Statistics associated with out of hospital birth outcomes in the US can be very difficult to interpret considering the limited data available and we are presented with varying studies without understanding the quality of the evidence or how said evidence can be generalized to the public in the US.
When looking at birthing statistics or opinion on the safety of out of hospital birth you are presented with conflicting information from many different sources. How are you as a consumer supposed to understand the data?
Let's start with breaking down evidence based on study type. If you'd like a video breakdown watch Levels of Evidence.
There are many different study types, the lowest being opinion or qualitative studies and the highest being systematic and quantitative studies. It is tough to decipher statistics surrounding homebirth and birth center birth due to ethics. We cannot force two groups of pregnant people to homebirths and hospital births for randomized control studies. Many studies on out of hospital birth are observational or cohort studies that follow groups that willingly choose either setting or rely on retrospective recounting of events. Other studies consist of analysis of data from the CDC. Both study types have flaws, data that is reported can vary depending on the quality of the reports, but we work with what we have.
This is what we do know, studies with low numbers of volunteer participants often are not considered high quality studies that represent the generalized public. Low volume studies in general are not considered a viable sample to generalize evidence to the public. Studies from other countries are not considered accurate or viable studies to support safety of out of hospital birth in the US. This is because midwifery as well as out of hospital birth standards are much different than in comparable countries such as Canada or the UK. (See previous blog post for midwifery breakdown in the US)
When asking out of hospital providers on the safety of homebirth or birth center birth we are often told, this mode of birth is "just as safe" as a hospital birth. Backed up by studies from other countries or with very small volunteer samples such as that from MANA statistics. These studies are misinterpreted and sold to pregnant people to validate the safety of out of hospital birth. Leaving out increased risk of neonatal death and obstetrical complications, especially in VBAC, breech presentation, and twin gestation. If you'd like to see the breakdown of common studies used to talk about out of hospital birth, click here.
While satisfaction is higher and intervention rates are much lower in out of hospital settings the rates of neonatal mortality and morbidity are much higher than in hospital setting. Any prospective parent should consider these facts before deciding where and with who they would like to birth.
When looking at studies some key notes to look at are the sample size, study type, whether the study is qualitative or quantitative, and how the evidence relates to you and your health. A great way to understand the evidence presented to you is to speak to someone who is trained to interpret the evidence such as a researcher or doctor.
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