Homebirth: Is homebirth really a safe birth option?

  • The authors don't tell you that these outcomes are only a few of a long list found on the birth certificate form. Other relevant items on this list are first-time cesarean, forceps delivery, vacuum extraction, umbilical cord prolapse, fetal distress, birth injury, meconium (the baby's first stool) aspiration syndrome, breathing assistance for less than 30 minutes, and newborn seizures. Researchers aren't allowed to cherry-pick results. Omitting the rest of the list gives the false impression that planning homebirth is riskier than it really is. Pang and colleagues' silence also raises the question of whether the authors have chosen to suppress outcomes that favor homebirth. Indeed, that they do this in one case increases suspicion that they might have done it elsewhere. Buried in a table, but otherwise unmentioned, is the information that despite being equally low-risk, more low-birth-weight babies were born in the planned hospital population (2.3% versus 1.3%).
  • The relevance of two of Pang and colleagues' choices can be questioned. Postpartum bleeding with no qualifying information isn't useful. Did the mother require a transfusion? A hysterectomy? Become severely anemic? If none of the above, so what? As for prolonged labor, it has little association with poor infant outcomes. Long labors can be hard on mothers, but, no doubt, the hospital women had their labors cut short by cesareans, which can be even harder.
  • Confining the study to birth certificate data will miss relevant outcomes. The birth certificate lacks check-boxes for maternal or newborn infection and for maternal injuries such as anal tears. These complications will likely be more common in women planning hospital births because C-section, vaginal instrumental delivery and episiotomy cause them.
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