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Subject:	Neonatal death rate 2000
Body:	<div class="NTForums_Quote">Posted By Archived User on 01/15/2007 9:51 PM<br>Amy, Amy, Amy, give it a rest. I'm going to paste in my response to the excess neonatal death rate argument you made in the Lamaze blog some weeks ago. As I pointed out, you were using the wrong statistic for making the comparison then, and you are still using the wrong statistic now. <BR> <BR>Pasted in from <a target=new class=ftalternatingbarlinklarge href="http://birthwithconfidence.blogs.lamaze.org/?p=113#comments">Lamaze blog thread</a>: <BR> <BR>"Amy Tuteur has made the egregious error of comparing apples to oranges. She cites a neonatal death rate (babies born alive who die on or before the 28th day of life) of 1 per 1000 in low-risk white women and compares this rate with two home birth studies (Murphy and Fullerton 1998 and Johnson and Daviss 2005) in order to show that home birth results in an excess of deaths. However, contrary to her assertion, the studies she compares unfavorably with her statistic report neonatal deaths PLUS intrapartum deaths (babies alive at the start of labor who are born dead). <BR> <BR>Fortunately, both studies allow us to calculate neonatal mortality rates so that we can compare “apples to apples.” Johnson and Daviss report 11 deaths overall in 5418 women intending home birth at the onset of labor. Of these, five were intrapartum deaths and six were neonatal deaths. The neonatal death rate (6/5418) in the Johnson and Daviss study calculates to—wait for it—1 per 1000. <BR> <BR>"Turning to Murphy and Fullerton, Tuteur incorrectly states that the neonatal death rate was 4.1 per 1000. In actual fact, the intrapartum plus neonatal death rate was 2.5 per 1000 (3 intrapartum or neonatal deaths in 1221 women) in women who had a baby alive at the start of labor. The 4.1 number included two women whose babies were not alive at first labor examination and who were immediately transferred to hospital care. Only one of the three remaining deaths was a neonatal death, so again, the neonatal death rate (1/1221) calculates to 0.8 per 1000 or roughly 1 per 1000. <BR> <BR>"Of further note, two of the three deaths in Murphy and Fullerton could have had nothing to do with the choice to birth at home. In one case, the woman was transferred to the hospital during labor for slow progress and meconium passage. The fetal heart rate was normal at hospital admission. She labored several hours more in the hospital and delivered a stillborn infant. Meconium aspiration was listed as the cause of death. The second infant died a day after birth and postmortem studies could not establish a cause. The third case was the home birth of a stillborn infant in the presence of meconium." <BR> <BR>-- Henci <BR> <BR> By: Henci Goer</div><br><br>
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