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Severe adverse maternal outcomes among low risk women with planned home versus hospital births in the Netherlands: nationwide cohort study

BMJ 2013; 346 doi: https://doi.org/10.1136/bmj.f3263 (Published 13 June 2013) Cite this as: BMJ 2013;346:f3263

Rapid Response:

Re: Severe adverse maternal outcomes among low risk women with planned home versus hospital births in the Netherlands: nationwide cohort study

As a psychologist with a professional interest in reproductive health, and being 30 weeks pregnant myself, I have recently been consulting the literature to determine my own birth options. I read the deJonge article (1) with interest and the subsequent correspondence by Teuter with surprise (2).

To begin with, it seems Teuter is unable to count. DeJonge et al. clearly state there were 5 maternal deaths in the study sample, 2 in the home birth category (2/100,000) and 3 in the hospital birth category (6/100,000) (3). Despite this clear and unambiguous statement, Teuter in her blog states “there were 3 maternal deaths attributable to pregnancy in the entire study, 2 in the homebirth group and one in the hospital group for a death rate of 2/1000, 000 in each group” (4) and uses these figures to argue that this paper in fact provides evidence that that home births are unsafe.

As the author of the Skeptical OB http://www.skepticalob.com/ (a clearly undeclared competing interest) it seems that Teuter’s raison d’etre is to rubbish homebirths at every opportunity. Let’s be clear, she is not just questioning the BMJ results, she is doing all she can to discredit them.

The public should be able to have confidence in their physicians. By confidence, I mean that they should expect their care to be based on evidence. Despite the clear and careful work of DeJonge et al, and the rigours of the BMJ peer review process, Teuter is unwilling to consider any alternatives to her own entrenched position. As a member of the public it is worrying to think that my medical care might be determined by a doctor’s personal agenda rather than clinical evidence.

References:

1) de Jonge, A., Mesman, J AJM, Manniën, J., Zwart, J. J. van Dillen, & J. van Roosmalen (2013) Severe adverse maternal outcomes among low risk women with planned home versus hospital births in the Netherlands: nationwide cohort study. British Medical Journal 346. doi: http://dx.doi.org/10.1136/bmj.f3263

2) Tuteur, A. (14th and 25th June 2013) Rapid Response. http://www.bmj.com/content/346/bmj.f3263?tab=responses

3) de Jonge, A., Mesman, J. A. J. M., Manniën, J., Zwart, J. J., van Dillen, J., & van Roosmalen. J., (24th June 2013) Rapid Response. Authors Reply. http://www.bmj.com/content/346/bmj.f3263?tab=responses

4) http://www.skepticalob.com/2013/06/surprise-there-were-homebirth-deaths-...

Competing interests: No competing interests

02 July 2013
Irenee C Daly
Psychologist
Centre for Family Research, University of Cambridge
Free School Lane, Cambridge, CB2 3RQ