I've read the full study and posted my thoughts about it. (I'm not a professional statistician, but I am studying it at the graduate level.) There were 12 studies amounting to 342,056 homebirths. Most of those came from a recent large-scale Dutch study. A very large portion of the data, when you eliminate the large Dutch study, came from two outdated and/or badly designed studies -- rural western Australia in the 1980s, and birth certificates in Washington state. They also didn't include the north American midwife study.
They also used a very small portion of the data, just five percent, to break out that triple neonatal mortality rate. I believe that they did it this way because some studies expressed the mortality rate as perinatal deaths and some of the other studies expressed it as neonatal deaths. The Dutch study had 300,000 + homebirths, and the perinatal death rate in this study (which showed similar safety to hospital births) had 300,000+ homebirths it pulled from. The neonatal death rate came from just 15,000 births.
So I'm assuming -- and they never actually say which studies were used to generate the neonatal deaths, so this is just an assumption -- I'm assuming that they pulled the perinatal death rate from the Dutch study and a few others, and the neonatal death rate from the remainder of the studies. But we don't know which studies. The way they aggregated their data is exceptionally murky.
If it shows that births in rural Australia in the 1980s had a high neonatal mortality rate, I don't find that relevant to our current situation in the UK, Canada or most of the U.S.
Here's my thoughts on it: It is a tragedy when any baby dies, and it is especially a tragedy when a baby dies from malpractice, at home or in the hospital. I want American midwifery to be legalized, regulated and monitored, because I think that produces the best safety outcomes. I believe American midwifery could be safer, both in the states where it's not yet legislated, and in the states where it is legal. But I believe that overall, knowing that birth anywhere always carries risk, homebirth with a qualified provider, in a low risk pregnancy, and with systems in place in case of transfer, is relatively safe. I believe it carries a different set of risks than hospital birth.
I also believe that there are so many things that are deeply wrong and non-evidence based with the way babies are born in hospitals today. Mothers are put through a huge amount of unnecessary morbidity, injury and trauma because so many practices are not evidence based. I truly, in my heart, believe that the state of obstetrics in America today is a violation of human rights.
Would less babies die if we gave every single pregnant woman a C-section at 38 or 39 weeks? Possibly. You could make a case that doing that would actually reduce the total rate of infant mortality. However, you would wind up with a whole lot of other costs -- actual financial costs to taxpayers and insurers, as well as health costs to the mother, and emotional costs. Is it worth it to give 5,000 women unnecessary C-sections to save one baby? That's the way that you have to think about it if you're looking at it from a true public health perspective.
They also used a very small portion of the data, just five percent, to break out that triple neonatal mortality rate. I believe that they did it this way because some studies expressed the mortality rate as perinatal deaths and some of the other studies expressed it as neonatal deaths. The Dutch study had 300,000 + homebirths, and the perinatal death rate in this study (which showed similar safety to hospital births) had 300,000+ homebirths it pulled from. The neonatal death rate came from just 15,000 births.
So I'm assuming -- and they never actually say which studies were used to generate the neonatal deaths, so this is just an assumption -- I'm assuming that they pulled the perinatal death rate from the Dutch study and a few others, and the neonatal death rate from the remainder of the studies. But we don't know which studies. The way they aggregated their data is exceptionally murky.
If it shows that births in rural Australia in the 1980s had a high neonatal mortality rate, I don't find that relevant to our current situation in the UK, Canada or most of the U.S.
Here's my thoughts on it: It is a tragedy when any baby dies, and it is especially a tragedy when a baby dies from malpractice, at home or in the hospital. I want American midwifery to be legalized, regulated and monitored, because I think that produces the best safety outcomes. I believe American midwifery could be safer, both in the states where it's not yet legislated, and in the states where it is legal. But I believe that overall, knowing that birth anywhere always carries risk, homebirth with a qualified provider, in a low risk pregnancy, and with systems in place in case of transfer, is relatively safe. I believe it carries a different set of risks than hospital birth.
I also believe that there are so many things that are deeply wrong and non-evidence based with the way babies are born in hospitals today. Mothers are put through a huge amount of unnecessary morbidity, injury and trauma because so many practices are not evidence based. I truly, in my heart, believe that the state of obstetrics in America today is a violation of human rights.
Would less babies die if we gave every single pregnant woman a C-section at 38 or 39 weeks? Possibly. You could make a case that doing that would actually reduce the total rate of infant mortality. However, you would wind up with a whole lot of other costs -- actual financial costs to taxpayers and insurers, as well as health costs to the mother, and emotional costs. Is it worth it to give 5,000 women unnecessary C-sections to save one baby? That's the way that you have to think about it if you're looking at it from a true public health perspective.
to you, Jen. This study is seriously flawed in every way. And everyone keeps concentrating on homebirth mortality but ignoring the tripling of neonatal and maternal death rates from c-sections which happen in hospital and the many many deaths and complications from hospital births. My son was one of those (he luckily lived, but no thanks to the hospital which made the complications). Everything has risks in life-I just wish that American midwives were covered by insurance, regulated and certified, and made more available for women both in hospital and in home.
So your Pubic Health Division is admitting to inputting flawed data?
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