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Home births scare me.

September 1, 2009

It’s the return of an old feature — health headline hyperbole.

Home Birth With Midwife As Safe As Hospital Birth: Study

Seems like good news, no?

“The mortality rate per 1,000 births was 0.35 in the home birth group, 0.57 in hospital births attended by midwives, and 0.64 among those attended by physicians, according to the study.”

Wow.  Those stats makes it look like home births are safer than hospital births and that’s probably what a lot of people will think after reading this article especially if they miss this statement:

“The authors acknowledge that “self-selection” could have skewed the study results, in that women who prefer home deliveries tend to be healthier and otherwise more fit to have a home birth.”

This study did not include high risk pregnancies.  The study also did not randomize women to one of the three types of delivery; each woman selected which type of delivery she wanted.  That’s what “self selection” means.  Women with any reason to worry about health risks for her baby or herself would tend to select a hospital delivery with a midwife or an obstetrician.  Women with any additional reasons for concern would tend to request an obstetrician.  Therefore, you would expect more bad outcomes with a doctor in a hospital based simply on the type of patients the doctor would be responsible for.

I’m not saying that home births with a midwife are bad but I think that this article oversells the safety of a homebirth without adequately explaining the study.  The headline needs a few more words:

Home birth with midwife as safe as hospital birth for very low risk pregnancies.

If I had delivered one of my daughters at home, she would be dead.  The pregnancy was uneventful and the delivery was smooth until the very end.  We had no hint that a crisis would hit at the very end.

One Comment leave one →
  1. December 1, 2009 7:17 am

    The study only looked at low risk pregnancies. So any hospital birth that did not fall into the same category as the home births (low risk) was not used in the study. Yes, self selection is not as good as randomization, but since the study still only looked at low risk births, it is not skewed by the hospital also caring for med-high risk births, they weren’t included (and it would be unethical to randomize such a study). My first one, born at home, also had an uneventful and smooth labor until the very end, but the midwives handled it beautifully and saved my baby’s life. The statisical risk of a sudden complication that truly needs a doctor’s/hospital’s help immediatley (instead of within 20-30 min, the same time it would take to get an emegency c-section which can be prepped while mother is transfered) is far lower than the statistical risk that an unneeded intervention at the hospital will indanger mother/baby. A hospital birth is every mother’s right, but so should be an attended at home birth. And the statistics (from good studies that ONLY look at low risk pregnancies and, if anything, are usually skewed in the hospital’s favor) show that home birth is a safe option that should not be ostericised by society. Given this study you are almost twice as likely to die in a hospital giving birth than at home, so why is home birth the option that is seen as ‘unsafe’? Midwives don’t take high risk cases (in many states are legally bound not to), anytime anyone is talking about homebirth, they are talking about low to mid risk pregnancy.

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