- The authors misrepresent the planning status of homebirth women who were transferred into the hospital. The study includes hospital transfers if the birth certificate "indicated that delivery was initially attempted at home by a health care professional." But a perusal of the birth certificate form reveals that there is no place to indicate who attended the mother at home when the baby was born in the hospital. This means that home-to-hospital transfers are actually a mixture of births with a trained attendant and births that were not. Homebirths with no trained attendant have much higher risks (2,13).
- The Pang study includes homebirths as early as 34 weeks of pregnancy. No competent homebirth attendant knowingly attends a preterm labor at home. The authors don't state how many births between 34 and 37 weeks were included, but you can derive it: it's a mere 1 in 100. Undoubtedly, most of them resulted from due-date miscalculations and were near full-term. But by including the 34 to 37 week range, the study gives the misimpression that preterm labor at home is accepted practice.
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