A new study has been making the rounds of the popular news sites. The abstract – 65: Neonatal outcomes associated with intended place of birth: birth centers and home birth compared to hospitals The abstract of the study is published in AJOG It was presented at the Society for Maternal-Fetal Medicine 32nd Annual Meeting.
It is strange that this abstract is getting so much attention. With only an abstract available it is impossible to judge the study’s merits. We look forward to the publication of the study. At this point we have to reserve judgment for later. We simply don’t have the data available to determine the strength or validity of the study. That said, it is amazing that the findings presented in the abstract are getting so much attention.
Here are some of the many articles, with varying perspectives, discussing it:
I found this article to be neutral verging on steering families toward hospital birth:
“Babies born at home were more than twice as likely to have an Apgar score of under 7 as children born in a hospital or at a birthing center, and also had double the chances of having a seizure….
The overall number of kids who had seizures was low — less than 1 percent at any location.
Prior research has shown that babies with lower Apgar scores are more likely to have complications after birth, such as needing breathing assistance, going to the ICU, having seizures or having developmental issues, Cheng said.”
This article has a positive spin for homebirth:
“But when a certified midwife was present, it seems babies born at home may fare as well as those born in hospitals, said study researcher Dr. Yvonne Cheng, an obstetrician and gynecologist at the University of California, San Francisco.
“It’s not just about where you deliver, but perhaps who you deliver with,” Cheng said.
Home births are known to be associated with fewer obstetric interventions — that is, women in labor at home receive fewer epidurals and less pain medication.
Women must weigh the benefits of home births against the risks to make an informed decision about where to give birth, Cheng said.”
This article seems to treat the study in a neutral manner:
“Women who have home births or plan to deliver at home have lower rates of cesarean delivery; however, their babies are more likely to have neonatal seizures and lower Apgar scores if a certified midwife is not in attendance, according to research presented here at the Society for Maternal-Fetal Medicine 32nd Annual Meeting.”
This one uses bad data to back a claim:
“…recent evidence suggests that while the absolute risk of planned home births is low, such births carry a neonatal death rate at least twice as high as that of planned hospital births. Neonatal death occurred less than once in 1,000 hospital births, compared with two in 1,000 home births, said an American Journal of Obstetrics & Gynecology meta-analysis published in September 2010.”
Home births rise despite higher neonatal mortality rate: Although the vast majority of deliveries occur in hospitals, more women who want a less institutional experience are opting to give birth at home.
This AMA article is citing the Wax et al study. Science and Sensibility has discussed the vast array of errors and misinformation in the Wax study on four separate occasions:
- When Scientific Methods Fail: New Criticisms Over the Wax et al Homebirth vs. Hospital Study
- Becoming a Critical Reader: Questions to ask about systemic reviews and meta-analysis
- Planned homebirth and neonatal death: Who do we believe?
- Meta-analysis: the wrong tool (wielded improperly)
Others have cited Wax et al, although not explicitly such as this one: Homebirths up Dramatically, but are they safe?
There were numerous letters written to AJOG with regards to the flaws in the study, as well. So, to have the Wax et al study brought up again is inappropriate and poor science. It feels to me like a scare tactic or propaganda.
Given that we don’t have all the information, I question the journalistic integrity with which the articles above are written. It’s always a good headline – about the dangers of home birth. It’ll get links clicked, newspapers sold and running commentary on social media sites. However, without proper analysis of the data things are potentially misrepresented. Once we gain access to the full study, Science and Sensibility will be able to respond appropriately.
Some questions we hope to answer:
- What data were used? How strong is the data set?
- Many home births are not reported as such, so data will be lacking. How is this accounted for?
- Does the legal status of a homebirth midwife impact outcomes? Especially because the author states that CNMs have better outcomes than do CPMs or DEMs. We are not aware of research that supports this.
- Is it considered homebirth if the mother was transferred from home to hospital mid-labor if her intention was to have a home birth?
For more on recent perspectives on homebirth please visit the Homebirth Consensus Summit.
Let’s get the discussion going here. What are your thoughts on homebirth?