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“Home birth triples the neonatal death rate”: public communication of bad science?

      To the Editors:
      Current debate and commentaries about the paper by Wax et al
      • Wax J.R.
      • Lucas F.L.
      • Lamont M.
      • Pinette M.G.
      • Cartin A.
      • Blackstone J.
      Maternal and newborn outcomes in planned home birth vs planned hospital births: a metaanalysis.
      regarding outcomes of home births have focused on methodological flaws.
      • Daviss B.A.
      • Johnson K.C.
      Home v hospital birth: recent meta-analysis is misleading.
      Another serious concern is the selective quoting of results and conclusions in the paper's abstract and the misleading press release from the American Journal of Obstetrics and Gynecology (AJOG) entitled “Planned Home Births Associated with Tripling of Neonatal Mortality Rate Compared to Planned Hospital Births,” that stated “…of significant concern, these apparent benefits are associated with a doubling of the neonatal mortality rate overall and a near tripling among infants born without congenital defects.” The news story was picked up by the mass media, and reported uncritically in BMJ and The Lancet.
      These practices are unethical, causing harm through unfounded confusion and fear, and misleading policymakers and the public. The Singapore statement on research integrity represents the first international effort to unify policies, guidelines, and codes of conduct for researchers worldwide.
      • Kleinert S.
      Singapore statement: a global agreement on responsible research conduct.
      Accordingly, the AJOG publication would fail on 2 counts: (1) poor quality of the study; and (2) author recommendations made beyond what the data support and outside of their professional expertise. Obstetricians are not the leading professional group in home birth and midwifery-led care, and should not reach policy conclusions in isolation. It is essential to use appropriate subject peer reviewers: in this case midwife and epidemiology experts in studies examining midwifery care and birth setting.
      The AJOG needs to review its quality assurance procedures to ensure that standards of assessing and communicating science are improved. “Bad science” damages both the public and professionals.

      References

        • Wax J.R.
        • Lucas F.L.
        • Lamont M.
        • Pinette M.G.
        • Cartin A.
        • Blackstone J.
        Maternal and newborn outcomes in planned home birth vs planned hospital births: a metaanalysis.
        Am J Obstet Gynecol. 2010; 203: 243.e1-243.e8
        • Daviss B.A.
        • Johnson K.C.
        Home v hospital birth: recent meta-analysis is misleading.
        BMJ. 2010; 341: c4699
      1. Elsevier news release.
        (Accessed Sept. 30, 2010)
        • Kleinert S.
        Singapore statement: a global agreement on responsible research conduct.
        Lancet. 2010; 376: 1125-1127

      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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          Thank you for the opportunity to respond to the preceding authors. For most, these submissions simply represent their latest of a series of letters to various editors on the same paper.1-4 At least one of the letters' clear intent is to discredit our study and force its retraction. This goal provides valuable interpretive context, calling the criticisms' severity and validity into question. Harboring no bias, we embarked on the study to examine an important clinical issue. Although our findings may be unpopular in certain quarters, they result from appropriate rigorous scientific methods that have undergone appropriate peer review.
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