Moments ago, the State of Oregon released the official homebirth death statistics for 2012 and they are worse than my worst prediction.
You may recall that back in August 2010, Melissa Cheyney, the Director of Research for the Midwives Alliance of North America (MANA) and also the head of the Board of Direct Entry Midwifery, rejected a call by the State of Oregon for access to the MANA homebirth death rates for Oregon. As a result, the State decided to collect the statistics themselves. They turned to Judith Rooks, a certified nurse midwife and midwifery researcher who is known to be a supporter of direct entry midwifery, to analyze the Oregon homebirth statistics for 2012.
Rooks testified this afternoon at a legislative hearing on HB 2997, a bill addressing the licensing requirements direct entry (homebirth) midwives.
She began by introducing herself:
I’m a certified nurse-midwife, a past-president of the American College of Nurse-Midwives, and a CDC-trained epidemiologist who has published three major studies of out-of-hospital births in this country.
In 2011 the Oregon House Health Care Committee amended the direct-entry midwifery—“DEM”—law to require collection of information on planned place of birth and planned birth attendant on fetal-death and live-birth certificates starting in 2012.
Oregon now has the most complete, accurate data of any US state on outcomes of births planned to occur in the mother’s home or an out-of-hospital birth center.
She then presented and explained the following table:
The death rate is horrific, even AFTER Rooks inappropriately eliminated the death of a baby at homebirth who had congenital anomalies. Since the hospital group contains congenital anomalies, it is not appropriate to remove them the homebirth group.
The total mortality rate associated with those births [planned OOH births with direct-entry midwives as the planned birth attendants] – excluding the one involving congenital abnormalities – is 4.8 per 1000.
For comparison, data on births planned to occur in hospitals is provided in the bottom row of the table.
The real death rate for planned homebirth with a direct-entry midwife in 2012 was actually 5.6/1000.
As Rooks regretfully acknowledges:
Note that the total mortality rate for births planned to be attended by direct-entry midwives is 6-8 times higher than the rate for births planned to be attended in hospitals. The data for hospitals does not exclude deaths caused by congenital abnormalities.
Many women have been told that OOH births are as safe or safer than births in hospitals…
But out-of-hospital births are not as safe as births in hospitals in Oregon, where many of them are attended by birth attendants who have not completed an educational curriculum designed to provide all the knowledge, skills and judgment needed by midwives who practice in any setting.
After reaffirming her support of direct entry midwives, Rooks pleads for more stringent standards:
The legislature won’t have another opportunity to make the law stronger on behalf of safety until 2015. Please keep the six women who lost their babies last year in mind as you legislate this year.
We can only hope that the legislators heed Rooks’ plea. The first two basic steps that they should take are these:
1. Mandate that Oregon homebirth midwives advise women, as part of obtaining informed consent, that homebirth has a death rate 8x higher than hospital birth.
2. Refuse to expand homebirth midwives’ scope of practice and limit them to attending ONLY the lowest risk births.
It’s the least they can do for the women and babies of Oregon.
