All right then, Dr. Amy, let's assume that the statistics *are* on your side, and that we are interpreting the difference as "significant".

Think about this then: Numbers never tell the whole story. It's actually unfortunate that homebirth advocates have had to resort to protecting their choice by playing by the medical establishment's rules -- that is, by giving numbers an inordinate amount of importance. I have no doubt that if enough studies were done, it would continue that some would find results that went one way, and some would find results that went another way (although I stand by my assertion that there have been many -- dozens, not "very few" -- of studies supporting the validity of homebirth, and relatively few supporting hospital birth.) But regardless, surely you realize that bias affects the conclusions drawn, no matter what the bias. It is naive to assume that bias exists only on one side and not on the other -- ACOG's glowing and noncritical acceptance of the Pang study is evidence of that. Possible confounding factors: what is the incidence of mortality specifically among religious groups that shun all medical involvement? What is the incidence of mortality due to poverty, lack of access to medical care when needed, and unwanted pregnancies? How is neonatal death defined -- are very ill and (sometimes iatrogenically) damaged babies that are temporarily being kept alive on machines included in hospital stats for "live births"?

Further, statistical "likelihood" within large groups is not necessarily relevant to the individual, as I touched on in my previous post. If 20 out of 100 babies die in a particular type of broadly-defined environment, it does not logically follow that I have a 20% chance of having my baby die in that environment. To be honest, my choice to not give birth in a clinical environment has little to do with statistics -- it has to do with a scientific understanding of the normal physiological process and what will facilitate it or cause it to become dysfunctional, as well as my specific physical and psychological needs as an individual.

If you have an emotional bias, you *will* find statistics to support it. At some point the intelligent, reasonable person has to move beyond that to look at the real issues involved.

[As regards your citations, all 6 are from the same people, all 6 are retrospective investigations of small numbers of individuals and most suffer from the inability to obtain large numbers of records (more than 25% of the relevant records are missing in some cirumstances). The citation of Odent is a letter, not a scientific paper. That letter is an attempted defense of the type of retrospective investigation that it thoroughly condemned in the Lancet.]

This last post quoted above is quite ridiculous. [All six are from the same people.]

At the risk of boring people on this list and at the risk of being [trolled] I will list the citations again.

1. Jacobson B et al. Opiate addiction in adult offspring through possible imprinting after obstetric treatment. British Medical Journal,

(1990), Vol301, p1067-1070.

2. Jacobson B, Nyberg K, Eklund G, Bygdeman M and Rydberg U. Obstetric pain medication and eventual adult amphetamine addiction in offspring.

Acta Obstet Gynaecol. Scand. (1988), 67, p677-682.

3. Jacobson B et al. Perinatal origin of adult self-destructive

behaviour, Acta psychiatr. scand. 198776, pp364-371.

4. Nyberg K et al. Obstetric medication versus residential area as perinatal risk factors for subsequent adult drug addiction in offspring.

Paediatric and Perinatal Epidemiology, (1993), 7, p23-32.

5. Nyberg K et al. Socio-economic versus obstetric risk factors for drug addiction in offspring. British Journal of Addiction, (1992), 87, p1669-1676.

6. Nyberg, K et al. Perinatal medication as a potential risk factor for adult drug abuse in a North American cohort. Epidemiology, 2000, vol 11 p715-6.

You are not a consultant for a drug company are you. They on the whole do a great job providing people with excellent medications cheaply and very effeciently, with controlled trials extending over many decades. But on anaesthesia for labouring mothers I would not want to be in their shoes when it becomes obvious that they have neglected to test over the long term.

Neither would I like to be an anaesthetist who specialises in providing his or her expertise in the field of birthing. They should have paid heed to the oath that they took, 'Do no harm.'

Now I am no great lover of sueing for every little problem that one might encounter. We do tend to call that 'The American Disease' Or we used to but since Thatcher we now have embraced that particular abberation. Our insurance in Britain is now skyrocketing due to Dr's feeling threatened by this quite new disease of the spirit.

I did promise myself when I was young that I would never say, 'When I was a lad etc; etc;' and now here I am. Oh, well so much for good intentions.

Happy nurturing,

Rayner

blueviolet:

"every single study done (many matched-population studies, and some quite large,) has shown that homebirth with a midwife attending is statistically as safe as hospital birth in terms of mortality"

I know that's what homebirth advocates tell themselves and each other, but like so much of homebirth advocacy, that's not true, either.

First of all, there are very few studies of homebirth. Most involve only a small number of women. The studies conducted by known homebirth advocates (such as Johnson & Daviss, BMJ 2005) CLAIM to show that homebirth is as safe as hospital birth, but they do not. The show that low risk homebirth is as safe as childbirth for women of all risk levels. There is not a single study that shows homebirth to be as safe as hospital birth for women of comparable risk. It is misleading and disingenuous for homebirth advocates to claim otherwise.

According to the recent report of the National Institute for Health and Clinical Excellence in the UK (a healthcare watchdog agency), a comprehensive review of the world wide literature on homebirth showed:

"...The quality of evidence available is not as good as it ought to be for such an important health care issue, and most studies have inherent bias. The evidence for standalone midwife led units and home births is of a particularly poor quality.

The only other feature of the studies comparing planned births outside [physician] units is a small difference in perinatal mortality ... Our best broad estimate of the risk is an excess of between 1 death in a 1000 and 1 death in 5000 births. We would not have expected to see this, given that in some of the studies the planned hospital groups were a higher risk population."

Patricia Janssen's study Outcomes of Planned Home Births vs Planned Hospital Births in British Columbia (CMAJ, 2002) is often cited as showing that homebirth is as safe as hospital birth. That is an especially audacious claim considering that the homebirth group had 2 perinatal deaths and the hospital group had none. Most homebirth advocates do not realize that Dr. Janssen publicly retracted her conlusions in a subsequent issue of CMAJ:

"The purpose of our study was not to determine which method of care was better, home vs. hospital, but rather to assess whether, at the 2-year interval, home birth was safe enough to continue to be offered as a choice for women in the context of ongoing evaluation."

Homebirth advocates claim that studies show homebirth to be as safe as hospital birth, but that is simply not true.