Risks of homebirths: latest Dutch research published today

[dikkertjedap]

This article was in today's Volkskrant
www.volkskrant.nl/vk/nl/2672/Wetenschap-Gezondheid/article/detail/1044490/2010/11/03/Babysterfte-hoog-door-falend-systeem.dhtml

it is in Dutch but summarises an article published in the British Medical Journal.

AMSTERDAM - Women who get prenatal care from midwives face more risk than women who get obstetric care from the start.When women start their giving birth with a midwife, they have two times more chance that their baby dies then if they had given birth with an obstetrician.

If a woman during a homebirth have to go to hospital or is passed from midwife to obstetrician, then the chance that her baby dies is four times as much.

This has become clear from research from the University Medic Centre (UMC) Utrecht that has been published today in the British Medical Journal. The Netherlands has been facing years of relatively high infant mortality. The new figures demonstrate the shortfalls of its system. The Netherlands has one of the highest levels of infant mortality, approximately 1 in 100 babies dies at/around birth. Only France and Latvia have worse figures.

dikker - you need to read "Lies, Damned Lies and Statistics" dear.

Aren you trying to say that midwives should not be working or do you have a campaign against homebirth?

Tell you what - all of us midwives will resign and leave it to ther "superior" obstetricians. Happy?

...and if a woman goes from homebirth to hosp or is passed to an Obstetrician the chance of her baby dying is 4X greater. Now is that the midwife or the Obstetrician to blame ?

Might be mildly interesting if I were giving birth in the Netherlands, but since I live in the UK, I'm perfectly happy with the evidence which shows home births and MLU births are every bit as safe as hospital, and indeed, that for the majority of births ( ie ones with the potential to be straightforward) a natural non medicalised delivery is the safest method for the baby.

Research done in the UK shows homebirth to be safer than hospital birth. So that either shows that you can make a study/research fit whatever you want it to. Or that there are more high risk women in the Netherlands having a homebirth. Or that midwives in the Netherlands aren't as good as UK midwives. Or quite probably something else as well.

interesting - a survey of 400000 births in the netherlANDS found HB to be as safe as hospital. unfortunately i can't understand this artile so can't crtique it.

Your statistic of 1:100 is actually quite wrong and as infant mortality and perinatal mortality are two different things, they should be looked at separately.

The 2008 figures for infant mortality are around 4 in 1000 or 0.4%, and much of this is explained in this article in the BMJ which I assume the newspaper has used in part to get its figures BMJ. This figure is also lower than in the UK, which had a rate of 4.9 per 1000 in 2008.

This abstract here might explain some of the reasons why there is a decline in Netherlands international ranking.

This article explains more clearly the what the newspaper is obviously trying to convey here.

Still quite surprising though.

thank youn mintpurple

This American report tells of similar findings. But it also says;

"Mothers in planned home births experienced significantly fewer medical interventions including epidural analgesia, electronic fetal heart rate monitoring, episiotomy, and operative vaginal and cesarean deliveries. Likewise, women intending home deliveries had fewer infections, perineal and vaginal lacerations, hemorrhages, and retained placentas. Data also showed that planned home births are characterized by less frequent premature and low birthweight infants."

Woman need to know the facts and be allowed to make uip their own mind where they would like to give birth.

Yes, well, if you do quote an article, then do it properly.

The article did not address the figures per se, but rather the system in which gyneacologists and midwives work separately. In the event of a hand-over (when the woman has to be transfered to hospital), 'a delay occurs' and hence more time elapses, meaning that valuable time is lost to save baby's life. So the researchers actually pleaded for a system where everyone would be included and not only midwife. Seems quite sensible. They did not at all mean to discredit midwives, far from.

They did however come with the idea of having compulsory (first) birth in a birthcentre of some kind where midwives and obstetritians could work together, but I should think that wouldn't happen, as that eats away at the rights of women to choose home birth if they want.

So basically a baby who is so much trouble that a vaginal birth with midwives - then being transferred to an obstetrician (c-section) means the baby is 4 times more likely to die? Well durr. Doesn't really make much of a difference surely if this is in the nee-naw from home or down to theatre - an anaesthetist and surgeons need to be scrambled and a theatre made free.

I had an emcs in NL this summer - damn right my baby was more likely to die - that's why I had an emcs and didn't just "push".

'De onderzoekers zetten grote vraagtekens bij het huidige systeem, waarin verloskundigen en gynaecologen gescheiden werken.'

I think that could be a very significant sentance - it;s saying that the investigators are setting question marks by the current system where the midwives and doctors work entirely separately.

This is when it helps not to have to rely on someone else's translation, the OP is being very selective in what she translates.

Hum. Why quote a Dutch newspaper rather than provide a link to the BMJ, where the actual research was published?

www.bmj.com/content/341/bmj.c5639.full

Here's the main conclusion from the authors:
"Infants of pregnant women at low risk whose labour started in primary care under the supervision of a midwife in the Netherlands had a higher risk of delivery related perinatal death and the same risk of admission to the NICU compared with infants of pregnant women at high risk whose labour started in secondary care under the supervision of an obstetrician. An important limitation of the study is that aggregated data of a large birth registry database were used and adjustment for confounders and clustering was not possible. However, the findings are unexpected and the obstetric care system of the Netherlands needs further evaluation."

We take what we read in the British press with a big pinch of salt - we know they are just trying to sell their newspapers. Their job isn't to educate, its to make money.
I don't think we should expect any more from the Dutch media.

So all we have learnt from this is that further investigation needs to be done in how the system operates in the Netherlands. But then we already knew that there was something about the Dutch system that doesn't work, seeing that they have one of the highest mortality rates of Europe.

the authors themselves say their conclusions were unexpected and require more research. It does, however, seem to me to be a well conducted piece of research, and not something to be written off because it has unpalatable conclusions.

I read the BMJ article yesterday and what I drew from it was that situations were being inaccurately categorised (in the system, not the research) as 'low risk', when in fact they weren't. And that a transfer when a situation has gone pear shaped is more risky than the 'high risk care' throughout labour. There were also some technical issues to do with the study counting deaths from outside the study area where the mothers were transferred in for obstetrician led delivery as an emergency.

TBH, it would make me think twice about having a HB for a first baby, though not for a subsequent birth (most risks were for first deliveries IIRC).

And I say this as someone who had a wonderful HB with DC2 and every intention of doing the same when DC3 arrives in the summer.

but nightlark - the risk in the UK are the same for first birth in, or out, of hospital.

the Netherlands perinatal mortality rate has risen slightly due to a high immigrant population forom deprived nations (think about, women with FGM, malnourishment, and a culture that may prevet them from accessing medical care).

it is still, as metioned earlier, better than the UKs.

Apparently 1/3 of births in the Netherlands are home births. If the infant mortality rate was really as high as 1/100, you'd think they might have picked up on the link earlier?

Perhaps I've misunderstood and 1/100 of those births which transfer to hospital result in fatality.

you know i'm willing to go with that if it's true. but the REALLY interesting thing about your post is that you state that france has a higher mortality rate which given the massive obstetric dominance in that country is really interesting!

Whatever it may or may not tell about the safety or otherwise of home births, it's looking at a whole population. That is of limited use for the individual: in much the same way as EBF is known to make conception rates lower across the population but will never mean it's something you can rely on as individual contraception.

Home birth is and always will be a personal decision based on individual factors.

The maternity system in the Netherlands is very, very authoritarian. Women are discouraged from pain relief (although public opposition is changing this) and there is very little choice. It is the American system in reverse - in US it is tricky to get a homebirth, in the Netherlands it is tricky to get anything else. There is an awful lot of post traumatic stress disorder because of their bizarre anti pain relief attitudes.
Ultimately, as other posters have said, women need good information and need to be able to make their own decision. The contentious bit is exactly what is accurate information :o I guess it is what you believe after you have read all the conflicting info!

DH and I were talking about this.

Apparently the reason why it is so high in the netherlands has nothing to do with the actual quality of the care but more to do with the fact that they don't do a detailed handover or keep medical records of the complications / labour and this is what causes problems.

I am not sure where the balance in the whole equation is. The mother's wish for the birth she wants should be respected but on the other hand the safety/health of mother and baby is paramount.

In the UK the maternity staff in hospitals at best pay lip service to what the mother wants but it is not really taken seriously. I also think iatrogenic factors are to blame for a LOT of interventions in the UK. Am I going off piste here?

BTABOBS where do you get your information from?

It is not 'tricky' to get a hospital birth at all. I had the choice. I chose hospital. Most chose to at least start the process at home.

I'm not sure I have heard of a higher rate of PTSD either, but am prepared to be educated if you can quote sources???

'Bizarre anti-pain relief attitudes?"

Not sure about the lack of "detailed records" either. From my first mw visit at 7 weeks right through until going in to hospital at 36 weeks (pre-eclampsia) I had in my posession at all times a medical/pregnancy card which carried all relevant medical information about me and the baby including how I was feeling about it all. The hospital has digitally recorded notes - and, afaik, do not routinely delete the files at the end of the day.

Like Undutchable I could've chosen a hospital birth at any point during my pregnancy.

For my next pregnancy I will be going back to the same midwife practice who looked after me during my first pregnancy. The exact same woman. Not just the same hospital/area/practice - but someone with whom I'm on first name terms with and who has visited me at home.