Friday, December 28, 2007

The year in homebirth

Across the web, people are summing up the news of the last year. In that spirit, I'd like to review the information about homebirth safety that I have written about in the last year.

The list of homebirth deaths is a terrible indictment of homebirth.

There has been no research published in support of homebirth safety, but there have been government reports showing that homebirth has an increased risk of neonatal death.

Homebirth Debate has been instrumental in bringing three homebirth safety issues to public attention:

The Johnson and Daviss BMJ 2005 study does NOT show that homebirth is as safe as hospital birth;

the Midwives Alliance of North America (MANA) refuses to release their statistics on homebirth safety from 2001-2006;

infant mortality, widely quoted by homebirth advocacy websites and publications as an indicator of obstetric care, is the wrong statistic. Perinatal mortality is the correct statistic. According to the World Health Organization 2006 report of perinatal mortality, the US has one of the lowest rates in the world, lower than Denmark, the UK and the Netherlands.

Homebirth deaths

Death (MA)- Baby born not breathing. Midwives call for ambulance. Baby dead on arrival at hospital.

Death (MA)- Mother transferred for fetal distress in 2nd stage. Bradycardia noted on arrival at hospital. Emergency C-section performed. Baby born dead.

Death (Quebec)- Baby born not breathing. Midwives attempted to intubate. Endotracheal tube accidently placed in esophagus. Baby dies.

Death (Budapest)- Homebirth attended by the doctor who leads Hungary's homebirth movement. Shoulder dystocia. Transfer to hospital with baby's head hanging out of vagina. Baby dead on arrival at the hospital.

Death (Oregon)- Attempted delivery of breech baby. Trapped head. Mother transferred to hospital with baby's body hanging from the vagina. Baby dead on arrival. Additional 20 minutes of manipulation required for dead baby to be extracted.

Death (New Zealand)- Baby born not breathing. Transferred to the hospital, intubated resuscitated. Neurological studies indicated brain death. Baby disconnected from respirator and died.

Death (Washington)- Attempted VBAC at home. Baby transferred for fetal distress. Ruptured uterus. Baby died.

Death - Planning VBAC. Refused C-section at 42 weeks. Baby died in utero.

Death (Wyoming)- Homebirth. Undiagnosed and untreated infection. Baby dies at 18 hours.

Death (UK)- Attempted breech birth at home. Nuchal arms. Baby died.

Death (Australia)- Attempted twin delivery at home. Delay in delivery of second twin. Transfer to the hospital, emergency C-section. Baby suffered seizures, heart damage and died.

Deaths posted on MDC

breech, nuchal arms (arms trapped behind head), brain dead, ventilator disconnected

shoulder dystocia, profound brain damage

unanticipated anoxic brain damage sustained during labor

normal labor, baby dead at birth

decelerations during attempted home VBAC, transfer to hospital, uterine rupture, baby dead, massive hemorrhage, hysterectomy

postdates, severe meconium aspiration

normal labor, baby dead at birth

post dates, baby dead at birth

unanticipated severe birth asphyxia

prolonged ruptured membranes, overwhelming infection

Homebirth research

No papers demonstrating homebirth safety

Government reports

National Insititute for Health and Clinical Excellence (NICE) review of the homebirth literature concludes that homebirth has an increased risk of neonatal death.

Report of Perinatal and Infant Mortality Committee Western Australia shows that homebirth had triple the rate of neonatal death compared to hospital birth.

Homebirth statistics

Johnson and Daviss acknowledge my criticism of the their study. The correct comparison group for homebirths in 2000 is low risk hospital births in 2000. Homebirth had a neonatal mortality rate of 2.5/1000 (including anomalies) and low risk hospital births had a neonatal mortality rate of 0.9/1000. The 2005 BMJ study actually showed that homebirth has a neonatal mortality rate almost triple that of hospital birth.

MANA (Midwives Alliance of North America) has maintained a database of CPM attended homebirths since 2000. The 2000 data was published in the BMJ study. The data from 2001-2006 is available to researchers who can show that they will use it for the "advancement of midwifery". Researchers must sign a legal non-disclosure agreement promising not to reveal any of the data. The elaborate precautions to prevent public release of the data suggests that the MANA database shows an increased risk of neonatal death at homebirth. See MANA is unethical in withholding its statistics.

Homebirth advocates repeatedly and deliberately use the wrong statistics to indict American obstetric care. Infant mortality is not an indicator of obstetric care since it includes deaths up until 1 year of age. The correct statistic is perinatal mortality. According to the World Health Organization 2006 Report on Perinatal Mortality, the US has one of the lowest perinatal mortality rates in the world, lower than Denmark, the UK and the Netherlands.

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