Originally Posted by Banana731
I have not read the study. Is that the case? I would find that surprising.
In the B.C. (Canada) study they only included women who met the criteria for home birth whether they delivered at home or not. (And yes in my province, Ontario, and in B.C. there are guidelines.)
However they also only went on the planned location - if a woman was having a home birth and transferred, that outcome counted as a home birth. Which seems fair because in that case the system works.
Anyways what I wanted to add to the discussion is that I think one of the big issues in neonatal death research in first-world countries today is that so many complications and issues now so rarely result in death that the stats can be confounding.
Lumping all complications together -- and putting the cut-off at 7 days for perinatal mortality -- means that it's hard to get a picture of which intervention "would have/might have/should have" helped.
So I don't find it surprising that perhaps particular complications would have better (or at least, not death) outcomes in hospital, and if the complications for the period of study tilted in that direction the study would show that.
It might be that homebirths have higher rates of neonatal deaths because hospitals can intubate newborns more quickly, for example. So you might have more babies surviving to 8 days in the hospital, taking them out of perinatal death stats.
Or conversely, if a study doesn't look at homebirths with a transfer, you could throw the stats in the other direction because more people who transfer will be in the middle of complications.
What I personally
would try to get (and have tried to get) from studies like that is a personal sense of where I stand.
If the fractional difference in risk in the meta-study were true, for example, and that fraction
were changing my mind about a homebirth, I think what it would be telling me personally is that I wouldn't be ready to be in a situation where there was a possibility that my choice to labour at home was the cause (however rare) of a loss.
In terms of policy, I don't think this study would be a good one to base public policy on because it is cross-country, and each country has a very different climate. In the US for example I am betting that there could be a small but significant number of women who hesitate longer before transferring because of insurance issues, whereas in Canada it's not as much of a concern so women who are homebirthing and find themselves in one of those rare situations might have a smoother transfer (and so better outcomes). Etc.