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Normal Birth Forum Featuring Henci Goer
Subject: two questions

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Author Messages
Amy Tuteur, MD (guest)

07/02/2008 9:48 AM Quote Reply

As I said originally, the complete dataset can be found at CDC Wonder http://wonder.cdc.gov/lbd.html. The dataset can be queried to find out the neonatal death rate for white women, 37+ weeks, 2500+ gm, with singletons who delivered in the hospital in 2000, which was 0.9/1000. Johnson and Daviss have already publicly acknowledged this on their website Understanding Birth Better.

If you prefer, we can remove lethal congenital anomalies. There were 1863 deaths, of which 1001 were due to lethal congenital anomalies. That means that the neonatal death rate for hospital birth in 2000  (white women 37+ weeks, 2500+ gm singletons) was 0.34/1000.

maria (guest)

07/03/2008 4:03 PM Quote Reply
Ok, I have looked and looked but I cannot find where Johnson and Daviss acknowledged anything about their research being inaccurate. Would you please link me to this, Dr. Amy?

Also, I thought it was not infant death that we needed to look at but neonatal death, death before 28 days. How does infant death rate say anything about homebirth?

maria.


maria (guest)

07/03/2008 4:08 PM Quote Reply
Oh, disregard my last question, I read something wrong.

maria
Amy Tuteur ,MD (guest)

07/05/2008 12:28 PM Quote Reply

maria:

"Would you please link me to this, Dr. Amy?"

I'm not ignoring your questions, maria. Henci Goer has limited me to only one response on this blog and I am saving the response for her.

If you'd like to find out more, a great deal more, you can visit my blog Homebirth Debate (homebirthdebate.blogspot.com). You can post as many questions as you want there and I will try to answer them all.

Angela Simpson
Posts:0

07/05/2008 12:44 PM Quote Reply
I don't mean to offend....but that just made no sense. If you're only allowed one reply, and you didn't want to reply to Maria to waste that one reply by answering her very good questions (I've been waiting for the responses myself), then why did you just reply in a manner that only advertises your own blog (by what you just said, wasting your one response) and doesn't answer the questions? I don't think that Henci meant one response EVER, I think she meant you're allowed one response for each question/topic, provided they are respectful responses. I'm thinking I may not be the only one waiting for the answers to Maria's questions, so can you please post them here? They've been the foundation of your debate, and I'd like to know where the research is.
maria (guest)

07/05/2008 2:14 PM Quote Reply
I don't think Henci would delete a post with a link to where you get your information from, Amy. Only bullying and posts which detort the truth from what I understand. So please, post that link and the exact quote. I have yet to find where Johnson and Daviss admitted to have detorted the truth in the link you gave earlier. All I could find online was this http://understandingbirthbetter.com/section.php?ID=31&Lang=En&Nav=Section
Someone posted this in the comments of the Baltimore article. It seems to refute adequately what your point of contemption is.

Also, I have been looking at the WHO report and I can also there not find anything that confirms what you write. Pleas quote where you found this, what page, the full paragrah etc.

I have tried reading your blog, Amy, but the tone of it is quite agressive and it honestly diminishes the validity of your points in my opinion. I thought upon reading the first page that I would find some good unbiased information, just as I find here, but upon following the debate link, I was appalled by the animosity of people, including yourself. I do not like going to your blog nor do I like referring people to it. To each their own I guess.

maria.
Henci Goer
Posts:0

07/05/2008 5:43 PM Quote Reply
Posted By n/a on 07/02/2008 9:48 AM

As I said originally, the complete dataset can be found at CDC Wonder http://wonder.cdc.gov/lbd.html. The dataset can be queried to find out the neonatal death rate for white women, 37+ weeks, 2500+ gm, with singletons who delivered in the hospital in 2000, which was 0.9/1000. Johnson and Daviss have already publicly acknowledged this on their website Understanding Birth Better.

If you prefer, we can remove lethal congenital anomalies. There were 1863 deaths, of which 1001 were due to lethal congenital anomalies. That means that the neonatal death rate for hospital birth in 2000  (white women 37+ weeks, 2500+ gm singletons) was 0.34/1000.

Thank you for providing the results of this data query. Six newborns of the 5418 women intending home birth at the start of labor died in the neonatal period in the Johnson study, which calculates to 1.1/1000. 

-- Henci  

Amy Tuteur, MD (guest)

07/05/2008 6:01 PM Quote Reply

'which calculates to 1.1/1000"

Those are not the only deaths. However, even if you restrict the deaths only to those 6, that still means that the neonatal death rate at homebirth in 2000 was triple that of the neonatal death rate at hospital birth in 2000 (0.34/1000), just as I have claimed.

Henci Goer
Posts:0

07/05/2008 6:33 PM Quote Reply

Posted by Maria (above): I have yet to find where Johnson and Daviss admitted to have detorted the truth in the link you gave earlier. All I could find online was this http://understandingbirthbetter.com/section.php?ID=31&Lang=En&Nav=Section

Thank you, Maria! I just went to the page and read it through. Anyone who wants a calm, reasoned, scholarly explanation of the caveats of making appropriate statistical comparisons with the MANA 2000 study should follow your link. It does a better job of responding to Tuteur than I can do, which is not surprising since the author is an epidemiologist, and I am not.  

As for Amy's mention of other deaths that I omitted from my calculation, this is a prime example of how she misuses data. The "other deaths" were not neonatal deaths. They were intrapartum deaths and therefore were not relevant to a comparison with hospital-based neonatal deaths. Indeed, Amy's persistent confusion over what is encompassed by "neonatal deaths"--this is not the first time I have pointed this out to her in this Forum--brings to mind Andrew Zang's comment: "He  [or, in this case, she] uses statistics the way a drunken man uses lamposts--more for support than illumination."

-- Henci

tienchinho (guest)

07/06/2008 4:44 AM Quote Reply
The link Amy Tuteur provided to CDC Wonder does not provide an appropriate cohort of births to compare to the MANA data.

Our original discussion was about finding an appropriate cohort from the year 2000 of planned HOSPITAL births to compare to data on planned HOME births published in the BMJ.

The CDC Linked Birth/Infant Death dataset for 2000 does not provide neonatal mortality rates based on planned HOSPITAL births.

The link http://wonder.cdc.gov/lbd.html navigates to a page that allows us to select one of three databases: Linked Birth/Infant Death Records with ICD 10 codes for 1995-1998, for 1999-2002, and for 2003-2004. It does not allow the user to select for data from 2000 alone.

Then we can separate the data out by maternal and infant characteristics. The data is not available by place of birth. The CDC Wonder link does not provide any information about hospital birth neonatal mortality rates in 2000.
tienchinho (guest)

07/06/2008 11:17 AM Quote Reply
Yes. Johnson and Daviss do not use the neonatal death rate in the hospital group in 2000.

The NEONATAL death rate includes live born babies that died in the first 28 days of life.

In their BMJ article, Johnson and Daviss examine the COMBINED INTRAPARTUM AND NEONATAL death rate which includes babies that died during labor and live born babies that died in the first 28 days of life.

The COMBINED INTRAPARTUM AND NEONATAL death rate for planned home births in the BMJ article was 2.0 / 1000 in 2000.

The COMBINED INTRAPARTUM AND NEONATAL death rate for planned hospital births in the BMJ article was drawn from ten sources with rates ranging from 0.5 to 3.4 / 1000.

See Table 4 at http://bmj.bmjjournals.com/cgi/content/full/330/7505/1416?ehom

No. The neonatal death rate published by the CDC for white women with 2500+ g babies was 0.9/ 1000 in 2000.

See Table 6 at http://www.cdc.gov/nchs/data/nvsr/nvsr50/nvsr50_12.pdf

Tienchin
Henci Goer
Posts:0

07/06/2008 11:37 AM Quote Reply
Posted By Amy Tuteur on 07/06/2008 4:08 AM

maria:

"Henci has also explained her point of view."

Unless and until you study some basic statistics, you will not understand the rules of statistical analysis and therefore you will not understand that Johnson and Daviss are flagrantly violating those rules.

Anyone who does not understand the difference between between intrapartum deaths (stillbirth) and neonatal deaths (commonly defined as born alive and dies between birth and 28 days), which Amy clearly does not, is either unqualified to discuss mortality statistics or intentionally misleading people for reasons of her own.

-- Henci



Henci Goer
Posts:0

07/06/2008 11:54 AM Quote Reply

So here's where I am with this: Aside from responding to Amy's assertion that she is qualified to discuss mortality stats and I am not, I have deleted Amy's posts along with your responses to Amy's attacks on my integrity. (Apologies for deleting the responses, but it didn't make sense to leave them up after I deleted the rant.) I think there is enough information in this thread and the links and sources provided in the posts that anyone who wants to make their own evaluation of the Johnson and Daviss paper, can do so. Therefore, I would like first to thank those of you who contributed positively to the discussion and second to declare that we are done with the topic of the MANA 2000 stillbirth and neonatal mortality statistics.

-- Henci

Henci Goer
Posts:0

07/06/2008 8:19 PM Quote Reply

Amy --

I have given you the rules for this site. They permit you to have your fair say. You may do as you please on your on website, but I will not allow you to hijack this Forum to use as another platform for your rants or to bully or attack me or others.  If you persist in flouting those rules--which, by the way, I would apply to anyone who behaves as objectionably as you do--you will be barred from posting in the future. It's your call.

-- Henci 

Amy Tuteur, MD (guest)

07/07/2008 3:10 AM Quote Reply

Could you please explain the rules?

Dr. Ho asked for clarification of links that I provided and I responded with the clarification and the exact relevant quotes. Why did you delete that post?

Angela Simpson
Posts:0

07/07/2008 8:24 AM Quote Reply
lol........ Maybe I'm missing it completely but he didn't ask for clarification. He posted the links that we've been asking for you to post. And then you refuted his well written piece with nothing but accusations and nothing to prove what you are saying, followed by a link to your own blog, again. (This message is hereafter directed to Tienchin.) Thank you, Tienchin for your post. It is exactly what I wanted to see. It feels like to me that these numbers really aren't a fair comparison to each other because there are entirely too many variables in the first place. What I wish these studies included was perhaps quality of prenatal care. I've been running this through my head time and time again while watching this conversation and it feels like these studies are simply looking at the wrong things. It seems rare to me that a neonatal death be directly linked to the actual birth when it gets as far as 28 days after, so how can that be used? (Or maybe there are factors that I'm not aware of?) That said, I don't think that these comparisons can be fairly used for either side of the debate. If there is proper prenatal care in a low risk woman, and proper monitoring during labor, it seems to me that an intrapartum death would be unlikely both at the hospital and at home for any other reason beyond a complication that would have ended in death anyway. A well trained midwife will see that there is a problem in time to transport the laboring woman while (if necessary) an operating room can be prepped for cesarean. If the woman is within an adequate amount of distance of the hospital, it doesn't seem to me that there would be any difference at all between hospital and home because even if she were in the hospital there would be a wait for the OR to get prepped. So really, the only difference that I can see is the type of fetal monitoring being used. A doppler doesn't print out a pretty piece of paper like a TOCO does, but you can still monitor the heart rate well, even during a contraction. In a hospital, they would basically do no differently than they would do at home, they just have more gadgets and infections laying around. So, if you have a well trained midwife, and you're within, lets say, a half hour of a hospital (enough time to prep the OR), and you've done well to take care of yourself and get adequate prenatal care.....what exactly is the advantage of a hospital birth? Because for me, those numbers say nothing. Tienchin, I think my question is what is the general consensus of what can be done better for a low risk, well prepared woman in labor in a hospital? I can't remember if I read that you are an advocate of home birth or not. I live in a state that outlaws home birth, and we now have a growing culture of unassisted births, which actually makes me a little scared. I think that home birth is a beautiful thing, but unassisted birth is not the way to go! I can understand the apprehension that may surround the idea of home birth, but I also feel that a woman's right to choose where she births should be number one. I don't know how it is that lawmakers can interfere with that.
Angela Simpson
Posts:0

07/07/2008 8:25 AM Quote Reply
I'm so sorry for my huge paragraphs replies. I can't figure out why my paragraphs don't space right.
maria (guest)

07/07/2008 10:12 AM Quote Reply
Thanks, Tienchin! This is very helpful!
maria.
Henci Goer
Posts:0

07/07/2008 1:49 PM Quote Reply
Posted By Amy Tuteur on 07/07/2008 3:10 AM

Could you please explain the rules?


You get one post and one rebuttal as follows:

  1. You post on a new topic.
  2. I respond.
  3. You rebut.
  4. I respond.

or

  1. You respond to a post of mine or someone else's.
  2. I respond.
  3. You rebut.
  4. I respond.

This provides a fair opportunity for you to make your case.

In light of what has gone on with this thread, I will add a new rule: You will respect my authority as moderator to declare a moratorium on a topic. I posted that there had been enough information and resource links on the issue of the MANA 2000 home birth neonatal mortality statistics for people to make their own evaluations. I could, of course, lock the thread so no one can post to it, but I'm not having a problem with anyone else, so rather than do that, I would rather handle the problem by dealing with you as an individual case. I am not singling you out. I would apply the same rules to anyone who behaves as you do, but so far, you are the only one.

-- Henci

Henci Goer
Posts:0

07/07/2008 1:56 PM Quote Reply
Posted By Angela Simpson on 07/07/2008 8:25 AM
I'm so sorry for my huge paragraphs replies. I can't figure out why my paragraphs don't space right.



When I type my posts and hit for a new paragraph, the software automatically puts an empty line between the paragraphs. If that doesn't happen for you, or if it happens when you are typing a post but not in the uploaded version, try hitting   twice when you want a new paragraph.

-- Henci

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