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  #43  
March 27th, 2013, 06:39 PM
LadyMorgan LadyMorgan is offline
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Join Date: Feb 2013
Posts: 61
Thank you for posting your statistics Val. I have a few of my own to post.

This is data from the CDC Wonder website, which publishes the causes of mortality for ALL deaths in every state in the United States, from any cause, as well a huge number of other health statistics. The website is http://wonder.cdc.gov/, anyone can log in and use the data that is published there, so you can independently verify this.

Looking at the most recent set of data, from 2007 and 2008, lets look at the Linked Birth/Infant Death records for white women between the ages of 20 and 44, with full term deliveries (37+ weeks and a weight of 2500+ grams). First lets see how many births occur in the hospital vs. outside of the hospital, for each of three categories of birth attendant: Medical Doctor (MD), Certified Nurse Midwife (CNM), and Other Midwife. This category of Other Midwife does not specify whether or not they are Certified Practical Midwives (CPM) or not. The category of MD does not specifiy if they are OB/GYNs or not, but knowing the US medical system I would suspect that they are. Feel free to copy/paste this into Excel to make it easier to read.

Medical Attendant "In Hospital" "Not in Hospital" Total % OOH
Certified Nurse Midwife(CNM) 302516 14778 317294 4.66
Doctor of Medicine(MD) 3652738 2429 3655167 0.07
Other Midwife 6855 19526 26381 74.02

We see here that a small percentage of births attended by CNMs (4.7%) occur out of hospital, a tiny percentage of births attended by MDs (0.07%) occur out of hospital, and a substantial percentage of births attended by "Other Midwife" (75%) occur outside of the hospital. There are some surprises here...I'm surprised that any births outside of the hospital are attended by MDs...maybe these are precipitous births that an MD rushes too? I'm also surprised that 25% of births attended by "Other Midwife" occur in the hospital. Maybe these are properly transferred births that developed complications? Maybe these are students training to be Nurse-midwifes, but not yet graduated?

OK, now lets look at the neonatal deaths (0 to 27 days after birth) occuring in each situation. Unfortunately this dataset does not contain info on stillbirths or babies born with hypoxic brain injuries, so death is the only adverse outcome we have to look at.

Attendant Birthplace Deaths Births death rate per 1K
MD Hospital 2065 3652738 0.57
MD OOH 5 2429 2.06
CNM Hospital 109 302516 0.36
CNM OOH 10 14778 0.68
Other MW Hospital 5 6855 0.73
Other MW OOH 28 19526 1.43

Hmmm...the highest death rate is among MDs attending out-of-hospital births. This would indeed be consistent with the possibility of these being precipitous or emergency births. Or maybe these are doctors attending planned home births, but I rather doubt it. The next highest death rate is with "Other Midwife" attendants at out-of-hospital births. Since the bulk of the births with Other Midwife attendants are OOH births, it does seem likely that these are planned.
The lowest death rate is among births attended by CNMs in the hospital...no surprise there since CNMs are highly trained professionals and they work with low-risk patients. Interestingly, the death rate for births that CNMs attend outside of the hospital is almost twice as high as for the births CNMs attend in the hospital. The second lowest death rate is among births attended by MDs in the hospital.
Now, lets calculate how many deaths would have been expected among births attended by "Other Midwife" attendants, if that death rate had been the same as it is for doctors or CNMs inside the hospital. For 19526 births, the expected number of deaths would have been 11 and 7, respectively. However, for those same 19526 births, the actual number of neonatal deaths was 28.