Whoa.. What? (Higher Newborn Death Rate w/ HB)

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OneLuckyScoop's picture
Joined: 01/07/08
Posts: 145
Whoa.. What? (Higher Newborn Death Rate w/ HB)

Very recent article on how there is a higher newborn death rate linked to home births.
http://www.webmd.com/baby/news/20100702/home-births-linked-higher-newborn-death-rate

Kind of goes against everything I have heard previously.. What the...?

krazykat's picture
Joined: 08/11/07
Posts: 1143

One question I would have: Does this include parents who are aware that they are having a stillborn child, and plan to deliver quietly, within the comfort of their own home, or people who know they will likely lose the baby soon after birth, and choose not to fight mother nature (there are folks out there)? I don't think that birth certificates give enough medical information to be a totally reliable source, and that is where they have gotten their numbers from. Interesting... but I would bet there are quite a few hidden factors there as well.

momW's picture
Joined: 09/29/09
Posts: 5634

My first reaction is WTF!!!

But on a side note there was one quote in there that I wish was closer to the top of the article or at the very least on the 1st page.

Kimberly D. Gregory, MD, MPH, vice chair of women's healthcare quality and performance improvement, department of obstetrics and gynecology at Cedars-Sinai Medical Center in Los Angeles, says the findings will have little impact on the rate of home births.

“Those women who are truly motivated are going to do it despite the odds, and most will do well and have a good outcome. It would be great if women (and clinicians) could take this message as evidence to encourage more ‘natural’ management of the birth process in a hospital where resources would be available if needed in an emergency.”

OneLuckyScoop's picture
Joined: 01/07/08
Posts: 145

I just don't get it either.. and besides, other than listing "names" -- there were no actual sources listed for the article. Not like a genuinely researched article would include so you know where exactly they got their facts.

DJMandyB's picture
Joined: 10/18/07
Posts: 68

I don't like where they got their data from either. There is a large variety of "planned home births". I wonder what the number would be if it was "planned home births" that were attended by certified/licensed midwife or similar professional, and as Ariel said, with planned stillborns removed.

mommys's picture
Joined: 05/08/06
Posts: 6264

Interesting article. Not good references, a few good points though. Nice that it wasn't all negative.

krazykat's picture
Joined: 08/11/07
Posts: 1143

"DJMandyB" wrote:

I don't like where they got their data from either. There is a large variety of "planned home births". I wonder what the number would be if it was "planned home births" that were attended by certified/licensed midwife or similar professional, and as Ariel said, with planned stillborns removed.

Yes, that is a good point as well about the attendants. If I remember correctly in my studies, birth certificates listed as homebirth also include accidental, unattended births and everything in between like the road-side scenarios, etc. I do wish they had provided resources like you said... it would make it possible to figure those variables out.

OneLuckyScoop's picture
Joined: 01/07/08
Posts: 145

To me, the article just seemed incredibly bias. It didn't seem well rounded at all.

Winky_the_HouseElf's picture
Joined: 02/10/02
Posts: 292

It isn't a new study. It's an analysis of several other studies. (Some of those studies at very old.) Here s a good article about it:

http://www.cbc.ca/health/story/2010/07/02/home-births-safety.html

Unfortunately, I know some home birh midwives are practicing outside their scope of practice by staying home with moms and/or babies that would be safer in a hospital. I'm not talking about gray areas like VBAC where some mothers are good candidates for home birth. There are some midwive in my community who encourage staying home even in situations where it is very obvious that hospital care would be more appropriate. My SIL's midwife had hours and at least four very good reasons to transfer, yet she continued to say they could stay home. My nephew was born dead (in the hospital because my SIL insisted on transport at the last minute), but then revived. He has brain damage because of it. I have no doubt that his chances for a good outcome would have been higher with timely appropriate transfer of care. My SIL very much wishes that her mw had transferred her sooner, even though a c-section would have been the probable outcome.

Now, I have had four home births and one of those very nearly was an emergency transport during labor. It was a $&@$ hits the fan sort of situation where my mw and I had to decide the fastest way to get my baby out safely. I chose to just push her out as quickly as possible because that seemed like the faster option. It worked and we were both very glad. I don't see how I could have gotten her out any faster even with a hospital transfer and a c-section, unless I had already been in a hospital. Considering my labor was only 3 hours, I'm not sure I would have been there.

Anyway, my point is that if home birh infant mortality rates are higher, it may be because of mws who insist on or recommend staying home even when there is time and medical indication to transfer. Obviously, babies die in hospitals from medical interventions and mismanaged care, too. All of this emphasizes the importance to me of asking lots of questions about a particular caregiver's statitics AND to continue to ask questions during the birth. My mw gets some flack for having a higher transfer rate than other mws, but I feel more comfortable with her approach of erring on the caution. There shouldn't be a contest to see who has the lowest transfer rate, but sometimes it feels like "My transfer rate is lower because I trust birh more." That is an unsafe attitude, IMO. Also unsafe is the idea that more interventions always equals more safety. As usual, somewhere between these two extremes is the safest place to be.

Well THAT turned into a rather long-winded rant! Blum 3

momW's picture
Joined: 09/29/09
Posts: 5634

I wonder too though if hospital mortality rates aren't a little under their mark. They can resuscitate babies with better equipment than a homebirth attendant. However, how many of those babies don't make it past 1 week or 2 months or 1 year and live on life support or various technological advances for that time. I'm not saying it's wrong, I'm just asking for more. I don't like to read studies of studies. I think a lot of information gets left behind, left out or just flat out isn't known to the authors. There's too many questions you can ask about the results, on either side. But the media and people with herd-like instincts will take it as the Gospel because AJOG published it.

kvo
kvo's picture
Joined: 12/18/06
Posts: 902

It mentioned lack of resucitation for the newborns---don't all MWs carry oxygen for that very reason? I too wonder if there are more people going "unassisted" and unprepared for things like that. Liam needed to be given oxygen, but was otherwise fine and would have been fine born at home too.

Also, remember this research was published and probably funded by ACOG. Medicine in the U.S. is a business, not a public service. I'm not saying doctors don't care about their patients wellbeing or put their financial gain above the safety of their patients, but it is something to consider.

Winky_the_HouseElf's picture
Joined: 02/10/02
Posts: 292

"momW" wrote:

I wonder too though if hospital mortality rates aren't a little under their mark. They can resuscitate babies with better equipment than a homebirth attendant. However, how many of those babies don't make it past 1 week or 2 months or 1 year and live on life support or various technological advances for that time. I'm not saying it's wrong, I'm just asking for more. I don't like to read studies of studies. I think a lot of information gets left behind, left out or just flat out isn't known to the authors. There's too many questions you can ask about the results, on either side. But the media and people with herd-like instincts will take it as the Gospel because AJOG published it.

Valid points. I think it would be difficult to get accurate reports of the injuries and deaths that result from routine obstetric interventions because people are likely to spin data to point the blame at some other cause. That goes for peole within the home birh community as well. People get mad when I share my SIL's story as a reason why I have concerns about her midwife and seek to explain it away as being my SIL's fault or imply that I am causing problems for the home birth community by talking about it at all. I'm concerned that if we don't police ourselves, the OBs will get even more restrictive laws to do it for us.

"kvo" wrote:

It mentioned lack of resucitation for the newborns---don't all MWs carry oxygen for that very reason? I too wonder if there are more people going "unassisted" and unprepared for things like that. Liam needed to be given oxygen, but was otherwise fine and would have been fine born at home too.

Much more important than oxygen is to have a midwife trained in neonatal resuscitation. Mine is (and she also brings O2), but some are not. It's a really important question to ask a prospective midwife, IMO.

jooniper's picture
Joined: 08/27/07
Posts: 780

I've read a few criticisms of the new study but can't find them at the moment. I'm sure we'll hear more from the HB community about it though.

MrsMangoBabe's picture
Joined: 04/09/07
Posts: 2276

If "planned homebirths" includes UC, that could affect the data. Some women who have UCs put a lot of effort into providing their own care and making smart decisons, but some are too "trust birth"-y--similar to the "low transfer rate" midwives Laura talked about. A few UCers are also people who are relgiously opposed to modern medicne, so the death rate among those is obviously going to be higher.

I recently read a great article by Rixa Freeze (who blogs at Stand and Deliver) which talks about how the strict opposition to homebirth by professional groups in the U.S. such as ACOG actually makes homebirth in the U.S. less safe, due to less smooth transfers of care from home to hospital. She also mentions some studies about homebirth safety, and includes references. Here is the article, if anyone is interested in reading it: http://dl.dropbox.com/u/2847775/Freeze%20Attitudes%20ExpRev%202010.pdf

It is also possible the the U.S. needs better midwifery training for direct entry midwives.

jooniper's picture
Joined: 08/27/07
Posts: 780

Here we go, http://www.birthactivist.com/2010/07/sorry-guys-homebirth-is-still-saf/ discussing some problems with the study:

This past Friday, the American Journal of Obstetrics and Gynecology released an article online about a study–more accurately, a meta-analysis–by Dr. Joseph R. Wax of the obstetrics and gynecology department at Maine Medical Center and his colleagues. The analysis reached the loud conclusion that homebirth, while having significantly better intervention and morbidity rates than planned hospital birth, had a threefold neonatal mortality rate. This is in sharp contrast to previous studies that have been done on the subject, which reached the conclusion that homebirth is as safe as a hospital birth for low-risk women. Bad news for homebirth supporters, right?

…Not exactly.

Firstly, the advantage of a meta-analysis is that it provides impressive numbers. Which is why this study is going to be flaunted and relished by anti-homebirth OBGYNs for years to come–the sheer scale of it is impressive. But the disadvantage is that it is synthesizing data from many different studies, it is not controlled and the population is not uniform. That means the conclusions are less reliable than a controlled study.

Also, a closer look at the study reveals some major differences between this analysis and the pro-homebirth studies. For one thing, those studies’ conclusion was not that all homebirths–attended or unattended by a professional–are safe. It was that low-risk births, attended by a professional and well-equipped midwife, are as safe as hospital births with significantly lower morbidity rates.

And actually, this analysis reaches the exact same conclusion (emphases and brackets mine):

“The analysis excluding studies that included home births attended by other than certified or certified nurse midwives had findings similar to the original study [meaning, significantly lower intervention and morbidity rates], except that the ORs [odds ratios] for neonatal deaths among all (OR, 1.57; 95% CI, 0.62–3.98) and nonanomalous (OR, 3.00; 95% CI, 0.61–14.88) newborns were not statistically significant.”

Hmm. They failed to mention that in the official conclusion.

Morever, as in this report on CBC, other epidemiologists are questioning the political motivation of the analysis as well as the methodology. According to UBC epidemiologist Patricia Janssen, quoted in the article in the link, the analysis includes studies that are highly questionable–some with as few as five recorded births, some dating back to the 1970s, and some in which the qualifications of the caregiver is unknown.

Another glance at the statistical analysis will raise a few eyebrows among those who know a thing or two about the US national birth rates. That’s right–the rate of C-section in the planned hospital births. 9.3%, huh? Extremely impressive, considering the national rate is higher than 25%. How optimistic. What other statistics listed in the analysis are so far removed from reality?

Basically, Dr. Wax… nice try, but no cigar.

jooniper's picture
Joined: 08/27/07
Posts: 780

And another critique of the study here: http://www.scienceandsensibility.org/?p=1316