The Blogospher Responds to claims “Planned Home Births Increase Neonatal Mortality 30%”

July 11th, 2010

The birth world is reeling over recent study results stating that planned home births increase neonatal mortality by 30%. The data will be published in an article in the September issue of the Journal of the American College of Obstetricians and Gynecologists and is authored by Joseph R., Wax, MD, and colleagues at the Maine Medical Center in Portland.

The “Fright Factor” of this article cannot be ignored. Any pregnant woman who may be considering a home birth and hears the headlines on any mainstream media outlet will certainly rethink her decision, and very likely her judgment, to have a home birth. The article cites numerous studies supposedly supporting the claims that home births are unsafe and carry an increased risk of neonatal death. There in lies the rub. The articles cited in the meta-analysis don’t support the claims that a planned home birth is unsafe. Additionally, many of the articles cited are themselves unreliable and/or inconclusive about the safety of home birth.

I could go ahead and cite what I think is wrong with this study and most certainly what a disservice such an article is to the public at large. However, many of my colleagues have done a superb job  outlining the issues with this article. So in addition to the response released by CIMS in the press release that I posted previously, I am presenting several responses for mamas on bed rest to read and to contemplate.

In the end, how and where you decide to deliver your baby is your decision. I only hope that decision is an informed one. So to help with that, here are several well written responses.

Characteristics of Planned and Unplanned Home Births in 19 States

This is the title of  a study published in the July 2010 Obstetric and Gynecology, which despite already being published has generated far less media buzz than the article yet to be published and reporting that planned home births carry a 30% increased risk of neonatal mortality. In this article the authors sought to determine what caused women to choose home birth and what characterized a safe home birth. Unnecesarean Blogger Jill does a superb job analyzing this article summarizing the pertinent data. Unecesarean also questions the timing of the release of data from a soon to be published article distinctly opposing home birth and citing that home births pose a threat to the life of infants. New York and Massachusetts are currently passing legislation to expand the practice privileges of midwives and the venues in which t hey can deliver. Could the publication of “alarming data” citing harm to infants born at home potentially alter the course of legislation? It remains to be seen.

A Review of the Data

The Birth Sense Blog took a different approach, one that is my favorite approach to published information. Because the article speaking out against home births cites data from a meta-analysis of 12 other research studies, the author of the Birth Sense Blog requested and received an advance copy of the article in question. She then looked up all the studies cited and evaluated whether or not they were even appropriate studies to be included in the tmeta-analysis. This intricate analysis lead her to the conclusion that the study proclaiming that planned home births are dangerous was poorly designed, included data that was inappropriate for this type of analysis and that overall the conclusions reached by the researchers didn’t even reflect their own data.

Meta-analysis: the wrong tool (wielded improperly)

Is the conclusion Amy Romano, CNM and blog researcher for Lamaze international draws after reading the study in question. She then goes on to describe the purpose of meta-analyses and explains why meta-analysis was a poor choice for this particular study. Finally she chastises the American College of Obstetricians and Gynecologists for even deigning to publish such flawed study with such biased conclusions.

The American College of Nurse Midwives

American midwives have the most to lose with the publication of this study. Midwives have been tirelessly lobbying for rights and privileges to study their craft. Just as they are about to see legislation passed in New York and Massachusetts granting them the right to legally practice their craft, delivering babies, this article blasts on the scene with the potential to undo years of their hard work and advances they’ve made.

I realize that many laypeople may be overwhelmed at the prospect of reading medical literature. However, I want to strongly encourage any woman who is considering a planned home birth to take the time to thoroughly consider all angles of this controversy before making her decision. Regardless of her final choice, my greatest hope is that her choice is an informed one.

What impact has the declaration that planned home births increase neonatal mortality had on your impression of home birth deliveries? Pleased share your comments below.

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