Talk about making lemonade out of lemons! Only a Dutch midwife could take the fact that the Netherlands has one of the highest perinatal mortality rates in Western Europe and the fact Dutch midwives caring for low risk women (home or hospital) have a higher perinatal death rate than Dutch obstetricians caring for HIGH risk women and turn it into a defense of homebirth.
But those facts are not a defense of homebirth; they are a scathing indictment of Dutch midwifery. Ank de Jonge’s new paper in BJOG tells us the same thing most of her old papers tell us: Dutch midwives provide substandard care.
This is the fourth paper that I know of where de Jonge presents misleading information in an effort to promote homebirth. I could almost feel sorry for her since her efforts serve only to highlight the deficiencies of Dutch midwives.
de Jonge thought that she had succeeded in showing that homebirth in the Netherlands is safe. She was the lead author on the paper Perinatal mortality and morbidity in a nationwide cohort of 529 688 low-risk planned home and hospital births back in 2009. The study showed that homebirth with a midwife in the Netherlands is as safe as hospital birth with a midwife. That triumph was very short lived.
A subsequent study, Perinatal mortality and severe morbidity in low and high risk term pregnancies in the Netherlands: prospective cohort study, was a stunning indictment of Dutch midwives. The study was undertaken to determine why the Netherlands has one of the worst perinatal mortality rates in Western Europe and the results were unexpected, to say the least.
We found that delivery related perinatal death was significantly higher among low risk pregnancies in midwife supervised primary care than among high risk pregnancies in obstetrician supervised secondary care.
In 2013 de Jonge in a paper in the journal Midwifery Perinatal mortality rate in the Netherlands compared to other European countries: A secondary analysis of Euro-PERISTAT data that attempted to absolve Dutch midwives, but actually CONFIRMED their poor mortality statistics
Later in 2013 de Jonge published Severe adverse maternal outcomes among low risk women with planned home versus hospital births in the Netherlands: nationwide cohort study. de Jonge found that there were fewer serious maternal complications at homebirth than hospital birth. There was just one teensy, weensy problem. de Jonge left out the mortality rates. Severe maternal morbidity is an appropriate measure of safely ONLY when death rate is zero or nearly zero. If the death rate is not zero, that MUST be taken into account in assessing safety. It was subsequently revealed that the homebirth group had a potentially preventable maternal death while the hospital group had none.
de Jonge’s latest paper is Perinatal mortality and morbidity up to 28 days after birth among 743 070 low-risk planned home and hospital births: a cohort study based on three merged national perinatal databases, She found:
Of the total of 814 979 women, 466 112 had a planned home birth and 276 958 had a planned hospital birth. For 71 909 women, their planned place of birth was unknown. The combined intrapartum and neonatal death rates up to 28 days after birth, including cases with discrepancies in the registration of the moment of death, were: for nulliparous women, 1.02‰ for planned home births versus 1.09‰ for planned hospital births, adjusted odds ratio (aOR) 0.99, 95% confidence interval (95% CI) 0.79–1.24; and for parous women, 0.59‰ versus 0.58‰, aOR 1.16, 95% CI 0.87–1.55.
And concluded:
We found no increased risk of adverse perinatal outcomes for planned home births among low-risk women. Our results may only apply to regions where home births are well integrated into the maternity care system.
But the combined intrapartum/neonatal death rates for both groups was higher than would be expected for a group of low risk women in midwifery care. Indeed, it is higher than the intpartum/neonatal death rate of 0.74/1000 (nullips) and 0.46 (multips) previously reported for HIGH risk patients under the care of Dutch obstetricians.
de Jonge, of course, was careful to leave out the death rates of Dutch obstetricians, though she does acknowledge that previous studies have shown midwifery mortality rates for babies of low risk women to be higher than those of obstetricians caring for high risk women.
de Jonge concludes:
This study did not show increased risks of intrapartum and neonatal mortality, among low-risk women planning a home birth.
That’s true as far as it goes but a more accurate conclusion would be:
This study did not show increased risks of intrapartum and neonatal mortality among low-risk women planning a home birth with a midwife compared compared to low-risk women planning a hospital birth with a midwife. It does, however show an increased risk of intrapartum and neonatal mortality among low risk women in midwifery care compared to HIGH risk women in obstetrical care.
de Jonge didn’t show that homebirth is safe. She showed that Dutch midwives are dangerous.
