Originally Posted by MyKidKissTrees
'the program doesn't allow you to adjust for low risk. which is kind of irrelevant, because all of the MWs I know take traditionally high risk patients."
When I had a homebirth the midwives did careful risk screening and I think it increased the safety. I know of midwives like you describe. My homebirth was so long ago maybe midwives were more careful as a whole then, I also had CNMs. Adjusting for risk would only help homebirth statistics I would guess.
" I think the impact of high risk is much lower then what anti-homebirth groups seem to believe. Many of the things that would force a hospital CNM to turn her client over to an OB, an out of hospital MW will take on. multiples, breech, GD, previous fetal demise, multiple losses, VBAC. Those women are all being serviced in the homebirth community."
I see this reflected online. I find it very scary. Hospital CNMs I have worked with do care for most of these women but an OB would be also involved in their care.
"Still birth is also not the most important data"
True but it is important data.
. " Almost all of still births are due to genetic deformity."
This isn't true. A signficant number of very normal appearing babies die in term and postterm stillbirths. From what I read online there are a fair amount of intrapartum deaths at home as well. This is exceedingly rare in the hospital. Stillbirth rates need to be included if women are to have good information from which to make a choice.
" If we remove them from the data of 24 hours post birth there isnt enough data to look at"
I am not sure what you mean here.
. " Looking at 1-28 days would be misleading here as well then. A woman in a hospital having a more medicalized birth would be more likely to abort a baby because she would have access to that information in advance of delivery. Homebirth moms often forego that type of testing and even if they do know, are less likely to abort. One would need to adjust for that."
In my personal experience I have cared for many mothers in the hospital that chose not to abort babies with lethal anomalies. I think you are generalizing stereotypes that are not accurate. As well I have known of, I choose not to be involved in terminations, mothers who planned homebirth who did have genetic testing and did terminate. It would be a horrible decision and I am not judging this. I know that you can't assume that homebirth moms do x and hospital birth moms do y in this regard.
" There is also the concern that things done in the hospital, during delivery, drugs given, etc. DO contribute to long term health problems that could caused delayed mortality. So, just using the data from infants who died in the first month wouldn't include children whose immune systems were compromised at a young age due to things done at the hospital (administration of vaccines, antibiotics, etc.)"
I don't think these are valid concerns. I still think up to 28 days is the best cut-off.
"If you look at highly viable infants (34-41 weeks gestation) the rates for a MD in hospital for mortality through the first year: 3.0
ALL midwives out of hospital, including lay MWs: 2.88
Just CNMs: 2.41
CNM in hospital would show a true collection of solely low risk women, so wouldn't be comparable to out of hospital CNMs who often take on high risk clients.(1.91)"
Again I don't think up until the first year is valid. There are too many other causes of death unrelated to maternity care in the first year. I think in hospital CNMs would be the best comparison and as I said they are often the birth attendants at some of the high risk births you listed.
"And of course, we are forgetting to include maternal mortality, which is obviously much higher in the hospital and which an increase can be majorly attributed to medical error Its a shame our government doesn't track that data and instead allow hospitals to have closed datas on their maternal mortality rates."
Is it much higher among women with the same risk factors? I doubt it. I haven't searched for the data recently but I know it is available. Sometime in the last decade death certificate redefined what is counted as maternal mortality, and that year many people exploited it as if maternal deaths had suddenly jumped. I am sorry I don't remember the year.
"If we really wanted to show the trust cost of hospital births we could throw morbidity into the mix, we would definitely see rates shoot up in the hospital for both mothers and babies. Unfortunately, that data is also not available."
Some studies have shown higher morbidity in hospitals. That is probably true. But major neonatal morbidity has been higher in some homebirth groups.
"So, while many of the deaths at home MAY have been prevented if the mother had delivered in a hospital, there are more deaths in a hospital that relate to poor medical treatment, that could have been avoided had those women had their babies outside of the hospital. "
I don't buy that. In Colorado midwives attending home birth have three times the perinatal death rate that all hospital birth ( including high risk, all gestational ages) has. The data is easy to find.
"Its more than just dead babies at 28 days in a "low risk" group. It's much more complicated than that."
I agree it is very complicated and hard to study. I believe that even if it were proven, to them, that home birth has a higher neonatal mortality that many women who choose it now would still choose it. Lots of things cannot be measured. Despite my opinions about safety I think women should have a right to birth at home if that is their choice.