I’ve long maintained that the authors of the UK Birthplace Study, the largest study of its kind, started with the conclusion and worked backward to find evidence to support it.
The Birthplace Study began after the British government had declared that homebirth was safe and should be encouraged to save money. The study strained to bolster that claim, slicing and dicing the data every which way. But the authors of the Birthplace Study went one step further. They buried the dead babies twice.
First they buried the babies who died in tiny coffins; then they buried them again from public consciousness by refusing to acknowledge them within the papers themselves. Perinatal deaths were deliberately hidden in a “composite outcome” that amalgamated results ranging from trivial (arm injury from shoulder dystocia) to catastrophic (death). They literally would not reveal how many babies died at homebirth compared to how many died at hospital birth.
[pullquote align=”right” color=”#333333″]The death rate in the home VBAC group was 500% higher than in the hospital group.[/pullquote]
Since the death rate at each location is the single most important piece of information to come from the study, the decision of the authors to bury it is inexplicable … unless they wanted to hide those deaths.
Now comes further evidence that the Birthplace Study plays fast and loose with the truth, and this one is even more egregious than the others that preceded it. Maternal and perinatal outcomes in women planning vaginal birth after caesarean (VBAC) at home in England looks at the outcome of attempted VBAC in the Birthplace Study.
The single most important piece of data is buried in paragraph 27:
Four babies were stillborn, two in each group. Two of these four stillbirths were associated with uterine rupture.
The death rates were 2/1227 = 1.6/1000 in the hospital group and 2/209 = 9.5/1000 in the homebirth group.
In other words, the death rate in the homebirth group was 500% higher than in the hospital group.
You might think that was worthy of mention in the abstract. The authors chose to bury it with deliberate bit of obfuscation:
The risk of an adverse maternal outcome was around 2–3% in both settings, with a similar risk of an adverse neonatal outcome.
Not exactly.
Apparently the authors didn’t like the real conclusion of their study, so they buried those babies in a “composite index” outcome that combined dead babies with … babies who had a 5 minute Apgar less than 7, a trivial outcome. There is no possible scientific justification for such absurd amalgamation.
The authors conclude:
Women in the Birthplace cohort who planned VBAC at home had a significantly increased chance of achieving a vaginal birth compared with women who planned VBAC in an OU, but their chances of transfer were high (37%) and the risk of an adverse maternal outcome was 2–3%, with a similar risk of an adverse neonatal outcome.
And that is deeply and unacceptably misleading
The real conclusion ought to be: the risk of stillbirth at VBAC is 500% higher at home than in the hospital. Home VBAC has an unacceptably high mortality rate and should be strongly discouraged.
I’m not the only one who thinks so.
In an accompanying commentary, J Scott notes:
…[I]n my opinion the primary outcomes should be the rates of uterine rupture and infant morbidity and mortality, since these are much more important in assessing safety in this situation.
Scott concludes:
In my view, home birth VBAC cannot be endorsed based on these results, and the current recommendations that VBAC should occur in a hospital setting should remain.
In my view, there’s another take away from this study: the authors are determined to bury the dead babies in the Birthplace Study twice, once in tiny coffins in the ground and then again from public consciousness. Their clumsy efforts to obfuscate the deaths that occur as a result of homebirth mean that all their conclusions are suspect.
That’s hardly surprising. Starting with the conclusion and then manipulating the data to force it to fit isn’t science, it’s politics.
Homebirth kills babies who didn’t have to die … and no amount of composite indices, failures to disclose deaths and death rates, or desire to reach predetermined conclusions changes that. It simply deprives women of the opportunity to make the decisions that are best for themselves and their babies as opposed to the decisions that are cheapest or best for politicians.
