Originally Posted by krst234
So there is some problem using birth certificates in determining intended place of birth at onset of labor.
The study did not use birth certificates. It used the CDC linked infant birth/death data, which is very reliable. And it covers all 50 states.
Originally Posted by Viola
So the person who criticized the study said that since birth certificates don't record intended place of birth, we don't really know how the majority of the birthing time was spent. I'm not sure if intended place of birth is important in evaluating the study, but if it is, then it's a valid criticism. Now if you are saying she is in favor of home birth and is trying to discredit it and failing, then that is a different situation.
However, it's possible that what she is saying that since home births where transfers are needed and happen in a timely manner are all part of the home birthing experience, the transfers, many of which likely have good outcomes, aren't counted as home births, which they should be. But if a transfer is needed and isn't done, and a baby dies, that gets counted as a home birth. So that might be what she is thinking.
But then, If the intended place of birth is the hospital, and a mother doesn't make it there, for whatever reason, and then has a bad outcome somewhere else, is that recorded as a hospital birth? Since many women do experience at least the first part of labor at home, if something happens before they get to the hospital, like a prolapsed cord or placental abruption or whatever, I would assume they would still be considered hospital births if the baby was born at the hospital, or even if the baby was born on the street or in a car or what have you.
I'm wondering how important intended place of birth really is, and how it all plays out.
The study looks at babies born by hospital midwives, hospital mds, freestanding birth center midwives, home birth midwives, and home birth "others."
The CDC linked birth/data records where the baby was born and who delivered it. So, if someone meant to go to the hospital but accidentally delivered the baby at home (or if someone did a UB), that would be recorded as home birth "others." If a woman delivered at home with a midwife, that would be counted as a "home birth midwife" birth. If a woman meant to deliver at home but was transferred to the hospital because of complications, that would be counted as a hospital birth (probably hospital md).
With that in mind, the study found that (NNM = neonatal mortality rate, death from birth to 28 days old): "NNM for those delivered at home by others and by midwives, and those delivered in a freestanding birthing center was significantly higher than those delivered by midwives in the hospital: hospital midwives: 3.1/10,000 (RR:1); home others: 18.2/10,000 (RR: 5.87; 95%CI: 4.21-8.19), home midwives: 13.2/10,000; (RR: 4.32 95%CI: 3.29-5.68), freestanding birthing center: 6.3/10,000;(RR: 2.03; 95%CI: 1.28-3.24)."
This means that for every ten thousand babies delivered by hospital midwives, 3.1 died. For every ten thousand babies delivered by birth center midwives, 6.3 died. And for every 10,000 babies delivered by home birth midwives, 13.2 died.
Intended place of birth is important only so far as to know that only those planning to have home births with midwives and who were able to accomplish that were counted in that group. Those who were intending to have hospital births and had accidental home births were not counted in the home birth midwives group. And the hospital midwives and mds, which had both intended hospital births and home birth transfers, had a much lower rate of neonatal death than the home birth midwives.