Friday, February 27, 2015

How to Handle a Home Birth Debate in 5 Steps

Step 1: When you hear: “There are plenty of studies that show that home birth is as safe as hospital birth.”

Kindly remind them that home birth studies performed in other countries do not apply to home births in the United States due to our vastly different midwifery training requirements and health care systems.

And then share with them that in the United States.... (click here to continue reading)

Thursday, February 26, 2015

Infant Mortality and Maternal Mortality

Let's clear up a little confusion. Are the infant mortality and maternal mortality rates in the USA reasons for women to be afraid to give birth in a hospital here?


Here's why:

Infant mortality refers to the death of a baby within the first year of life. Infant mortality refers only to babies born alive that die before they turn one. If a baby dies at 4 days old or 364 days old it will affect the infant mortality rate. So yes, it includes pregnancy and birth-related issues that may later cause a death like birth defects, low birth weight and neonatal hemorrhage but also includes things like accidents, disease, and SIDS… those are all encompassed (and more) in the infant mortality rate.

Perinatal mortality refers to death around the time of delivery and includes both fetal deaths (of at least 20 weeks of gestation) and neonatal deaths (death during the first 28 days after live birth). Neonatal mortality is encompassed within perinatal mortality.

Infant mortality is not the correct mortality rate to use to gauge safety of obstetrics / maternity care. 

Perinatal mortality is a much more accurate measure for maternity care (even the World Health Organization acknowledges this). It includes prematurity, fetal mortality (death of baby in utero), intrapartum mortality (death of baby during labor and delivery) and neonatal mortality (death of baby during first 27 days of life).

So why don’t the leaders of the home birth movement discuss perinatal mortality? Because the United States does very well with perinatal mortality, tied with countries like France and Japan, and actually better than countries like the Netherlands and the UK.

The USA unfortunately does rank poorly for infant mortality. Why is that? You might be surprised to hear that it is not due to obstetrics. It is mainly due to two factors:

1. We include micro preemies in our infant morality rate while other countries would consider them to be miscarriages or stillbirths. In other words, it's not a matter of more babies dying in the USA, it's a matter of us recording deaths that other countries would not. (this also affects our neonatal mortality rate... read more about that in the article below). Infant deaths within the first month of life are less frequent in the USA than they are in Finland, which has the lowest infant mortality rate in the world.

2. Socio-economic issues is unfortunately the other issue, families lacking means to have what they need to safely raise a baby in their home (for example, not being able to afford to take their child to the doctor or hospital if the child is sick). Unfortunately, there are a lot of deaths happen after the first month of life but before the first birthday.

You can read this short but informative article that expands on these issues here, the studies are included within this piece: new infant mortality studies

There is also the neonatal mortality rate. Neonatal refers to the newborn period of life, specifically the first month. Neonatal mortality rate refers to the death of a baby any time after live birth and through the first 27 days. If a baby dies prior to labor or prior to birth, the baby will not be included in the neonatal mortality rate. Only babies born alive but die some time in those first full 27 days are included in the neonatal mortality rate. Neonatal mortality rates can be broken up into early neonatal (death in the first week) and late neonatal (death after the first week but before the 28th day). 

We have an excellent neonatal mortality rate in the USA. The overall neonatal mortality rate for the United States is 4/1000 (4 deaths for every 1000 live births -- which is the same neonatal mortality rate as Canada). This rate includes all gestational ages (including extreme prematurity), all risks, all complications, lethal anomalies, etc. If you are looking at full-term, low risk women and exclude lethal anomalies, the neonatal mortality rate is much lower than 4/1000... it is currently approximately 0.3/1000.

Maternal mortality - why does the USA have a rising maternal mortality rate? Unfortunately, the real issue in our country is health of pregnant women. Maternal death is very rare (which is why it's measured per 100,000). And it's even more rare for healthy, low risk women.

Our number one pregnancy-related killer for women in the USA is cardiovascular disease.

Some important information to read/consider:

"In the U.S., deaths from hemorrhage, sepsis (infection) and abortion (the medical definition of which includes ectopic pregnancy, miscarriage and induced abortion) are on the decline.... But deaths from medical complications that were either exacerbated by pregnancy or started during pregnancy -- things like congenital heart disease, diabetes, obesity and kidney problems, are on the rise." (my emphasis; quote from Maternal Mortality Article << this link includes a recent study on maternal mortality around the globe)

In other words, mass majority of the women dying due to pregnancy-related issues in the USA have chronic health issues and need more intervention, not less.

That should clear up the confusion. Don't let someone scare you away from a hospital birth with infant and maternal mortality rates. Now you have the information you need to know that our hospitals in the USA do quite a good job of keeping our babies and mothers safe during childbirth.

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