11 responses to “Wax homebirth study”

  1. Beverley Walker

    Lisa thanks for all the effort you have put in here to critique this Wax and Wane study. I took a lot of interest in this study.Our colleagues across the sea and locally did a good job dissecting the discrepancies. One critique that stood out for me was that the Netherlands studies were not included but the SA Kierse et al package as well as old Bastian et al studies were included. Clearly suggesting selective bias.

    The best study as far as I am concerned is the one done in Canada released in October 2009.
    Pulblished Agust 31st 2009 CMAJ Janssen, Saxell and Klein. Just in time to counter the shall I say simplistic study published in the pharmaceutical funded Australian Medical Journal.
    This major work was a longitudinal study placing a cohort of planned home births conducted by HB midwives from 2001 – 2004.
    The same cohort of midwives (4752) were placed as well with hospital births – those women who would have been eligible for home birth. They also examined hospital births attended by (5331) physicians. The outcomes measured were fetal mortality and interventions plus maternal and fetal outcomes . The outcomes overall were significantly better for the home births attended by HB midwives. This is a complicated read but I believe as an experienced researcher this study was conducted with very little room for bias and with meticulous attention to research methodology.

  2. Michelle Breen

    Love the picture! I am in complete agreement about how disturbing it is a professional medical society publishes junk science and then uses the publication as support of its position.

    I would like to explain that planned home births do sometimes result in “epidural analgesia, electronic fetal heart rate monitoring, episiotomy, and operative delivery”. It happens when the mothers transfer to hospital either before or during delivery. Good science will keep these transfers in the home birth group when analyzing results.

    The Wax Paper, however, is not a good study. It is an example example of the problems associated with meta-analysis. Garbage in, garbage out.

  3. damidwif

    I’d like to add that if you have your baby in a hospital, they CAN AND WILL place blame on you, depending on the situation. The more “cooperative” you are, the “better” time you’ll have. Think of it in psychological theory terms, people tend to like most people who are like them–who have the same beliefs, etc. If you think your doctor knows everything and always has your own best interest in mind, and you follow his/her orders, the easier things will be. If, on the other hand, you are knowlegeable, questioning, and see yourself as the sole person who has your best interest in mind, you invite trouble. And on top of that, they will tell you NOT how lucky you were to be in the hospital, but how DUMB you are for having considered otherwise.

  4. Serena26

    I also wanted to comment that things like sections, epidurals etc. need to be included as the research should be about planned place of birth, so all results after a transfer should apply to homebirth group. But the term planned should be planned at the moment labour starts not at 12 weeks (remembering horrible piece of research by Kennare).
    I had a worried HB mother ask me about this Wax study so I read it carefully and the mistakes just jump at you if you know where to look. Any meta study with the surname Pang is immediately not to be taken seriously as Pang study included 25% of births which could be planned homebirths, but could be unattended or completely by accident. Which could significantly increase mortality, and it does not include data about transfers which on the other hand could exclude some bad results. But in general – you can not study planned homebirth the way Pang did. And some very good studies done in Canada were not included in the meta study. Probably because they would mess up the whole bad result :)

    Wax has a nice loophole not to include the de Jonge – Netherlands study because they use a different time for neonatal mortality. Then again – I think almost all countries have slight differences in the definitions on perinatal and neonatal. If de Jonge results are added – the mortality levels are low and equal.

    I admit if the mortality in hospital is extremely low like it is in Sweden (one of the studies included), homebirth could end up with higher mortality during labor as any rare and serious complication – cord prolapse, placental abruption, would be more likely to result in babies death at home than in a hospital. But in most of the other countries hospital mortality is not that low and homebirth is equal. And that anyway is about intrapartum not neonatal mortality. I could not figure out how you can get higher neonatal mortality rates. Only if you do not have proper postpartum care and miss severe jaundice or other complications for the baby. And homebirth babies in most countries get excellent post partum care with several visits during the first week and more followup during the first month. So – I could believe in more neonatal deaths in unattended births, but not in proper planned homebirths.

    Actually Ina May Gaskin has written a good piece about this study and about how USA needs to improve maternity and postpartum care in her newest book – Birth Matters. Recommended reading :)

  5. Serena26

    P.S. i do agree that it is ridiculous to write that more babies die after birth because women do not have epidurals and other interventions during birth. Which was sort of the way it was written in some news.

  6. Rebecca

    I kind of wonder though whether the higher neonatal mortality rate is because in hospital there is the means and pressure to resuscitate at all costs, even if it results in the permanent damage of a baby. I have a friend with a severely disabled twin, born in hospital and resuscitated after emergency caeserean, and while she is a joy to her parents, it is a hard road to walk down for them.

    I haven’t seen any studies comparing the long term morbidity issues for the child for hospital vs homebirth. I wonder if there is a difference here that compensates for the difference in neonatal mortality. Are women who choose homebirth more likely to request ‘no heroics’ in an emergency situation? Have you read anything?

  7. Susan Fierro-Baig

    Lisa, I can’t find an email for you, so I am going to ask you here if you’d be willing to come on my blogtalkradio show, MamaBaig On The Air, to discuss this study. I have quite a few conclusions myself about it and would like to discuss them with you.


    The 1/2 hr. conversation would be conducted over the phone, so this would require an international call to the states, via a land based line.

    Thanks for considering this request. ;)

  8. Frits van den Haag

    I wrote I long comment and the computer here in Helsinki have the whole text “eated”.
    I prepared a text for 2 hours and I have no more time…

    The worst of the big lie of Wax, that some autorities, like in Hungary, use it as a fact and through the influenced and corrupt judges have pushed the best midwife in prison. And she is nowdays also not free.