I recently subscribed to Essentially MIDIRS. (Can I tell you how much I LOVE this magazine!) The April 2011 issue presents the abstract of an in-depth review, "Examining autonomy's boundaries: a follow-up review of preinatal motality caes in UK independent midiwfery" of a study showing a significantly higher perinatal mortality rate for births booked under and independent midwife compared with births in National Health Service units. Now what would we do if a study showed a similar finding in the United States? Run articles touting the dangers of home birth (a majority of the births attended by independent midwives in the study were at home) of course. Interestingly enough, in the UK, they take a different, more evidence-based approach. They took an in-depth look at the findings for the study. What did they discover? According to the abstract, there were 15 perinatal deaths at term with the independent midwives. Seven of the deaths were unpreventable (ie, they would have happened in a hospital with a doctor). The abstract notes "Elective cesarean may have changed the outcome in eight cases. However the pregnant women had declinded this option.... Care management was judged to be clinically acceptable within the parameters set by the mother's choices." The conclusion states, "If reality is to match rehetoric about 'patient autonomy,' such decision making in high-risk situations must be accepted" (emhasis mine). Overall perinatal mortality was low, 1.7% for independent midwives vs. .6% for the births in the National Health Service Units.
So it turns out the higher perinatal mortality rate was not due to a deficiency in care. Hmm, I can think of similar studies in the U.S. (hmm, can anyone say Wax) that may have benefitted from a careful review of the results.