Home :: Blog :: Blog :: Statistics – Truth or Dare Doctor Pesce? The New Home Birth Study proves birth is safer for mothers & babies at home.

Statistics – Truth or Dare Doctor Pesce? The New Home Birth Study proves birth is safer for mothers & babies at home.

Sydney, 19 January 2009: Home birth families around the country have been fascinated to read the new study published in the Medical Journal of Australia this week which in fact supports their belief that homebirth is safe for mothers and babies.

The new study assessed the outcomes of almost 300,000 births in South Australia from 1991 up to 2006.

Only 1,141 of these were planned homebirths and they were found to result in a similar overall rate of child deaths compared to planned hospital births (7.9 deaths per 1,000 planned homebirths compared to 8.2 deaths in planned hospital births).

For babies born at home the news is even more encouraging. There were only 2.5 deaths per 1,000 actual homebirths making homebirth 328% safer for babies than planned birth in hospital.

The study also proves what homebirth advocates have long known. The outcomes for mothers and babies are vastly improved by choosing to birth at home.

The study says:

  • Rates of intervention such as caesarean section and instrumental delivery were lower in the planned home birth group.
    (Planned homebirth group 9.2% caesarean section rate vs. planned hospital birth group 27.1% caesarean section rate.)
    (Planned homebirth group 4.4% instrumental delivery rate vs. planned hospital birth group 12.8% instrumental delivery rate.)
  • No measurable increase in rate of postpartum haemorrhage for planned home birth group.
    (Planned homebirth group 4.4% postpartum haemorrhage rate vs. planned hospital birth group 5.5% postpartum haemorrhage rate)
  • No statistical difference in Apgar scores for liveborn infants between home and hospital birth.
  • Women who gave birth at home or planned to were more likely to have an intact perineum.
  • Women who planned a homebirth had a seven times lower episiotomy rate than planned hospital birth.
    (Planned homebirth group 3.6% episiotomy rate vs. planned hospital birth group 21.7% episiotomy rate. Actual homebirth episiotomy rate was 0.4%)

    Women who had a home birth had a fifty times lower episiotomy rate than women who had a planned hospital birth.

For a long time now we have heard the rumours of a new home birth study that Dr Pesce had hidden under his hat, waiting to release it at the perfect moment. Reportedly it showed a baby had seven times more chance of dying at a homebirth but a close inspection of the research reveals these claims as false.

When we look closely at the research what we find is that the study is based on 1,141 planned homebirths. This includes women who were planning to birth at home but ended up birthing in hospital. This decision could have been made during the pregnancy or during labour. There are nine deaths reported in the planned homebirth group and seven of these occurred in hospital. Of the two babies who died at home in 16 years, one had congenital abnormalities that would have meant the outcome would have been the same wherever the birth occurred and only one death is a stillbirth at home.

Many studies of this kind exclude babies with congenital abnormalities but this study has chosen to leave those in.

There is no explanation or investigation of the thousands of babies who died in hospital during the same 16 year period who are conveniently left out of the study.

What is most concerning about this study is the way it has been presented as proving homebirth unsafe, even ‘deadly’ according to one headline when if we read it closely the opposite is actually true.

Let’s look at the claim that a baby has 27 times more chance of intrapartum asphyxiation – From the results of the study what we see is that only ONE baby of the TWO babies who died at home during the 16 year study suffered from this. Yet the authors and Dr Pesce claim this means there is a 27 times higher risk of death to a baby from intrapartum asphyxiation at a planned homebirth.

Family experience the bliss of a natural birth

Family experience the bliss of a natural home birth

The use of ‘research’ like this to push a political agenda by the AMA is unethical and dangerous. Dr Pesce says in his editorial “health policy makers should focus on evidence based decisions rather than political ones.” Yet it is he who has taken this flawed study and aggressively pushed the AMA agenda to the media to further their own political aims. The AMA does not want the Government to fund and indemnify private midwives as this is a threat to their own business and client base.

When we look at the real evidence and see the truth about birth statistics from the perinatal data reported across Australia what we find about homebirth is in 2006 not a single baby died at a homebirth and in 2007 there were 3 fetal deaths at homebirth.

In 2007, 870 planned homebirths, representing 0.3% of all women who gave birth, were reported nationally. There were 2174 fetal deaths in Australian hospitals/birth centres in 2007. There were 3 fetal deaths at home during planned homebirths in 2007. Of babies born at home in 2007, 99.7% were liveborn.

In 2006, 708 planned homebirths, representing 0.2% of all women who gave birth, were reported nationally.

There were 2091 fetal deaths in Australian hospitals in 2006.

No babies died at home during planned home births in Australia in 2006.

This does not sound like the frightening 27 times more chance of a baby dying of asphyxiation or 7 times more deadly that this study and the headlines claim.

(Statistics from Australia’s Mothers and Babies 2007 Report — this is the most recent Australia wide report publicly available)

The three most well recognised international studies on homebirth have shown home birth to be safe and is some cases, safer for babies and mothers. In the Netherlands they studied 529,688 low-risk planned home and hospital birth. This study shows that planning a home birth does not increase the risks of perinatal mortality and severe perinatal morbidity among low-risk women, provided the maternity care system facilitates this choice through the availability of well-trained midwives and through a good transportation and referral system.

A Canadian study of over 12,000 births showed planned home birth attended by a registered midwife was associated with very low and comparable rates of perinatal death and reduced rates of obstetric interventions and other adverse perinatal outcomes compared with planned hospital birth attended by a midwife or physician.

A study of over 5000 births in the USA and Canada showed women who intended at the start of labour to have a home birth with a certified professional midwife had a low rate of intrapartum and neonatal mortality, similar to that in most studies of low risk hospital births in North America. A high degree of safety and maternal satisfaction were reported, and over 87% of mothers and neonates did not require transfer to hospital.

An economic analysis found that an uncomplicated vaginal birth in hospital in the United States cost on average three times as much as a similar birth at home with a midwife in an environment where management of birth has become an economic, medical, and industrial enterprise.

Birthing women and babies deserve so much better.

“The safety of mothers and babies must come first in any debate,” Dr Andrew Pesce said yesterday and we completely agree. This study and many others actually show that it is safer for mothers and babies to be born at home.

We call on the AMA and RANZCOG to stop their scare mongering for political and financial gain and look at how to improve the safety of mothers and babies during birth in ALL settings. Women will continue to home birth as they have done for centuries and the medical establishment must provide willingly the support and backup for those women and their chosen care providers, their private midwives.

It is unacceptable that the President of the AMA, himself an obstetrician has chosen to take this study and use it for his own political gain.

We call for Dr Pesce’s resignation as he has breached repeatedly his professional oath, ‘First do no harm.’

The authors of this study say themselves “Although it is not anticipated that large numbers of women will opt for homebirth, women’s autonomy in choosing reproductive behaviour is a fundamental human right enshrined in Australian law.” It is the Governments responsibility to uphold that law, despite the increasing pressure and scare campaigns from so-called ‘professional’ bodies such as the Australian Medical Association, which is a trade union for Doctors and exists to protect their interests.

Any family who has been blessed to have their child born peacefully at home knows what an outrageous lie these headlines are.  We all vote and we won’t forget the decisions this Government chooses to make about our basic human rights, Kevin Rudd and Nicola Roxon.

LINKS

Read the study here:

Planned home and hospital births in South Australia, 1991–2006: differences in outcomes
http://www.mja.com.au/public/issues/192_02_180110/ken10465_fm.html

Read Dr Pesce’s editorial here:
http://www.mja.com.au/public/issues/192_02_180110/pes11237_fm.html

RELATED COVERAGE

That Homebirth Study in South Australia from Hoyden about Town
http://hoydenabouttown.com/20100116.7157/that-homebirth-study-in-south-australia/

Homebirth Australia
http://homebirthaustralia.org/

Crikey – Don’t believe the homebirth horror headlines
Melissa Sweet takes a close look at the home birth study and the media coverage. She concludes “we can’t rely on the media — or medical organisations — to contribute much light to this debate.”
http://www.crikey.com.au/2010/01/20/don%E2%80%99t-believe-the-home-birth-horror-headlines/

Crikey – More critique of the homebirth study and its reporting by the media
Associate Professor Hannah Dahlen, Vice President of the Australian College of Midwives, and an academic at the University of Western Sydney, and Professor Caroline Homer, Professor of Midwifery at the University of Technology Sydney, also had a critical look at the study and the way its findings are being portrayed.
http://blogs.crikey.com.au/croakey/2010/01/20/more-critique-of-the-homebirth-study-and-its-reporting-by-the-media/

Crikey – The AMA says we are “shooting the messenger” re homebirth critique
Dr Andrew Pesce, President of the Australian Medical Association replies to criticism of his ‘evidence’ that homebirth is 7 times more likely to result in a baby dying and 27 times more likely to result in a baby dying from intrapartum asphyxiation.
http://blogs.crikey.com.au/croakey/2010/01/21/the-ama-says-we-are-shooting-the-messenger-re-homebirth-critique/

Crikey – Medical Journal of Australia editor responds to homebirth study concerns
Why did they choose Dr Pesce to write the editorial? Who writes the press releases? Should they have acknowledged the uncertainties & complexities of the study more in the press release? Do they publish what the AMA tells them to?
http://blogs.crikey.com.au/croakey/2010/01/21/medical-journal-of-australia-editor-responds-to-homebirth-study-concerns/

RESOURCES

Outcomes of planned home births with certified professional midwives: large prospective study in North America
A study of over 5000 births in the USA and Canada. Women who intended at the start of labour to have a home birth with a certified professional midwife had a low rate of intrapartum and neonatal mortality, similar to that in most studies of low risk hospital births in North America. A high degree of safety and maternal satisfaction were reported, and over 87% of mothers and neonates did not require transfer to hospital.

An economic analysis found that an uncomplicated vaginal birth in hospital in the United States cost on average three times as much as a similar birth at home with a midwife in an environment where management of birth has become an economic, medical, and industrial enterprise. (2005)

Outcomes of planned home birth with registered midwife versus planned hospital birth with midwife or physician
This Canadian study of over 12,000 births showed planned home birth attended by a registered midwife was associated with very low and comparable rates of perinatal death and reduced rates of obstetric interventions and other adverse perinatal outcomes compared with planned hospital birth attended by a midwife or physician. (2009)

Perinatal mortality and morbidity in a nationwide cohort of 529,688 low-risk planned home and hospital birth
This is the largest study of the safety of home birth that has ever been done, and the authors rightfully argue that the Netherlands is the only Western country that a study of this size could be done, as about 30% of Dutch women give birth at home. They analysed the births of all low-risk women who delivered between Jan 1, 2000 and Dec 31, 2006.

This study shows that planning a home birth does not increase the risks of perinatal mortality and severe perinatal morbidity among low-risk women, provided the maternity care system facilitates this choice through the availability of well-trained midwives and through a good transportation and referral system. (2009)

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6 Responses to “Statistics – Truth or Dare Doctor Pesce? The New Home Birth Study proves birth is safer for mothers & babies at home.”
  1. descemet

    Can you explain why you have excluded 5 deaths in the home birth group? They were transferred to a hospital, but presumably they were transferred when a problem arose. By excluding them are you suggesting that everything was going fine until they were transferred to hospital and then it was the hospital that caused the death?

    • “They were transferred to a hospital, but presumably they were transferred when a problem arose”

      Unfortunately we can make no such assumptions from this study – and that is one of its many flaws. Any woman who planned to have a homebirth when she started prenatal care was included in the planned homebirth group. She may have changed her mind and chosen to birth in hospital for any reason at any time during her whole pregnancy and labour and if her baby then died, it is recorded in this study as a planned homebirth fetal death. To be more accurate a study like this should only include women who planned a homebirth at the start of their labour. There were actually 7 babies who died in a hospital birth who were included in the planned homebirth group, not 5.

      There is no analysis of the 2447 babies who died in hospital in the same period. Rather the study concludes from 2 babies who died at home in 16 years that homebirth is 7 times more likely to result in a dead baby and a baby is 27 times more likely to suffer intrapartum asphyxiation in a planned homebirth.

      The key point is that you can spin the statistics any way you want if you have an agenda to push which is what the AMA and the authors have clearly done.

  2. JH

    I’m not arguing against home birth itself, but certain aspects of this article really grated with me.

    Don’t a lot of the risk factors that would indicate some of these outcomes form part of the decision to have a home birth in the first place? If there are well known factors that indicate that a birth might be risky, wouldn’t the mother be more likely to forgo a home birth? And therefore the results for hospitals are far more conflated with these factors than home birth results are? Or have I missed something in your analysis? I admit I haven’t taken the time to read through most of the references.

    Also, take the statement: “the outcomes for mothers and babies are vastly improved by choosing to birth at home,” — is this really universally applicable? If every mother chose homebirth, would that really be safer every time?

    “Women will continue to home birth as they have done for centuries” — I don’t think that this is a particularly compelling statement, and has some really terrible connotations. It’s hard to get good numbers, but the rate of complications and mortality was pretty high even 100 years ago. (Of course, *that* difference is due to both medical advances and general sanitation levels, and separating those two factors is not something I really want to try myself.) Not sure about 500 years, since they didn’t have the internet back then.

    Claims that the AMA are conspiring against you are really adversarial. If they took out ads in the paper, then maybe it’s warranted (although I guess it’s not really a conspiracy then, is it?). But equating disagreement on the interpretation of some difficult-to-interpret studies to an actual conspiracy? It just comes off as ad-hominem. It’s the work of medical professionals in the first place that allow women to have the information they require to safely make the decision to have a home birth. It’s also their work that allows women who have higher risks of complications to lower those risks during a hospital birth. Setting up this “us vs. them” culture — and underestimating the power of that kind of culture — really undermines the efforts of anyone trying to get people to just listen to the numbers. All of a sudden it’s not about the numbers, it’s about where they came from.

    I agree with you that the newspaper headline writers are morons, though. I think we can all agree on that.

  3. michelle

    Thanks for the critique of the article JH. I can see we will have to agree to disagree.

    Perhaps you would like to also do a similar critique of Dr Pesce’s editorial in the Medical Journal of Australia?

  4. JH

    The Netherlands study you cite is the perfect analysis — comparing like for like, women who *would* have been told they could have homebirths, but some didn’t. But for this statistic:

    “There were 2091 fetal deaths in Australian hospitals in 2006.”

    …you don’t say how many of these would have been told they could home birth in the first place. Since you don’t, it’s just a number without any bearing on the current discussion. How do you know that this number would have changed if those particular women had given birth at home? Would they have been told that they probably shouldn’t in the first place?

    In other words, a woman cannot look at that and answer the question: “I’ve been told I’m at a low enough risk of complications to give birth at home. What difference will it make if I decide to do that?” Because most of those 2091 would not have been in that situation in the first place.

    This misrepresents the relative risk just as much as anyone else. Does that mean that you are biased by a political agenda, or financial gain?

    (Also, you don’t give references for the Netherlands study, the Canadian study or others.)

    “Perhaps you would like to also do a similar critique of Dr Pesce’s editorial in the Medical Journal of Australia?”

    There’s plenty of criticism and discussion there already, and not much I could add.

  5. Dear JH

    It is not possible to say how many were told they could home birth as this data is not collected.

    They key point is that you can spin the statistics any way you choose as has been clearly done in the case of this study.

    If I am biased in any way it is by a deep respect for women’s right to choose how she births and my own experiences as a woman and a birthing mother.

    All the references are in the article if you click on the links in the titles in the Resources section above.

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