FOR IMMEDIATE RELEASE
Contact: Mary Lawlor, CPM, 917-453-6780, president@nacpm. org
RE: Maternal and Newborn Outcomes in Planned Home Birth Vs. Planned
Hospital Births: A Meta-Analysis, Wax JR, Lucas FL, Lamont M, et al., Am
JObstet Gynecol 2010
____________ _________ _________ _________ _________ _________ _
__
High-quality research on the safety of out-of-hospital birth with
professional midwives is an essential support to good practice and to
continuous improvement in the delivery of services to women and infants.
Unfortunately, the recent meta-analysis by Wax, et al, of the Maine Medical
Center in Portland, Maine published online on July 1, 2010 in the American
Journal of Obstetrics and Gynecology (AJOG) on newborn outcomes in planned
home birth vs. planned hospital birth, is far from the high-quality rigorous
review that health care providers and the public expect. Not only are Wax's
conclusions in direct conflict with a growing international body of quality
research that demonstrates the safety of home birth for low-risk women and
their infants when attended by trained professional midwives, but his
methodology is deeply flawed. Rather than contributing to the improvement
of services and reliable information for childbearing women and providers,
his alarmist conclusions will only serve to support the increased use of
medical interventions in childbirth that have consistently been shown to
cause more harm than good to women and infants.
The widely publicized conclusion that implies risk to neonates is not
supported by the best quality data. Indeed this author acknowledges the
similar outcomes of low neonatal mortality shown by most of the articles he
reviews, yet amazingly arrives at an opposite conclusion by using statistics
drawn from several highly criticized and poor quality studies. Michael C.
Klein, MD, a University of British Columbia emeritus professor and senior
scientist at The Child and Family Research Institute in Vancouver, states,
"A meta-analysis is only as good as the component studies. When the author
does his sensitivity analysis, after excluding the old and lower-quality
papers, there is no statistically significant difference in either perinatal
or neonatal mortality by place of birth."
Among the many flaws and troubling inaccuracies in this analysis are: Wax's
misrepresentation of the support of listed citations for his claims for
increased neonatal mortality; referral to studies that are poorly designed
and which mix low-risk and high-risk cases; failing to account for the
quality of the trials included within the inclusion and exclusion criteria;
the omission of several key, well-designed studies; and the flawed and
completely unsubstantiated association of low-intervention maternity care
with increased newborn death. His discussion includes findings from his own
poorly designed review based on birth certificate data which is known to be
unable to differentiate between planned and unplanned home birth and is
therefore unreliable in studying neonatal outcomes. And by his selection
criteria and careful crafting of his search strategy, the author has managed
to eliminate the only prospective study of planned home births in the United
States. This study demonstrates excellent outcomes for both mothers and
infants in the care of Certified Professional Midwives (CPM) (Johnson &
Daviss, BMJ, 2005).
His flawed analysis of neonatal death rates downplay the fact that the very
studies used in Wax's review demonstrate that mothers choosing home birth
have better outcomes in every single measure of maternal and neonatal
well-being over mothers having hospital births. Wendy Gordon, CPM and
Director of Research Education for the Midwives' Alliance Division of
Research, states: "When the authors removed the flawed data in their study,
their own results show that there is actually no difference in the rates of
deaths between home and hospital, a conclusion that has been supported over
and over by high-quality research. In a stark move that can only be assumed
to be politically- motivated the authors don't even mention this lack of
difference in the neonatal mortality rate in their final conclusion."
Women and families deserve to know the truth, and the authors of this study
are obscuring important information about the safety of home birth and
neonatal outcomes. The mixing of poor-quality and high-quality studies from
countries all over the world leads to defective research design, and the
misleading conclusions about neonatal mortality do nothing to help U.S.
women understand the true risks and benefits of home birth versus hospital
birth.
Contact: Mary Lawlor, CPM, 917-453-6780, president@nacpm. org
RE: Maternal and Newborn Outcomes in Planned Home Birth Vs. Planned
Hospital Births: A Meta-Analysis, Wax JR, Lucas FL, Lamont M, et al., Am
JObstet Gynecol 2010
____________ _________ _________ _________ _________ _________ _
__
High-quality research on the safety of out-of-hospital birth with
professional midwives is an essential support to good practice and to
continuous improvement in the delivery of services to women and infants.
Unfortunately, the recent meta-analysis by Wax, et al, of the Maine Medical
Center in Portland, Maine published online on July 1, 2010 in the American
Journal of Obstetrics and Gynecology (AJOG) on newborn outcomes in planned
home birth vs. planned hospital birth, is far from the high-quality rigorous
review that health care providers and the public expect. Not only are Wax's
conclusions in direct conflict with a growing international body of quality
research that demonstrates the safety of home birth for low-risk women and
their infants when attended by trained professional midwives, but his
methodology is deeply flawed. Rather than contributing to the improvement
of services and reliable information for childbearing women and providers,
his alarmist conclusions will only serve to support the increased use of
medical interventions in childbirth that have consistently been shown to
cause more harm than good to women and infants.
The widely publicized conclusion that implies risk to neonates is not
supported by the best quality data. Indeed this author acknowledges the
similar outcomes of low neonatal mortality shown by most of the articles he
reviews, yet amazingly arrives at an opposite conclusion by using statistics
drawn from several highly criticized and poor quality studies. Michael C.
Klein, MD, a University of British Columbia emeritus professor and senior
scientist at The Child and Family Research Institute in Vancouver, states,
"A meta-analysis is only as good as the component studies. When the author
does his sensitivity analysis, after excluding the old and lower-quality
papers, there is no statistically significant difference in either perinatal
or neonatal mortality by place of birth."
Among the many flaws and troubling inaccuracies in this analysis are: Wax's
misrepresentation of the support of listed citations for his claims for
increased neonatal mortality; referral to studies that are poorly designed
and which mix low-risk and high-risk cases; failing to account for the
quality of the trials included within the inclusion and exclusion criteria;
the omission of several key, well-designed studies; and the flawed and
completely unsubstantiated association of low-intervention maternity care
with increased newborn death. His discussion includes findings from his own
poorly designed review based on birth certificate data which is known to be
unable to differentiate between planned and unplanned home birth and is
therefore unreliable in studying neonatal outcomes. And by his selection
criteria and careful crafting of his search strategy, the author has managed
to eliminate the only prospective study of planned home births in the United
States. This study demonstrates excellent outcomes for both mothers and
infants in the care of Certified Professional Midwives (CPM) (Johnson &
Daviss, BMJ, 2005).
His flawed analysis of neonatal death rates downplay the fact that the very
studies used in Wax's review demonstrate that mothers choosing home birth
have better outcomes in every single measure of maternal and neonatal
well-being over mothers having hospital births. Wendy Gordon, CPM and
Director of Research Education for the Midwives' Alliance Division of
Research, states: "When the authors removed the flawed data in their study,
their own results show that there is actually no difference in the rates of
deaths between home and hospital, a conclusion that has been supported over
and over by high-quality research. In a stark move that can only be assumed
to be politically- motivated the authors don't even mention this lack of
difference in the neonatal mortality rate in their final conclusion."
Women and families deserve to know the truth, and the authors of this study
are obscuring important information about the safety of home birth and
neonatal outcomes. The mixing of poor-quality and high-quality studies from
countries all over the world leads to defective research design, and the
misleading conclusions about neonatal mortality do nothing to help U.S.
women understand the true risks and benefits of home birth versus hospital
birth.
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