Homebirth Risks: Babies Three Times More Likely To Die
More than 10,000 American women each year choose planned homebirth with a homebirth midwife in the mistaken belief that it is a safe choice. In fact, homebirth with a homebirth midwife is the most dangerous form of planned birth in the US.
In 2003 the US standard birth certificate form was revised to include place of birth and attendant at birth. In both the 2003 and 2004 Linked Birth Infant Death Statistics, mention was made of this data, but it was not included in the reports. Now the CDC has made the entire dataset available for review and the statistics for homebirth are quite remarkable. Homebirth increases the risk of neonatal death to double or triple the neonatal death rate at hospital birth.
As this chart shows, the neonatal mortality rate for DEM (direct entry midwife, another name for homebirth midwife) assisted homebirth is almost double the neonatal mortality rate for hospital birth with an MD. This is all the more remarkable when you consider that the hospital group contains women of all risk levels, with all possible pregnancy complications, and all pre-existing medical conditions. An even better comparison would be with the neonatal mortality rates for CNM assisted hospital birth. The risk profile of CNM hospital patients is slightly higher than that of DEM patients, but CNMs do not care for high risk patients. Compared to CNM assisted hospital birth, DEM assisted homebirth has TRIPLE the neonatal mortality rate.
The chart shows the data for 2003-2004, but the data for 2005 has recently become available. Homebirth death continues to be far higher than death in the hospital for comparable risk women. In 2005 the neonatal death rates were CNM in hospital 0.51/1000, MD in hospital 0.63/1000 and DEM attended homebirth 1.4/1000.
No wonder the Midwives Alliance of North American (MANA), the trade union for homebirth midwives, is suppressing their safety statistics. From 2001-2008, they have collected the single largest repository of data on homebirth. The data is publicly available, but only to those who can prove they will use them for the “advancement” of midwifery, and even then, a legal non-disclosure agreement must be signed as part of the process. MANA’s data may very well confirm that homebirth with a DEM has triple the neonatal mortality rate of hospital birth for comparable risk women in the same year.
What is also notable is that the results are consistent with all existing scientific studies, including the Johnson and Daviss study (Outcomes of planned home births with certified professional midwives: large prospective study in North America). Johnson and Daviss actually showed that homebirth with a CPM has a neonatal mortality rate almost triple that of hospital birth for low risk women. The latest statistics are the most recent and most reliable confirmation of that fact.
There really is no question about it. Homebirth with a homebirth midwife dramatically increases the risk of neonatal death.
*This blog post was originally published at Science-Based Medicine*
Why has Dr. Amy not published these findings?
This is American data. Canadian women who work within the medical system with highly trained Registered Midwives and have a choice of home birth if they are low-risk. This very recent study http://www.cfpc.ca/local/user/files/%7BB51825B6-44FF-4F63-9413-2B8829E117D6%7D/Ontario%20Home%20Birth.pdf shows that home birth in Ontario is just as safe as a hospital birth. It studied almost 7000 women in each cohort. Perhaps the title of this article should be “American Midwives should be better trained and screen women wanting a home birth more rigorously”
Before you believe “Dr. Amy”, you might consider checking the data yourself. It paints a very different picture to me than it does to her. Grouping the data by Medical Attendant, I see 2.88 deaths per 1,000 for Certified Nurse Midwives (CNMs) and 3.69 deaths per 1,000 for Other Midwives. This is compared to the 7.17 deaths per 1,000 for MDs. Grouping by Birthplace and then Medical Attendant, we see that these figures are very close (2.70, 3.84, and 7.15 respectively) when we look only at “out of hospital” midwive-assisted births and only hospital births attended by an MD.
That sounds to me like homebirths are twice as SAFE.
Now granted, midwives select only the low-risk cases. This does place an unfair bias against hospital births. In order to meaningfully study the difference between hospital and home births, a randomized study would need to be conducted. Since most women want to choose their place of birth for themselves, this is not particularly feasible. So we work with the data we have.
Note: I have seen this post (or a very similar one) before. In the comments of that previous post, Dr. Amy refuted numbers similar to those I have cited by claiming that those numbers look at the death rates within the first year of the child’s life. According to Dr. Amy, the “correct” numbers look at the death rates within the first 28 days of the child’s life. So - again, according to Dr. Amy - it doesn’t matter if your child lives to be a toddler; as long as they can survive on a ventilator in the hospital for at least a month, the medical system has not failed you.
No, I don’t think so.
I want to choose what gives my child the best chance of living a long and happy life. For me, these numbers support homebirth, with a midwife.
Oh yes, and as for the study cited by Dr. Amy near the end of the article, here is the conclusion pasted from the study abstract:
“Planned home birth for low risk women in North America using certified professional midwives was associated with lower rates of medical intervention but similar intrapartum and neonatal mortality to that of low risk hospital births in the United States. ”
Similar mortality rates to hospital births, but with a lower rate of medical intervention. Sign me up!
Oh, and Dr. Amy - if you would like to make a case comparing direct entry midwives to certified professional midwives, I am open to listening. However, I would expect such an article to avoid claiming that “homebirth” is dangerous as this article does. The studies cited here clearly show that homebirth is as safe as, if not more safe than, a hospital birth. Which brand of midwife you choose is an entirely different topic.
I’m no Harvard school grad, and I may be from Mississippi, but the percentage math you are doing is certainly not anything I am familiar with. This is what I get:
Births Deaths Mortality Rate
CNM 375,387 140 .04%
MD 4,240,989 2,606 .06%
DEM 23,476 27 .12%
To me the difference does not seem that significant, but the proper percentages definitely make a difference. A difference of .06 is a lot less than the aforementioned .54 of a difference.
Just thought that I would make that know.