On Wednesday I reviewed the homebirth deaths that appeared on this blog in the past year. Today, we’ll take a look at the state, national and international homebirth statistics I wrote about in 2011 as well as scientific papers that looked at the safety of homebirth.
From The 13th Report of the Perinatal and Infant Mortality Committee of Western Australia for Deaths in the Triennium 2005–07 full report (here). The results are truly appalling AND entirely consistent with the terrible homebirth death rate in the US. The major finding is that homebirth QUADRUPLED the risk of perinatal death compared to hospital birth. Indeed, homebirth dramatically increased the risk of death at every level, from stillbirth to infant death.
The state of South Australia, which includes the city of Adelaide, has published it’s perinatal mortality rates. The data shows that planned homebirth has a perinatal mortality rate more than 17X higher than comparable risk hospital birth.
The report, Pregnancy Outcome in South Australia 2009, is a dry recitation of birth statistics without editorial comment. The statistics are analyzed in every possible way to give a vivid picture of birth in the state. Among the ways the data is analyzed is according to place of birth and the results are surprising and distressing.
From Birth outcomes of planned home births in Missouri: a population-based study by Chang and Macones published in the American Journal of Perinatology in August 2011:
… We observed that planned home births attended by non-CNMs remained positively associated with odds of newborn seizures after controlling for confounders. Specifically, the adjusted OR of newborn seizure among births delivered by non-CNMs was more than 5 times as much as the odds in hospital/birthing center births delivered by physicians/CNMs … For intrapartum fetal death, planned home births attended by non-CNMs and physicians/CNM yielded adjusted ORs of 11.24 and 20.33 respectively relative to hospital/birthing center births attended by physicians/CNMs …
Planned Home Compared With Planned Hospital Births in The Netherlands by van der Kooy et al. is large, comprehensive and raises troubling questions about the safety of homebirth.
The large amount of data is analyzed in a bewildering number of ways, but the bottom line is that homebirth is safe when nothing goes wrong; in the presence of life threatening problems, homebirth increases the risk of death. Moreover, while homebirth with a Dutch midwife in the absence of complications is nearly as safe as hospital birth with a Dutch midwife, the perinatal mortality rate in both groups is 33% higher than comparable risk women delivered in hospitals by obstetricians just across the border in Flanders.
Drum roll please …
The death toll of planned homebirths attended by licensed Colorado hoomebirth midwives in the last reported year is so high that the midwives, in violation of Colorado law, refuse to relase them!
Let me repeat that. After 4 years of high, rising, and nothing short of appalling death rates, Colorado homebirth midwives are now refusing to report how many babies are dying at their hands. They published an annual report. as they always do, but they left out the homebirth deaths.
A new website, Oregon Homebirth Midwife Info, has compiled a Midwife Directory that makes for stomach-churning reading. The directory lists midwives by name and includes reports of deaths as well as other major morbidity and actions taken against the midwives.
It is an incomplete list; not all Oregon midwives are included and there may have been additional deaths that are not recorded. Nonetheless, the statistics are no less than horrifying.
In the past decade, no less than 19 babies have died at the hands of Oregon homebirth midwives.
To put that in perspective, consider that there are approximately 1000 homebirths per year in Oregon and that the neonatal death rate for low risk women in a hospital setting is 4/10,000 (0.4/1000). That means that you would expect approximately 4 homebirth deaths per decade. Instead there were at least 19 deaths, for a rate more than 4X higher (375%) than expected.
the homebirth group had lower rates of major interventions and the homebirth group had lower rates of minor interventions. How about deaths?
Well, funny you should mention that. There was a little bit of a problem there and the authors made a valiant attempt to hide it.
A total of six neonatal deaths (a death occurring up to 27 days after birth) occurred in the sample, two (0.11%) from women planning a home birth and four (0.15%) from women planning to give birth in the tertiary hospital. No intrapartum, intrauterine deaths were reported.
Hey, the death rates are exactly the same! Wait, what? The authors deliberately used the wrong denominator for calculating the hospital birth death rate?
Indeed they did. They compared the death rate at homebirth with the death rate in tertiary [high risk] facilities, but that’s not what we want to know. We want to know how the death rate at homebirth compares with the death rate at all hospital births, not the death rate at tertiary facilities.
What the authors should have told us was that there were two neonatal deaths (0.11%) among women planning a home birth and four (0.03%) from women planning to give birth in the hospital. In other words, the homebirth death rate was more than triple that of the hospital birth death rate. Oops!
The Birthplace Study is the most important homebirth study published this year, and it is one of the most important homebirth studies ever published. In involved a large multi-year study, was designed to address the safety of place of birth by controlling for the many factors that had not been handled properly in other studies. The study looked at intended place of birth to rule out improperly assigning transferred patients to the hospital group, and included only the lowest possible risk women. The study was conducted by The National Perinatal Epidemiology Unit in the United Kingdom.
What did it show?
Homebirth increases the risk of perinatal death and brain damage in the lowest risk women receiving care from highly trained midwives (often two) and liberal access to transfer.
Homebirth increases the risk of perinatal death and brain damage even when, at the start of labor, breech, twins, VBAC. positive GBS status, gestational diabetes and obesity were excluded. All routinely occur at homebirths in the US, the UK and Australia.
And how about the purported “risks” of interventions that homebirth advocates are always taking about?
Homebirth increases the risk of perinatal death and brain damage even though the incidence of epidural use was 5 times higher in the hospital group.
Homebirth increases the risk of perinatal death and brain damage even though the incidence of pitocin augmentation was 5 times higher in the hospital group.
Homebirth increases the risk of perinatal death and brain damage even though the incidence of operative vaginal delivery was 3-4 times higher in the hospital group.
Homebirth increases the risk of perinatal death and brain damage even though the C-section rate was 4 times higher in the hospital group.
In other words, any way you choose to look at it, no matter how carefully you slice and dice the data, there is simply no getting around the fact that homebirth increases the risk of perinatal death and brain damage.
American homebirth with a homebirth (non-CNM) midwife had a neonatal mortality rate 7.7 times higher than comparable risk hospital birth!
The table shows that the neonatal mortality rate for homebirths attended by an American homebirth midwives (CPM, LM) is 7.7 time higher than comparable risk hospital birth attended by a CNM (certified nurse midwife). This extraordinarily high death rate is all the more remarkable because it actually under-counts the homebirth death rate. That’s because homebirth transfers ended up in the hospital MD group and were not counted in the homebirth group. The real number of homebirth deaths is almost certainly significantly higher.
It’s a pretty damning collection of evidence. In every state, province and country where the issue of homebirth safety was examined, homebirth increased the risk of newborn death and serious injury.
There is, of course, one set of statistics that is missing. That would be the safety data compiled by MANA (Midwives Alliance of North America) on the 24,000 homebirths in its database. MANA explicitly refuses to release the death rates to the American public. The executives of MANA know that homebirth increases the risk of neonatal death; they just don’t want American women to find out.