You are reading Part 2 of my MANA study series. Click to view:
MANA Study Part 1: Intrapartum Mortality Rates
MANA Study Part 2: Neonatal Mortality Rates (currently reading)
MANA Study Part 3: Total Mortality Rates
MANA Study Part 4: Vaginal Birth After Cesarean
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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). I will be looking at TOTAL neonatal mortality rates, which is simply early neonatal mortality plus late neonatal mortality.
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 is includes all gestational ages (including extreme prematurity), all risks, all complications, lethal anomalies, etc. For obvious reasons, this is not the correct comparison to the MANA study neonatal mortality rate.
Just as I did for the comparison of
intrapartum mortality rates, I am going to compare the neonatal mortality rates from 3 different data sets:
1.
The MANA study - planned home births with a midwife in the USA, attended mostly by CPMs, LMs and LDMs (Certified Professional Midwives, Licensed Midwives and Licensed Direct-Entry Midwives)
2.
The Birth Center study - planned births in
select CABC-accredited birth centers with a midwife in the USA, attended mostly by CNMs (Certified Nurse Midwives)
3.
USA hospitals - births in hospitals in the USA
First, let's look at comparing MANA to the Birth Center study.
Here are the neonatal mortality rates, both rates are excluding anomalies:
MANA study = 0.77/1000
Birth Center study = 0.40/1000
That is an increase risk for babies born at home of just shy of two times. Small yes, but
per 10,000 it is an additional 3-4 babies that die at home births during the neonatal period.
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Now, let's compare to hospitals using the
CDC Wonder Database. Since it is impossible to get an
exact comparison group for hospital births, I will use different hospital groups for the comparison: one that is as close of a match as I can get to the MANA study, and one that is broader. I will define each of them below.
In the first comparison, I will try to match the MANA study as close as possible. So the search results will be based off of the following criteria:
Years 2004-2009 (same as the MANA study)
White Women (92.3% of women in the MANA study were white)
Singles and Twins (small percent were twins in the MANA study, the rest were singletons)
37 Weeks and Above (97.5% of women in the MANA study were 37 weeks and above)
Birth weight of 2500 grams or more (99.2% of babies in the MANA study were 2500 grams & up)
Excluding
most lethal anomalies*
*Excluded are congenital malformations, deformations and chromosomal abnormalities from the hospital group. This may not include all lethal anomalies, as some may be labeled as something else, like cardiac disease, for example.
My search includes everything else... all ages (maternal), all education levels, all marital statuses, etc.
2004-2006:
2007-2009:
Neonatal mortality rates for hospitals based on this search criteria are:
Medical Doctor = 0.33/1000
Certified Nurse Midwife = 0.25/1000
Please note: The hospital CNM group is mostly low risk women; the hospital MD group is low risk and high risk. MD refers not only to OB/GYNs but high risk pregnancy specialists, such as perinatologists and even other medical doctors who may deliver babies, even on rare occasions (such as ER doctors).
Comparing this similar hospital group to the MANA study and we have the following for neonatal mortality rates:
MANA study = 0.77/1000
Hospital CNMs = 0.25/1000
Hospital MDs = 0.33/1000
MANA study rate is 3 times greater than the hospital CNM rate and 2 times greater than the hospital MD group.
Per 10,000 it is an additional 5-6 babies that die at home births during the neonatal period, compared to the hospital CNM group;
compared to the hospital MD group, per 10,000 it is an additional 4-5 babies that die at home births during the neonatal period.
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CDC neonatal mortality data is very accurate, despite what MANA and Citizens for Midwifery have claimed (I will get to that in another post). However, birth certificate data isn't perfect. We are
potentially sacrificing the high accuracy the more search criteria we use. So that is why I will do another comparison with hardly any criteria selected.
The rates below are based on the following:
Years 2004-2009
Birth weight of 2500 grams or more
Excluding
most lethal anomalies*
*Excluded are congenital malformations, deformations and chromosomal abnormalities from the hospital group. This may not include all lethal anomalies, as some may be labeled as something else, like cardiac disease, for example.
My search includes everything else... all races, all ages (maternal), all gestational ages, all singles and multiples, all education levels, all marital statuses, etc.
2004-2006:
2007-2009:
Neonatal mortality rates for hospitals based on this search criteria are:
Medical Doctor = 0.42/1000
Certified Nurse Midwife = 0.28/1000
Please note: As I stated above, the hospital CNM group is mostly low risk women; the hospital MD group is low risk and high risk. MD refers not only to OB/GYNs but high risk pregnancy specialists, such as perinatologists and even other medical doctors who may deliver babies, even on rare occasions (such as ER doctors).
Comparing this similar hospital group to the MANA study and we have the following for neonatal mortality rates:
MANA study = 0.77/1000
Hospital CNMs = 0.28/1000
Hospital MDs = 0.42/1000
MANA study rate is just shy of 3 times greater than the hospital CNM rate and just shy of 2 times greater than the hospital MD group.
Per 10,000 it is an additional 4-5 babies that die at home births during the neonatal period, compared to the hospital CNM group;
compared to the hospital MD group, per 10,000 it is an additional 3-4 babies that die at home births during the neonatal period.
Again we are seeing an increase to babies born at home compared to hospitals, even when we are looking at a much higher risk hospital group for comparison.
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At least 5 babies from the MANA study that died during the neonatal period were due to hypoxia or ischemia. This basically means those babies were deprived of oxygen at some point. I cannot help but wonder how many of these 5 cases (and potentially more) were due to lack of
proper monitoring during labor, especially during second stage (pushing).
For a look at the intrapartum mortality rates,
click here.
Up next, I will put it all together and we can look at the total mortality rates.
References:
1. MANA study:
http://onlinelibrary.wiley.com/doi/10.1111/jmwh.12172/full
2. Birth Center study:
http://onlinelibrary.wiley.com/doi/10.1111/jmwh.12003/full
3. USA Hospitals:
http://wonder.cdc.gov/
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MANA Study Part 1: Intrapartum Mortality Rates
MANA Study Part 2: Neonatal Mortality Rates
MANA Study Part 3: Total Mortality Rates
MANA Study Part 4: Vaginal Birth After Cesarean
