Saturday, April 21, 2007

Does urgent transfer really prevent neonatal death?

I have written about this in the past, but it certainly bears repeating. The idea that proximity to the hospital is "just as safe" as being in the hospital is absurd. The existing scientific research (most of it from pro-homebirth papers) demonstrates that the neonatal mortality rates for homebirth emergencies are astronomical:

Johnson & Daviss: 8 deaths in 63 emergency transfers for a death rate of 127/1000. Let's look at the death rates for specific complications:

Thick meconium 13
Sustained fetal distress 31 - 2 deaths
Baby's condition 5 - 4 deaths
Placenta abruptio or placenta previa 5
Cord prolapse 3 - 1 death
Breech 1 - 1 death

So the death rate at home for babies needing expert resuscitation was 80%! The death rate for cord prolapse was 33% and the death rate for unanticipated breech was 100%.

As I have said many times in the past, if nothing goes wrong, it doesn't matter where you give birth. However, if there is an unanticipated emergency, the chance of the baby dying is very high. Certain emergencies are more likely to result in the baby's death. The most dangerous situation appears to be the unanticipated need for expert neonatal resuscitation. Without the equipment and personnel for an expert resuscitation, 80% of babies will die.


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