New Home Birth Study

I haven’t read this study yet (it’s next on my list of things to read; but I have a sick child right now, and might come down with something myself, so I wanted to get this out ASAP, even if I hadn’t read it yet — especially since if I get sick and feel like my kids are acting, I won’t be in any mood to read it!); but here is a lay article summarizing it.

Here’s the abstract (although the link is to the complete study):

Background: Studies of planned home births attended by registered midwives have been limited by incomplete data, nonrepresentative sampling, inadequate statistical power and the inability to exclude unplanned home births. We compared the outcomes of planned home births attended by midwives with those of planned hospital births attended by midwives or physicians.
Methods: We included all planned home births attended by registered midwives from Jan. 1, 2000, to Dec. 31, 2004, in British Columbia, Canada (n = 2889), and all planned hospital births meeting the eligibility requirements for home birth that were attended by the same cohort of midwives (n = 4752). We also included a matched sample of physician-attended planned hospital births (n = 5331). The primary outcome measure was perinatal mortality; secondary outcomes were obstetric interventions and adverse maternal and neonatal outcomes.
Results: The rate of perinatal death per 1000 births was 0.35 (95% confidence interval [CI] 0.00–1.03) in the group of planned home births; the rate in the group of planned hospital births was 0.57 (95% CI 0.00–1.43) among women attended by a midwife and 0.64 (95% CI 0.00–1.56) among those attended by a physician. Wo men in the planned home-birth group were significantly less likely than those who planned a midwife-attended hospital birth to have obstetric interventions (e.g., electronic fetal monitoring, relative risk [RR] 0.32, 95% CI 0.29–0.36; assisted vaginal delivery, RR 0.41, 95% 0.33–0.52) or adverse maternal outcomes (e.g., third- or fourth-degree perineal tear, RR 0.41, 95% CI 0.28–0.59; postpartum hemorrhage, RR 0.62, 95% CI 0.49–0.77). The findings were similar in the comparison with physician-assisted hospital births. Newborns in the home-birth group were less likely than those in the midwife-attended hospital-birth group to require resuscitation at birth (RR 0.23, 95% CI 0.14–0.37) or oxygen therapy beyond 24 hours (RR 0.37, 95% CI 0.24–0.59). The findings were similar in the comparison with newborns in the physician-assisted hospital births; in addition, newborns in the home-birth group were less likely to have meconium aspiration (RR 0.45, 95% CI 0.21–0.93) and more likely to be admitted to hospital or readmitted if born in hospital (RR 1.39, 95% CI 1.09–1.85).
Interpretation: Planned home birth attended by a registered midwife was associated with very low and comparable rates of perinatal death and reduced rates of obstetric interventions and other adverse perinatal outcomes compared with planned hospital birth attended by a midwife or physician.

Now, the big question that so many people ask when faced with studies like this that show similar or better outcomes for mothers and babies who have home births is, “how is this possible?” The idea is that since hospitals have all the bells, whistles, gadgets, and even the machine that goes *ping*, that this means that births there have to be safer than births at home. Well, the answer, I believe, lies in the balance of risk and benefit. There are numerous studies that indicate that when interventions are used unnecessarily (whether that’s inductions without a medical reason, elective C-sections, etc.), then both mothers and babies have worse outcomes. Some of these worse outcomes are higher mortality, or higher morbidity, greater NICU admissions, and more infections (particularly maternal — healing from either a C-section or episiotomy incision). The situation at a home birth is that most of these interventions are simply not used at all — if there is an indication for an intervention, the mother is transferred to the hospital (for an epidural, Pitocin augmentation, a C-section, etc.), with very few interventions performed at home. Studies will keep any hospital transfers in the “planned home birth” group, but with the average rate of hospital transfer being 10%, that means that 90% or more of all planned home births are accomplished with few or no interventions. When interventions are necessary or beneficial, that’s one thing; but even a certain percentage of these will have adverse effects — so to reduce the “side effects” they should be limited to only those that are necessary. If 10% of women with epidurals have an adverse reaction, but 100% of all women get an epidural, then 10% of all women will have adverse reactions. If, however, only 30% of women get epidurals, and 10% of those have adverse side effects, then only 3% of all women will be negatively affected. The same thing applies to all other interventions, for both mothers and babies.

It appears that for low-risk women, avoiding the interventions (with their attendant risks), even if they have to stay out of a hospital to do it, then the risks and benefits balance, or even tip in favor of planned home birth. It may be that some babies born at home are negatively affected by a lack of immediate medical attention (for instance, a baby with an unknown heart condition that requires immediate surgery postpartum — obviously rare); but it also appears that other babies born at the hospital are negatively affected by too much “medical attention.” I have yet to see a study that shows worse maternal outcomes for planned home births; and most if not all good studies show similar or better fetal/neonatal outcomes for home birth.

19 Responses

  1. Hi Kathy, it beats me why anyone needs to study the safety of homebirth when the definitive work has been done by Marjorie Tew of Glasgow University. Her book “Safer Childbirth?” lays the whole game out clearly.

    Midwives in B.C., Canada have been regulated and paid by the provincial government since Jan l, 1998. The statistics for perinatal morbidity and mortality were better for homebirth midwives before regulation. That is something which these researchers never touch on.

    When the mws became registered in 1998, they were forced to have hosp privileges. Hospital privileges are given out by doctors. In exchange, the drs required the mws to induce at 41 weeks. You know the rest.

    When you read the stats and see 20% of healthy, low risk women being transported to the hosp., you know you are looking at medicalized midwifery. I’m not sure if they include in their reporting all the women who are referred out to obstetricians in the pregnancy.

    What no one wants to speak about in B.C. is the fact that homebirth midwives were doing a very good job prior to gov’t regulation and many women have been sacrificed on the altar of medical management post licensing.

  2. Your post reminds me that the study did not include either the percentage of women transferring in birth or the various causes of perinatal death. I wish that information were included. It appears from the “eligibility requirements” that women who had a “significant disease” arising during pregnancy (including PIH, DM requiring insulin, placenta previa or abruption, etc.) were risked out and not included in any cohort. Probably, they would not have been allowed to give birth at home, and then to keep the groups even, would have been excluded as high-risk from the “low-risk” hospital cohort. It would have been interesting to see how many women would have “risked out” of the three groups, and which group, if any, would have had fewer women moving from low-risk to high-risk. I’m still waiting for *that* research.😉

  3. Hi Kathy, Thanks for posting this. I was going to and then got so heated about the ACOG drama that I didn’t get around to it. You explanation of risk versus benefits is great especially since for some reason people seem to think that the risk lies in staying home when in fact the increased risks happen when you step foot in the hospital and start the cascade of unnecessary intervention!

  4. […] You can read some great commentaries from Amy Romano over at Science and Sensibility and from Kathy over at Woman to Woman. […]

  5. As I wrote on my own blog, this is actually bad news for American direct entry midwives. According to the CDC data, homebirth with a direct entry midwife has more than triple the neonatal mortality rate of homebirth in Canada and the Netherlands.

    That’s not surprising since both Canada and the Netherlands have much higher levels of midwifery education and training and far more rigorous eligibility requirements for homebirth.

    It’s just another example of how American homebirth midwives have dismal statistics in comparison to anyone else.

    • It’s bad news for Canadian doctors, since they had worse statistics with the same patient population that the midwives of both groups had. It’s bad news for Canadian hospitals, since midwives had better statistics at home births than at the hospital.

      You’ve already commented on my blog about the 3x NMR of the CDC on this post, in which I pointed out that there is a greater than 3x rate (.21/1000 vs. 0.06/1000) of nonpreventable death in the “other midwife” category, due solely to anencephaly, Edwards’ Syndrome, Patau’s Syndrome, and thanatophoric short stature. There may be numerous others. Certainly some babies have lethal defects associated with Down Syndrome, although most such babies are aborted if known about — and home-birthing women are notorious for avoiding most if not all tests which would reveal fetal defects, so would have a lower rate of abortion and induced pre-term birth. This is one example of a fatal flaw of using raw data which you are certainly already aware of, though you choose to ignore. In addition to the notoriously inaccurate data of birth certificates, is the fact that there really are no true controls, and no close look at whether the excess deaths were avoidable or not. One example of inaccurate data is that “other midwife” is listed as the in-hospital birth attendant for over 13,000 births, and as for Cesarean attendants — over 13,000 CNMs, over 4000 “other” and 501 “other midwives” performed C-sections, according to this data, with another 5000+ unknown or not stated. Not to mention the fact that there are hundreds of births that took place from 17-20 weeks in which every baby would have certainly died, with perhaps one rare case here or there (although I’ve not heard of any), although their deaths are not recorded/linked, so it appears that they lived at least a full year. The CDC stats can be useful for some things, but you can’t hang your hat on it for this.

      Plus, there are no guarantees that the midwives were certified or educated — I’ve been told that my state has basically no laws governing midwifery, so that I could start calling myself a “midwife” right now if I chose. I might be lumped in with CPMs, in the “other midwife” category and that would be a bad thing for them. I’ve seen you gripe about CPM education and training, and say that this school or that school has classes to teach midwives how to write good birth stories and such. [Frankly, if a midwife is going to offer a written birth story to her clients, I think that’s a good subject to offer.] But others have retorted with the evidence that the core subjects for CPMs are the same and many even use the same books, as CNM training. I will grant you that CNMs have to have nursing education (which encompasses a lot of information midwives don’t need), and they will be able to assist at C-sections (something home-birthing midwives don’t need to know); but I’ve seen some CNMs praise CPM training as better than CNM training, particularly for home-birth settings.

      If I were you, I’d support The Big Push for Midwives, which would require midwives to be certified in the states in which they practice. Right now, only 26 states have legal CPMs; if the remaining 24 were to have legal CPMs, then no midwives would have to be illegal or work under the radar, and they’d have to be subjected to eligibility requirements for home birth to be certified. As it is now, with no registration, midwives that so choose can take on anyone they wish. Granted they still *could* work illegally, but they also *could* be certified, regulated, and thus restricted. Registration and certification are a two-edged sword, in that respect — as Gloria already pointed out in this thread. It requires a certain standard, which could be good or bad. You would think it would be good to restrict the midwives; Gloria said that home-birth midwives had better statistics prior to registration, and the restrictions incumbent with it, which appears to be bad for mothers and babies. In the past year or so, Utah has had a problem with this — they allowed legal midwives earlier, and then introduced a bill forbidding them to attend VBACs and certain other births. Many women would choose to have unassisted births, rather than submit to what even you would call an unnecessary C-section.

  6. “It’s bad news for Canadian doctors, since they had worse statistics with the same patient population that the midwives of both groups had. ”

    No, the difference between the groups is not statistically significant. Moreover, unless and until we find out the causes of the deaths, we don’t even know if the authors conclusions are correct. If the hospital deaths were stillbirths before 28 weeks, they are not relevant to the safety of the birth setting.

    “I pointed out that there is a greater than 3x rate (.21/1000 vs. 0.06/1000) of nonpreventable death in the “other midwife” category, due solely to anencephaly, Edwards’ Syndrome, Patau’s Syndrome, and thanatophoric short stature.”

    But of course, if you remove anomalies from one group, you must do so from the other group and when you do, the neonatal mortality rate at homebirth is still 3 times higher than hospital birth.

    Kathy, why do you think Amy Romano (Science and Sensibility) refused to comment about my analyses of the homebirth statistics? Obviously, it’s because she cannot refute them. Nor can Henci Goer or Jennifer Block. They can’t refute them so they try to change the subject.

    I would think that by now you, of all people, would have learned that my claims are based on scientific evidence. Amy Romano, Henci Goer and Jennifer Block know it; they don’t dare deny it. So why do you keep pretending that the matter is still up for debate?

    • I’m not talking about just mortality, but in the better results across the board, except in infant admissions for jaundice in the home-birth group (that’s the only case I remember for worse outcomes, anyway), including things like episiotomy, vacuum extraction, C-section, etc.

      “But of course, if you remove anomalies from one group, you must do so from the other group and when you do, the neonatal mortality rate at homebirth is still 3 times higher than hospital birth.”
      Sigh, yes, I did that! Which is why I brought up the *other* relevant problems with using merely the CDC as the sole hammer for hitting home birth. You complain about Amy, Henci & Jennifer Block “refusing to comment” about your analyses of homebirth stats and/or not being able to refute them, yet you ignore these extenuating circumstances when I bring them up to you. Can you not refute my claims?

      I brought up the causes of death that are absolutely unavoidable to show that you have to take that into account. There may have been many other unavoidable causes of death in the “other midwife” group. My friends had a baby to die at 3 weeks of age, on the operating table, attempting to correct a heart defect. Within a week of his birth, they noticed that his breathing was labored and took him to a doctor, who transferred him to a cardiologist, who sent him on to Le Bonheur (six hours away from them, but the nearest hospital that could treat him). He was given a 50/50 chance of living with the surgery, and a 0% chance of living without it — he would have died within 6 weeks. IIRC, his aorta had developed on the wrong place on his heart. He was born at home. His birth had nothing to do with his death. I bring that up as an example of an unavoidable cause of death, although his death certificate might have just said, “heart defect” and recorded his death at 21 days of age, and you would point to his death and say, “SEE!! Home birth yields excess death!!” But you’d be wrong. How rare was his defect? 1/10,000? 1/1,000,000? I don’t know. Certainly not common. There are limitations to the usefulness of the CDC data, as I have repeatedly indicated, and you repeatedly refuse to admit.

      I haven’t seen your analyses of homebirth statistics, other than what you’ve written on my blog, and the arguments ad nauseum we had on your blog over a year ago. Where on the S&S blog have you commented about it?

      I know that you believe your claims to be based on scientific evidence. Actually, that’s not *exactly* the case. Evidence is evidence; what you and I do is build an argument based on the *interpretation* of the evidence. I disagree with your *interpretation* of the evidence, for the above-stated reasons.

  7. “I’m not talking about just mortality”

    I am. There are very few people who think it is worth letting a baby die in order to avoid an intervention.

    “Evidence is evidence; what you and I do is build an argument based on the *interpretation* of the evidence.”

    Yet no professional homebirth advocate disagrees with my interpretation.

    There’s no doubt that homebirth with an American homebirth midwife is the most dangerous form of planned birth in the US.

    There’s no doubt that planned homebirth with a DEM has almost triple the neonatal mortality rate of low risk hospital birth.

    There’s no doubt that homebirth with a DEM has triple the neonatal mortality rate of homebirth in Canada or the Netherlands.

    There’s no doubt that MANA has collected safety statistics for the past 8 years, has publicly offered them to supporters, but is hiding them from the general public.

    Simply put, Kathy, everything that you believe about homebirth safety is flat out false and the people in the best position to dispute these points don’t even try.

    • There are very few people who think it is worth letting a baby die in order to avoid an intervention.
      But these groups had equal mortality, and the home-birth cohort had lower morbidity! But speaking of interventions and death — you know as well as I do that interventions introduce risk. When *not* doing an intervention is risky, then the benefit of doing the intervention outweighs the risk; but when the intervention is *not* indicated, then the risk of the intervention outweighs the risk. C-sections lead to greater maternal/neonatal mortality, not to mention morbidity. You have said repeatedly that VBAC is safe, and C-sections are overused — women and babies are dying due to too many interventions; home birth is some women’s attempt at avoiding unnecessary interventions. If you’d stop trying to demonize women for trying to avoid interventions **YOU AGREE** are not necessary much of the time (esp. with your 10-16% C-section rate when you were practicing; and you blamed the increase on a different type of epidural; and said that due to defensive medicine you could no longer have such a low rate, but still it would have to be less than 31.7%, the official rate now) — if you’d stop trying to demonize these women, and WORK ON THE REAL PROBLEM, then *maybe* we could move forward.

      On Rixa’s blog, you’ve demonized Dr. Fischbein for his sexcapades; many people (myself included) think that there has to be a better doctor to spearhead the attempt at restoring women’s right to choose a VBAC — someone without his personal baggage. You could do that, if you just would. Instead, you seem to get your kicks out of stomping on home birth as an idea and we who promote it as people. You could do more good and save more babies if you would stop focusing on the less than 1% of women who give birth in homes, and instead focus on the 31.7% of women who get C-sections, at least half of them unnecessary — according to you.

      Instead, you rely on unscientifically interpreting raw (and admittedly inaccurate) data, so you can skew numbers and keep beating up on home birth. In the name of “saving babies.” Just not babies that die or are injured due to the over-use or over-zealous use of interventions that are not warranted.

      I’ve given you my reasons for not believing your interpretation, and your best come-back is, “Well, nobody else has told me I’m wrong, so you ought to believe I’m right.” Who am I supposed to believe — you or my own eyes and intellect? I raise an objection, and you ignore it, pretending like it has no grounds, when you know very well that it does.

      This comment on Rixa’s blog was very interesting; I’ll paste it in a subsequent comment, as soon as I finish writing this one. Basically, it shows that Canadian midwives are essentially direct-entry midwives, since they are not required to be nurses at all, and have similar training to CPMs, although there is some variation of midwifery programs in the U.S. Which indicates to me that the excellent results of the Canadian midwives is not so much due to their training, compared to American midwives, but perhaps due to other factors, one such may be *integration* into the system.

      American midwives tend to have about a 10% t/f rate; the Canadian study showed about a 20% rate; and the Dutch study showed about a 30% rate. A high number of those t/f were probably due to non-emergency transfers, for things like epidurals or Pitocin. One factor that may make some midwives and/or patients hesitant to t/f to a hospital from a home birth, is how they will be treated or mistreated at hospitals. If you want to lower the resistance of t/f to the hospital, you can work to change the system, so that midwives are welcomed and accepted and integrated into hospitals, rather than being demonized for transferring a patient that needed it. You can also work for legalization for midwives, because with legalization comes restrictions — the kind of restrictions you want, to keep women from having HBACs and home breech births and such. It wouldn’t eliminate such things, certainly, but it would probably minimize them.

      You have two choices right now — continue to fight to eliminate home birth in the United States (a fight which you will not and cannot win), or fight to make American home-birth more like the Canadian and Dutch system. You don’t have an argument, really, against these two studies, esp. the Canadian one, which is why you’re falling back on the ol’ reliable CDC stats to say, “look at the difference between midwives here and midwives there!” Showing that “midwives there” have unassailable stats. So, if you REALLY wanted to save babies, you could work WITH all the rest of us birth junkies in trying to change the system, so that the American system becomes more like what you are pointing to as a superior standard. But for some reason, you won’t; preferring to just sit back and bash pregnant women and midwives for doing what the ACOG code of ethics says they should be allowed to do — namely, to make choices for themselves, even if that means going AMA.

      We can be on the same team as I wrote in this post, and work for safe births for mothers and babies, or we can continue to fight and argue and spin our wheels and get nowhere. You have no credibility in home-birth circles, because of your vehement, vitriolic anti-homebirth stance. Few people listen to you because of your hostility, as Gloria’s comment below shows. Call it a knee-jerk reaction, but when I read something you write, my first impulse is to disagree with it in total and to pick it apart as best I can. The more you fight and scream, the less credibility you have, particularly as study after study comes out saying the opposite of what you have been harping about for years. You may have great credibility with the Suzannes of your world/blog, but not with the home-birthers you claim to want to save from the errors of their ways. I suggest a change in tactic.

      • “continue to fight to eliminate home birth in the United States”

        I’m not fighting to eliminate homebirth. I’m fighting to make sure that women have accurate information so they can make informed decisions.

        The CPM is being promoted by trickery. It is a made up credential designed to confuse women by its similarity to the CNM. Homebirth advocates have been disingenuous and deceitful in their promotion of homebirth.

        The discussion of the Canadian study on other blogs is a perfect example. The impression is given that homebirth in Canada is just like homebirth in the US. But, of course, it is nothing like homebirth in the US. The education and training of Canadian midwives is far more rigorous, and the eligibility requirements for homebirth are far more strict.

        American women deserve to know that CPMs don’t meet the standard for midwives in any first world country. If they want to use them anyway, that’s their choice. However, if they don’t understand that other countries consider the CPM inadequate, they cannot make an informed decision.

        What I find outrageous is that professional homebirth advocates like Henci Goer and Jennifer Block know that what I am writing is true. They don’t even bother trying to contradict it; they merely resort to personal insults to divert attention from the truth. That’s unethical.

        • Actually, all midwives trained outside of Canada get additional training or supervision within Canada. CNMs and CMs from the US, as well as midwives from the UK get an additional 2-6 months of supervision, while DEMs from the US get 3-12 months, which reflects the diversity of training they may have received in the US.

    • An anonymous poster on Rixa’s blog.

      Needing to remain anonymous here, but I have posted some responses to the bitter doctor on her blog addressing this issue. Her response was akin to “you’re wrong and I’m not going to talk about it anymore.” I’m reposting my comments here, stringing several of them together — hope it adds to the conversation. Sorry for the length!

      Many Canadian midwives are educated in U.S. direct-entry midwifery schools, at least as many as (if not more than) the number of Canadian midwives educated in Canadian schools. Seattle Midwifery School regularly admits a number of Canadian students every year, as does the Midwives College of Utah. Canadian midwifery programs are generally quite small and local preceptors are lacking. Unlike the U.S., Canada values home birth and midwives, and there is a tremendous shortage of midwives there. They have to bring in foreign-trained midwives to meet the consumer demand, and the U.S. trains many, many of them.

      Canada doesn’t distinguish between direct-entry midwives and nurse-midwives. (In fact, Canadian midwives are not required to be nurses at all, so by definition, they technically ARE direct-entry midwives.) Canadian midwives must have both hospital and homebirth experience in order to practice, which seems quite prudent.

      Canadian midwives are required to meet competency standards, not educational standards. Look it up. This is exactly the way that the North American Registry of Midwives measures competency to receive the CPM credential in the U.S. In fact, if you were to compare the Canadian Competencies side-by-side with the NARM Competencies, you would find very few differences at all, aside from pharmacological treatments (most direct-entry midwives in the U.S. have a narrow range of drugs that can be administered).

      So aside from some prescriptive differences and the fact that Canadian midwives can flow seamlessly between home and hospital (as is the case in the Netherlands where outcomes are also spectacular), there is virtually no difference between Canadian midwives and U.S. direct-entry midwives. They are being trained here.

      In order for Canada to ensure a single set of standard competencies for entry-level midwives, they have an additional process that foreign-trained midwives must complete. This used to be the PLEA process, but it has been replaced by the Multi-jurisdictional Midwifery Bridging Project in most provinces. It includes an assessment of the midwife’s skills and knowledge, as well as education on the Canadian healthcare system. Seems reasonable.

      It’s important to note first that ALL foreign-trained midwives must complete some amount of time under supervision. For example, British midwives usually take 3-6 months and U.S.-trained CNMs take 2-6 months of supervised practice (“often focused on community-based and out-of-hospital midwifery care”). The wider range of potential supervision for U.S. direct-entry midwives [3-12 months] reflects the wide variety of training programs in the U.S.

  8. Amy, it’s possible that smart women don’t argue with you
    1. because you are a time suck
    2. because you’re nuts

  9. As far as American direct entry midwifery schools are concerned, the College of Midwives of British Columbia says:

    “Students in these US direct entry programs usually work only in out-of-hospital settings, although some do offer hospital experience, usually in poorer nations with different equipment and standards than we have in BC hospitals. Often standards for inter-professional communication and collaboration with other health professionals are different than in BC. Students may or may not gain experience with continuity of care. PLEA candidates from these schools are usually required to complete three to twelve months of supervised practice. Some graduates from US direct entry schools have been found to be ineligible to take BC’s registration examinations because their programs did not meet CMBC midwifery education requirements.”

    In other words, graduates of US direct entry midwifery programs must have additional clinical training even if they pass the exam. Other graduates are not even allowed to take the exam because the educational requirements of their programs are so deficient.

    • Y’know, if you read the whole thing, you’ll see that even your beloved and precious first-class CNMs from the US and midwives in the UK also need 2-6 months of training “even if they pass the exam”!

      And in the discussion about US DEMs, it notes that, The US also offers a wide variety of other direct-entry midwifery education programs. The majority are offered by small private schools. The programs can last from a few months to four years and they range from formal educational programs incorporating classroom study and supervised clinical placements to self-study distance education theoretical courses and apprenticeship style training.

      So, a woman can “graduate” from a 3-4 month midwifery “program”… but since it’s not accredited, she won’t be allowed to sit for an exam. Makes sense to me. And if a woman has graduated from an accredited program (such as one that produces CPMs), she is allowed to sit for the exam, and if she passes, has to have “3-12 months of supervised practice” — NOT “additional clinical training,” which is what you said.

      On page 7 of the PDF, it says, “PLEA applicants from nurse-midwifery and ACNM accredited direct-entry programs usually require a period of supervised practice for about two to six months, often focused on community-based and out-of-hospital midwifery care. So, all CNMs, all CMs, and some (perhaps even most) DEMs *are* allowed to sit for the exams, and *all* PLEA applicants have a period of supervised practice ranging from 2-12 months.

  10. […] media usually supported the data of the CDC.  And if not the CDC how about the data from the recent Canadian study that controlled for risk and showed that YES planned homebirth is SAFE! And it’s obvious they did […]

  11. Dr. Amy said: Moreover, unless and until we find out the causes of the deaths, we don’t even know if the authors conclusions are correct. If the hospital deaths were stillbirths before 28 weeks, they are not relevant to the safety of the birth setting.

    One of the researchers commented on Science & Sensibility’s post about this study, so I asked him. He responded:
    “In Canada, stillbirth death is defined as intrauterine death after 20 weeks gestation. Early neonatal death is from birth to 7 days. Together this time period is referred to as perinatal death and it is a standard mortality rate in Canada.

    Following this first broad data search from 20 wks to 7 days after birth, the three groups were then matched for comparison. All three groups had to meet the eligibility requirements for home birth, regardless of planned place of birth. In order to qualify for a home birth in BC you must be between 37 and 42 weeks gestation so all births occurring between 20 and 36+6 wks gestation were eliminated from the final data set.”

  12. Amy, Stop treating birth as a risky, missing death by a hair, type of disease! Of course you will always want to argue and look for the negative. You obviously are one of the doctors that lead by fear mongering. That said, thank goodness for those doctors that are practicing out there who actually care about the patients and don’t just care about the $!

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