Tuesday, May 26, 2009

Baby killers?

Every so often I like to plug "home birth" into a google news search and see what's out there. This morning I found something that has consumed my thoughts all day: "New study indicates hospital delivery safer for babies than home birth." What?! I hadn't heard anything about this study, so I checked it out.

Here's an excerpt describing the study's findings:
"The risk of neonatal death (dying during or shortly after birth) with a hospital delivery for a baby at term (between 37 and 42 weeks) was approximately 0.06%. The risk with a home delivery with a certified nurse midwife was almost double at 0.1% and with a non-certified midwife at home that number jumped to 0.18%. Low Apgar scores, a reflection of oxygen levels at birth, were also more common with home deliveries than in the hospital"(source).
Those are some disturbing numbers. Especially considering that they conflict with the growing body of evidence already published in peer-reviewed journals about the safety of home birth for low-risk women. Obviously I wanted to know more. So I poked around the internet off and on all day trying to find an original source for this study. All I could find were a few articles reporting about it. For example...

"Safety of midwife-attended home births questioned,"
from Canada.com
"Analysis Finds Risks With Midwife-Attended Home Births," from redOrbit.com

There were several other similar links. They all seem to be regurgitating the same words, but none of them directs me to more information. (It appears that this study has not yet been published in a peer-reviewed journal.) I want to know details!

Based on their findings, the researchers concluded that "the safest setting for the delivery of babies is in a hospital attended by a certified nurse midwife"(source). While the media grasped onto the home birth headline, they could just as easily have written: "New Study Shows Nurse-Midwives Safer Birth-attendants than Doctors." Except, while the press release willingly shared the neonatal death rates of the midwife-attended births, the only information we get about the doctor-attended neonatal death rate is: "Malloy hypothesized that in-hospital deliveries attended by certified nurse midwives had lower mortality risks in his study than in-hospital physician deliveries because the physicians were delivering babies at higher risk"(source). Wait a second... only a few paragraphs earlier, we're told that they limited the analysis to "low risk" births, which they define as full-term vaginal deliveries. If the only births included were "low risk," how could "high risk" babies explain why doctors were less safe?

Other questions I have about this study...

Were babies born with conditions or defects incompatible with life included?
Where did they find the records for these births?
What was the death rate for the babies delivered by doctors?
What about the birth center rate?
When was the "recent 5-year time period" they pulled data from?

I also have a hard time with their limiting the study to full-term vaginal deliveries. It seems sort of ridiculous to imagine including cesareans in such a comparison, but think about it... One of the reasons mothers choose home birth midwives is to avoid unnecessary interventions--for example, unnecessary cesareans. How many women began labor as "low risk," but ended up having their babies surgically removed because their labors were derailed by the bright lighting, immobility, strangers, or drug side effects? What about neonatal deaths preceded by cesareans that were brought about through iatrogenic complications? Excluding those neonatal deaths by removing cesareans from the study analysis removes one of the largest strikes against hospital birth in the minds of home birth proponents--the "cascade of interventions" leading to cesareans and increased risks for both mother and baby.

Clearly it's difficult to compare home birth and hospital birth. They're two completely different species. And there's no perfect way to structure a study's cohort to make home and hospital birth comparable.

But here's what we do know... at present, the published body of peer-reviewed research indicates that home birth is just as safe for low-risk women as hospital birth. We also know that home birth would be even safer than it is if hospitals and doctors would collaborate more fully with midwives in creating a better system for handling those rare emergency transfers (as we see in many European countries). Home birth would also be safer if practicing midwifery weren't illegal in some areas of the U.S.

Couldn't we focus on making all births safer instead of bickering about who's better? Couldn't we collaborate with each other in working to provide women and babies with the absolute best care possible? Couldn't we incorporate practices that facilitate healthy births in all settings? When will we demand that our care be evidence-based?

As for me, I knew giving birth to my son at home was the right choice for us regardless of the research. God trumps research... even studies of 12 million births.

If you have any more details about this recent home birth study, please let me know.


Buscando la Luz said...

P.S. I edited this post after a night of sleep. :-)

Diana J. said...

Interesting.... Generally, though, I've noticed that whenever one of these "homebirth isn't safe" studies come out, it turns out in the end to have been majorly biased and to have included data that shouldn't have been included. The best studies repeatedly show that homebirth is as safe or safer than hospital birth. I'll let you know if I see anything out there on this!

The Fifes said...

it's really silly how people can manipulate "data" to try to say their point, and include or disregard important parts of a study. Silly people.

Sarah H said...

I think this is such an excellent post. I've read it twice just digesting it all. It is frustrating to say the least.
I used to be one of those people who thought homebirth was weird, then I got to the point where I thought it was great for some people, but now I see it as a good alternative to a system that isn't trustworthy. I admit, I don't trust doctors now. And I wouldn't trust this study. You brought up many good points, thanks for sharing.

Jill--Unnecesarean said...

Headlines sell. This reminds me of an Aussie headline awhile back about how babies are getting huge! The articles had quotes from "experts" about the dangers of big babies, S/D, obesity in later life... basically anything you could pull out. I went and looked at the study expecting to see a graph of babies doubling in size over the last decade or whatever it was and it was a flat line with a slight upward slope.