Wednesday, June 04, 2008

DEMs on postdates: doubly wrong

DEMs like to tell mothers that the baby "knows" when to be born. In other words, whenever labor starts, it's the right time. Therefore, going beyond 42 weeks of pregnancy is not a problem. The 2003 and 2004 Linked Birth Infant Death Statistics data set shows that DEMs are doubly wrong. Postdates babies attended by a DEM at home have an appalling rate of neonatal death. In addition, since DEMs fail to refer their postdates patients for inductions, they have a higher proportion of postdates pregnancies among their patients.

These statistics show that DEM attended postdates homebirths have more than TRIPLE the neonatal death rate of MD attended postdates hospital births (all risk groups) and more than 500% higher neonatal death rate than comparable risk CNM attended postdates hospital births.

There are a number of conclusions to be drawn from this data:

The neonatal mortality rate for postdates in the hospital (CNM or MD) is virtually the same as the mortality rate for term pregnancies, suggesting that both CNMs and MDs are appropriately managing the increased risk of postdates.

In contrast, DEM attended postdates homebirths have more than double the neonatal mortality rate of DEM attended term homebirths, indicating that DEMs are not capable of managing the complications that are more likely to arise in postdates labors.

The neonatal mortality rate of 2.43 at DEM attended postdates homebirths is appallingly high, which is consistent with the fact that DEMs lack basic knowledge about the risks of postdates, and lack basic knowledge and training managing complications. Keep in mind that the mortality rate of 2.43/1000 is almost certainly lower than the true rate since patients who were transferred to the hospital for complications that occurred in labor are counted in the hospital group, not in the DEM homebirth group.

Postdates hospital births represent 6.9% and 8.8% of MD and CNM hospital births respectively. In contrast, postdates births represent 10.5% of DEM attended homebirths. DEMs are allowing a greater proportion of patients to go postdates without referring them for induction.

The fact that DEMs lack the most basic knowledge about the risks of postdates pregnancy leads them to be doubly wrong. First, they are not capable of properly managing postdates complications at home. Second, because they don't understand the risks of postdates, they allow more of their patients to go postdates, increasing the number of women who are likely to have complications at home.

We always come back to the same place with DEM attended homebirth: Ignorance and incompetence lead to an increased risk of neonatal death.


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