We’ve had lots of questions from families, midwives, and others about the recent release of two articles that were based on the Midwives Alliance of North America dataset (MANA Stats). Here are answers to some common questions, along with a roundup of some of the coverage.
Numbers are useful, but only if they can be compared to something. What outcomes can we compare to the Cheyney article’s findings?
In the study, the authors compare the findings to the best available observational studies of planned home births and birth center births. For low-risk women, the authors find similar rates of both positive and negative outcomes for mothers and babies as nearly every other large, well-designed study.
Some of these well-designed studies are able to compare to hospital rates (which is difficult to do in the U.S.). For example, the Hutton et al (2009) study found no difference in risks to babies between home and hospital in Ontario, Canada. While it is reassuring that the Hutton study had comparable rates of mortality at home as the Cheyney study and it found no difference in risk between home and hospital, more research will be needed to compare U.S. home birth and hospital birth rates.
Why doesn’t the Cheyney study compare home birth to hospital birth mortality rates?
It makes sense to want to draw these comparisons. However, hospital rates in the U.S. are derived from vital statistics data (birth certificates and/or death certificates). A number of organizations, including the American College of Nurse Midwives and Citizens for Midwifery have spelled out the limitations, which include a failure to capture the intended place of birth and inaccurate reporting of some outcomes.
Also, the MANA Stats data captures three kinds of mortality outcomes:
Intrapartum = a baby that was alive at the onset of labor, but died prior to birth
Early neonatal = a baby that was born alive, but died during the first week of life
Late neonatal = a baby that was born alive, but died between 7 and 28 days of life
Vital Statistics data report only two: early and late neonatal deaths. You may have participated in discussions that attempt to make these comparisons. Many have confused the combined rate (intrapartum+early+late neonatal) with rates that include only one or two of these outcomes. When attempting to compare rates, we encourage you to ask whether the rate is for intrapartum, early, or late neonatal, and to ask for the source of their data.
How could the findings of this research be so different from findings that suggest home birth has a greater risk than hospital births?
Those studies primarily rely on Vital Statistics data. For a helpful fact sheet on how to assess the quality of articles based on medical records - the “gold standard” for research and the basis of MANA Stats - against those based on Vital Statistics, see this in-depth look at Citizens for Midwifery.
I’m looking for unbiased analyses of this article and home birth evidence to share with families, policy makers, and others.
Here’s a few we’ve found:
Evidence-Based Birth summary on Facebook. Rebecca Dekker is known for her thoughtful and unbiased approaches to the literature.
Judith Lothian’s review at Science and Sensibility.
ACNM’s preliminary review of the Chervenak/Grunebaum findings. This includes a comment on MANA Stats.
Citizens For Midwifery's summary of the findings.
The Daily Beast’s look at how “alarmist studies . . . from data pulled from vital-statistics data” are getting in the way of ensuring safety for mothers and babies, from the Daily Beast.
Hutton EK, Reitsma AH, Kaufman K. (2009). Outcomes associated with planned home and planned hospital births in low-risk women attended by midwives in Ontario, Canada, 2003-2006: a retrospective cohort study. Birth 36(3):180-9.
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