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n/a on 6/30/2008 11:58:18 PM |
| Subject: |
RE: two questions |
| Message: |
It is unfortunate that the data for 2001-2007 is not available. I look forward to its publication.
The data for 2000 published in the BMJ does not show that “homebirth with a CPM to have almost triple the rate of neonatal mortality as low risk hospital birth in 2000.”
The BMJ article takes 5418 women who intended to birth at home at the start of labor. Out of these “five deaths were intrapartum and six occurred during the neonatal period. This was a rate of 2.0 deaths per 1000 intended home births.”
Babies who die during labor and before birth are counted in intrapartum mortality rates.
Babies born alive that die in the first 28 days of life are counted in neonatal mortality rates.
So their home birth neonatal mortality rate was 6/5418 = 1.1 per 1000 births and their combined intrapartum and neonatal mortality rates was 2.0 per 1000 intended home births.
Ideally, the mortality rate of a cohort who had planned hospital births would be compared to this group of 5418 women. In addition, factors other than place of birth that could change the mortality rate such as practice patterns, prematurity, etc would be similar in both groups of births.
The authors of the BMJ article present several different sources for such a cohort to compare to their combined intrapartum and neonatal mortality rate. The combined intrapartum and neonatal mortality rates for hospital births ranged from 0.5 to 3.4 per 1000 births. Unfortunately the CDC National Vital Statistics Report on Infant Mortality Statistics from the 2000 period does not provide numbers for a matched cohort of births.
The fact is that all the existing scientific evidence to date shows clinically undetectable differences in neonatal mortality rates between planned home birth and hospital births. No good data demonstrates that neonatal mortality is lower in hospital births compared to home births.
Fortunately, no matter where a birth is planned, neonatal mortality is low. Unfortunately, for most families, scientific outcome measures are difficult to translate into a decision regarding where to birth. They have no way to measure what the local obstetrician’s or midwife’s neonatal mortality rates are. They may be exactly the same as those seen in published studies or they may be different.
Tienchin |
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