Planned Home vs Hospital Birth: A “Flawed Study”

Planned Home vs Hospital Birth: A “Flawed Study”

Last Summer, ACOG “leaked” data from a study to be published in the American Journal of Obstetrics and Gynecology stating that planned home births carried a 2-3 fold increase in neonatal death compared with hospital births.  The article,

“Maternal and newborn outcomes in planned home birth vs planned hospital births: a metaanalysis” by Joseph R. Wax, MD; F. Lee Lucas, PhD; Maryanne Lamont, MLS; Michael G. Pinette, MD; Angelina Cartin; and Jacquelyn Blackstone, DO, appeared  in the American Journal of Obstetrics & Gynecology, Volume 203, Issue 3 (September 2010) published by Elsevier. DOI: 10.1016/j.ajog.2010.05.02

There has been outrage ever since from Midwives and from other physicians and researchers. The principle objection is the method of study (a meta-analysis) and the data and analysis used to come to the conclusions.

Well, the battle continues and this one is a doozie! Authors from studies included in the analysis take a swing at Wax and his colleagues stating that not only is their methodology flawed, but their analysis and use of data is also flawed and misleading. Carl A. Michal, PhD; Patricia A. Janssen, PhD; Saraswathi Vedam, SciD; Eileen K. Hutton, PhD; Ank de Jonge, PhD are researchers from British Columbia and The Netherlands and together they have come together to pretty much dismantle “The Wax Report”. Here is their abstract from their analysis and the full article can be read on MedScape.

“The highly charged debate over the safety of home birth was inflamed by the publication of a meta-analysis by Joseph R. Wax and coworkers,[1] which concluded that “less medical intervention during planned home birth is associated with a tripling of the neonatal mortality rate.” The statistical analysis upon which this conclusion was based was deeply flawed, containing many numerical errors, improper inclusion and exclusion of studies, mischaracterization of cited works, and logical impossibilities. In addition, the software tool used for nearly two thirds of the meta-analysis calculations contains serious errors that can dramatically underestimate confidence intervals (CIs), and this resulted in at least 1 spuriously statistically significant result. Despite the publication of statements and commentaries querying the reliability of the findings,[2-6] this faulty study now forms the evidentiary basis for an American College of Obstetricians and Gynecologists Committee Opinion,[7] meaning that its results are being presented to expectant parents as the state-of-the-art in home birth safety research.

In this article we describe in detail numerous mistakes in design, methodology, and reporting in the Wax meta-analysis that place clinicians and patients at risk for being misinformed.”

While most laypeople won’t likely want to read the entire analysis and rebuttal of Wax’s work, it is significant because these researchers pretty much refute all of Wax’s work and show, step by step, how flawed the study was and how referencing this study as a basis for decision making is also flawed. Because ACOG has created its position on home births based on much of the data from Wax’s meta analysis, the researchers warn that physicians and women who are considering home births and using this study as a reference for their decisions are not getting reliable information and may not be making a well informed decision.

Their bottom line is that more reliable, evidenced based information is needed before such decisions and position statements can be made. For now, there is not conclusive data that proves home births are any more dangerous than hospital births and carry the 2-3 fold neonatal mortality risk.