Friday, May 19, 2006

Homebirth in Ireland

The following study of homebirth in Ireland showed that the risk of a normal, term baby dying from hypoxia (lack of oxygen) at a homebirth was 50 times higher than at a hospital birth!

Safety of Home Delivery Compared with Hospital Delivery in the Eastern Region Health Authority in Ireland in the Years 1999-2002

Author : P McKenna, T Matthews
The Irish Medical Journal, July/August 2003 Volume 96 No 7.

Abstract

A comparison was made of deaths from intrapartum hypoxia of normally formed babies >2.5kg born at home (N =346) and those born in hospitals (N=61,215). If the intended place of birth is home the chance of dying due to intrapartum hypoxia is 1:70 (5 in 346). If the intended place of birth is hospital the chance of dying is 1:3600 (17 in 61,215). Although the sample size of home births is smaller, the difference is significant (<0.01 level of significance). In view of the small number of home births, the need for ongoing monitoring of home births over a longer period is essential.

9 Old Comments:

I do not have the tools handy to do a power analysis. But in all fairness this study doesn't LOOK so hot, as the # of home births they looked at is exceedingly small (346 births, as far as i can tell).

Nonetheless, if you draw any conclusions from the study, it would be negative.

By Blogger sailorman, at 12:11 PM  

I agree. The study is too small to draw any definitive conclusions. I posted is for two reasons. First is comes from yet another country. Second, it attempts to look at something a little different. It is not looking at all neonatal deaths, but rather neonatal deaths that the researchers believe could be ascribed to hypoxia, which might have been a sign that fetal distress was not recognized.

By Blogger Amy Tuteur, MD, at 12:49 PM  

It is nonetheless an interesting study. I do not have the background in pathology and postmortem analysis to know this; perhaps you do: How accurate is a postmortem diagnosis of hypoxia as cause of death?

By Blogger sailorman, at 2:25 PM  

In the thread at Neonatal Doc's, Amy, you said this about small studies, "No, according the rules of statistics, those studies are not valid." ;-) Of course, in that instance you were talking about Davies et al. (n=249; no perinatal deaths) and Ackermann-Liebrich et al. (489 homebirths planned initially; one antepartum fetal death).

Thanks for posting this link -- I'm happy to look at research with poor outcomes since there is so little of it (and, in fairness, since it gets little press in the sources I'm reading). It's interesting to me that there's no analysis of the midwives' standards of care. Were they not assessing FHTs? inadequately equipped? using inappropriate protocols for transfer? You have to wonder why their results are so different.

By Blogger Jamie, at 2:53 PM  

Sorry, I misquoted the Davies et al. study. There were 256 women enrolled and 5 miscarried. Does that mean n=256 or n=251? Either way, not n=249. (Since the numerator for the perinatal death calculation is zero, nothing changes. But I think it's important to be as accurate as possible in talking about the papers.)

By Blogger Jamie, at 3:02 PM  

Hi Amy,

you've had some medical students of mine crawling on this blog this week. Thanks for showing them the importance of sharp analysis and making my job as an educator easier.

You can see their quick group summary on home birth here:

http://talesfromthewomb.blogspot.com/2006/05/medical-student-blog-crawl-3.html

By Blogger Ex Utero, at 5:23 PM  

Hello all,
I am an Irish woman and just wanted to post a couple of links for anyone interested in the truth behind this farsical ridiculous study......... I have had two hospital births and one homebirth...... Homebirth is safe and is being actively promoted by the Department of Health in this country. There is a growing demand for homebirthservices here and all over the developed world. In the part of Ireland where i live a free homebirth service is available to women and is provided by the State Health Board in conjunction with a group of eight fantastic independent midwives. Across the water the English Government are also promoting homebirth and have recently began a campaign to encourage more women to give birth at home......
http://homepage.tinet.ie/~maternitymatters/maternity_truth_fiction.htm

By Anonymous Anonymous, at 11:11 AM  

Hello again,
The link doesn't work.The website is maternity matters.org- go to the articles section and the title is 'Truth or Fiction?:
A review of a new medical
"study" on home birth in Dublin'
© Marie O’Connor
There is lots of great info on this website for anyone interested in maternity care in ireland.

By Anonymous Anonymous, at 11:18 AM  

Thank you for the link to the critique, anon! Very interesting.

By Blogger Jamie, at 12:21 AM