The Sept 15 issue of Canadian Medical Assoc Journal has a new study on the safety of homebirth in comparison to hospital birth.

The full study with stats is attached here or can be read at this link:http://www.cmaj.ca/

The study's conclusion says:

"Our study showed that planned home birth attended by a regis-
tered midwife was associated with very low and comparable
rates of perinatal death and reduced rates of obstetric interven-
tions and adverse maternal outcomes compared with planned
hospital birth attended by a midwife or physician. Our popula-
tion rate of less than 1 perinatal death per 1000 births may
serve as a benchmark to other jurisdictions as they evaluate
their home-birth programs. "

http://www.cmaj.ca/

Tags: CMAJ, Ricki, birth, book, home, homebirth, lake, pregnancy, study

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I think it would be interesting to see what the causes of death are. I have a feeling it would be different in each group, as there are different risks in each group. (So, home birth deaths are related to length of drive to the hospital while hospital births are related to infections). But as long as the study is comparing the same things, it sounds valid to me. Now, if they were using 20 weeks on in only the hospital births and 28 weeks on in the home births, then there would be issues. As long as they are comparing the same thing, it shouldn't matter.
I agree - if we could see the causes of death it would be helpful.

I'm asking because if, (as the commentator suggested), the researchers' choice to include the 20 week stillbirths may have raised the number of hospital deaths, it would (artificially) make hospital birth look less safe than it is. So, from that point of view, it may matter that they chose to including 20 week stillbirths (instead of 28 week). However, if the causes of death from hospital birth were all post-28 weeks, then yes --- it wouldn't matter.

The reason I'm inquiring about this is because I'm very interested in HB as an option for myself. I loved Ricki's movie. I know that there are challenges with previous studies that compare HB to hospital births. This one seems to be structured well, so and I just wanted any questions with this particular study to be resolved.
I did some research and the WHO defines perinatal mortality as being a death that occurs from 20 weeks of completed gestation to 7 days after birth. I believe that this explains why the researchers in this study used this specific time period. It allows the stats from this study to be compared w/reported perinatal and neonatal outcomes from across the world. Also, according to the study there were no deaths between 8 and 28 days after delivery in either group so using the neonatal time period in comparing risks/deaths is irrelevant.

My personal opinion: America is really bad about seeing their way as THE way, and since we define the perinatal period differently then the WHO, the commenter is basing their judgement on the fact that the researchers used a time period not recognized by America. However, the time period they used makes it easier to compare their results across the board, globally.
Thank you for looking into this, Sara. That makes complete sense, and I agree with your assessment about why the commentator may have taken issue with the timeframe.
No problem :) thanks for bringing up the comment. I am sure that is just the first of many that will attempt to discredit the reliability and outcomes of the study. In the interest of informing the author of my research and my opinon/position on the reliability and accuracy of the study I sent her the following e-mail:

Dr. Amy B. Tuteur,

The defined perinatal and neonatal period vary greatly depending on the author and country of origin of the study. The typical definition you cited is the common definition in America, but not necessarily the definition commonly accepted in other parts of the world. The World Health Organization (WHO) defines the perinatal period as 22 weeks of full gestation to 7 days of life. This corresponds closely to the time period chosen for this study. Maybe the authors/researchers chose that specific definition of the perinatal period so that the outcomes of their research could easily be compared with the outcomes of births globally as defined by the WHO.

In addition, the neonatal period is defined by the WHO as occurring in 2 stages, early and late. The early period is defined as birth to 7 days, which overlaps with the defined perinatal period. The late neonatal period is defined as 8-28 days after birth. According to the study, no deaths occurred in either group after 7 days. This means that focusing solely on the perinatal period encompassed all complications/deaths that occurred in the study, making the study/comparison of the neonatal period irrelevant for research and reporting.

I would like to have seen the causes of death included, but I suspect that that was beyond the scope and purpose of this study. The manner of death has no direct relevance in comparing the rates of complications/deaths between the defined groups. Including this information may have clouded the original purpose/intent of the study. None of the complications are accompanied by an explanation of their suspected causes and not reporting the causes of deaths maintains continuity of the methods of reporting throughout the study.

If you would like to check my information use this link. The definitions can be found on page 12.

http://whqlibdoc.who.int/publications/2006/9241563206_eng.pdf

Best Regards,

Sara W.

A Well-Informed, College Educated American Woman

I will let you know if I get a response :)
If it's the Amy Tutuer I think it is, it's not really worth the effort...she is stubornly anti-natural, anti-home birth. If you do get a response, don't let it get you down. My advise would be to not try and debate her or get sucked into her negativity. If your curious about her stance, you can find her on homebirthdebate.com, but like I said, don't get sucked in. There are much better people to debate and discuss this topic with.
Thanks for the info. I never expect a response from these people, but sometimes I am pleasantly suprised and get one. Other times I get one and realize they are not interested in adademic discourse on the topic, only defending their positions. If that is the case w/her she'll go the same way they all do straight into the recycle bin :)

I reach out to these people and I figure if I reach just 1 or 2 then its worth it. If I reach just 1 and they reach 1 and that person reaches 1....word of mouth at its very best!
I checked out the link you suggested and WOW, she refuses to acknowledge the idea that any of the studies are reliable except the ones that are against HB. She made no mention of the study by the Cochrane Collaboration that found "no reason to suggest HB or HosB, b/c outcomes were the same." I did find where she said that the types of studies done by Cochrane were unreliable, which I find amusing b/c it is considered one of the most credible resources for scientific based evidence worldwide, and almost all studies are done retrospectively, just like Cochrane does theirs. Eventuallythere will be too many studies and stats for her to dismiss and...she will have to eat her words :)
I'm surprised that this is the only thing she found wrong, It must mean this is actually a good study:)
LOL! I am sure she will find other things when she had time to fully dissect it, we just need to give her some time cuz she'll have to pick it apart throughly :)
The Science and Sensibility blog got a response from Lee Saxell, who is one of the authors of the study. I hope it's OK with Amy Romano to post his/her (Lee is so gender neutral) reply in full. It clarified my questions about the data set.

"I am one of the Canadian home birth study authors. Thanks for all your thoughts and opinions on our study - and the links to other sites discussing it.

I just want to clarify that we used the provincial data base for our study information. All identifiers were removed before we received the data and we did not have permission to view the actual charts. We could eliminate mortality caused by preterm birth, congenital anomaly etc, but we could not drill down on the deaths occurring after labour began. And sadly, as we all know, there is often no definitive cause for intrapartum death."

...

"In Canada, stillbirth death is defined as intrauterine death after 20 weeks gestation. Early neonatal death is from birth to 7 days. Together this time period is referred to as perinatal death and it is a standard mortality rate in Canada.

Following this first broad data search from 20 wks to 7 days after birth, the three groups were then matched for comparison. All three groups had to meet the eligibility requirements for home birth, regardless of planned place of birth. In order to qualify for a home birth in BC you must be between 37 and 42 weeks gestation so all births occurring between 20 and 36+6 wks gestation were eliminated from the final data set."
This is great for VBAC moms (at least in Canada...)

Tracy

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