New CDC statistics, same old increased homebirth death rate

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In 2003 the US standard birth certificate form was revised to include place of birth and attendant at birth. That makes it possible to compare neonatal death rates at home vs. in the hospital. The latest set of statistics (2008) have been released by the CDC and can be found on the CDC Wonder website. The statistics from the latest year show what the statistics have shown every year: homebirth with a non-nurse midwife increases the risk of neonatal death.

The beauty of the CDC Wonder database is that you can set the parameters to find specific information and control for various risk factors. Therefore, it is possible to look specifically at white women (almost all homebirths are to white women) ages 20-44, singleton pregnancies, at term (37+ weeks), not suffering from intrauterine growth restriction (2500+ gm). Moreover, because the data are based on who signed the birth certificate, we know that all out of hospital births with a non-nurse midwife were PLANNED births.

This year’s data is shown below:

homebirth mortality CDC 2008

The table shows that the neonatal mortality rate for PLANNED homebirth attended by a non-nurse midwifes (CPM, LM) is 3.5 time higher than comparable risk hospital birth attended by a CNM (certified nurse midwife). In fact, the rate of homebirth death is more than double that of MDs and their statistics include all high risk births.

Keep in mind that these statistics dramatically undercount the real rate of homebirth death. Why?

1. All homebirth transfers are included in the MD numbers. That means that any deaths that occurred after the mother was transferred to the hospital are in the MD group and not in the homebirth group where they belong. This is important because we know that many homebirth deaths occur because even being “10 minutes from the hospital” is not close enough to save a baby in a life threatening emergency.

2. Intrapartum deaths are not included in these statistics at all, because those babies don’t get birth certificates. All those homebirths where dead babies drop into the hands of unsuspecting homebirth midwives (“the heart rate was just fine a minute ago”) are not noted here.

So the real rate of homebirth death could be double or more the death rate of these CDC statistics.

The dramatic increase in homebirth death rates has been remarkably consistent over the years.

CDC statistics homebirth 2003-2008

The consistency over a 6 year period demonstrates beyond doubt that homebirth increases the risk of neonatal death.

No wonder the Midwives Alliance of North American (MANA) continues to hide their death rates. How many of the 27,000 babies in their database of outcomes from 2001-2008 died at the hands of homebirth midwives? They won’t say, but the rate is probably comparable to, or likely even higher than the CDC data.

Homebirth with an American homebirth midwife kills babies. There is simply no question about it. Even the Midwives Alliance of North America knows that this is true. It’s time that American homebirth advocates stopped lying about the safety of homebirth and start doing something to reduce the number of preventable neonatal deaths.

  • concerned

    I will start out by letting you know I had 4 successful Doctor assisted homebirths. Homebirth can be a safe option for low risk mothers, it seems that you have a problem with DEM’s more than homebirth, please correct me if I’m wrong. If that is the case why not advocate for better training and education for DEM’s rather than calling the practice of homebirth unsafe? Why not work together to find a solution? The OB/GYN and CNM’s in America are overburdened by patient loads, (According to Amnesty International there are 9.6 OB/GYN’s and 0.4 CNM’s available per every 1,000 births) having better trained CPM’s seems like a nice solution for that problem, in fact why not have them work collaboratively with OB/GYN’s, maybe we can all work together to find a common ground where evidenced based practice take place in the hospital to support physiologic birth, since the lack of such practice is what turns many women away looking for alternative choices.

    • PrimaryCareDoc

      What’s stopping people who are DEMs or CPMs from becoming CNMs? Nothing. Nothing at all…other than the fact that they don’t want to do all that schooling. It’s not a matter of advocating for better training for DEMs. The training is available. They choose not to make use of it.

      • Gwyneth Margaret Arnold-Starr

        Or they don’t have the funds.

    • The Bofa on the Sofa

      If that is the case why not advocate for better training and education for DEM’s rather than calling the practice of homebirth unsafe?

      Welcome. Stick around.

      BTW, “better trained CPMs” is basically an oxymoron. If they were actually better trained (or sufficiently trained), they wouldn’t be CPMs.

      It is the CPMs who refuse to up their standards to acceptable levels.

  • Observer

    You have to ask the CDC how are they getting these numbers…
    Many times its just by survey and the people they survey are people who they will say are “highly” insured. Don’t believe everything CDC says.

    • The Bofa on the Sofa

      Have YOU asked them how they get those “numbers”? Or do you just dismiss them out of hand?

  • jennshansha

    This is BS. It says non-nurse midwives. All of my births at home were with a CNM.

  • Sarah

    I’m an epidemiologist, and this is bullshit. It’s entirely dishonest to maintain that rates are actually higher if you account for risk when NO SUCH ANALYSIS HAS BEEN DONE. CDC data shows that neonatal mortality is about half as high with CNM and “other” midwives (there’s no direct entry of homebirth category) as it is for MDs for all births, as well as by weeks gestation. It’s also dishonest to select a particular subpopulation that supports your argument when the big picture does not. Especially if you falsify the data. I just ran this on CDC wonder, and the neonatal rate for white mom, singletons, @ 37 -39 wks, is 2.38 for MDs and 1.8 for CNMs – no data for “other:” midwives because there aren’t enough births in that category, even without parsing it further with maternal age and infant weight. And where did that data in the graph come from? It’s astonishing how blatantly false this is. As a skeptic, and a health professional, I’m embarrased. As a person who works with mothers to ensure healthy births, I’m really very angry. You should be ashamed of yourself.

    • WAIT A MINUTE, are you an epidemiologist or a person who works with mothers to ensure healthy births?

      I’m getting reaaaaal sick of NCBers making up titles to try and make themselves seem authoritative. Be honest.

    • Amy Tuteur, MD

      You’re a doula, not a health professional and you make money by attending homebirths. You have a financial interest in believing in the safety of homebirth, even though the data indicates the opposite.

      • Margaret

        Doulas assist women in hospitals as well. So your point is not valid.

      • kimbriel

        aren’t you an OB? So you have a financial interest in this argument as well?

  • Captain Obvious

    Well, Br Biter recently had a Homebirth death.

  • Shockedatignorance

    I see a whole lot of meek sheep following the rest above and only a few that actually learnt to think for themselves.. The ‘research’ done to try and prove to people that home birth would be more dangerous than hospital birth is usually in favor of hospitals…Why? Because hospitals are businesses, they make money. The home birth advocates however, have nothing to gain by telling people that home births are safe…Nothing. They don’t get paid because of it. Same for the vaccines. Do you really think the pharmaceutical industry makes these vaccines to help people? THINK! They’re a business, they want to make money and if people would get better by taking medicine, they’d be out of business…I’ve had three kids, two with registered midwives that interfered a lot. I was in a lot of pain. They lied to me about numerous things. The last one I had at home, by myself with partner. Result: NO PAIN and a quiet birth and healthy baby.
    ‘Are you saying that women’s hearts know how to pump blood and their lungs can exchange oxygen, but their uterus doesn’t have a clue what to do when it is time to expel a baby?’ The birthing (medical/hospital) world is mainly male…Obstetricians are mostly male. Now, I do not have to do any research, but just use common sense, to know that a man doesn’t know ANYTHING about what it means to have a baby, what contractions feel like…They are completely unsuitable to deliver babies…
    Oh, and none of my kids are vaccinated, they never had antibiotics and never any other meds. They are healthy and happy. 🙂

    • Karen in SC

      Homebirth midwives do, in fact, get paid for the births. Contracts are usually written so they are paid even if they miss the birth. In some areas, that is upwards of $5000. Multiply that by 3-4 births a months and that’s a great income. Maybe not even reported to the IRS.

      • Trixie

        I wonder if you’re practicing as midwife underground in a state where you’re not licensed, if you sort of by default don’t report your income, since what you’re doing isn’t a legal profession? I wonder what the rate of tax evasion is with underground midwives. I bet it’s high.

        • Elizabeth A

          I’d highly recommend avoiding the tax evasion. That’s how they got Al Capone.

        • Karen in SC

          Yes, I bet it is high, too. And if you ever suspect anyone of doing this, there is an anonymous way to report any tax evading individual at irs.gov. Note – even illegal income is taxable. I would not hesitate to report if I knew of anyone. Maybe after I retire, I will look up midwife websites and fill out some forms.

      • Shockedatignorance

        Oh, of course midwives are getting paid for their services, and it’s is up to the woman to get a registered one or not (is that how it works in the US?). I know that here in Europe, in most countries, it is not possible to even get an unregistered midwife. The thing with the midwives is, however, that she is more likely to be taken to court if anything happens. If a baby or mother dies in hospital, they usually say that there was nothing they could do…to cover their ass. This just happened here in Ireland, twice in the past few months…where they wouldn’t admit that they made mistakes, but after months and months they would discover that it was them, and not just bad luck. But hospitals make money of the births too right? I lived in the states for three years and was 3 months pregnant when I visited the hospital and I was shocked when the nurse during intake asked me if I wanted an epidural for the birth and she added that it was 800 dollars…Now, I know the epidural itself costs maybe a few dollars, so the rest of that money goes to the doctor and hospital. Just imagine what the rest costs…(maybe you should watch ‘The business of being born’.) Birth is a perfectly natural happening and when a woman is healthy and with a healthy pregnancy, there is no reason why she could not have the baby at home. The power (that every woman has) is taken from her by technical/medicinal ways of acting. The medical world is trying to control nature and they really can’t. They keep themselves to time tables and protocols, but that is not how it works. If the woman does not birth within a set time-frame (they need the bed for the next money maker) it is sped up by medicine, mostly ending in C-sections. The US is very high up when it comes to C-sections, especially compared to countries like the Netherlands. So why would women in the US need c-sections more often than here? Also, unnecessary interventions are usually done in the hospitals, for their own comfort, not because they need to do it. There is hardly any obstetrician who would choose not to give a cut for instance if the only reason not to do it is that it will severely hurt and mutilate the woman. I interviewed a registered midwife in Belgium once, who had been working at a hospital for 15 years and is now working independently for the past 20 years who told me that in her career she had never placed a cut. Her response was: ‘Why should I?’ Also, birthing on your back is the most unnatural way of birthing.. Invented by men, for their comfort, and nothing else. Just think about it: when you’re pregnant, you can’t drink, smoke, eat certain things and more things you can’t do, but when it’s time to give birth it is suddenly ok to give the woman a bunch of drugs? Drugs she needs mostly due to unnecessary interventions like induction…Because of the epidural, the woman hardly feels the contractions, contractions slow down, more drugs…which leads to more pain killers and many times to a c-section. Just read the studies if you know it all. I bet you never have been brought to the butcher yourself in the hospital or you wouldn’t be talking the way you do. And I’m not sure if you meant me when you said I was an underground midwife? Well I am not. I just had my youngest son UC, painless, no painkillers, nice and calmly in a pool. No cuts and no stitches needed…My daughter before that, I had with a registered midwife who was supposed to be skilled and I needed 9 stitches and was being lied to by her and the doctor many many times (and have it in writing too). The difference between you and me is, is that I trust myself as a mother to give life in the most gentle way possible. I know the power a woman has and I know that I can trust my own feelings to know if anything is wrong or everything is just fine. I live in rural Ireland and pregnant. And guess what? I am going to do it again, because I know that a 1 hour drive to the hospital is going to do more damage than good.

        • Young CC Prof

          Oh, OK. You don’t have much experience with the US system. We have two different midwife credentials. One is the CNM, and it’s a good training program, the other is the CPM, and it’s completely inadequate for anything. Many mothers don’t understand the difference, as the CPMs’ organization has deliberately created confusion on the matter.

          As for going to court, these minimally-trained midwives don’t have malpractice insurance, which makes it almost impossible to sue them for damages. (You can’t take money someone doesn’t have.) On the other hand, in the USA it’s fairly easy to sue a hospital. Even if it wasn’t the hospital’s fault, juries are very sympathetic to a baby with a birth injury.

          • Shockedatignorance

            Thank you Young CC Prof, finally someone who can talk like a normal person without attacking someone who has done their own research as well as own experiences. The way you put it, I would not get the CPM midwife myself if I’d be in the US and I would go with the midwife. All midwives here (I am from the Netherlands but live in Ireland) have had 4 years of training and I believe they have attended a certain number of births before they can practice on their own. And even then, these midwives usually have a second midwife with them or close. I don’t condemn people who choose a hospital birth, or midwife lead birth, however, I do believe that when a woman wants this and feels it is right that they should be more hands-off and not act on protocols all the time. Every woman is different and every birth is different, but what I see in hospitals a lot is, that the insurance companies have staff on a short leash and that they therefore treat everyone according to the same protocols. I met a woman recently who has two sons and had two miscarriages. The babies were both girls. Now she was pregnant with another girl and the OB thought she might have another miscarriage again. Now, there are no scientific researches to be found that state that the sex of a baby have anything to do with miscarriages. However, due to this, the OB thought it was a good idea to induce her at 36 weeks (healthy pregnancy) which is too early. Subsequently, this did not work, so they added more drugs. Which resulted in a lot of constant contractions that were very painful, for two days. The baby was born after two days. Now, I don’t see the point in this inducing labour, since nature cannot be forced and if it is forced it usually has very nasty consequences, either for the baby or the mother or both. If they really would have worried about the baby, they should have performed a c-section instead of all the unnecessary interventions this woman had. She described the birth as a horror story with insensitive doctors and nurses, above all: they were very impatient. Giving birth in a hospital with lots of people walking in and out and poking around in the woman will not have any positive effects. It is like going to the toilet or having sex with a few strangers around. I would not be able to do it, would you? When it comes to suing here, the hospital will usually not admit any mistakes. Read this link: http://www.hindustantimes.com/world-news/indian-woman-died-pleading-irish-abortion-laws-denied-a-termination/article1-959655.aspx
            There is another case just like it, just recently. And they would have gotten away with it, if the family would not have hired high-paid lawyers to dig in deep. See, low or middle income people cannot do this, so there might be more cases…
            Like I said before, my third birth was nice and calm. Labour had started, and I didn’t even notice much because contractions came and went about every half hour, very lightly. For about 7 hours. Then, when it started to get serious, I had my son in my hands within 15 minutes. Now with my 4th, there is a huge chance it will be as quick as that. So driving in the car, for an hour to the hospital, on bumpy roads to me would be completely irresponsible. And inducing before the due date ‘just to be sure’ to me is completely insane too. I take full responsibility because I feel that is what is the right thing to do. And even if a hospital or midwife admits fault in the case of a death or injury, the consequences still lie with the parents. No law suit or amount of money can ever take that away. The thing is, is that I have trust in myself and my own power as a woman to give life. I am not some hippie as many might think. I am a highly educated individual and anyone who knows me will say that too. If I feel there is a need to go to the hospital or see a doctor, in whichever state of the pregnancy, I will. But until then, I trust myself more than anyone with a white coat. Thanks again for your explanation.

          • Captain Obvious

            Again, your ignorance about American Homebirth made you look stupid. Calling everyone here ignorant and slamming this blog, when NOW you state you would not want a CPM. Had you read through a few posts here first you wouldn’t have looked like an a$$

          • Captain Obvious

            You probably don’t realize that OBs in America only get to bill private insurance a global package fee for the whole pregnancy. Meaning the doctor cannot bill extra for episiotomy, longer labors, pudendal blocks, inductions, etc. it is one global fee that gets billed.

          • Shockedatignorance

            So maybe that is the reason why the Obs give the women a certain time to birth, because they don’t want to spend too much time on it? If I’d come into your hospital, how long would you give me before you start your array of interventions to get the baby out as soon as possible? I would be interested to know this.

          • AlisonCummins

            No, I don’t think so. As you say, the “array of interventions” are costly. It’s cheaper to let someone labour for days in a corner than to monitor her closely and intervene.

            The expectation is that if labour doesn’t progress at a certain rate that there are risks (infection, maternal exhaustion, fetal death) associated with further waiting; that the longer labour stalls the less likely it is to start progressing normally (if the baby is too stuck to move after two hours of labour, it’s probably too stuck to move after two days of labour) and there are no benefits to a long labour. Of course this is all about risk. Someone can deliver a live baby after two days of labour and look back and think that they didn’t need a c-section and be glad they didn’t get one, but if a woman has been actlively labouring for 12 hours, chances are that the risks of augmentation or a c-section are lower than the risks of waiting. We don’t know what the outcome *for that woman* would have been if she doesn’t get assistance, we just know statistically which choice is safer for both mother and baby.

            In practice, 12 hours is already long but fetal monitoring means that they can tell if your baby is in distress. If your baby is doing fine and you want to keep labouring without pitocin or a c-section, in general they’ll let you. If your baby starts to not be doing fine they’ll want to get it out ASAP because they are frightened for your baby.

          • Captain Obvious

            As long as you need, 1-2 days. We work as a team in the hospital. The doctor, the nurse, your doula, the anesthesiologist. I can be in the office or OR while you labor and the rest of the team attends to your needs. I come in often to visit and evaluate your progress and even spend a little time with you and your family chit chatting, waiting for the wonderful birth to occur. I don’t know where you get your lies about hospitals, but you are really ignorant. I mean that as not knowledgable about it, not derogatory about it. But your comments are really derogatory about your ignorance.

          • Shockedatignorance

            Well, to be honest, if you really are during a woman’s birthing process as the way you describe, then I have to applaud you. I respect everyone’s views and I have nothing but respect for the OB’s who do have a hands-off approach. The lies that you mention, are not lies but true life stories. From women all over the world, including the US. The stories I hear, would have anyone believe that the most OB’s are not like you, but act mostly out of the medical point of view. I work with women who go through heavy depression due to birthing trauma. I’ve heard stories where a male OB was pressing on a woman’s stomach to get the baby or placenta out leaving her bruised. There was a case in Holland, where the nurse discovered a strange bump on the babies shoulder after a few days at a check-up in the hospital and they discovered that the baby had a broken shoulder. The baby was taken from the parents by child protection without even listening to the parents or investigating. After a horror fight of 2 weeks and the baby missing out on the valuable breast milk, the hospital acknowledged that the broken shoulder may have happened during the birth. The child and parents were traumatized for two weeks due to this, but the doctor in question never got charged for child abuse (however, the parents were in the first place…). Now I don’t call that fair, do you? My own midwife with my second child, thought that the placenta took too long to be born (it had been 20 minutes) and she started pressing my belly and said: ‘Now, I do it nicely, but if ambulance/hospital staff is going to do it, there might be two 180 pound guys pressing on you.’ Now, I wonder, how is that going to help the situation? See, we do not have the opportunity to sue here like you do, because the hospital/midwife almost always wins. I had a mother who was crying due to the birthing process of her daughter. She said she saw the doctor literally put his knee on her belly and pull the cord to get the placenta out. My midwife with the second, also told me she pulled the baby straight out of the water because of the blood loss. However, she left me in the birthing pool to nurse my daughter for 15 minutes (to bleed to death??). When I got out of the pool (because of course, there seems to be more blood in water), she suddenly started to panic and an ambulance was called. After all this, she told me I had lost about 1.5 litre of blood, however, I didn’t feel dizzy and walked into the ambulance myself. I left the hospital three hours later…In the hospital, I asked the intern gynaecologist who was going to stitch me up, how many stitches I would need and he shrugged and said: ‘Uh, I don’t know, about 2.’ I had 9 stitches….Now I call that a lie, or would he not have been knowledgeable enough to know that it would be more than 2? Like I said, I work with women to overcome birth trauma, and I can honestly say that 95% of them had hospital births (healthy, elected hospital births…not a home birth that ends in hospital) and intervention hungry midwife led births. Only 5% of them had home births. I know all of the hands-off midwives in this and surrounding countries and I have no women who had a birthing trauma with them. Unfortunately, there are only few of those. As said before, if you are one of those OB’s who are off-hands and give the women the time and space they need: fair play to you. If that is the case, I have nothing but respect for you.
            But in my work, sadly, I see a lot of different cases. I work all over the world, so I see American women too, who birthed at American Hospitals. Maybe, I should send them all to yours the next time. I have just two more questions: how do you evaluate progress? And do you in fact listen to what a woman needs and wants, or do you go your own way? Also, are there a lot of times when you place a cut or do you let birth happen without it?

        • Captain Obvious

          Well talk about shocked at the ignorance. You really don’t know the problems about American unlicensed uninsured home birth midwives, yet you come onto the this blog shouting from your soapbox how ignorant we are. Doh! You must feel stupid.

    • Captain Obvious

      So many wrong comments here. Most OBs are now female. Midwives charge $3000-6000 per delivery, and usually still keep the money even if they transfer you. The midwives lose money/business if women decide not to use them at all, so midwives must be creative to convince you to come to them in the first place. Midwifery is the true Business of Being Born. You got the midwives, the birthing kit, the birthing tub, their massage therapist, their acupuncturists, their chiropractor, their herbs, their baby slings, it’s a regular freak show.

      • Shockedatignorance

        It was my 3rd delivery and it was painless because there was no intervention and no fear. The midwives I had before (one in hospital and one at home) told me what to do and therefore I lost all sense with myself. With the third I knew intuitively what to do because no one was interfering. This was also the first time where I knew exactly what went on in my body and at which stage I was, before this, I didn’t know because they were pushing it to get it done quick. The midwife happily chatting away with the nurse about former births didn’t show one bit of respect and the reason why I had 9 stitches the 2nd time was because she forced me to push without having the urge. With my son, I hardly had to push because my body took over and when that happens, there is no need to intervene or push. But yeah, you keep believing the mainstream media (I actually used to be part of the journalist mainstream media and quit it because I was being told to tell lies…people needed lies, not the truth because if people know the truth, they are going to revolt) and stay ignorant yourself…You bunch will never learn to trust your inner feelings and I am not going to continue to try to even tell you, because you are all too brainwashed into believing you are free and that the medical world and pharma actually care about you. Good luck with your life…

        • Captain Obvious

          You haven’t responded to the other false claims from my comment, like most OBs are men, etc. oh well. I deliver babies every week, for last 21 years. I think my experience is valid in that subsequent births are generally faster, less painful, and less likely to need pain meds or sutures. But you go on believing the woo claims that it was because you freed yourself from big pharma and a medicalized birth, keep drinking the fla-vor-aid. Stay brainwashed and ignorant and pushing your lies on unsuspecting novice women.

    • Durango

      Hearts and lungs and uteruses all work pretty well most of the time, but when they don’t, it gets ugly fast.

      Your anti-vax comments just shows us that you are gullible and easily buy into ludicrous conspiracy theories. Glad your kids have not yet had to pay the price.

    • Young CC Prof

      Wow, it really is impressive how gullible the extreme naturalists can be. Throwing the profit motive out there over vaccines, of all things! A cheap treatment that you only need to use a few times in your life!

      Tell me, do you use any natural remedies? Oils, herbs, homeopathics? How much money do you spend on those?

      • Shockedatignorance

        Yes, maybe a vaccine is cheap.
        But did you ever read the ‘manual’ with it with the side-effects? Do you know what it in it? Because that is what worries me. And no, I don’t use natural remedies as such. But I do know that my son had a chest infection and the doctor gave me antibiotics because ‘that would be the only way to get rid of it’. I gave my son what my mother used to give us when we were kids: garlic in the food, and ginger and lemon tea (I always have it in the house anyway, because I love it) and his chest was cleared up within a day. I went back to the GP to let her listen after 3 days and she said: ‘Ahhh, I can see the AB has done its job.’ So, no, I am not gullible…you are! The big pharma makes billions over our backs, and to be honest, I have never seen anyone get better from the meds…especially insuline etc. My aunt was told that she had colon cancer and the doctors told her she would die but with chemo and treatment they could give her 6 months….She decided to skip the treatment and she kept eating her organic food,skipped the red meats, and started (yes) drinking mother’s milk from donor…She lived another 6 years and was hardly sick in those years. So no, it is not just stupid talks, I see what happens around me. Did you know that EVERY GP gets paid by the pharma to write prescriptions as much as they can? Mine actually admitted to it…But I don’t really care what others think, all I know is that I love life and my family and if you want to give your loved ones poison, that is really up to you. (oh, and even with vaccines, you are still not 100% sure to keep from getting the disease you’re vaccinated for, do your research, it’s in the books). I am not a midwife, nor am I a gullible extreme naturalist. I actually give pregnancy courses and inform women about how the world works and give them back some of their power. With great results, because even though most opt for hospital births, most have drugfree/ interventionfree and painfree births…They have taken back their power, and obviously you still lost it.

        • Trixie

          Lol.

          • Young CC Prof

            Yeah, I can’t really come up with any other response to that run-on paragraph, other than to pull out the “natural-health myths” bingo card and start checking them off.

  • Elizabeth

    Where is that number at? Because I see that a birth with a non nurse midwife is way lower then both the cnm and MD. you say that the REAL number of deaths is higher with a DEM but it is shoved into the md category. did it add 50,000… 30… 100.. or what. you just say that it is in there somewhere but you dont specify by how many.

    • What chart are you looking at? The death rate for non-CNM midwives (which only happens at home) is 1.33/1,000 births. The death rate for CNM is 0.37/1,000 births, and the death rate for doctors is 0.58/1,000 births. We don’t know exactly how many deaths homebirth transfers added to the “doctor” category, but anecdotally at least, it’s going to be more than 1 and probably more than 10. Dr. Tuteur writes about more than 10 homebirth deaths a year, many of which take place at or are called at the hospital, the majority of which meet those criteria for being included in the analysis. Considering how few DEM-attended births take place compared to other birth locations, another 1-10+ deaths that should be counted in that category is huge. Even 1 more death is a 5% increase in deaths in the DEM group.

  • Perinateberkeley

    excellent analysis of the data, Dr. Tuteur. I am a MFM and I must say that I am realizing everyday that the obstetric community, inspite of the lowest maternal and infant mortality rates in years, is losing the battle against untrained practitioners who are making a business and a mockery out of many susceptible clueless first time moms…unfortunately a lot of babies will have to suffer/die before things turn around. In the meantime, we will continue the fight to provide safe obstetric care in the hands of trained CNMs and covering MDs.

  • disgustedbymdlies

    Where you think that the 3 categories makes it easier to say home birth is clearly more dangerous, I would like to point out that it just lumps all non MD and non-nurse midwife births into one category. That means that the number for home births includes every birth outside of the hospital. Births that happened in the car on the way to the hospital, extremists that didn’t have a professional attend, births in an ambulance, and so on. It does not contain soley homebirths attended by midwives.

    • Amy Tuteur, MD

      No, it doesn’t. It only includes births where a self-identified non-nurse midwife signed the birth certificate. Therefore it is only PLANNED homebirths.

      • jonathon wisnoski

        So what about homebirths with accreditednurse midwifes?
        It seems like it would make sense to compare the professionals to the professionals.

        Why would you only compare the unprofessionals to the medical healthcare professionals?

        • Captain Obvious

          I believe Dr Amy’s point is that these unprofessionals (CPM and DEM) are the problem. Homebirths with anyone, MD, CNM, or unprofessional CPM have risks. But Homebirth with CPM is definitely the highest risk. Most CNM won’t even do Homebirth. And if you think Dr Amy is just a biased MD, google Judith Rooks CNM.

        • Young CC Prof

          Because the CPMs claim to be qualified to safely deliver babies alone out of hospital. This is evidence that they aren’t.

        • Rachel B

          I agree Jonathon. I would like to see statistics relating to CNMs in a home setting vs. CNMs and MDs in hospital settings.

    • Squillo

      That’s why there’s an “other” or “unknown” variable in the attendant category. The deaths Amy writes about here were all marked as attended.

      Moreover, the number of deaths attributable to homebirth is likely undercounted in these stats because any transfers from home that resulted in a neonatal death are going to be listed as attended by an MD, a fact that even a MANA spokesperson conceded to me when discussing the CDC stats.

  • lame duck

    I could argue that hospital birth in America kills mothers as much as you argue that home birth kills babies. Mothers who give birth at home are as concerned with the under-reported and grossly high maternal mortality rate in hospitals as the infant mortality rate. They are linked, and I think it’s dishonest to ignore one and focus on the other, which might reflect favorably on hospitals if the data are distorted enough. While losing a baby is tragic, a family can survive. When the mother dies, families are crippled. Maternal mortality is the bigger problem in this country doctor, especially in hospitals, and many states don’t have to list a botched birth as a contributing, if not the sole, reason for a woman’s death in a hospital. Maybe if all hospitals were required by law, and not some honor code, to truthfully report maternal causes of death, quality of care wouldn’t be sacrificed for profit like it is with over-managed, over-medicated, and over-induced low-risk pregnancies that turn into unnecessary tragedies. As it is, questioning senseless interventions while in labor gets a mother threatened with loss of insurance. It’s unprofessional and quite frankly, bullying. I’ve had nothing but healthy pregnancies and children, despite hospitals’ efforts to complicate them with unreasonable induction, medication, and preventative measures. I’m more concerned with my child’s life than any doctor is, so preaching to mothers intent of birthing at home about what’s best for their families according to duplicitous shills and the hospitals they work for is laughable. Luckily, my family survived the incompetence and profit-driven hospital staff, but there are many children, and many mothers, who don’t.

    • Amy Tuteur, MD

      You could argue it, but that wouldn’t change the fact that it is false. The most common mistake in maternal deaths is NOT ENOUGH medical care, not too much medical care. That’s just another lie made up by NCB advocates to convince the gullible. Looks like it worked on you.

      • mandy

        I live in Belgium where we have extensive medical care for mothers in comparison with other EU countries and yet in comparison with other EU countries, we have a higher rate of maternal mortality. http://www.theguardian.com/news/datablog/2010/apr/12/maternal-mortality-rates-millennium-development-goals#data

        • LibrarianSarah

          Correlation does not equal causation. Please repeat that sentence to yourself at least 5 times.

        • The Computer Ate My Nym

          Higher risk pregnancies tend to receive more extensive medical care. I don’t know that there is any particular reason to believe that Belgium has particularly high risk pregnancies, but that should be investigated as the etiology as well as investigating the medical care.

          Actually, looking at the numbers more carefully, I think you may have a case of small number statistics here: Belgium’s a small country. Maternal mortality is rare. Just a few cases going bad can rapidly change the statistics. Consider the change from 1990 to 2008, for example. In 1990, Belgium’s maternal mortality was 8.2, better than the genetically similar countries* of France and the Netherlands. In 2008, it is now worse than the Netherlands, but still better than France. Does that indicate worsening care? Maybe. Or it could just be that 2008 was a bad year by random fluctuation. Or even changes in how the statistics are reported. You’d need to know more: what’s changed and what kind of differences that change made.

          *I think, at least. But I’m basing on language groups. Sorry if that’s wrong and/or insulting.

          • Young CC Prof

            I think you’re on to something there. There are only about 125,000 babies born each year in Belgium, according to Wikipedia, and maternal death rates in the first world are measured in deaths per hundred thousand. Which means that, for example, a change from 8.2 to 9 would be literally one more death. No, in a country as small as Belgium, for an event as rare as maternal death, I would expect to see fluctuations from year to year. If the rate doubled, then I MIGHT take notice, but nothing less.

    • The Computer Ate My Nym

      Most insurance companies pay a flat rate for maternity care, regardless of mode of delivery. Interventions cost money. So how is there a profit motive to “over-managing” low risk pregnancies?

    • Lynnsey Sorrentino

      Yay!!! Thanks for sharing your perspective/the truth. This “doctor” is truly misled, cruel, and/or slightly insane. My OBGYN came to my home for my labor. She snoozed on my couch while my doula and I made our way to pushing…Then she awoke like a superhero and checked the heartbeat and said some encouraging things and joined my hubby in the other room. 🙂 lol She was awesome, and actually did much more than that (of course), but she never pretended like birthing my baby was her job! Midwives don’t either, because it is Mommy’s task! Which may be why so many doctors intervene in the birth–they have this false sense of a woman’s inability, or they consider every birth high-risk, or just because they want to get out of the hospital in time for dinner (it happens). Also, their training isn’t in assisting normal birth, it is in all of these interventions and high-risk scenarios. Many docs have never witnessed a natural birth! It is possible for OBs to support home birth, however. Please, anyone who is reading this woman’s garbage info. and believing it, first find yourself some studies of home birth in the Netherlands (or any non-bullshit, totally misleading study from the U.S) and then go ahead and tell Dr. Toot that she saved you from the primitive drudgery of a reckless home birth…Wake up to your full potential, ladies. Don’t let this puppet tell you that you can’t have your baby at home.

  • Mrs Jackson

    Err… CNM also do homebirths. My midwife is a CNM.

    • Captain Obvious

      That is the minority. Dr Amy does acknowledge CNM performing homebirths, it’s just that most CNM do not.

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