Estimating intrapartum-related perinatal mortality rates for booked home births: when the 'best' available data are not good enough

For further information about homebirth, midwifery, or anything relating to pregnancy and birth, contact Melissa Maimann at Essential Birth Consulting. It's interesting that whenever some pro-homebirth data is published, the medical community find something wrong with it. The Netherlands study was very large. Its results are consistent with other research that has also concluded that low-risk, midwife-attended home birth is safe.

Even more interesting is that this abstract details the comments of a mere six members of a multidisciplinary group. What would the medical community say if a group of six midwives published comments about a medical journal article that included a sample of over half a million women?

ABSTRACT Objective: To critically appraise a recent study on the safety of home birth (... BJOG 2008;115:554) and assess its contribution to the debate about risks and benefits of planned home birth for women at low risk of complications.

Design: Critical appraisal of a published paper.

Setting: England and Wales.

Population or Sample: Home births from 1994–2003 and all women giving birth in the same time period.

Methods: Six members of a multidisciplinary group appraised the paper independently. Comments were collated and synthesised.

Main outcome measures: Assessment of: overall methodology; assumptions used in estimating figures; methods used for calculations; conclusions drawn from the results and reliability and consistency of data.

Results: Although there were some positive aspects to the study, there were weaknesses in design and an inaccurate estimate of risk. Our evidence suggests that the conclusions drawn did not reflect the results and the methodological weaknesses found in the study rendered both the results and conclusions invalid.

Conclusions: On the basis of our critical appraisal, the study does not contribute to the existing evidence about the safety of home birth to inform decision-making or provision of care. The limitations could have been identified by the peer review process and the problems were compounded by an inaccurate press release. Great care needs to be taken by journals to ensure the accuracy of information before dissemination to the scientific community, clinicians and the public. These data should not have been used to inform national guidelines.

"Great care needs to be taken by journals to ensure the accuracy of information before dissemination to the scientific community, clinicians and the public." - aka "doctors should be in charge of what the public get to read". Anyone else come to that conclusion?

Melissa Maimann, Essential Birth Consulting 0400 418 448