public? In order to gain access to the entire database, you must first, be a researcher, submit a research proposal (that must be approved) and then pay $50 to gain access to the stats.
    • I see this as a significant issue. Why the need privacy and control over access? Is it for protection? Is it to prevent any anti-midwifery studies using "our" stats? Shouldn't our data speak for itself, and if there are problems, should they not be free and open to criticism so that we can better our trade? 

These are just a few of the glaring incongruities of this project with the concept of statistics.

I would like to start an open discussion on this topic.

Are you as a midwife or student midwife contributing to this database?
Are you gaining any benefits?
Do you support this collection?
Do you think its beneficial?
Do you agree with my criticisms?

Just a list of possible questions to respond to.


  1. If this information is not (made) public, it simply won't be regarded as serious. People can deduct all they want from their private data but unless it withstands scrutiny, it is worthless. I also think that it is dangerous to base maternity care on study results and treat every woman as the middle data in the study. I am not the middle data, and in my case,'odds' were defied when the numbers said that I should have done x, y and z. This goes for so many women I know. So, not sure what those numbers would even be used for.
    There is so much more to say about this.

  2. I don't think MANA has a clear idea of how the information WILL be used. They have clear suggestions on how it MAY be used. In the end they have final approval over research topics, which i personally find a bit dodgy.

  3. BUT!!! they are useful for establishing a personal database and statistical analysis.

  4. I'm not really anonymous, just no good at blogs and cannot figure out my profile. My name is Sarah and I am a student midwife in Phoenix AZ. Our practice does contribute to MANA stats. In fact, I am already enrolled and participating as an individual. We benefit individually by looking at our statistics. In typical numbers style, they have often shown that our perceptions may be a bit off. It is reassuring to clients to be able to see the numbers that prove we have good outcomes. I do support this collection which is why I elected to sign up immediately.

    Research data is vitally important for the western legitimization of midwifery. As much as we (as midwives) may operate on trust and feel this doesn't work for all (most) westerners. We are trained, in our culture, to ask for the "proof." A very Piscean age practice of wanting words and numbers, an inability to find our intuition causes us to rely on such dry statistics. In addition, the world is much to big for women to be able to "know" the local midwife - a good argument for keeping statistics as well as licensing.

    Obviously with self-reporting, there is always the risk of manipulating data. However, like any quality database, MANAstats is requiring Review Boards for any proposed studies and part of the agreement to be a participator is that you are willing to allow researchers to verify the data by examining your records. And researchers will randomly audit records; they have to take this step to demonstrate the accuracy of their data. You can read the project contributors application here

    Which brings me to your last point. A research database is never meant to be public knowledge; it is meant to be a tool for researchers to use and in the process of their research they establish "evidence-based" studies. Raw data requires interpretation and heavy statistics to be used in an effective manner because of self-reporting errors, sample grouping and sample sizes, etc. The raw database is exceptionally difficult to navigate and could easily be misinterpreted by someone who doesn’t understand the organization of the numbers.