A new study of nearly 500,000 births in North America and Europe found that death rates for babies in planned home births were doubled vs. births in hospitals. Tripled, if congenital defects were excluded. Deaths were almost entirely due to respiratory distress and failed attempts at resuscitation. One difference between this study and other studies looking at home birth safety is the way the numbers were tabulated. Deaths that occurred in the hospital after a home birth emergency transfer were regarded as home birth deaths, not as hospital deaths.
The rate of deaths was 15 in 10,000 for home births and 4 in 10,000 for hospital births. Consistent with previous research, the women in the home birth group had fewer interventions and complications such as tears, hemorrhages and infections than those in the hospital. Authors of the study claim the lack of interventions are responsible for increased neonatal mortality.
What I don’t see in this story is a breakdown of who assisted the home births. Previous studies have shown that a home birth for a low risk mother with a certified nurse midwife and easy access to back-up hospital care is as safe as a hospital birth, with fewer complications for mom. From what I can tell this new study has lumped in home births attended by certified nurse midwives or otherwise highly trained midwives with those attended by poorly trained assistants.
For this reason and others, Dr. Michael Klein, an emeritus professor of family practice and pediatrics at the University of British Columbia, questions the conclusions drawn. Klein, whose data was used in the study, is quoted in Canada’s CBC News saying the U.S. conclusions are “crap.” “The data and the methods taints the quality of the study,” his partner Patricia Janssen said, speaking specifically about data included in the study where the qualifications of the caregiver was not known. Klein also questions the agenda of the researchers: “It’s a politically motivated study that was motivated by the American College of Obstetrics and Gynecology who is unalterably opposed to home birth.”
But there may be something positive here for everyone. As home-birther Madeline Holler points out over at Strollerderby, both home birth and hospital birth care-providers can learn from this study: “midwives and home birth attendants should be sure their resuscitation skills are excellent and that they possess all of the equipment necessary for assisting respiratory distress. And doctors and hospitals could be open about learning a thing or two from homebirth attendants and what they’re doing (or not doing) for moms.”