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n/a on 7/8/2008 3:01:23 PM |
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RE: two questions |
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Posted By n/a on 07/06/2008 4:44 AM
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.
You are right that you can't do the query on place of birth in 2000. You can in 2003 and 2004 though. But there is the rub...it is simply "place of birth" not "planned place of birth." 12% of women who start labor planning to birth at home end up transporting to the hospital...and likewise a certain percentage of women who plan to birth in a hospital will accidentally birth out of the hospital--happened to one of my clients with her second baby (ironically she had a lot of stress over her hospital choice because the hospital she'd used for her first baby closed its maternity ward during her second pregnancy, and she just wasn't sure she was going to like the alternate...turned out her labor went too fast for her to get to either of the hospitals). Also, there is a significantly larger number of women in the "other midwife" category than one would expect based on the 2005 BMJ study...which leads to the logical conclusion that many of those births were not attended by CPM's, but may have been attended by women with very little formal training. In my state, because of the Amish and Mennonite population, there are a lot of lay midwives who I'm told would not pass the NARM exam to get the CPM designation. This has made efforts to get legislation for licensure difficult. Amy believes of course that licensure will be the downfall of CPM's because she thinks it will expose them as being substandard care providers. I believe the opposite--that licensure will allow CPM's to be less hesitant to transfer care when it is meritted, thus increasing the safety for women and babies. |
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