Are you asking me what I'm talking about? I'm not sure I'm referencing the same specific study you're asking about, so I'm not arguing what that determined.
A Good Birth, a Safe Birth describes a study in which researcher Marjorie Tew classified births into categories of "very low," "low," "moderate," "high," or "very high," and "at each level of risk, perinatal mortality was lower out of hospital." Furthermore, it states that, "except for very high-risk births, the differences in [perinatal mortality rate] were what statisticians call statistically significant....At the very low and low levels of risk, hospital births had a two-to-three times higher rate of perinatal mortality. At a a moderate level of risk, the hospital PNMR was more than eight times greater than out-of-hospital PNMR. Even at a high level of assigned risk to the birth, the hospital PNMR was over three times higher."
Apparently, her further studies since have shown an increasing disparity (with hospital PNMR getting worse).
Do I, personally, have any way of verifying this? No. But I'm not making it up!
These are just looking at live births who died within their first year of age.
That's from almost 30 years ago. Also, how do they define perinatal mortality? If a baby is stillborn, are they counting that? A frail, sick baby born in hospital who subsequently dies would be counted; would a stillborn baby at home be counted, or do they have to have drawn breath? There are countries where stillbirths don't count in perinatal mortality stats, which is one reason the US looks bad compared to some places. We'd want to look at the study to make sure apples are being compared to apples; you can't conclude anything from the abstract.
Infant mortality is not the right comparator to use either, because it measures pediatric care in addition to OB care.
Subbing to try to join in this discussion...a bit late, I know. 
As I recall when re-researching HB again for my second birth a couple of years ago, I did come to the conclusion that HB presented a slight increased risk in mortality/morbidity from pregnancy-maybe 1 year of life (can't quite remember). To me, the small increased risk was weighed against the increased risk of an already relatively small risk. I weighed that against very large chance of a variety of negative outcomes in a hospital birth.
I just lost a bunch of my post but will come back when I have more time to read the links and videos posted.
I'll also see if I can find some threads here on the subject because I'm sure I've discussed this back when I was pregnant with my LO.
I'm remembering more about this topic as I post around the forum today. I have a pretty terrible time of retaining some of this stuff after I've made my decision so I'll just share a few thoughts that maybe can be added to the discussion by members who are currently reading the stats and etc.
I remember reading the studies and one thing that struck me is that a lot of hospital practices that I would consider morbidity are not listed as such. So, if in a HB setting the mother or child needed abdominal surgery...I think that would be listed as a form of morbidity. But I don't think c-section is listed like that in most of the studies. Correct me if I'm wrong. So, there's also things like forceps delivery, prolonged separation of mother and baby, and lots of other things that were factors for me in terms of morbidity but that weren't applied to the studies the way I would have liked.
...If we're objectively comparing statistics, shouldn't they be studies from at least the same period? Not one from 1990-2009, the other from 2005-2009 and then an abstract from 1986? That just makes it seem as though someone has made up their mind on a subject and has searched for sources to back up their statement.
This is the reason we'll never be able to obtain unbiased data. Someone always has a dog in the fight. When you get past the data and people's personal preferences, there is still the indisputable fact that some babies will do well and some will do poorly no matter what type of birth is chosen. There will never be an available control group, one baby can never be compared to another. One baby can be born on a sidewalk in -20C temperatures, to a young mom who hid her pregnancy and received no prenatal care, be pronounced dead, spend 3 hours in a morgue and be discovered alive (which happened here about two weeks ago), another baby may not be able to survive the most delicate birth attended by the most skilled and qualified professional. The fact that statistics need to be argued and picked apart at such lengths leads me to believe that almost any option available today as just as safe as another. It's six of one, half a dozen of the other.
Nope, but I've seen this one from College of Family Physicians of Canada: http://www2.cfpc.ca/local/user/files/%7B1E683014-14EB-489F-99CE-B5A2185A6FC5%7D/Medscape%20%20Wax%20Critique%20-%20Michal,%20Janssen,%20Vedam,%20Hutton,%20de%20Jonge.pdf
And, personally, I find the fact that she's not a dr. or midwife a GOOD thing in a study like this - she doesn't have a vested interest in skewing the data to show what she wants it to show.
Yes, it's dated. I didn't go digging for it; I have better things to do with my time at the moment than go digging for new information to back up a decision I already researched and made years ago. ;) I just shared what I remembered having already read. Feel free to ignore it if you like. But I think it's still relevant, particularly since I don't know of any truly similar study having been done since.
Nope, but I've seen this one from College of Family Physicians of Canada: http://www2.cfpc.ca/local/user/files/%7B1E683014-14EB-489F-99CE-B5A2185A6FC5%7D/Medscape%20%20Wax%20Critique%20-%20Michal,%20Janssen,%20Vedam,%20Hutton,%20de%20Jonge.pdf
Wow, that's some dense stuff right there! Thanks for a GREAT link. 
When I was making my decision (again, I re-researched for my second planned HB...and it was a much different experience with the internet being my friend) I made some peace with a slight increase in risk of HB (and I chose my personal risk factors and quality of midwifery care accordingly) but I would have loved to have seen this just the same.
Thanks for linking!
Wow, that's some dense stuff right there! Thanks for a GREAT link.
When I was making my decision (again, I re-researched for my second planned HB...and it was a much different experience with the internet being my friend) I made some peace with a slight increase in risk of HB (and I chose my personal risk factors and quality of midwifery care accordingly) but I would have loved to have seen this just the same.
Thanks for linking!
AND it's written by doctors! LOL
I don't mean any offence to my lovely American friends but it's tough to trust studies from a country where one's bread and butter is either from the "pharmaceutical industry", the "health care industry" or the "home birth industry". Their objective is always to prove why theirs is better and why you, the customer should give them your money. In our system, the government takes all of our money up front via income tax and they decide for us which is safer saves them the most money in the long run. They take into account what lifestyle choices will produce the least expensive and most productive tax payers. So far there haven't been any studies convincing enough for them to suggest that one is actually safer than another. As a result, we have complete freedom at this point to choose home birth (if we qualify)(which is the least expensive for them), midwife (at home or in a hospital), an OB or elective caesarean. They have absolutely no interest in saving a few bucks on a birth if it means long term harm because they'd just be on the hook for further tax dollars whether it's medical care, psychological treatment or a person will require social assistance.
If home births were as significantly better as US midwives claim they are, our government would be all over them. Elective caesareans cost about $4,800, hospital births $2,400 and a midwife assisted birth is about $1,000. If one was SO much safer AND 5 times less expensive, wouldn't our government be behind them 100%?
I'm not advocating for one type or another, I'm just thinking the proof isn't there yet for there to be enough to argue over.
...and on the third hand, I'm very much "pro choice" and believe women should be able to choose the type of birth that is right for them. While caesarean is inhumane for one woman, a home birth will be for another. No woman should be bullied by either the medical community or other mothers (especially not other mothers) about what choice they feel is right for them.
I'm not advocating for one type or another, I'm just thinking the proof isn't there yet for there to be enough to argue over.
...and on the third hand, I'm very much "pro choice" and believe women should be able to choose the type of birth that is right for them. While caesarean is inhumane for one woman, a home birth will be for another. No woman should be bullied by either the medical community or other mothers (especially not other mothers) about what choice they feel is right for them.
Yes, I feel the same way. I didn't make my birth choices based on this strong feeling that I'm right. It was more complicated and all the choices were very subtle and the factors were woven together. I assume that many other mothers make their choices in a similar way and are perfectly able to do so and come up with another perfectly valid choice.
In the end of the day, though, how we choose birth and the factors we use and all of that are just one of a zillion choices we make for our kids. If I didn't think I could trust another mother's choice about where to give birth...I would be so stressed over the welfare of the children of the world that I don't think I could go on. Seriously.
So "Escaping" in the Canadian health care system I am assuming it is mostly RM doing home births, although as a member of the MDGC list I know that there are a fair number of FPs and OBs who also support those midwives and home birth.
There have been some well done home birth studies like Vedam's Vancouver study. And I think there was another one that was in Ontario before that. Both of these studies used university educated midwives (RM) compared to the CPM study in the US where the educational background of the midwives was not mentioned. However, from NARM documents it is known that until very recently that completing even a high school education was not a requirement for becoming a midwife, and almost none of the CPMs have a university based education. This means that they most probably do not have the university classes that are required to meet the ICM standards for anatomy and physiology, microbiology, and the other sciences and none of their placements or clinicals takes place in hospital.
I think it would be very difficult to compare the results from a study about home birth with midwives (CPMs and other non in US and a study in Canada with RMs. The World Health Organization has found that increasing the educational requirements for midwives to a university based system decreases maternal and neonatal mortality and morbidity.
So "Escaping" in the Canadian health care system I am assuming it is mostly RM doing home births, although as a member of the MDGC list I know that there are a fair number of FPs and OBs who also support those midwives and home birth.
Sorry, I'm not sure what you mean by FP, but all midwives in Ontario are registered, regulated and university educated and have been since 1993. I'll just copy and paste their requirements at the end of this post.
Midwives are very much supported in the Canadian system, but it isn't as much an adversarial system as it seems to be in the US. Neither one is promoted as better or worse, the focus seems more to be on respecting the wishes of the mother (lol for once! I don't agree with much that goes on around here, but I must say I was very satisfied with the way I was treated throughout my pregnancy). I'm not one of those "loud and proud" Canadians, overall I think I would enjoy living in the US more, but as far as having children goes, I think I'd rather be pregnant in Canada.
Midwives in Ontario are regulated by the College of Midwives of Ontario (the College). You cannot practice midwifery, call yourself a 'midwife' or hold yourself out to be such unless you are registered with the College.
Midwives in Ontario are primary caregivers. As such, they hold full legal responsibility for their clients and are not supervised by a physician or obstetrician. Midwives in Ontario never work in only one area of client care, such as prenatal or intrapartum care. They are required to provide full service to their clients in all trimesters, throughout labour and birth and for six weeks postpartum. Under normal circumstances, a midwifery client and her newborn do not see any other health care practitioner during this time.
All midwives must attend both home and hospital births. Midwives are required to hold admitting privileges in at least one hospital and to attend a minimum number of both home and hospital births per year in order to maintain their registration.
Midwives in Ontario work as independent practitioners in group practices that are funded by the provincial Ministry of Health and Long-Term Care. They are not salaried employees of hospitals, health centres or clinics and do not work shifts. Midwifery practices provide 24 hour on-call service to their clients. This means that every midwife works on call for set periods of time and while on call must be available 24 hours a day.
To be eligible for registration with the College of Midwives of Ontario you must:
There are three classes of registration with the College of Midwives of Ontario:
General, General with Conditions, and Supervised.
General
Registrants in the General class practice with no restrictions on their registration.
General with Conditions
Graduates of the Ontario Midwifery Education Program (MEP) are registered in the General with Conditions class. The conditions imposed on their registration are those of the College's New Registrant's Policy. This policy states that for the first year of practice, all new registrants must practice within an established Ontario practice, must work full time and must attend births with an experienced midwife. Other than these conditions, the new registrant is like any other midwife in the province, and provides the full scope of midwifery care. Once the conditions of this policy have been met, the member's registration class is changed to General.
Supervised
Graduates of the International Midwifery Pre-Registration Program (IMPP) are registered in the Supervised class. The supervision is imposed in order to enable the supervised midwife to meet the clinical birth numbers required by the College's Registration Regulation, as well as to make up any gaps in clinical skills identified during the International Midwifery Pre-Registration Program. Supervised midwives are fully registered members of the College and provide the full scope of midwifery care to their clients. They are paid at the same rate as all other new registrants. Supervision will typically last anywhere from 6-12 months. Each supervised midwife has an individualized supervision plan prepared by the College prior to registration. Once the supervision plan is complete, the member's registration class is changed to either General with Conditions or General, depending on whether the midwife is still in her new registrant's year. A supervised certificate may only be issued for twelve months or less.
FPs are Family Practice doctors. The MDCG is a discussion list of FPs who do OB along with OBs, MFMs, and midwives, mostly Canadian, but from various countries also.
I think part of why some of the US system is adversarial is physicians and the university educated midwives worrying about the knowledge, skills, and proficiency of the CPMs and non- CPM midwives because of their lack of advanced education in the sciences and midwifery. RMs in Canada are more integrated into the larger health system, but in the US a general statement is that the non-CNMs prefer to see themselves as the alternative to CNMs and OBs rather than part of the larger system. The stories I have heard women tell about the fear-mongering propagated by some OOH midwives is horrific. The women become fearful of the OBs and transferring in when appropriate. Then when they do come in, the situation is quite serious, so the hospital staff is quite upset because if the woman had presented earlier there would have been more options for her. The hospital staff becomes upset with the midwife for the lack of good judgement and it all becomes a vicious cycle. And their lack of a university based education (science) puts the non-nurse midwives at a disadvantage in the larger discussion of appropriate patient care.
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