Re: Zaplaťpámbu PRO JOSEFA

Bastian,H.; Keirse,M.J.; Lancaster,P.A.
Perinatal death associated with planned home birth in Australia: population based study
British Medical Journal, 317, 1998
CONCLUSIONS: Australian home births carried a high death rate compared with both all Australian births and home births elsewhere.

ZAVER: Australske domaci porody s sebou nesou vyssi rizika umrtnosti ve srovnani jak s Australskymi porody v nemocnicich tak DOMACIMI PORODY JINDE.
Retrospective analysis lends itself to two obvious issues of bias where the author knows what information to look for and therefore unwittingly finds only information that fits the hypothesis; and where the researcher is classifying a cause of death and the underlying pathology may not be documented or searched for, which again allows the author"s argument to be strengthened in a certain direction.
The nature and extent of the data what percentage of births and deaths were reported and to whom are unstated in Bastian et al"s study.1 Readers are not told which states supplied perinatal data for 1989-90 whether the non-participants in the Homebirth Australia register complied with these data collections. Eleven deaths were excluded for reasons not stated. Thereafter the authors still refer to 50 deaths but it is not clear whether there were 61 deaths or the minimum data were available on 39.
Birthweight specific data were available for 1985-8 (table 4). Is it possible to calculate a five year mortality without birthweight specific data and without giving the number of known births over five years? The paper does not reference the source of national figures on birthweight specific perinatal mortality or give the years for which the data were available.
Can gestational age and cause of death be ascertained with any certainty through retrospective case analysis without confirmation from a postmortem examination by a perinatal pathologist? What percentage of the intrapartum fetal deaths (table 4) might otherwise have been described as inevitable spontaneous abortions?
Is it justifiable to compare perinatal mortality internationally? The baseline measurement for a fetal death in Australia is 20 weeks, for the United Kingdom 24 weeks, for Norway 16 weeks, and for New Zealand (until recently) 28 weeks. The political, educational, and social determinants for home birth differ widely between Australia and the countries compared, as do the exclusion criteria and the discrepancies in collecting study data.
What is the link between late neo- natal deaths and home birth? The five late neonatal deaths (table 3) include death from postviral cardiomyopathy, chromosomal abnormality, and the sudden infant death syndrome. Definitions of late neonatal death and the sudden infant death syndrome are usually mutually exclusive.
Should researchers attempt to draw definitive conclusions with regard to shortcomings in perinatal care, risk assessment, rates and severity of intrapartum asphyxia, cause and time of death, and failure to transfer women safely in a study such as this?

Tato studie ma tolik ‘vad’, ze clovek ani nevi, kde zacit. Ale HLAVNE, pokud neni zajisteny system, zeny rodi daleko (velmi daleko) od porodnic, PA nejsou nijak monitorovane, neni zajisten prevoz do nemocnice atd atd, pak I kdyby to cele bylo tak, jak se nas autor snazi presvedcit, neni se cemu divit. Akorat ze o tomhle se tady nikdo nebavi…



Pang,J.W.; Heffelfinger,J.D.; Huang,G.J.; Benedetti,T.J.; Weiss,N.S.
Outcomes of planned home births in Washington State: 1989-1996
Obstet.Gynecol., 100, 2002
CONCLUSION: This study suggests that planned home births in Washington State during 1989-1996 had greater infant and maternal risks than did hospital births

The authors of the paper about home births in Washington State explain in the full text of the study that they tried to guess which births were planned home births by excluding results for all women who did not fulfil low-risk criteria. Yet in fact many women who plan home births are not strictly low-risk. Of course, it could be that home births in Washington State would perform worse still if the data were more accurate - but the point is that we do not have all the data which would be needed to make a full assessment.
Dalsim zajimavym faktorem jsou studie, ktere si autor vybral jako odkazy a studie, ktere si vybral ignorovat :o).

The Midwives Association of Washington State:
Childbearing women and health policy makers should be made aware that the study contains numerous flaws and limitations. It is critical to distinguish between planned and unplanned home births when examining birth outcomes. The researchers, by their own admission, could not satisfactorily address this problem using the available birth certificate data and their findings are therefore unreliable. This study alone should not be used to make decisions that could restrict women"s choice of birthplace or access to birth attendants with expertise in home birth.



Sorensen,H.T.; Steffensen,F.H.; Rothman,K.J.; Gillman,M.W.; Fischer,P.; Sabroe,S.; Olsen,J.
Effect of home and hospital delivery on long-term cognitive function
Epidemiology, 11, 2000
Our findings raise the possibility that home birth can lead to lower cognitive function in adulthood.

Aaaaah, toto je moje oblibena studie :o)))). Pred zverejnenim odkazu byva dobre sit u kterou studii precist, aby pak clovek nenachytal sam sebe, ze. Nekolik bodu: 1. Jedna se o jedince narozene v letech 1973-1976. Opravdu se v roce 2006 musime bavit o bezpecnosti porodu doma v dobach davno minulych? 2. Jedna se pouze o muze, kdovi, co by se ukazalo, kdyby se studovaly zeny? :o))) 3. Po nejakych 18ti letech se podivat na rodny list a z pouheho faktu ‘Misto narozeni: doma’ vyvozovat nejake zavery, je prinejmensim zvlastni. “The researchers did not know how many of the home births were planned, and how many were unplanned, a problem which for many years bedevilled the UK statistics. Many unexpected births which take place at home (or sometimes in ambulances or taxis) were originally booked for hospital, and these are at very high risk, as the Northern Region Study showed.3
They often arrive precipitately, with no professional present, and there may be additional hazards from whatever caused the unexpected birth e.g. infection, injury or haemorrhage). Many more die, and it would not be unusual if survivors were less likely to be in the best possible state.
In the Danish study, the mothers who gave birth at home were twice as likely to be expecting a third or later child - which would make them more prone to rapid labours. In fact the study proves nothing about a causal effect of home birth on later mental function.”
A nakonec bod 5. Nejvyssi IQ ze vsech skupin prokazali jedinci narozeni v Birth Clinic, tedy porodnich domech! A tam o doktora nezakopnete.
PS: Je samozrejme nutno priznat, ze do tech porodnich domu samozrejme chodi pouze zeny nizkorozikove, coz je dulezitym faktorem. IMHO kdyby se ta studie zamerila na planovane porody doma v terminu, zrejme by dosla k podobnym zaverum (jenze jak to po tolika letech zjistovat, ze).


A. Janssen, S. K. Lee, E. M. Ryan, D. J. Etches, D. F. Farquharson, D. Peacock, and M. C. Klein.
Outcomes of planned home births versus planned hospital births after regulation of midwifery in British Columbia. CMAJ. 166 (3):315-323, 2002.
Zaver teto prace byl, ze i kdyz v skupine deti rodicich se doma 3 umreli (minimalne dve by meli sanci v nemocnici) a v kontrolni skupine neumrelo zadne, nejedna se o statisticky vyznamny rozdil !!!! a porody doma jsou bezpecne. Prace byla podrobena velke kritice v kanadskych kruzich.

Opet musim zkonstatovat, ze pises bludy! Za prve, v kontrolni skupine zemrelo jedno dite, ne ze zadne. A za druhe bys nam mozna mohl vysvetlit, ktere dve z tech trech deti by mely v nemocnici sanci???????
Among perinatal deaths in the home birth group (Table 5), the first stillbirth had no obvious explanation and permission to perform an autopsy was refused by the parents. Fetal demise appeared to have occurred before the onset of labour. In the second stillbirth, a specific cause of death could not be identified by autopsy. The pregnancy had been uneventful, but the midwife ceased to be able to hear the fetal heart during early labour and an emergency transport was initiated. The infant was born at home "tangled in the cord" and resuscitative efforts failed both in transit and on arrival at the hospital. Fetal death was thought to have occurred within a few hours prior to delivery. The infant who died at 2 days of age was the subject of a detailed coroner"s inquest, which could not determine a final cause of death. There was no evidence that the ischemia took place during labour and delivery; fetal heart rate patterns during labour were essentially normal. The baby was extremely asphyxiated at birth, however, and never breathed spontaneously. There was evidence of severe hypoxic ischemic encephalopathy with extensive hemorrhage and infarction in other major organs, indicative of a pre-labour insult.

Omlouvam se, ze je to tak dlouhe a ze mi to tak trvalo, jsem momentalne ponekud zaneprazdnena. Jsem zvedava, jestli se mi jeste dostane odpovedi :o).
Zdravim