Summarizing the debate

The ongoing debate over on another blog about the statistical analysis of the Johnson and Daviss study and where birth is safest for the baby is confusing. It is meant to be. I believe it is to distract women from the truth -- the real and serious problem of high maternal AND infant mortality rates in the United States.

Clearly the debate (of one study by Johnson and Daviss) over safety about home versus hospital birth has to eventually switch to some obvious issues and the bigger picture of maternal safety and the consequences to her and baby when drugs and technology are misused. The now routine use of life-saving interventions and drugs meant for at-risk and high-risk women that are being routinely mis-used on low-risk women and babies are what harms and traumatizes both women and babies (and fathers who must watch powerlessly and caregivers who are numbed and hypnotic perpetrators of violations).

Several posters there have some good summations (and then, we'll move on to the meat):

Jamie:
A couple of considerations here: most important, you're conflating the intrapartum and neonatal death rates for J&D. J&D claimed a death rate of 1.7/1000 for combined intrapartum and neonatal deaths. Neonatal death rate alone for J&D = 1.1/1000 without congenital anomaly deaths, or 1.66/1000 if they're added back in.


Second: adding the congenital anomalies back in and making a direct comparison to nationwide rates is exactly the kind of tactic you faulted J&D for in your posts on cohort studies. More than 12% of the J&D cohort was Amish/Mennonite, a population known to have a higher than average burden of lethal genetic disease. You'd need to control for that difference instead of just putting the numbers side by side if you wanted to make a valid comparison.


Third: the table you cite shows higher rates of neonatal death for babies born at 36-39 weeks than those born at 40-41 weeks, with a death rate of 2.59/1000 in the 36-37 week range. The J & D midwives delivered babies down to 37 weeks gestation.


In sum, we don't have the information needed to make a statistically meaningful comparison between these authors' data and the J & D outcomes. But it is simply incorrect to say that the neonatal death rate in the J&D cohort was more than twice as high as it should have been.

Congenital anomaly and prematurely appear to be major considerations in the loss of newborn lives, regardless of location of birth. Congenital anomaly -- now, that is a very different subject -- preconception preparation and testing and the prenatal period. (Guest articles welcomed!)

Another poster, Someone, commented:

As congenital anomalies are irrelevant as to the safety of birth location, "putting them back" is misleading. They were removed for a reason, which is that those babies would have died anyways. Did you "put back" the babies who died of congenital anomalies in the hospital, too? Even if 'putting them -all- back' makes the neonatal death rate at home higher, that doesn't mean homebirth is less safe, just that those babies just happened to have congenital anomalies. That more homebirth babies had congenital anomalies and thus died doesn't say anything about the safety of homebirth whatsoever, and that is the reason they were removed. The safety of birth location isn't dependant on how many babies overall died, but of how many babies overall died that would or might have lived in the hospital. The babies with the congenital anomalies, both born at home and in the hospital, need to be exempt because their deaths don't have anything to do with the safety of either birth location which is the entire focus of the study.

Someone summarized saying, it is misleading to add in the congenital anomalies, cases where the babies died as a result of their genes and would have died no matter where they were born.

From a poster in England comes the recommendation to look at the studies of homebirth there. Chamberlain et al would be a really good one for you to pick to pieces and then Walsh and Downs work. The majority of births in England are at home and obstetricians are used for high-risk deliveries. Since the 1930’s England has incorporated midwifery care that is attributed to the lower maternal and infant mortality rates there.

The reader provide a link to a government publication in the UK: http://www.dh.gov.uk/assetRoot/04/09/05/23/04090523.pdf

In the previous post, "What about the mamas?" there are numerous links to historical information that show that the industrialized nations (and some third world) with the lowest maternal and infant mortality rates were the countries who developed midwifery based models of care since the early thirties. THIS is the major difference between obstetric care in the US and every country with lower infant and maternal mortality rates.

Who is going to change this dangerous situation is the United States?? Consumers. WOMEN.

RISE UP, SISTERS!! Say, "YES! to ME! and YES! to my BABY!"

more about that in a minute .... stay tuned ......