Imagine the following “analysis” released by the manufacturer of thalidomide, the drug that caused severe limb deformities in the children whose mothers took it while pregnant:
Thalidomide for morning sickness may be equally safe if not safer for women than other treatments. Unfortunately, thalidomide increases safety concerns for the child.
Such appalling callousness and nonchalant dismissal of the pain and suffering that thalidomide caused would suggest that the manufacturer was far more concerned with touting thalidomide than with the safety of babies.
Amazingly, the researchers responsible for the report Outcomes of Home vs. Hospital Births Attended by Midwives: A Systematic Review and Meta-analysis appear to have a similarly callous view of homebirth deaths.
As I discussed in yesterday’s post (New analysis from Arizona shows — yet again — that homebirth triples the neonatal death rate), the authors of the analysis, after demonstrating that homebirth increases the risk of neonatal death by a factor of three reach a bizarre conclusion:
The findings suggest that homebirths attended by midwives may be equally safe if not safer for women with low-risk pregnancies.
Reader Lynnette Hafken, MA, IBCLC was so disturbed by the obvious disconnect between what the authors found and what they concluded, she wrote to the lead author John Ehiri, PhD, MPH, MSc (Econ.) for clarification. Ehiri thanked her for pointing out this “oversight” and informed her that the authors had added an additional sentence to the 34 page paper.
The conclusion now reads:
The findings suggest that homebirths attended by midwives may be equally safe if not safer for women with low-risk pregnancies. Unfortunately, home births attended by midwives increase safety concerns for the child.
Unfortunately? Unfortunately??!!
Frankly, I am shocked by the appalling callousness of dismissing preventable deaths of babies in such a brutally short and dismissive sentence.
The KEY ISSUE in any analysis of homebirth is its safety for babies. It’s not the only issue, but all others pale into insignificance next to it. The conclusion of the analysis ought to be:
Homebirth attended by midwives increases the risk of neonatal death by a factor of 3. Homebirth has no deleterious impact on the health of mothers and may reduce morbidity. Women should be counseled to weigh the increased mortality to babies against the decreased morbidity to mothers before choosing homebirth.
The fact that the authors reduced preventable neonatal deaths to an “unfortunate” side effect of homebirth suggests to me that authors were far more concerned with touting the safety of homebirth (regardless of what their own data showed) than with the safety of babies.
If Dr. Ehiri would like to contest my assertion that the authors have callously and deliberately ignored the immense pain and suffering associated with neonatal death, he can write to me at the email address listed at the top of the sidebar. I will publish his response/explanation in full.
But I have a better suggestion for Dr. Ehiri and colleagues:
Remove the absurd and offensive claim that “homebirths attended by midwives may be equally safe if not safer for women” and replace it with the language I suggested, giving primacy to the fact that homebirth increases the risk of neonatal death by a factor of 3 and offers only a small reduction in maternal morbidity as a result.
Even the drug company that promoted thalidomide didn’t dare tout its safety and effectiveness after it was shown that it caused horrible birth defects as a result. Surely Ehiri and colleagues could demonstrate as much sensitivity in promoting homebirth.
