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Archive for December 3rd, 2009

A critique of the leading study of American homebirth

Its authors boast that it is one of the ten most downloaded papers from the British Medical Journal (BMJ). That makes it even more unfortunate that the conclusions of the paper are directly at odds with the findings of the paper. Outcomes of planned home births with certified professional midwives: large prospective study in North America by Kenneth Johnson and Bettye Ann Davis is the premier paper on the safety of American homebirth. It claims to show that homebirth is as safe as hospital birth, but actually shows that homebirth has nearly triple the neonatal death rate of hospital birth for comparable risk women.

Johnson and Daviss, in collaboration with the Midwives Alliance of North America (MANA), the organization of American homebirth midwives, collected data on all homebirths attended by Certified Professional Midwives (CPMs, homebirth midwives, as distinct from CNMs, Certified Nurse Midwives) in the year 2000. Then the authors compared the outcomes for interventions and for neonatal deaths with a hospital group.

According to Johnson and Davis, when analyzing the different intervention rates of home and hospital:

We compared medical intervention rates for the planned home births with data from birth certificates for all 3 360 868 singleton, vertex births at 37 weeks or more gestation in the United States in 2000, as reported by the National Center for Health Statistics [Births: final data for 2000. National vital statistics reports. Martin JA, Hamilton BE, Ventura SJ, Menacker F, Park MM. Hyattsville, MD: National Center for Health Statistics, 2002;50(5)]

They used singleton, vertex births at 37+ weeks as a proxy for low risk women. They found, not surprisingly, that intervention rates are lower for homebirth. Then they turned to neonatal mortality rates. They should have compared the neonatal mortality rate of the homebirth group to the neonatal mortality rate of the hospital birth group, but they did not. Instead, they compared homebirth deaths to hospital births in a variety of out of date studies extending back more than 20 years.

The authors conclude:
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Posted in: Obstetrics & gynecology

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