BMJ Deputy Editor on Home Birth: 'Throwing the baby back into the bathwater'

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By Jill—Unnecesarean

Deputy editor of the British Medical Journal, Tony Delamothe, published an article in the BMJ to answer the question “What explains the fall in planned home births in developed countries?

Here are two interesting excerpts:

 

On the rise of hospital birth as the alternative to home birth:

Since the second world war numbers of planned home births have fallen precipitously in the developed world, mostly to rates of less than 5% of all births. Yet over that time no compelling evidence has emerged that hospital delivery—the main alternative—routinely produces better outcomes in uncomplicated pregnancies. That has not stopped the issue becoming highly contentious, with official bodies lining up on opposite sides of the argument. For example, the United Kingdom’s Royal College of Obstetricians and Gynaecologists and the Royal College of Midwives think that planned home births are fine. The American College of Obstetrics and Gynecology and the Australian Medical Association do not. 

 

On the Wax paper:

As they might do with the second study, published last month in the American Journal of Obstetrics and Gynecology (doi:10.1016/j.ajog.2010.04.041; see BMJ 2010;341:c3551, doi:10.1136/bmj.c3551). This meta-analysis of 12 studies from “developed Western countries” compared outcomes of 342 056 planned home and 207 551 planned hospital deliveries. As in the Australian study, perinatal mortality (this time defined as the sum of stillbirths among fetuses of at least 20 weeks’ gestation or 500 g weight and deaths of liveborns within 28 days of birth) did not differ statistically between the two groups. So can home birthers now breathe a sigh of relief? 

Not so fast. For reasons unclear from the published article the authors switched their attention to neonatal mortality (perinatal mortality minus stillbirths) (BMJ 2010;341;c4033, doi:10.1136/bmj.c4033), despite having relevant data for these calculations on only 9% of their total sample. Neonatal deaths were twice as high among the planned home birth group and three times as high among infants without congenital abnormalities. Despite the reassuring finding on perinatal mortality, it was these differences in neonatal mortality that were seized on by the headline writers of medical journals and newspapers alike. (None of them thought to ask why stillbirths suddenly didn’t matter.)