Just read article about homebirth...

[Path2Felicity]

http://www.sciencebasedmedicine.org/?p=2392

Any thoughts?

[lovebeingamomma]

my first thought is where are the statisitcs for CNM's & CPM's attending homebirths, why aren't they included?

[Mama Metis]

I agree with some of the comments made below the article: This data demostrates that an out of hospital birth with a CNM has half the mortality rate of an in-hospital birth with an MD, whereas out of hospital birth with a CPM has double the mortality rate of an in-hospital birth with an MD. Homebirth with a CNM is safer than hospital birth. Homebirth with a CPM is less safe than a hospital birth. This data doesn't surprise me. The real headline should be "US needs to improve standardization and quality in training of midwives."

[Mama Metis]

Quote:

Originally Posted by lovebeingamomma 

my first thought is where are the statisitcs for CNM's & CPM's attending homebirths, why aren't they included?

DEM and CPM are being used interchangably. For CNM attended homebirths, the data is is one of the studies. I'll see if I can give you a link.

ETA: I used the CDC data and tried to replicate their findings:http://wonder.cdc.gov/lbd-current.html. They looked only at white women, which kind of makes me roll my eyes, although if you do happen to be white, this is the most accurate way to look at the numbers given the extreme racial/ethnic inequality in this country, which affects birth outcomes to an extreme degree. Here's what I pulled up:

2.03 = death rate for neonate delivered by CNM at home (I had to calculate this number myself, because they didn't provide a rate because the numerator is less than 20. To be precise, 17 babies died out of 8,364 CNM-attended homebirths.)

1.74 = death rate for neonates delivered by CNM in hospital

4.08 = death rate for neonates delivered by CPM/DEM outside of hospital

2.25 = death rate for neonates  delivered by MD in hospital
 

Keep in mind these numbers vary widely depending on the variables you select in the CDC data set. For example, I selected birth weights above 2500 grams, which is what the article did, which obviously decreases neonatal death rates across the board. But it gives a better sense of death rates for births at term.

Edited by Mama Metis - 12/20/10 at 10:08am

[Path2Felicity]

So I was reading through the comments, and came across this:

I did not include the information on the chart, but homebirth with a CNM has double the neonatal mortality rate of hospital birth with a CNM.

The chart does not show that CNM hospital birth is safer than MD hospital birth since the CNM patient population is much lower risk and because all CNM patients who require physician transfer end up in the MD group. If we looked at outcomes based on the attendant at the beginning of labor, the CNM mortality rate would be higher than stated and the MD mortality rate would be lower than stated.

Some of these comments are really rude and disrespectful.

[Mama Metis]

Quote:

Originally Posted by Path2Felicity 

So I was reading through the comments, and came across this:

I did not include the information on the chart, but homebirth with a CNM has double the neonatal mortality rate of hospital birth with a CNM.

The chart does not show that CNM hospital birth is safer than MD hospital birth since the CNM patient population is much lower risk and because all CNM patients who require physician transfer end up in the MD group. If we looked at outcomes based on the attendant at the beginning of labor, the CNM mortality rate would be higher than stated and the MD mortality rate would be lower than stated.

Some of these comments are really rude and disrespectful.

Interesting...

The first part of this statement isn't true at all. Homebirth with a CNM does NOT have double the neonatal mortality of hospital birth with a CNM. The numbers are too small to be really meaningful statistically, but if 15 instead of 17 babies died at home with a CNM, then the home and hospital rates for CNM-attended delivery would be identical. This rate will tend to change drastically year to year because the numbers are so small. One year, CNM-attended birth at home could look great, the next year it could look less great. The solution would be to look at it across a 3-5 year period. Bottom line is, the rates are really similar for home and hospital.

The second part is true though. Docs SHOULD have the highest mortality rate because they attend the high-risk and problematic cases. CNMs SHOULD have lower rates. So it would be more accurate to look at the provider that the woman started with, rather than the one she ended up with.

[CBEmomma]

Originally Posted by Mama Metis 

I agree with some of the comments made below the article: This data demostrates that an out of hospital birth with a CNM has half the mortality rate of an in-hospital birth with an MD, whereas out of hospital birth with a CPM has double the mortality rate of an in-hospital birth with an MD. Homebirth with a CNM is safer than hospital birth. Homebirth with a CPM is less safe than a hospital birth. This data doesn't surprise me. The real headline should be "US needs to improve standardization and quality in training of midwives."

Agree