Apples and Oranges are, On Average, Orangey

…if your study follows five hundred oranges and ten apples.

There’s yet another bang-up job of scientific/medical reporting in the Guardian today, entitled ‘Home Births are Good for Mother, Riskier for Babies, Study Says’. The article reports that a US study of home birth mortality/morbidity statistics shows that home births lessen the likelihood of interventions that are detrimental to the health of the mother, but triple the risk of death for the baby.

The researchers pulled together data from studies in the US and in Europe, including two from the UK. They considered a total of 342,056 planned home births and 207,551 planned hospital births.

So, what’s my problem with this? Well it’s simple: UK midwives are university trained and nationally certified. They are hospital affiliated and most NHS trusts have thorough, detailed home birth plans in place that, among other things, bring women/babies rapidly into specialist care in case of complication.

In the US, certification differs state-by-state, with some states allowing anyone at all, regardless of training (or lack of) to call themselves ‘midwives’; and midwives, as a general rule, have no affiliation with any hospital or obstetric team, which means that, if an emergency arises, american home birth women dial 911 and wait for an all-purpose ambulance to take them to a medical team with no prior knowledge of their circumstances, prenatal history, etc.

In short, the lot of home birth women in these two countries are practically as different as they could possibly be. Safety and efficacy conclusions based on averages across the two systems are *totally meaningless*–especially when we don’t even know how many studies came from each.  (thank you, Guardian! Bang-up reporting!)

8 thoughts on “Apples and Oranges are, On Average, Orangey

  1. In fairness, this isn’t a feminist issue. The Guardian’s science reporting is lousy across the board. :-P

  2. And in some US states, midwife-assisted homebirth is illegal, which must really skew the statistics for those states.

    Carl: True, and no newspaper seems to have good science reporting, but it’s strange how the worst science reporting often seems reserved for those studies which can be reported to reinforce existing prejudices

  3. Good point.

    One aspect of bad reporting, is that you can only report what you think you understand, which will of course be biased towards conventional prejudices. So, if a study goes against “commonsense” it won’t be understood or reported, or if it is reported, it will be misinterpreted as reinforcing commonsense.

  4. I just wanted to make two points-

    I haven’t been able to find what the selection criteria for the birthing moms (other than birth location) was. Ethical and competent midwives don’t deliver high-risk babies at home, and always work with enough staff and medical back-up.

    Also- the representation of midwifery in the post here isn’t quite accurate. This link might be helpful:

    American midwives do, as a rule, have relationships with hospitals and work with back-up. They go through training either as certified nurse midwives or direct entry midwives, and are licensed and regulated in many states. There are, unfortunately, still states where all midwifery is illegal. But the situation described in this post is not indicative of the professionalism of American midwives.

  5. Slightly on the side, the Netherlands (which has an EXCELLENT midwife training and pre and post natal support system, and around 30 percent of home birthing) is also getting increasingly worried about whether home birthing is such a great idea – despite historically huge support for this practice from within and outside the medical community.

    It is difficult to disentangle the data from the factor of increasing age of (first) mothers, but the data seem to indicate that the NL has unusually bad perinatal mortality by EU standards and for its level of development, etc… So there maybe something in it – although this has nothing to do of course with the point that this was bogus reporting. Maybe the Guardian would like to look at some Dutch studies though?

  6. amanda- a very late reply, indeed, but all the same… i definitely didn’t mean to be taking a jab at the professionalism of american midwives, just so you know. to my mind, the problem (and i think it’s a big one) is the american healthcare system’s failure to support midwifery. second, thanks excellent much for this link. very interesting to be able to see, state-by-state, what the situation is. i think, tho, that the point still stands re this meta-analysis: they’re combining data across a whole spectrum of midwifery/regulatory systems. it’s just not possible to draw any safety conclusions at all from this.

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