MANA Stats: Fetal/Neonatal Mortality Review (FMNR) Project: Preliminary Findings and Implications for Practice
Melissa Cheyney PhD CPM LDM
Melissa Cheyney Ph.D. CPM LDM is Associate Professor of Clinical Medical Anthropology at Oregon State University (OSU) with additional appointments in Public Health and Women Gender and Sexuality Studies. She is also a Certified Professional Midwife in active practice and the Chair of the Division of Research for the Midwives Alliance of North America where she directs the MANA Statistics Project. Dr. Cheyney currently directs the International Reproductive Health Laboratory at Oregon State University where she serves as the primary investigator more than 20 maternal and infant health-related research projects in nine countries. She is the author of an ethnography entitled Born at Home (2010, Wadsworth Press) along with dozens of peer-reviewed articles that examine the cultural beliefs and clinical outcomes associated with midwife-led birth at home in the United States. Dr. Cheyney is an award-winning teacher, and in 2014 was given Oregon State University’s prestigious Scholarship Impact Award for her work in the International Reproductive Health Laboratory and with the MANA Statistics Project. She is the mother of a daughter born at home on International Day of the Midwife in 2009.
In 2004, the Midwives Alliance of North America’s (MANA’s) Division of Research developed a Web-based data collection system designed to gather information on the practices and outcomes associated with midwife-led births in the United States. This system, called the MANA Statistics Project (MANA Stats), grew out of a widely acknowledged need for more reliable data on outcomes by intended place of birth. In this presentation, we describe findings from a study designed to examine all fetal and neonatal deaths recorded in MANA Stats between 2004 and 2015. Using a modified Fetal-Infant-Mortality-Review (FIMR) approach, midwife-researchers conducted detailed interviews with midwives for all non-miscarriage fetal and neonatal deaths in the sample. The objective was to clarify the gestational age at which the death occurred and to properly classify late miscarriages. The reviewers also collected as much qualitative data as possible on when, how, and why the death occurred, as well as data on whether an autopsy was conducted, and the official cause of death assigned via medical examiner or coroner’s report. Using the three delays model as proposed by Thaddeus and Maine (1994), we will discuss rates of intrapartum and neonatal death in a large sample of more than 50, 000 planned, midwife-led, home births in the United States. We will also provide an in-depth thematic analysis of the primary contributors to mortality in the sample.
Findings indicate that while the overall rate of death is low, there are three major contributors to fetal and neonatal mortality, including:
1) delays in the decision to transfer to the hospital due to failure to identify early signs of fetal distress and/or hesitancy to transport due to fear of “punitive cesarean section”;
2) delays in reaching care due to the distance from the hospital or fractured collaborations with Emergency Medical Services; and
3) delays in receiving care once arriving at the hospital due to fear, poor inter-professional communication, blaming and shaming. All are potentially ameliorable factors contributing to death and suffering in planned US homebirths; improved systems integration and inter-professional collaboration are urgently needed.