Thanks for sharing Blade.
I need to throw this in the mix.
As Blade - I think - was trying to point out, hospital births with midwives are the "lowest" in risk not only because of the midwives skill level but also their proximity to emergancy care. The same midwife-group in a home setting could end-up with very different statistics should emergancy care for mother and child be 5 minutes away.
The idea is that if you are having an uncomplicated birth it doesn't really matter where you are.
However, should their be a complication or emergancy situation you and your child are statistically better off in a hospital which is equipped to handle such emergencies. (Also something important to consider when doing research early on).
The reason why the hospital-midwife statistics are lowest isn't necessarily that they are the "best" but because they only get the numbers for the uncomplicated hospital-births while high-risk pregnancies and complications are immediately transferred to a doctor. (So obviously the doctors numbers are skewed because they include almost all of the hospitals high-risk pregnancies).
Yes, these are American statistics but the general findings probably don't change much (at least for hospital-midwives vs hospital-doctors) in any country with a comparable medical-skill level). This has nothing to do with who the midwife is but purely what location the baby is born in. Saying that home-births in New Zealand or Australia are "safer" because it's the same midwife as in the hospital is fallacious. It may very well be the case that they are better trained and have higher professional requirements (which is always awesome), but you can't compare personal numbers to location numbers -> it's like comparing apples and celery.
Interesting post! I am not very good with all the numbers/statistics but reading your final statement helped keep me in the mind set of why I want to have my first child and all children probably in a hospital with the professionals. I know two people who had their first child at home and it totally freaks me out. Granite it went well for them. But my thoughts are, do they know what they are truly doing (midwives)? Do they have machines monitoring my baby, and what if something where to go wrong how much of a window period do you truly have to rush yourself and your baby to a hospital? Too many risky factors with a home birth to ever do it. Great article Blade!
Very important research! I am really glad someone did an extensive study on this. Personally, I've always felt much safer in a hospital than most people probably do (had a parent in healthcare) so I'm gratified to hear that the birth setting I've used is probably the safest.
My only question is, from my limited memory of stats, what about the sample size of 14,000 observations? Is that "large" enough to cause issues with p-values and goodness of fit?
I'm not super experienced with big data sets, just genuinely curious about how the info would be interpreted, since I will eventually be doing a research project for my masters.
I have seen studies that are studies that dispute safety of hospital births.
Here's one that suggests that homebirth is MUCH safer for the mother (particularly 2nd+ time moms) than hospital birth: http://www.bmj.com/press-releases/20...ng-home-births
I will be having a homebirth with a midwife (certified nurse midwife, not a CPM or DEM). I am well-educated on my options and this is my second low-risk birth. After 2 full days on pitocin in the hospital with an OB for my first (no epidural TYVM), I'm 100% confident that the best place for my baby to be born this time is right at home. I'm a trained doula myself and have attended numerous home births. I have no reservations about them for the right birth and with the proper support. My midwife and her staff are fully trained in neo-natal resuscitation and carry all the necessary supplies such as masks and O2 tanks. I also live about 5 minutes from a major trauma center.
Women need to know their options and know their health history and risks. I also find it critical that parents-to-be prepare themselves with a comprehensive childbirth course over several weeks such as Bradley Method or Informed Beginnings. Informed consent cannot be given for procedures if mom is not actually informed first and only fear is used to sway her towards the decision that the doctor wants her to make. Hospital classes do not prep new moms as well as they should.
IMO, Posts like this only breed fear and are biased, particularly when it's unknown what the provider's credentials actually are.
Blade said homebirth midwives in the US are all completely unqualified (which isn't actually true, there are both lay and qualified midwives who handle homebirths there) vs professional, qualified midwives who work in hospitals. Any country which has lay midwives operating is going to have completely different homebirth stats than countries which don't. And actually, I think it's a big shame they didn't differentiate between the qualified and unqualified midwives. I agree that having an unqualified midwife attend your birth is unsafe (wherever you birth), but that doesn't make *homebirth* intrinsically unsafe, it makes your midwife unsafe.
From the body of the paper:
"Patients delivering at home attended by midwives were significantly more likely to be
multiparous, non-Hispanic white, ≥30 years of age, delivering beyond 41 and 42 weeks,
and having macrosomic infants over 4,000 and 4,500 grams (p<.0001)."
It seems biased to me to exclude small and premature babies (more likely to be born in a hospital) but not to exclude large and post-dates babies (more likely to be born at home).
Also worth noting:
"The CDC data on seizures or serious neurologic dysfunction include those
of genetic, prenatal, intrapartum, and neonatal origin that might not be related to birth
Finally... aside from some basic exclusions (premature, low birthweight, multiple gestations) I can't find any qualifier about how many of the births were classed as low risk. Given that nearly all health providers only recommend homebirth for low risk pregnancies - but often homebirth stats include high risk women who birthed at home anyway - that seems like a pretty serious oversight. Studies that compare only low risk births often find little difference in outcome between hospital and home.
It seems fairly self-evident to me that giving birth in a setting with medical intervention on-hand is going to be "safer" for complicated births (and of course you never know whether this will be the case until it is too late).
However, I still believe that there are other factors to consider that would sway some mothers towards a home birth, despite the need to travel to hospital if things go horribly wrong: the comfort of being at home, having complete control over the birth setting and the birth. For instance, if you have had an uncomplicated first birth, some women may be willing to trade the risk of a 15 minute ambulance ride for the security of knowing that they won't receive any unnecessary intervention (I've heard that my closest hospital will transfer a woman from the midwife led unit to the delivery suite for medical intervention if her labour is not progressing quickly enough after four hours - I don't like the idea of being on a stop watch, and all medical intervention carries its own risks).
So, the statistics around safety are only one factor (if arguably the most important) in making a decision about where to give birth.