A Letter to "Time" on Home Birth
By Rachel Walden — October 5, 2010
Last month, Time magazine published an article, American Women: Birthing Babies at Home, which covered the small but increasing number of women choosing home birth, the legal status for providers, safety issues, and the debate over home birth in general. It included commentary on the Wax meta-analysis, summarizing the controversy thusly:
The authors of the paper, which consists of a review of 12 previous studies, acknowledged significant benefits associated with home birth: fewer maternal interventions, including epidurals, episiotomies and C-sections; and fewer cases of premature birth and low birth weight.
But the finding that made headlines was that planned home births led to a two-to-three-times higher risk of neonatal death than planned hospital deliveries among healthy, low-risk women.
Time reporter Catherine Elton notes that the study’s lead author Dr. Joseph Wax “cautions against alarm,” quoting him as stating: “Home birth is quite safe for the baby. But not as safe as a hospital birth.”
Below is an unpublished letter to the editor of Time coordinated by OBOS’s Judy Norsigian:
Catherine Elton’s recent article is a thoughtful analysis of the the fragmented and sometimes underground system of home birth care in the United States, and the reasons women access it in spite of these shortcomings. However, in her discussion of the recent high-profile meta-analysis showing a significantly higher neonatal death rate in home birth compared with hospital birth, Elton states that the meta-analysis included hundreds of thousands of births, but fails to make it clear that the researchers’ calculation of neonatal mortality risk was not based on hundreds of thousands of births…not by a long shot. For reasons that are unclear, the researchers excluded from their neonatal mortality analysis a study that included over a half-million births, leaving fewer than 10,000 planned home births in their calculations of newborn death rates. The large Dutch study that was excluded found identical, very low rates of newborn deaths in the first week of life in both the planned home birth and planned hospital birth groups, and these data come from much more reliable databases than the Washington study, which the meta-analysis researchers included and which Elton acknowledged was flawed. All reliable data on home birth midwifery in regulated and integrated systems like the Netherlands and Canada suggest that home birth is safe for the baby and associated with significant health benefits for the mother.
Marjorie Greenfield MD, FACOG
Professor, Obstetrics and Gynecology
Division Director, General Obstetrics and Gynecology MacDonald Hospital for Women University
Hospitals Case Medical Center Case Western Reserve University School of Medicine, Cleveland Ohio
Mark Nichols, MD, FACOG, Professor, Chief of General Gynecology & Obstetrics, Oregon Health and
Elizabeth Allemann, MD, Family Physician, Columbia, MO
Lucy Candib, MD, Professor, Department of Family Medicine and Community Health, University of
Massachusetts Medical School, and Family Health Center of Worcester, MA.
Eugene Declercq, PhD, Professor of Maternal and Child Health, Boston University School
of Public Health Daniel Grossman, MD, FACOG Senior Associate, Ibis Reproductive Health
Michael C. Klein, MD, CCFP, FAAP (Neonatal-Perinatal), FCFP, ABFP, FCPS, Emeritus Professor
Family Practice & Pediatrics, University British Columbia, Sr. Scientist Emeritus, Child and Family
Research Institute, BC Children’s & Women’s Health Centre Vancouver, BC Canada
Michael C. Lu, MD, MPH, Associate Professor of Obstetrics, Gynecology and Public Health, UCLA (Los
Lauren Plante, MD, MPH, FACOG, Associate Professor, Obstetrics & Gynecology, Thomas Jefferson
University (Philadelphia, PA)
Amy Romano, MSN, CNM Author, Science and Sensibility blog: www.scienceandsensibility.org/
Judith Rooks, CNM, MS, MPH, midwife and epidemiologist, Portland, OR
Sara G. Shields, M.D., M.S., FAAFP
Clinical Associate Professor of Family Medicine and Community Health University of Massachusetts
Family Health Center of Worcester, Worcester, MA 01610
Mark Sloan, MD, pediatrician and author of Birth Day: A Pediatrician Explores the Science, the History,
and the Wonder of Childbirth,
Naomi E. Stotland MD, FACOG
Associate Professor, Department of Obstetrics, Gynecology, and Reproductive Sciences University of
California, San Francisco, San Francisco General Hospital
Cornelia van der Ziel, MD, FACOG, obstetrician, Harvard Vanguard Medical Associates, Cambridge,
OBOS urges all readers to share this letter with maternity care providers who may not have had time to fully read or consider potential limitations of the Wax study.
Thank you, Ms Norsigian for coordinating this letter. At the same time can’t believe that it went unpublished when it should have been published. As for me I know about this until now. Also, I found that I’m in the middle of this and have no clue which side I will ultimate head up on. Found both types to be proven to be effective, but at the same time theres proven risks to it. Haven’t really done any serious learning and researching on this or etc as well. Basically, its a huge subject and etc.
Thank you for writing about this, Rachel! And thank you to Judy and all who signed onto the letter. It’s a wonderful, concise response to a home birth analysis which, unfortunately, was highlighted more for its sensationalism than authenticity. However, it’s thanks to you all and so many of us who work to counter this misinformation that, hopefully, women who are searching for answers about the safety of different birthing environments and birth attendants, and who want honest information, will find what they need.
I’m not sure how to make an informed decision about homebirth in the US by comparing births in the US, births that are in the context of a “fragmented and sometimes underground system” with births in countries where midwives receive greater training, and have more integrated back-up and transport than can be found in most states here. Is it fair to tell US women that homebirth is safe when our system lags behind Canada and the Netherlands?
Thank you for sharing that – those are essential details, that everyone who wants to consider the validity of the Wax meta-analysis should have access to.