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Comment on the Wax et al., (2010), meta-analysis of home vs. hospital birth

Abstract:

Systematic reviews aim to ‘identify, evaluate and summarise the findings of all relevant individual studies’ (Centre for Reviews and Dissemination, 2008, p. v). A systematic review is often considered level one evidence as it reviews all known randomised controlled trials on the subject and synthesises the findings. When done well a systematic review can provide a reliable estimate of the effectiveness of any particular type of intervention because combining results of several similar studies can provide more evidence than one study alone. As with any research project a systematic review needs to be undertaken in a particular way so that the review question, the search strategy, the population, interventions, comparators, outcomes and study designs are clear and the review could be easily replicated. Any knowledge claims need to be clearly based on evidence found in the review, as such there is a need to minimise bias, and ensure objectivity when undertaking reviews. A recently published systematic review in the American Journal of Obstetrics & Gynecology has raised questions about homebirth. The paper in question – Maternal and newborn outcomes in planned home birth vs planned hospital births: a meta-analysis by Wax, Lucas, Lamont, Pinnette, Cartin, and Blackstone (2010) provides a systematic review and metaanalysis of homebirth. It claims that home Authors: • Susan Crowther BSc (Hons), MSc, RM Lecturer, School of Midwifery Auckland University of Technology (AUT) • Andrea Gilkison PhD candidate, M.Ed (Dist), B.A, RM Senior Lecturer, School of Midwifery AUT • Marion Hunter: MSc Senior Lecturer School of Midwifery AUT birth results in less medical intervention for the mother but is associated with a tripling of the neonatal mortality rate. We have identified several issues with this paper leading us to question the motivation of the researchers, the assumptions taken into the review and the validity of this systematic review. In this paper we critically appraise this systematic review and outline our concerns.

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Home birth, hospital birth, medical intervention., neonatal mortality rate