Friday, November 07, 2008

Epidural mortality only 1 per 4 million

Homebirth advocates routinely overestimate the "risks" of hospital interventions and grossly underestimate the risks of homebirth. They are constantly prattling about the "risks" of an epidural for pain relief in labor, without any understanding of how very rare epidural complications are.

Hawkins et al. have presented their latest data on anesthesia related mortality in the US.
The authors reviewed maternal death certificates matched with live birth or fetal death certificates of all pregnancy-related deaths occurring during 1997-2002 associated with anesthetic complications. These were reported by states in ongoing Pregnancy Mortality Surveillance at the Centers for Disease Control and Prevention. Cases were independently reviewed by three obstetric anesthesiologists to confirm that the death resulted from anesthetic complications. The type of anesthesia involved, mode of delivery and cause of death were determined.

The pregnancy-related mortality ratio (PRMR), defined as pregnancy-related deaths due to anesthesia per million live births was calculated...

RESULTS: There were 49 anesthesia-related deaths; 31 associated with live births or stillbirths, 16 during abortion, 1 associated with ectopic pregnancy and 1 unknown outcome during 1997-2002. Among deaths following live births or stillbirths, 6 were related to general anesthesia, 16 to regional, 1 to combined regional/general, 1 to local anesthesia and 7 to unknown type of anesthesia. The regional anesthesia-related deaths occurred during spinal (7), epidural (8), and paracervical block (1). Eighty percent of these anesthesia-related deaths were associated with cesarean delivery.

... During 1997-2002, the PRMR due to anesthetic complication was 1.3 per million live births ...
Since 80% of anesthesia related maternal deaths were associated with cesarean, only 20% were associated with epidurals for pain relief in labor. That means that the pregnancy-related mortality ratio for labor epidurals was 0.26/ million or approximately 1 death per 4 million labor epidurals.

Compare that to the excess rate of neonatal death at homebirth of 1-2/1000. The risk of a neonatal death at homebirth is approximately 4000-8000 times higher than the risk of maternal death from a labor epidural. If homebirth advocates are concerned about the "risks" of epidurals, they should be appalled by the risk of neonatal death at homebirth.

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