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Faulty Reporting on a Flawed Study on Home Birth


The New York Times, as well as dozens of other media outlets, is reporting this week that a new review of studies shows that infants born at home have a higher rate of death than infants born in the hospital.


This is a strange way to spin a review of studies that, according to the authors, actually shows that in every other index measured, women who give birth at home have equal or more positive outcomes than women who give birth in the hospital.


According to the study’s abstract, women who give birth at home: “are less likely to experience lacerations, hemorrhage, and infections. Neonatal outcomes of planned home births revealed less frequent prematurity, low birthweight, and assisted newborn ventilation.”


However, the study also concludes that the evidence reviewed shows that babies born at home are more likely to die between one week and one month of life than babies born in the hospital.


I have not read the original study, or all of the studies cited to come to this conclusion. But other more knowledgeable critics than I have found that this review of studies, authored by Joseph R. Wax, M.D., et al, ” Maternal and newborn outcomes in planned home birth vs planned hospital births: a metaanalysis,” is seriously flawed.


According to the Midwives Alliance of North America (MANA) press release, Saraswathi Vedam, a nurse midwife and researcher at the University of British Columbia, who is an acknowledged expert on assessing the quality of literature related to home birth, finds the study deeply flawed: “[T]he authors’ conclusions are not supported by their own statistical analysis.” Vedam states that Dr. Wax et al acknowledges the consistent findings of low perinatal and neonatal mortality in planned home births across the best quality studies they reviewed “but amazingly Wax does not emphasize or even mention this in his sole conclusion.”


MANA’s press release continues, “This begs the question of whether the author’s analysis and reporting of reviewed articles on homebirth do not support his foregone conclusion about the safety of homebirth.”


In her article, “Tripled Risk of Newborn Death at Home?,” the Midwife Next Door provides links to and quotes from the original studies cited in this review. Her conclusion: “This is a situation where the evidence simply does not add up to the conclusion. The preponderance of the evidence still falls in support of safety of planned home births with a certified/registered/licensed attendant.”


The Big Push for Midwives also argues the timing of the release of and the framing of the conclusions of this review of studies is politically motivated. “Given the fact that New York just passed a bill providing autonomous practice for all licensed midwives working in all settings, while Massachusetts is poised to do the same, the timing of this study could not be better for the physician groups that have been fighting so hard to defeat pro-midwife bills there and in other states,” said Susan M. Jenkins, Legal Counsel for The Big Push for Midwives Campaign. “Clearly the intent is to fuel fear-based myths about the safety of professional midwifery care in out-of-hospital settings. Their ultimate goal is obviously to defeat legislation that would both increase access to out-of-hospital maternity care for women and their families and increase competition for obstetricians.”


“The conclusions don’t match the study,” agrees Augustine Colebrook, CPM, LM, who has been in private practice for seven years and has attended over 300 births. “Home birth is actually safer for the low-risk pregnancy baby and mother … before, during, and after labor.”


But the American College of Obstetrics and Gynecology (ACOG) actively opposes home birth. ACOG issued a statement in February 2008 condemning home birth. The anti-home birth resolution belittles home birth advocates by claiming they are painting a “rosy picture” of birth and, despite the fact that over a dozen large scale studies show that planned home birth is as safe or safer than hospital birth, ACOG cites “safety concerns” as the primary reason for their position against home birth.


The new study will be published in the American Journal of Obstetrics and Gynecology, a peer-reviewed obstetrics journal that has an advisory board, an editorial team, and a list of consultants made up in large part of ACOG members. Most doctors in America are no longer attending home births. They lose their patients and a significant income stream when women choose to give birth at home. That they have a bias against home birth is understandable, though unfortunate. That they skew the scientific evidence to support that bias is unpardonable.




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Tags: ACOG, ACOG's anti-home birth resolution, AJOG, doctors, home birth, home birth safety, infant mortality, Joseph R. Wax, MANA, obstetricians, prejudice against home birth, Susan M. Jenkins



 

Comments (16)

Lies, damn lied, statistics and then LIES about statistics.
If you don't like the statistics you've got, use the ones you like? Since when do researchers get to pick and choose? And what's this about finding that the only studies telling the "big secret" of higher infant mortality were found in the bottom drawer, and not published in peer review journals? (The published studies all confirmed good infant post-natal stats.) Since when do meta-studies include unpublished research? Were these articles not good enough or reliable enough to be published in the peer-reviewed journals of medical doctors who are already biased in favor of hospital birth? How can anyone take this seriously?
What I would like to know is WHY is the rate of death supposedly higher at those age ranges? Are these families who do not have the baby checked out after birth at all and there are conditions or problems that are not caught? It seems to me very unlikely that the fact that the baby is born at home by itself increases the risk of death that much later.
I haven't seen that study, so I'm going out on a limb with a blindfold over my eyes. But that one conclusion about more dying a week or a month later seems like one of those false correlations to me. You know the one about ice cream causing murders because rates of both go up at the same time, when in reality more people get murdered during the summer because it's hot and hot people get angry and they also eat more ice cream (or some such). I think, assuming there is any correlation at all, that babies that are born quickly (ie not enough time to get to the hospital) or babies that are born to a specific demographic that tends to birth at home (don't really know what that is, just tossing it out), might be at a higher health risk genetically. What I would love to see is this: * Comparisons between the US (where home birth is low) and other countries (like the Netherlands) where it is high. Who has higher infant mortality. (I know the answer is us, just tossing the question out there) * Comparisons between Amish (who birth at home, I believe) and hospital births. Who has higher infant mortality? Stuff like that. It's really easy to skew stats to fit a predetermined objective, as it sounds like this study has done. It would be nice is these researchers would drop their agendas and just, for once, give us information so we can make informed decisions. .-= Alisa Bowman´s last blog ..What to do when a spouse lets himself go =-.
It's too bad that research so frequently uses statistics to suit their needs. There are too many open-ended questions here, as Alisa points out above. Aren't there many types of home births? Maybe they're referring to those that are unplanned, where the mother cannot get to the hospital soon enough vs. the ones that are carefully and strategically planned out. Too many variables here. .-= sheryl´s last blog ..Why You Cant Be a Couch Potato Even if You Work Out =-.
This study makes me really angry. I think women need to be encouraged to look outside the box and consider all options. If the NYT is reporting death from home birth, that will scare off a lot of women unfortunately. .-= Alexandra´s last blog ..Submission Update &amp Films That Make Us Think =-.
Regardless of which side you support, you have to cringe when you discover stats are falsified and information skewed. Especially when it comes to health and safety. I enjoy your blog because you provide a global and close-up look at some many issues. Thanks. .-= Meredith´s last blog ..The Huge Myth of Control =-.
I had "safety concerns," which I why I chose to birth my second child at home.
Where does the ACOG think most women have had their babies for the thousands of years that they weren't in existence, as well as most other countries in the world? This is exactly the type of thing that makes people not want to trust the medical profession at all...it's becoming too difficult to distinguish whether anything they recommend is not motivated by their own financial position. This is just sad...pregnancy is not an illness! .-= Kelly Seow´s last blog ..“Working With You to Make YOUR Message Stronger!” =-.
Jennifer, I'm so glad you posted on this topic, and with clarity and grace. I remember that when I had my first two children in the U.S., it took so much effort and research to find birth options I felt comfortable with, unlike the society I live in now where I had my last two kids and where natural birth is more the norm. .-= Christine´s last blog ..Home birth in Japan =-.
"If you don’t like the statistics you’ve got, use the ones you like?" Oh, too true, Helen!
I gave birth to my first child in the hospital and had a terrible outcome. I had an improperly place foley catheter that was left in for 5 hours even though I complained (they said "you're in labor - it's supposed to hurt"), an unnecessary c-section, and I wasn't even treated like a human being. As a result I had a urinary tract infection and severe post partum depression that took over a year of medication and therapy to overcome. And I still have issues with my incision. With my second child I was determined to give birth at home. I had to drive an hour to find a midwife who would do a VBAC at home, but I found her. My birth at home was amazing! I was treated with compassion and respect during my labor and delivery. My midwives supported me emotionally and spiritually as well as taking care of me physically. As a result, I felt strong and competent, bonded immediately with my baby and was completely recovered from a tear that didn't even need stitches by six weeks. Not everyone wants to deliver at home, but every woman should be aware of ALL the birth options available to her so she can make an informed choice with her birth partner. Healthy babies are important, but healthy moms are just as important, and very little attention is being paid to the emotional and physical toll hospital birth and unnecessary interventions are taking on women in this country. All so doctors and hospitals can line their pockets. For healthy, low-risk moms who want to deliver at home, home birth is safer and less expensive.
Too bad the NYT chose to publish the results of this bogus study. Those of us who have chosen homebirth over hospital birth can attest to the safety, sanctity, and sensitivity of our experience. The AMA vs. MANA, gotta keep fighting the good fight.
I'm fascinated by the point you make about the timing of the release of this study. So suspicious, and so sad that something as supposedly factual and unbiased should be politically motivated. The choices surrounding birth are hard enough to make without inaccurate information!!! And shame on a paper as important as the NYT for covering ANY health research that's not of the highest quality, given how much top drawer research is out there that's not getting covered. .-= Melanie Haiken´s last blog ..Chicago the Cycling City =-.
As with most studies--even those that are peer-reviewed--I think you always need to do a little digging on your own if the topic is something that's important to you. Thanks Jennifer for doing the digging. While I wasn't comfortable giving birth at home I can fully understand why women would choose too. .-= MyKidsEatSquid´s last blog ..Dinner on a Stick- Thai Chicken Satay &amp Cucumber Relish =-.
From ACOG's "Statement on Home Birth" (http://www.acog.org/from_home/publications/press_releases/nr02-06-08-2.cfm) they acknowledge that they believe that there are no scientifically sound studies comparing Hospital birth and other settings: "It should be emphasized that studies comparing the safety and outcome of births in hospitals with those occurring in other settings in the US are limited and have not been scientifically rigorous". With this position, how can they make any claims about the safety of home birth?
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