Pregnant with controversy: Nursing Review Article

[Schmickers]

An interesting article, SB.

It is unfortunate for Keirse et. al. that they chose to word their study in the way that they did - drawing assertions in the article that were not supported by the data. If the data need to be looked at in context, and the small confidence intervals limit the usefulness of the data (which is true, they do), then why make the declarations that they do? That intrapartum mortality is seven times higher, that birth asphyxia is 27 times higher? Why not simply tell the truth - that they were unsuccesful in recruiting enough valid homebirths to the study to draw meaningful conclusions? Why claim that closer monitoring might have changed the outcome of a stillbirth when there is no such evidence to support that claim?

It is certainly true that the AMA have sensationalised the study in a vain attempt to use it to support their unjustified opposition to homebirth, and I do feel for the authors that the message they wished to convey is being missed. But this is as much their fault as the AMAs. The way the study was conducted was fundamentally flawed. It failed at the very first hurdle - accurately classifying those women who had a homebirth - and therefore, any results from the study are simply invalid. This is the fault of no one but the authors.

[AngelsMum]

He says this:

Home birth groups are saying the study is flawed while doctors are saying babies born at home will die,” he said.

then this:

the findings of a sevenfold higher risk of intrapartum death for home births needed to be looked at in context.

Nine deaths occurred among the home birth group, but seven of those occurred in hospital after the mother had changed her mind against a homebirth or needed transferring.

“It’s also disappointing that the positive benefits of home birth reported in the study have not made it into many articles. There was significantly less intervention in the home birth group with 9 per cent of women who planned a home birth having a caesarean, compared to 27 per cent in the hospital group.”

And from the Professors' critical look

You would need more than 10,000 births at home to show clinical relevance and have some confidence in the statistical significance in relation to perinatal mortality rates.

Isn't this what the home birth groups are trying to point out?