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UK Institute Declares Home Birth 'Not as Safe' ... but based on what?

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Wednesday, June 28, 2006

Just ran across this article today...


http://www.24dash.com/content/news/viewNews.php?navID=47&newsID=7281


and it says...

Midwife-led home births appear to be less safe than those co-ordinated by consultants in hospital labour wards, according to the Government's health watchdog.

In new draft guidance, the National Institute for Health and Clinical Excellence (Nice), has set out advice on reducing unnecessary medical intervention and how health staff should treat women.
It said a birth at home "increases the likelihood of a normal vaginal birth and satisfaction in women who are committed to giving birth in this setting".

Giving birth that way is likely to result in transfer to a hospital for between 4% and 20% of women in labour.

In a standalone midwifery-led unit, such as a birthing centre, women were more likely to feel satisfied with their labour and need less intervention, the guidance said.

Giving birth in one of those centres is likely to result in transfer to a hospital unit for about 12% of women in labour, it added.

In a consultant-led unit, women are more likely to have access to epidurals, more likely to receive anaesthetic and interventions such as forceps, and are less likely to feel satisfied.

But there is also less chance of the mother or baby dying in that setting, the guidance said.


The problem is...it NEVER cites any studies or data to explain where it gets the "information" that shows that there is less chance of mother or baby dying in the hospital than at home. It also doesn't distinguish if they count overall numbers or low-risk numbers, planned home births or all home births, etc...

Any UK readers have any more information on this new statement?

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  1. Blogger Sandy Kristin Piderit | 4:42 AM |  

    I'm not sure exactly which research the institute is relying on, but there has been a lot of back-and-forth about safety of homebirth at this site recently:

    http://homebirthdebate.blogspot.com/

  2. Blogger Jennifer | 6:47 AM |  

    Thank you for the link! Good resource for picking up some information to see what they're talking about. Now I'm even more convinced that they are relying on faulty interpretations to come to this conclusion...

    Sounds like one of the posts over there IS going into detail about some of the studies being cited here, but there are LOTS of wierd bits in th studies...

    For example...

    The Janssen study: A cross-sectional study conducted in British Columbia ... compared 862 women who planned a home birth with a matched control group of 571 women with a planned midwifery-led unit birth (MLU) and 743 women with a planned consultant-led unit birth (CLU)... Perinatal mortality involved 3 babies in 860 planned home births, 1 baby in 733 planned CLU births and no babies in 563 planned MLU births. No further details were given regarding the perinatal deaths... Furthermore, there were 5 infants out of 860 in the home birth group who received assisted ventilation for more than 24 hours, but none in the MLU and CLU groups.

    First off...we need more data on those women that planned the home birth. Were they serviced by midwives? Did it include UCs? Were they low risk? Singletons? Vertex or Breech? You can't just lump together ALL women that plan a home birth...that's not a good study...because no one has ever claimed that home birth is safe for everyone. Plus, 3 babies in 860 planned home births gives a death rate more than THREE TIMES the BMJ study, which included both the United States AND Canada. Last time I checked, British Columbia was still part of Canada...

    Bastian: A cross-sectional study (N=1,502,756) was conducted in Australia between 1985 and 1990. This ... included a comparison of planned home birth with data for the whole country, including details of perinatal deaths for home births. ... birth weight specific mortality for babies > 2500g showed a higher mortality rate with home birth ... The intrapartum-related perinatal mortality rate, excluding perinatal mortality associated with congenital malformation and/or extreme immaturity, was higher for babies born at home ... Intrapartum asphyxia was responsible for about half (24 out of 50 deaths) of infants dying after a planned home birth in Australia between 1985 and 1990.

    First off, this study is OLD. The most recent data is still from 15+ years ago. It also gives very little information about the criteria for the study. If she's gonna use this to speak up against home birth, she's got to give a little more reason than what's above.

    National Birthday Trust: A UK questionnaire-based cohort study conducted in 1994 compared 5971 women who had a planned home birth and 4634 women who had a planned hospital birth. Women were matched for age, parity and area of residence. A further 1337 women in the planned hospital birth group were not matched, but were included in the analysis. The complications in current pregnancies reported by women, differed between groups [higher risk in the hospital group] ... The characteristics of the babies showed a marginal but significant difference between groups [higher risk in the hospital group] Perinatal mortality rates were 10.7 per 1000 livebirths for planned home birth and 15.6 per 1000 livebirths for planned hospital birth.

    I'll say two things on this one...

    1.) Questionnaire-based cohort study? Are they serious? We've already gone over how horrificly innacurate those can be.
    2.) The perinatal mortality rates are 50% LOWER in the home birth group, but even still...the rates are five times higher than the BMJ study. Something funky is going on there...

    The Farm study: A large cross-sectional study conducted in the US compared outcomes for 1707 planned home births from the Farm midwifery service in rural Tennessee (between 1971 and 1989) with 14033 comparators from the 1980 US National Natality/National Fetal Mortality Survey... The 2 groups cannot be compared directly and the study should be regarded as a case-series.

    Sure, you can't compare the Farm directly to hospitals, though in reality, the Farm does take on high-risk casesAfter we excluded four stillborns who died before labour but whose mothers still chose home birth, and three babies with fatal birth defects, five deaths were intrapartum and six occurred during the neonatal period (see box). This was a rate of 2.0 deaths per 1000 intended home births. that most homebirth midwives would not accept. That said, it doesn't negate the stats from the Farm births, it just means they don't make a fair cross comparison.

    Johnson and Daviss: A large case-series was conducted in the US and Canada upon 5418 women expecting to give birth at home in 2000 supported by midwives with a common certification.... There were 18 perinatal deaths in the 5418 planned home births (3.3 perinatal deaths per 1000 planned home births).

    This is the one that seals it for me, because now she's clearly selectively quoting data in order to prove her point. Apparently she thinks that no one else reads studies...

    Yes there were 18 perinatal deaths in that study...HOWEVER...from the Johnson and Daviss study...

    After we excluded four stillborns who died before labour but whose mothers still chose home birth, and three babies with fatal birth defects, five deaths were intrapartum and six occurred during the neonatal period (see box). This was a rate of 2.0 deaths per 1000 intended home births.

    AND...

    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 M.D. that is posting there has this great habit of accusing home birthers of selectively quoting studies and of putting together biased research for their cause, which is ironic...well...for absolutely obvious reasons.

  3. Blogger Sandy Kristin Piderit | 5:39 PM |  

    The M.D. that is posting there has this great habit of accusing home birthers of selectively quoting studies and of putting together biased research for their cause, which is ironic...well...for absolutely obvious reasons.

    Yes, indeed.

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