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Comment by mentalpiracy | Hacker News Reader

> risk of maternal death for planned out-of hospital births more than double

While your assertion is technically correct, this singular take is a misleading characterization of the source you linked. Per your source:

> Perinatal mortality was higher with planned out-of-hospital birth than with planned in-hospital birth, but the absolute risk of death was low in both settings.

More specifically

> adjusted risk difference, 1.52 deaths per 1000 births; 95% CI, 0.51 to 2.54

I'm not sure this necessarily follows your original description of "pure insanity."

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More than a doubling of maternal death risk isn't pure insanity to you? It wipes out 20-30 years of progress on that statistic. It's also not that low in absolute terms. With 4 million births per year, an increased death rate of 1.52 deaths per 1000 births is an additional 6,000 deaths per year, under pretty much the most tragic circumstances imaginable.

And that's with the status quo of only the healthiest pregnancies being candidates for home birth. It'll only go downhill as it becomes more prevalent.

But it's not more than doubling if the confidence interval ranges from 0.5 to 2.5. It's somewhere between "halves the risk" and "quintuples the risk", which translates to "we don't really know what's going on here."

That's the absolute additional deaths, not the change ratio.

> Planned out-of-hospital birth was associated with a higher rate of perinatal death than was planned in-hospital birth (3.9 vs. 1.8 deaths per 1000 deliveries, P=0.003; odds ratio after adjustment for maternal characteristics and medical conditions, 2.43; 95% confidence interval [CI], 1.37 to 4.30; adjusted risk difference, 1.52 deaths per 1000 births; 95% CI, 0.51 to 2.54). The odds for neonatal seizure were higher and the odds for admission to a neonatal intensive care unit lower with planned out-of-hospital births than with planned in-hospital birth. Planned out-of-hospital birth was also strongly associated with unassisted vaginal delivery (93.8%, vs. 71.9% with planned in-hospital births; P<0.001) and with decreased odds for obstetrical procedures

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