Home Birth Article

[Hermya321]

Here.

I was a bit but the study that they use comes from the United States and from what I was aware they seem to like hosiptal births over home ones.

One of the women on BBC breakfast stated that studies done in the Netherlands showed the opposite of the study.

The Lancet article was very dodgy, based on poor American data which counted unplanned home births and home births unattended by a qualified midwife.

An excellent, large scale, recent study in the CMAJ had quite different results and found home birth to be safer and have fewer complications than hospital birth.

I agree that research in the US doesn't tell you a whole lot about homebirth in the UK. The system there is completely different, the geography is completely different, and the interaction between midwives and doctors is completely different.

In the absence of a homebirth study specifically done within the NHS, I think British women are more than entitled to continue to make up their own minds.

I was also particularly about this quote: ?women have the right to choose how and where to have birth, but they do not have the right to put their baby at risk?.

This is exactly the kind of misogynistic, emotionally manipulative, dishonest approach that I HATE about the way women are treated in labour. Actually until the baby is born (and even thereafter) parents DO have the right to put their baby at risk both before and after birth. There are all sorts of ways in which practicalities are prized over safety - driving in a car, for example. Yet no-one says that women should not be "allowed" to put their babies at risk by driving to work. And no-one dictates to fathers about what they are "allowed" to do even though numerous studies prove that their lifestyle impacts on their children almost as much.

Yet somehow women, by virtue of actually carrying the child, are seen as having handed their bodies over to the medical profession for 9 months and vetoed any right to make decisions for themselves.

Yes by all means tell women what the risks are - but "allowing" them to behave in certain ways? Sheesh - maybe let's lock them up for the duration, why not.

It annoys me that the BBC Breakfast news has a journalist and an author on to debate this. Why do we not have properly qualified people who can discuss the validy of the research and actually report the facts rather than personal opinions.

I fail to see how a study looking at the safety of giving birth at home in the USA is relevant in this country. (IIRC, studies recently showed giving birth in USA is a fairly dangerous activity, full stop).

It is so wrong to publicise this study with no proper analysis - how are women truly offered an informed, eidence-based choice with rubbish like this going on in the background!! Grrrrrrrr.

I agree with the general thrust of the criticism here, but we should be clear about the facts. The study was first published in an American journal, but it was not of the American experience alone. It was a study of births across the world. That was both its strength (lots of data -- more than had ever been accumulated in a single study before, and about 100x the number of patients as covered by the CMAJ study) and its weakness (it assumed that home births across countries and hospital births across countries were sufficiently similar to be comparable, when they're not). By the time context is taken into account, it's very difficult to sustain the conclusions that it is birth setting rather than presence/absence of two qualified midwives that is driving the differences in mortality.

But in this case, the generalizations cannot be applied to the UK model. I fail to see how the statistics coming out of the US, can apply to the UK.

The UK has, on paper at least, one of the best provision for home births in the world yet it represents a tiny minority of the home birth statistics gathered from the multitude of countries where the service and the medical infrastructure are much weaker.

It's numbers (and that of the Netherlands with a large percentage of home births and also a great tradition of home births) will be greatly diluted by the numbers coming out of the US and developing countries where home births will include women who never have antenatal care, who may have risks related to poverty and deprivation (for some developing countries) or who by choice or by necessity will go on to have unassisted deliveries.

I may of course be talking out of my rear end so has anyone ever come across the list of countries and the time frame of this US study?

foxytocin, it's not a study of the US, it's a study led by US authors. I've got a copy.

Objective: "We sought to systematically review the medical literature on the maternal and newborn safety of planned home vs planned hospital birth."
Study design: "We included English-language peer-reviewed publications from developed Western nations reporting maternal and newborn
outcomes by planned delivery location. Outcomes? summary odds ratios with 95% confidence intervals were calculated."

So no developing countries included. And in fact, by far the largest quantum of data came from the Netherlands, because they used national perinatal registration data. So that data included >300k births, while the other studies were all hundreds or thousands of births. Studies published from 1985 to 2009 were included.

I've just read and re-read the trial, and tbh, I think you'd need to be a fairly well-qualified medical researcher to be clear on what conclusions can be drawn and what can't. The discussion at the end of it is complex and I don't know what to make of it myself.

I do think that the study was written by people who will have thought carefully about the issues that have been discussed here -- eg comparability across sites etc. So I would tend not to dismiss it out of hand, despite being dubious about the Lancet editorial.

The NHS runs an interpretive service to do just that, but it doesn't cover this study yet.
www.nhs.uk/News/Pages/NewsArticles.aspx?TopicId=Pregnancy%2fchild
Perhaps if enough of us wrote in, it would.

Oops, forgot to post this:
Maternal and newborn outcomes in planned home
birth vs planned hospital births: a metaanalysis
Joseph R. Wax, MD; F. Lee Lucas, PhD; Maryanne Lamont, MLS; Michael G. Pinette, MD;
Angelina Cartin; Jacquelyn Blackstone, DO

Cite this article as: Wax JR, Lucas FL, Lamont M, et al. Maternal and newborn outcomes in planned home birth vs planned hospital births: a metaanalysis. Am J
Obstet Gynecol 2010;203:x.ex-x.ex.

www.ajog.org

I meant it was a US review of studies. sorry. Not that it was a US study.

So, which countries does it include exactly?
what are the figures and timescales for each country? I wonder what their definition of developed?

I am curious because I have never heard which data is used and how old it is.

I also wonder what are the controlling factors they used when analysing the statistics.

In some countries, for example, a neonatal death that occurs before say 27 weeks (for argument's sake), is not counted as among the infant mortality statistics but in another countries a neonatal death at 24 weeks will.

How robust were the studies (all of them) have to be before it was used?

I'd like to know the criteria which they used for selecting the studies for their review.

In my ignorance, one piece of data cannot nullify so many other studies out of hand. So until more is revealed to the layperson like myself how these conclusions were drawn then.

sorry, i noticed you included the dates. so data which was 25 yrs old was used...

birth practices can change a lot in 25 yrs.

even if a lot of the info comes from the Netherlands, the US has a population over 20 times larger so the numbers of home births in the US can still massively skew the figures.

And unassisted births (esp with or without antenatal care) are still home births and the riskiest. Were those included?

Foxytocin, I can answer your questions by going through the study and pulling the answers out, but it would take a while -- more time than I had. You can go online and get the article from the website, but I'm afraid you'd have to pay.

I think it's an excellent thing to test the study for robustness. However, it was published in a peer-reviewed journal by credible authors, so I think that most of the questions you raise will have been adequately answered. eg they set out the search criteria, which were reasonable; they used a standard instrument to test for study quality; they explain the statistical approach in some detail and I'm sure the controlling factors will have been sensible, although I've not looked in detail.

I do think it's best to assume:
a) competence
b) lack of mal-intent on the part of the authors
unless you have reason to suspect otherwise. By contrast, I wouldn't assume either of those things about the journalists reporting on the study.

The dummy article about SIDS a few years ago was published in a peer reviewed journal and in my very humble opinion it was a rubbish study.

I cannot give them the benefit of the doubt regarding

1. competence
2. (i don't think they had mal-intent) but it would be good to know who funded the study as this factor seems to influence results even in science.

and we agree about journalists plus a lot of them don't know how to interpret medical journals and a lot of them have their own, unintentional at times, bias so read stuff into good research that is not there.

And I ain't paying for the full document.

I can't believe that a major news item during which those of us who choose home birth were castigated as unacceptable risk takers has amassed so little debate on here today.

I was pretty mad TBH. I hope the lack of discussion reflects the fact that, as others have pointed out, there weren't any experts commenting, and not that the majority agree that I'm a negligent mother.

msbossy, if it's any consolation, I got quite cross too. Thought that passed through my mind was "if the Lancet really cares about better outcomes, perhaps it would like to editorialise about the disgrace of consultant-led wards who don't have anything like 24/7 consultant cover".

This meta analysis has been done' on mn before as it isn't new news.

Medical doctors are not scientists and the rules of assuming a thorough peer review cannot be assumed (though to be fair, they can't always be assumed in more scientific journals).

I've come to distrust a lot of medical papers now as through DH I have come to see how the majority of them come about.

I know it's not a US study, but I will say that the US counts miscarriages at home as homebirths...which completely skews the results for home births. Hospital births are HUGE business in America...because all insurance is private...the more women they get to use hospitals, epidurals, even c-sections, the more money docs and hospitals make. OF COURSE it makes sense that they would discourage home births...a home birth is a no earner for them!

A lot of researchers decide on the outcomes before doing their research. Many doctors quite sincerely think homebirth is reckless and its nothing to do with money. My GP is very anti homebirth.

Birth is always a risk and good ante natal care minimises the risk. Certainly there are women for whom home birth is not a good option, however there are other women where home birth is a safer option than a hospital.