"While we will not restrict discussions only to those who birth at home or in a freestanding birth center, members posting to this forum should have a sincere interest in learning about or supporting the option to HB."
Thank you for realizing this. Trust me, we hear all the time about the horrors and dangers of homebirth. I worked as an EMT as well as several other fields, I've had 3 hospital and 2 home births, and I was pre-med and know all about reading scientific studies and statistics-all of which was required for my program. So in a support forum, it might not be best to jump in assuming none of us can understand the statistical methods as well as the inherent fallability in many studies.
Of course the Farm study wasn't conducted to be utterly scientific. It was factored in after they lived the life delivering babies for decades. Many of those deaths took place before we had the technology in place for preemies or life threatening birth defects. Some of those births were included when they knew the baby was stillborn and wanted a more peaceful process. It's a simple fact of biology that as much as we try to save every baby, sometimes it's not always possible. It's heartbreaking, and we should do all we can, for sure, but it would be impossible for a 0% rate.
For example, in my county the C-section rate is 38%. While some of those were surely life saving, it is fact that C-section increases the mortality rate for baby and mother. As for the Farm's 1% rate, right now in my state: "The neonatal mortality rate decreased from 5.2 in 2003 to 4.8 in 2004, the lowest ever recorded for Illinois. "
"In Illinois in 2005, the rate of perinatal mortality was 7.2 per 1,000 live births and fetal deaths."
So I hardly think that the Farm disqualifies as a good example of birth safety.
Another study on Apgar and outcomes in South Australia: http://hoydenabouttown.com/20100116.7157/that-homebirth-study-in-south-australia/
I would like to see the end outcome past that 5 minute score. One reason why:
"An Apgar score of 0 to 3 at 5 minutes is associated with an increased risk of cerebral palsy in full-term infants, but this increase is only from 0.3% to 1%. Scores of 4 through 6 are intermediate and are not markers of high levels of risk of later neurologic dysfunction. Such scores are affected by physiologic immaturity, medication, the presence of congenital malformations and other factors. Because Apgar scores at 1 and 5 minutes correlate poorly with either cause or outcome, the scores alone should not be considered evidence of or a consequence of substantial asphyxia. Therefore, a low 5-minute Apgar score alone does not demonstrate that later development of cerebral palsy was caused by perinatal asphyxia.
Correlation of the Apgar score with future neurologic outcome increases when the score remains 0 to 3 at 10, 15 and 20 minutes but still does not indicate the cause of future disability. The term asphyxia in a clinical context should be reserved to describe a combination of damaging acidemia, hypoxia and metabolic acidosis. A neonate who has had asphyxia proximate to delivery that is severe enough to result in acute neurologic injury should demonstrate all of the following(.../snip for space)
The Apgar score alone cannot establish hypoxia as the cause of cerebral palsy. A full-term infant with an Apgar score of 0 to 3 at 5 minutes whose 10-minute score improved to 4 or higher has a 99% chance of not having cerebral palsy at 7 years of age. Conversely, 75% of children with cerebral palsy had normal Apgar scores at birth.
Cerebral palsy is the only neurologic deficit clearly linked to perinatal asphyxia. Although mental retardation and epilepsy may accompany cerebral palsy, there is no evidence that they are caused by perinatal asphyxia unless cerebral palsy is also present, and even then a relationship is in doubt.- American Academy of Pediatrics policy statement, Volume 98, Number 1, July 1996"
Another study on asphyxiation: http://www.jpma.org.pk/full_article_text.php?article_id=3855
Therefore, I think just the apgar scores should be expanded in this study by including other data that has a significant outcome on cerebral palsy and mortality.