Planned home compared with planned hospital births in the Netherlands: Intrapartum and early neonatal death in low-risk pregnancies
Thank you for the opportunity to respond to the preceding authors.
Wax and Pinette suggest that our “perfect guideline analysis” actually underestimates the true perinatal mortality rate among low-risk deliveries. We agree. To demonstrate the potential bias introduced by previous authors who ex post facto excluded high-risk groups, we developed the more natural ex ante prospective approach, reflecting daily practice (Table 2 in our article), and estimated the effect of stepwise consecutive exclusion of categories (subgroups) on the perinatal mortality rate (Fig. 3 in our article). Both may point toward a higher perinatal mortality rate in specific highrisk groups, in agreement with Wax’s study.
Wax and Pinette also emphasize the need for including a risk-adjusted comparison with physician-led care in the hospital. Our primary research goal was to compare planned homebirth with planned hospital birth—both midwife-led—to support policy-making on the optimal setting of care, leaving the midwife’s position as independent professional caregiver unchanged. A comparison of settings naturally includes the gynecologist– hospital combination. However, the Dutch registry data do not allow for such a comparison because low-risk women rarely have their deliveries at the hospital and because too few case-mix data are recorded. Finally, we unintentionally did not refer to the postpublication correspondence of Wax’s study. We generally agree with the views expressed in that correspondence. [...]
|Keywords||gynecology, home births, hospital births, neonatal death, pregnancy|
|Persistent URL||dx.doi.org/10.1097/AOG.0b013e318244c268, hdl.handle.net/1765/53387|
|Journal||Obstetrics and Gynecology|
van der Kooy, J, Poeran, V.J.J, de Graaf, J.P, Birnie, E, Denktaş, S, Steegers, E.A.P, & Bonsel, G.J. (2012). Planned home compared with planned hospital births in the Netherlands: Intrapartum and early neonatal death in low-risk pregnancies. Obstetrics and Gynecology, 119(2). doi:10.1097/AOG.0b013e318244c268