Obstetric Lie #87- Home Birth Is Dangerous
(Picture kindly donated by Westmama Designs
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Breathtaking Photography)
This is a question that mothers, fathers, and critics ask frequently. There are a plethora of studies within the field of obstetrics, and contradictory information is rampant on almost medical study you can find. This post is an attempt to pull together a few well done studies concerning the safety of home birth verses hospital birth.
One of the best and most recent studies I could find was this one. You can read it in full here and I highly suggest that you do. The choice of where you birth is deeply important. There are risks and benefits to every choice, including some inherent risk in birthing no matter where you birth. Overwhelmingly this risk is higher for the baby than the mother. When we choose pregnancy we must accept some degree of risk.
What is most telling about this study though is the type of midwife that it is examining. The Certified Professional Midwife or CPM has been widely criticized, even among home birth advocates. ACOG (the American Congress of Obstetricians and Gynecologists) only endorses the use of CNMs or Certified Nurse Midwives. The difference between the two, in short, is the type of education they recieve.
CPMs in this study were certified through NARM or the North American Registry of Midwives. They do not necessarily have a bachelors degree nor are they registered nurses. They are not medical personnel per se. They do not have hospital rights in the United States. Their legality is questioned still in some states. CNMs however are medically trained, mostly practice within hospitals and are much more accepted among the medical world at large. They are nurses with an advanced training in midwifery.
It is also important to note that in the United States there is not often a good working relationship between CPMs and the medical model of care. They do not often have transfer doctors or MDs that they work with. They are not supported by the hospital system.
Why are these things important to note? Those within the medical industry grudgingly admit that some midwives (CNMs) who have more medical training are capable of attending births within the hospital setting. However the idea of a competent CPM is often found repulsive and is discouraged by ACOG. It has also been claimed by some that NARM refuses to share their actual data on the safety of home birth. This study proves otherwise.
But let's get to the data, the science, behind home birth safety in the United States.
To start, the sample size was decent, and this study compared home birth moms to similar hospital birthing mothers.
"We focused on the 5418 women who intended to deliver at home at the start of labour. Table 1 compares them with all women who gave birth to singleton, vertex babies of at least 37 weeks or more gestation in the United States in 2000 according to 13 personal and behavioural variables associated with perinatal risk."First, they found that intervention rates were quite different between the home birth and the hospital birthing groups.
"Individual rates of medical intervention for home births were consistently less than half those in hospital, whether compared with a relatively low risk group (singleton, vertex, 37 weeks or more gestation) that will have a small percentage of higher risk births or the general population having hospital births (table 3). Compared with the relatively low risk hospital group, intended home births were associated with lower rates of electronic fetal monitoring (9.6% versus 84.3%), episiotomy (2.1% versus 33.0%), caesarean section (3.7% versus 19.0%), and vacuum extraction (0.6% versus 5.5%). The caesarean rate for intended home births was 8.3% among primiparous women and 1.6% among multiparous women."They found that despite lower interventions, the home birth mortality rates were comparable to hospital birth rates.
"The intrapartum and neonatal mortality was 1.7 deaths per 1000 low risk intended home births after planned breeches and twins (not considered low risk) were excluded. The results for intrapartum and neonatal mortality are consistent with most North American studies of intended births out of hospital11-24 and low risk hospital births"
If you would like to see the table of mortality rates in hospitals, (it is a great resource) you can find it here.
This study also looked at client satisfaction with their midwife. They found that:
"Among the stratified, random 10% sample of women contacted directly by study staff to validate birth outcomes, no new transfers to hospital during or after the birth were reported and no new stillbirths or neonatal deaths were uncovered. Mothers' satisfaction with care was high for all 11 measures, with over 97% reporting that they were extremely or very satisfied. For a subsequent birth, 89.6% said they would choose the same midwife, 9.1% another certified professional midwife, and 1.7% another type of caregiver."
Some things to note about the strength of this study compared to others done are mentioned here.
"Our study has several strengths. Internationally it is one of the few, and the largest, prospective studies of home birth, allowing for relatively stable estimates of risk from intrapartum and neonatal mortality. We accurately identified births planned at home at the start of labour and included independent verification of birth outcomes for a sample of 534 planned home births. We obtained data from almost 400 midwives from across the continent."
The choice to birth at home is not a popular one despite some recent media attention to the contrary. Women overwhelmingly choose to birth in the hospital. The common criticisms of home birth, that only CNM's should be used and that the American CPM is badly trained and dangerous were not found in this study. In fact, their results were very similar to those of medically trained OBGYNs. The assertion that NARM does not disclose their statistics is also disproved in this study. One particularly telling thing is that these good results were present even in the United States where there is little cooperation between obstetrics and home birth midwifery care as compared to some other European countries where there is also stricter home birth midwifery requirements.
Wherever you choose to birth, it is imperative that you have studied your choice and that you are comfortable with it. Knowing your care provider, their skill level, their certifications, their experience, and their history of deaths, if any, is something that the woman entering motherhood should be far more interested in than the nursery theme.
If you are interested in more studies on this subject, there are many more. You can find them at the links below.
Birth safely and in peace and with full knowledge of what is safe and what is not. You have a responsibility to know what is true and what is false.
This study points out that planned home birth was slightly safer than hospital birth (Canadian).
This is the response by Johnson and Davis to the critics of their home birth study, and is fascinating reading.
Comments
The study is a bait and switch. As your quotes reveal, the authors compared medical interventions at homebirth in 2000 with hospital birth in 2000. But when it came to mortality, they compared homebirth in 2000 with ... a bunch of out of date studies extending back to 1969.
Why didn't they compare homebirth in 2000 with comparable risk hospital birth in 200? Afterall, they had the data (which was part of the same dataset as the medical interventions). They didn't do that comparison because it would have shown that homebirth with a CPM in 2000 had a mortality rate almost triple that of comparable risk hospital birth in 2000.
This study was specifically written to trick people, and it tricks almost all homebirth advocates.
Schlenzka22 California 1989-90 806 402 1.9
Eden et al30 Twelve hospitals Illinois, 1982-5 8135 1.9
Rooks et al28 National natality survey, 1980 2935 2.5†
Janssen et al14 Washington, 1981-90 23 596 1.7†
I just cut and pasted a few above-
Yes- some of the mortality rates DO extend back farther, but not all.
What you fail to notice is that the data that they used for OUT OF HOSPITAL death rates also extended back just as far-
So the claim that they used only modern HB infant mortality rates and only old hospital infant mortality rates is false. The data was from the same time periods for both in and out of hospital birth.
Nice try- anything else?
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC558373/table/tbl4/
Thanks for reading!
By the way, Johnson and Daviss have already publicly acknowledged that the death rate they should have used in the study is the death rate from 2000.
http://homebirthdebate.blogspot.com/2007/12/johnson-and-daviss-acknowledge-validity.html
"... Since our article was submitted for publication in 2004, the NIH has published analysis more closely comparable than was available at that time, and some have tried to use it as a comparison. While we still do not offer the comparison as a completely direct one, as it is the closest we have and the comparison is occurring regardless of our cautions, we offer the following adjustments that have to be made to provide the comparison of the CPM2000 analysis in as accurate a manner as is possible with the published NIH analysis."
They say that the data wasn't available, but it was published in 2002 at the same time as the medical intervention data.
The only valid comparison is to homebirths of comparable risk women in the same year (approximately 0.7/1000). That information was available, but they didn't do that comparison because it shows that homebirth increases the risk of death.
This is why there is such a gulf between homebirth advocates and obstetricians. Homebirth advocates cite studies that claim to show that homebirth is safe, but when you actually read the studies you learn that they show nothing of the kind. The Farm Study (Durand, 1992) is another bait and switch. Durand did not compare homebirths at The Farm with comparable risk hospital births in the same year. He compared them (as he acknowledges in the article) with a survey of HIGH RISK births in the same years. That was the only way to make The Farm statistics look good.
Interestingly, MANA has continued to collect data on homebirth safety. They have collected information on 23,000 homebirths but they refuse to release the death rates. How can you trust people who won't even tell you how many of their patients died?
I don't know how you can read deceit into a study or the intent of those doing it. How can you know that anybody intends to be deceitful?
I am not following what MANA has to do with this discussion directly? NARM is the group quoted in the study as collecting data- and they DID provide their data, unless I am mistaken.
I don't know anything about MANA but don't see how their unwillingness to supply data (if that is in fact true, you did not provide anything other than your word on that either) has anything to do with the actual article quoted- they were not even mentioned in it.
I simply cited a study and provided quotes from it (actually I mentioned 5 studies)
The reason there is a gulf between HB and obstetrics is not just HBirthers citing studies they like- each side does that. You are not exactly trying to calm the waters and close the divide mama.
Planned home birth with CPM= 1.7 per 1,000 perinatal mortality
Planned c-sections without medical reason, including previous c-section= 1.77 per 1,000 neonatal mortality
I just hope and wish that people would then be more fair about both of these things, considering how comparable they seem to be.
"When the author compared
3,385 planned home births with 806,402 low risk
hospital births, he consistently found a nonsignificantly
lower perinatal mortality in the home
birth group. The results were consistent regardless
of liberal or more restrictive criteria to define low
risk, and whether or not the analysis involved simple
standardization of rates or extensive adjustment for
all potential risk variables collected."
You can find this chart here
http://www.cdc.gov/nchs/data/nvsr/nvsr50/nvsr50_12.pdf
I realize it doesn't include intrapartum mortality- but still this mortality rate is much much higher than the home birth mortality rate, is it not?
http://understandingbirthbetter.com/section.php?ID=24&Lang=En&Nav=Section
click on the pdf link on the bottom of the page to view the full article.
Your article claims that they should have included the hispanic death and the hispanic births in their study though the NIH study only included white/non hispanic mothers.
This makes no sense- why should they include death rates and deaths for groups in their HB study when they were not included in the NIH hospital birth data?
Hint- "because I, Amy, don't like HB" is NOT a valid answer.
It makes no sense for them to include data that is not included in the comparable hospital studies.
What on earth are you talking about? Can somebody else please cite their sources besides me?
"The only valid comparison is to homebirths of comparable risk women in the same year (approximately 0.7/1000). That information was available, but they didn't do that comparison because it shows that homebirth increases the risk of death."
As you probably know, they did not compare to that data set for specific reasons. And I quote,
"It has
been suggested as a comparison group for examining
risk in the CPM2000 study. However that would not
be a comparison of like with like. It is not appropriate
as a comparison group to the BMJ study results
because it excluded not only births with risk factors
discovered before labour but also those births where a
risk factor occurred during labour. The CPM2000
study did not exclude women with risk factors that
occurred during labour."
The study you suggest they use as a comparison is not a good comparison, it DOES (despite your claim to the contrary) eliminate women in which risk factors occurred in labor. It would have also eliminated the deaths you claim that the Johnson and Davis study should have included (the significant anomalies and babies that would have died despite birth place) because these mothers had they been birthing in hospital would have had their risks risk them out of this study too- so it is perfectly logical and more comparable for the Johnson and Davis study to also remove them from the data set.
I get that you don't like home birth- that is fine by me. I am not discouraging hospital birth, only offering evidence with links to studies that home birth is a safe option for low risk women.
Just because we don't like the outcome or findings of articles does not mean that we should dismiss them. This goes for you as much as it goes for me.
Happy hunting and thanks for visiting. It's been fun.
Peace out-
You can find this chart here
http://www.cdc.gov/nchs/data/nvsr/nvsr50/nvsr50_12.pdf"
This is why it is so important to understand statistics, otherwise you are easily tricked. Like must be compared with like. The overall neonatal death rate includes all races, all gestational ages and all pregnancy complications. Therefore it is the wrong comparison.
The correct comparison is with "all women who gave birth to singleton, vertex babies of at least 37 weeks or more gestation in the United States in 2000according to 13 personal and behavioural variables associated with perinatal risk." Johnson and Daviss knew that. That's why they used that comparison group for medical interventions. But they didn't use it for mortality because the mortality rate in that group in 2000 was 0.9/1000, far less than in the homebirth group.
Johnson and Daviss have already acknowledged that they should have used the same group for both comparisons, but claimed that the mortality data wasn't available. Considering that the data was published in 2002, fully 3 years before their paper, that's just another attempt to trick homebirth advocates.
Maybe you should quote yourself again to back up your claims?
I am sorry but I am having a hard time taking your supposed word on anything. You send me in the general direction looking for stuff you claim, but don't tell me where it actually is.
Still, I read all the stuff you linked to (including the CDC data which you also linked to in your blog article- BTW, a blog article is not a study, it is not scientific, nor does it carry any weight, no matter who writes it).
I only mentioned the CDC data because you linked to in in YOUR article as though it showed the data you were claiming. The number I quoted, which you claim can be "easily confusing" to lay people is the only overall mortality rate I could find in there. If it is incorrect why did you link to it?
Could it be that you only included these links to appear as though you were backing up your data, knowing full well that most people would not peruse them, and definitely not trudge through pages and pages of CDC reports.
Except I did trudge through all your links and I NEVER found what you are saying was in there.
A link or a quote or a number is totally useless if it doesn't actually say what you say it does.
I am not trying to find incorrect data, I was simply restating what you posted as backup to YOUR claim. I fully realize that it is a very different number.
Nowhere did I find that they "acknowledged" any such thing. But I did quote what they ACTUALLY said above.
Sadly, A, what people say for real and what you say they say seems to be very different.
Do you really want to tell me again how dishonest "they" are?
Again- it's been fun. You are a fascinating individual with an even more fascinating approach to statistics, truth, and "science".
Thanks for reading, and please, come again.
HA!
Different studies, different group of women, different methods, different means to an end- not sure how it applies, frankly.
There is no possible way that studies extending back 40 years (when the mortality rates were substantially higher) is a valid comparison.
The death rate for comparable risk women in 2000 was 0.9/1000.
By the way, you might be wondering why Johnson and Daviss would deliberately offer an invalid comparison. Perhaps it has something to do with the fact that Ken Johnson is the former Director of Resaerch for MANA (not disclosed in the paper) and the study was funded by a homebirth advocacy foundation (disclosed at the end of the paper).
Betty Daviss, his wife, is a homebirth midwife.
Let's leave the Johnson and Daviss study out of this for a moment. What studies can you provide that show homebirth in the US is dangerous? You claim the Johnson and Daviss study is flawed, Ok. The Wax study is flawed too, right? So, what is your evidence that homebirth is so dangerous? I know you like to use studies from other countries but that doesn't apply here, if it did, I could use the study done in Canada to prove homebirth is safe here. I know you like to use the CDC data set but that is not scientific evidence because it has not been peer reviewed. In addition to that, the CDC dataset is based on two years and DOES include high risk women. What real evidence do you have that LOW risk women attended by CPMs is dangerous here in the USA? Because that is the bottom line. Do you have the proof to say homebirth is dangerous? If you don't have it then ALL of this nonsense is futile. Let mothers make their own choices and stop telling them they are being reckless and selfish by having a homebirth. You can't use what you speculate MANAs numbers to be- I didn't know that people who claim to be scientific and skeptical, can turn assumption into fact and provide it as evidence-?? I know you may think the study done in Missouri proves homebirth is dangerous too. The outcomes of one state still does not prove homebirth is dangerous across the board. Honestly, Dr. Amy, what do you have? Even the Wax Study showed that the perinatal death rate for homebirth babies and hospital babies is the same. And that study was supported by ACOG. I know you are famous for saying that the WHO states the perinatal death rate is the best measure of obstetric care. If that is the case, doesn't the Wax Study prove that midwives have the same outcomes as OBs, as far as deaths go?
So, low risk women giving birth at the hospital have a neonatal death rate of .9/1000?
And according to you, the CDC dataset states that homebirth mothers have a neonatal death rate of 1.2/1000( including high risk ones.. as you have said yourself, birth certificates are notoriously bad for leaving out details of the mother. Details which prove if she was high risk or low risk. I can link to where you said this in case you forgot).
So, let me get this straight. This entire homebirth is dangerous hoopla is based on a difference of .9/1000 and 1.2/1000? And the 1.2/1000 numbers include high risk women??
I am going to go out on a limb here and say that if the high risk women were removed from the equation, the neonatal death rate for mothers choosing homebirth would be somewhere around - oh, .9/1000. Yeah, I'm thinking that homebirth is as safe as hospital birth, unless of course all these numbers are wrong. Are they Amy?
Hehe.
As an aside, "they have an agenda" --Seriously mama- are you trying to be funny or does it just come naturally?
So many statistics seem to miss their marks anyway, since so many people just tend to take part of who was studied- like the elective c-section statistic not applying to repeat c-sections. Or the home birth statistic being for low-risk women. (isn't it?)
The Skeptical Mother, I thought the home birth statistic was 1-2/1,000. (1 slash 2 rather than 1 dot 2) ?
According to Dr. Amy, the CDC dataset from 2004-2005, shows the neonatal death rate to be 1.2/1000. Also according to Dr. Amy, birth certificates leave out a lot of information about the mother (the CDC numbers are based on birth certificates) such as, was she high risk or wasn't she. The truth is we do not know if the CDC numbers are based on only low risk women, therefore we cannot assume that they are based on only low risk women. We do know that high risk women sometimes choose homebirth though.
http://www.ncbi.nlm.nih.gov/pubmed/20598284
It says that neonatal mortality for home births is 3x higher. That the perinatal mortality rates were similar.
What is interesting about that study is that the perinatal death rate is the same, which is stillbirths and births up to seven days. The neonatal death rate is births from seven days to 28 days of life. What is happening between day 7 and 28 that makes more babies from homebirth die? BUT, and this is even more interesting, the perinatal death rate from this study was based on around 500 deaths- the neonatal death rate was only based on 37. So, why the big focus on the neonatal death rate? Especially since the perinatal death rate is the best measure of obstetric care. That study has been criticized by a lot people actually. And I believe the main issue that most people have a problem with is the neonatal death rate. I don't think anyone argues that the perinatal death rate from that study is wrong. I could be wrong though. Anyway, my opinion is that the Wax Study makes homebirth look safe and it also concludes that mother and baby have many more benefits by staying at home.
I'm going to have to look into all more.
It seems no matter what kind of study is done, we all might be able to find fault with it. It seems that, within reason, all of these things can be safe and vary depending on the situation.
Outside of definite negligence (and I guess that is where the debate always lies...) everything seems to have its place. Maybe simplifying the whole matter, but only something like the Nazi's taking newborns in concentration camps and drowning them really warrants all the outrage.
Bingo!! However you choose to birth is your decision, just make sure you are informed of the risks. There is no need to tell someone she is a bad mother for how she chooses to give birth. Wait.. isn't that what you often say Amy? That should go both ways. Leave homebirth mothers in peace already. FFS.
It's not my job to prove that it is dangerous. It is your job to prove that it is safe. The J&D study actually shows that homebirth increases the risk of death. The Farm Study actually shows that homebirth increases the risk of death. In fact, there is not a single American study that shows that homebirth is safe.
There are copious statistics that show that homebirth is not safe:
The CDC statistics (on CDC Wonder) show that planned homebirth with a CNM has double the neonatal mortality rate of comparable risk hospital birth and planned homebirth with a non-CNM midwife has triple the neonatal mortality rate of comparable risk hospital birth. This finding is quite robust, occurring in every year for which homebirth statistics exist.
Statistics from the licensed midwives of Colorado show that they have an appalling and rising rate of perinatal mortality. Their mortality rate is double that for the state as a whole (which includes all gestational ages and all pregnancy complications) and the intrapartum death rate is 10 times higher than comparable risk hospital birth.
A new paper "Birth outcomes of planned home births in Missouri: a population-based study" by Chang and Macones published in the American Journal of Perinatology in August 2011 shows that planned homebirth with a non-CNM midwife has an intrapartum death rate 20 times that of comparable risk hospital birth.
The Midwives Alliance of North America (MANA) spent 8 years and tens of thousands of dollars collecting data on 23,000 planned CPM attended homebirths. While they were collecting the data, they promised that it would demonstrate that homebirth is safe, but once they analyzed the data, they refused to release it. So even MANA knows that homebirth has an unacceptable death rate. They just don't want potential customers to find out.
My claim is that there is not a single scientific paper that shows homebirth to be as safe as hospital birth for comparable risk women. The Johnson and Daviss paper doesn't show it and the Farm Study doesn't show.
If you want to rebut me, you need to find scientific evidence that homebirth is safe.
Only homebirth advocates think that homebirth is safe and that's because professional homebirth advocates (and lay ones like Mama Birth) misrepresent the scientific evidence either deliberately or because they never read it and wouldn't understand it if they did.
ALL the scientific evidence as well as state and national statistics show that homebirth increases the risk of neonatal death. Even MANA's own data shows that homebirth increases the risk of neonatal death! The only people who are unaware of the facts are homebirth advocates.
YOU are the one who constantly tells us homebirth is dangerous. If I was eating a cheeseburger and someone came up to me and said- "Stop eating that!! Don't you know cheeseburgers are dangerous??!!" Would I really need to go find evidence that eating a cheeseburger was dangerous or would that person need to present me with something that proved that what I was doing dangerous? You claim it, you need to back it up.
You can't use the CDC dataset until 2004 because before that time there was not enough information put on birth certificates to be able to even use birth certificates and get any accurate info on the homebirt #s. If I am not mistaken.. 2004 was the year that MOST states implemented place of birth and attendant at birth on birth certificates but not all states. When did all states implement this? That is a pertinent question because if it missing from the birth certificate than unattended births could be included in the homebirth numbers.
Putting that aside though, the CDC numbers are raw data that has not been peer reviewed. You always say all the *scientific evidence* supports the fact that homebirth triples the neonatal death rate. Well, the CDC numbers are not scientific evidence. And they include high risk women, at the very least we cannot prove that high risk women are not included.
Again, data from Missouri and Colorado do not prove homebirth is dangerous across the board. What if Florida and Vermont release their statistics and it shows homebirth is safer than the hospital? Does that mean we can say that all hospitals are dangerous??
Dr. Amy, you are not being honest to women. If you want to be honest then say that it some evidence shows that homebirth may be riskier than hospital birth but at this time, we do not have enough evidence to make any conclusive statements.
What about the fact that elective c-sections have a higher neonatal death rate than homebirth? You support elective c-section and I have even seen you write that elective c-sections are the safest route of birth. What does that say about homebirth then?
Oh, please. We all know that if the data showed that homebirth is safe, MANA would be shouting it from the rooftops. Moreover, regardless of what it shows, it is unethical to withhold homebirth death rates. MANA knows what they are and American women deserve to know what MANA knows.
I can't think of a single legal, moral or ethical reason for withholding the death rates. Can you?
Yup. And there also isn't any scientific evidence in this country that proves homebirth is dangerous. So, what do we really have here? Well, we have a choice, as mothers, to decide where we would rather give birth and you, Dr. Amy need to stop calling us names for choosing homebirth. You simply do not have the evidence to back up your claim that we are all being selfish and ignorant. If that is the case, make sure you start advocating to end elective c-sections. You may lose some fans though if you do that!! Talk about chaos over at the SOB!! lol
I can't think of a single legal, moral or ethical reason for withholding the death rates. Can you?"
That is not the point though. The point is, we do. not. know. what the MANA numbers reveal.
Listen, we know homebirth has the capacity to be safe. That is a fact because of the study that was done in Canada. So, if it has the capacity to be safe, how about we all work together to make sure it is as safe as possible? That is not going to happen by creating all this friction between the two sides. We could work together, you know.. actually accomplish something. It would be nice!!
Women will always choose homebirth, I really wish you would stop judging us so harshly for this choice.
Maybe you are aware and maybe you are not but I chose homebirth for a very personal and emotional reason and it really mattered to me. You are wrong about why I chose it, yet you often tell people all over the internet the reasons why I did- as if you have some insight into my personal choices- thousands of women's personal choices? Think about that next time. I'd appreciate it.
Sure there is. The Johnson and Daviss study actually shows homebirth triples the mortality rate.
The Farm Study actually shows that homebirth triples the mortality rate.
The CDC statistics shows that homebirth triples the mortality rate.
The Colorado statistics show that homebirth has an intrapartum death rate 10 higher than comparable risk hospital birth.
The Missouri statistic show that homebirth has an intrapartum death rate 20 times higher than comparable risk hospital birth.
And, in addition to that evidence, MANA refuses to release its own death rates.
You can desperately keep pretending that homebirth is as safe as hospital birth, but you have no evidence to support it.
Moreover, I noticed that you can't think of a single legal, moral or ethical reason for MANA to hide its death rates, either. We both know that they are hiding their death rates because homebirth with a CPM has an unacceptable rate of neonatal death.
But Canada has abolished the CPM because they consider CPMs unqualified. And we already know that American homebirth with a CNM has double the rate of neonatal mortality of comparable risk hospital birth (Infant outcomes of certified nurse midwife attended home births: United States 2000 to 2004, Malloy, Journal of Perinatology (2010) 30, 622–627).
So, no, we don't know that homebirth with a homebirth birth midwife (CPM) has the possibility of being safe. And in the meantime, American women deserve to know the truth:
ALL the existing scientific evidence AND national and state statistics show that homebirth increases the risk of neonatal death and there is NO evidence that it doesn't.
You can't be informed about homebirth if you don't know that.
But back to the subject at hand-
I read all the info- it does not say what you say it says.
It is ok if you don't like home birth. It is ok if you think it is unsafe.
It is also OK if there are studies to the contrary. You still don't have to like it.
I would have changed my post if I could have actually confirmed your claims. I checked them- all of them. They were just that- claims. The data and sites you sent me to did not confirm your claims.
I do like home birth- but I absolutely refuse to lie just to justify my opinion. I repeat- I REFUSE to lie to do justify my opinion. The fact remains that this study DOES find home birth as safe as hospital birth. PERIOD. You don't have to agree with the study.
Still- it is OK to hate home birth. Really- I will still love ya! You are entitled to your opinion. But if you want to share it here- back it up. You didn't- you won't- you can't.
That is why I spent a few hours last night checking all your claims (you wouldn't give me the data yourself) and they are simply false.
Once again- it's been fun- feel free to carry on. Oh- and thanks for sending some peeps my way Amy- much appreciated!
No, it doesn't. You don't have to take my word for it. Ask any independent person with a background in science and statistics and they'll tell you it's a bait and switch. The fact that you don't understand that tells us more about you than about the study.
Please get back to me when you have shown it to an independent person who has a college level background in statistics. You are going to show it to someone else, aren't you? After all, you do want to know the truth, don't you?
Decide for yourself what you believe based on the evidence. Don't let me or my blogger friend Amy tell you what to think.
Apply the same standards to claims from both sides. Remember that blogs are just that- blogs. No matter who claims to write them or what degrees they claim to have. Nobody fact checks a blog.
And A- I thought the assault on my intelligence and ethics was a low blow after all we have been through! That just cuts me to the core! I thought we knew each other better than that....sigh...
Blessings on your births ladies-
MANA- we know nothing, all we have is speculation. Next.
CDC data- includes high risk women, only two years of RAW data, is not scientific evidence. Includes unplanned/unassisted births. Next.
Missouri and Colorado data- two states, Amy. What about the rest?
And here is some more info on the Missouri stats:
Rates of neonatal death were 1.4/1000 among planned homebirths attended by non-CNMs, 0 among planned homebirths attended by physicians/CNMs and 0.6/1000 among hospital/birth center births attended by physicians CNMs.
ZERO homebirth deaths attended by physician/CNMs and .6/1000 at the hospital? So, does this mean it is safer to have a homebirth with a CNM in MIssouri than to give birth in the hospital? Maybe we should let people know that, Amy!
And then how about this:
the rates of intrapartum fetal death were 0.9 per 1000 births among planned homebirths attended by non-CNMs, 1.7/1000 among planned home births delivered by physicians/CNMs.
Doesn't THAT mean that the intrapartum fetal death rate is lower when one gives birth at home with a CPM rather than a CNM or physician? Hmmm. Interesting. Next.
Johnson and Daviss study- you are the one that claims it is flawed so if that is your claim, you can't use it. A flawed study is a flawed study. Next.
The Wax study- flawed again. However, does show the perinatal death rate between home and hospital to be exactly the same. Next.
The study done in Canada- CPMs were working in Canada when that study was done. Do you have sufficient evidence to prove that the midwives in that study were not educated here in the states?
Do you have sufficient evidence that proves that no CPM or canadian midwife who was educated here, is working in Canada? Next.
The Farm Study- many high risk women delivered at the farm and any woman who had prenatal care at the farm and gave birth in the hospital was included in those numbers. Next.
Am I missing anything? Is this really all that you've got Amy? This is pitiful. All this fuss over not one bit of substantial evidence.
Yes. You're missing even the most basic understanding of science, statistics and childbirth. You have literally no idea what you are talking about.
If I am wrong, it should not be difficult to show that.
Point out my mistakes, provide links, explain it, Dr. Amy. Go down the list and give a simple explanation of why I am wrong. I am interested to know.
Bwahahahahaha!
In the (over 100) comments you will find that even scientists find the same problem with your "doctored" claims that I did.
But hey- if people don't buy you un-cited "claims", read the evidence and find you are fabricating what you say- you can always call them uneducated!!! If you were right you wouldn't need to resort to insults.
I expect more from you Aimee- after all we have been through the last few days!!!! You are breaking my heart sister.
"Discussions about these issues would be complicated enough, even without the unscientific accusations and conclusions from Amy. Even the latest comment, “Because homebirth midwives are grossly undereducated and grossly underqualified and homebirth increases the risk of neonatal death,” is simply unnecessary. It has already been pointed out that qualifications of midwives in America vary, and that the risk of neonatal death in home birth is firstly, not directly comparable, and secondly, the methods Amy uses are not much better than the study she’s criticizing. Even more unnecessary are suggestions about Colorado midwives not disclosing data, when similar data regarding hospital births are also hard to come by. And I’ve already pointed out the strawman argument about midwives vs. obstetricians."
Overall, I think the data _is_ supportive of the idea that homebirth is associated with an increased risk of perinatal/neonatal death. I think a three times elevated risk is fairly well supported in the literature, and don't find that there is a consistent problem with the research methodology that would lead one to doubt that.
Furthermore, as a practicing obstetrician who has delivered or supervised the deliveries of over a thousand deliveries, I find that number very easy to believe. I have seen plenty of situations that could not have been easily handled at home. I have also seen situations where hospital practice has led to outcomes that might have been avoided at home, but never a neonatal death that could be attributed to such.
I do wonder when people doubt these figures, and question whether or not they really a very comprehensive experience in childbirth. Certainly one could attend 20 deliveries and get the idea that nothing bad ever happens by sampling error alone, but if one delivers 300-400 babies one is going to know that some things are just unexpected and sudden. The whole idea of "low risk" versus "high risk" falls apart when you realize that a great number of bad things actually happen to "low risk" mothers, if only because there are just so many more of them.
That all said, the studies still only show a 3x risk of neonatal/perinatal death, which totals to 3/1000, which is still very low. I do recognize that homebirth provides something for mothers that they value, and that they may think it is worth it. We accept very small risks for various reasons all the time, and this risk is small enough that it is OK to do this in my opinion. Mothers are bound to to take reasonable actions to protect their children, not go to the ends of the earth to eliminate every conceivable risk.
As for the MANA data, I do believe that it shows a surprisingly high death rate. I have not seen it myself, but take this on advisement from a homebirth midwife who did see this data and shared her opinion of it with me. While I disagree that we can know for certain what the data is without having seen it (as Dr Tuteur implies), I think more than likely she is correct in this issue.
N Fogelson MD
http://www.academicobgyn.com
I don't think there is NO risk to HB, I also realize that there certainly are risks that can't be handled at home. Not only that I realize that either way the risks are low.
I have not been able to find that data though- ANYWHERE. I would read it, talk about it, share it, if I could actually find it.
The numbers that Miss Amy gives are not from any actual study. They are numbers that she made up when she added back in deaths that would have been deaths anywhere.
She doctored the numbers to suit her purposes.
The data in the study which was from the MANA data didn't show a 3X risk.
I hear lots of anecdotal evidence constantly on the risks of hospital birth- even neonatal death at the hands of care providers. That is sad- but I don't know if it is true and I can't prove it. Hearing from someone in a field that such and such is true does not make it so. Personal opinion varies.
What is a chance for this woman at a hospital? >99%
But what is a chance for this woman to have unnecessary medical intervention deteriorating her birth experience at a hospital? at home?
I guess a choice is quite obvious "on average" :-)
About myself - I had 2 great experiences with water birth at St. John's hospital in Westlake, OH, attended by a CNM and rather "normal and natural" first "dry" birth at CCF, Cleveland, OH. So you would not suspect that I'm all biased.(I hope not to provoke outrage regarding water birth :-) I've chosen hospital birth because of great 5-star resort-like experience we had there (and good insurance coverage). If my territorial and financial circumstances were different I'd gone for home birth. If all US hospitals had similar teams and conditions as mentioned ones there would be nothing to discuss here.
Doctors and hospitals certainly have a place. Not all women are able to birth naturally and without complications. That's what OBs are for: to address those complications. But to assume every woman's body is doomed to fail in regards to the most natural and biologically imperative function it's capable of is outright INSULTING. The burden of proof lies with people like you to PROVE to me that somehow every single woman's body on the planet is incapable of birthing without your intervention.
I'm sorry, but every intervention forced (yes, FORCED) on me during my first birth was completely unnecessary and even more than that-- WORSE for me than the natural alternative.
The first step in giving hospitals credence to their safety assertions would be for hospitals to actually follow protocols that are best for mother and baby, rather than best for the doctor's convenience. As long as hospitals prevent laboring women from eating, force them to give birth on their backs, and use terms like "failure to progress" to label their own impatience with the process, they can't possibly have a leg to stand on when they insist on their "highest level of safety." I'm sorry, but an establishment that ignores basic and straightforward science in favor of convenience and lawsuit avoidance loses their credibility when asserting their "safety."
I'd rather give birth in a ditch than in a hospital again. I'd be treated with more respect and more evidence-based care.
Let's! This post is almost five years old, so I'm assuming you'll want to know what the latest studies say. You can find them at ishomebirthsafe.blogspot.com. It's a great source of information provided by an LDS mother and scientist. Guess what? Every study done on planned, midwife-attended home birth in the United States has found significantly increased rates of babies dying at home birth. Even MANA's own self-selected stats showed a homebirth rate 5.5 times higher than the hospital. Wouldn't this be important information to share with prospective mothers?