More homebirth deception
Last month's issue of the Journal of Midwifery and Women's Health included the article Outcomes of Planned Home Birth: An Integrative Review by Judith Fullerton, et al. According to the paper:Generally stated, in each instance in which the perinatal mortality rate is compared to a reference or comparison population, the PMR reported for the planned home births in this review is very similar, or even favorable, to the PMR of the reference or comparison population.That's NOT what the data show, however, and a careful examination of the papers reviewed make the deception plain.
The authors reviewed 28 papers. Of these, only 19 contained information about perinatal mortality rates. In 9 of the 19 papers, the authors of the paper showed that homebirth had a higher perinatal mortality rate than hospital birth. A further 5 papers showed that homebirth had a perinatal mortality rate comparable to figures for ALL risks groups, and actually substantially higher than perinatal mortality for low risk women delivering in the hospital.
Of the remaining 5 papers, 3 had homebirth groups ranging from 71-256 women. The fact that there were no perinatal deaths tells us nothing because the samples were too small. The remaining 2 papers appear to perinatal mortality rates in the same range as low risk women in the hospital; one is from a single practice group in London, the other from 461 women in Southern California. Both papers report on data from the late 1980's.
What does the review of the literature really show? Of 19 papers that report on perinatal mortality at homebirth, 14 show an excess rate of perinatal mortality compared to hospital birth for low risk women. In 4 of the 5 remaining papers, the sample size is too small to draw valid conclusions. In other words, as I say over and over again, the existing scientific evidence shows that homebirth has an increased risk of neonatal death compared to hospital birth. Homebirth advocates may refuse to admit it; they may even brazenly deny it; but there is no doubt about what the evidence shows.
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