Sunday, March 9, 2014
POINT OF CONTENTION
Home births are significantly more dangerous than hospital births for babies, according to a new international study by doctors at Maine Medical Center.
The paper, published last week in the American Journal of Obstetrics, said normal newborns are three times as likely to die after a planned home birth than after a planned hospital birth. When all babies were counted, including those with congenital problems, the risk is twice as high after planned home births, the paper said.
The study by Maine's largest hospital is facing an immediate backlash, however, both here and abroad. Some home-birth midwives and researchers are calling the paper biased.
"It's a very emotionally laden topic. It's a highly charged area to delve into," said Joseph Wax, a doctor of maternal and fetal medicine at Maine Medical Center and the lead author of the paper. "It's based on the available facts. There are still facts that need to be uncovered and hopefully this will encourage folks to embark on those studies."
Wax and the Portland-based research team combined previous studies from several developed nations, including the United States, Canada, the United Kingdom and Australia. The comparable risks may be different in the United States and Maine, where about 1 percent of babies are born at home.
"There is, unfortunately, quite a dearth of data on home births versus hospital births in the United States," Wax said.
The findings were not all good for hospitals. Wax found that hospital births are more risky for mothers because they are more likely to experience bleeding, infections and other complications.
Wax also said that, despite the difference, the risk of babies dying is small whether born at home or in a hospital. Fifteen in 10,000 babies died after having a planned home birth, compared with four in 10,000 after a planned hospital delivery, according to the study.
Wax said he and the local researchers took on the study because of a lack of related data, especially data that compares planned home deliveries with planned hospital deliveries.
Past studies have overstated the risks of hospital births by including births that were planned to take place at a home but ended up taking place in hospitals because of medical complications, he said. The Wax study instead counted those births as planned home births.
The researchers can't say for sure, but they suggested the higher risk of home births is due to less medical intervention in such emergencies as respiratory distress. They also say home-birth mothers are generally lower-risk and should anticipate more favorable outcomes.
Robin Illian, a Portland-based certified professional midwife who attends about three home births a month, said the findings don't change her views.
"It does surprise me. That's not what I see. We take really good care of babies and we're conservative. We don't stay home if we see any signs of fetal distress," she said.
If a baby shows signs of trouble, Illian takes the mother to Maine Medical Center to complete the delivery, she said. That relationship with the hospital, along with trained and certified midwives, makes home births a safe alternative, she said.
The new study may reflect practices in other countries more than here, she said.
"It's a big difference from what every other study has been saying," Illian said. "I hope that it spurs some more research so we can find out if this is really true in the U.S."
Nell Tharpe, a certified nurse midwife and midwifery teacher from Boothbay, said the paper is biased and overstates what the data says.
"The authors are very clear at stating the position of the American College of Obstetricians and Gynecologists (to not support home births) and they apparently have that bias throughout the paper," she said. "There are a number of very large studies in other countries that make clear statements" about home births being safe.
Tharpe said the bias against home births sometimes creates tension between hospital personnel and midwives. "Women should have a full range of choices about where to have babies. Home birth can be a safe option for carefully selected low-risk women," she said.
The study has also been criticized in other countries where there are similar tensions between hospitals and home-birth midwives.
Dr. Michael Klein, a University of British Columbia professor who has studied home births in Canada, called the conclusions "crap," according to the Canadian Broadcasting Corp. "It's a politically motivated study that was motivated by the American College of Obstetrics and Gynecology (which) is unalterably opposed to home birth, and they probably were quite happy to publish this article because it fits with their political position," he told the CBC.
Wax said he knew the findings would be controversial. But, he said, he hopes they ultimately help reduce health risks to mothers and babies.
"I think (Klein's) response to our publication demonstrated just how powerfully charged and emotionally laden the topic is, even for scientists," Wax said.