Monday, November 26, 2007

Extremely high intrapartum mortality on MDC

One of the key points about homebirth is that the intrapartum mortality rate is extremely high. That's one of the reasons why the hospital is safer. If you start labor with a live baby, the chance of giving birth to a live baby is higher in the hospital than at home.

In the hospital, the intrapartum mortality rate is approximately 0.3 per thousand, and that includes all gestational ages and all pregnancy complications. Virtually every homebirth study, including those done by homebirth advocates, has high intrapartum mortality.

Over at MDC, there appear to have been at least 2 intrapartum deaths and 2 deliveries of brain dead infants in the past 2 years among midwife assisted homebirths (possibly 3, if you count the most recent case). It is difficult to be sure of the denominator, but there appear to have been less than 300 midwife attended homebirths per year. That would put the intrapartum mortality rate at approximately 3 per thousand, ten times higher than the rate for all hospital births of any gestational age and all possible complications.

There appear to have been at least 5 additional neonatal deaths at midwife assisted homebirth in the last 2 years (plus 2 deaths from undiagnosed congenital anomalies). At approximately 300 homebirths per year, that yields a perinatal death rate at home of more than 7.5 per 1000. The hospital neonatal death rate is approximately 0.9 per thousand, and 0.4 per 1000 when congenital anomalies are excluded. That means that the neonatal death rate on MDC over the last 2 years is as least 19 times higher than the hospital neonatal death rate.

addendum: Unfortunately I need to amend the numbers. As I keep reviewing, I find more deaths. There are 3 additional neonatal deaths and 1 additional intrapartum death. That brings the total in the last 2 years to 3 intrapartum deaths for an intrapartum death rate of approximately 4.5 per 1000, and 8 neonatal deaths at midwife attended homebirths for a rate of 12 per 1000. It's simply unbelievable how many babies have died at MDC homebirths in the last 2 years.


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