Jan 31 2014

Death Rate for Home Births

A new study publishes data from The Midwives Alliance of North America Statistics Project, 2004 to 2009. It is being presented as evidence for the safety of homebirths. The authors conclude:

“For this large cohort of women who planned midwife-led home births in the United States, outcomes are congruent with the best available data from population-based, observational studies that evaluated outcomes by intended place of birth and perinatal risk factors. Low-risk women in this cohort experienced high rates of physiologic birth and low rates of intervention without an increase in adverse outcomes.”

Unless, of course, you consider death an adverse outcome.

Their data show that the death rate for birth and up to six weeks following birth was 2.06 per 1000 overall (excluding fatal congenital anomalies), and 1.61 for low risk births. Amy Tuteur (the Skeptical OB) calculates from the CDC database that the same statistics for planned hospital births are 0.38 per 1000 for low risk births. That’s 4.2 x higher.

This is consistent with prior data. A 2010 systematic review concluded:

“Less medical intervention during planned home birth is associated with a tripling of the neonatal mortality rate.”

The press release from Citizens for Midwifery claims about this new study:

“New Home Birth Study from the MANA Statistics Dataset Shows That Planned Home Birth with Skilled Midwives is Safe for Low-Risk Pregnancies”

Generally speaking in medicine we don’t consider a more than 4x increase in death rate to be “safe.” Of course, to be fair, I am talking about relative risk. In absolute terms this is about a 0.13% increase in risk. When talking about mortality, however, a 0.1% increase in risk is considered significant. In the study population this amounted to about 20 extra perinatal deaths.

Dr. Tuteur also points out:

“MANA and homebirth midwives have been lobbying extensively for a scope of practice that includes breech, twins, VBAC, etc.”

These are the same high risk patients that had an even higher mortality rate according to MANA’s own data.

Conclusion

The birthing process is a very personal and emotional topic for many people. A discussion about the ethics, risks and benefits of home birth vs hospital birth is a complex topic. However, any such discussion should be informed by a honest treatment of the data.

The MANA data is legitimately concerning. Trying to whitewash such results paints MANA in a very bad light. If they wish to promote midwifery they need to be honest about and own those results, and explain why they believe homebirths are still a reasonable option.

Also, there are certain conditions for which the home birth mortality rate was significantly higher than the average. A reasonable (non-ideological) position, at the very least, would be to specifically recommend that such high risk births occur in a hospital, rather than lobbying for expanded home birth.

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