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March 27th, 2013, 04:45 AM
Based on a True Story
Join Date: Jun 2008
Location: Texas and stuff
Originally Posted by
Here is the link to the Oregon study that I referred to. In Oregon, planned homebirth with a direct-entry midwife is not illegal, and the state specifically collected information about birth outcomes and planned-site-of-birth in order to properly address the question of out-of-hospital safety.
Here are my issues with this information:
1. As someone else pointed out, this is not a "study." These are statistics. Two very different things.
2. These statistics cover roughly 40,000 (ish) births in the state of Oregon. Correct me if I'm wrong, but I'm fairly positive that there are 49 more states in this country. I'm not sure how anyone can be expected to make an informed decision based on data that is so painfully incomplete.
3. Where is the information detailing the cause of death in any of these scenarios? If 25 hospital births resulted in death, then we can conclude that deaths DO occur in hospitals during or shortly after labor. We can also conclude from the data that deaths occur during home births as well. However, because deaths occurred in both locations, we CANNOT conclude that the OOH deaths occurred due to the result of a lack of medical interference. We can assume all we want, but that doesn't make it true.
4. The number of IP deaths were not included in the in-hospital statistics. The statistics given explain this by saying that the number is extremely low and then goes on to give an estimated rate based on studies in two completely different countries. These studies are not cited.
5. The number of in-hospital deaths that were caused by congenital abnormalities is not given.
6. These are the statistics for 2012. Where are all the other years? One year is incomplete data.
I also found this quote in another article commenting on Judith Rooks' findings:
"The article quotes Ms. Judith Rooks as stating that in “Oregon hospitals,.. there were 25 neonatal deaths out of 40,000” births. This statement should be explained. Ms Rooks is referring to the loss of a baby during the time of birth. The hospital neonatal mortality rate for term babies was stated as being 2.1 per thousand for that year (an unusually low number). I wish it could be accurately stated that only 25 term babies died out of 40,000 births, but sadly this is not true; there were actually 84. The mortality rate in the US may be close to the achievable minimum in preventable deaths, but we do want to continue to work to lower it!"
"'The article says that Ms. Rooks “cited statistics showing last year in Oregon, direct-entry midwives attended 7 infant deaths out of 1,200 births — a rate 8 times higher than in Oregon hospitals” .
I have the report which Ms Rooks was reading from and there are some errors in this article. The report is “ Preliminary Data on Oregon Birth Outcomes, by Planned Birth Place and Attendant Pursuant to: HB 2380 (2011)” No authors are listed, but it is from the Public Health Division Directors Office .
There is no quotation in this report of a death rate 8 times higher than hospital, and there were not 7 “infant” deaths. Three of these losses occurred in the days or weeks before labor ever began; just four babies were lost after birth. The report lists the term mortality rate of hospital born babies as being 2.1 per thousand, and the out-of-hospital rate as 4 per thousand. At no point does the report ever state that the homebirth loss rate was 8 times higher than the hospital loss rate.
That report states there were 1,995 planned out of hospital births (home or birth center): that midwives attended 1235 of them (at least a third of these would have been in a Birth Centers. The term Out-of-hospital may mean Birth Center, Clinic, or home.) Licensed midwives attended 1040 births, and nonlicensed midwives attended 195. The rate of lost babies was statistically identical for both LDEMs and nonlicensed midwives. Based upon this report from a single year or statistics, licensed midwives and non-licensed have the same birth outcome, and there would be nothing gained from mandatory licensure.
Statistics are difficult things. They can be used to demonstrate trends and facts, but often can cloud an issue. A different way of looking at this data collection would be to include only the four losses which occurred during labor or birth, because this the midwife's role. This intrapartum loss would calculate out to 3.3 per thousand, which is closer to the hospital statistics of 2.1 per thousand.
It is difficult to compare rates when the number of events is very small: when the rates are close: and when there is only single year of statistics. When dealing with low numbers, even one event can skew the rates severely and result in inaccurate conclusions of the data. To avoid error, most studies of this size will gather years of data before publishing. The rate of hospital loss in this data collection was unusually low that year. Oregon rates are usually closer to 3 per thousand (For example, in 2009, the last year of available data, the rate of loss at term in Oregon hospitals was 3.2 per thousand.). The rate of loss in the homebirth group was also unusually high due to two losses at twin births (generally considered higher risk and seldom attempted at home). Subtracting just these two from the neonatal loss would bring the rate to 1.6 per thousand. If this had been a more typical year, the rates of home and hospital birth would likely be closer, and almost identical as they have been in most years"
My biggest problem with what you posted is that it tells an incomplete story. Most of the information I found on Judith Rooks came from a blog written by a doctor named Amy Tuteur who openly expresses her disdain for home births and accuses midwives of hiding statistics in order to commit insurance fraud. Is she right? Maybe. It's one opinion, in any case.
That said, I don't see many doctors keeping track of adverse event statistics to the mountains of medications they prescribe every year... but whatever.
You have also missed the POINT of these statistics. Judith Rooks thought it was important that midwives in Oregon meet higher requirements to practice, and I can't say that I don't agree. After she gave testimony to this information, a bill was passed in Oregon stating (among other things) that this was no longer an option for midwives and they must all now practice under license and be subject to investigation by the State Board of Direct Entry Midwifery.
As you can see... all of this is up for debate in Oregon just like it is on these boards. Whether by doctors or regular moms just like us. But for you to come here and say you found these numbers and therefore home births are not safe is honestly pretty ridiculous considering how incomplete your information is.
Find an actual study. Complete and unbiased. THEN come argue statistics. Because one year in Oregon isn't cutting it.
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