Thursday, December 27, 2007

Neonatal mortality of term babies

Homebirth advocates compare neonatal mortality rates at homebirth with hospital neonatal mortality rates in an effort to show that homebirth is safe. It is instructive, therefore, to look at the neonatal mortality rates of term infants in the hospital setting. Mortality of full-term infants during the first month of life in a tertiary care hospital published in the journal Perinatology addresses this issue.
The neonatal mortality rate is disproportionately influenced by preterm infants and does not reflect the rate in full-term infants. Our objectives were to estimate the full-term neonatal mortality rate and to identify causes of death in full-term infants during the first month of life...

During the study period there were 44 703 full-term births and 31 deaths, representing a mortality rate of 0.69 per 1000 live births. The main cause of death was congenital anomalies (64.5%), specifically cardiac anomalies. Other causes were chromosomal anomalies or syndromes (12.9%), labor complications (12.9%), infections (3.2%), congenital diseases (3.2%) and metabolic disorders (3.2%).
Only 12.9% of neonatal deaths of term infants were due to labor complications. That means that the expected neonatal death rate for otherwise healthy term infants is in the range of 0.09/1000. In other words, the death of a term baby should be an exceedingly rare occurance. That is not what we find in the studies of homebirth.

One of the central premises of the homebirth movement is that while there may be preventable deaths at homebirth, these are balanced out or exceeded by hospital deaths due to "interventions". Studies like this show that the idea of neonatal deaths due to "interventions" is a fabrication of homebirth advocates and has no basis in reality. When a woman chooses to give birth at home, her baby faces an increased risk of preventable neonatal death and this is not counterbalanced by a risk of preventable neonatal death in the hospital.

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