Wednesday, March 28, 2007

Some midwifery organizations DO publish their statistics

In contrast to MANA (Midwives Alliance of North America), there are midwifery organizations that do make their statistics available to the public. The Independent Midwives Association in the UK is a group of self-employed midwives caring for women who desire homebirth. They include their clinical statistics on their website.

Let's look at their most recently published neonatal mortality statistics:

In 2003-2004, they cared for 337 women who gave birth to a total of 347 babies. Both the stillbirth rate and the neonatal death rate were quite high.

There were 4 stillbirths, 2 were intrauterine fetal demises of unknown cause, one was the result of rupture of a C-section scar and the fourth was due to hypoxia. The overall stillbirth rate was 11.5/1000.

There were 4 neonatal deaths among 343 livebirths. Of the 4 deaths, 2 were due to respiratory distress, 1 to hypoxia and 1 to genetic anomalies. The overall neonatal death rate was 11.7/1000.

The stillbirth neonatal death rates were very high. What is most interesting is that half the stillbirths and 3/4 of the neonatal deaths were due to potentially preventable causes.

This data is valuable, but the dataset is so small that it is difficult to draw conclusions. However, it is yet another homebirth dataset that shows that homebirth has an excess of preventable neonatal death.

In contrast, the MANA dataset is large and it would contribute greatly to our understanding of the safety (or lack thereof) of homebirth. The subset of the dataset that has been published (Utah in 2006) showed a neonatal death rate of 10.6/1000 (1 death in 94 births) and that death was due to hypoxic encephalopathy (brain damage from lack of oxygen). It is possible that those results were replicated at the national level; that might be the reason that MANA is withholding the data.

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