Abstract
We thank Ms Snyder for her Letter to the Editor concerning our most recent publication.1Grünebaum A. Mccullough L. Brent R. Arabin B. Levene M. Chervenak F. Perinatal risks of planned home births in the United States.Am J Obstet Gynecol. 2015; 212: 350.e1-350.e6Abstract Full Text Full Text PDF PubMed Scopus (40) Google Scholar Ms Snyder correctly states that birth certificates only include live births and not stillbirths, and we clearly state that difference in our publications.1Grünebaum A. Mccullough L. Brent R. Arabin B. Levene M. Chervenak F. Perinatal risks of planned home births in the United States.Am J Obstet Gynecol. 2015; 212: 350.e1-350.e6Abstract Full Text Full Text PDF PubMed Scopus (40) Google Scholar, 2Grünebaum A. McCullough L.B. Sapra K.J. et al.Early and total neonatal mortality in relation to birth setting in the United States, 2006-2009.Am J Obstet Gynecol. 2014; 211: 390.e1-390.e7Abstract Full Text Full Text PDF PubMed Scopus (67) Google Scholar, 3Grünebaum A. McCullough L.B. Sapra K.J. et al.Apgar score of zero at five minutes and neonatal seizures or serious neurologic dysfunction in relation to birth setting.Am J Obstet Gynecol. 2013; 209: 323.e1-323.e6Abstract Full Text Full Text PDF Scopus (69) Google Scholar We agree with Ms Snyder on 2 important points. First, most planned home births in the United States “are attended by unqualified individuals.”1Grünebaum A. Mccullough L. Brent R. Arabin B. Levene M. Chervenak F. Perinatal risks of planned home births in the United States.Am J Obstet Gynecol. 2015; 212: 350.e1-350.e6Abstract Full Text Full Text PDF PubMed Scopus (40) Google Scholar Second, in the United States “the rates of adverse outcomes [from planned home birth] are likely much higher due to the exclusion of fetal death reports.” This is but another component of the clinical reality that, because adverse outcomes in planned home births transferred to the hospital are likely attributed to hospital births, the outcomes of planned home birth are even worse than documented in our papers. An improved birth certificate that included more information on hospital transfers from planned home births would help in elucidating this important information. We thank Ms Snyder for reinforcing the main finding of our papers: planned home birth has increased risks of serious adverse perinatal events that can be prevented by planned hospital birth.1Grünebaum A. Mccullough L. Brent R. Arabin B. Levene M. Chervenak F. Perinatal risks of planned home births in the United States.Am J Obstet Gynecol. 2015; 212: 350.e1-350.e6Abstract Full Text Full Text PDF PubMed Scopus (40) Google Scholar, 2Grünebaum A. McCullough L.B. Sapra K.J. et al.Early and total neonatal mortality in relation to birth setting in the United States, 2006-2009.Am J Obstet Gynecol. 2014; 211: 390.e1-390.e7Abstract Full Text Full Text PDF PubMed Scopus (67) Google Scholar, 3Grünebaum A. McCullough L.B. Sapra K.J. et al.Apgar score of zero at five minutes and neonatal seizures or serious neurologic dysfunction in relation to birth setting.Am J Obstet Gynecol. 2013; 209: 323.e1-323.e6Abstract Full Text Full Text PDF Scopus (69) Google Scholar, 4Cheyney M. Bovbjerg M. Everson C. Gordon W. Hannibal D. Vedam S. Outcomes of care for 16,924 planned home births in the United States: the Midwives Alliance of North America statistics project, 2004 to 2009.J Midwifery Womens Health. 2014; 59: 11-27Google Scholar Perinatal risks of planned home births in the United StatesAmerican Journal of Obstetrics & GynecologyVol. 214Issue 2PreviewAccording to the 2010 through 2012 Centers for Disease Control and Prevention birth certificate data records analyzed by Grünebaum et al,2 the risks of home births were shown to be significantly increased compared to a hospital delivery in the United States.3 However, there is an inherent flaw in the data chosen to emphasize the dangers of unqualified midwives performing vaginal deliveries in homes. Birth certificates are administered to live births as determined on the state level.1 By solely using birth certificates in the analysis, the babies born without signs of life have fetal death reports filed and are not included in the analysis. Full-Text PDF
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