I think that the more swagger and sarcasm involved is present in an argument, the less evidence there usually is to back it up. I find this post particularly disturbing in its tone, and its lack of real obstetrical knowledge to back up the assumptions mixed among the insults.
I am not happy with the extreme bias and apparent interest in just supporting a world view (while criticizing the same in others, ironically) as opposed to actual truth finding in the few posts I read at this site, and I don’t think this site is going to be worth much investment of my time and limited stress reserve. I was pointed at this post, which discusses a recent, flawed meta-analysis of home births that includes unplanned, precipitous births at home in its analysis, instead of using an “intent to treat” model. I felt the need to answer this particular post, which simply assumes at the end that precipitous, unplanned home births only happen in snow storms, and would have no confounders associated with poor neonatal outcomes. With no discussion of the pathology or etiology of precipitous delivery or neonatal morbidity, of course, and no citations.
“The Pang study, for example, contributed a large chunk of the population analyzed for neonatal deaths, but has been widely debated and criticized for including unplanned home births in its analysis of neonatal death at home birth.”
How could this possibly make a difference? It was limited to near or full-term deliveries. People simply don’t have many near full term at home accidentally. These have to be things like getting snowed in.
Do you have any data about what percentage this is? Did you know you can calculate how big the effect would have to be to shift the results. (hint: if it is huge, than it can’t make a difference) Have you done that? If you haven’t why do bring this up?
Here is my reply:
(Reposted with the html fixed)
I can tell you how it could make a difference, even at full term delivery.
First of all, especially if there is no trained attendant at the delivery, and/or if a labor is precipitous, it would be very unlikely that a GBS colonized mother would receive antibiotics, as per protocol. Strep pneumonia is the “leading infectious cause of neonatal morbidity and mortality in the United States”. This is an issue regardless of term.
The next few points are all taken from Gabbe’s Obstetrics. 2% of labors in the United States are precipitous. This is not just an issue during snow storms.
Another way a precipitous labor may be associated with poor outcomes? Maternal cocaine use is a risk factor for precipitous labor, and is independently linked with poor neonatal outcomes. And, it’s linked with not having adequate prenatal care or a trained attendant at the delivery.
Also, placental abruption is associated with precipitous delivery. Also independently associated with poor neonatal outcomes, including hypoxia. According to Mahon’s retrospective analysis of TERM precipitous deliveries, it is the ones that are really abrupt (above the 95%) that are associated with neonatal mortality. You know, the ones that come so fast you can’t make it to the hospital, and end up being unintended home births.
Also according to Gabbe, precipitous labor is also associated with uterine tetany, which may cause intrapartum fetal hypoxia or fetal distress, which are related to poor outcomes.
I would rather see citations than insults and conjecture.