AJOG criticized for publishing skewed study on safety of homebirth

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The Coalition to Improve Maternity Services released the following press release on July 9 in response to the recent publication of an extremely skewed study on the safety of homebirth in the American Journal of Obstetrics and Gynecology (AJOG).

Raleigh, NC (July 9, 2010)
The Coalition for Improving Maternity Services (CIMS) is outraged that the publishers of the American Journal of Obstetrics and Gynecology (AJOG) accepted a poorly designed and methodologically unsound study in which authors concluded there is a three-fold increase in neonatal mortality in planned home births compared with planned hospital birth. “In our analysis of multiple studies from countries worldwide,” stated CIMS Chair Michelle Kendell, MBA, AAHCC, “CIMS found that the authors of the study included confounding data, such as outdated and low-quality studies, low-risk and high-risk mothers, babies born preterm, babies unintentionally born at home, births attended by unqualified providers, and data from birth certificates that researchers have found to be notoriously inaccurate.” Although the authors acknowledged that most of the articles reviewed had similar outcomes of low neonatal mortality, they based their conclusion on statistics drawn from questionable and poor quality studies.

Furthermore, the study’s lead investigator Joseph R. Wax, MD, and his co-authors inexplicably eliminated the only high-quality study of planned homebirths in the U.S. that showed excellent health outcomes for infants and their mothers when attended by certified professional midwives. (Johnson & Daviss BMJ 2005).

In a press release, the American College of Nurse-Midwives, a CIMS Organizational Member, reported, “the authors’ conclusion differs significantly from findings of many recent high-quality studies on home birth outcomes which found no significant differences in perinatal outcomes between planned home and planned hospital births.” Other research conducted by the CIMS Expert Work Group found that planned home births with a qualified care provider resulted in similar, not greater, perinatal mortality rates compared with a similar low-risk population of women having hospital births, despite lower intervention rates, including electronic fetal monitoring, use of IVs, pain medication, instrumental deliveries, and cesarean sections.

… The study at the heart of this debate, “Maternal and newborn outcomes in planned home birth vs planned hospital births: a metaanalysis”, originally intended for print publication in the September 2010 issue of the American Journal of Obstetrics and Gynecology (AJOG), was published online on July 1. Researchers and critics suspect that the early release was politically motivated to discredit midwives who attend the majority of home births in the U.S. and to discourage legislators from passing increasingly pro-midwife state legislation such as New York State’s Midwifery Modernization Act (Bill S5007a/A8117b), which passed on June 28 with overwhelming bipartisan support, providing autonomous practice for all licensed midwives working in all settings.

Posted by Patty on July 29, 2010 • Filed under On the Edge (Thursdays)
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