Planned Home vs Hospital Birth: A Meta-Analysis Gone Wrong

Carl A. Michal, PhD; Patricia A. Janssen, PhD; Saraswathi Vedam, SciD; Eileen K. Hutton, PhD; Ank de Jonge, PhD


April 01, 2011

In This Article

Paradoxical Results

The main conclusion of the analysis by Wax and coworkers that planned home and planned hospital births exhibit similar perinatal mortality rates, but home births are characterized by 2-3 times higher neonatal death rates,[1] is drawn from data that are self contradictory. The mortality rates reported in the paper are reproduced in Table 1. CIs for these proportions were not provided in the article.

Table 1: Perinatal and Neonatal Death Rates Reported by Wax and Colleagues

  Planned Home Birth (%) Planned Hospital Birth (%)
Perinatal death    
All 0.07 0.08
Nonanomalous 0.07 0.08
Neonatal death    
All 0.20 0.09
Nonanomalous 0.15 0.04

Adapted from Wax JR, et al. Am J Obstet Gynecol. 2010;203:243:e1-e8.[1]

Wax and colleagues defined perinatal death as stillbirth of at least 20 weeks or 500 g, or death of a liveborn infant within 28 days of birth. Neonatal deaths are defined as deaths of liveborn infants within 28 days of delivery.[1] With the definitions chosen by these investigators, neonatal deaths are a subset of perinatal deaths. As can be seen in Table 1, however, the investigators' results show that for planned home births, the neonatal death rates are actually far higher than the corresponding perinatal death rates. According to the investigators' definitions, these results are impossible. This is not unique to the planned home birth statistics, and in fact the neonatal death rate for all hospital births is also greater than the corresponding perinatal death rate. These paradoxical results arise from the dramatic differences in outcomes among the included studies, as will be described. It is clear, however, that the perinatal and neonatal death results cannot possibly represent comparable populations.

Because the perinatal death statistics are drawn from more than 500,000 births, whereas the neonatal death statistics are drawn from fewer than 50,000 births (and for many other reasons described below), the neonatal death statistics in the study by Wax and colleagues cannot be defended.


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