Ricki Lake Fires Back in Debate on Home Birth

study about newborn deaths after home birth

According to a study done in Washington state done over a decade, babies born at home were twice as likely to die as newborns. (http://www.greenjournal.org/cgi/content/full/100/2/253)

A very well done and unbiased study. Over 15,000 births were tallied and this study does not have the problems pointed out by the other posts.

I agree with the point about one person's perspective may not be typical such as"I had a great home birth" or "I am very glad I was at hospital" - but it is hard to argue with 15,000 births.

it's a money thing

Over 25 years ago I was to have a baby in a birthing center in azusa,ca. The hospital was around the corner. This was my first baby and I could not see myself in a hospital with all the germs. Upon labor ama decided to take my doctor's license away. I was shipped off to Hawiian Gardens and had to have my baby in a germ filled hospital. Since then the hospitals have their so called birthing rooms. Not the same. We should be able to have a choice to where we have our babies. The hospitals just want their money. Having babies are a big money maker and they know it. I back you up Ricki we should have a choice who, where and how we want to have our babies.

Let's talk epidemiology

but in fact, their citation "Births Final Data...." does NOT contain any infant mortality data."

Who said the figures were in "Births Final Data ..." ? As an epidemiologist, you surely know that neonatal mortality figures are published yearly as Linked Birth/Infant Death datasets. The mortality figures for the low risk hospital group in 2000 were published as "Infant Mortality Statistics from the 2000 Period Linked Birth/Infant Death Data Set "(http://www.cdc.gov/nchs/data/nvsr/nvsr50/nvsr50_12.pdf) in 2002, two full years before Johnson and Daviss wrote their paper. The neonatal mortality data was available to and known by Johnson and Daviss. They deliberately left it out because it showed that homebirth in 2000 had almost triple the neonatal death rate of low risk hospital birth.

I'm sure you would agree that this is the correct comparison group and that there is no excuse for omitting it.

Please cite sources

I see

"All the existing scientific evidence and national statistics indicate that homebirth doubles or triples the rate of neonatal death compared to hospital birth. Unfortunately, homebirth advocates make claims that are not supported by the scientific evidence."

But I do not see any references. I do have a few comments on the above post.

1. There is full disclosure regarding funding sources.

2. Authors must disclose CURRENT competing interests, not past. Therefore the authors did not hide anything as you have insinuated.

3. You also insinuate that the authors were remiss in not citing NCHS data for infant mortality, but in fact, their citation "Births Final Data...." does NOT contain any infant mortality data. In fact, as you SHOULD know (seeing as how you thoroughly read articles) national infant mortality data (in fact all mortality data) is incredibly hard to ascertain as death certificate coding is notoriously inaccurate. Finally, the infant mortality data that is available from NCHS is not stratified according to risk as defined by the authors. This would seem to indicate that home birth is much safer, when in fact the comparisons would not be equal, as the national data includes data for all risk groups and thus would be inaccurate for comparison. Thus the authors showed admirable scientific rigor by NOT citing this as their source in this instance. Therefore, it seems logical to include similar data from all sources as they did. You discounted that as 'outdated' when in fact it was right on scientifically. Also two of the neonatal deaths were classified as SIDS and one seems to be iatrogenic in nature, but again the authored were right on scientifically by keeping these deaths as part of the cohort, even though they probably do not reflect a strength or weakness of planned location of birth.

4. Please cite your source on the national data that you speak of, as I was unable to find it (although admittedly, it was a quick search).

So maybe you should take your advice and read the article and NOT just part of it. The discussion part is particularly helpful. Also some background in statistics and study methodology might serve you well before you make judgments on studies.

Signed,

An Epidemiologist

home births

I am a female OB/GYN and I do not advocate home births. I do believe in empowering women to make informed choices. I have many patients request natural delivery and I do my best to accomodate their wishes. My only agenda is safety for the mom and the baby. We have to remember though that there are 2 patients involved. And at a time when the standard of medical care is so high in the US, it is not acceptable, in my opinion, to chance losing even one baby or the mom. But it is not for me to make decisions for others. We live in a free country, I believe that all woman should be allowed to make that decision for herself and her baby. After all, she will be the one living with the consequences of her actions.

With this movement towards homebirths, we will be obtaining some concrete prospective data on the safety of homebirths. I am curious to see what the findings will be. I just hope that this doesn't happen at the risk of loss of life.

Don't trust the citations, read the paper

"All the literature I've read cites studies showing low-risk pregnancies that end in homebirths, when attended by competent and well-trained midwives, whether CPM, CNM or otherwise, are safe - safe for the mother, and safe for the baby."

That's why it is very important to read the actual papers, not the citations and not just the abstracts. You will find that there are papers that CLAIM to show that homebirth is as safe as hospital birth, but they do so by comparing homebirth to hospital birth of high risk women or to hospital birth in decades past.

Take the widely cited Johnson and Daviss BMJ 2005 study, for example. In the first part of the study, Johnson and Daviss compare medical interventions of over 5000 women who had homebirths in 2000 with low risk women who had hospital birth in 2000. When it comes to neonatal death rates, though, Johnson and Daviss do not mention that the homebirth group had a neonatal death rate almost triple the neonatal death rate for low risk women in the hospital in 2000. Instead, they compare homebirth in 2000 to hospital birth in a variety of outdated studies extending back to 1969.

Moreover, Johnson and Daviss fail to disclose that both are long time public advocates of homebirth. Johnson is the former Director of Research for MANA (the Midwives Alliance of North America) and Daviss, his wife, is a homebirth midwife. The study was conducted in collaboration with MANA and was funded by money from a homebirth advocacy foundation.

All the existing scientific evidence and national statistics indicate that homebirth doubles or triples the rate of neonatal death compared to hospital birth. Unfortunately, homebirth advocates make claims that are not supported by the scientific evidence.

Women are entitled to decide where they give birth, but they can't possibly make an informed decision when they are deliberately misinformed.

Risk of transport

Transport time is the the fatal flaw of homebirth to me.

Skilled birth attendants

After years of trying a variety of ways to reduce the maternal/infant mortality rate all over the world, the World Health Organization has learned that what really saves lives is the presence of a "skilled birth attendant"during the childbearing year. That means vigilant prenatal care with appropriate referral for high risk women, having the correct medications and equipment available at every birth, knowing how to use them, having ready transportation for emergency cases, and having a hospital well-equipped to deal with emergencies when the woman gets there.

Too many women in this world have none of the above. They die needless deaths from postpartum hemorrhage caused by preventable anemia from either worms, malaria, or poor nutrition. They die from seizures from hypertension. Their babies die of tetanus, sepsis, or lack of simple resuscitation skills.

Those of us who are working to increase the number of skilled attendants in developing countries and who are working to help make hospitals safer, are at a loss to know why, in this country, anyone would choose to deliver without a skilled attendant. You would not want your best friend or daughter delivering a baby in rural Haiti unless you had all of the above resources readily available.

The midwives who are working with Midwives for Haiti need the support of the obstetricians in the U.S and in Haiti. We lose credibility if we appear to be aligned with any group that supports "going it alone" for childbirth. Thankfully, I do not think that is what Ricki Lake and the BOBB are advocating. But the media surrounding the BOBB is frequently forgetting to emphasize that "skilled birth attendants" are what make all the difference.

All over the world and here in the U.S. we struggle with who qualifies for the right to be called a skilled birth attendant. There is an effort to make the educational requirements uniform and there are many discussions in countries like Brazil and the UK about the issues of which midwives are legal and which are not. Let's work together to make the definition of a "skilled birth attendant" uniform to end the confusion of our clients and to further the efforts to make childbirth safer all over the world. www.midwivesforhaiti.org

birth safety

As a certified nurse midwife, I personally have attended over 500 births. Prior to that, I was a labor and delivery nurse and attended close a 1,000 births. The truth as I see it: Fear has dominated our culture. Money is a prority. Women are second class citizens. This all impacts birth. Things have spun out of control. Study after study has shown evidence of the safety of normal birth, the safety and in fact better outcomes with midwives, and the safety of homebirth in the care of well trained professionals, yet we all ignore the evidence and argue from our fear. I fight everyday for women and babies. I fight for them to be educated, supported and advocated for...which often means to be quietly watched and assessed, but mostly to be left alone. I never have to fight for interventions. Everyone is happy to induce, happy to get you an epidural, even happy to do a cesarean section(even happier if ist's daylight hours). My worki s my passion. I believe birth is our right as women. I believe women should be supported to explore options and they should have options. There are not enough midwives to serve all the women. We do need the medical communities working with us, to provide safe care for mothers and babies. We need to change the whole insurance structure in this country, both health insurance and liablility insurance. Women need to find their voices. We fought for our right to own property, our right to vote, our right to pain releif in birth(we hased been used against us), we fought and continue to fight for our reproductive rights, but are silent to insurance companies, medical associations and congress when it comes to birth. We must clear our fog of fear. And support women in their choices and work to provide a system of safety. A System that is evidenced based. A system that largely involves midwives providing care to low risk women.

What study shows higher neonatal death at home?

Dr. Tuteur,

You write: "Homebirth is NOT as safe as hospital birth. All the existing scientific evidence shows that homebirth has an increased risk of neonatal death...[Insurance Companies'] own actuarial data tells them that homebirth increases the risk of neonatal death."

Please cite where you are getting this information. All the literature I've read cites studies showing low-risk pregnancies that end in homebirths, when attended by competent and well-trained midwives, whether CPM, CNM or otherwise, are safe - safe for the mother, and safe for the baby.

In my estimation, the lack of unnecessary routine interventions at home make birthing there safer for a low-risk pregnant woman and her baby than birthing in a hospital, where the mother's body is often not allowed to birth her baby as it was designed to - often due to time constraints imposed by doctors, not nature - often resulting in the need for more, and sometimes emergency, interventions.

I would very gladly educate myself and learn some things if I was reading what you appear to be reading. Please help me become better informed.

I've known women who have lost their babies being born at home. I've also known women who have had tragedy befall their babies being born at hospitals. I've had two pregnancies. The first ended in a 1st-trimester miscarriage that I passed at home with no medical interventions. The second ended in a beautiful water birth, also at home, attended by a highly trained doula and CNM. Unless absolutely medically necessary, I will not choose to birth any of my future babies at a hospital.

Again, I would appreciate the sources of your assertions.

- Liz of CA, mother to one daughter, born at home, in the water