Homebirth Debate

Controlling comments

I have written in the past that professional homebirth advocates never appear anywhere that they can be questioned by other professionals. They don't present their data at scientific conferences, they rarely submit it to scientific journals and they don't appear anywhere they can be questioned by other medical professionals. That is deliberate. They know that the only lay people can be scammed, and that their scams would be revealed immediately if they were force to answer medical questions.

They do the same thing on the web. It is called "moderating comments". I don't mean moderating comments to remove spam. That can be done automatically with a captcha program. I mean personally reviewing all comments and publishing only those that are complementary or do not ask difficult questions. A new homebirth blogger has appeared and she is doing the same thing.

Dr. Tienchin Ho is a bariatric (weight loss) surgeon who has retired to care for her children. She had one C-section, followed by a homebirth (with an OB friend available as back up). She posts on MDC and the "Normal" Birth Forum. I have questioned her claims there, but she did not respond. Now she has a blog, and this is what she wrote recently:

Critics of home birth claim:

Babies born to parents who plan home births have triple the neonatal mortality of babies born to parents who plan hospital births.

There is no scientific data to support this.

That's funny. I provided Dr. Ho with copious scientific data to support this claim, including a long explanation of the fact that the Johnson and Daviss study ACTUALLY shows homebirth to have a neonatal death rate almost TRIPLE that of hospital birth in the same year, and a link to the CDC 2003-2004 data that shows that homebirth with a DEM has triple the neonatal mortality rate of low risk birth.

Home birth critics cite various sources of mortality (death) rates for babies that are not even about planned home or planned hospital births. Having a baby at home with an experienced attendant and appropriate equipment is not the same as having a baby in the car on the way to the hospital. Information taken from birth certificates suffers from this problem since birth certificates only report where each birth actually happened, not where it was planned. Sources with the birth certificate error include the Pang study and the CDC Wonder 2003 – 2004 dataset.

That's right, Dr. Ho. That means that while NO homebirths with a DEM present were planned hospital births, many hospital births were originally planned homebirths. Therefore, the CDC statistics for 2003-2004 which show homebirth with a DEM to have triple the neonatal mortality rate of low risk hospital birth actually UNDERCOUNT homebirth complications. The real risk of neonatal death at homebirth is even HIGHER than what the CDC data shows.

How a death is classified depends on when it happened. Looking at how many deaths happen during labor is not the same as how many happen during the first seven days of life... This simple error occurs when comparing the combined intrapartum and neonatal mortality rate in the Johnson-Daviss study to rates of neonatal mortality alone.

There are two problems with that claim, Dr. Ho. The first is that Johnson and Daviss made up their own definition of "intrapartum death". We know that because they included at least one liveborn baby (with an Apgar score) in their group of "intrapartum" deaths. Second, even if it were true that the "intrapartum" deaths in the J&D study really occurred during labor, you can't just forget about them. You must compare them to the intrapartum death rate in the hospital. If there were 5 intrapartum deaths in the J&D study, that's an intrapartum death rate of 1/1000. That's 3-4 times higher than intrapartum death rates of ALL risk categories in the hospital. You can't simply discard the babies who died intrapartum and pretend that they never existed. ANY way that you slice and dice the data, it still shows that homebirth with a CPM in 2000 has a much higher rate of neonatal mortality than hospital birth.

Let's see if Dr. Ho will reply. I've posted a shortened version of this in the comments section of her website, so she knows that it exists.

posted by Amy Tuteur, MD @ 8:29 AM