A great many weeks back, my aunt posted this article on my Facebook wall and wanted to know what my response was. Now that I am finally getting around to writing something about it, I can’t find the post, so it’s going here instead. Aren’t you lucky to get to read it?
The Midwives Alliance of North America (MANA) collects voluntarily submitted data on home births from midwives themselves. They don’t do anything with the data themselves except organize it, and accept applications from researchers who do want to do something with it. There is no nationwide requirement for reporting data from home births. MANA comes the closest, but since they do not have the backing of a legal mandate, all the information must be submitted voluntarily. This means both the midwife and the mother both have to agree to submit information. This agreement is made in writing on a release form at the onset of prenatal care with all the other initial paperwork. The midwife starts submitting information to MANA immediately, and continues doing so until the six-week postpartum visit is completed, and the client-midwife relationship comes to an end for that pregnancy and birth.
I bring this up because in various circles there are accusations that the data collected by MANA is “cherrypicked” to include the maximum number of positive outcomes and the minimum number of negative outcomes. It is obvious from the process described above that such cherrypicking is impossible. Nobody knows exactly how a birth will unfold before the birth, in fact, unfolds. So unless we are going to run completely contrary to the universally recognized wisdom that birth is ultimately unpredictable (although not without indicators) and begin claiming that every birth can be accurately foretold from, say, the 12-week mark, or any mark prior to the conclusion of birth, accusations of cherrypicking are a lousy attempt to discredit the information which MANA collects.
This is a link to the study itself: Outcomes of Care for 16,924 Planned Home Births in the United States: The Midwives Alliance of North America Statistics Project, 2004 to 2009
I highly suggest reading the whole thing. I am a big proponent of reading original source documents rather than relying on paraphrased commentary by third parties. The water has the potential to get much, much too muddied for truly informed discourse on the subject. I dislike it equally when proponents or detractors of any contentious issue do not read the source material in question, and draw faulty conclusions or simply parrot what some other commenter, who may have an axe to grind, may have a conflict of interest, may be biased, or may simply not be up to the task of correctly interpreting the facts, has to say.
The point of contention here is how home birth stacks up, safety-wise, with hospital birth. In order to have meaningful results, we must start with meaningful data. In other words, the data on both sides must be comparable in every significant way, or else you are comparing apples to oranges. This fact sheet gives an excellent background summary on the issues involved in gathering information on home birth and the difficulties encountered in trying to isolate truly comparable data sets: Interpreting Home Birth Research: Understanding Conflicting Evidence. I don’t want to rehash it all here when it’s already laid out so well, so please read the whole thing before we continue.
So let’s get in to what statistician Dr. Brooke Orosz actually has to say about her analysis. First off, there is no webpage with the full text of her analysis to link to; there’s just a text document to download. MANA_STATS_response Orosz
Let’s go through it.