- The study doesn't indicate which of the homebirth babies who died or had complications were actually born in the hospital. Pang and colleagues make much of the fact that 10 of the 20 babies who died had diagnoses of congenital heart disease or respiratory distress. They argue that the outcome in these cases might have been different had the baby been born in the hospital. An additional three babies in the homebirth group had major congenital anomalies, another situation where hospital birth might affect survival. Most of these babies probably were hospital births.
The Washington State government study, which followed women who received prenatal care from licensed midwives, reported that nearly all newborn deaths occurred in the hospital (3). They took this as an indication of appropriate transfer of high-risk cases. In any case, the possibility of heart defects or other major congenital anomalies makes an argument for an ultrasound scan to screen for them, but it doesn't indict homebirth per se.
- The study doesn't consider whether more babies died of congenital heart problems or other major anomalies in the homebirth population because these conditions were more common in the homebirth population. The Washington State government study reported that 7 per 1,000 women receiving prenatal care from licensed midwives versus 2 per 1,000 in the background population had babies with a major malformation. This difference is probably because this is a group that is less likely to terminate a pregnancy (3).