Thursday, January 24, 2008

Wisconsin statistics confirm high homebirth death rate

I have written repeatedly about the fact that, contrary to the claims of homebirth advocates, all the existing scientific evidence shows that homebirth has a higher rate of preventable neonatal death than hospital birth for low risk women. I have also written repeatedly about the efforts of MANA (the Midwives Alliance of North America) to withhold the safety statistics it has gathered since 2001 suggesting that their statistics also show that homebirth has a higher rate of neonatal death. Now comes hard data from Wisconsin demonstrating the homebirth with a direct entry midwife has a substantially higher rate of neonatal death than hospital birth for low risk women.

The table is derived from Wisconsin Department of Health and Family Services data on linked birth infant deaths. The table compares neonatal mortality by attendant at delivery. Neonatal mortality for homebirth attended by a DEM is consistently TRIPLE the rate of neonatal mortality for CNM attended births. Neonatal mortality at homebirth with a DEM exceeds neonatal mortality at CNM births by 2.5 deaths/1000.

These data provide hard evidence to confirm what the scientific literature has shown: homebirth increases the rate of neonatal death. There are several specific advantages to this type of data. Linked birth infant death data are the most reliable data on neonatal mortality because every death is traced back to the original birth, ensuring accuracy. The data include all types of direct entry midwives, not just CPMs. The data come from a large cohort of births. During the years 2000-2006 in Wisconsin, there were 4,471 births attended by a DEM. These data are more recent than any in the scientific literature.

In this comparison, CNM births are used as a proxy for low risk hospital births. From 2000-2006, there were 28,778 CNM attended births, of which 98.75% took place in the hospital. If the home births are excluded, the neonatal mortality rate for CNM attended deliveries falls to 1.17/1000.

This is hard data confirming the increased risk of neonatal death at homebirth attended by a DEM. The real increase in risk is almost certainly greater than that depicted in the table. That's because the true CNM neonatal mortality rate for low risk women is probably lower than the data shows, and the true DEM neonatal mortality rate is almost certainly higher. The CNM neonatal mortality rate is probably lower than the rate depicted because it includes women who are not low risk, since CNMs care for all women anticipating a vaginal delivery. The DEM neonatal mortality rate is almost certainly higher because it does not include emergency transfers of the mother during labor. The attendant recorded on the birth certificate is the attendant who actually delivered the baby, not the attendant who supervised the labor, so all DEM intrapartum transfers are recorded in the MD group, not the DEM group.

So here it is: hard evidence that DEM attended homebirth has a rate of neonatal death triple that of hospital birth for low risk women.


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