Nov 23, 2008 02:29 AM
Would you look at this study and tell me if this is of any value when talking about the safety of homebirth in low risk women? Isn't the home birth perinatal death still lower than the hospital one? Is that because there were less premies?
What are 'late neonatal death rates'?
Lisa, have you looked at this?
It's funny. I read a conclusion like this one and then read and try and understand the study in its proper light, and I go wait a minute, what exactly are they saying and how relevant is it.
Nov 30, 2008 02:11 AM
I have looked at it and have it in my files. To start with your question about definitions, the study looked at perinatal deaths, which investigators defined as stillbirths plus deaths within 28 days after birth. They further broke down neonatal deaths into deaths within the first week and late neonatal deaths. In other words, late neonatal deaths are deaths after day 7 through day 28.
The core issue was that the still birth plus death rate in the first 7 days (6.4 per 1000) was substantially higher than in other large studies of planned home birth with a qualified birth attendant conducted in the U.S., U.K., and the Netherlands (2.0-3.5 per 1000). The investigators attributed the difference to two main factors: First, Australian midwives were caring for babies who were not low risk (breech, twin, less than 37 weeks gestation, 42 weeks gestation or more) in the home birth setting. Study authors speculated that, "Overintervention and lack of choice for women with high risk pregnancies, however, could well encourage some to choose home rather than hospital birth. In many Australian hospitals, women with breech presentation or twins, for example, would only be offered caesarean section" (p. 387). (Sound like another country we know and love?) There also appeared to be failure of timely transfer in cases where there was meconium, episodes of slow heart rate, or both for several hours before fetal death. Study authors comment, "Our study highlights the need for objective guidance on what constitutes safe practice for birth at home" (p. 387), and conclude, "Australian women, like women elsewhere, will continue to choose to give birth at home. They and their infants are entitled to effective care and support in their choice." I would add that they are also entitled to hospital care that does not force them outside of the hospital in order to avoid overly interventive care with its attendant risks and unnecessary cesarean surgery.
All Times America/New_York
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