A new meta-analysis on the safety of home birth?
This holiday weekend, which was also the sixth anniversary of my own first home birth, was busy with news of a new meta-analysis (followed by a curious revision of the meta-analysis) of the safety of home birth published in the American Journal of Obstetrics and Gynecology. The revised meta-analysis reports a 3-fold increase in neonatal mortality in planned home birth compared with planned hospital birth.
I hope to get to a more thorough deconstruction in the coming days, but in the meantime here are my preliminary notes.
1. The meta-analysis is compromised by the inclusion of a deeply flawed study that relies on birth certificates and includes preterm births, unplanned home births, and home births attended by unqualified providers. In the only analysis in which the researchers excluded this study, the significant excess of neonatal mortality disappeared.
2. The meta-analysis also includes studies that report on births that took place as early as 1976.
3. Home birth research has come a long way in the past several years. Lack of appropriate data collection and other major methodological problems have plagued this area of research. In contrast, a few new studies have really changed the game. And all of these high-quality studies, conducted in low-risk women in integrated maternity care systems, find no excess risk for babies and significant benefits for mothers. Here are some previous posts in which I reported on these studies:
- Why the largest study of planned home births won’t sway ACOG
- A new era of home birth research
- Home birth: the rest of the story