I am not a Statistician so cannot speak about the stats in the study. What I can speak about is how the statistics were gathered and what that might mean about the whole study’s validity.
My own statistics are a part of this study. I have filled out the paperwork not only for myself, but for other midwives as well. In fact, I have spent hours filling out the statistics paperwork, poring through charts, answering questions from the beginning of pregnancy through six weeks postpartum.
The study says they enrolled the clients before they knew the outcome of the births, but I beg to differ. They may do that now, but back when I was doing them (2004-2009), we didn’t even fill out the paperwork until the woman was past six weeks postpartum. In fact, we used to sit with a pile of charts in our laps and fill out stat sheet after stat sheet, some women even a year (or more) postpartum. At that time, the stats were filled out on paper and sent in, so I know we weren’t supposed to send in any statistics before the woman was six weeks postpartum. I can’t imagine we were the only ones that did it that way.
So, while there are parts of the statistics that are objective – whether the woman has a breech baby, twins or was a transport – there are other aspects where the answers to the questions are subjective. How long a woman’s labor was, how long she had Rupture of Membranes, the degree of her tear… are all areas where subjectivity come into play. You wouldn’t think so, but I have seen midwives lie in the chart (and then on the stats forms) about such things, not wanting the Powers That Be to know they let a woman with ROM labor for 32 hours without transferring her or that she sutured a third degree tear. I never saw charts be subjective when I worked with the CNMs in the two birth centers I worked at, but it was a distinct part of the midwifery culture I worked in as a CPM/LM. I know I stretched the truth myself when it came to extra long labors or trying to get the best blood pressure on a woman.
As we know, the statistics gathering was completely voluntary. I knew several midwives who never did the stats; a few that did. And this was just in one city! How can anything really be known by such skewed statistics (if you even want to call them that anymore)? And I am sure that midwives with a bad outcome just didn’t finish that woman’s stats. It would have been encouraged in the culture. So that so many did send in negative outcomes lets us know how bad the perinatal mortality and morbidity rate really was.
I look forward to more dissecting of the perinatal mortality part of the statistics being done. They don’t look good now. That so many are just taking what pro-home birth sites have to say about the study is frustrating. Look at the naysayers, too.
I know it sounds like I am anti-home birth now, but there is nothing like that at all. I am still pro-home birth… with a highly trained and skilled midwife with a transport plan in place and supportive back up care. I am against breeches and twins at home births (as the study distinctly says should not happen at home!) and am slowly coming to see that even VBACs might not be best to do at home (after talking to HBAC loss moms). But, I do still believe in home births, just with some caveats.
I, more than anyone else, would love to see a real study telling us about the safety of home birth, but this one sure is not it.