Saturday, June 10, 2006

Why don't midwives do studies of homebirth?

There are actually very few studies of homebirth. In some ways that is not surprising since in many countries homebirth does not occur that often; in the US it represents less than 1% of births. Therefore it does not command a lot of attention from obstetricians or epidemiologists.

What is surprising to me is that homebirth midwives have not been doing studies of homebirth. After all, they are collecting the statistics. All they would have to do is analyze them or hire a statistician to analyze them. If they produced impressive statistics about neonatal mortality, it would more or less end the debate.

It would not cost a lot of money to collect the data or do the analysis. Why hasn't it happened?

16 Old Comments:

Most of the studies conducted by home birth midwives that I have seen are conducted as part of their Phd education.

You're right, not very many done by Non-CNMs.

By Anonymous Cherrie, at 11:02 PM  

I'm sure someone at MANA can answer your question: info@mana.org

By Anonymous clever ID, at 12:16 AM  

costs more money than we have--- and time which we don't. many midwives have jobs on top of doing midwifery and families- and usually don't work in partnerships so are personally on call 24/7 , so lets see what else- training people to help- which is never ending most of the time- with not alot back from your time investment- guess we could do it in our spare time--

By Anonymous Anonymous, at 12:37 AM  

"costs more money than we have--- and time which we don't."

It might not cost very much money at all. If everyone sent their data to a central source (like MANA), and if MANA hired a statistician for the project, it should not be very expensive. Certainly it would be less expensive for midwives who already have the data, than for anyone else who would need to get it from them.

Furthermore, don't DEMs have a responsibility to THEIR patients to do research on their methods? The only alternatives are to do no research and accept everything on faith, or to let physicians do the research they choose to do in the way they choose to do it.

Do midwifery organizations collect any statistics? Do they make any statistics public? Is it possible that there have been no published midwifery studies because the data is not favorable to homebirth?

I strongly favor making physician and hospital data public so patients can make informed choices about all forms of healthcare. There is a fair amount of physician and hospital opposition to this which takes the form of the absurd claim that patients won't be able to understand the data. I interpret this opposition as an effort to conceal the truth.

DEMs do not have to wait for physicians to fight it out among themselves, and eventually accept the fact that patients DESERVE this information. DEMs don't need permission from doctors. They could collect and release their information. Don't their patients also deserve to know?

By Blogger Amy Tuteur, MD, at 8:50 AM  

But, wait! You are talking about retrospective study, which you (erroneously) slammed the BMJ, CPM 2000 study as (it was actually prospective).

That's basically what NARM did. It required before and after stats from all CPMs in the year 2000. It's probably more expensive than you think. Remember the demographics of home birth is (in a nutshell):

~more likely to be white,

~more likely to be higher educated,

~more likely to be poorer than the white, higher educated mainstream.

The one study that has been done specifically on a category of U.S. DEMs (and a few in Canada) -- the above referenced CPM200 BMJ study -- had excellent numbers. I disagree with your previous twisting of those numbers, btw.

By Anonymous Anonymous, at 10:02 AM  

Wouldn't you then criticize those studies as biased due to the funding behind them?

By Anonymous Anonymous, at 10:23 AM  

I agree we should all continue to do research. And that it has been done, the BMJ study for DEMs and the Murphy-Fullerton for CNMs. Also look at the huge birth center study (rooks et al) sometime, which was an enormous project. I definitely agree about disclosure (and remember I posted our practices stats on this website).

By Anonymous maribeth, CNM, at 10:41 AM  

I am aware of the studies that have been done to date. My point is that DEMs have not done any of the studies. Why not? Don't they have a responsibility to their own patients to constantly study and re-evaluate their methods?

By Blogger Amy Tuteur, MD, at 11:00 AM  

Geez. I posted a link to MANA and no one looked, not even the midwives?

MANA has a link (and this time I will be more specific): MANA Statistics Project, which is a voluntary PROSPECTIVE stat collecting project. The midwife (CNM, CM, CPM, undocumented, licensed, etc.) signs up for the project, obtains informed consent of her client and the client is entered into the record either electronically or on paper. Data will be entered as the pregnancy progresses in hopes of biases being reduced (ie not reporting a transfer or death) and MANA will hound the midwife and/or her client to obtain the data if it is not entered in a timely manner.

I'm a new CPM and signed up for it... every midwife here should be signed up for it. No excuses. If you have time for this nonsense on the blog you have time for that.

By Anonymous clever ID, at 12:02 PM  

good idea amy---I do know of midwives doing some studies but...

here are some questions who keeps the records? who has access to the records? and will clients comply with this kind of release of information?

what are the legalities of studies and the hoops you need to jump through in order to have a study approved?

By Anonymous Anonymous, at 12:30 PM  

Thanks Clever ID. Unfortunately, I did not know about this. We do nearly 200 births a year - Mana should get this out more. I was a member until this year.

By Anonymous maribeth, CNM, at 12:43 PM  

You can also refer to the ACNM research dept, where a lot of data is being collected, though not re: homebirth at the present time http://midwife.org/
publications.cfm

By Anonymous maribeth, CNM, at 2:52 PM  

"MANA has a link (and this time I will be more specific): MANA Statistics Project, which is a voluntary PROSPECTIVE stat collecting project. The midwife (CNM, CM, CPM, undocumented, licensed, etc.) signs up for the project, obtains informed consent of her client and the client is entered into the record either electronically or on paper. Data will be entered as the pregnancy progresses in hopes of biases being reduced (ie not reporting a transfer or death) and MANA will hound the midwife and/or her client to obtain the data if it is not entered in a timely manner."

My CPM collected this information from me during my pregnancy and birth last year. This is an excellent project.

By Blogger Mama Liberty, at 3:46 PM  

Thanks Clever ID. Unfortunately, I did not know about this. We do nearly 200 births a year - Mana should get this out more. I was a member until this year.

Maribeth, as far as I can tell from my application, membership to MANA is not a requirement. Get those 200 births a year counted!

By Anonymous Anonymous, at 5:29 PM  

maribeth: 200 births a year? home births? how many midwives are there? that sounds like a LOOOT!

By Anonymous Anonymous, at 1:08 PM  

so that is more than a birth every-other-day. I am tired just thinking about it. how many in your group?

By Anonymous Anonymous, at 1:22 AM