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Thread: Homebirth midwives reveal death rate 450% higher than hospital birth

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    #1

    Homebirth midwives reveal death rate 450% higher than hospital birth

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    I am putting this in debates since I know this topic can get heated.

    Homebirth midwives reveal death rate 450% higher than hospital birth, announce that it shows homebirth is safe | The Skeptical OB

    True to form, the Midwives Alliance of North America continues its deceptions about the risk of death at homebirth.

    For the past 5 years, I have been relentlessly publicizing the fact that the Midwives Alliance of North America (MANA) has refused to release their own death rates. It doesnít take a rocket scientist to realize that the death rates must be hideous, AND recognized as hideous by MANA executives.

    After 5 years, and mounting pressure, MANA finally decided how to spin their hideous death rate: pretend that the hideous death rates arenít hideous!

    Isnít that clever?

    They are hoping that journalists will print their bogus conclusion, instead of the actual numbers.

    The papers themselves are due to be released later today (at which point I will analyze them in depth), but the press releases include some of the numbers so we can take a look at them now.

    According to Citizens for Midwifery:

    The overall death rate from labor through six weeks was 2.06 per 1000 when higher risk women (i.e., those with breech babies or twins, those attempting VBAC, or those with preeclampsia or gestational diabetes) are included in the sample, and 1.61 per 1000 when only low risk women are included. This rate is consistent with some published reports of both hospital and home birth outcomes, but is slightly higher than others.

    No, it isnít ďslightlyĒ higher. It is MASSIVELY higher.

    According to the CDC Wonder database, the neonatal death rate for low risk white women at term from the years 2004-2009 is 0.38/1000. As Judith Rooks, CNM MPH noted in her review of Oregon homebirths, intrapartum death among low risk babies is essentially non-existent in the hospital, so the neonatal + intrapartum death rate for the hospital is still 0.38

    As the chart above demonstrates, the MANA death rate for the same years was 5.5X HIGHER. In other words, the MANA death rate was 450% higher than the hospital death rate.

    On what planet is a death rate 450% higher than expected a safe outcome? Not on this planet.

    MANA and homebirth midwives have been lobbying extensively for a scope of practice that includes breech, twins, VBAC, etc. Now they want to exclude those same births from their statistics. Even then, the MANA death rate is 4.2X higher than hospital birth. So even when homebirth midwives stick to low risk patients, homebirth has a death rate 320% higher than comparable risk hospital birth.

    Thatís hardly a safe outcome, either.

    The results for various risk factors are even more appalling.

    Of 222 babies presenting in breech position, 5 died either during labor or the neonatal period.

    So the homebirth death rate for breech was 20/1000 compared to approximately 0.8/1000 in the hospital. Thatís a breech death rate 25X higher (2400%) than the hospital.

    To summarize, the MANA statistics show that homebirth as practiced in the US has a death rate 450% higher than hospital birth.

    No wonder MANA has been hiding these numbers for years.
    The blogger is of course very biased and against home births and her post definitely reflects that. But reading the actual study is pretty scary! The results on adverse neonatal outcomes and the maternal and neonatal mortality rates are alarming. Especially given the patient population is a fairly low risk patient population to begin with.

    Here is the link to the actual study
    Outcomes of Care for 16,924 Planned Home Births in the United States: The Midwives Alliance of North America Statistics Project, 2004 to 2009
  2. In vino veritas
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    There is a reason people spend 8+ years learning medicine, and over the past 15-20 years there has been a push AGAINST medicine, with people trusting their own 'research' on Dr. Google and blogs over people who have been trained in a specialized field. Would you not trust your mechanic to fix your brakes? Would you do your own research onto how to properly fly the plane and suggest to the pilot mid-flight as to which landing technique is best? No, so why has there been this push in medicine? I dunno, riddle me confused. And angry. As always when it comes to the idiocy that is the combination of First World Citizens and Healthcare.
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    #3
    That's a five year old study. I'd love to see the numbers for the last five years.
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    #4
    Quote Originally Posted by RetepDoc View Post
    I am putting this in debates since I know this topic can get heated.

    Homebirth midwives reveal death rate 450% higher than hospital birth, announce that it shows homebirth is safe | The Skeptical OB



    The blogger is of course very biased and against home births and her post definitely reflects that. But reading the actual study is pretty scary! The results on adverse neonatal outcomes and the maternal and neonatal mortality rates are alarming. Especially given the patient population is a fairly low risk patient population to begin with.

    Here is the link to the actual study
    Outcomes of Care for 16,924 Planned Home Births in the United States: The Midwives Alliance of North America Statistics Project, 2004 to 2009
    I thought about the bolded too ... like high risk pregnancies aren't eligible for homebirths (?) so if those numbers are accurate that's pretty crazy.

    I'm going to look through the study when I have more time lately ... I wonder if the numbers of non-fatal complications are also that high.

    General thought - I think it's really shady when people refuse to release numbers. Really sketch.
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    #5
    This is interesting. I'm going to read the study paper before I comment though.
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    Quote Originally Posted by Crystal View Post
    That's a five year old study. I'd love to see the numbers for the last five years.
    The study was just released yesterday. the reason the numbers are from 2010 to 2014 is because that was when the data was collected.

    Quote Originally Posted by Tojai View Post
    I thought about the bolded too ... like high risk pregnancies aren't eligible for homebirths (?) so if those numbers are accurate that's pretty crazy.

    I'm going to look through the study when I have more time lately ... I wonder if the numbers of non-fatal complications are also that high.

    General thought - I think it's really shady when people refuse to release numbers. Really sketch.
    Looking through the patient population of the study, the homebirth patients are caucasian (92%), high school or greater education (92%), self-pay/private insurance, with no medical conditions (only 0.8% had GDM). So that tells me they are a very healthy and low risk patient population.

    and I agree...it is very shady to not release numbers.
  7. By the power of Greyskull...
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    #7
    I've long been concerned about midwives.

    Let me clarify- most NURSE midwives do not do home births. Most recognize the dangers and are not willing to put their advanced nursing practice license on the line. CNM's (certified nurse midwives) also need a physician backing and they probably won't get physician approval for this either. (On a side note- MIL is a CNM in your old town!)
    When referring to homebirths and midwives, these are not nurse midwives. The are people who have had training in prenatal and delivery care. Susie that worked at the bank up the road could go decide she wants to deliver babies and go learn how to be a midwife. If someone uses inappropriate resources to find a midwive (instead of through a reputable source, vs. finding someone on CraigsList or something stupid like that) then they could easily find one of these unlicensed midwives.

    What I'd LOVE to see if a push towards more birthing centers associated with hospitals. You still have the medical back-up you need for an emergency but you have the relaxing environment that many mothers desire.


    ETA- So if you're seeing a midwife for prenatal care and it's associated with an established medical practice (with doctors and all) then you're in good hands.
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    #8
    I don't understand why people opt for homebirths anyway. I completely understand wanting to avoid a c-section and drugs etc etc etc. But I don't know why you would choose to remain outside of a hospital with a trained staff while doing something that has such huge consequences if anything goes wrong. That makes NO sense to me.

    It seems like the argument a lot of the time is that women have been giving birth for thousands of years without medical intervention, but look how high the mortality rate was! Nonsense.
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    #9
    there were some numbers included in the actual study...
    only 1.5% of the infants had a 5minute APGAR of <7... however, 2.8% of them went to the NICU by 6 weeks of age.... I honestly don't know completely what to make of the numbers...

    It's a little worrying, because I really wanted to go to a free-standing birth center near me (mid-wife), but now I'm concerned again

    Also... the study doesn't have any comparison that shows numbers of births that went to hospitals...
    Last edited by CrestedTern; 01-31-2014 at 09:09 PM. Reason: I broke the smileys the first time
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  10. By the power of Greyskull...
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    #10
    Quote Originally Posted by Heisenberg View Post
    I don't understand why people opt for homebirths anyway. I completely understand wanting to avoid a c-section and drugs etc etc etc. But I don't know why you would choose to remain outside of a hospital with a trained staff while doing something that has such huge consequences if anything goes wrong. That makes NO sense to me.

    It seems like the argument a lot of the time is that women have been giving birth for thousands of years without medical intervention, but look how high the mortality rate was! Nonsense.
    They lose a lot of autonomy when they enter the hospital as a patient. You don't want an IV? As nurses we're going to bug the shit out of you for one because we know we want that asap if something goes wrong. It might not be in their birth plan but our role is to help prepare for the very worst and sometimes that means things they may not want- a different bed, visitor restrictions (you mean my 14 kids can't come watch me shoot another human out of my clown car vagina?) or visitor restrictions for other reasons (right now our hospital is limiting all visitors under age 12 because of flu outbreak), IV's, nothing to eat diet in case they need surgery, etc...

    That being said- put an IV in me and call it good. I'd rather have an IV and deliver in a controlled setting with emergency back-up than risk it at home.
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