Cornell Study - 4x higher rate of death at Homebirth - Page 3 - Mothering Forums

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#61 of 69 Old 03-05-2014, 08:17 AM
 
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BTW: the CDC study I mentioned is based on birth certificate data.


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#62 of 69 Old 12-10-2014, 03:15 PM
 
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On reading the study itself, my main criticism is that it cannot differentiate between the various types of homebirth midwives. The homebirth-with-midwife NNM is more than DOUBLE that of birth center births, which strongly suggests to me that there is a large proportion of lay midwives in the homebirth data--probably because of Amish, Mormon, far-out hippie, and ethnic populations. Comparing birth centers (i.e., generally better trained) attendants against hospital midwives, risk of NNM is doubled, which is consistent with other studies.

The NNM for some hospital birth populations, for example young unmarried black mothers with no prenatal care in Mississippi, is far, far worse than that for homebirths with a midwife. I'm still waiting for the medical community to do something about Mississippi.
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#63 of 69 Old 01-02-2015, 11:09 AM
 
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Has anyone noticed that the study hasn't actually been published? the ajog website simply links to a pdf of the presentation abstract from the conference proceedings that occurred 1 year ago. Being accepted to present a study at a conference is very very different from having the study published in a scholarly peer-reviewed journal (even then you have to be careful because good science must be replicable). This may indicate that the study was too methodologically inadequate/inappropriate for the conclusions that were drawn to be published.

Scarily, the study's findings have been rehashed all over the internet (the only citation given being the conference presentation), though the academic community has been unable to critique them.

If anyone can find where the study has actually been published in its entirety in a peer-reviewed journal, please post. I would love to be able to take a look so I can comment.
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#64 of 69 Old 01-02-2015, 12:13 PM
 
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Quote:
Originally Posted by wwatx View Post
Has anyone noticed that the study hasn't actually been published? the ajog website simply links to a pdf of the presentation abstract from the conference proceedings that occurred 1 year ago. Being accepted to present a study at a conference is very very different from having the study published in a scholarly peer-reviewed journal (even then you have to be careful because good science must be replicable). This may indicate that the study was too methodologically inadequate/inappropriate for the conclusions that were drawn to be published.

Scarily, the study's findings have been rehashed all over the internet (the only citation given being the conference presentation), though the academic community has been unable to critique them.

If anyone can find where the study has actually been published in its entirety in a peer-reviewed journal, please post. I would love to be able to take a look so I can comment.
The study was published in the AJOG in Feb. 2014. There's a link on page one of this thread.
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#65 of 69 Old 01-02-2015, 02:25 PM
 
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Originally Posted by MeepyCat View Post
The study was published in the AJOG in Feb. 2014. There's a link on page one of this thread.
The link on page one is for the WebMD site that discusses the conference proceedings in Feb 2014. The article was not accepted for publication in AJOG until October 13, 2014 and was published online on October 14. I do not know what the print publication date is.

Here is a link to the article abstract and other information but not the full text. Unless someone has posted the full text online, you would need to have access to an institution that subscribes to that journal. Or just pay some $$ to buy the article.
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#66 of 69 Old 01-02-2015, 04:31 PM
 
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Here's the actual study, since a lot of people will want to look at that: Term neonatal deaths resulting from home bIrths: an increasing trend
Sorry, I was on my phone earlier, and wasn't sufficiently clear. THe link I was thinking of is the one quoted above, from post 16 (not the opening post). The full text is available here. Is it wwatx's contention that the above is not official publication?

In any case, this is not the article published by AJOG in October - the Jan/Feb article under discussion in this thread is entitled "Term neonatal deaths resulting from homebirths: an increasing trend" and is co-authored by Kate Sapra and Frank Chernevak. The October article is entitled "Perinatal risks of planned home births in the United States," and has co-authors McCullough, Brent, Aravin, Levene and Chernevak.
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#67 of 69 Old 01-02-2015, 05:42 PM
 
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Quote:
Originally Posted by MeepyCat View Post
Sorry, I was on my phone earlier, and wasn't sufficiently clear. THe link I was thinking of is the one quoted above, from post 16 (not the opening post). The full text is available here. Is it wwatx's contention that the above is not official publication?
Okay - the above linked article (Feb 2014) is an official publication from the conference proceedings (Volume 210) and is not a peer-reviewed article (to answer wwatx's question):
34th Annual Meeting of the Society for Maternal-Fetal Medicine: The Pregnancy Meeting
03 February 2014 - 08 February 2014

Quote:
Originally Posted by MeepyCat View Post
In any case, this is not the article published by AJOG in October - the Jan/Feb article under discussion in this thread is entitled "Term neonatal deaths resulting from homebirths: an increasing trend" and is co-authored by Kate Sapra and Frank Chernevak. The October article is entitled "Perinatal risks of planned home births in the United States," and has co-authors McCullough, Brent, Aravin, Levene and Chernevak.
Ahh - yes. You are correct. Reading the abstract, it looks like the article (Oct 2014) I linked above uses a similar set of data as the conference proceedings article but I haven't read either very closely. Thanks for your reply!
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#68 of 69 Old 01-03-2015, 11:50 PM
 
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I'm following this thread with great interest. I believe "evidence based" needs to apply equally to all practices, and I'm wanting a better understanding of the statistics at play here. To that end, I downloaded the full text of the analysis posted on Dr. Amy's website. There are a couple of things in it that strike me as extrapolation, but this part from section 2, Neonatal Morbidity:

"Alarmingly, of the 245 infants with low recorded APGARs, 69 were transferred to the hospital intrapartum, but only 66 were transferred postpartum, meaning that over 100 low-APGAR infants did not receive prompt medical attention."

in particular is confusing to me. If 69 of the 245 infants were transferred to the hospital intrapartum, then they should have counted toward the statistical assessment of hospital outcomes, no? Am I reading incorrectly? This is specified as an analysis of a 5-minute APGAR score. According to the National Library of Medicine National Institutes of Health:

"Any score lower than 7 is a sign that the baby needs medical attention. The lower the score, the more help the baby needs to adjusting outside the mother's womb.
Most of the time a low Apgar score is caused by:
Difficult birth
C-section
Fluid in the baby's airway
If your child has a low Apgar score, he or she may receive:
Oxygen and clearing out the airway to help the baby breathe
Physical stimulation to get the heart beating at a healthy rate
Most of the time, a low score at 1 minute is near-normal by 5 minutes.
A lower Apgar score does not mean a child will have serious or long-term health problem. The Apgar score is not designed to predict the future health of the child."

This might go back to the question about various certifications and qualifications where midwives are concerned, but in my location, midwives carry oxygen and other implements, which, according to NIH would be part of the medical attention protocol, whereas the statistician above is assuming that no medical attention was given. This reads as a bias to me, but I'm not sure that I'm reading correctly.

Any thoughts?
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Last edited by mama2004; 01-03-2015 at 11:51 PM. Reason: a letter :)
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#69 of 69 Old 01-04-2015, 01:22 PM
 
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astrogeoCole and MeepyCat - thank you. your clues led me to the "Perinatal risks..." article in press (I do have access to the AJOG journal through the university where I work). This article has similar authors to the "term neonatal death" study, but it says nothing about neonatal deaths. the only conclusions of this article are that one third of planned home births attended by midwives are not "low-risk" as defined by ACOG.

However, I also found the AJOG article "Early and total neonatal mortality in relation to birth setting in the United States, 2006-2009" by the same authors using the CDC dataset and have begun reviewing this. Based on a cursory inspection of the article, a few glaring things that stand out to me: that 1) the home birth setting group included deliveries by "other" people (“any other person delivering the baby,such as a husband or family member,emergency medical technician, or taxi driver”) and also 2) that "midwife home birth" could include any uncredentialed or untrained midwife, so they may have just been layfolks calling themselves midwives. None of the research about the safety of homebirth would dare assert that uncredentialed, untrained midwives or taxi drivers can provide safer care than a hospital. The authors themselves say "We emphasize that this increased risk is a function of the out-ofhospital setting rather than the provider," emphasizing that the unplanned, emergency home births that took place were a big part of the tentative signifiacnt differences they found. Not to mention, the study does not control for income level or maternal morbidity. Tsk, tsk. So this research offers no new information.
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