- Perinatal & maternal mortality in a religious group avoiding obstetric care– Am Jour Obst Gyne 1984 Dec 1: 150(7):926-31:
Synopsis: Data on this group of purposefully unattended home births came from Indiana state mortality statistics for a fundamentalist religious group. This childbearing population consisted of essentially healthy, well-nourished, primarily white women with adequate economic resources.
However, these families rejected all aspects of modern medical care under all circumstances based on the group’s religious belief. As a result, pregnant women had:
- no prior diagnosis or treatment of chronic medical problems
- no risk-screening prior to or during pregnancy
- no prenatal care
- no trained attendant during labor, at the time of the birth or immediately postpartum/postnatal
- no use of emergency services if the laboring woman, newly delivered mother or a newborn developed life-threatening complications
The virtual absence of scientifically-based healthcare is similar to parts of the developing world such as sub-Sahara Africa and Afghanistan.
It also replicates the health dangers that all childbearing faced prior to the development of the biological sciences in the late 19th century and advances in life-saving medical services over the course of the 20th century.
Out of 344 births in this unattended group, there were:
- 6 maternal deaths
- 21 perinatal losses
The baseline maternal mortality rate for unattended childbirth was the
- death of one mother per 57 births (i.e. MMR of 872 per 100,000 live births, which is 92 times higher than Indiana’s MMR for the same period)
- one perinatal loss for every 16 births (i.e. PNM rate of approximately 45 per 1,000.
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Earliest record of Egyptian midwives providing care during normal childbirth 5,000 years ago
“Home Delivery & Neonatal Mortality in North Carolina”, Claude Burnett, Judith Rooks; JAMA, Dec 19, 1980, Vol. 244, No. 24, p. 2741-2745: (births occurred during 1974 through 1976)
Original paper presented April 1978 at the EIS Conference, US Department HEW, Family Planning Evaluation Div, Bureau of Epidemiology, Center for Disease Control, Atlanta Georgia, 30333
This study included 1,296 births that occurred OOH (both planned and unplanned/precipitous and/or unattended) during this 3 years period with 36 neonatal deaths.
However, the majority of OOH births (72%) were both planned and attended by country-registered lay midwives, while 28% were unplanned, unattended or precipitous deliveries, or attended by non-registered caregivers.
The raw data for unattended births or ones attended only by an untrained person was the death of one newborn for every 36 OOH births. However the vast majority of these bad outcomes — 83% — were in the unplanned/unattended group, a rate that is five times higher.
The unplanned OOH cohort had a dramatically increased perinatal mortality rate that ranged from 30 to as high as 120 stillbirth and neonatal deaths per 1,000 births.
This extremely high perinatal mortality rate in unplanned or unattended OOH birth is consistent with 3rd world countries and unattended births among the religious group in Indian identified in the study published in 1984.
Lay midwife-attended planned home births had no maternal deaths and only 4 neonatal losses per 1,000, 2 of which were lethal birth defects.
Quotes from pages 3 & 4:
“It should be noted, before leaving Table 2, that [home} births attended by lay midwives experienced a slightly lower neonatal mortality rate than birth attended by physicians in the hospital.
Also, birth delivered by other attendants had a statistically significant 9 times the neonatal mortality compared with midwives. ….
Fewer prenatal visits were associated with higher neonatal mortality. Making further comparisons by (birth) attendant, lay midwives delivered predominantly black, less-educated women whose infants were of higher birth weight. Thus, the screening process of prenatal care appears to have resulted in the selection low-risk birth with subsequently lower neonatal mortality.
Two of the 4 deaths associated with midwives were congenital anomalies, thus reducing their potentially avoidable mortality to a very low level.
… controlling for birth weight and race, home deliveries attended by other than a physician or a lay midwife {i.e. untrained neighbor or family members} experienced the highest neonatal mortality — nearly 4 times that of lay midwives and twice that of physician…
Not only did this group make fewer prenatal visits, but also they were predominantly white. Nearly 40% of them had more than a high school education…
- “Prophylactic Cesarean Section at Term?”; Feldman GB, Friedman
JA; New England Journal of Medicine 1985;312:1264-1276
Excerpt: This peer-reviewed paper in the NEJM proposed that the prophylactic use of Cesarean section become a new standard of care for all childbearing women, claiming that pre-labor Cesarean surgery would save 36 to 360 babies for everyone “extra” woman dying from complications of their surgery.
- 1266 ….the number of extra women dying as a result of a complete shift to the prophylactic cesarean section at term would be 5.3 per 100,000….
This may be the proper moment to recall that the number of fetuses expected to suffer a disaster after reaching lung maturity is between 1 in 50 to 1 in 500. … if it could save even a fraction of the babies at risk, these calculations would seem to raise the possibility that a shift toward prophylactic cesarean section at term might save a substantial number of potentially healthy infants at a relatively low cost of excess maternal mortality.
- 1267….is it tenable for us to continue to fail to inform patients explicitly of the very real risks associated with the passive anticipation of vaginal delivery after fetal lung maturity has been reached?
If a patient considers the procedure and decides against it, must she then be required to sign a consent form for the attempted vaginal delivery?