tag:blogger.com,1999:blog-4923885836586206729.post7653001132197245660..comments2023-11-02T06:49:24.564-07:00Comments on American Home Birth: MANA Study Part 1: Intrapartum Mortality RatesAnonymoushttp://www.blogger.com/profile/10460197503063601577noreply@blogger.comBlogger5125tag:blogger.com,1999:blog-4923885836586206729.post-70551256702201074432014-03-07T13:09:20.538-08:002014-03-07T13:09:20.538-08:00If I could like your comment I would do so a thous...If I could like your comment I would do so a thousand times.Anonymoushttps://www.blogger.com/profile/10460197503063601577noreply@blogger.comtag:blogger.com,1999:blog-4923885836586206729.post-45355436680474764502014-03-07T12:02:09.493-08:002014-03-07T12:02:09.493-08:00Well, it isn't actually a "study" an...Well, it isn't actually a "study" anyways. I'm no sociologist, but as a historian, I have always been told that any "study" where the participants are self-selected isn't worth much. This was more of a survey than anything else, and there was nothing to stop midwives from simply not reporting the bad results. I was pretty amazed that there were a few cases where the outcomes were unknown because the pt transferred to the hospital in labor and the midwife never followed up with her pt. A provider who doesn't follow up with her pt? Yikes. Proserpinahttps://www.blogger.com/profile/01905050625403590363noreply@blogger.comtag:blogger.com,1999:blog-4923885836586206729.post-73184222688961856082014-03-07T09:37:28.461-08:002014-03-07T09:37:28.461-08:00Yes, I agree about the guidelines. I believe that ...Yes, I agree about the guidelines. I believe that you are correct and that the rate for (truly) low risk multips would be even lower. <br /><br />It is unfortunate the many holes there are in this study. I cannot help but wonder if things were left out on purpose. When they list all of the intrapartum deaths, they did not mention which ones happened due to certain high risk pregnancies. They list the GDM deaths and the pre-e death but did not list which ones were the VBAC, breech and twins deaths. Why not? That makes no sense. It makes me wonder if some of the high risk pregnancies were actually doubled up... like perhaps one of the VBAC deaths was labeled a GDM death... meaning they potentially subtracted two deaths instead of one when calculating the low risk IP rate... which would mean the rate for low risk women would be higher if that was the case. It might not be the case. But it just doesn't make any sense that if they know a baby died due to complications of breech/twins/VBAC, why wasn't it listed? Also, they didn't note if there were any uterine ruptures in the VBAC group. This information should be known. Even if there were zero uterine ruptures, they should list that information. VBAC moms deserve to know how many ruptures there were, regardless of positive or negative outcome. That number could be zero or that number could be 20 or whatever. Who knows? Why isn't it listed? There are 11 intrapartum transfers for which the data is not availabe... were any of those ruptures?<br /><br />So many holes.... Anonymoushttps://www.blogger.com/profile/10460197503063601577noreply@blogger.comtag:blogger.com,1999:blog-4923885836586206729.post-2673534860388305052014-03-07T05:54:21.517-08:002014-03-07T05:54:21.517-08:00This was from a note that Rebecca Dekker of Eviden...This was from a note that Rebecca Dekker of Evidence-Based Birth posted on her Facebook page: <br /><br />"The in-labor stillbirth rate was 1.3 per 1,000 for the entire sample, excluding fatal birth defects. It was lower for both low-risk women (0.85 per 1,000) and women who had given birth before (0.84 per 1,000), and higher for first-time moms (2.92 per 1,000), breech presentation (13.5 per 1,000), and VBAC attempts (2.85 per 1,000)."<br /><br />I assume that the 0.84 per 1,000 for primips/multips includes all risk groups, which makes me wonder what the intrapartum death rate would have been for primips/multips who were truly low-risk (not VBAC, not twins, not breech, not GD, not preeclampsia). It sounds like homebirth *could* have relatively less risk for such women, and I imagine that risk would go down even further if they were attended by a truly capable provider, i.e. a CNM or MD/DO with hospital privileges. <br /><br />That said, the risk category for everyone else is just so much higher. Homebirth "safety" guidelines should clearly state that FTMs and everyone in higher risk categories should be strongly advised to birth in the hospital. Proserpinahttps://www.blogger.com/profile/01905050625403590363noreply@blogger.comtag:blogger.com,1999:blog-4923885836586206729.post-26565618717791758832014-03-05T10:34:33.096-08:002014-03-05T10:34:33.096-08:00Excellent! Thank you for this analysis.Excellent! Thank you for this analysis.Karen in SCnoreply@blogger.com