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Study validity questioned

  • Noam Zohar
    Affiliations
    Graduate Program in Bioethics, Department of Philosophy, Bar Ilan University, Israel, Currently: Visiting Scholar, School of Social Science, Institute for Advanced Study, Princeton, NJ
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  • Raymond De Vries
    Affiliations
    Bioethics Program/Medical Education/Sociology/Obstetrics and Gynecology, University of Michigan Medical School, 300 North Ingalls St., Rm 7C27, Ann Arbor, MI 48109-5429, AVM University of Midwifery Education and Studies, Faculty of Health, Medicine, and Life Sciences, Maastricht University, Postbox 1256, 6201 BG MAASTRICHT
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      To the Editors:
      We read with some alarm the article by Wax et al entitled, “Maternal and newborn outcomes in planned home births vs planned hospital birth: a metaanalysis.”
      • Wax J.R.
      • Lucas F.L.
      • Lamont M.
      • et al.
      Maternal and newborn outcomes in planned home birth vs planned hospital births: a metaanalysis.
      We agree with several researchers who point out that the method used to select studies for inclusion in this metaanalysis requires serious scrutiny.
      But even if we accept the authors' flawed data, their main argument remains highly misleading. Of greatest concern is the conclusion that home birth is associated with a greater risk of neonatal death. This conclusion is an artifact of the authors' study design, in that the home birth data used for comparison include births not attended by a certified midwife.
      The authors do inform us that when these studies are excluded from the analysis, the odds ratio for neonatal death between home and hospital births is no longer statistically significant. However, this information appears only in a complex sentence at the end of Results, opening the door to the publication of false reports on the safety of birth at home by the mass media. A more honest title for this study would be “Outcomes of unattended birth vs births attended by trained professionals.” The misleading presentation of data begins in the title and continues in the abstract and virtually throughout the article.
      This misrepresentation of data is contrary to what the public rightly expects from science.

      Reference

        • Wax J.R.
        • Lucas F.L.
        • Lamont M.
        • et al.
        Maternal and newborn outcomes in planned home birth vs planned hospital births: a metaanalysis.
        Am J Obstet Gynecol. 2010; 203: 243.e1-243.e8

      Linked Article

      • Maternal and newborn outcomes in planned home birth vs planned hospital births: a metaanalysis
        American Journal of Obstetrics & GynecologyVol. 203Issue 3
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          We sought to systematically review the medical literature on the maternal and newborn safety of planned home vs planned hospital birth.
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      • Editors' comment
        American Journal of Obstetrics & GynecologyVol. 204Issue 4
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          We have received numerous letters to the editors regarding the article by Wax et al: Maternal and newborn outcomes in planned home birth vs hospital births: a metaanalysis, published in the September, 2010 edition of the Journal. Five of these letters are selected to be published here with the reply from the authors. In response to the concerns that were expressed in the letters, the American Journal of Obstetrics and Gynecology convened an independent review panel to (1) review the article that was published and these letters to the editors and (2) make recommendations to the Journal.
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      • Reply
        American Journal of Obstetrics & GynecologyVol. 204Issue 4
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          We are utterly dismayed by Drs Zohar and De Vries' citing unnamed detractors and nonspecific unreferenced criticisms of our study. Their characterization of the data as “flawed” is particularly interesting regarding a metaanalysis. We were especially taken aback by the proposed alternative title for our paper. Not only is it disingenuous considering the clearly stated objective, study inclusion criteria, and method of study identification, but it is also an affront to midwives with credentials other than the certified midwife (CM) or certified nurse-midwife (CNM) designation.
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