April 4, 2011

New Materials Available Related to Wax Homebirth Meta-Analysis

Readers at OBOB and on birth issues generally will know that the Wax meta-analysis on home birth generated much controversy and discussion about its methods, conclusions, and presentation, which Nature News summarizes in a recent story.

As a result of the high level of interest and debate, the American Journal of Obstetrics and Gynecology has allocated additional space to discussion of the paper, making letters to the editor, supplemental materials, and its editorial freely available to the general public for review, saying “There were a number of issues raised in the letters, many of which the panel believed were subjective and should be debated openly.”

The journal also convened a review panel to examine the paper, with the following outcomes as reported in the editorial:

…the results the panel found was slightly different from the result in the manuscript, although there was no difference in (1) the direction of the point estimate of the pooled odds ratio or (2) the overall “statistical significance” of the result. The panel made the following recommendations: (1) The Journal should publish online full summary graphs for each outcome that was assessed in the study, which will allow readers to assess the study findings better, and (2) no retraction of the article is necessary.

The editors themselves conclude, “It is clear that we need more rigorous and better designed research on this important safety issue of home birth, given the many confounding factors.”

The editorial page links to several of the letters to the editor, author replies, and supplementary data.

The supplementary materials from Wax et al, posted this February, thankfully include a type of forest plot for many of the outcomes, making it much easier to see and understand what the results were from each included paper for each variable than it was in the original publication.


One Response to “New Materials Available Related to Wax Homebirth Meta-Analysis”

  1. Terra RN Says:

    Thank you for posting this. This highly controversial study continues to generate buzz among my RN colleagues who are divided on the issue of home birth, and more data is always helpful when deciding on the worth of a study for practice.

    I think one thing that everyone can agree on is that further study is warranted to find out once and for all whether planned homebirth for low risk pregnancies is a safe alternative.

    One thing is for certain, we as a country need to pursue any and all research avenues that could result in improving our poor maternal/neonatal outcomes.

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